EMMadmin, Author at The Emergency Medical Minute

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Podcast 681: Internal Hernias

Contributor:  Adam Barkin, MD Educational Pearls: Internal hernias, when bowel herniates through iatrogenic or congenital defect in mesentery, represent 1-6% of all small bowel obstructions Mortality of strangulated internal hernias is over 50% due to bowel necrosis and sepsis Intermittent symptoms presenting with nausea, vomiting, abdominal pain, abdominal distension Increased risk in patients with gastric…

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Podcast 680: Coronary Artery Dissection

Contributor:  Adam Barkin, MD Educational Pearls: Spontaneous coronary artery dissection (SCAD) is the most common cause of acute MI in women under 50 years old Risk factors include fibromuscular dysplasia, extreme exercise, stress, pregnancy, and recent birth Diagnosed in cath lab but medically managed and usually do not get a stent Treated with dual antiplatelet…

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Podcast 679: Antibiotics for CAP

Contributor:  Peter Bakes, MD Educational Pearls: Community-acquired pneumonia (CAP) is normally stratified into outpatient-candidates vs. inpatient candidates for treatment For outpatient treatment, antibiotic selection is driven by presence or absence of comorbid health conditions (chronic lung/kidney/liver disease, DM, immunocompromised state, alcoholism, asplenia) No comorbidities: High dose amoxicillin, doxycycline, azithromycin Comorbidities: augmentin, cephalosporin, doxycycline, macrolide with…

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Podcast 679: ECMO for Refractory VFib

Contributor:  Aaron Lessen, MD Educational Pearls: Refractory ventricular fibrillation, defined as 3 defibrillation shocks without resolution, was studied via RCT looking to compare ECMO with cardiac cath vs. typical resuscitation After 30 patients (15 each arm), the trial was stopped because such a significant benefit seen in the ECMO arm 6 patients survived and 3…

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Podcast 677: Oatmeal Cream for Hand Eczema

Contributor:  Jared Scott, MD Educational Pearls: Hand eczema is present in about 10% of the population and has a great prevalence in hairdressers, healthcare workers, and food service employees Using 1% oatmeal cream instead of a base cream showed statistically significant improvement in outcomes of HE in healthcare workers in a double-blind study References Sobhan…

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The Invisible Bleed

the invisible bleed Chief Complaint: Hematemesis HPI: 43-year-old woman with a history of gastroparesis and seizures suddenly vomited blood about 4 hours prior to arrival to the ED. She has never vomited blood like this before. She describes copious hematemesis with clots. She has a history of esophagitis with mild hematemesis several years in the…

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Podcast 676: Spontaneous Bacterial Peritonitis

Contributor:  Sam Killian, MD Educational Pearls: Patients with cirrhosis and ascites are frequently evaluated for spontaneous bacterial peritonitis, an infection of the ascites fluid that is not from a surgically treated source Fever, abdominal pain, and altered mental status should all raise clinical suspicion in a patient with ascites Fluid from paracentesis may show increased…

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Pharmacy Phriday #10: Colorado Pharmacists Association 2020 Opioid Prescribing and Treatment Guidelines

This week’s Pharmacy Phriday features a short excerpt from a longer podcast released as promo for the Colorado’s CURE initiative, Clinicians United to Resolve the Epidemic, that combats the opioid crisis through education. Frequent contributor to the podcast, Rachael Duncan, PharmD, is joined by host, Elizabeth Esty, MD, to discuss the opioid prescribing guidelines for…

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Podcast 675: CHF like it’s 1966

Contributor:  Chris Holmes, MD Educational Pearls: Medicine is cyclical and practice is always evolving A description of recommended treatment for CHF from 1966 Give oxygen Give one dose morphine then switch to demerol Decrease venous return and start PPV Immediately apply tourniquet to 3 extremities rotating tourniquets every 20 minutes Phlebotomy of 350-500 cc blood…

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Podcast 674: Facial Nerve Palsy in Kids

Contributor:  Aaron Lessen, MD Educational Pearls: Facial nerve palsy (Bell’s palsy) can occur in pediatric patients with Lyme disease, viral infection, or even leukemia One trial sought out to find if steroids and acyclovir would benefit pediatric patients with facial nerve palsy However, during screening process, around 1% of enrollees had leukemia (5 of the…

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