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A Shocking Adverse Effect

A Shocking Adverse Effect Chief Complaint: Defibrillator shock HPI: 50-year-old biologic male who identifies as a female presented after reportedly being shocked by her defibrillator 5 times before calling EMS, EMS noted that they witnessed 1 shock. They also noted that blood pressure was in the low 100s and heart rate was between 200-260 before…

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Podcast 797: Vitamin C in Sepsis

Contributor: Aaron Lessen, MD Educational Pearls: Prior, smaller studies showed intravenous Vitamin C given to patients with sepsis significantly improved patient mortality and additional outcomes.  A recently published, randomized control trial with >800 ICU patients who received up to 4 days of IV Vit C or placebo concluded that the end points of death or…

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Podcast 796: Fluid Amounts in Septic Shock

Contributor: Aaron Lessen, MD Educational Pearls: Septic shock management has traditionally endorsed rapid fluid resuscitation and the administration of vasopressors Current guidelines are for patients to initially receive a 30 ml/kg fluid bolus then additional fluid as needed for continued hypotension The ideal volume of fluid needed to maximize patient outcomes has been debated A…

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Podcast 795: Lithium Toxicity

Contributor: Peter Bakes, MD Educational Pearls: Lithium remains a commonly used medication for treating bipolar disorder Lithium toxicity can be acute, acute-on-chronic, or chronic  Measuring blood lithium level Therapeutic range of lithium is around 1.6-1.8 mEq/L >2 mEq/L is likely to cause significant toxicity >4 mEq/L necessitates lifesaving treatment The lethal dose of lithium is…

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Podcast 794: Brain and Pain

Contributor: Don Stader, MD Educational Pearls: Pain sensation is generated and modified by the brain Multiple case reports provide evidence that the degree of pain a patient experiences correlates with how severe they perceive their injury/illness to be        Patients who feel safe and reassured about the care they are receiving have less pain     The patient’s…

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Podcast 793: Postintubation Sedation and Analgesia

Contributor: Peter Bakes, MD Educational Pearls: When intubating a patient, it is important to consider what medications will be used for post-intubation sedation and analgesia The common non-benzodiazepine sedating medications are propofol, precedex, and ketamine Propofol is frequently used in the emergency department, and it lowers ICP and MAP making it the preferred sedative for…

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Podcast 793: Atypical Toxicology Overview in SI

Contributor: Aaron Lessen, MD Educational Pearls: There are several online products that have been marketed towards individuals with SI Sodium nitrite Food preservative that can cause methemoglobinemia when ingested in large amounts Patients present with blue skin discoloration and severe respiratory distress Treat with methylene blue to reduce methemoglobin back to hemoglobin Formic acid and…

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Podcast 792: Rectal Prolapse

Contributor: Jarod Scott, MD Educational Pearls: Rectal prolapse is an evagination of the rectal tissue through the anal opening Factors that weaken the pelvic floor muscles increase the risk of rectal prolapse These include age > 40, female, multiple pregnancies, constipation, diarrhea, cystic fibrosis, prior pelvic floor surgeries, or other pelvic floor abnormalities Noninvasive treatment…

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Podcast 791: Hyperglycemic Hyperosmolar State

Contributor: Aaron Lessen, MD Educational Pearls: Hyperglycemic Hyperosmolar State (HHS) is less common than Diabetic Ketoacidosis (DKA) but is associated with a mortality rate up to 10 times greater than that seen in DKA Typically seen in elderly patients with severely elevated blood glucose levels (>1000 mg/dL) and an increased plasma osmolality Unlike in DKA,…

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