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Podcast 714: Intradermal Sterile Water for Back Pain
Contributor: Aaron Lessen, MD Educational Pearls: Randomized controlled-trial evaluated intradermal injections of sterile water to manage low back pain versus an IV NSAID Four intradermal injections of 0.1 cc sterile water in a square around the area of musculoskeletal pain Reduction of pain was 7 points with the procedure and 2 points with the IV…
Read MorePodcast 713: Oral Ketamine
Contributor: Don Stader, MD Educational Pearls: Those on chronic opioid therapy may have high tolerance to opioids and/or opioid hyperalgesia Ketamine is a good adjunct for pain control in patients on chronic opioid therapy To avoid the time constraints often required to push ketamine intravenously, it can be given orally: Ketamine IV 25-50 mg (~0.01-0.03…
Read MorePodcast 712: Cephalosporin with a Penicillin Allergy
Contributor: Aaron Lessen, MD Educational Pearls: Retrospective cohort study in the Kaiser system looked at over 4 million patients receiving antibiotics to determine the effect of penicillin allergy prompts in the EHR on antibiotic prescribing Half of the sites removed prompts stating penicillin allergy and half kept the prompts Patients with penicillin allergies who received…
Read MoreOn the Streets #10: IO Administration Gone Awry
Dr. Glenda Quan, trauma surgeon from Swedish Medical Center joins our host Jordan Ourada to review a case of an incorrectly placed IO and how to avoid it. The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for…
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Mr. Freeze
mr. freeze Chief Complaint: Painful wounds on skin for months HPI: 32-year-old male with past medical history of alcohol use disorder and general anxiety disorder presents with painful skin wounds to the right thigh for approximately four months. He curbed his cravings for EtOH with inhalant use. He uses keyboard duster cans several times a…
Read MorePodcast 710: Droperidol vs. Zyprexa
Contributor: Nick Tsipis, MD Educational Pearls: Prospective trial studied 5 mg IM droperidol to 10 mg IM olanzapine (Zyprexa) in the reducing levels of agitation Time to adequate sedation was about 16 minutes for both agents Droperidol was slightly less sedating than olanzapine and length of stay for olanzapine was longer Olanzapine had a higher…
Read MorePodcast 709: Clown Therapy
Contributor: Jared Scott, MD Educational Pearls: Using LET, procedural sedation, and distraction techniques are often needed to successfully perform painful procedures in pediatrics patients The technique of clown therapy has been studied as an adjunct to LET and other distraction techniques for procedures in pediatric patients One randomized-controlled trial from 2016 found anxiety was greatly…
Read MorePodcast 708: Diagnostic Paracentesis
Contributor: Peter Bakes, MD Educational Pearls: Paracentesis is a procedure where fluid is removed from the peritoneal cavity by needle Indications for paracentesis include: large volume paracentesis (5-6L), diagnosis of transudative or exudative ascites, evaluation for spontaneous bacterial peritonitis (SBP) Infection of ascitic fluid is more likely in transudative processes due to the increased frequency…
Read MorePodcast 707: Sigmoid Volvulus
Contributor: Aaron Lessen, MD Educational Pearls: Sigmoid volvulus occurs when the sigmoid colon twists 180 to 360 degrees 10% of intestinal obstructions in the US; 50-70% of intestinal obstructions worldwide More common in elderly patients with chronic constipation Eventually may lead to bowel perforation, a surgical emergency Treatment is sigmoidoscopy or sigmoid colectomy References Lieske…
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