Emergency Medical Minute
1,047 episodes - English - Latest episode: 23 days ago - ★★★★★ - 221 ratingsOur near daily podcasts move quickly to reflect current events, are inspired by real patient care, and speak to the true nature of what it’s like to work in the Emergency Room or Pre-Hospital Setting. Each medical minute is recorded in a real emergency department, by the emergency physician or clinical pharmacist on duty – the ER is our studio and everything is live.
Homepage Apple Podcasts Google Podcasts Overcast Castro Pocket Casts RSS feed
Episodes
Episode 897: Adrenal Crisis
April 01, 2024 10:00 - 4 minutes - 10.4 MBContributor: Ricky Dhaliwal MD Educational Pearls: Primary adrenal insufficiency (most common risk factor for adrenal crises) An autoimmune condition commonly known as Addison's Disease Defects in the cells of the adrenal glomerulosa and fasciculata result in deficient glucocorticoids and mineralocorticoids Mineralocorticoid deficiency leads to hyponatremia and hypovolemia Lack of aldosterone downregulates Endothelial Sodium Channels (ENaCs) at the renal tubules Water follows sodium ...
Podcast 896: Cancer-Related Emergencies
March 25, 2024 10:00 - 2 minutes - 5.76 MBContributor: Travis Barlock, MD Educational Pearls: Cancer-related emergencies can be sorted into a few buckets: Infection Cancer itself and the treatments (chemotherapy/radiation) can be immunosuppressive. Look out for conditions such as sepsis and neutropenic fever. Obstruction Cancer causes a hypercoagulable state. Look out for blood clots which can cause emergencies such as a pulmonary embolism, stroke, superior vena cava (SVC) syndrome, and cardiac tamponade. Metabolic Cancer ...
Episode 895: Indications for Exogenous Albumin
March 18, 2024 10:00 - 2 minutes - 5.67 MBContributor: Travis Barlock MD Educational Pearls: There are three indications for IV albumin in the ED Spontaneous bacterial peritonitis (SBP) Patients with SBP develop renal failure from volume depletion Albumin repletes volume stores and reduces renal impairment Albumin binds inflammatory cytokines and expands plasma volume Reduced all-cause mortality if IV albumin is given with antibiotics Hepatorenal syndrome Cirrhosis of the liver causes the release of endogenous vasodilators...
Episode 894: DKA and HHS
March 11, 2024 10:00 - 7 minutes - 17.8 MBContributor: Ricky Dhaliwal, MD Educational Pearls: What are DKA and HHS? DKA (Diabetic Ketoacidosis) and HHS (Hyperosmolar Hyperglycemic State) are both acute hyperglycemic states. DKA More common in type 1 diabetes. Triggered by decreased circulating insulin. The body needs energy but cannot use glucose because it can’t get it into the cells. This leads to increased metabolism of free fatty acids and the increased production of ketones. The buildup of ketones causes acidosis. T...
Episode 893: Home Treatments for Button Battery Ingestion
March 04, 2024 11:00 - 2 minutes - 5.9 MBContributor: Aaron Lessen MD Educational Pearls: Button batteries cause alkaline corrosion and erosion of the esophagus when swallowed Children swallow button batteries, which create a medical emergency as they can perforate the esophagus A recent study compared various home remedies as first-aid therapy for button battery ingestion Honey, jam, normal saline, Coca-Cola, orange juice, milk, and yogurt The study used a porcine esophageal model to assess resistance to alkalinization with...
Episode 892: Tourniquets
February 27, 2024 05:45 - 5 minutes - 11.7 MBContributor: Ricky Dhaliwal, MD Educational Pearls: What can you do to control bleeding in a penetrating wound? Apply direct pinpoint pressure on the wound as well as proximal to the wound. Build a compression dressing. How do you build a compression dressing? Think about building an upside-down pyramid with the gauze. Consider coagulation agents such as an absorbent gelatin sponge material, microporous polysaccharide hemispheres, oxidized cellulose, fibrin sealants, topical thrombi...
Pharmacy Phriday #11: Riddles, Medical Jargon, NNT, and Time Travel
February 23, 2024 06:57 - 43 minutes - 100 MBContributors: Kali Olson PharmD, Travis Barlock MD, Jeffrey Olson MS2 Summary: In this episode of Pharmacy Phriday, Dr. Kali Olson joins Dr. Travis Barlock and Jeffrey Olson in studio to discuss a variety of interesting topics in the form of a segment show. Dr. Kali Olson earned her Doctorate of Pharmacy from the University of Colorado, Skaggs School of Pharmacy and completed a PGY1 residency at Detroit Receiving Hospital and a PGY2 residency in Emergency Medicine at Denver Health. She n...
Episode 891: Hypothermia
February 19, 2024 11:00 - 4 minutes - 11.3 MBContributor: Taylor Lynch MD Educational Pearls Hypothermia is defined as a core body temperature less than 35 degrees Celsius or less than 95 degrees Fahrenheit Mild Hypothermia: 32-35 degrees Celsius Presentation: alert, shivering, tachycardic, and cold diuresis Management: Passive rewarming i.e. remove wet clothing and cover the patient with blankets or other insulation Moderate Hypothermia: 28-32 degrees Celsius Presentation: Drowsiness, lack of shivering, bradycardia, hypotensi...
Podcast 890: Outdoor Cold Air for Croup
February 14, 2024 02:58 - 4 minutes - 9.41 MBContributor: Jared Scott MD Educational Pearls: Croup is a respiratory condition typically caused by a viral infection (e.g., parainfluenza). The disease is characterized by inflammation of the larynx and trachea, which often leads to a distinctive barking cough. A common treatment for croup is the powerful steroid dexamethasone, but it can take up to 30 minutes to start working. A folk remedy for croup is to take the afflicted child outside in the cold to help them breathe better, but ...
Podcast 889: Blood Pressure Cuff Size
February 05, 2024 11:00 - 1 minute - 4.29 MBContributor: Aaron Lessen MD Educational Pearls: Does the size of a blood pressure (BP) cuff matter? A recent randomized crossover trial revealed that, indeed, cuff size can affect blood pressure readings Design 195 adults with varying mid-upper arm circumferences were randomized to the order of BP cuff application: Appropriate Too small Too large Individuals had their mid-upper arm circumference measured to determine the appropriate cuff size Participants underwent 4 sets of t...
Podcast 888: Low GCS and Intubation
January 29, 2024 11:00 - 2 minutes - 6.16 MBContributor: Aaron Lessen MD Educational Pearls: Is the adage, “GCS of 8, you’ve got to intubate” accurate? A recent study published in the November 2023 issue of JAMA attempted to answer this question. Design Multicenter, randomized trial, in France from 2021 to 2023. 225 patients experiencing comatose in the setting of acute poisoning were randomly assigned to either a conservative airway strategy of withholding intubation or “routine practice” of much more frequent intubation. Th...
Podcast 887: Family Presence in Cardiac Resuscitation
January 22, 2024 11:00 - 2 minutes - 6.36 MBContributor: Aaron Lessen MD Educational Pearls: A 2013 study randomized families of those in cardiac arrest into two groups: Actively offered patients’ families the opportunity to observe CPR Follow standard practice regarding family presence (control group) Of the 266 relatives that received offers to observe CPR, 211 (79%) accepted vs. 43% in the control group observed CPR The study assessed a primary end-point of PTSD-related symptoms 90 days after the event Secondary end-points ...
Podcast 886: Cough in Kids
January 15, 2024 11:00 - 6 minutes - 15.4 MBContributor: Ricky Dhaliwal, MD Educational Pearls: Croup Caused by: Parainfluenza, Adenovirus, RSV, Enterovirus (big right now) Age range: 6 months to 3 years Symptoms: Barky cough Inspiratory stridor (Severe = stidor at rest) Use the Westley Croup Score to gauge the severity Treatment: High flow, humidified, cool oxygen Dexamethasone 0.6 mg/kg oral, max 16mg Severe: Racemic Epinephrine 0.5 mL/kg Consider heliox, a mixture of helium and oxygen Very severe: be ready to intu...
Podcast 885: Penetrating Neck Injuries
January 10, 2024 04:49 - 4 minutes - 10.6 MBContributor: Ricky Dhaliwal MD Educational Pearls: Three zones of the neck with different structures and risks for injuries: Zone 1 is the most caudal region from the clavicle to the cricoid cartilage Zone 2 is from the cricoid cartilage to the angle of the mandible Zone 3 is superior to the angle of the mandible Zone 1 contains the thoracic outlet vasculature (subclavian arteries and veins, internal jugular veins), carotid arteries, vertebral artery, apices of the lungs, trachea, eso...
Laboring Under Pressure Episode 2: Postpartum Hemorrhage with Dr. Kiersten Williams
January 08, 2024 05:03 - 25 minutes - 58.4 MBContributor: Kiersten Williams MD, Travis Barlock MD, Jeffrey Olson MS2 Summary: In this episode, Dr. Travis Barlock and Jeffrey Olson meet in the studio to discuss a clip from Dr. Williams’ talk at the “Laboring Under Pressure, Managing Obstetric Emergencies in a Global Setting” event from May 2023. This event was hosted at the University of Denver and was organized with the help of Joe Parker as a fundraiser for the organization Health Outreach Latin America (HOLA). Dr. Kiersten Will...
Podcast 884: Nerve Blocks
January 01, 2024 22:28 - 6 minutes - 16 MBContributor: Meghan Hurley MD Educational Pearls: What is a nerve block? A nerve block is the medical procedure of injecting anesthetic into the area around a nerve to block pain signals. They are typically done with ultrasound guidance. Are nerve blocks effective? Most of the information we have about nerve blocks is extrapolated from fascia iliaca blocks. This nerve block targets the fascia iliaca compartment, which contains the femoral, lateral femoral cutaneous, and obturator ne...
Podcast 883: Migraine Treatment in Cardiovascular Disease
December 25, 2023 11:00 - 3 minutes - 7.39 MBContributor: Jorge Chalit, OMS II Educational Pearls: Migraine pathophysiology Primarily mediated through the trigeminovascular system Serotonin, dopamine, and calcitonin gene-related peptide (CGRP) Trigeminovascular system is linked to the trigeminal nucleus caudalis, which relays pain to the hypothalamus and cerebral cortex One effective treatment for acute migraines is -triptan medications 5-HT1D/1B agonists such as sumatriptan Often combined with NSAIDs and dopamine antagonists ...
Podcast 882: Thrombolytics for Minor Strokes
December 20, 2023 04:23 - 2 minutes - 5.38 MBContributor: Aaron Lessen MD Educational Pearls: How is the severity of a stroke assessed? Strokes are assessed by the NIH Stroke Scale (NIHSS), this scale has different tasks, such as asking the person to repeat words, move their arms, or follow simple instructions. The maximum score is 42 but any score over 21 is considered severe. What would qualify as a minor storke? NIH<5 This could be achieved with minor symptoms such as numbness Should patients with minor strokes be given thr...
Podcast 881: Pediatric Readmissions
December 12, 2023 11:00 - 3 minutes - 8 MBContributor: Nick Tsipis MD Educational Pearls: The review article assessed 16.3 million patients across six states to identify those at high-risk for critical revisit Criteria for critical revisit was ICU admission or death within three days of discharge from the ED Critical revisits are extremely rare 0.1% of patients have a critical revisit after discharge 0.00001% die after revisit Of the patients that do experience critical revisits, the two major risk factors are Asthma - rel...
Podcast 880: OB Delivery in the ED
December 04, 2023 11:00 - 8 minutes - 18.7 MBContributor: Meghan Hurley MD Educational Pearls: Pearls about labor: Labor is split into 3 stages. Stage 1 starts when the first persistent contractions are felt and goes up until the cervix is fully dilated and the mother starts pushing. Stage 1 is split into two phases: the latent phase (cervix is dilated from 0-4 cm), and the active phase (cervix dilates from 4-10 cm). The latent phase can take between 6 and 12 hours with contractions happening every 5 to 15 minutes. The active pha...
Podcast 879: A Case of Pediatric Anaphylactic Shock
November 27, 2023 11:00 - 5 minutes - 13.6 MBContributor: Dr. Taylor Lynch Educational Pearls: Time of arrival until intubation was 26 minutes but nobody tried anterior neck access like a cricothyrotomy until his dad arrived Traditional ACLS protocol is not enough for anaphylactic respiratory arrest Circulating O2 from compressions alone is not enough to sustain the brain Patients need a definitive airway and endotracheal tube is the best method BVM ventilation is not enough to get patients the oxygen they need Time to anoxic b...
Podcast 878: Opioids for Low Back and Neck Pain
November 20, 2023 11:00 - 3 minutes - 8.26 MBContributor: Jared Scott MD Educational Pearls: Should we use opioids to treat low back and neck pain? The OPAL Trial, published in The Lancet, in June 2023, attempted to answer this very question. Objective: Investigate the efficacy and safety of a short course of opioid analgesic (oxycodone-naloxone) for acute low back pain and neck pain. Trial Design: Triple-blinded, placebo-controlled randomized trial, conducted in Emergency and Primary Care in Sydney, Australia, involving adults w...
Podcast 877: Viral Respiratory Infections in Children
November 13, 2023 11:00 - 3 minutes - 7.23 MBContributor: Jared Scott MD Educational Pearls A recently published study assessed the burden of respiratory viruses in a longitudinal cohort of children from 0 to 2 years of age The children in the study received nasal swab PCR testing weekly to determine infectivity They were also monitored for symptoms via weekly text surveys The study differentiated between infection and illness by defining an acute respiratory illness (ARI) as fever ≥38°C or cough. The median infectivity rate wa...
Podcast 876: Sedation Pearls
November 06, 2023 18:53 - 5 minutes - 2.51 MBContributor: Travis Barlock MD Educational Pearls: Common sedatives used in the Emergency Department and a few pearls for each. Propofol Type: Non-barbiturate sedative hypnotic agonizing GABA receptors. Benefit: Quick on and quick off (duration of action is approximately 2-7 minutes), helpful for suspected neurologic injury so the patient can wake up and be re-evaluated. Also has the benefit of reducing intracranial pressure (ICP). Downsides: Hypotension, bradycardia, respiratory dep...
Podcast 875: A Pediatric Case of Myopericarditis
October 30, 2023 10:00 - 6 minutes - 15.3 MBContributor: Meghan Hurley MD Educational Pearls: Pericarditis is inflammation of the pericardial sac, which can arise from infectious or non-infectious etiologies Myocarditis is inflammation of the myocardium, which may accompany pericarditis Pericarditis clinical findings include: Diffuse concave ST elevation, classic for acute pericarditis with myocardial involvement. More common in younger male patients Elevated high-sensitivity troponin - higher levels may occur in young healthy ...
Episode 874: Bradyarrhythmias
October 23, 2023 10:00 - 2 minutes - 6.15 MBContributor: Dylan Luyten MD Educational Pearls: What is a Bradyarrhythmia? Also known as a bradyarrhythmia, it is an irregular heart rate that is also slow (below 60 beats per minute). What can cause it? Complete heart block AKA third-degree AV block; identified on ECG by a wide QRS, and complete dissociation between the atrial and ventricular rhythms with the ventricular being much slower. Treat with a pacemaker. Medication overdose, especially beta blockers. Many other drugs can s...
Podcast 873: Intravesical Tranexamic Acid for Gross Hematuria
October 16, 2023 10:00 - 2 minutes - 5.48 MBContributor: Aaron Lessen MD Educational Pearls: Tranexamic acid (TXA) is a common medication to achieve hemostasis in a variety of conditions Patients visiting the ED for gross hematuria (between March 2022 and September 2022) were treated with intravesical TXA 1 g tranexamic acid in 100 mL NS via Foley catheter Clamped Foley for 15 minutes Subsequent continuous bladder irrigation, as is standard in most EDs Compared with a cohort of patients visiting the ED for a similar concern be...
Podcast 872: Preseptal and Orbital Cellulitis
October 09, 2023 10:00 - 4 minutes - 10.7 MBContributor: Meghan Hurley MD Educational Pearls: What is Cellulitis? A common and potentially serious bacterial skin infection. Caused by various types of bacteria, with Streptococcus and Staphylococcus species being the most common. What is Preseptal Cellulitis and why is it more serious than facial cellulitis? Preseptal Cellulitis, also known as Periorbital Cellulitis, is a bacterial infection of the soft tissues in the eyelid and the surrounding area. This requires prompt and ag...
Mental Health Monthly #17: Mania
October 05, 2023 04:46 - 40 minutes - 93.6 MBContributors: Andrew White MD - Outpatient Psychiatrist; Fellowship Trained in Addiction Psychiatry; Denver Health Travis Barlock MD - Emergency Medicine Physician; Swedish Medical Center Summary In this episode of Mental Health Monthly, Dr. Travis Barlock hosts Dr. Andrew White to discuss the elements of mania that may be encountered in the emergency department. The discussion includes a helpful mnemonic to assess mania, work-up and treatment in the ED, underlying causes of mania, m...
Podcast 871: Increased Intracranial Pressure and the Cushing Reflex
October 02, 2023 10:00 - 3 minutes - 8.51 MBContributor: Travis Barlock MD Education Pearls: The Cushing Reflex is a physiologic response to elevated intracranial pressure (ICP) Cushing’s Triad: widened pulse pressure (systolic hypertension), bradycardia, and irregular respirations Increased ICP results from systolic hypertension, which causes a parasympathetic reflex to drop heart rate, leading to Cushing’s Triad. The Cushing Reflex is a sign of herniation Treatment includes: Hypertonic saline is comparable to mannitol and p...
On The Streets #15: Hydrofluoric Acid Case Review
September 29, 2023 02:05 - 41 minutes - 94.7 MBContributors: Kalen Abbott, MD - EM Physician and Medical Director for AirLife Denver Brendan Reiss - Flight Nurse AirLife Denver Matt Spoon - Flight Paramedic AirLife Denver Jordan Ourada - EMS Coordinator at Swedish Medical Center and Paramedic Summary: In this episode, hosted by Jordan Ourada, Brendan Reiss and Matt Spoon present a first-hand experience case of hydrofluoric acid exposure in a pediatric patient. Commentary and educational pearls are provided by EM Physician, Kalen A...
Episode 870: Advanced Trauma Life Support (ATLS)
September 25, 2023 10:00 - 7 minutes - 17.2 MBContributor: Meghan Hurley MD Educational Pearls: What is ATLS? Advanced Trauma Life Support (ATLS) is a systematic and comprehensive approach to the evaluation and management of trauma patients It was developed by the American College of Surgeons (ACS) The key components include the Primary Survey ("ABCDE"), the Secondary Survey, Definitive Care, and Special Considerations What are the issues with ATLS? ATLS relies on many algorithms and rules-of-thumb, which might be helpful for i...
Podcast 869: Shift Work
September 18, 2023 10:00 - 4 minutes - 10.3 MBContributor: Meghan Hurley MD Educational Pearls: Shift work is defined as anything that takes place outside of a 9-5 schedule, not exempting day-shift medical workers Various ill effects of shift work on overall health: Increased all-cause mortality Increased number of accidents Glucose metabolism dysregulation Increased BMI Fertility impacts for men and women Increased breast cancer risk Decreased cognitive functioning Mitigation strategies Work at the same time every day Anc...
Episode 868: Airway Management in Obesity
September 11, 2023 10:00 - 3 minutes - 8.49 MBContributor: Aaron Lessen MD Educational Pearls: Why is airway management more difficult in obesity? Larger body habitus causes the chest to be above the head when the patient is lying supine, creating difficult angles for intubation. Reduced Functional Residual Capacity (FRC) causes these patients to deoxygenate much more quickly, reducing the amount of time during which the intubation can take place. What special considerations need to be made? Positioning. The auditory canal and s...
Episode 867: Occult Scaphoid Fractures
September 04, 2023 10:00 - 4 minutes - 9.55 MBContributor: Nick Tsipis MD Educational Pearls: The scaphoid bone is the most proximal carpal bone just distal to the radius Fractures of the scaphoid bone are sometimes missed by plain X-rays A 2020 review found a 21.8% incidence of missed scaphoid fractures later diagnosed by advanced imaging modalities Only MRI has a sensitivity above 90% for diagnosing scaphoid fractures Sensitivity of plain-film radiography is low unless it is a displaced fracture Physical examination techniques...
Podcast 866: Carbamazepine (Tegretol) Overdose
August 28, 2023 10:00 - 2 minutes - 6.36 MBContributor: Aaron Lessen MD Educational Pearls: What is Carbamazepine (Tegretol)? Carbamazepine is an anti-epileptic drug with mood-stabilizing properties that is used to treat bipolar disorder, epilepsy, and neuropathic pain. It functions primarily by blocking sodium channels which can prevent repetitive action potential firing. What are the symptoms of an overdose? Common initial signs include diminished conscious state, nystagmus, ataxia, hyperreflexia, CNS depression, dystonia, ...
Laboring Under Pressure- Episode 1. ACLS in Pregnancy with Dr. Jason Papazian
August 24, 2023 10:00 - 32 minutes - 73.6 MBContributor: Jason Papazian MD, Travis Barlock MD, Jeffrey Olson Summary: In this episode, Dr. Travis Barlock and Jeffrey Olson meet in the studio to discuss several clips from Dr. Jason Papazian’s talk at the event “Laboring Under Pressure, Managing Obstetric Emergencies in a Global Setting” from May 2023. This event was hosted at the University of Denver and was organized with the help of Joe Parker as a fundraiser for the organization Health Outreach Latin America (HOLA). Dr. Ja...
Podcast 865: Nausea Treatments - Droperidol vs Ondansetron RCT
August 21, 2023 10:00 - 2 minutes - 4.74 MBContributor: Aaron Lessen MD Educational Pearls: A recent randomized controlled trial compared ondansetron 8 mg IV with droperidol 2.5 mg IV for the treatment of nausea & vomiting in the emergency department. Overall, droperidol and ondansetron had similar primary outcomes in acute nausea control Symptom improvement in 93% of patients receiving droperidol vs. 87% receiving ondansetron (P = 0.362) Secondary measures were, however, statistically significantly different between groups ...
Podcast 864: Arterial Blood Gas (ABG) vs Venous Blood Gas (VBG)
August 14, 2023 10:00 - 2 minutes - 5.86 MBContributor: Aaron Lessen MD Educational Pearls: What is measured in an ABG/VBG? Blood values for oxygen tension (pO2), carbon dioxide tension (pCO2), acidity (pH), oxyhemoglobin saturation, and bicarbonate (HCO3) in either arterial or venous blood Other tests can measure methemoglobin, carboxyhemoglobin, hemoglobin levels, base excess, and lactate What are they used for? Identification of ventilation/acid-base disturbances. For example: if a patient is in septic shock, oxyhemoglobin...
Podcast 863: Treatments for Alcohol Use Disorder
August 07, 2023 16:30 - 2 minutes - 5.6 MBContributor: Aaron Lessen MD Educational Pearls: Patients with alcohol use disorder are frequently discharged from the ED without further resources Pharmacological treatments to reduce cravings in AUD exist Naltrexone Effective at reducing alcohol cravings and heavy drinking Gabapentin Reduces the percentage of heavy drinking days in AUD Patients being discharged from the ED should be asked if they feel their alcohol use is a problem, which can further direct appropriate pharmacol...
Podcast 862: How to Apply a Painful Stimulus
July 31, 2023 10:00 - 2 minutes - 5.73 MBContributor: Travis Barlock MD Educational Pearls: When might you need to apply a painful stimulus in a medical setting? The main reason is to assess the patient's level of consciousness, such as when they are waking up from anesthesia or have potentially suffered a brain injury. It can be part of the Glasgow Coma Scale (GCS) if patients are not responding to auditory stimuli. Possible levels of consciousness include Alert, Lethargic, Obtunded, and Comatose (ALOC) What are the approv...
Podcast 861: Alcohol Withdrawal and Delirium Tremens
July 24, 2023 10:00 - 4 minutes - 11 MBContributor: Travis Barlock MD Educational Pearls: Alcohol binds the GABA receptor, which produces an inhibitory response, hence the “depressive” effects of ethanol beverages. Over time, alcohol downregulates the GABA receptors, leading to unopposed glutamate activity. Given that glutamate is excitatory, this can lead to seizures. Alcohol also suppresses REM sleep; in patients with chronically suppressed REM sleep, the brain starves for dream sleep and it spills over into the wakeful st...
Ukraine Brewtalk Featuring Dr. Dave Young
July 21, 2023 10:00 - 38 minutes - 89.1 MBContributors: David Young MD, John Hesling MD, Travis Barlock MD, Jeffrey Olson Summary: In this episode, Dr. Travis Barlock and Jeffrey Olson meet in the studio to discuss several clips from the event “Ukraine Brewtalk” from October 2022. This event was hosted by the University of Colorado’s Center for COMBAT Research and Emergency Medical Minute assisted in the audio recording of the speakers. The first clip is of a brief talk by Dr. John Hesling who was presenting some of his resear...
Podcast 860: Thyrotoxicosis
July 20, 2023 10:00 - 2 minutes - 5.23 MBContributor: Travis Barlock MD Educational Pearls: Clinical picture: A patient comes in with altered mental status, tachycardia, fever, elevated T4, and low TSH. What’s the diagnosis?... Thyrotoxicosis secondary to Graves’ Disease. How do you treat thyrotoxicosis? First, give a beta-blocker such as propranolol. This suppresses the elevated adrenergic activity. Second, give a thionamide such as propylthiouracil (PTU) or methimazole. This decreases the synthesis of new thyroid hormone....
Podcast 859: Teamwork Really Makes the Dream Work
July 10, 2023 10:00 - 2 minutes - 5.91 MBContributor: Aaron Lessen MD Educational Pearls: 33 Medical residents and 91 nurses at Massachusetts General Hospital were randomized into two groups: Intervention group: 15 PGY-1 residents assigned to the same medical service floor for a 16-week period (12 weeks after adjustment for COVID-19 restrictions) alongside 43 nurses. Control group: 18 PGY-1 residents assigned to the usual 4-week block rotations across 6 medical floors. At 6 months, there were no differences in teamwork perfo...
Podcast 858: Whole Blood Pregnancy Test
July 03, 2023 15:00 - 4 minutes - 9.4 MBContributor: Meghan Hurley MD Educational Pearls: What do you do if you need a stat pregnancy test on an incapacitated patient? You can send a serum quantitative human chorionic gonadotropin (beta-HCG), but that might take a while for the lab to process. Another option is to place a drop of whole blood on a urine pregnancy immunoassay. These tests are already verified for urine and serum. 2012 study showed that whole blood was 95.8% sensitive for pregnancy compared to 95.3% for urine...
Podcast 857: Alice in Wonderland Jeopardy
June 26, 2023 10:00 - 3 minutes - 7.96 MBContributor: Chris Holmes MD Educational Pearls: “It’s a poor sort of memory that only works backwards” - Transient Global Amnesia A syndrome with sudden retrograde memory loss in which patients cannot retain new information Characterized by perseveration in frequent intervals Typically improves within hours MRI is normal initially Alice In Wonderland Syndrome A disorder in which patients experience distortions in their visual perceptions Most often characterized by micropsia and/o...
Podcast 856: ED Errors and Counterstudy
June 19, 2023 12:45 - 4 minutes - 9.37 MBContributor: Nicholas Tsipis, MD Educational Pearls: What study was Dr. Tsipis talking about? In December of 2022, the Agency for Healthcare Research and Quality (AHRQ) put out a study titled “Diagnostic Errors in the Emergency Department: A Systematic Review.” This study triggered many news stories from prominent outlets with headlines such as, “More than 7 million incorrect diagnoses made in US emergency rooms every year, government report finds,” from CNN, and “E.R. Doctors Misdiagn...
Podcast 855: QT Intervals
June 12, 2023 10:00 - 4 minutes - 9.2 MBContributor: Travis Barlock MD Educational Pearls The QT interval represents phases 2 and 3 of ventricular plateau and repolarization, respectively. As the QT interval lengthens, more sodium and calcium channels are available and susceptible to action potentials. Prolonged QT interval is more concerning in the setting of bradycardia. This scenario increases the likelihood of R on T phenomenon. R on T phenomenon occurs due to an early afterdepolarization event in which a premature v...
Mental Health Monthly #16: Psychosis in the ED Part II
June 07, 2023 20:23 - 24 minutes - 56.2 MBContributors: Andrew White MD & Travis Barlock MD In this follow-up episode Dr. Andrew White, a practicing psychiatrist with an addiction medicine fellowship, and Dr. Travis Barlock, an emergency physician at Swedish Medical Center, discuss mental health holds, psychiatric placement, pharmacologic vs. non-pharmacologic treatments, and outpatient care of psychotic patients. If you missed it, be sure to listen to part I for details on the management of psychotic patients in the ED. Educati...