Emergency Medical Minute
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Our 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.
Emergency Medical Minute
11h ago
Contributor: Travis Barlock MD
Educational Pearls:
Ketamine is an NMDA receptor antagonist with a wide variety of uses in the emergency department. To dose ketamine remember the numbers 0.3, 1, and 3.
Pain dose
For acute pain relief administer 0.3 mg/kg of ketamine IV over 10-20 minutes (max of 30 mg).
Note: There is evidence that a lower dose of 0.1-0.15 mg/kg can be just as effective.
Dissociative dose
To use ketamine as an induction agent for intubation or for procedural sedation administer 1 mg/kg IV over 1-2 minutes.
IM for acute agitation
If a patient is out of control and a ..read more
Emergency Medical Minute
1w ago
Contributor: Travis Barlock MD
Educational Pearls:
Thrombolytic therapy (tPA or TNK) is often used in the ED for strokes
Use of anticoagulants with INR > 1.7 or PT >15
Warfarin will reliably increase the INR
Current use of Direct thrombin inhibitor or Factor Xa inhibitor
aPTT/PT/INR are insufficient to assess the degree of anticoagulant effect of Factor Xa inhibitors like apixaban (Eliquis) and rivaroxaban (Xarelto)
Intracranial or intraspinal surgery in the last 3 months
Intracranial neoplasms or arteriovenous malformations also increase the ris ..read more
Emergency Medical Minute
1w ago
Contributor: Ricky Dhaliwal, MD
Educational Pearls:
Takotsubo cardiomyopathy, also known as "broken heart syndrome,” is a temporary heart condition that can mimic the symptoms of a heart attack, including troponin elevations and mimic STEMI on ECG.
The exact cause is not fully understood, but it is often triggered by severe emotional or physical stress. The stress can lead to a surge of catecholamines which affects the heart (multivessel spasm/paralysed myocardium).
The name "Takotsubo" comes from the Japanese term for a type of octopus trap, as the left ventricle takes on a distinctive ..read more
Emergency Medical Minute
3w ago
Contributor: 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 and generates a hypovolemic state
Glucocorticoid deficiency contributes further to hypotensi ..read more
Emergency Medical Minute
1M ago
Contributor: 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 can affect the metabolic system in a variety of ways. For example, certain cancers like bone ..read more
Emergency Medical Minute
1M ago
Contributor: 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
The renin-angiotensin-aldosterone system (RAAS) fails systemically but maintains vasocons ..read more
Emergency Medical Minute
1M ago
Contributor: 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.
The kidneys attempt to compensate for the acidosis by increasing diuresis.
These patients prese ..read more
Emergency Medical Minute
1M ago
Contributor: 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 the different home remedies
Honey and jam demonstrated a significantly lower esophageal tissue ..read more
Emergency Medical Minute
2M ago
Contributor: 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 thrombin, or tranexamic acid.
What are the indications to use a tourniquet?
The Stop The Bleed campaign re ..read more
Emergency Medical Minute
2M ago
Contributors: 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 now works as an Emergency Medicine Pharmacist at Denver Health.
In segment one of the show, Kali and Tr ..read more