
Emergency Medical Minute
2,336 FOLLOWERS
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
4d ago
Contributor: Travis Barlock, MD
Educational Pearls:
What is Portal Vein Thrombosis?
The formation of a blood clot within the portal vein, which carries blood from the gastrointestinal tract, pancreas, and spleen to the liver
Not only can this cause problems downstream in the liver, but the backup of venous blood can cause ischemia in the bowels
How does it present?
Similar to acute mesenteric ischemia: Sudden onset of abdominal pain, nausea, vomiting, and fever
How is it diagnosed?
Abdominal CT or MRI with contrast
What causes it?
Cirrhosis
Coagulopathy (Factor V Leiden mutat ..read more
Emergency Medical Minute
1w ago
Contributor: Jorge Chalit-Hernandez, OMS3
Educational Pearls:
Acute mountain sickness (AMS) is the term given to what is otherwise colloquially known as altitude sickness
High altitude cerebral edema (HACE) is a severe form of AMS marked by encephalopathic changes
Symptoms begin at elevations as low as 6500 feet above sea level for people who ascend rapidly
May develop more severe symptoms at higher altitudes
The pathophysiology involves cerebral vasodilation
Occurs in everyone ascending to high altitudes but is more pronounces in those that develop symptoms
The reduced par ..read more
Emergency Medical Minute
2w ago
Contributor: Meghan Hurley, MD
Educational Pearls:
Gastroenteritis clinical diagnoses:
Diarrhea with or without vomiting and fever
Vomiting in the absence of diarrhea has a large list of differential diagnoses, so the combination of diarrhea and vomiting in a patient is helpful to indicate the gastroenteritis diagnosis
Symptom timeline is usually 1-3 days, but can last up to 14 days – diarrhea persists the longest
Treatment for mild to moderate dehydration: oral or IV rehydration
Begin orally to avoid unnecessary IV in a pediatric patient
Administer ODT Ondansetron (Zof ..read more
Emergency Medical Minute
3w ago
Contributor: Aaron Lessen, MD
Educational Pearls:
If a patient sustains a cut, the provider has several options on how to close the wound. If they choose to suture the wound closed, it involves needles both in the form of injecting numbing medication (lidocaine) as well as with the suture itself. Other techniques are “needleless,” like closing the wound with adhesive strips (Steri-Strips) or skin adhesive (Dermabond). But which method is best?
A recent study looked to compare guardian-perceived cosmetic outcomes of pediatric lacerations repaired with absorbable sutures, Dermabond, and Ster ..read more
Emergency Medical Minute
1M ago
Contributor: Jorge Chalit-Hernandez, OMS3
Educational Pearls:
Serotonin syndrome occurs most commonly due to the combination of monoamine oxidase inhibition with concomitant serotonergic medications like SSRIs
Examples of unexpected monoamine oxidase inhibitors
Linezolid - a last-line antibiotic reserved for patients with true anaphylaxis to penicillins and cephalosporins
Methylene blue - not mentioned in the podcast due to its uncommon usage for methemoglobinemia
Other medications that can interact with SSRIs to cause serotonin syndrome
Dextromethorphan - primarily an anti-tussi ..read more
Emergency Medical Minute
1M ago
Contributor: Aaron Lessen, MD
Educational Pearls:
Many patients present to the ED with elevated BP
Many are referred from outpatient surgery centers or present after an elevated measurement at home
Persistent questions on the best way to treat these patients
The AHA published a scientific statement on the management of elevated BP in the acute care setting
Hypertensive emergencies: SBP/DBP >180/110–120 mm Hg with evidence of new or worsening target-organ damage
Includes aortic dissection or subarachnoid hemorrhage
Require aggressive treatment
Asymptomatic mar ..read more
Emergency Medical Minute
1M ago
Contributor: Megan Hurley MD
Educational Pearls:
What is the mediastinum?
The thoracic cavity is separated into different compartments by membranes
The lungs exist in their own pleural cavities, and the mediastinum is everything in between
The mediastinum extends from the sternum to the thoracic vertebrae and includes the heart, the aorta, the trachea, the esophagus, the thymus, as well as many lymph nodes and nerves.
What is a pneumomediastinum?
Air in the mediastinum
How can pneumomediastinum be categorized?
Traumatic
Ex. Stab wound to the trachea
Ex. Boerhaave’s Syndro ..read more
Emergency Medical Minute
1M ago
Contributor: Ricky Dhaliwal MD
Educational Pearls:
Etomidate was previously the drug of choice for rapid sequence intubation (RSI)
However, it carries a risk of adrenal insufficiency as an adverse effect through inhibition of mitochondrial 11-β-hydroxylase activity
A recent meta-analysis analyzing etomidate as an induction agent showed the following:
11 randomized-controlled trials with 2704 patients
Number needed to harm is 31; i.e. for every 31 patients that receive etomidate for induction, there is one death
The probability of any mortality increase was 98.1%
Ket ..read more
Emergency Medical Minute
2M ago
Contributor: Aaron Lessen MD
Educational Pearls:
Pregnant patients at high risk of cardiac arrest, in cardiac arrest, or in extremis require special care
A useful mnemonic to recall the appropriate management of critically ill pregnant patients is TOLDD
T: Tilt the patient to the left lateral decubitus position
This position relieves pressure exerted from the uterus onto the inferior vena cava, which reduces cardiac preload
If the patient is receiving CPR, an assistant should displace the uterus manually from the IVC towards the patient’s left side
O: Administer high-flow adjun ..read more
Emergency Medical Minute
2M ago
Contributor: Travis Barlock MD
Educational Pearls:
What is the ST segment?
The ST segment on an ECG represents the interval between the end of ventricular depolarization (QRS) and the beginning of ventricular repolarization (T-wave).
It should appear isoelectric (flat) in a normal ECG.
What if the ST segment is elevated?
This is evidence that there is an injury that goes all the way through the muscular wall of the heart (transmural)
This is very concerning for a heart attack (STEMI) but can be occasionally caused by other pathology, such as pericarditis
What if the ST segmen ..read more