Emergency Medical Minute

Contributor: Meghan Hurley, MD Educational Pearls: What animal is the most lethal to humans?  Depending on how we define lethal, and animal, this answer is actually not straight forward.  Globally and in the U.S. the most lethal animal is humans, accounting for ~436,000 to ~20,000 deaths (homicides) per year on average respectively.  In the United States the most lethal animal is of the Hymenopter...

Contributor: Travis Barlock, MD Educational Pearls:   First-pass success is critical to limit complications from apnea, hypoxia, and airway trauma.  Complication rate for patients intubated on the first pass is 14% Complication rates increase to 47% after two attempts, 64% after three, and 71% after the fourth attempt   How to improve likelihood of first-pass success: Use Video laryngoscopy (VL)....

Dan Orbidan, OMS-II and Dr. Travis Barlock, MD discuss a real out of hospital call. This episode covers the implications of a pharmacologically abnormal patient presentation and the pre and post hospital considerations for patient management and care.

Carepoint Journal Club is a quarterly series with discussions about a medical topic, brought to you by Carepoint's Emergency Physicians.

Contributor: Aaron Lessen, MD Educational Pearls:   UTIs are commonly seen in older women We often see them taking long-term prophylactic antibiotics because of common recurrence. Around 20-30% of older women who develop a UTI have a recurrence due to either diagnostic failure, treatment failure or non-compliance with treatment.  UTI signs and symptoms Burning sensation when urinating Strong urge...

Contributor: Aaron Lessen, MD Educational Pearls:  Back pain is a common presenting complaint in the emergency department. Challenges arise when tailoring care to elderly populations using standard medical therapy: Muscle relaxants carry the risk of CNS depression or anticholinergic effects such as urinary retention and confusion. Pain medications such as opiates have side effects including consti...

Contributor: Travis Barlock, MD Educational Pearls:   Caffeine Geography and Types: Caffeine is found throughout the world and has evolved independently in various plants that are not evolutionarily related through direct lineage, but rather demonstrate convergent evolution (i.e. different species evolve the same traits).  These plants use caffeine as an insecticide.  Examples of caffeine sources...

Contributor: Travis Barlock, MD Educational Pearls:   Endocannabinoid System: THC binds CB1 and CB2 receptors in neurons and immune cells Δ9-Tetrahydrocannabinol (THC) is the main psychoactive compound in cannabis CB1 and CB2 receptors typically bind endogenously-produced 2-arachidonoylglycerol (2-AG) and anandamide (AEA) to regulate pain, stress, and inflammation THC similarly binds CB1 and CB2,...

Contributor: Aaron Lessen, MD Educational Pearls: There has long been many questions about which IV fluid is best for ED resuscitation Multiple adult studies have shown no clear benefit of balanced fluid vs normal saline A large pediatric randomized clinical trial published in April compared balanced fluid vs normal saline in children with septic shock  The study included about 9,000 patients from...

Carepoint Journal Club is a quarterly series with discussions about a medical topic, brought to you by Carepoint's Emergency Physicians.

Contributor: Taylor Lynch, MD Educational Pearls:    Conduction abnormalities are a common and clinically significant complication in patients who undergo transcatheter aortic valve replacement (TAVR)   Clinical Features The most common abnormalities include high grade AV block and new onset LBBB  Due to the close proximity of the aortic annulus to the AV node and His-Purkinje system More common i...

Contributor: Alec Coston, MD Educational Pearls: What are nasal intubations and when do we use them? Nasal intubations function similarly to oral intubations with the end goal of passing an endotracheal tube (ETT) through vocal cords and into the trachea to allow for a patent and secure airway, but differ in the main access point for the ETT (nare v.s. mouth). Nasal Intubations are seldom preferre...

Contributor: Aaron Lessen, MD Educational Pearls: What are the common causes of agitation in the elderly? Baseline dementia causing a behavioral disturbance Delirium precipitated by an acute medical problem such as a UTI, pneumonia, overdose/side effect of home medications, urinary retention, constipation, pain, hypoxia, electrolyte abnormality, etc. Exacerbation of a primary psychotic condition s...

Contributor: Aaron Lessen, MD Educational Pearls: Patients with pulmonary embolism (PE) are divided into three risk categories Low risk (non-massive PE): patients are stable Treatment: prescribe anticoagulants and discharge home Intermediate risk (submassive PE): patients are stable but display evidence of clot burden such as elevated troponin, elevated BNP, and/or right heart strain Treatment is...

Hosts: Don Stader, Nate Novotny, Travis Barlock, and Jeffrey Olson In this episode, we reminice about the first 1000 medical minutes presented by EMM and what the next 1000 might hold. Below are all of the episodes referenced in this episode. Please go back and give them all a listen. Segment 1- Recap and Facts 1st medical minute o   April 29, 2016. Almost exactly 10 years ago. o   Diverticulitis...

Contributor: Aaron Lessen, MD Educational Pearls: Burns range in complexity from minor first-degree burns to more severe full-thickness burns. Initial basic burn management: Run the burn under cool running water for 20 minutes. Do not scrub the skin. Do not use ice water. Ideally initiated as soon as possible, but no later than 3 hours after injury. Applicable to all burns ranging from superficial...

Contributor: Travis Barlock, MD Educational Pearls: What is an internal jugular catheter (IJ) and when do we use it? IJs are catheters that can be placed in either the left or the right internal jugular vein to provide central venous catheter (CVC) access. CVCs can be placed in other locations other than the internal jugular vein (i.e. subclavian vein or femoral veins). IJs are used when the patie...

Contributor: Aaron Lessen, MD Educational Pearls: How long do we need to watch patients with a presumed overdose who were treated with naloxone in the field? A 2025 study in the Annals of Emergency Medicine took a look at this question Methods Prospective, multi-institutional cohort study Included ED patients with suspected acute opioid overdose with biologic testing to confirm substances. This pa...

Contributor: Travis Barlock, MD Educational Pearls: D-dimer: fibrin degradation product used to evaluate for clot formation and breakdown Threshold:

Contributor: Taylor Lynch MD Educational Pearls: Melatonin is an endogenous hormone released primarily by the pineal gland Also released by extrapineal regions in the retina, the GI tract, and some immune cells Peak secretion occurs at night and is suppressed during the day Secretion and production decrease with age Older patients experience the greatest improvement in sleep latency and sleep qual...

Contributor: Travis Barlock, MD Educational Pearls:  Foul-smelling urine and cloudy urine are commonly misinterpreted as indicators of a UTI. However, these findings alone are not diagnostic. Criteria for UTI: Presence of localized urinary symptoms: Suprapubic pain Dysuria Hesitancy Urgency Urinalysis with WBC > 10 Urine culture with > 100,000 CFU/mL Colonization differs from infection - many pati...

Contributor: Aaron Lessen, MD Educational Pearls: What is anaphylaxis and what are its treatments?  Anaphylaxis is a broad term for potentially life threatening allergic reactions that can progress to cardiovascular collapse (anaphylactic shock).  It is triggered by IgE and antigen cross-linking on mast cells to induce degranulation and the release of histamines, which can cause diffuse vasodilati...

Contributor: Alec Coston, MD Educational Pearls: Disclaimer: this has nothing to do with the ER but is too cool to not talk about. Condition: Carbamoyl phosphate synthetase 1 (CPS1) deficiency Rare inborn error of metabolism Inability to properly break down ammonia Leads to severe hyperammonemia and hepatic encephalopathy Natural history: Without treatment, typically fatal within the first few wee...

Contributors: Travis Barlock MD, Ian Gillman PA, Jacob Altholz MD, Jeffrey Olson MS4 In this episode, EM attending Travis Barlock and medical student Jeffrey Olson listen in to the two remaining cases presented from EMM's recent event, Tox Talk 2025.  Talk 1- Methemoglobinemia- Ian Gillman Cyanosis + chocolate-colored blood + normal PaO₂ + pulse ox stuck at ~85% = Methemoglobinemia → Treat with me...

Contributor: Alec Coston, MD Educational Pearls: BiPAP is often effective in severe asthma, but many patients struggle with mask tolerance due to intense air hunger–driven anxiety, often compounded by hypoxia. Benzodiazepines are commonly used for anxiety, but they can depress respiratory drive, making clinical improvement difficult to interpret (a lower RR may reflect sedation rather than true ph...