Emergency Medical Minute

Contributor: Nick Tsipis, MD Educational Pearls: Recent randomized controlled trial compared early intervention (PCI/CABG) to medical management for those diagnosed with moderate to severe cardiac ischemia on stress testing Primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arres...

Contributor: Nick Hatch, MD Educational Pearls: An AC (acromioclavicular joint) separation in the shoulder is a common traumatic injury XRs can help rule out other injuries as well as help with grading the injury There are six different grades for AC separations: Grade I: is stretching of the AC ligament without disruption or displacement of the clavicle and recovers with time. Grade II:  is parti...

Host : Elizabeth Esty, MD. Smoking is known to increase both susceptibility and severity of all manner of colds and pneumonias, so you'd think the world's 1.1 billion smokers would be at risk in this pandemic of what at first seemed to be a just a respiratory virus.  What's more, tobacco smoking increases risk for COPD, diabetes and coronary disease, so it may increase risk for more severe COVID i...

Contributor: Nick Tsipis, MD Educational Pearls: Case series reported 5 cases of generally young and healthy patients with COVID-19 who presented to the ER with acute stroke Now several case series showing cardiovascular involvement or complications related to COVID-19 While these case series may shed light on the nature of COVID-19 complications, it's worth remembering that so far these cases rep...

Contributor: Don Stader, MD Educational Pearls: Buprenorphine has been shown to decrease morbidity and mortality in opioid use disorder Buprenorphine used in naloxone-induced withdrawals can displace naloxone at opioid receptors, leading to reduced withdrawal symptoms and lessen the chance of using after discharge Patients in acute withdrawal due to naloxone after an overdose should be given Bupre...

In the US, few people receive vaccination for tuberculosis (TB), a disease that hasn't been a major killer here for many decades.  But while we in the US mostly experience TB as a relatively rare but real threat in its multidrug resistant form, particularly in pts with HIV--or in Victorian novels--TB still kills 2 million people a year. There is a vaccine for TB, a live attenuated vaccine called B...

Contributor: Don Stader, MD Educational Pearls: COVID-19 commonly appears as a bilateral patchy infiltrate on chest radiograph, but this is a non-specific finding  Sensitivities range from 17-70% for COVID-19 Many other viral pneumonias such as RSV and influenza can have similar findings Point-of-care ultrasound (POCUS) demonstrates B-lines, water-fall sign , or hepatization of the lung, but these...

In this timely installment of Mental Health Monthly, mental health expert Lexi Eliades shares useful tips for identifying burnout and mental health decline as well as ways to maintain mental wellness amidst adversity and significant stress. We at Emergency Medical Minute know many of our listeners are on the frontlines of the COVID-19 pandemic. We hope this piece is helpful and that it reaches som...

Contributor: Dylan Luyten, MD Educational Pearls Acidosis can be caused by a respiratory, metabolic, or mixed source A respiratory acidosis will have a low serum pH and elevated bicarbonate if it's chronic, but most importantly end tidal CO2 or arterial CO2 will be high.   With a metabolic acidosis we expect to see a low serum pH and low serum bicarbonate. Once it's determined a patient is in a me...

Contributor: Don Stader, MD Educational Pearls: Acute respiratory distress syndrome (ARDS) is a catch all term for when lung injury leads to fluid collection in the air spaces of the lungs  Ventilatory management in ARDS patients involves lower FiO2 and PEEP than other patients and relies on lung protective ventilation strategies to prevent barotrauma Proning these patients has also been utilized...

Last week we looked at neurologic presentations of COVID-19; this week we'll look more closely at strokes in young people with COVID. A letter published 2 days ago in the NEJM with lead author Thomas Oxley, the Neuro ICU director at Mt Sinai, presents five case studies of relatively young patients who had strokes at home and presented to Mt Sinai between 23 March and 7 April . In pre-COVID days, M...

Contributor: Don Stader, MD Educational Pearls:   COVID-19 is diagnosed with a nasopharyngeal swab (q-tip). This unfortunately can be painful, but if the swab doesn't go deep into the nasal cavity the sample can be inadequate leading to false negatives (missed infections). The sensitivity of the COVID-19 RT PCR test is low, ranging from 66-80% in various studies. Another study has shown 23% of pat...

Contributor: Eric Miller, MD Educational Pearls: A cell count is performed on tubes 1 and 4 to account for changes that may occur from blood entering the first sample from the needle insertion Tube 2 and 3 are usually used for the other studies like protein levels, glucose levels and gram staining  Protein levels are often elevated in bacterial meningitis but can be helpful in diagnosis conditions...

Contributor: Don Stader, MD Educational Pearls: When do we give antiplatelet drugs or anti-coagulation drugs? Arterial issues get antiplatelet therapy Venous issues, or slow flow states, get anticoagulation therapy. High flow areas (arteries) are more prone to platelet clotting while the venous system is more prone to allowing blockages caused by coagulation factors. The main side effect with anti...

Accumulating clinical evidence suggests that many patients with COVID have neurological symptoms a nd that some may even present with neurologic manifestations of the disease. Most COVID patients have a cough, respiratory distress, and while clinicians often speak about how similar the presentations of patients with respiratory COVID are, it's worth looking at the possibility that COVID has atypic...

In this organic conversation, Nick and Dr. Helman establish a warm rapport early on as they discuss musical beginnings, life-changing mentors and the origins of Emergency Medicine Cases. Their banter includes Dr. Helman's views on FOAMed and multimodal learning and treatment hacks learned on the frontlines of COVID-19.   Intro Music: Backbay Lounge Kevin MacLeod (incompetech.com) Licensed under Cr...

In this episode of the COVID-19 Digest, we revisit the airborne vs droplet transmission debate and analyze a highly publicized study on Remdesivir from the New England Journal of Medicine.  Host: Elizabeth Esty, MD & Dylan Luyten, MD Research By: Tanisha Crosby-Attipoe & Nathan Novotny Sound Editing By: Stephen Bahmani Time Stamps: 0:00 - Numbers 0:58 - " Transmission Potential of SARS-CoV-2 in Vi...

In part 2 of our interview with Dr. Adam Graham, Jordan takes a deep dive into posterior circulation strokes and how to identify them in the field. 

Contributor: Dave Rosenberg, MD Educational Pearls: White noise is all the surrounding sound frequencies mixed together that your brain tunes down so you don't get distracted while you're sleeping Pink noise, or deep soothing noises, is the accentuated bass sounds like falling rain or waves crashing your brain keys into while sleeping. Brain electrical waves during stage 4 sleep (the deepest of sl...

The circumstances that led to the national shortage in PPE for healthcare workers, the inspiring work of New Orleans med students to equip medical providers with PPE and the science behind personal use of cloth masks are all topics covered in this special edition of the Emergency Medical Minute.  Host : Elizabeth Esty, MD Research By : Julia Luyten Sound Editing By : Stephen Bahmani Time Stamps :...

Contributor: Dylan Luyten, MD Educational pearls: Clinical management of COVID-19 is rapidly evolving, relying on case reports and clinical experience In just a month, the consensus around management of COVID patients with severe hypoxia has shifted from an early intubation strategy to other, non-invasive means Intubating early can quickly consume ventilator resources, require increased intensive...

In our coverage of COVID-19 this week, we've investigated the shakey evidence for NSAID use making COVID worse, heard first-hand accounts from ED clinicians with COVID, and looked at the status of testing in the United States. Before capping our week of coverage off, we wanted to analyze some of the most recent literature on clinical interventions for COVID, particularly the recently FDA approved...

A dive into how the United States responded to an emerging pandemic and the pitfalls along the way that led to stalled testing capacity across the country before community transmission was confirmed. Hear what led us to our current situation, what continues to be an issue and new technologies on the horizon as well as how the rest of the world has responded. Host : Elizabeth Esty, MD Research By :...

Long time friends of EMM, Aaron and Bree, share their experiences on the frontlines in the ED, coping with COVID, managing anxiety and quarantining with their family.

In the past two weeks, warnings, questions, and misinformation concerning COVID-19 and NSAID use have been spreading...no pun intended..virally. The pace of this evolving pandemic and the equally quick pace of the news and social media news cycle have meant that information and misinformation travel equally fast. Today we bring to you the story of how a letter in The Lancet led to a world of confu...