Emergency Medical Minute

Author: Gretchen Hinson, M.D. Educational Pearls:   PNES vs. epilepsy: postictal state is diagnostic of an epileptic seizure (sonorous respirations and/or confusion, lasting typically 20-30 minutes); Epileptiform seizures show decrease in convulsion frequency, but increase in convulsion amplitude while PNES convulsions demonstrate episodic convulsion amplitudes; and epileptiform seizures usually d...

Author: Dr. Peter Bakes Educational Pearls: High risk patients: underlying lung disease, immunocompromised, extremes of age ( 65), underlying cardiac/renal/neurologic disease, and pregnant women Testing: RT-PCR (RNA based test that is both sensitive and specific) Workup: comorbidities dictate whether or not they are screened ; CXR indicated in high risk patients with respiratory symptoms Morbidity...

Author: Sam Killian, M.D. Educational Pearls:   Spinal cord injury without radiographic abnormality (SCIWORA) is a diagnosis defined as traumatic injury to spine with clinical sx of traumatic myelopathy (paraplegia, paresthesias, FND) without radiographic abnormalities. Term was established in  1970's before MRI and accounted for about 15% of injuries at the time (mainly children). Today SCIWORA a...

Author: Aaron Lessen, M.D. Educational Pearls: Recurrence rate for first time unprovoked seizures - 5% after 48 hours, 14% at 2 weeks , 30% after 4 months. Higher risk for recurrence: age under 3; patients with multiple seizures at initial presentation, focal neurologic findings on initial presentation. Useful for counseling patients and recommending follow up. References: Shinnar S, Berg AT, Mosh...

Author: Gretchen Hinson, M.D. Educational Pearls: Controversial topic. Pathophysiology - acidosis leads to an extracellular potassium shift. Patients in DKA will be intracellularly potassium deplete, but will have a falsely normal/elevated serum potassium. 3 risk of giving bicarb in DKA - alkalosis will drive potassium intracellularly but can overshoot (hypokalemia) and  increase risk of arrhythmi...

Author: Alicia Oberle, MD Educational Pearls:   Recent study has shown risk factors for return included patients at high risk for resistance (nursing home, obstructive uropathy), patient where diagnogsis of pyelonephritis was missed, but the biggest risk factor was the existence of bug-drug mismatches. Cephalexin (Keflex) was associated with highest rate of return, while nitrofurantoin (Macrobid)...

Author: Aaron Lessen, M.D. Educational Pearls: There is currently debate within the medical community about what constitutes cardiac activity on ultrasound in the setting of cardiac arrest. A recent study has shown there providers looking at the same clips from an echo will disagree about what constitutes cardiac activity. Some of the confusion stems from movement that is not cardiac in etiology....

Author: Peter Bakes, M.D. Educational Pearls:   Rare disease with 1-2 patients out of 100,000. About 60% of patients report a preceding diarrheal illness and classically presents with an ascending motor weakness. Pathophysiology is likely due to molecular mimicry where the immune system creates antibodies against a pathogen ( C. jejuni ) which appears similar to the myelin of peripheral nerves res...

Author: Nick Hatch, M.D. Educational Pearls Tramadol acts at multiple receptors and is a partial agonist at the mu opioid receptor, but also blocks reuptake of serotonin and norepinephrine throughout the body among others.   One major side effect to be aware of is that it lowers the seizure threshold. Useful in setting of pain control in patients with contraindications to NSAIDs who are poor opioi...

Author: Aaron Lessen, M.D. Educational Pearls A "stuffer" is a term for someone who hastily and conceals a bag of drugs orally/rectally/vaginally in an unplanned situation. A "packer" is someone who is planning to smuggle drugs, and does so in a similar manner.   "Stuffers"are more likely to have the drug container open up in their system, while packers tend to have more reliable containment, but...

Author: Dylan Luyten, MD Educational Pearls   Johannes Hoffer coined term Nostalgia in 1688 in his medical dissertation.   Nostalgia was a formal medical diagnosis, and one that dates back to 17th century when soldiers had longing for home and melancholy with a constellation of symptoms including lethargy, sadness, disturbed sleep, heart palpitations, GI complaints, and/or skin findings for which...

Author: Dylan Luyten, M.D. Educational Pearls The Lazarus phenomenon is the delayed return of spontaneous circulation after cessation of CPR. A prospective study in Finland found 5 out of 840 patients where CPR was attempted in the setting of cardiac arrest experienced the Lazarus effect (about 0.6%). 3 of these patients died on scene, and the other 2 died in the hospital at 1.5 and 26 hours respe...

Author: Jared Scott, M.D. Educational Pearls Flu is widespread throughout the US (through Jan 20 th 2018). All age groups have seen surge in hospitalizations, but 65 + age group has seen the largest surge in hospitalizations due to flu. New recommendations for treating with Tamiflu! Treat the following high-risk groups at any stage of illness:  Children under age 2, Adults 65 and older, patients w...

Author: Don Stader, M.D. Educational Pearls Common pathologies include cholecystitis, choledocholithiasis, and in concerningly ascending cholangitis. Cholecystitis is obstruction at the cystic duct leading to inflammation of gallbladder wall, while choledocholithiasis is a distal obstruction of the biliary tree, and ascending cholangitis is an ascending infection of the biliary tree secondary to o...

Since the tragic overdose of his son, Admiral Winnefeld has developed an intriguing strategy on how to combat the Opioid Epidemic. 

Sam Quinones, American journalist and author of the critically acclaimed book,  Dreamland: The True Tale of America's Opiate Epidemic , shares the story of how he discovered the truth about the Opiate Epidemic. 

Lisa Raville, executive director of The Harm Reduction Action Center in Denver, shares tales from her perspective as a Harm Reductionist. 

Emergency Medical Minute's very own Donald Stader, MD explains Medicine's contribution to the catastrophe that is the Opioid Epidemic. 

Dr. Robert Valuck, director of the Colorado Consortium, presents 10 fallacies that have fueled the Opioid Epidemic. 

The Honorable Alby Zweig shares his impactful first-hand experience with addiction, recovery and triumph.

Admiral James Winnefeld and Mary Winnefeld speak publicly for the first time about the tragic overdose of their son, Jonathon, and how 'No Family is S.A.F.E...yet'. 

Author: Peter Bakes, M.D. Educational Pearls Probiotics are living bacteria that are taken as an oral supplement. Most of the data to support their use is in the prevention of antibiotic-related diarrhea and the reduction of the symptoms of ulcerative colitis (UC). Some studies have some a reduction of the incidence of antibiotic-related diarrhea in children of up to 12% with the use of probiotics...

Author: Chris Holmes, M.D. Educational Pearls It's estimated that about 25 million people died during the Black Plaque. Researchers have confirmed this number by assessing how much old, broken pottery was buried in front of homes and churches from that time period. Traditional thinking has been that the Black Plague was spread primarily by flea bites. However, using mathematical modeling, research...

Author: Sam Killian, M.D.  Educational Pearls The availability of antiepileptic treatment has changed in the last 30 years. A recent study in JAMA followed 18,000 pts with epilepsy for 30 years to assess the effectiveness of looked at seizure control. The study found that although there have been new drugs introduced over the last 30 years, there has not been much of an improvement in seizure cont...

Educational Pearls Truvada (Emtricitabine/tenofovir) is a combination nucleotide reverse transcriptase inhibitor that can be used as pre-exposure prophylaxis (PrEP) for HIV. It has been shown to dramatically reduce the risk of contracting HIV. It is used in high-risk patients, like the MSM community or those who are in a relationship with someone with HIV. Side effects include nausea, vomiting, he...