Emergency Medical Minute

Author: Nick Hatch, M.D. Educational Pearls CPR-induced consciousness is a phenomenon that occurs when someone who was previously unconscious and is undergoing CPR regains consciousness and makes purposeful movements. Studies have shown that this phenomenon is increasing, likely because of increased quality of CPR. Many people use a sedative such as ketamine  to keep patients unconscious to reduce...

Author: Sam Killian, M.D. Educational Pearls Anaphylaxis is common in the ED. These patients are treated and then usually watched for 4-6 hours. Biphasic happens in patients that have a complete resolution of their anaphylaxis  for at least an hour, but then have a recurrence that requires pharmacologic  intervention. Most of the time this happens 3-6 hours later, but can happen more than 10 hours...

Author: Dylan Luyten, M.D. Educational Pearls Rhogam is commonly used when an Rh negative woman has an Rh positive fetus. It is commonly used in the ER in the setting of a miscarriage. Rh(+) fetal blood can enter the Rh(-) maternal circulation, sensitizing the woman to the Rh antigen. During a subsequent pregnancy, if the fetus is Rh(+), the woman may mount an immune response to the fetus, lead to...

Author: Justin Harper Justin Harper, a paramedic married to a pediatric nurse, discovered his own son had type I diabetes 2 years ago. Despite their medical experience, this diagnosis came as surprise to Justin and his wife. This is the compelling story about how their son was diagnosed with type I diabetes and how this has impacted their lives. 

Author: Dr. Larry Wolk,  Executive Director and Chief Medical Officer for the Colorado Department of Public Health and Environment. Topic:  Dr. Larry Wolk educates us on how cannabis has affected Colorado since medical and recreational legalization.

Authors: Don Stader, M.D. & Lauren Gibbs Topic:  Lauren breaks the stoner stereotype and explains how marijuana has positively impacted her life.

Author: Erik Verzemnieks, M.D. Topic: Erik speaks about how slightly altering the chemical composition of marijuana can create a drug with drastic effects on the human body. WARNING: Explicit Language

Author: Sophie Yorkwilliams -B.A. (Psychology) -Dual Ph. D. Candidate, Clinical Psychology and Neuroscience. Expected graduation: 2020 Topic: Studying cannabis comes with its own set of challenges. Find out how Sophie and her team have overcome obstacles to get accurate data on marijuana.

Authors: Don Stader, M.D. & Peter Pryor, M.D. Topic:  What caused Dr. Pryor to leave emergency medicine and enter the realm of medical marijuana?

Author: Rachael Duncan, PharmD BCPS BCCCP Topic: Rachel explains   the science behind one of the most common maladies thought to be induced by chronic cannabis use.

Author: Brett Marlin, M.D. Topics:  Brett explains the biochemical and physiological properties of cannabis.

Author: Don Stader, M.D Topic:  Don kicks things off with an overview of the history of marijuana and how it has made its way into medicine.

Author: Sam Killian, M.D. Educational Pearls Not every troponin elevation is an MI. Trop elevates in about an hour in ACS and stays elevated for days. Non-MI conditions that cause elevated troponin: Critical illness (sepsis), increased cardiac demand, right heart strain, LV dysfunction, hypotension, pressor use, acute PE, SAH, chronic renal failure, CHF, aortic dissection, and peri/myocarditis. El...

Author: Nick Hatch, M.D. Educational Pearls Acyclovir toxicity can uncommonly cause altered mental status, low blood glucose, hallucinations and myoclonic jerks. Toxicity often occurs in the setting of renal insufficiency, as it is cleared by the kidneys. Acyclovir is often used to treat shingles, which can also cause similar symptoms as acyclovir toxicity due to encephalitis - rule this out in th...

  Author: Michael Hunt, M.D. Educational Pearls Wells Criteria was initially designed to screen patients for further workup for PE.   Aspects of the Wells Criteria include: signs and symptoms of DVT (3 points), PE most likely dia (3 points), HR > 100 (1.5 points), immobility for > 3 days or surgery in last 4 weeks (1.5 points), documented history of PE (1.5), hemoptysis (1), treatment for cancer i...

Podcast #221: Walking Corpse Syndrome Author: Erik Verzemnieks, M.D. Educational Pearls Walking Corpse Syndrome (aka Cotard Delusion) is a very rare psychiatric disorder that leads to the belief that one is a "walking corpse". Often co-presents with depression, schizophrenia, and starvation. Responds to ECT. References: https://en.wikipedia.org/wiki/Cotard_delusion

Author: Aaron Lessen, M.D. Educational Pearls Atrial fibrillation is common. One of the best treatments for a fib is cardioversion back into sinus rhythm. Cardioversion may increase stroke risk if A-Fib duration is greater than 48 hours, but some new data suggests that this risk may happen as soon as 12 hours. However, newer studies show that cardioversion is generally safe as a treatment for A-Fi...

  Author: Chris Holmes, M.D. Educational Pearls "Sepo' is a term from Homer (author of The Iliad  and The Odyssey ), and means "I rot". Hippocrates in 400 BC identified sepsis as a "dangerous decay within the body". Galen in 200 AD believed pus was "laudable". The Greeks and Romans used the term "myasma" to describe the smell of swamp and rotting flesh. Dr. Emmanuel Rivers in Detroit did one of th...

Author:  Aaron Lessen, M.D. Educational Pearls Asking parents and Broselow Tape are common options for estimating pediatric weight. Equipment sizes should not be adjusted for under/overweight kids based on Broselow Tape estimates. The finger counting method (see reference) is just as accurate as Broselow Tape method, according to one study. References: http://handtevy.com/images/Casestudies/Americ...

Author: John Winkler, M.D. Educational Pearls: Designer, or "synthetic" drugs include bath salts, synthetic THC, and many others. Many of these drugs are originally manufactured in China and are shipped globally. Treatment usually involves airway control and sedation - ketamine may be useful. Traditional tox screens do not test for these drugs. References: https://www.drugabuse.gov/related-topics/...

Author: Aaron Lessen, M.D.  Educational Pearls: Anecdotal evidence suggests that roller coasters may help with kidney stones. A recent study used a model of a kidney and ureter with different sized stones and put it on Thunder Mountain roller coaster in Disney World. There was "dramatic passage" of the kidney stones at the rear of the roller coaster. References: Marc A. Mitchell, DO; David D. Wart...

PRACTICE RECOMMENDATIONS 1. Patients who abuse opioids should be managed without judgement; addiction is a medical condition and not a moral failing. Caregivers should endeavor to meet patients "where they are," infusing empathy and understanding into the patient/medical provider relationship. 2. Every emergency clinician should be well-versed in the safe injection of heroin and other intravenous...

PRACTICE RECOMMENDATIONS 1. All emergency departments should implement ALTO programs and provide opioid-free pain treatment pathways for the following conditions: a. Acute on chronic opioid-tolerant radicular lower back pain b. Opioid-naive musculoskeletal pain c. Migraine or recurrent primary headache d. Extremity fracture or joint dislocation e. Gastroparesis-associated or chronic functional abd...

RACTICE RECOMMENDATIONS 1. Opioids are inherently dangerous, highly addictive drugs with significant abuse potential, numerous side effects, lethality in overdose, rapid development of tolerance, and debilitating withdrawal symptoms. They should be avoided whenever possible and, in most cases, initiated only after other modalities of pain control have been trialed. 2. Prior to prescribing an opioi...

The Emergency Medical Minute proudly presents an educational podcast series sponsored by the Colorado Hospital Association addressing our the United States' opioid epidemic.