Podcast #222: Wells Criteria for PE

 

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 in last 6 mo (1).
  • ACEP uses a score of less than or equal to 4 to define “low risk.” Greater than 4 is “high risk”.
  • Use Wells to guide clinical decisions about PE workup.

References: http://www.ebmedicine.net/media_library/files/1212%20Pulmonary%20Embolism

Podcast #221: Walking Corpse Syndrome

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

Podcast #220: A-Fib Cardioversion

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-Fib.

References: Aatish Garg, Monica Khunger, Sinziana Seicean, Mina K. Chung, Patrick J.Tchou Incidence of Thromboembolic Complications Within 30 Days of Electrical Cardioversion Performed Within 48 Hours of Atrial Fibrillation Onset. JACC: Clinical Electrophysiology Aug 2016, 2 (4) 487-494; DOI: 10.1016/j.jacep.2016.01.018

Podcast #219: History of Sepsis

 

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 the the first big studies about sepsis and was an advocate for goal-directed therapy.
  • Now, Vitamin C cocktails are in use, but new sepsis treatments should be investigated carefully before implementation.

References: Funk, Duane J. et al. Sepsis and Septic Shock: A History. Critical Care Clinics , Volume 25 , Issue 1 , 83 – 101

Podcast #218: Estimating Pediatric Weight

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/Americanjournalofemergencymedicine.pdf

 

Podcast #217: Designer Drugs

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/trends-statistics/national-drug-early-warning-system-ndews

Podcast #216: Roller Coasters and Kidney Stones

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. Wartinger, DO, JD. Validation of a Functional Pyelocalyceal Renal Model for the Evaluation of Renal Calculi Passage While Riding a Roller Coaster. The Journal of the American Osteopathic Association, October 2016, Vol. 116, 647-652. doi:10.7556/jaoa.2016.128. http://jaoa.org/article.aspx?articleid=2557373

 

Podcast #215: Ankle Pain

Author: Donald Stader, M.D.

Educational Pearls:

  • The most common ankle injury mechanism is an inversion.
  • Most common broken bone in the ankle is the fibula.
  • During exam, it is important to palpate over the fibular head, medial and lateral malleoli, over the 5th metatarsal and over the cuboid bone. If no tenderness in these areas and the patient is walking – they have a  sprain and can be sent home without imaging.
  • In calcaneal fractures, make sure to image the lumbar spine since up to 30% of calcaneal fractures are associated with lumbar spine injury.

References: http://orthosurg.ucsf.edu/oti/patient-care/divisions/sports-medicine/physical-examination-info/ankle-physical-examination/

Podcast #214: Dizziness

Author: Aaron Lessen, M.D.

Educational Pearls:

  • We can differentiate vertigo into benign problems such as vestibular problem (peripheral problem), or something more worrisome that originates in the brain (central problem).
  • Dizziness + other symptoms makes us think about origination in the CNS.  Symptoms include Dizziness, Diplopia, Dysarthria, Dysphagia, Dysmetria.

References:  http://www.medicalnewstoday.com/knowledge/160900/vertigo-causes-symptoms-treatments

http://www.mayoclinic.org/diseases-conditions/dizziness/basics/causes/con-20023004

Podcast #213: Oats and Potatoes

Author: Michael Hunt, M.D.

Educational Pearls:

  • Oats have been shown to lower LDL.
  • Oat bran is the most effective way to consume oats to lower LDL.
  • A Swedish study of 69,000 people who ate at least 3 servings of potatoes a week showed no increased risk of a MI or stroke associated with potato consumption.

References: Larsson SC, Wolk A. Potato consumption and risk of cardiovascular disease: 2 prospective cohort studies. Am J Clin Nutr. 2016