Podcast #307: Guillain-Barre Syndrome

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 resulting in autoimmune demyelination.
  • Diagnosis is made by clinical presentation +/- a spinal tap with a characteristic high protein count but without cells.
  • Treatment is IVIG or plasmapharesis. It is important to monitor respiratory function because about 15% of patients progress to respiratory failure.



Sejvar, James J.; Baughman, Andrew L.; Wise, Matthew; Morgan, Oliver W. (2011). “Population incidence of Guillain?Barré syndrome: a systematic review and meta-analysis”

van den Berg, Bianca; Walgaard, Christa; Drenthen, Judith; Fokke, Christiaan; Jacobs, Bart C.; van Doorn, Pieter A. (15 July 2014). “Guillain?Barré syndrome: pathogenesis, diagnosis, treatment and prognosis”. Nature Reviews Neurology. 10 (8): 469?482.

Yuki, Nobuhiro; Hartung, Hans-Peter (14 June 2012). “Guillain?Barré Syndrome”. New England Journal of Medicine. 366 (24): 2294?2304.

Podcast #306: Tramadol Drama

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 opioid candidates.
  • Use with caution as it potential for abuse.



Hennies HH, Friderichs E, Schneider J (July 1988). “Receptor binding, analgesic and antitussive potency of tramadol and other selected opioids”. Arzneimittel-Forschung. 38 (7): 877?80.

“Tramadol Hydrochloride”. The American Society of Health-System Pharmacists. Retrieved Dec 1, 2014.

“Withdrawal syndrome and dependence: tramadol too”. Prescrire Int. 12 (65): 99?100. 2003

Podcast #305: Stuffers vs. Packers : Drug-Packet Ingestion

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 typically have larger quantities on-board.
  • Be on look out for symptoms associated with the drug’s exposure (drug dependent) as well as mechanical symptoms (perforation; obstruction).
  • If suspicious, order CT as X-rays underestimate severity.
  • Management: treat symptoms of intoxication appropriately, observe if packets are intact, consider surgery/endoscopy if necessary.



Dueñas-Laita A, Nogué S, Burillo-Putze G (2004). “Body packing”. New England Journal of Medicine. 350 (12): 1260?1

Hergan K, Kofler K, Oser W (2004). “Drug smuggling by body packing: what radiologists should know about it”. Eur Radiology. 14 (4): 736?42.

Traub SJ, Hoffman RS, Nelson LS (2003). “Body packing?the internal concealment of illicit drugs”. New England Journal of Medicine. 349 (26): 2519?26.

Podcast #304: Nostalgia

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 the only cure was to return home.


  • In the civil war, over 5000 soldiers were given medical leave for nostalgia.
  • Always remember to view your patient in the appropriate context (psychosocial, cultural, historical, etc.)



Beck, J. (2013, August 14). When Nostalgia Was a Disease. Retrieved March 08, 2018, from https://www.theatlantic.com/health/archive/2013/08/when-nostalgia-was-a-disease/278648/

Podcast #303: Lazarus Effect

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 respectively.
  • Ultimately, the Lazarus effect is rare, but it does occur and providers and family members should be aware that signs such as gasping or twitching may be seen after cardiac arrest, but the prognosis is still dismal.


Kuisma, M, et al. (September 2017) “Delayed return of spontaneous circulation (the Lazarus phenomenon) after cessation of out-of-hospital cardiopulmonary resuscitation”. Resuscitation. 118: 107-111

Podcast #302: Flu

Author: Jared Scott, M.D.

Educational Pearls

  • Flu is widespread throughout the US (through Jan 20th 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 with comorbidities such as chronic lung disease, heart disease, blood disorders, kidney disorders, liver disorders, neurological disorders, immunosuppressed, pregnant women, American Indians, extreme obesity, women under 19 on long-term aspirin, and nursing home residents.




Podcast #301: Biliary Pathology

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 obstruction.
  • Risk factors for Cholecystitis are the 5 F’s (Fat, Forty, Female, Fertile, Family Hx).
  • Classic symptoms seen in ascending cholangitis are Charcot’s Triad of fever, RUQ pain, and jaundice, or Reynold’s pentad which is more severe and has the addition of
    altered mental status and hypotension.
  • Porcelain gallbladder is a radiographic finding showing calcification of the gallbladder that is associated with cancer of the gallbladder.


Kimura Y, Takada T, Kawarada Y, et al. (2007). “Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines”. J Hepatobiliary Pancreat Surg.

Strasberg, SM (26 June 2008). “Clinical practice. Acute calculous cholecystitis”. The New England Journal of Medicine. 358 (26): 2804?11.

Dreamland in Denver

Thank you to all of our speakers, sponsors, volunteers and listeners for contributing to the success of Dreamland in Denver!

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Dreamland in Denver Part I: “No Family is S.A.F.E. …Yet”

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’.

Dreamland in Denver Part II: “Why Calling it ‘the Opioid Epidemic’ Misses the Point”

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

Dreamland in Denver Part III: “Opioid Mythbusters: 10 Fallacies that Fueled the Opioid Crisis”

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

Dreamland in Denver Part IV: “Doing Harm: Medicine’s Role in Creating the Opioid Crisis.”

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

Dreamland in Denver Part V: “Tales from a Harm Reductionist”

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

Dreamland in Denver Part VI: “Dreamland”

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.

Podcast #300: Probiotics

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.
  • There may be a reduction of up to 60% in the incidence of antibiotic-related C. diff infection in adults with probiotic use
  • Studies have shown a 10% or more reduction in the duration and severity of the symptoms of UC with probiotic use.
  • Proposed mechanisms of probiotics include a decrease in gut permeability and a decrease in pathogenic gut bacteria due to resource competition.

References: http://www.cochrane.org/CD006095/IBD_use-probiotics-prevent-clostridium-difficile-diarrhea-associated-antibiotic-use