Podcast #447:  IV Tylenol

Author: Dylan Luyten, MD

Educational Pearls:

  • Recent randomized controlled trial compared intravenous to oral acetaminophen in emergency department patients
  • There was no difference in pain relief between the groups
  • While the actual acquisition cost of these drugs are not significant, the cost multipliers that are passed onto patients lead to real dollars
  • With the significant cost of IV acetaminophen, it may not be the best choice given the lack of superiority to other formulations

References:

Furyk J, Levas D, Close B, Laspina K, Fitzpatrick M, Robinson K, Vangaveti VN, Ray R. Intravenous versus oral paracetamol for acute pain in adults in the emergency department setting: a prospective, double-blind, double-dummy, randomised controlled trial.Emerg Med J. 2018 Mar;35(3):179-184. doi: 10.1136/emermed-2017-206787. Epub 2017 Dec 15. PubMed PMID: 29247042.

Summarized by Will Dewsipelaere, MS3 | Edited by Erik Verzemnieks, MD

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Podcast #446:  Retinal Detachment

Author: Dylan Luyten, MD

Educational Pearls:

  • 1:500 patients will experience a retinal detachment
  • Consider stroke on your differential (central retinal arterial occlusion)
  • Flashes and floaters are a common complaint with retinal detachments
  • Though patients may report fields of vision loss, visual acuity is often spared
  • Ocular ultrasound is an effective way to diagnosis retinal detachment in the ED
  • These require urgent ophthalmologic consultation for surgical repair

References:

https://www.aliem.com/2014/03/ocular-ultrasound-retinal-detachment-posterior-vitreous-detachment/

Gottlieb M, Holladay D, Peksa GD. Point-of-Care Ocular Ultrasound for the Diagnosis of Retinal Detachment: A Systematic Review and Meta-Analysis. Acad Emerg Med. 2019 Jan 13. doi: 10.1111/acem.13682. [Epub ahead of print] PubMed PMID: 30636351.

 

Summarized by Will Dewsipelaere, MS3 | Edited by Erik Verzemnieks, MD

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Podcast #445: Hunting for the endotracheal tube

Author: Michael Hunt, MD

Educational Pearls:

  • Bedside transtracheal ultrasound to confirm proper endotracheal intubation is simple and effective
  • Review of 17 studies showed transtracheal ultrasound was was 98.7% sensitive and 97.1% specific
  • Curvilinear probe may be preferable as it provides a larger field of view

Editor’s Note: rather than explain what you’re looking for… just go here

References:

Gottlieb M, Holladay D, Peksa GD. Ultrasonography for the Confirmation of Endotracheal Tube Intubation: A Systematic Review and Meta-Analysis. Ann Emerg Med. 2018 Dec;72(6):627-636. doi: 10.1016/j.annemergmed.2018.06.024. Epub 2018 Aug 14. PubMed PMID: 30119943.

Summarized and edited by Erik Verzemnieks, MD

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Podcast #444: Dyspnea in the intubated patient

Author: Aaron Lessen, MD

Educational Pearls:

  • Dyspnea can occur in up to 50% of intubated patients
  • Dyspnea is associated with prolonged mechanical intubation
  • Often goes undiagnosed as these patients have difficulty communicating
  • Expert opinion on reducing sensation of dyspnea
    • Reduce stimulation of respiratory drive like fever and acidosis
    • Give bronchodilators for patients with wheezing
    • Optimize the ventilator settings
    • Use medications for comfort (i.e. opioids, benzodiazepines)

References:

Decavèle M, Similowski T, Demoule A. Detection and management of dyspnea in mechanically ventilated patients. Curr Opin Crit Care. 2019 Feb;25(1):86-94. doi: 10.1097/MCC.0000000000000574. PubMed PMID: 30531366.

Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD

 

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