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Podcast #35: Coumadin Reversal

Run Time: 3 minute Author: Dr. Samuel Killian Educational Pearls: 5 million people are on Coumadin. Coumadin is in the top 5 of most adverse events. 2 options for reversal in the ER: Vitamin K and FFP or vitamin K and 4 factor PCC. FFP is cheap but harder to use and takes longer –…

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Podcast #34: Hard Signs for Vascular Injury

Run Time: 1 minute Author: Dr. Nicholas Hatch Educational Pearls: Hard signs of vascular injury include: loss of pulses, severe arterial bleeding, active uncontrolled hemorrhaging, rapidly expanding pulsatile hematoma, and palpable thrill or bruit. Patient with these signs and suspected injury needs to be moved to the operating room ASAP. Soft signs of vascular injury include:…

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Podcast #33: Adverse Reactions during Procedural Sedation

Run Time: 3 minutes Author: Dr. Samuel Killian Educational Pearls: Agitation – 16% of patients experience agitation with Ketamine. Aspiration – rare with 1 in 2500 cases exhibiting aspiration. Bradycardia – Happens most often with Etomidate, 1 in 250 cases. Hypotension – 2% of cases with Propofol – still less frequent than patients on a…

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Podcast #32: Preoxygenation

Run Time: 4 minutes Author: Dr. David Rosenberg Educational Pearls: Preoxygenation provides plenty of oxygen to the patient so that he/she does not desaturate during RSI. Even if the patient is at 100% on spO2 monitor, preoxygenation is necessary for continued saturation of hemoglobin and transport of oxygen to the rest of the body – respiration…

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Podcast #31: Difficult Patient

Run Time: 2 minutes Author: Dr. Susan Brion Educational Pearls: Difficult patients include those who are rude, disruptive, or with multiple medical problems – 15% of patients qualify as difficult. In study in the British Medical Journal family practice resident were given 3 difficult patients and 3 normal patients. Residents misdiagnosed the difficult patients 42%…

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Podcast #30: Pancreatitis

Run Time: 5 minutes Author: Dr. Samuel Killian Educational Pearls: Acute pancreatitis care can be very different from someone with chronic pancreatitis – mortality rate is high at 6-10% for acute pancreatitis. 90% of pancreatitis cases are from alcohol and biliary disease. The remainder of cases are from medication, auto-immune, trauma, hyperlipidemia, and idiopathic causes. True…

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Podcast #29: Management of Stingray Injuries

Run Time: 3 minutes Author: Dr. Eric Miller Educational Pearls: Do not urinate on the stingray envenomation site – does not work for jellyfish either. First, wash the wound thoroughly with warm, not hot, water to denature the proteins in the venom. Second, care for the penetration wound and explore for a foreign body with…

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Podcast #28: Flomax and Kidney Stones

Run Time: 4 minutes Author: Dr. Samuel Killian Educational Pearls: Greater than 1 million visits per year in American for kidney stones. 12% men and 6% women will have kidney stone at some point during their lifetime. Most studies that discredited Flomax were not properly organized – there was no placebo, the study was not…

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Podcast #27: Variceal Upper GI bleed

Run Time: 9 minutes Author: Dr. Donald Stader Educational Pearls: Patients with variceal bleeding are sick at baseline, and come from a very sick patient population with a higher mortality rate. Varices occur in a patient with cirrhosis when blood goes through other pathways to get back to the heart – rather than going through…

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Podcast #26: Salicylate and Camphor Poisoning

Run Time: 2 minutes Author: Dr. John Winkler Educational Pearls: Camphor from Vicks Vapor rub and Tigerbalm has a very low toxic level and can cause lethargy, altered mental status, and seizures – very dangerous for children. Oil of Wintergreen contains Salicylates – basically aspirin – which only takes 1 teaspoon to be deadly for…

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