Podcast # 464: Narcan’t?

Author: Aaron Lessen, MD

Educational Pearls:

  • A problem of take-home-naloxone is the administration of it by an able-bodied bystander
  • Australian study looked at consecutive opioid overdose deaths in a single year to identify characteristics of overdose and potential for bystander administered naloxone
  • Of the 235 fatal heroin overdoses reviewed, 83% were alone with only 17% (38 cases) having another person present
  • Half of those in the presence of others had a bystander that was not impaired
  • Take-home-naloxone needs a competent person to administer it. Make sure to review this along with other harm reduction strategies when prescribing/dispensing it to patients

References

Stam NC, Gerostamoulos D, Smith K, Pilgrim JL, Drummer OH. Challenges with take-home naloxone in reducing heroin mortality: a review of fatal heroin overdose cases in Victoria, Australia. Clin Toxicol (Phila). 2019 May;57(5):325-330. doi: 10.1080/15563650.2018.1529319. Epub 2018 Nov 17. PubMed PMID: 30451007.

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

Podcast #201: Task Interruption

Author: Mark Kozlowski M.D.

Educational Pearls:

  • Humans cannot “multitask” effectively – a more accurate term is “task interruption.”
  • When doing more than one task at once, we are more likely to forget key details and perform both tasks more slowly overall.
  • Do not interrupt people who are focusing on critical tasks – programming a pump or drawing up doses.
  • Think about ways to reduce task interruption in your hospital for a better clinical practice.

References: Westbrook JI, Woods A, Rob MI, Dunsmuir WTM, Day RO. Association of Interruptions With an Increased Risk and Severity of Medication Administration Errors. Arch Intern Med. 2010;170(8):683-690. doi:10.1001/archinternmed.2010.65

 

Podcast #133: Consent in Minors

d54934c9-718d-4241-8146-ea4aa81742bfRun Time: 4 minutes

Author: Suzanne Chilton M.D.

Educational Pearls:

  • For psych-specific cases where a minor is being transferred for a higher level of care, a judge or department of social services can be engaged to obtain temporary custody of the minor. The same situation as if the minor had acute appendicitis, there is no surgeon available and the parent is blocking transfer.
  • A minor 15 years of age or over can consent for his/her own mental health treatment. The parent has no legal recourse to block transfer or treatment.
  • Other instances that a minor can consent with no restriction on age limit include HIV testing, STD testing, drug or alcohol treatment, as well as reproductive health, minus sterilization.
  • Sometimes a parent will want their kid drug-tested, but this falls under drug and alcohol treatment and the parent does not have to be made aware of the results unless the minor wants that to happen.
  • Pregnant minors have consent for treatment and care of their unborn child, but not their own health, such as appendicitis.

Link to Podcast: http://medicalminute.madewithopinion.com/consent-in-minors/ 

References:  https://www.cde.state.co.us/sites/default/files/documents/healthandwellness/download/school%20nurse/understanding%20minor%20consent%20and%20confidentiality%20in%20colorado.pdf

Podcast #122:  Weight Estimation for TPA Candidates

obesity-factsRun Time: 2 minutes

Author: Stephen Lee, PharmD, BCPS

Educational Pearls:

  • In 2016, a tertiary stroke center performed a study on the estimation of weight in stroke patients needing TPA. TPA can be a life and lifestyle saving medication for patients with acute CVA and getting an accurate weight is essential to giving the correct dose.
  • The Stroke Center providers estimated the weight and gave the TPA dose. They found the lightest patients were overestimated and the heaviest patients were underestimated.
  • It was found that 19.7% of the doses were given incorrectly and those that had the largest deviation of dose had the least improvement in NIH score.
  • In a separate study done in 2004, doctors, nurses, and medical students and had them estimate the weight of the patient within five kilos. It was found that they were only correct 25% of the time.
  • Moral of the story, don’t be sloppy! GET AN ACCURATE WEIGHT! It could mean a world of difference for a patient suffering a stroke.

Link to Podcast: http://medicalminute.madewithopinion.com/weight-estimation-for-tpa-candidates/

References:  http://stroke.ahajournals.org/content/47/1/228.abstract

http://www.ncbi.nlm.nih.gov/pubmed/15666254

Podcast #114: Pseudo Axioms – Sterile Saline vs. Tap Water

water from the tapRun Time: 2 minutes

Author: Dylan Luyten M.D.

Educational Pearls:

  • Axiom: a universally accepted truth.
  • Pseudo Axiom: Something that is held to be a truth, but is just handed down, and not questioned or scrutinized.
  • The use of sterile saline to irrigate wounds has been aggressively studied and definitively demonstrated to be unnecessary.
  • Studies have shown that tap water is at least as good or better at wound infection vs. sterile saline.
  • It is estimated that if the patient’s hand is run under tap  water for 5 minutes as opposed to a liter of saline w/ splash guard and syringe the cost savings in the United States wound be $66 million.

Link to Podcast: http://medicalminute.madewithopinion.com/pseudo-axiom-tap-water-vs-sterile-saline/

References: http://bmjopen.bmj.com/content/3/1/e001504.full

Podcast #107: Sepsis Protocol

sepsis2Run Time:  3 minutes

Author: Jared Scott M.D.

Educational Pearls:

  • Recent study in the Annals of Emergency Medicine as of January 2016 looking at the efficacy of a Sepsis Protocol in an Emergency Department.
  • The looked at 180 patients before using the protocol and 180 patients after using the protocol. It was noted that the patients seen after the use of the protocol received a bolus of fluid an average of 31 minutes faster and antibiotics a full hour faster than before the use of the protocol.
  • Sepsis is a time-sensitive diagnosis, so eliminating any time between the arrival of the patient to the ED and fluid and antibiotic therapy saves lives.

Link to Podcast:  http://medicalminute.madewithopinion.com/sepsis-protocol/

References:  http://www.ajemjournal.com/article/S0735-6757(15)00707-X/abstract

Podcast #96: BRUE in Infants

9281e629-4719-4b27-8840-fa4aedf66680Run Time: 2 minutes

Author: Dr. Suzanne Chilton

Educational Pearls:

  • The American Academy of Pediatrics changed terminology for ALTE – Apparent Life Threatening Event in infants. The new term is BRUE – Brief Resolved Unexplained Event, which is much less scary. These children are also now divided into high and low risk categories.
  • BRUE encompasses any event of cyanosis or pallor, decreased respiratory drive, and a change in tone or level of consciousness in any child less than one year of age.
  • High risk BRUE has to meet the criteria of less than two months of age, less than 32 gestation, and lengthy or multiple episodes.
  • Low risk BRUE has to meet the criteria of greater than two months of age, greater than 32 weeks of gestation, and only one episode.

Link to Podcast:  http://medicalminute.madewithopinion.com/brue-in-infants/

References:  http://pediatrics.aappublications.org/content/early/2016/04/21/peds.2016-0591

Podcast #89: Difficult IV Access

5f5fd46b-631b-467d-9aa8-98828e6e5cdaRun Time: 2 minutes

Author: Dr. Dylan Luyten

Educational Pearls:

  • Study looked at that IV catheter secured with Dermabond – studied the rate of failure within 48 hours, rate of dislodgment, rate of infection, rate of phlebitis, and pain.
  • There was statistically significant lower rate of failure and dislodgment by 10% with Dermabond when compared with the control – there was no difference in the rate of pain, phlebitis, or infection.

Link to Podcast:  http://medicalminute.madewithopinion.com/difficult-iv-access/

References:  http://bmjopen.bmj.com/content/5/9/e008689.full

Podcast #63: Better to Have & Not Need

Run Time: 6 minutesemergency-room

Author: Dr. Mark Kozlowski

Educational Pearls:

  • When preparing for a critical patient there are seven top preparations that are better to have in the room than to need in the room after their arrival.
  • 1. EPOC
  • 2. Glide Scope and Stylet (suction would also be very nice)
  • 3. Ultrasound – in the room and turned on
  • 4. Slide Board
  • 5. Level 1 Infuser (for trauma)
  • 6. Thoracotomy Tray (for chest trauma)
  • 7. Blood!

Link to Podcast:  http://medicalminute.madewithopinion.com/better-to-have-not-nees/