Podcast #443: Measles – a timely revisit

Author: Sue Chilton, MD

Educational Pearls:

  • Measles is highly contagious
  • Typically patients just look sick
  • Remember 4 & 4, 14, and 4-C’s:
    • Contagious 4 days before and after onset of rash
    • 14 days for rash to appear
    • Cough, coryza, conjunctivitis (non-purulent), and Koplik’s spots
  • Under 2 and over 20 are highest risk groups
  • 1 in 1000 will die
  • Subacute sclerosing panencephalitis is one of  the most feared, degenerative, 100% fatal complications that can occur up to two decades after initial infection

Editor’s Note: Don’t be pro-plague – if you can, vaccinate your children.

References:

https://www.denverpost.com/2019/01/16/denver-measles-exposure/

Moss WJ. Measles. Lancet. 2017 Dec 2;390(10111):2490-2502. doi: 10.1016/S0140-6736(17)31463-0. Epub 2017 Jun 30. Review. PubMed PMID: 28673424.

Bester JC. Measles and Measles Vaccination: A Review. JAMA Pediatr. 2016 Dec 1;170(12):1209-1215. doi: 10.1001/jamapediatrics.2016.1787. Review. PubMed PMID: 27695849.

Summarized and edited by Erik Verzemnieks, MD

Podcast # 426: Ho Ho – Oh No!

Author: Katrina Iverson, MD

Educational Pearls:

  • The winter holiday months present a unique picture of patient presentations to the emergency department
    • Some of the unique presentations include:
    • Children falling off Santa’s lap
    • Sledding injuries
    • Falling off ladders
    • Lacerations, ingestion, and insertion of broken ornaments (pediatrics)
  • Parents tend to hurt themselves on their children’s toys


References:

Lauche R, et al. (2018). ‘Santa baby, hurry [extra carefully] down the chimney tonight’ – Prevalence of Christmas related injuries 2007–2016 in the United States: Observational study. Advances in Integrative Medicine. https://doi.org/10.1016/j.aimed.2018.11.004

https://areyouawellbeing.texashealth.org/common-winter-injuries/

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

Podcast #411: Mass Casualty Incident

Author: Dylan Luyten, MD

Educational Pearls:

 

  • Early recognition that the current situation is a mass casualty incident (MCI) is essential with establishing a sole provider/nurse to oversee
  • Team members labeling themselves by name and role is also helpful
  • Practice and prepare for these unfortunate events

 

Editor’s note: This podcast comes at the end of a MCI drill over several days

References:

http://epmonthly.com/article/not-heroes-wear-capes-one-las-vegas-ed-saved-hundreds-lives-worst-mass-shooting-u-s-history/

 

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

Podcast # 356: Babies can’t be born addicted

Author: Don Stader, MD.

Educational Pearls:

  • A baby can be born dependent on opioids but not addicted to them.
  • Opioid addiction (Opioid Use Disorder) is a disease of mature brains and is characterized by compulsive drug use despite adverse consequences.
  • Opioid addiction is a disease that affects the reward center of the brain
  • Pregnant patients struggling with addiction do better when started on buprenorphine or methadone. This treatment will cause opioid withdrawal syndrome in newborns, but not the long term morbidity and mortality of illicit opioids.

References

Gowing L, Farrell MF, Bornemann R, Sullivan LE, Ali R. Oral substitution treatment of injecting opioid users for prevention of HIV infection. Cochrane Database of Systematic Reviews 2011, Issue 8: CD004145. DOI: 10.1002/14651858.CD004145.pub4.

Volkow ND, Koob GF, McLellan AT ( 2016). “Neurobiologic Advances from the Brain Disease Model of Addiction.” New England Journal of Medicine. 374 (4): 363?371.

Podcast # 328: Sleep Deprivation

Author: Sam Killian, MD

Educational Pearls:

  • Insufficient sleep and disrupted circadian rhythms are a major health problem today
  • Millions of dollars, thousands of deaths, and millions of  injuries are related to sleep deprivation every year
  • 56 billion dollars – 24,000 deaths – 2.5 million disabiling injuries related to a sleep-type deprivation
  • Exxon valdez, challanger, chyrnobel linked to sleep deprivation- at least partially
  • Data has shown that in the Spring (when people lose an hour of sleep) there were 8% more traffic accidents on the Monday immediately after daylight savings. Conversely, in the Fall (when people gain an hour of sleep), there were 8% fewer traffic accidents on the Monday immediately after daylight savings.
  • Studies have also shown an increased risk of myocardial infarction in Spring immediately after daylight savings, and a decreased risk of myocardial infarction in the Fall immediately after daylight savings.

References:

Corren S. Traffic Accidents and Daylight Saving Time. New England Journal of Medicine. 1996;335(5):355-357. doi:10.1056/nejm199608013350517

Janszky I, Ljung R. Shifts to and from Daylight Saving Time and Incidence of Myocardial Infarction. New England Journal of Medicine. 2008;359(18):1966-1968. doi:10.1056/nejmc0807104.

Podcast #313: Flu Screening

Author: Peter Bakes, M.D.

Educational Pearls:

  • High risk patients: underlying lung disease, immunocompromised, extremes of age (<2 or >65), underlying cardiac/renal/neurologic disease, and pregnant women.
  • Testing: RT-PCR (RNA based test that is both sensitive and specific)
  • Workup: comorbidities dictate whether or not they are screened; CXR indicated in high risk patients with respiratory symptoms.
  • Morbidity from flu comes from secondary pneumonia, sepsis, and septic shock.
  • Treatment options are Tamiflu and Relenza (Relenza is contraindicated in patients with lung disease).
  • High risk patients see average of 2.5 days shortening of illness and a decrease in illness severity. Low risk patients see average of 1.5 days shortening of illness.

References:

https://www.cdc.gov/flu/about/disease/high_risk.htm

Binnicker MJ, Espy MJ, Irish CL, Vetter EA. Direct Detection of Influenza A and B Viruses in Less Than 20 Minutes Using a Commercially Available Rapid PCR Assay. J Clin Microbiol. 2015 Jul; 53(7): 2353-4.

Longo, Dan L. (2012). “187: Influenza”. Harrison’s principles of internal medicine (18th ed.). New York: McGraw-Hill. ISBN 9780071748896.

Podcast #308: Ultrasound in Cardiac Arrest

Author: Aaron Lessen, M.D.

Educational Pearls:

  • There is currently debate within the medical community about what constitutes cardiac activity on ultrasound in the setting of cardiac arrest. A recent study has shown there providers looking at the same clips from an echo will disagree about what constitutes cardiac activity.
  • Some of the confusion stems from movement that is not cardiac in etiology. For example, some alvular movement can be due to IV fluids and some cardiac motion can be due to the patient being bagged.
  • Cardiac activity is defined as “Any intrinsic motion of the myocardium.” However, even if this is present, it is important to ask if it clinically significant cardiac activity.
  • Despite disagreement, ultrasound can be useful for clinical decision making.

References:

Gaspari R et al. (2016) Emergency Department Point-Of-Care Ultrasound in Out-Of-Hospital  and in-ED Cardiac Arrest. Resuscitation; 109: 33 ? 39.

Hu K et al. (2017) Variability in Interpretation of Cardiac Standstill Among Physician Sonographers. Ann Emerg Med.

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.

 

References

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 #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.

References:

https://www.cdc.gov/flu/about/disease/high_risk.htm

https://www.cdc.gov/flu/weekly/summary.htm