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

Dreamland in Denver

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

previous arrow
next arrow
Slider

 

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 #284: Plane Emergencies

Author: Erik Verzemnieks, M.D.

Educational Pearls

  • 1/600 flights has an on-board request for medical assistance.
  • Most common complaints on board include: syncope, respiratory complaints, and GI complaints. Most of the time, these are exacerbations of underlying chronic conditions.
  • Except for situations involving gross negligence, the Aviation Assistance Act protects providers from legal action as long as they are acting within their scope of practice.
  • Flight crew are CPR and AED trained.
  • The onboard medical kit includes: epinephrine, dextrose, nitroglycerin, NSAIDs, injectable antihistamine, antiemetic, steroids, beta-blocker,  aspirin, stethoscope, BP cuff, airway tools, thermometer and more.
  • There is ground-based medical control for consult and guidance.

References: https://www.acep.org/Clinical—Practice-Management/Emergency-at-30,000-Feet—What-You-Can-Do/#sm.0001eqpidqrpoczltzg1epg0m0aqu