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.



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.




Dreamland in Denver

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

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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

Podcast #270: Wound Botulism


Author: Don Stader, M.D.

Educational Pearls

  • Wound botulism should be considered in patients with cutaneous lesions and neuromuscular weakness.
  • The toxin produced by clostridium botulinium is the causative agent. If forms spores, so it is very resistant to killing by heat.
  • It presents with weakness, most often in the extrocular muscles.
  • Treatment includes wound care and respiratory support. Anti-toxin is rarely used as it is stored at the CDC and must be flown in.

References: Kalka-Moll WM, Aurbach U, Schaumann R, Schwarz R, Seifert H. Wound Botulism in Injection Drug Users. Emerging Infectious Diseases. 2007;13(6):942-943. doi:10.3201/eid1306.061336.

Podcast #253: Total Eclipse of the Eye – Solar Retinopathy

Author: Nick Hatch, M.D.

Educational Pearls

  • Photic or solar retinitis occurs when you stare at the sun. The refractive power of the lens of the eye concentrates the light of the sun on the retina, stimulating the production of free radicals, damaging photoreceptors.
  • Solar retinitis may present hours-days after light exposure.
  • Patients will present with patchy loss of vision without pain, since the retina has no pain receptors.
  • In one study during an eclipse in the UK, of those who initially presented with vision loss due to solar retinitis, 92% recovered full vision.

References: Dobson R. UK hospitals assess eye damage after solar eclipse. BMJ?: British Medical Journal. 1999;319(7208):469.

Podcast #184: Frostbite

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Author: Michael Hunt M.D.

Educational Pearls:

  • Frostbite injuries are graded by the severity of tissue depth.
  • A Grade 1 injury has no cyanosis of the tissue, and usually just redness is present.
  • A Grade 2 injury has acral cyanosis.
  • A Grade 3 injury has cyanosis past the mid phalanx of the digits, resulting in a high chance of amputation.
  • A Grade 4 injury has cyanosis beyond metacarpal/metatarsal phalangeal joints, and almost certain amputation.
  • Treatment for frostbite is gradual rewarming in water of 100-104 degrees fahrenheit. If a patient has injuries to all 4 extremities the entire patient can be placed into a warm bath.
  • It is suggested that IV or intra arterial tPA can also be used to improve salvage of the digits because ice crystals form in the tissues when frostbite occurs, and when the patient is rewarmed they can be subjected to clotting.
  • The tPA must be started within 24hrs of rewarming – the time that the patient suffered the frostbite injury is not as important.

Link to Podcast: http://medicalminute.madewithopinion.com/frostbite/

References: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3440898/