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

c0f1bd63-7a23-4a10-83b7-9e4491410320Run Time: 3 minutes

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/

Podcast #176: Football Injuries

0c0fc049-f8e1-41cb-a236-47f02a359e71Run Time:  4 minutes

Author: Michael Hunt M.D.

Educational Pearls:

  • Stinger – a stretch of cervical nerves from a lateral blow to the head and causes immediate pain and numbness in the arm. There is no specific treatment, and symptoms last seconds to minutes or as long as a few days. A small percentage of stingers result in significant neurologic damage.
  • Hip pointer – a contusion of the pelvis most commonly at the iliac crest.
  • Sports hernia – a soft tissue injury (muscle, ligament, tendon) that is torn or damaged in the groin or pelvic area. Some more serious tears may require surgery.
  • Turf toe – hyperextension of the great toe that puts stress on MTP joint and causes a strain or sprain of the tendons. Categorized into grades 1, 2, & 3 based on severity from least serious to most serious.

Link to Podcast: http://medicalminute.madewithopinion.com/football-injuries/

References: http://www.stopsportsinjuries.org/STOP/Prevent_Injuries/Football_Skating_Injury_Prevention.aspx

Podcast #170: Spice

synthetic-marijuana-plagues-southwest-floridaRun Time:  2 minutes

Author: John Winkler M.D.

Educational Pearls:

  • There are multiple synthetic marijuana alternatives that causes more amphetamine reaction. Known as Spice, K2, and many other names, they are made by changing the side branches of THC.
  • An overdose can cause a spectrum of reactions from general agitation to severe excited delirium to death.
  • Patients present physiologically with tachycardia, elevated blood pressure, elevated temperature, psychosis, and severe agitation.
  • It is important to make sure that the patient is kept calm and safe with multiple doses of sedating medication, end tidal CO2, and airway protection.
  • In New York City on 7/13/16 33 people had a suspected overdose on synthetic marijuana.
  • To make a synthetic marijuana illegal the exact chemical structure needs to be presented to the legislature, and can sometimes take up to 1 year. However, the frequency of changes in the chemical structure of synthetic marijuana hard to keep illegal.

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

References: https://www.drugabuse.gov/publications/drugfacts/synthetic-cannabinoids

http://www.nytimes.com/2016/07/13/nyregion/k2-synthetic-marijuana-overdose-in-brooklyn.html?_r=0

Podcast #169: Lyme Disease

bd9fdb03-4845-4c2d-b1fc-f4bcd1253d7cRun Time:  7 minutes

Author: Greg Burcham M.D.

Educational Pearls:

  • Case presentation: A 48 year-old male cyclist travels to new england for a race. Afterwards he is sore, tired and fatigued, but 1 week later back in Colorado he is still sore, tired, and fatigued, and he also noticed a rash that started after a few days. The patient presents to the ED after a syncope with HR in the low 40s.
  • This patient has Lyme Disease. Hallmarked by the rash that he has, known as erythema migrans – a migrating red rash.
  • Symptoms usually present 1-2 weeks after a tick bite, and generally start as nonspecific – fever, myalgias, headache, arthralgias, malaise. 80% of patients present with the rash that starts as a small red lesion that enlarges with a bright red border.
  • A smaller percentage of patient get early disseminated disease. The most concerning complications are cardiac – Atrioventricular Block, bradycardia, and syncope – or a meningitis presentation.
  • Late disseminated findings include chronic joint and muscle arthralgias, seizures, paresthesias, memory and cognitive changes. Amy Tan – author of The Joy Luck Club – has chronic lyme and she loses memory if she is off her antibiotics for any period of time.
  • Lyme Disease is increasing by more than 10% per year for several years due to the destruction of habitat of predators, leading to mice population explosion, and global warming.
  • Each stage of the tick life cycle require a blood meal – larva to nymph to adult. Normally larva find it hard to get a blood meal in the fall after they hatch in the late summer. The larva go dormant until spring when they are able to find a blood meal and eventually become adults so the life cycle can start over on an annual basis.
  • As the climate has warmed a higher percentage of larvae are feeding earlier in the year, with a greater frequency in the New England area.
  • The bacteria that causes Lyme Disease needs time to replicate in the host, but due to asynchronous feeding between the mice and ticks there is a higher concentration of the bacteria in both the mice and the ticks.

Link to Podcast: http://medicalminute.madewithopinion.com/lyme-disease/

References: http://rstb.royalsocietypublishing.org/content/370/1665/20140051

https://www.cdc.gov/lyme/