Podcast # 430: Humeral IO

Author: Aaron Lessen, MD

Educational Pearls:

  • Choose the longest needle for the humeral IO
  • Internally rotate and adduct the patients hand (resting on umbilicus) for best access to the site
  • Aim 1 cm superior to the greater tuberosity of the humerus with the needle angled 45 degrees inferiorly
  • Maintaining the line is critical – keep arm internally rotated with sling, tape or whatever works

References

Kovar J, Gillum L. Alternate route: the humerus bone – a viable option for IO access. JEMS. 2010 Aug;35(8):52-9. doi: 10.1016/S0197-2510(10)70207-2. PubMed PMID: 20708143.

http://epmonthly.com/article/get-humeral-io-access/

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

Podcast # 427: Cookie Dough is Delicious

Author: Eric Miller, MD

Educational Pearls:

  • Recent CDC statement warns against consumption of cookie dough
  • Two common ingredients can pose risk: eggs and flour
  • Flour in dough is a raw agricultural product not treated to kill E. coli
  • A 2016 E. coli outbreak was linked to flour

 

References:

https://www.cdc.gov/features/no-raw-dough/index.html

https://www.cdc.gov/ecoli/2016/o121-06-16/index.html

Summarized by Travis Barlock, MS4 | 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 # 415: Myofascial Pain Syndrome & Fibromyalgia

Author: Ryan Circh, MD

Educational Pearls:

  • Myofascial pain syndrome (MFPS) is typically unilateral with discrete points of palpable pain
  • Often secondary to repeated use and poor posture.
  • MFPS typically responds very well to trigger point injections.
  • Fibromyalgia is bilateral and diffuse and is thought to have a psychological component
  • Some of the best pharmacological treatments for fibromyalgia are Tramadol and Flexeril

References:

Tofferi JK, Jackson JL, O’Malley PG. Treatment of fibromyalgia with cyclobenzaprine: A meta-analysis. Arthritis Rheum. 2004 Feb 15;51(1):9-13. PubMed PMID: 14872449.

Goldenberg DL, Burckhardt C, Crofford L. Management of fibromyalgia syndrome. JAMA. 2004 Nov 17;292(19):2388-95. Review. PubMed PMID: 15547167.

Giamberardino MA, Affaitati G, Fabrizio A, Costantini R. Myofascial pain syndromes and their evaluation. Best Pract Res Clin Rheumatol. 2011 Apr;25(2):185-98. doi: 10.1016/j.berh.2011.01.002. Review. PubMed PMID: 22094195.

Borg-Stein J, Iaccarino MA. Myofascial pain syndrome treatments. Phys Med Rehabil Clin N Am. 2014 May;25(2):357-74. doi: 10.1016/j.pmr.2014.01.012. Epub 2014 Mar 17. Review. PubMed PMID: 24787338

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

Check out this episode!

Podcast #404: Electric Scooter Injuries

Author: Sam Killian, MD

Educational Pearls:

 

  • Recent news articles are showing an increase in injuries related to riding electric scooters
  • Year-to-year, scooter injuries have increased as high as three to four times
  • More definitive evidence still to come

Editor’s note: don’t follow birdgraveyard on instagram

References:

https://www.washingtonpost.com/business/economy/scooter-use-is-rising-in-major-cities-so-are-trips-to-the-emergency-room/2018/09/06/53d6a8d4-abd6-11e8-a8d7-0f63ab8b1370_story.html?noredirect=on&utm_term=.a6e46ff35bdc

https://kutv.com/news/local/er-doctors-report-161-increase-in-scooter-injuries-in-downtown-salt-lake-city

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

Check out this episode!

Podcast #388: Antibiotics for Appendicitis

Author:  Aaron Lessen, MD

Educational Pearls:

  • 5-year follow up study on antibiotic treatment for uncomplicated appendicitis showed 39.1% recurrence rate requiring appendectomy by 5 years
  • Nearly 60% chance then of preventing an appendectomy by using antibiotics only for uncomplicated appendicitis

 

Editor’s note: not surprisingly, complications were much higher in the group receiving surgery, which reiterates why an antibiotic-only approach is attractive for the right patient population

References:

Salminen P, Tuominen R, Paajanen H, Rautio T, Nordström P, Aarnio M, Rantanen T, Hurme S, Mecklin JP, Sand J, Virtanen J, Jartti A, Grönroos JM. Five-Year Follow-up of Antibiotic Therapy for Uncomplicated Acute Appendicitis in the APPAC Randomized Clinical Trial. JAMA. 2018 Sep 25;320(12):1259-1265. doi: 10.1001/jama.2018.13201. PubMed PMID: 30264120.

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

Podcast #386: Respecting Transgender Patients

Author:  Kasey Champion, MD

Educational Pearls:

  • Transgender populations are frequent victims of discrimination in healthcare.
  • Ask transgender patients what their preferred pronoun is.
  • It is sometimes important to ask about transition status (i.e. on hormones, surgery).

References:

Chisolm-Straker M, Willging C, Daul AD, McNamara S, Sante SC, Shattuck DG 2nd, Crandall CS. Transgender and Gender-Nonconforming Patients in the Emergency Department: What Physicians Know, Think, and Do. Ann Emerg Med. 2018 Feb;71(2):183-188.e1. doi: 10.1016/j.annemergmed.2017.09.042. Epub 2017 Nov 3. PubMed PMID: 29103796.

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

Podcast #379: Patient Perspectives of the Flu

Author:  Sam Killian, MD

Educational Pearls:

  • Patients may have certain fears or expectations about the flu based on hearsay and other less reliable sources
  • Taking extra time explaining the risks of the flu may help base these expectations more in reality
  • This includes providing good return precautions and acknowledging that the disease can still be unpredictable

 

Podcast # 366: Ehlers Danlos

Podcast # 366: Ehlers Danlos

Author: Gretchen Hinson, MD.

Educational Pearls:

  • Heritable mutation in collagen synthesis and expression commonly resulting in joint hyperextension and skin elasticity.
  • Vascular type can result in aneurysm formation and rupture in young patients.
  • Patients are also at risk for spontaneous bowel rupture.
  • Pregnant women can present with uterine rupture.

 

References

Byers PH, Murray ML (2012). “Heritable collagen disorders: the paradigm of Ehlers?Danlos syndrome”. Journal of Investigative Dermatology. 132 (E1): E6?11.

Pepin MG, Byers PH. Ehlers-Danlos Syndrome Type IV. In: Pagon RA, Bird TD, Dolan CR, et al., eds. GeneReviews [Internet]. Seattle (WA): University of Washington, Seattle; 1993-.

Yoneda, A., Okada, K., Okubo, H., Matsuo, M., Kishikawa, H., Naing, B. T., ? Shimada, T. (2014). Spontaneous Colon Perforations Associated with a Vascular Type of Ehlers-Danlos Syndrome. Case Reports in Gastroenterology, 8(2), 175?181. http://doi.org/10.1159/000363373

Podcast # 347: Fasting and Procedural Sedation

 

Author: Sam Killian, MD

Educational Pearls:

  • Recent study examining fasting and adverse events during procedural sedation found no association between fasting duration and any type of adverse event.
  • Of the 6,183 children in the study, about 6 vomited during the procedure, and about 300 vomited recently after the procedure, and there were no episodes of aspiration.

References

Bhatt, M, et al.  (2018). Association of Preprocedural Fasting With Outcomes of Emergency Department Sedation in Children. JAMA Pediatrics, doi: 10.1001/jamapediatrics.2018.0830. [Epub ahead of print]