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

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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

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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]

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 #243: Hypoglycemia

Author: Dylan Luyten, M.D.

Educational Pearls

  • Hypoglycemia is very common in type 2 diabetics, and is often caused by insulin overdose or missed meals. Knowing the peak time of action for common diabetes medications can help inform treatment and disposition.
  • Regular insulin’s action peaks around 60 minutes. By the time most of these patients present to the ED, the drug has had most of its effect.
  • Lantis’ action does not peak, and will continue to exert its effect for 12 or more hours.
  • Levamir has a peak around 6-8 hours.
  • Metformin sensitizes tissues to insulin, so it cannot cause hypoglycemia alone.
  • Glipizides have half-lives over 12 hours and work by increasing insulin release by the pancreas. Hypoglycemia in a patient taking a glipizide usually indicates there is another medical issue interfering with clearance

References: http://emedicine.medscape.com/article/122122-workup

Podcast #237: Tetanus in the ED

Author: Rachel Beham, PharmD, Advanced Clinical Pharmacist – Emergency Medicine

Educational Pearls

  • Tetanus Ig is indicated in those who have no or unknown tetanus vaccination history who present with contaminated cuts that or dirty puncture wounds
  • The tetanus vaccine is a 5 shot series (DTAP) for children, TDAP is used for adults
  • There is no harm is receiving the TDAP more than once if vaccination history is unknown

References: https://www.cdc.gov/features/tetanus/index.html