Author: Jared Scott, MD
- From 1996 to 2012, the total quantity of opioids prescribed increased 647% for non-cancer pain
- Office based prescriptions accounted for 84% of the total opioid prescriptions, up from 64%
- The total share of opioids prescribed from the emergency department declined from 10% to 3.9% but
- Total opioids prescribed from the ED still increased 219% over this same time frame
Axeen S, Seabury SA, Menchine M. Emergency Department Contribution to the Prescription Opioid Epidemic. Ann Emerg Med. 2018 Jun;71(6):659-667.e3. doi: 10.1016/j.annemergmed.2017.12.007. Epub 2018 Jan 16. PubMed PMID: 29373155
Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD
Author: Dylan Luyten, MD
- Johannes Hoffer coined term Nostalgia in 1688 in his medical dissertation.
- Nostalgia was a formal medical diagnosis, and one that dates back to 17th century when soldiers had longing for home and melancholy with a constellation of symptoms including lethargy, sadness, disturbed sleep, heart palpitations, GI complaints, and/or skin findings for which the only cure was to return home.
- In the civil war, over 5000 soldiers were given medical leave for nostalgia.
- Always remember to view your patient in the appropriate context (psychosocial, cultural, historical, etc.)
Beck, J. (2013, August 14). When Nostalgia Was a Disease. Retrieved March 08, 2018, from https://www.theatlantic.com/health/archive/2013/08/when-nostalgia-was-a-disease/278648/
Author: Chris Holmes, M.D.
- It’s estimated that about 25 million people died during the Black Plaque. Researchers have confirmed this number by assessing how much old, broken pottery was buried in front of homes and churches from that time period.
- Traditional thinking has been that the Black Plague was spread primarily by flea bites. However, using mathematical modeling, researchers have theorized that person-to-person spread was more common.
Author: Dave Rosenberg, M.D.
- Poiseuille’s Law addresses the flow of a fluid through a tube.
- Many common ED presentations involve alterations in flow: asthma, MI, ischemic stroke, etc.
- According to the law, flow increases with the 4th power of the radius. That is to say, doubling the radius of the tube will increase the flow by 16x.
- Therefore, in situations that require re-opening of an anatomic tube (artery, airway), small changes in the size of the opening will result in dramatic effects.
Author: Sam Killian, M.D.
- Andrew Jackson was the 7th president of the USA. He served 2 terms from 1829-1837.
- He had had many medical issues during his presidency. He was said to be chronically underweight with rotting teeth. Furthermore, he had chronic infections and lead poisoning from bullets lodged in his arm and chest.
- He suffered from smallpox that he contracted while in a British prison during the Revolutionary War.
- He died from “dropsy” (CHF).
Author: Dave Rosenberg M.D.
- Louis Pasteur developed the technique that is now known as pasteurization. It was first used in the wine-producing regions of France, and eventually in dairy products like milk.
- Pasteur also investigated infectious disease. During one experiment, Pasteur’s lab assistant accidentally infected chickens with a weakened form of cholera. When none of the chickens died, Pasteur re-infected them with a stronger strain. This time, none of the chickens became sick because they had been inoculated against the disease. This experiment paved the way for modern vaccination.
References: Smith KA. Louis Pasteur, the Father of Immunology? Frontiers in Immunology. 2012;3:68. doi:10.3389/fimmu.2012.00068.
Run Time: 3 minutes
Author: Christopher Holmes M.D.
- In the chapter on altered mentation in a 1966 pamphlet on handling emergency medical situations, the number one suspicion of altered mental status was toxic substance ingestion.
- The key suspects for toxic ingestion at that time were benzodiazepines and bromide toxicity. They specifically state in the pamphlet that opiods are rarely a cause for altered mentation.
- Bromide was commonly used in the 18th and 19th century as a headache remedy and sedative. Until the 1970s, bromo-seltzer was used for headaches before being withdrawn from the market. Bromide is currently used to treat epilepsy in dogs and in Germany.
- Reportedly, bromide was given to the British soldiers of WW I and people with epilepsy during Victorian times to decrease their sexual drive. Epilepsy was believed to be caused by masturbation, during the Victorian age, and therefore decreasing sexual drive decreased seizure activity.
- The half-life of bromide is 12.5 days, so chronic use leads to bromism. 5-7% of psych admissions were due to bromism caused by the chronic use of bromide. The maximum daily recommended dose of bromide is 0.5 to 1 gram per day to avoid toxicity. In the 1960s, typical doses were between 3-5 grams per day.
- Symptoms include somnolence, psychosis, seizures, delirium, headache, fatigue, ataxia, memory loss, restlessness, irritability, and hallucinations.
- The treatment is a fluid flush and salt load the patient.
Link to Podcast: http://medicalminute.madewithopinion.com/bromide-toxicity-1966/
Run Time: 3 minutes
Author: Dylan Luyten M.D.
- Scurvy is a terrible disease caused by vitamin C deficiency. Causes failure of collagen synthesis and breakdown of connective tissue, and ultimately, death.
- British sailors were called “Limeys” because of the practice of taking limes to prevent scurvy.
- James Lind is notable in the history of medicine because he conducted the first clinical trial in 1747 and proved that citrus fruit cure scurvy.
- Interestingly, he did not understand how vitamin C actually cured scurvy. The concept of “vitamins” did not exist at the time, and he and the rest of the medical profession at the time thought that scurvy was a result of poor hygiene and food “putrifaction”, and that the citrus had an antiseptic function. Just goes to show that you don’t have to understand how something works to know, and prove, it works!
Link to Podcast: http://medicalminute.madewithopinion.com/james-lind/
Run Time: 5 minutes
Author: Christopher Holmes M.D.
- The New England Journal of Medicine produced a pamphlet in 1966 about the management of emergencies.
- Cardiac arrest treatment algorithm at that time consisted of a precordial thump, then artificial ventilation via mouth to mouth (as intubation wastes too much time), and then initiating compressions.
- The first line was to give epinephrine…by a cardiac needle directly into the cardiac muscle tissue every 3-5 minutes (Pulp Fiction style)! The next step was to perform a venous cut-down, instead of getting an IV. Then the standard of care was to give one amp of sodium bicarbonate every eight minutes!
- They also administered a medication called metaraminol (an alpha-agonist), 60 mg of levophed, and solu-cortef for each cardiac arrest.
- For the treatment of ventricular fibrillation, intracardiac epinephrine and calcium chloride would be given first and foremost. For defibrillation, the patient had a paste applied to their chest and were given 450 volts AC (which is 4 times the power of your home plug). For continued management, the patient was given procainamide, sodium bicarbonate, and made hypothermic.
Link to Podcast: http://medicalminute.madewithopinion.com/old-school-cpr/
References: For Subscribers: http://www.nejm.org/doi/pdf/10.1056/NEJM196607072750107
Run Time: 6 minutes
Author: Christopher Holmes M.D.
- In 1966, sepsis was believed to be comprised of bacteremia, endotoxins and exotoxins, and disruption of capillary blood flow.
- Risk factors were women who underwent “non-sterile abortions” (A common occurance before Row vs Wade in 1973) and being an “old” man over 40 y/o.
- For work up, the standard practice was measuring the Central Venous Pressure (CVP) with a manometer by inserting a polyvinyl catheter via surgical cutdown in the basilic vein and using a tape measure to roughly gauge the distance of the column of water to the heart.
- If CVP was low, blood and plasma were given along with isoproterenol (a beta-agonist) and digoxin (to increase contractility). If this failed, then phenoxybenzamine (an alpha-antagonist) was used to dilate the capillaries. At this point, norepinephrine was not used for treatment.
- The antibiotics of the day were kanamycin, streptomycin, and chloramphenicol. These treatments were almost always used along with 60 million units of penicillin, the “go-to” antibiotic. Interestingly, every million units of penicillin has 1 milliequivalent of potassium, which is counter-intuitive to give to patients in possible renal failure from sepsis.
- Steroids and permissible hypotension were in vogue as well, and pressors were supposed to be given only if a blood pressure was not palpable.
Link to Podcast: http://medicalminute.madewithopinion.com/state-of-sepsis-1966/