Medical Minute Archives - The Emergency Medical Minute

Medical Minute

Podcast 565: Cesarean Scar Pregnancies

Contributor: Nick Hatch, MD Educational Pearls: A cesarean scar ectopic pregnancy occurs when the pregnancy implants along the scar tissue deep in the myometrium from a prior cesarean surgery, felt to be precipitated by a small fissure or fistula residual in the scar Diagnosis can be challenging and ultrasound may not clearly show this type…

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Podcast 564:  Cardiac Ischemia Management Update

Contributor: Nick Tsipis, MD Educational Pearls: Recent randomized controlled trial compared early intervention (PCI/CABG) to medical management for those diagnosed with moderate to severe cardiac ischemia on stress testing Primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest Secondary outcome was…

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Podcast 563:  DC ACs

Contributor: Nick Hatch, MD Educational Pearls: An AC (acromioclavicular joint) separation in the shoulder is a common traumatic injury XRs can help rule out other injuries as well as help with grading the injury There are six different grades for AC separations: Grade I: is stretching of the AC ligament without disruption or displacement of…

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Podcast 562:  COVID-19 Occlusions*

*(A shorter and more clinically focused follow up piece to our COVID Digest released on 5/1/20) Contributor: Nick Tsipis, MD Educational Pearls: Case series reported 5 cases of generally young and healthy patients with COVID-19 who presented to the ER with acute stroke Now several case series showing cardiovascular involvement or complications related to COVID-19…

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Podcast 561:  Give Bup

Contributor: Don Stader, MD Educational Pearls: Buprenorphine has been shown to decrease morbidity and mortality in opioid use disorder Buprenorphine used in naloxone-induced withdrawals can displace naloxone at opioid receptors, leading to reduced withdrawal symptoms and lessen the chance of using after discharge Patients in acute withdrawal due to naloxone after an overdose should be…

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Podcast 560: Imaging in a COVID world

Contributor: Don Stader, MD Educational Pearls: COVID-19 commonly appears as a bilateral patchy infiltrate on chest radiograph, but this is a non-specific finding  Sensitivities range from 17-70% for COVID-19 Many other viral pneumonias such as RSV and influenza can have similar findings Point-of-care ultrasound (POCUS) demonstrates B-lines, water-fall sign, or hepatization of the lung, but…

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Podcast 559: Metabolic Acidosis

Contributor: Dylan Luyten, MD Educational Pearls Acidosis can be caused by a respiratory, metabolic, or mixed source A respiratory acidosis will have a low serum pH and elevated bicarbonate if it’s chronic, but most importantly end tidal CO2 or arterial CO2 will be high.   With a metabolic acidosis we expect to see a low serum…

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Podcast 558:  Rapid ARDS Review

Contributor: Don Stader, MD Educational Pearls: Acute respiratory distress syndrome (ARDS) is a catch all term for when lung injury leads to fluid collection in the air spaces of the lungs  Ventilatory management in ARDS patients involves lower FiO2 and PEEP than other patients and relies on lung protective ventilation strategies to prevent barotrauma Proning…

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Podcast 557: COVID-19 Lab Trends

Contributor: Don Stader, MD Educational Pearls: COVID-19 is diagnosed with a nasopharyngeal swab (q-tip). This unfortunately can be painful, but if the swab doesn’t go deep into the nasal cavity the sample can be inadequate leading to false negatives (missed infections). The sensitivity of the COVID-19 RT PCR test is low, ranging from 66-80% in…

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Podcast 556:  CSF – What is it good for?

Contributor: Eric Miller, MD Educational Pearls: A cell count is performed on tubes 1 and 4 to account for changes that may occur from blood entering the first sample from the needle insertion Tube 2 and 3 are usually used for the other studies like protein levels, glucose levels and gram staining  Protein levels are…

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