Medical Minute

Podcast 552: PE Management and Risk Stratification

Contributor: Dylan Luyten, MD Educational Pearls: After you diagnose a pulmonary embolism (PE) via CT or VQ scan, we need to categorize the PE as massive, sub-massive, or just PE to dictate treatment.   Massive PE: shock with hypotension due to an embolism, and the treatment of choice is thrombolysis with IV tPA with anticoagulation after…

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Podcast 551:  PPIs are Not Benign

  Contributor: Don Stader, MD Educational Pearls: PPIs (Proton pump inhibitors) reduce stomach acid levels and are commonly prescribed in patients with GERD or peptic ulcer disease Stopping a PPI after sustained use for a month or longer can lead to withdrawal – causing a rebound indigestion or reflux due to a surge in acid…

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Podcast 550: Good ol’ Versed

Contributor: Sam Killian, MD Educational Pearls: Agitation can be due to a number of causes, but regardless of the cause, sedation often plays a key role in patient and provider safety. But what is the best sedative agent? A study looked at control of agitation with intramuscular medication. Specifically, 5 different IM sedative agents were…

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Podcast 549:  Just Use Epineprhine

Contributor: Sam Killian, MD Educational Pearls: Classic dogma teaching that epinephrine should not be used in the fingers, nose, penis, and toes when performing local anesthesia due to concerns for ischemia is wrong This has been well documented in multiple literature reviews A prospective, randomized double-blind study compared lidocaine vs lidocaine with epinephrine for finger…

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Podcast 548:  Adrenal Crisis

Contributor: Nick Tsipis, MD Educational Pearls: Congenital adrenal hyperplasia (CAH) is a group of enzyme deficiencies in the adrenals leading to a deficiency of hormones normally synthesized by the adrenals (mineralocorticoids, glucocorticoids, androgens) 21-hydroxylase is most commonly the deficient enzyme. 21-hydroxylase is needed to produce aldosterone and cortisol, and those with chronic cortisol deficiencies need…

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Podcast 547: Capsaicin Cream to the Rescue

Author: Aaron Lessen, MD Educational Pearls: A recent retrospective study looked capsaicin cream in treating cannabinoid hyperemesis syndrome in regards to length of stay, cost analysis, use of rescue therapies, and adverse events Results showed a trend towards reduced length of stay but did not reach statistical significance Use of opioids was reduced in the…

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Podcast 546: Complete Heart Block

Author: Jared Scott, MD Educational Pearls: Differentiating symptomatic bradycardia from asymptomatic may be essential in determining workup and treatment Airway, breath, circulation always hold true Symptoms may  include dizziness, syncope, or weakness An EKG is essential in the majority of cases Complete heart block can be a cause of symptomatic bradycardia and requires immediate attention…

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Podcast 545: So You Quit Smoking… Now What?

Author: Aaron Lessen, MD Educational Pearls:  New data shows within 5 years of smoking cessation, the risk of cardiovascular disease becomes half of those who continue to smoke After 10-15 years of cessation, cardiovascular disease rates return to rates seen in non-smokers. Lung disease, COPD, and cancer rates do not decrease quite as rapidly, but…

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Podcast 544: C is for Sepsis

  Author: Aaron Lessen, MD Educational Pearls: Previously, trials had shown promising evidence that vitamin C may improve mortality rates in patients with sepsis or septic shock.   A 2017 retrospective before-after study gave a “cocktail” of hydrocortisone, vitamin C, and thiamine to patients with severe sepsis or in septic shock and reported a decrease in…

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Podcast 543: Scoring Blunt Traumatic Aortic Injury

Author: Nick Tsipis, MD Educational Pearls: Aortic injury caused by blunt trauma is very rare Chest x-ray findings might include widening of the mediastinum Ligamentum arteriosum (remnant of the ductus arteriosus) tethers the aorta to the chest wall, potentially causing injury with abrupt decelerations and motion XR lacks significant sensitivity (around 75%) to be utilized…

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