Podcast # 354: Hematometra

Author: Sam Killian, MD

Educational Pearls:

 

  • Hematometra: uterus filled with blood due to obstruction of outflow tract.
  • Most commonly a result congenital abnormalities (imperforate hymen, transverse vaginal septum, etc.) but can be acquired due to cervical stenosis, intrauterine adhesions, neoplasms, and post-surgical scarring.
  • Symptoms include: pain, abnormal bleeding, enlarged uterus
  • Diagnosis: commonly achieved by ultrasound and physical exam.
  • Treatment is surgical (cervical dilatation, hysteroscopy, etc.).

 

References

U Nayak A, Swarup A, G S J, N S. Hematometra and acute abdomen. Journal of Emergencies, Trauma and Shock. 2010;3(2):191-192. doi:10.4103/0974-2700.62117.

Kotter HC, Weingrow D, Canders CP. Hematometrocolpos in a Pubescent Girl with Abdominal Pain. Clinical Practice and Cases in Emergency Medicine. 2017;1(3):218-220. doi:10.5811/cpcem.2017.3.33369.

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Podcast # 353: Xofluza

Author: Sam Killian, MD

Educational Pearls:

 

  • Japan recently approved baloxavir marboxil (Xofluza), which may potentially “kill” Flu A/B within 24 hours
  • Recent RCT trial showed superiority over oseltamavir (Tamiflu) in cessation of viral shedding (24 vs 72 hours)
  • Compared to placebo, superior in time to symptom resolution (53.7 vs 80.7  hours)
  • Administered as single dose
  • Yet to be considered for FDA approval

 

References

Portsmouth S, Kawaguchi K, Arai M, Tsuchiya K, Uehara T. Cap-dependent Endonuclease Inhibitor S-033188 for the Treatment of Influenza: Results from a Phase 3, Randomized, Double-Blind, Placebo- and Active-Controlled Study in Otherwise Healthy Adolescents and Adults with Seasonal Influenza. Open Forum Infectious Diseases. 2017;4(Suppl 1):S734. doi:10.1093/ofid/ofx180.001.

 

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Podcast #352: TXA for Epistaxis

Podcast #352: TXA for Epistaxis

Author:  Chris Holmes, M.D.

Educational Pearls:

 

  • TXA: tranexamic acid; used in control of bleeding in major trauma, postpartum hemorrhage, etc.
  • In study of 216 patients with epistaxis, TXA placed on a pledget was compared to anterior cotton nasal packing.
  • The TXA group had faster time to bleeding control, quicker time to discharge, better patient satisfaction, and lower rates of re-bleeding.

 

References:

Zahed R, Moharamzadeh P, Alizadeharasi S, Ghasemi A, Saeedi M. A new and rapid method for epistaxis treatment using injectable form of tranexamic acid topically: a randomized controlled trial. Am J Emerg Med. 2013 Sep;31(9):1389-92. doi: 10.1016/j.ajem.2013.06.043.

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Podcast #286: Coronary Vascular Conditions that aren’t STEMI

Author: Don Stader, M.D.

Educational Pearls

  • While we usually associate the coronary vasculature with STEMIs, there are other pathologies that can affect the heart’s blood supply.
  • Kounis syndrome: an allergic vasospasm of the coronary arteries. This can happen post anaphylaxis or be caused by a stent allergy. It is best treated with aggressive management of the allergic reaction.
  • Kawasaki disease: An autoimmune condition that presents in kids as conjunctivitis, lymphadenopathy, hand/foot swelling, rash, and fever. It can also cause coronary aneurysms, which can rupture and be rapidly fatal.  
  • Prinzmetal angina: Caused by coronary vasospasm. Presents with transient chest pain at rest. Treat with CCBs.
  • Cocaine: Causes coronary vasospasm. Cocaine-induced vasospasm is best treated with BZDs.
  • Coronary artery dissection: increased risk in pregnant women and those with connective tissue disorders.

References:  Memon S, Chhabra L, Masrur S, Parker MW. Allergic acute coronary syndrome (Kounis syndrome). Proceedings (Baylor University Medical Center). 2015;28(3):358-362.

 

Podcast #180: Aortic Dissection

a_dissectionRun Time:  4 minutes

Author: Jared Scott, MD

Educational Pearls:

  • Aortic dissection = separation between 2 layers of vessel wall (usually intima and media)
  • Aortic Aneurysm = cystic dilation of the aorta
  • Aortic dissection associated with severe HTN or connective tissue disorders (Marfan’s, Ehlers-Danlos, etc.)
  • AAA associated with HTN, DM, HLD, smoking (same risks for MI)
  • Aortic dissection starts proximal in chest and peels down
  • AAA confined to abdomen and can rupture. 90% mortality.

Link to Podcast: http://medicalminute.madewithopinion.com/aortic-dissection/

References: http://www.mayoclinic.org/diseases-conditions/aortic-dissection/basics/definition/con-20032930

Podcast #179: Concussions

b3a1b8b3-ea78-4c07-bbc8-8db303511de8Run Time: 1 minutes

Author: Aaron Lessen M.D.

Educational Pearls:

  • Patients with concussions are frequently seen in the ED, and generally are given good home health care precautions.
  • A new study for post concussion management looked at driving performance after a concussion.
  • The study showed that 48 hours after symptoms had resolved, patients who were diagnosed with a concussion did worse on a standard performance test than people without a concussion.

Link to Podcast: http://medicalminute.madewithopinion.com/concussions/

References: http://psycnet.apa.org/journals/neu/24/4/493/

http://emedicine.medscape.com/article/92095-overview