Author: Erik Verzemnieks, MD
- In the panic of a precipitous ED delivery, remember: Warm. Dry. Stim. It will solve most of your problems in most scenarios
- Start compressions if heart rate is less than 60
- Put the pulse ox on the right hand – it may make a difference as it is preductal
Editor’s note: detecting a heart rate can be tough in a newborn – you can feel the umbilical stump or just listen with your stethoscope
Gary Weiner & Jeanette Zaichkin. Textbook of Neonatal Resuscitation (NRP), 7th Ed, 2016. American Academy of Pediatrics & American Heart Association.
Author: Don Stader, M.D.
- 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.
Authors: Rebecca van Vliet MS, APN; Michelle Whaley MSN, CNS, CCNS, ANVP-VC
The Stroke Team at Swedish Medical Center gives us a taste of how they are breaking records with door-to-needle time in management of acute cerebrovascular accidents.
Author: Michael Hunt M.D.
Dr. Hunt shares his wealth of experience with biological terrorism over the course of his career.
Run Time: 4 minutes
Author: Jared Scott, MD
- 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/
Run Time: 1 minutes
Author: Aaron Lessen M.D.
- 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/
Run Time: 3 minutes
Author: Gretchen Hinson M.D.
- Case presentation: a 44 year-old male after a syncope was found to have a heart rate of 261 wide complex tachycardia and a SBP in the 80s for EMS in the field. The patient was given adenosine on arrival to the ED, but with no resolution of the tachycardia, but after electrocardioversion the patient’s heart rate converted to 100 but still in a wide complex tachycardia.
- The missing piece of history for this patient is a diagnosis of lupus with previous pulmonary complications and systemic skin changes.
- Lupus can also cause myocarditis and conduction abnormalities along with the more common skin changes and renal complications.
Link to Podcast: http://medicalminute.madewithopinion.com/lupus-myocarditis/
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