Podcast #230: Concussive Treatment

Author: Aaron Lessen, M.D.

Educational Pearls

  • 2 studies this past year looked at pediatric and adolescent patients following a concussion. They found people who returned to activity sooner did better than those who went on “brain rest”.  
  • While patients should still follow up with their PCP following a concussion, it is ok for patients to return to physical activity as tolerated.

References: Grool AM, Aglipay M, Momoli F, Meehan WP, Freedman SB, Yeates KO, Gravel J, Gagnon I, Boutis K, Meeuwisse W, Barrowman N, Ledoux A, Osmond MH, Zemek R, for the Pediatric Emergency Research Canada (PERC) Concussion Team. Association Between Early Participation in Physical Activity Following Acute Concussion and Persistent Postconcussive Symptoms in Children and Adolescents. JAMA. 2016;316(23):2504-2514. doi:10.1001/jama.2016.17396

Podcast #229: Andrew Jackson

Author: Sam Killian, M.D.

Educational Pearls

  • 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).

References: http://www.doctorzebra.com/prez/g07.htm

Podcast #228: BB Guns

Author: Jared Scott, M.D.

Educational Pearls

  • BB gun eye injuries are most common in August and September. They most often happen to males aged 16-17 year old. Around 10% of the BB eye injuries lead to eye loss.
  • Accidental firearm injury is common in children and is a common cause of mortality. One-third of homes with children have a firearm.
  • Most accidental pediatric gun injuries happen to young, male children with guns owned by family members. It is important to educate gun owners about proper gun storage.

References: Childhood Firearm Injuries in the United States Katherine A. Fowler, Linda L. Dahlberg, Tadesse Haileyesus, Carmen Gutierrez, Sarah Bacon. Pediatrics Jun 2017, e20163486; DOI: 10.1542/peds.2016-3486

Podcast #227: CPR-Induced Consciousness

Author: Nick Hatch, M.D.

Educational Pearls

  • CPR-induced consciousness is a phenomenon that occurs when someone who was previously unconscious and is undergoing CPR regains consciousness and makes purposeful movements.
  • Studies have shown that this phenomenon is increasing, likely because of increased quality of CPR.
  • Many people use a sedative such as ketamine  to keep patients unconscious to reduce the psychologic trauma of CPR.
  • 39% of people who survive CPR with good neurologic details remember the process of CPR.

References:

Joshua Pound, P. Richard Verbeek, and Sheldon Cheske. CPR Induced Consciousness During Out-of-Hospital Cardiac Arrest: A Case Report on an Emerging Phenomenon. 2017. Prehospital Emergency Care Vol. 21.

 

Check out this episode!

Podcast #226: Biphasic Anaphylaxis

Author: Sam Killian, M.D.

Educational Pearls

  • Anaphylaxis is common in the ED. These patients are treated and then usually watched for 4-6 hours.
  • Biphasic happens in patients that have a complete resolution of their anaphylaxis  for at least an hour, but then have a recurrence that requires pharmacologic  intervention. Most of the time this happens 3-6 hours later, but can happen more than 10 hours later.
  • More commonly happens in patients that have a delayed presentation,  a wide pulse pressure, need multiple doses of epi, require the use of  a beta agonist, or are ages 6-9 years old.
  • Educate patients about the possibility of Biphasic anaphylaxis before discharge. 

 

Check out this episode!

Podcast #225: Rhogam

Author: Dylan Luyten, M.D.

Educational Pearls

  • Rhogam is commonly used when an Rh negative woman has an Rh positive fetus. It is commonly used in the ER in the setting of a miscarriage.
  • Rh(+) fetal blood can enter the Rh(-) maternal circulation, sensitizing the woman to the Rh antigen. During a subsequent pregnancy, if the fetus is Rh(+), the woman may mount an immune response to the fetus, lead to fetal demise. Rhogam is used to block this process.
  • Use of Rhogam has reduced this complication from 16% of Rh(+) pregnancies in the 1960’s to less than 1% today.
  • Under 10 weeks, the amount of maternal-fetal blood exchange is very small, so the use of Rhogam in a 1st trimester miscarriage is unnecessary. It should be used in patients with a miscarriage after 12 weeks, or women undergoing a surgical D&C.
  • Rhogam is expensive and in limited supply, so it is important to only use it when necessary.

References: Hannafin, Blaine et al. Do Rh-negative women with first trimester spontaneous abortions need Rh immune globulin? 2006.  The American Journal of Emergency Medicine, Volume 24 , Issue 4 , 487 – 489

Deep Dive #4: Pediatric Type I DKA

Author: Justin Harper

Justin Harper, a paramedic married to a pediatric nurse, discovered his own son had type I diabetes 2 years ago. Despite their medical experience, this diagnosis came as surprise to Justin and his wife. This is the compelling story about how their son was diagnosed with type I diabetes and how this has impacted their lives.

Podcast #224: Troponin

Author: Sam Killian, M.D.

Educational Pearls

  • Not every troponin elevation is an MI.
  • Trop elevates in about an hour in ACS and stays elevated for days.
  • Non-MI conditions that cause elevated troponin: Critical illness (sepsis), increased cardiac demand, right heart strain, LV dysfunction, hypotension, pressor use, acute PE, SAH, chronic renal failure, CHF, aortic dissection, and peri/myocarditis.
  • Elevated troponin in settings other than MI is correlated with increased mortality.

References: Korff S, Katus HA, Giannitsis E. Differential diagnosis of elevated troponins. Heart. 2006;92(7):987-993. doi:10.1136/hrt.2005.071282.

Podcast #223: Acyclovir Toxicity

Author: Nick Hatch, M.D.

Educational Pearls

  • Acyclovir toxicity can uncommonly cause altered mental status, low blood glucose, hallucinations and myoclonic jerks.
  • Toxicity often occurs in the setting of renal insufficiency, as it is cleared by the kidneys.
  • Acyclovir is often used to treat shingles, which can also cause similar symptoms as acyclovir toxicity due to encephalitis – rule this out in the setting of a concomitant shingles infection.

References: http://www.rxlist.com/zovirax-drug.htm

Podcast #222: Wells Criteria for PE

 

Author: Michael Hunt, M.D.

Educational Pearls

  • Wells Criteria was initially designed to screen patients for further workup for PE.  
  • Aspects of the Wells Criteria include: signs and symptoms of DVT (3 points), PE most likely dia (3 points), HR > 100 (1.5 points), immobility for > 3 days or surgery in last 4 weeks (1.5 points), documented history of PE (1.5), hemoptysis (1), treatment for cancer in last 6 mo (1).
  • ACEP uses a score of less than or equal to 4 to define “low risk.” Greater than 4 is “high risk”.
  • Use Wells to guide clinical decisions about PE workup.

References: http://www.ebmedicine.net/media_library/files/1212%20Pulmonary%20Embolism