Podcast #211: E-cigarettes

Author: Michael Hunt, M.D.

Educational Pearls:

  • Children under age of 6 are at greatest risk of accidental nicotine overdose from ingestion.
  • Biphasic presentation:
    • Hyperadrenergic = nausea, vomiting, tachycardia, flushing.
    • Bradycardia and respiratory depression.

References:

http://www.aapcc.org/alerts/e-cigarettes/

Mayer B. How much nicotine kills a human? Tracing back the generally accepted lethal dose to dubious self-experiments in the nineteenth century. Archives of Toxicology. 2013;88(1):5-7. doi:10.1007/s00204-013-1127-0.

Podcast #210: Bear Mauling

Author: Jared Scott M.D.

Educational Pearls:

  • Bear mauling is not a common issue in the ED.
  • The Ursus americanus (black bear) is the most common in Colorado, but Ursus arctos horribilis (grizzly bear) attacks are more frequent because they are more aggressive.
  • Head and neck lacerations are the most common injuries. Complications include infection and long term PTSD.
  • Most bear attacks are defensive in nature.
  • If a bear attacks you – lay face down and cover your neck with your hands.

References: Frank RC, Mahabir RC, Magi E, Lindsay RL, de Haas W. Bear maulings treated in Calgary, Alberta: Their management and sequelae. The Canadian Journal of Plastic Surgery. 2006;14(3):158-162. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2539044/

Podcast #209: Rabbit Done Died

Author: Sam Killian, M.D.

Educational Pearls:

  • “The Rabbit Has Died” is a lesser used phrase to denote finding out one is pregnant.
  • During a test used in the 1930s, the “Rabbit’s Test,” a rabbit was injected with a potentially pregnant woman’s urine.  If the woman was pregnant, the rabbit would begin displaying signs of pregnancy itself.
  • This test required killing the rabbits to visualize the ovaries, hence the term “Rabbit Done Died”.

References: https://www.early-pregnancy-tests.com/history

 

Podcast #208: Vocal Cord Dysfunction

Author: Martin O’Bryan M.D.

Educational Pearls:

  • Vocal cord dysfunction can mimic other causes of stridor, such as asthma and upper airway obstruction.
  • Patients are often very anxious because of the difficulty of inspiration.
  • The definitive diagnosis is laryngoscopy that must be done by a pulmonologist.
  • The treatment is general reassurance, asthma medications will not help. CPAP and heliox can be used to help with the stridor.
  • Benzodiazepines can be used to reduce the associated anxiety.

References: https://asthmarp.biomedcentral.com/articles/10.1186/s40733-015-0009-z

Podcast #207: Boxer’s Fracture

Author: Sam Killian, M.D.

Educational Pearls:

  • Defined as fracture of neck (distal segment) of 5th metacarpal.
  • Intrinsic muscles of hand pull segment to palmar aspect of hand.
  • 30 degrees of angulation is allowed. Any more increases risk of chronic pain, grip strength and grasping deficits, and rotational deformities.
  • Reduce fracture if more than 30 degrees of angulation or if rotation is present.
  • Splint fracture in “ulnar gutter” with goal being flexion at MCP and extension at DIP and PIP.

References: http://www.emedicinehealth.com/boxers_fracture/article_em.htm

Podcast #205: Post Cardiac Arrest Temperature Control

Author: Michael Hunt, M.D.

Educational Pearls:

  • Research has shown that the higher temperatures post-cardiac arrests may lead to poorer outcomes.
  • Initially, 33 deg C was the target temp. However, more research is being done to find therapeutic temperature levels.
  • New studies have shown that the cooling protocol differs for inpatient cardiac arrests vs. outpatient cardiac arrests.   The results show that it may not be necessary to cool inpatient cardiac arrests.

References: http://www.hopkinsmedicine.org/healthlibrary/test_procedures/cardiovascular/therapeutic_hypothermia_after_cardiac_arrest_135,393/

 

Podcast #204: Thoracotomy

Author: Aaron Lessen M.D.

Educational Pearls:

 

  • Thoracotomy is a potentially life-saving procedure. However, outcomes are often poor and the procedure itself poses many risks to provider and patient.
  • Chance of surviving a thoracotomy when there is no cardiac activity on ultrasound is 0%.
  • Performing a thoracotomy is unlikely to benefit patients with no cardiac activity on ultrasound or patients that lost vital signs greater than 10 minutes before starting the procedure.
  • A thoracotomy is maximally beneficial in patients with a penetrating chest injury that occurred less than 10 minutes before the procedure.

 

References: K. Inaba et al, “FAST Ultrasound Examination as a Predictor of Outcomes After Resuscitative Thoracotomy: A Prospective Evaluation” Ann. of Surgery, 2015. https://www.ncbi.nlm.nih.gov/pubmed/26258320