PODCAST WRITTEN SUMMARIES

Podcast #20: REBOA

Categorization: Trauma

Run Time: 1 minute

Author: Dr. John Winkler

Link to Podcast: http://medicalminute.madewithopinion.com/reboa-balloon/#

Educational Pearls:

  • REBOA stands for Resuscitative Endovascular Balloon Occlusion of the Aorta.
  • The balloon is often placed via femoral artery and placed in the aorta at the level of the heart to increase perfusion to the brain in trauma.
  • Significantly less invasive than a thoracotomy and has less complications of infection.

References:


Podcast #19: Pediatric Procedures

Categorization: Pediatrics

Run Time: 2 minutes

Link to Podcast: http://medicalminute.madewithopinion.com/peds-procedures/#

Educational Pearls:

  • “Superman” the patient by placing their hands in a pillow case and wrap them in a sheet to help combative kiddos. Have the parents pull up a phone or tablet to distract the kids as well.
  • Utilizing a well-sized cervical collar can help when repairing a face laceration.

Podcast #18: Lemierre’s Syndrome

Categorization: Infectious Disease

Run Time: 3 minutes

Author: Dr. Jared Scott

Link to Podcast: http://medicalminute.madewithopinion.com/lemierre-s/#

Educational Pearls:

  • A patient presented with tachycardia, hypoxia, shortness of breath, neck swelling, neck tenderness, and knee pain.
  • Lemierre’s Syndrome is a thrombosis of internal jugular vein following a seemingly benign oral infection caused by Fusobacterium necrophorum.
  • This thrombosis is a nidus for further infection across the body.
  • Patients often do not have an oral infection upon the presentation to the ED.
  • Most common complication is a septic pulmonary embolism.
  • An antibiotic course is the treatment of the syndrome.

References:


Podcast #17: Sick Sinus Syndrome

Categorization: Cardiovascular

Run Time: 4 minutes

Author: Dr. Gretchen Hinson

Link to Podcast: http://medicalminute.madewithopinion.com/sick-sinus-syndrome/#

Educational Pearls:

  • Sick Sinus Syndrome is a malfunction of the sinoatrial node causing any combination of bradycardic dysrhythmias, sinus arrests, and tachycardic dysrhythmias.
  • Symptoms include dyspnea on exertion, palpitations, fatigue, and/or chest pain.
  • On a cardiac monitor, patients can be bradycardic and immediately after tachycardic as a common presentation of the dysrhythmias.
  • Chronotropic incontinence is often a symptom of SSS and is defined as the inability for the heart to increase its rate with increased demand.
  • Patients will usually end up with a permanent pacemaker upon diagnosis of SSS.

References:


Podcast #16: Medications for AFib

Categorization: Toxicology and Medication

Run Time: 2 minutes

Author: Dr. Chris Holmes

Link to Podcast: http://medicalminute.madewithopinion.com/meds-for-a-fib/#

Educational Pearls:

  • Rate control with beta blockers or calcium channel blockers; with a slightly increased efficacy using calcium channel blockers.
  • It is not contraindicated to give both if the first medication tried does not work.
  • Magnesium has been shown to supplement the beta blockers and calcium channel blockers in patients with AFib.

References:


Podcast #15: Ketamine!

Categorization: Toxicology and Medication

Run Time: 4 minutes

Author: Dr. Michael Hunt

Link to Podcast: http://medicalminute.madewithopinion.com/ketamine/#

Educational Pearls:

  • Ketamine is a dissociative anesthetic that can be used for sedation, anesthesia, or to calm down agitated patients.
  • Can be given IV at 1-2 mg per kilo or IM at 4-5 mg per kilo every ten minutes and will last anywhere from five to thirty minutes depending on administration.
  • Complications include laryngospasm (1%), increased IC pressure, increased ocular pressure, rash (15%), and acute psychosis.

References:


Podcast #14: Wound Care Myths

Categorization: Environmental

Run Time: 3 minutes

Author: Dr. Christopher Holmes

Link to Podcast: http://medicalminute.madewithopinion.com/wound-care-myths/#

Educational Pearls:

  • Betadine and hydrogen peroxide are toxic to the cells that are attempted to help heal the wound.
  • A Cochran review was done recently that compared saline, boiled-steralized water, and potable tap water. It was determined there was no significant difference between the three for wound irrigation success.
  • A study in 1982, showed that there was no significant difference between using no gloves, sterile gloves, or gloves out of the box for wound management.

References:


Podcast #13: Bougie

Categorization: Critical Care and Resuscitation

Run Time: 3 minutes

Author: Dr. Aaron Lessen

Link to Podcast: http://medicalminute.madewithopinion.com/bougie/#

Educational Pearls:

  • The “bougie” or “endotracheal tube introducer” is a low tech adjunct for difficult airway management.
  • The bougie is a flexible stylet that can be used almost blindly when the vocal cords cannot be visualized.
  • The stylet has a Coude tip at the end, which allows you to feel the tracheal rings and will stop at the carina if you enter the trachea.
  • The “bougie” can also be used very easily for cricothyrotomy and ET tube changes.

References:


Podcast #12: TXA in the ED

Categorization: Toxicology and Medication

Run Time: 3 minutes

Author: Dr. Nicholas Hatch

Link to Podcast: http://medicalminute.madewithopinion.com/txa-in-the-ed/#

Educational Pearls:

  • TXA is short for tranexamic acid.
  • Most often use in the ED is with severe bleeding or problematic bleeding associated with trauma.
  • Crash II trial determined the benefit of TXA is only applicable for about three hours after a trauma.
  • Typical dosing is 1 gram in the first ten minutes and 1 gram over the next eight hours.

References:

  • http://www.ncbi.nlm.nih.gov/pubmed/23477634

Podcast #11: Exotic Urticaria

Categorization: Allergy-Immunology

Run Time: 5 minutes

Author: Dr. Jared Scott

Link to Podcast: http://medicalminute.madewithopinion.com/exotic-urticaria/#

Educational Pearls:

  • Urticaria means “burning nettles” in Latin.
  • Lymph nodes release immunoglobulin IgE and IgG, which trigger mast cells located all over the body to release histamines.
  • Along with the well-known acute urticaria, there are chronic types of urticaria, which last longer than six weeks.
  • There are many types of urticaria including: dermatographic urticaria, food-induced urticaria, drug-induced urticaria, cholinergic urticaria, solar urticaria, and cold-induced urticaria among others.

References:


Podcast #10: The Thyroid Don’t Get No Respect

Categorization: Endocrine-Metabolic

Run Time: 11 minutes

Author: Dr. Don Stader

Link to Podcast:  http://medicalminute.madewithopinion.com/the-thyroid-don-t-get-no-respect/#

Educational Pearls:

  • Thyroid literally means shield and is important for growth and cortisol/adrenaline modulation.
  • Hyperthyroidism puts the body in a hypercatabolic state causes agitation, fine tremors like you just had a lot of coffee, and Atrial Fibrillation.
  • Iodine – like the kind given for a contrast CT scan – has been associated with precipitating a Thyroid Storm.
  • A thyroid storm is triggered by 2 things: 1. A Physiologic stressor and 2. High thyroid hormone levels.
  • The thyroid storm is treated in steps: 1. Beta-blocker – Propranolol because it inhibits T3 2. Methimazole and PTU – inhibits the body from making more thyroid hormone 3. Iodine – causes the wolff-chaikoff effect 4. Steroid – decrease conversion of T4 to T3 5. Cholestyramine – decreases absorption of thyroid hormone.

References:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4383116/


Podcast #9: Patient Satisfaction

Categorization: Administrative Updates

Run Time: 7 minutes

Author: Dr. John Winkler

Link to Podcast:  http://medicalminute.madewithopinion.com/patient-satisfaction/#

Educational Pearls:

  • 429 studies show that patient satisfaction has a positive association with the patients’ improvement after their hospital visit. 127 studies that show no change and only 1 study that has a negative association.
  • Good communication and good rapport with the patient and the patient’s family suggests that the patient is more likely to follow after-care instructions, follow up, and ask questions to understand what it happening.

References:  http://www.nejm.org/doi/full/10.1056/NEJMp1513708


Podcast #8: Hypertensive Emergency with Normal Pressure

Categorization: Cardiovascular

Run Time: 5 minutes

Author: Dr. Eric Miller

Link to Podcast:  http://medicalminute.madewithopinion.com/hypertensive-emergency-with-normal-pressure/#

Educational Pearls:

  • Hypertensive Emergency is generally over 180/100 with at least one associated symptom, but there are cases where this will not happen.
  • Patient 4-5 days postpartum with eclampsia.
  • For a patient who’s aorta is dissecting and an initial BP around 150/100 the goal is to get the systolic BP down to around 100 to decrease sheer forces on the aorta.
  • A patient who is pregnant and a normal blood pressure around 110 who comes in with a systolic BP of 130.

References: http://onlinelibrary.wiley.com/doi/10.1111/j.1524-6175.2001.00449.x/epdf


Podcast #7: Heroin Overdose and OTC Narcan

Categorization: Toxicology and Medication

Run Time: 4 minutes

Author: Dr. Don Stader

Link to Podcast:  http://medicalminute.madewithopinion.com/heroin-overdose-and-otc-narcan/#

Educational Pearls:

  • Mexico is number 2 in opium production in the world – Opioids now kill more people than car accidents in the United States.
  • Heroine originally marketed as a less addictive form of Morphine – actually more addictive.
  • 20 in 100,000 deaths in CO are due to Opioid overdose.
  • Naloxone is now available over the counter and should be prescribed for patients to go home with and given information about coming to the ER if it needs to be used.

References:  http://www.bmj.com/content/346/bmj.f174.full

http://projectlazarus.org/about-project-lazarus


Podcast #6: Trauma in Pregnancy/Perimortem C-section

Categorization: Trauma;OB/GYN

Run Time: 15 minutes

Author: Dr. Don Stader

Link to Podcast:  http://medicalminute.madewithopinion.com/trauma-in-pregnancy-perimortem-c-section/#

Educational Pearls:

  • Trauma ABCs change in pregnancy.
  • A: Progesterone dilates to blood vessels in the nose and the back of the throat changing the airway in pregnant women, causes intubation to be more difficult because of increased redundant tissue.
  • B: Pregnant women desaturate very quickly because of metabolic demands and diaphragm is pushed up. Supplemental oxygen should be used liberally.
  • C: Volume of fluids is increased during pregnancy. There is more blood flow to the uterus.
  • D: Starting in the 2nd trimester the uterus can push on the major blood vessels. Moving the uterus away from the Vena Ceva to the left will allow blood flow – either by left lateral decubitus or physically moving the uterus to the left.
  • E: Pregnant women need a complete head to toe exam and a manual vaginal exam.
  • Fibrinogen, rh, Kleihauer-betke tests are important for the current pregnancy and future pregnancies as well.

References:  http://www.aafp.org/afp/2014/1115/p717.html


Podcast #5: The Physiology of Emesis

Categorization: Gastrointestinal

Run Time: 3 minutes

Author: Dr. Jared Scott

Link to Podcast:  http://medicalminute.madewithopinion.com/the-physiology-of-emesis/#

Educational Pearls:

  • The area postrema controls vomiting – not protected by blood-brain barrier – gets input from several types of receptors, the vagus nerve, serotonin input from gastric mucosa, and cranial nerve #8.
  • Physiologic steps: Increased salivation, Involuntary deep breath to avoid aspiration, retro-peristalsis of the upper half of the small intestine, increased intra abdominal pressure, contraction of the diaphragm and abdominal musculature, and finally the lower esophageal sphincter opens.
  • The stomach does not contract when you vomit – it is passive.
  • Sympathetic nervous system is activated and endorphins are released immediately afterwards.

References:  http://arbl.cvmbs.colostate.edu/hbooks/pathphys/digestion/stomach/vomiting.html


Podcast #4: Isopropyl Alcohol for Nausea

Categorization: Toxicology and Medication

Run Time: 5 minutes

Author: Dr. Don Stader

Link to Podcast:  http://medicalminute.madewithopinion.com/isopropyl-alcohol-for-nausea/#

Educational Pearls:

  • Can be inhaled for relief from nausea – works for approximately 50% of people within 10 minutes.
  • Administered by cupping the swab in the hands and inhaling through the nose and exhaling out of the mouth.
  • Works through a process known as olfactory distraction, but it unknown how olfactory distraction actually works!

References:  http://www.annemergmed.com/article/S0196-0644(15)01361-X/fulltext


Podcast #3: Alexis St. Martin

Categorization: Current Events

Run Time: 3 minutes

Author: Dr. Chris Holmes

Link to Podcast:  http://medicalminute.madewithopinion.com/alexis-st-martin/

Educational Pearls:

  • Shot with musket to upper abdomen in 1822 on Mackinac Island – survived standard of care of blood letting and cathartics – was left with a fistula from his stomach to his abdominal wall.
  • Alexis St. Martin was illiterate and signed a contract with Dr. William Beaumont, who then performed unethical experiments on the patient – William Beaumont was hailed as a great physician for his discoveries through his unethical experiments on Alexis St. Martin.

References:  http://www.ncbi.nlm.nih.gov/books/NBK459/


Podcast #2: Buprenorphine

Categorization: Toxicity and Medication

Run Time: 4 minutes

Author: Dr. Jared Scott

Link to Podcast: http://medicalminute.madewithopinion.com/buprenorphone/#

Educational Pearls:

  • Semi-synthetic methadone used for chronic pain and nausea treatment.
  • Partial agonist to opioid receptors, which decreases respiratory depression – theoretically decreases likelihood of respiratory arrest in a patient who overdoses.
  • Patients on Buprenorphine chronically need Sufentanil for surgery – 10 times more potent than Fentanyl and 100 times more potent than Morphine.
  • Buprenorphine is the main ingredient in Suboxone – 4:1 ratio of Buprenorphine and Narcan – used by patients trying to get off of narcotics.

References:  https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8a5edcf9-828c-4f97-b671-268ab13a8ecd


Podcast #1: Diverticulitis & Antibiotics

Categorization: Gastrointestinal

Run Time: 3 minutes

Author: Dr. Chris Holmes

Link to Podcast: http://medicalminute.madewithopinion.com/diverticulitis-antibx/#

Educational Pearls:

  • 2 Billion Dollars is spent on Diverticulitis a year
  • Typically has been treated with antibiotics
  • Large studies in Sweden / Netherlands – treated patients in the hospital with either Antibiotics or normal saline. They had the same resolution rate! Suggests antibiotics are of little utility.
  • Old myth – you don’t have to avoid nuts / seed / pop corn / etc in Diverticulitis – as is the old teaching – this has been disproven!
  • Key question – Can we consider discussion with patients to not treat antibiotics – may be an evolving standard of care.

References: http://www.medscape.com/viewarticle/857275