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Podcast # 490: Canadian Syncope Rule
Contributor: Don Stader, MD Educational Pearls: Syncope is usually benign but can be caused by serious etiologies which include: PE, certain cardiac arrhythmias, AAA, intracranial bleed/stroke The Canadian Syncope...
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Podcast # 489: Bats & Rabies
Contributor: Jared Scott, MD Educational Pearls: The CDC recommends rabies prophylaxis if there was a direct encounter with a possibly rabid animal except… Bats are treated differently since their...
Podcast # 488: Dalbavancin
Contributor: Nick Hatch, MD Educational Pearls: Dalbavancin (Dalvance®) is an antibiotic that can be used for skin and soft tissue infections, providing MRSA coverage It cannot be used in...
Podcast # 487: Hunting for Epiglottitis
Contributor: Michael Hunt, MD Educational Pearls: Due to the efficacy of vaccination, epiglottitis is now more common in adults than children Risk factors include smoking and other immunocompromising co-morbidities,...
Podcast # 486: Morel Mushrooms
Contributor: Nick Hatch, MD Educational Pearls: True morel mushrooms are commonly foraged The false morel mushroom (Gyromitra esculenta) looks similar to the true morel, but is toxic False morel...
Podcast # 485: Cerebellar Stroke
Contributor: Jared Scott, MD Educational Pearls: Cerebellar strokes make up a disproportionate number of missed or delayed diagnosis for stroke likely due to the subtle nature of the presentation...
Podcast # 484: Elevated ICP
Contributor: Charleen Gnisci, PharmD Educational Pearls: Causes of increased intracranial pressure may include intracranial hemorrhage, malignancy, and trauma. While definite treatment is to remove the offending cause, there are...
Podcast # 483: Dual Antiplatelet Therapy in TIA
Contributor: Don Stader, MD Educational Pearls: Antiplatelets include Aspirin and Clopidogrel, and are generally used for arterial clotting (MI, stroke) Anticoagulants such as Coumadin, Xarelto, Eliquis are generally used...
Podcast # 482: Tetracyclines and Hyperpigmentation
Contributor: Michael Hunt, MD Educational Pearls: Tetracycline antibiotics such as minocycline can cause greyish hyperpigmentation This hyperpigmentation can sometimes be reversible but not always Minocycline has been used for...
Podcast # 481: Medical Errors and Cognitive Bias
Contributor: Peter Bakes, MD Educational Pearls: While there are many different types of medical error, one of the most common errors in emergency medicine is failure to diagnose Systematic...
Podcast # 480: Inhalant Abuse
Author: Sam Killian, MD Educational Pearls: Abuse occurs by breathing in volatile substances such as solvents, glues, paints, butane, and propane Inhalants are generally depressants Estimated that 100-125 people...
Podcast # 479: Clots and Pregnancy
Author: Nick Hatch, MD Educational Pearls: Pregnancy is a hypercoagulable state, which predisposes women to venous thromboembolism, but also elevates levels of circulating d-dimer A recent study evaluated the...
Podcast # 478: Psychedelics and Depression
Author: Chris Holmes, MD Educational Pearls: Hallucinogenic drugs have been in use since ancient times for both medical and recreational purposes Ayahausca is an ancient psychedelic with origins in...
Podcast # 477: Postpolypectomy Electrocoagulation Syndrome
Author: Nick Hatch, MD Educational Pearls: Postpolypectomy electrocoagulation syndrome (PES) is a rare complication of polypectomy and electrocautery during colonoscopy Occurs when cautery causes transmural thickening from a contact...
Podcast # 476: Evidence for Patient Satisfaction
Author: Dylan Luyten, MD Educational Pearls: Actual wait times are weakly correlated to patient satisfaction but the difference between perceived/expected wait times and actual wait times is strongly correlated...
Podcast # 475: Orthostatic Vital Signs and Syncope
Author: Michael Hunt, MD Educational Pearls: A recent study evaluated the relationship between abnormal orthostatic vital signs and serious outcomes within 30 days in patients over 60 presenting to...
Podcast # 474: Obesity Hypoventilation Syndrome
Author: Peter Bakes, MD Educational Pearls: The differential diagnosis for pedal edema includes issues in the heart, kidney, and liver Obesity hypoventilation syndrome (OHS) is an important and common...
Podcast # 473: Direct to Consumer Antibiotics
Author: Sam Killian, MD Educational Pearls: A recent study in Pediatrics compared the rates of antibiotic prescriptions for acute respiratory infections (ARIs) between direct to consumer (DTC) telemedicine, urgent...
Podcast # 472: SMART Crystalloids
Author: Gretchen Hinson, MD Educational Pearls: In most healthcare settings, normal saline (NS) has become ubiquitous as an intravenous fluid despite some potential drawbacks Compared to normal saline, a...
Podcast # 471: Cyclic Vomiting
Author: Don Stader, MD Educational Pearls: Cyclic vomiting syndrome (CVS) is different than cannabis hyperemesis syndrome (CHS). It is important to differentiate the two. CHS is thought to be...
Podcast # 470: Zofran and Pregnancy
Author: Jared Scott, MD Educational Pearls: Ondansetron (Zofran) is one of the latest drugs that has had concerns raised about side effects, particularly in pregnancy 2018 study probed two...
Podcast # 468: Typhlitis
Educational Pearls: Typhlitis refers to the presence of enterocolitis in the setting of neutropenia – also known as neutropenic enterocolitis Commonly a result of chemotherapy for hematologic malignancies. The...
Podcast # 467: Cauda Equina Syndrome
Author: Erik Verzemnieks, MD Educational Pearls: Cauda equina syndrome is caused by the compression of the nerve roots that extend beyond the termination of the spinal cord Trauma, infection,...
Podcast # 466: Subacute Sclerosing Panencephalitis
Author: Nicholas Hatch, MD Educational Pearls: Measles has a period of infectivity starts before the appearance of the characteristic rash, up to 4-5 days A devastating consequence of measles...
Podcast # 464: Narcan’t?
Author: Aaron Lessen, MD Educational Pearls: A problem of take-home-naloxone is the administration of it by an able-bodied bystander Australian study looked at consecutive opioid overdose deaths in a...
Podcast # 463: Buproprion Overdose
Author: Erik Verzemnieks, MD Educational Pearls: Buproprion is used as an antidepressant and for smoking cessation Severe buproprion overdoses can cause seizures and lead to cardiac dysrhythmias Benzodiazepines are...
Podcast # 462: Death after OD
Author: Don Stader, MD Educational Pearls: 10% of patients seen in the emergency department for opioid overdose patients will die within a year Half of these overdoses will occur...
Podcast # 461: Breath Stacking
Author: Gretchen Hinson, MD Educational Pearls: Breath stacking occurs when a patient is unable to expire fully before another inspiration In intubated/ventilated patients, this is because adequate time has...
Podcast # 460: Hunting for PE in Syncope
Author: Michael Hunt, MD Educational Pearls: Most causes of syncope are benign Pulmonary embolism can result in syncope and is life threatening A recent study of Canadian and...
Podcast # 459 Clonidine Ingestion
Author: Julian Orenstein, MD Educational Pearls: Severe clonidine ingestion can present as a fluctuating mental status between typically accompanied by changes in vital signs (hypotension/bradycardia) Respiratory depression requiring...
Podcast # 458: A Tylenol a Day Keeps the Delirium Away?
Author: Nick Hatch, MD Educational Pearls: A recent study investigated the effect of scheduled IV acetaminophen on the incidence of delirium in post-CABG patients in the ICU The...
Podcast # 457: Stroke Scores
Author: Jared Scott, MD Educational Pearls: Modified Rankin Score: measure of disability often used to qualify outcomes following stroke = no disability, 6=dead, 0-1 indicate good outcome) 0-6...
Podcast # 455: Hunting for PeeCP
Author: Michael Hunt, MD Educational Pearls: Like all tests, urine toxicology (utox) screens can have false positives Prescription medications such as demerol, antipsychotics, ketamine, and tramadol can all...
Podcast # 454: Tylenol Overdose
Educational Pearls: Acetaminophen overdose can also present in patients taking too much over the course of days to weeks – not just intentional ingestions If acute overdose is...
Podcast # 453: Headache Triggers
Author: Sam Killian, MD Educational Pearls: Headache is a common complaint in the ED. It’s plausible that headaches could be correlated with environmental factors A 2015 study ED...
Podcast # 452: CADASIL
Author: Sam Killian, MD Educational Pearls: Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) occurs in 1:100000 individuals The disease is caused by a defect in the...
Podcast # 451: NSAIDs
Author: Don Stader, MD Educational Pearls: Non-steroidal anti-inflammatory drugs (NSAIDs) are effective pain relievers but come with important side effects NSAIDs inhibit COX-1 and/or COX-2, which decreases the production...
Podcast # 450: Probiotics in Gastroenteritis
Author: Sam Killian, MD Educational Pearls: Viral gastroenteritis alters the gut microbiome and it is theorized that probiotics may help reduce the duration and severity of the disease. Double-blind...
Podcast #449: Banana Bags
Author: Dylan Luyten, MD Educational Pearls: A “banana bag” is a bag of IV fluid that contains various vitamins and minerals including folate and thiamine IV fluids do not...
Podcast #448: Chronic Salicylate Toxicity
Author: Ryan Circh, MD Educational Pearls: Chronic salicylate (ASA) toxicity can present in elderly patients as altered mental status Consider chronic toxicity in patients with an unexplained anion gap...
Podcast #447: IV Tylenol
Author: Dylan Luyten, MD Educational Pearls: Recent randomized controlled trial compared intravenous to oral acetaminophen in emergency department patients There was no difference in pain relief between the groups...
Podcast #446: Retinal Detachment
Author: Dylan Luyten, MD Educational Pearls: 1:500 patients will experience a retinal detachment Consider stroke on your differential (central retinal arterial occlusion) Flashes and floaters are a common complaint...
Podcast #445: Hunting for the endotracheal tube
Author: Michael Hunt, MD Educational Pearls: Bedside transtracheal ultrasound to confirm proper endotracheal intubation is simple and effective Review of 17 studies showed transtracheal ultrasound was was 98.7% sensitive...
Podcast #444: Dyspnea in the intubated patient
Author: Aaron Lessen, MD Educational Pearls: Dyspnea can occur in up to 50% of intubated patients Dyspnea is associated with prolonged mechanical intubation Often goes undiagnosed as these patients...
Podcast #443: Measles – a timely revisit
Author: Sue Chilton, MD Educational Pearls: Measles is highly contagious Typically patients just look sick Remember 4 & 4, 14, and 4-C’s: Contagious 4 days before and after onset...
Podcast #442: When a severe man cold isn’t
Author: Jared Scott, MD Educational Pearls: CXR is 40-90% sensitive for detecting pneumonia when compared to CT Patients with a high degree of suspicion for pneumonia may still...
Podcast #441: Is Heparin Worthless for ACS?
Author: Don Stader, MD Educational Pearls: Recent study demonstrated patients with non-STEMI treated with heparin had no difference in survival, but had an increased risk of major bleeding...
Podcast # 440 : Carbon Monoxide Poisoning
Author: Katie Sprinkle, MD Educational Pearl: Carbon monoxide (CO) is the leading cause of death from poison world-wide CO forms from the combustion of any carbon based product...
Podcast # 439 : Oops I did it again
Author: Aaron Lessen, MD Educational Pearl: A double ingestion of a single pill is typically a benign event but several drug classes may cause problems A published review of...
Podcast # 438 : tPA for Frostbite
Author: Aaron Lessen, MD Educational Pearls: Several studies have shown administration of tPA can improve outcomes and reduce need for amputation tPA is considered in grade III and...
Podcast # 437 : Myasthenia Gravis
Podcast # 437 : Myasthenia Gravis Author: Gretchen Hinson, MD Educational Pearls: Myasthenia gravis (MG) is an antibody mediated autoimmune disorder against the acetylcholine receptors at the neuromuscular...
Podcast # 436 : Epinephrine Autoinjectors
Author: Charleen Gnisci, PharmD Educational Pearls: Between 2011 to 2016, Mylan increased EpiPen prices by 400% ($700 for 2 packs) AUVI-Q was recalled in 2012, which left the...
Podcast # 435 : UCL Injury
Author: Ryan Circh, MD Educational Pearls: Ulnar collateral ligament injury is often called gamekeeper’s thumb or skier’s thumb Can results from traumatic deviating the thumb radially (abduction) Poor rabbits...
Podcast # 434 : TIA
Author: Peter Bakes, MD Educational Pearl: Transient ischemic attack (TIA) is defined as neurologic symptoms that resolve in 24 hours with no new changes on head imaging Mimics...
Podcast # 433: Geriatric Ketamine
Author: Michael Hunt, MD Educational Pearls: Recent study compared ketamine to morphine in elderly patient Ketamine (IV dose 0.3 mg /kg) provided equivalent pain control to morphine (IV dose...
Podcast # 432: Hunting for UTIs
Author: Michael Hunt, MD Educational Pearls: As many as 20% of women in assisted living have asymptomatic bacteriuria This can present a diagnostic conundrum when seeing these patients in...
Podcast # 431: Medication Errors
Author: Rachel Brady, MD Educational Pearls: Medication errors are estimated to be the 3rd leading cause of death A 2016 study estimated 250,000 errors occur per year, with 7000-9000...
Podcast # 430: Humeral IO
Author: Aaron Lessen, MD Educational Pearls: Choose the longest needle for the humeral IO Internally rotate and adduct the patients hand (resting on umbilicus) for best access to the...
Podcast # 429: Oldschool Syphilis Treatment
Author: Chris Holmes, MD Educational Pearls: In WWI, the 2nd leading cause of soldier disability were STDs. An early treatment of syphilis included topical and inhaled mercury Bloodletting, vitriol,...
Podcast # 427: Cookie Dough is Delicious
Author: Eric Miller, MD Educational Pearls: Recent CDC statement warns against consumption of cookie dough Two common ingredients can pose risk: eggs and flour Flour in dough is a...
Podcast # 426: Ho Ho – Oh No!
Author: Katrina Iverson, MD Educational Pearls: The winter holiday months present a unique picture of patient presentations to the emergency department Some of the unique presentations include: Children falling...
Podcast # 425: Oseltamivir Efficacy in Children
Author: Aaron Lessen, MD Educational Pearls: Recent meta-analysis reviewed efficacy oseltamivir (Tamiflu) in pediatric populations treated for influenza, showing an 18 hour reduction in duration of illness for those...
Podcast # 424: Hunting for Measles
Author: Mike Hunt, MD Educational Pearls: Measles is highly contagious and successfully infects 90% of those at risk exposed to the virus. 10 day prodrome where patients are asymptomatic....
Podcast # 423: Blunt Cardiac Injuries
Author: Mike Hunt, MD Educational Pearls: Blunt cardiac injuries most commonly occur in motor vehicle collisions, auto-pedestrian collisions, and from sports injuries The more anterior right ventricle is...
Podcast # 422: ED Opioid Prescription Trends
Author: Jared Scott, MD Educational Pearls: From 1996 to 2012, the total quantity of opioids prescribed increased 647% for non-cancer pain Office based prescriptions accounted for 84% of...
Podcast # 420: CT Contrast and the Kidneys
Author: Don Stader, MD Educational Pearls: Recent meta-analysis has demonstrated that there is no significant risk for kidney injury from CT contrast Most kidney injury seen after contrast...
Podcast # 419: Etripamil
Author: Don Stader, MD Educational Pearls: Etripamil is an intranasal calcium channel blocker in development for use in SVT A recent study showed that etripamil has an SVT...
Podcast # 418: Vertebral Artery Dissection
Author: Don Stader, MD Educational Pearls: Vertebral artery dissection (VAD) contributes to just 2% of strokes overall but ~25% of strokes for patients < 30 VAD is associated with...
Podcast # 416: Wide Complex Tachycardia
Author: Aaron Lessen, MD Educational Pearls: Defined as QRS over 120 ms and rate over 120 Two major rhythms = Vetricular tachycardia (VT) or SVT with aberrancy Safest approach...
Podcast # 415: Myofascial Pain Syndrome & Fibromyalgia
Author: Ryan Circh, MD Educational Pearls: Myofascial pain syndrome (MFPS) is typically unilateral with discrete points of palpable pain Often secondary to repeated use and poor posture. MFPS typically...
Podcast # 414: Acute Limb Ischemia
Author: Dylan Luyten, MD Educational Pearls: Symptoms of acute limb ischemia are the 5 P’s: Pulselessness, pain, pallor, paresthesias, and poikilothermia Sudden onset of non-traumatic extremity pain should...
Podcast # 413: Fascia Iliaca Block
Author: Katie Sprinkle, MD Educational Pearls: The fascia iliaca block is useful for hip and proximal femur fractures. Typically involves injecting 40-60 mL of diluted bupivacaine (0.25%) under...
Podcast #412: tPa Mission Creep
Author: Aaron Lessen, MD Educational Pearls: Patients with “minor” strokes with NIHSS 0 to 5 can still end up having poor long-term outcomes Recent study compared use of alteplase...
Podcast #411: Mass Casualty Incident
Author: Dylan Luyten, MD Educational Pearls: Early recognition that the current situation is a mass casualty incident (MCI) is essential with establishing a sole provider/nurse to oversee Team...
Podcast #410: FAMbulance
Author: Aaron Lessen, MD Educational Pearls: Retrospective study looking at type of transportation and mortality outcomes for patients with penetrating trauma Mortality was 2.2 % for those brought in...
Podcast #409: Acute CHF Second Liners
Author: Nick Hatch, MD Educational Pearls: Quick review on typical treatments for acute CHF: Nitrates are a mainstay to reduce preload Furosemide has fallen out of favor in...
Podcast #408: Go the hell to sleep
Author: Don Stader, MD Educational Pearls: Recent study showed efficacy 5mg IM midazolam > 10mg IM olanzapine > 10mg IM haloperidol for quickly sedating an agitated patient If you...
Podcast #407: Choose your own blister adventure
Author: Don Stader, MD Educational Pearls: Three options for a blister in partial thickness burns: do nothing, unroof it, or poke a hole in it Recent study suggest...
Podcast #406: PO vs. IV Tylenol
Author: Don Stader, MD Educational Pearls: Intravenous Tylenol currently is many times more expensive than oral Single ED study comparing the two has methodology flaws and there is...
Podcast #405: Infant Walkers
Author: Don Stader, MD Educational Pearls: Recent study has revealed that infant walkers are more harmful than helpful Infant walkers can also delay motor function The American Academy...
Podcast #404: Electric Scooter Injuries
Author: Sam Killian, MD Educational Pearls: Recent news articles are showing an increase in injuries related to riding electric scooters Year-to-year, scooter injuries have increased as high as...
Podcast #403: Meniscus Lock
Author: Mark Hinton, MD Educational Pearls: Meniscus lock can occur with a tear leading to inability to extend the knee Treatment can include an intra-articular joint block followed...
Podcast #402: Rapid sequence intubation medications
Educational Pearls: RSI includes induction agent (sedative) and a paralytic Succinylcholine is a depolarizing paralytic of rapid onset and short duration with contraindications in hyperkalemic states and muscular dystrophy...
Podcast #401: Foreign Body Aspiration
Author: Gretchen Hinson, MD Educational Pearls: Diagnosis can be difficult and often delayed Asymmetric breath sounds, choking, stridor may be present, but children also present asymptomatically Peak incidence around...
Podcast #400: ECMO
Author: Dylan Luyten, MD Educational Pearls: Extracorporeal membrane oxygenation (ECMO) is similar to bypass ECMO is being utilized routinely at some centers and even prehospital in cardiac arrest...
Podcast #399: Hunting for pancreatitis
Author: Michael Hunt, MD Educational Pearls: Alcohol and gallstones are most common causes of pancreatitis Diagnosis is not simply based on lipase alone – must have at least two...
Podcast #398: Who is gonna fail your antibiotic plan?
Author: Erik Verzemnieks, MD Educational Pearls: Recent study provides at least some evidence to help predict antibiotic failure for cellulitis, which is not necessarily straight forward Intuitive risk factors...
Podcast #397: Pharyngeal Trauma
Author: Aaron Lessen, MD Educational Pearls: Injuries from penetrating pharyngeal trauma are often subtle on examination in children Potentially serious complications including carotid artery injury, mediastinitis from spreading infection,...
Podcast #396: Oncologic Emergencies
Author: Rachel Brady, MD Educational Pearls: Hypercalcemia of malignancy: Hypercalcemia of malignancy can present with lethargy, muscle weakness, hyperreflexia, altered mental status, cardiac dysrhythmias, and even cardiac arrest. Treatment...
Podcast #395: Aspirin for everyone!
Author: Aaron Lessen, MD Educational Pearls: In patients without indications for aspirin, three recent studies looked at prevention of several end points in the elderly These showed no benefit...
Podcast #394: Myths of Medication Assisted Treatment
Author: Katie Sprinkle, MD Educational Pearls: Medication Assisted Treatment (MAT) is the treatment of addiction with medications, commonly used for opioid use disorders A long held belief is MAT...
Podcast #393: Neonatal Vomiting
Author: Peter Bakes, MD Educational Pearls: Important historical information to elicit is the birth history, feeding habits, stooling habits, associated symptoms, presence of bile, and presence of trauma. Volvulus...
Podcast # 392: Maggot Therapy
Author: Jared Scott, MD Educational Pearls: Interest started as it was noticed soldiers who had wounds infected with maggots had better outcomes than those without maggots Studies have shown...
Podcast # 391: Necrotizing Fasciitis
Author: Peter Bakes, MD Educational Pearls: Necrotizing fasciitis is an infection of the deep soft tissues with destruction of the muscle fascia and overlying fat Think of it if...
Podcast # 390: Haloperidol for Pain
Author: Gretchen Hinson, MD Educational Pearls: Reasonable approach of haloperidol 10 mg IM (or 5 mg IV) for pain relief in opioid-dependent patients; can repeat once. Chronic opioid use...
Podcast #389: BRUE
Author: Sarah Normandin, MD. Educational Pearls: BRUE (Brief Resolved Unexplained Event) replaces what was previously called ALTE. BRUE describes an event in a child less than one year of...
Podcast #388: Antibiotics for Appendicitis
Author: Aaron Lessen, MD Educational Pearls: 5-year follow up study on antibiotic treatment for uncomplicated appendicitis showed 39.1% recurrence rate requiring appendectomy by 5 years Nearly 60% chance then...
Podcast #386: Respecting Transgender Patients
Author: Kasey Champion, MD Educational Pearls: Transgender populations are frequent victims of discrimination in healthcare. Ask transgender patients what their preferred pronoun is. It is sometimes important to ask...
Podcast #385: Probiotics
Author: John Winkler, MD Educational Pearls: Probiotics are bacteria that are ingested to promote gut health but recent research casts doubt on their effectiveness. Recent study suggests that most...
Podcast #384: Don’t stab a PTA?
Author: Don Stader, MD Educational Pearls: Recent study suggests we may not need to drain uncomplicated peritonsillar abscesses. Patients who received medical therapy alone had no difference in complications...
Podcast #383: Prehospital Tubes
Author: Sam Killian, MD Educational Pearls: Two high-quality randomized control trials published in 2018 demonstrated no difference in mortality or neurologic outcomes when using a supraglottic airway compared to...
Podcast #382: Shoulder Separations
Author: Ryan Circh, MD Educational Pearls: A “shoulder separation” is when the clavicle separates from the scapula – also referred to as an acromio-clavicular (AC) separation Diagnosis is clinical:...
Podcast #381: MRI… Burns?
Author: Sam Killian, MD Educational Pearls: MRI machines can generate enough heat from the radiofrequency to cause thermal burns Patients with EKG stickers, medication patches, clothing impregnated with metallic...
Podcast #380: Oxygen for the kill
Author: Ryan Circh, MD Educational Pearls: Review of 25 randomized control trials encompassing 16,037 acutely ill hospitalized patients Patients given oxygen with saturations > 94% on room air...
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