Podcasts about emerg med j

patients diagnosis lp references mri sensitivity occult hc xr fractures tenderness systematic review summarized elicitation scaphoid emerg med j

Play Episode Listen Later Sep 4, 2023 4:09

Contributor: Nick Tsipis MD Educational Pearls: The scaphoid bone is the most proximal carpal bone just distal to the radius Fractures of the scaphoid bone are sometimes missed by plain X-rays A 2020 review found a 21.8% incidence of missed scaphoid fractures later diagnosed by advanced imaging modalities Only MRI has a sensitivity above 90% for diagnosing scaphoid fractures Sensitivity of plain-film radiography is low unless it is a displaced fracture Physical examination techniques fail to definitively rule out scaphoid fractures A 2023 systematic review assessed the sensitivity and specificity of several common physical exam maneuvers: Tenderness of the anatomical snuffbox has a sensitivity of 92.1% and specificity of 48.4%; i.e. absence reduces the likelihood of an occult scaphoid fracture but does not rule it out Another common physical exam maneuver is pain with ulnar deviation, which carries a sensitivity of 55.2% and specificity of 76.4%. Elicitation of pain with supination against resistance demonstrated a sensitivity of 100% and specificity of 97.9% in the study, so the authors recommend externally validating this method Patients should be counseled on the importance of follow-up given that a fracture may not show up on imaging unless an MRI or repeat XR is done References 1. Bäcker HC, Wu CH, Strauch RJ. Systematic Review of Diagnosis of Clinically Suspected Scaphoid Fractures. J Wrist Surg. 2020;09(01):081-089. doi:10.1055/s-0039-1693147 2. Coventry L, Oldrini I, Dean B, Novak A, Duckworth A, Metcalfe D. Which clinical features best predict occult scaphoid fractures? A systematic review of diagnostic test accuracy studies. Emerg Med J. 2023;40(8):576 LP - 582. doi:10.1136/emermed-2023-213119 Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit, OMSII

In this episode we interview Andrew Buttery and Andy shares his story into simulation and passion for learning. Proudly sponsored by Innovative SimSolutions LLC.

The Sim Cafe~

Play Episode Listen Later Jul 31, 2023 38:29 Transcription Available

Andrew Graham Buttery; BSc; MSc; DipMedEd (Dist.); RODP (Ex RC(UK) ALS Instructor, CHSE (expired)After 20 years clinical work as an Operating Department Practitioner (ODP), my increasing interest in education and improvement led to my first full-time educator role as Simulation Specialist, and only full-time clinician, for the Trent Simulation & Clinical Skills Centre, Nottingham in 2004 with a concurrent secondment to design and deliver an Anaesthetic Assistant Course at the Nottingham School of Nursing. I served on the Board of the Association of ODP during the process to join the HCP (Health Professions Council, as was), contributing to the QAA Benchmarking and the HPC Standards of Proficiency for ODP and taking part in numerous professional Validation of ODP Programmes. 2004 I attended a 4 – Day Aviation “Crew Resource Management” Train-the-Trainer course and have been delivering Simulation & Human Factors Education ever since. I was treasurer for NAMS (National Association for Medical Simulation) before it became ASPiH (Association for Simulated Practice in Healthcare) and was a member of Faculty for the NAMS/Laerdal collaboration “SimSKills” Train the Trainers Course and have contributed to several Laerdal “Simulation User Group (SUN) Meetings. I was one of two Human Factors Editors for SESAM 2014 and the European subject expert on the SSH working panel for the first Certification as Healthcare Simulation Educator (CHSE) during two USA workshop events. I qualified as a TeamSTEPPS Master trainer in 2015.I co-designed and delivered a workshop on Human Factors Education for the UK Clinical HumanFactors Group [http://chfg.org/] in 2012.I left Trent Simulation for Doha, Qatar in 2015, returning to a Patient Safety Management role at Nottingham University Hospitals (NUH) in 2016 then Simulation Faculty Director for Canterbury Christ Church University in 2017 and now Regional Simulation and Human Factors Project Lead. The affidavit for my NUH Corporate “NUHonours” Award in 2011 included: “Andy's passion for human factors and patient safety and his desire to share this knowledge with others is demonstrated every day he teaches…”I have delivered presentations and workshops, mostly upon Simulation Faculty Development, at local, national and international conferences and was a member of the expert panel for a plenum event at SESAM (Society for Simulation in Europe) 2013. I have led pre-conference workshops for the ASPiH National Conference. I contribute to NHS E National Programmes & Training, I designed and led the MSc Simulation Pathway Lead for Canterbury Christ Church University. I presented to the Royal College of Physicians National Clinical Trainer Conference 2022. I am member of the ASPiH Executive and the Operative board of IJoHS.PublicationsC Wood, C Buss, A Buttery, D Gardiner. Evaluation of deceased donation simulation. Journal of theIntensive Care Society. 2012 April; 13(2): 107-114 https://www.researchgate.net/publication/271850263_Evaluation_of_Deceased_Donation_SimulationS Timmons, B Baxendale, A Buttery, G Miles, B Roe, S Browes. Implementing Human Factors inClinical Practice. Emerg Med J. 2014 March; https://emj.bmj.com/content/emermed/early/2014/03/14/emermed-2013-203203.full.pdfE Ferguson, A Buttery, G Miles, C Tatalia, D D Clarke, A Lonsdale, B Baxendale, C Lawrence. TheTemporal Rating of Emergency Non-Technical skills (TRENT) index for self and others:psychometric properties and emotional responses. BMC Medical Education (2014) 14; 240 https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-014-0240-yJ Scott, P Dawson, E Heavey, Aoife De Brun, A Buttery, J Waring, D Flynn. Content Analysis of Patient Safety Incident ReportInnovative SimSolutions.Your turnkey solution provider for medical simulation programs, sim centers & faculty design.

27 - Brain Abscesses, Torsion, and Delirium

The FlightBridgeED Podcast

Play Episode Listen Later Jul 15, 2023 55:02

Show Notes for Episode 27 of “The 2 View” – Brain abscesses, torsion, and delirium. Brain Abscesses Accorsi EK, Hall M, Hersh AL, Shah SS, Schrag SJ, Cohen AL. Notes from the Field: Update on Pediatric Intracranial Infections - 19 States and the District of Columbia, January 2016-March 2023. MMWR Morb Mortal Wkly Rep. CDC, Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/72/wr/mm7222a5.htm Brook I. Clinical Case. Brain Abscess Clinical Presentation. Medscape.com. https://reference.medscape.com/article/212946-clinical Goodman B. Doctors watching for more cases after mysterious cluster of brain infections strikes kids in southern Nevada. CNN. CNN Health. https://www.cnn.com/2023/04/28/health/brain-abscess-cluster-nevada/index.html The Center for Medical Education. 23 - Dear Doctor, Skin Closures, and Wound Management. 2 View: Emergency Medicine PAs & NPs. https://2view.fireside.fm/23 What's “ordinary negligence”? //Missed brain abscess//Special offer. Mad Mimi. Medical Malpractice Insights: Learning from Lawsuits. https://madmimi.com/s/3fc5711 Testicular Torsion Lukosiute-Urboniene A, Nekrosius D, Dekeryte I, Kilda A, Malcius D. Clinical risk factors for testicular torsion and a warning against falsely reassuring ultrasound scans: a 10-year single-centre experience. Emerg Med J. BMJ Journals. https://emj.bmj.com/content/40/2/134.info Mellick LB, Watters BC. The Torsed Testicle Traction Technique and 2 Case Reports. Pediatr Emerg Care. https://journals.lww.com/pec-online/Citation/2023/05000/TheTorsedTesticleTractionTechniqueand2_Case.14.aspx Sessions AE, Rabinowitz R, Hulbert WC, Goldstein MM, Mevorach RA. Testicular torsion: direction, degree, duration and disinformation. J Urol. PubMed. NIH: National Library of Medicine. National Center for Biotechnology Information. https://pubmed.ncbi.nlm.nih.gov/12544339/ Ovarian Torsion Long B, Koyfman A, Gottlieb M. Dispelling 5 Ovarian Torsion Myths. ACEP Now. https://www.acepnow.com/article/dispelling-5-ovarian-torsion-myths/ Ovarian Torsion. Acep.org. ACEP Emergency Ultrasound Section. https://www.acep.org/emultrasound/newsroom/sept2020/ovarian-torsion Spinelli C, Piscioneri J, Strambi S. Adnexal Torsion in Adolescents: Update and review of the literature. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/08/adnexal-torsion-in-adolescents Swenson DW, Lourenco AP, Beaudoin FL, Grand DJ, Killelea AG, McGregor AJ. Ovarian torsion: Case-control study comparing the sensitivity and specificity of ultrasonography and computed tomography for diagnosis in the emergency department. European Journal of Radiology. ScienceDirect. https://edus.ucsf.edu/sites/edus.ucsf.edu/files/wysiwyg/1-s2.0-S0720048X14000023-main.pdf Delirium ACEP's Position on Hyperactive Delirium. American College of Emergency Physicians. https://www.acep.org/news/acep-newsroom-articles/aceps-position-on-hyperactive-delirium Hatten BW, Bonney C, Dunne RB, et al. ACEP Task Force Report on Hyperactive Delirium with Severe Agitation in Emergency Settings, Approved by the ACEP Board of Directors, June 23, 202. American College of Emergency Physicians. https://www.acep.org/siteassets/new-pdfs/education/acep-task-force-report-on-hyperactive-delirium-final.pdf Hayes BD, O'Brien M. Should Diphenhydramine be included in an Acute Agitation Regimen? AliEM: Academic Life in Emergency Meedicine. https://www.aliem.com/diphenhydramine-acute-agitation-regimen/ Psychiatric Patient. American College of Emergency Physicians. https://www.acep.org/patient-care/clinical-policies/Psychiatric-Patient Reuben. Emergency Department Agitated Patient Treatment Map. Emergency Medicine Updates. https://emupdates.com/danger/ Veraart JKE, Smith-Apeldoorn SY, Bakker IM, et al. Pharmacodynamic Interactions Between Ketamine and Psychiatric Medications Used in the Treatment of Depression: A Systematic Review. Int J Neuropsychopharmacol. Oxford Academic. https://academic.oup.com/ijnp/article/24/10/808/6309481?login=false Prescription Drug Monitoring Programs D'Souza RS, Lang M, Eldrige JS. Prescription Drug Monitoring Program. StatPearls Publishing. NIH: National Library of Medicine. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK532299/ Something Sweet Brito C. Bobi, the world's oldest dog, turns 31 years old. CBS News. https://www.cbsnews.com/news/bobi-the-worlds-oldest-dog-turns-31-years-old/ Recurring Sources Center for Medical Education. http://ccme.org The Proceduralist. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com

director doctors brain medicine cnn states treatments position nevada columbia cdc prevention missed pac clinical centers lawsuits disease control american colleges approved national center cbs news msn emergency medicine dispelling nps delirium radiology medical education citation pubmed european journal ovarian emergency physicians testicular medscape bobi acep case reports torsion cnn health dear doctor wound management oxford academic emerg med j mmwr morb mortal wkly rep mad mimi statpearls publishing pediatr emerg care acep now

E226: MDCast: ASA Overdose Rebuttal & Practical Application w/ Dr. Mike Lauria

Play Episode Listen Later May 3, 2023 15:46

Join FlightBridgeEDs new Chief Medical Director, Mike Lauria, as we launch the FlightBridgeED MDCast. Dr. Lauria will hijack these episodes for a new perspective on current topics in critical care medicine. In this episode, Dr. Lauria looks at Eric's previously published podcast [episode 224] on ASA Overdose and gives his insight, practical application, and overall thoughts on these difficult-to-manage patients. Don't miss this episode! So much good stuff! Please like, subscribe, and leave any questions or comments. References for Acute Salicylate Intoxication Anderson RJ, Potts DE, Gabow PA, Rumack BH, Schrier RW. Unrecognized adult salicylate intoxication. Ann Intern Med. Dec 1976;85(6):745-8. doi:10.7326/0003-4819-85-6-745 Chyka PA, Erdman AR, Christianson G, et al. Salicylate poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007;45(2):95-131. doi:10.1080/15563650600907140 Dargan PI, Wallace CI, Jones AL. An evidence-based flowchart to guide the management of acute salicylate (aspirin) overdose. Emerg Med J. May 2002;19(3):206-9. doi:10.1136/emj.19.3.206 Delaney TM, Helvey JT, Shiffermiller JF. A Case of Salicylate Toxicity Presenting with Acute Focal Neurologic Deficit in a 61-Year-Old Woman with a History of Stroke. Am J Case Rep. Feb 15 2020;21:e920016. doi:10.12659/AJCR.920016 Espírito Santo R, Vaz S, Jalles F, Boto L, Abecasis F. Salicylate Intoxication in an Infant: A Case Report. Drug Saf Case Rep. Nov 27 2017;4(1):23. doi:10.1007/s40800-017-0065-9 Goldberg MA, Barlow CF, Roth LJ. The effects of carbon dioxide on the entry and accumulation of drugs in the central nervous system. J Pharmacol Exp Ther. Mar 1961;131:308-18. Juurlink DN, Gosselin S, Kielstein JT, et al. Extracorporeal Treatment for Salicylate Poisoning: Systematic Review and Recommendations From the EXTRIP Workgroup. Ann Emerg Med. Aug 2015;66(2):165-81. doi:10.1016/j.annemergmed.2015.03.031 Kuzak N, Brubacher JR, Kennedy JR. Reversal of salicylate-induced euglycemic delirium with dextrose. Clin Toxicol (Phila). Jun-Aug 2007;45(5):526-9. doi:10.1080/15563650701365800 McCabe DJ, Lu JJ. The association of hemodialysis and survival in intubated salicylate-poisoned patients. Am J Emerg Med. Jun 2017;35(6):899-903. doi:10.1016/j.ajem.2017.04.017 Miyahara JT, Karler R. Effect of salicylate on oxidative phosphorylation and respiration of mitochondrial fragments. Biochem J. Oct 1965;97(1):194-8. doi:10.1042/bj0970194 Oliver TK, Jr., Dyer ME. The prompt treatment of salicylism with sodium bicarbonate. AMA J Dis Child. May 1960;99:553-65. doi:10.1001/archpedi.1960.02070030555001 Oualha M, Dupic L, Bastian C, Bergounioux J, Bodemer C, Lesage F. [Local salicylate transcutaneous absorption: an unrecognized risk of severe intoxication: a case report]. Arch Pediatr. Oct 2012;19(10):1089-92. Application cutanée localisée d'acide salicylique : un risque méconnu d'intoxication : à propos d'un cas. doi:10.1016/j.arcped.2012.07.012 Palmer BF, Clegg DJ. Salicylate Toxicity. N Engl J Med. Jun 25 2020;382(26):2544-2555. doi:10.1056/NEJMra2010852 Penniall R. The effects of salicylic acid on the respiratory activity of mitochondria. Biochim Biophys Acta. Nov 1958;30(2):247-51. doi:10.1016/0006-3002(58)90047-7 Shively RM, Hoffman RS, Manini AF. Acute salicylate poisoning: risk factors for severe outcome. Clin Toxicol (Phila). Mar 2017;55(3):175-180. doi:10.1080/15563650.2016.1271127 Stolbach AI, Hoffman RS, Nelson LS. Mechanical ventilation was associated with acidemia in a case series of salicylate-poisoned patients. Acad Emerg Med. Sep 2008;15(9):866-9. doi:10.1111/j.1553-2712.2008.00205.x Thurston JH, Pollock PG, Warren SK, Jones EM. Reduced brain glucose with normal plasma glucose in salicylate poisoning. J Clin Invest. Nov 1970;49(11):2139-45. doi:10.1172/JCI106431 See omnystudio.com/listener for privacy information.

history local application references stroke reversal mechanical reduced acute overdose practical applications rebuttal year old woman kennedy jr new england journal of medicine unrecognized lauria chief medical director ann intern med ann emerg med salicylate am j emerg med acad emerg med emerg med j j clin invest clin toxicol phila mike lauria biochim biophys acta

25 - Pediatric Nurse Practitioners Are Not Okay, DEA Updates, and Hyperacute T-Waves

The Podcasts of the Royal New Zealand College of Urgent Care

Play Episode Listen Later Apr 10, 2023 55:36

Welcome to Episode 25 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 25 of “The 2 View” Pediatric Nurse Practitioners Are Not Okay Della Volpe K. We Are Not Ok, Say Pediatric NPs. Clinical Advisor. Published March 17, 2023. Accessed March 27, 2023. https://www.clinicaladvisor.com/home/meeting-coverage/napnap-2023/pediatric-nps-not-ok/?utmsource=newsletter&utmmedium=email&utmcampaign=NWLTRCADCONFNAPNAPMODERNA032023RM&hmEmail=1f%2FJfEV7hN5vJr6vg%2FQRqK0NA6IXtyO3&sha256email=092493d8223fdfa40d9e995176d13e5fc5b5211674db9deb440c025fd462c80c&hmSubId=&NID=1639413404&elqTrackId=31abe541d69a4ca587368d18c07e2aeb&elq=24134fa5abd64addafddd14ad54e8f8d&elqaid=13088&elqat=1&elqCampaignId=10964&fbclid=IwAR2YZErTgA9ET7Yzib3bPYuhD68VDtGAayIfQ2bu398LBTX6xEmLjZX3EY Sarjoo A. Pediatricians: We Can't Bear the Burden of Teen Angst. Medscape. Published March 13, 2023. Accessed March 27, 2023. https://www.medscape.com/viewarticle/989552 New TASER Bleetman A, Hepper AE, Sheridan RD. The use of TASER devices in UK policing: an update for clinicians following the recent introduction of the TASER 7. BMJ Journals. Emerg Med J. Published 2023. Accessed March 27, 2023. https://emj.bmj.com/content/40/2/147.long Taser Injuries. Emergency Central. Unboundmedicine.com. Accessed March 27, 2023. https://emergency.unboundmedicine.com/emergency/view/5-MinuteEmergencyConsult/307682/all/Taser_Injuries Vilke G, Chan T, Bozeman WP, Childers R. Emergency Department Evaluation After Conducted Energy Weapon Use: Review of the Literature for the Clinician. NIH National Library of Medicine: National Center for Biotechnology Information. PubMed. J Emerg Med. Published September 26, 2019. Accessed March 27, 2023. https://pubmed.ncbi.nlm.nih.gov/31500994/ Hyperacute T-Waves Dr. Smith's ECG blog. Blogspot.com. Published March 2023. Accessed March 27, 2023. http://hqmeded-ecg.blogspot.com/search/label/hyperacute%20T-waves Koechlin L, Strebel I, Zimmermann T, et al. Hyperacute T Wave in the Early Diagnosis of Acute Myocardial Infarction. Ann Emerg Med. PubMed. NIH: National Library of Medicine. National Center for Biotechnology Information. Published online February 9, 2023. Accessed March 27, 2023. https://pubmed.ncbi.nlm.nih.gov/36774205/ Writing Committee, Kontos MC, de Lemos JA, et al. 2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. Published November 2022. Accessed March 27, 2023. https://www.jacc.org/doi/10.1016/j.jacc.2022.08.750 DEA Updates – Segment with Dr. Rick Bukata Criteria for Furnishing Number Utilization by Nurse Practitioners. State of California, DCA (Department of Consumer Affairs). Board of Registered Nursing. Rn.ca.gov. Accessed March 27, 2023. https://www.rn.ca.gov/pdfs/regulations/npr-i-16.pdf DEA Announces Proposed Rules for Permanent Telemedicine Flexibilities. Drug Enforcement Administration (DEA). Published February 24, 2023. Accessed March 27, 2023. https://www.dea.gov/press-releases/2023/02/24/dea-announces-proposed-rules-permanent-telemedicine-flexibilities Mid-Level Practitioners Authorization by State. US Department of Justice. Drug Enforcement Administration. Diversion Control Division. Usdoj.gov. Accessed March 27, 2023. https://www.deadiversion.usdoj.gov/drugreg/practioners/ Removal of DATA Waiver (X-Waiver) Requirement. SAMHSA. Substance Abuse and Mental Health Services Administration. Samhsa.gov. Last Updated January 25, 2023. Accessed March 27, 2023. https://www.samhsa.gov/medications-substance-use-disorders/removal-data-waiver-requirement Statutory Changes in Pharmacy Law. Pharmacy.ca.gov. Published December 9, 2022. Accessed March 27, 2023. https://www.pharmacy.ca.gov/lawsregs/newlaws.pdf Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

DESI EM PROJECT - EPISODE 24 - THE ONE WITH "ANAPHYLAXIS"

THE DESI EM PROJECT

Play Episode Listen Later Feb 1, 2023 14:24

In this episode I explore the small yet deadly world of Anaphylaxis. Remember the most common cause of death in anaphylaxis is the wrong dose at the wrong time of epinephrine! Feel free to go through the following references - 1. McHugh K, Repanshek Z. Anaphylaxis: Emergency Department Treatment. Emerg Med Clin North Am. 2022 Feb;40(1):19-32. doi: 10.1016/j.emc.2021.08.004. Epub 2021 Oct 29. PMID: 34782088. 2. Sampson HA, Munoz-Furlong A, Campbell RL, et al. Second symposium on the definition and management of anaphylaxis: summary report–second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. Ann Emerg Med 2006;47(4):373–80. 3. Manivannan V, Hess EP, Bellamkonda VR, et al. A multifaceted intervention for patients with anaphylaxis increases epinephrine use in adult emergency department. J Allergy Clin Immunol Pract 2014;2(3):294–9.e1. 4. Alqurashi W, Ellis AK. Do corticosteroids prevent biphasic anaphylaxis? J Allergy Clin Immunol Pract 2017;5(5):1194–205. 5. Thomas M, Crawford I. Best evidence topic report. Glucagon infusion in refractory anaphylactic shock in patients on beta-blockers. Emerg Med J 2005;22(4): 272–3 6. Ahmad I, El-Boghdadly K, Bhagrath R, et al. Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults. Anaesthesia 2020;75(4):509–28.

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Urgent Bite 157 - Needle Expectation

Play Episode Listen Later Jan 19, 2023 8:37

Does expectation influence the experience of receiving an injection? Check out the paper mentioned Quaba O, Huntley JS, Bahia H, McKeown DW. A users guide for reducing the pain of local anaesthetic administration. Emerg Med J. 2005 Mar;22(3):188-9. doi: 10.1136/emj.2003.012070. PMID: 15735267; PMCID: PMC1726707. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1726707/ www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc Music licensed from www.premiumbeat.com Full Grip by Score Squad This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals. Please ensure you work within your scope of practice at all times. For personal medical advice always consult your usual doctor

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Podcast 841: Wound Care

university significance aussie stokes ntg matt wilkinson emerg med j

Play Episode Listen Later Jan 3, 2023 3:02

Contributor: Aaron Lessen, MD Educational Pearls: Wound care in the emergency department aims to prevent future infection Copious wound irrigation is the important step in preventing wound infection Studies have shown that irrigation with tap water is just as effective, if not superior, to irrigation with saline or other solutions Several studies have shown no reduction in wound infection rates when using sterile gloves during wound care Recent study in the Netherlands compared infection rates between patients undergoing wound repair with and without sterile gloves Receiving wound care with nonsterile gloves was noninferior to wound care utilizing sterile gloves References Fernandez R, Griffiths R. Water for wound cleansing. Cochrane Database Syst Rev. Feb 15 2012;(2):Cd003861. doi:10.1002/14651858.CD003861.pub3 Heckmann N, Simcox T, Kelley D, Marecek GS. Wound Irrigation for Open Fractures. JBJS Rev. Jan 2020;8(1):e0061. doi:10.2106/jbjs.Rvw.19.00061 Zwaans JJM, Raven W, Rosendaal AV, et al. Non-sterile gloves and dressing versus sterile gloves, dressings and drapes for suturing of traumatic wounds in the emergency department: a non-inferiority multicentre randomised controlled trial. Emerg Med J. Sep 2022;39(9):650-654. doi:10.1136/emermed-2021-211540 Summarized by Mark O'Brien, MS4 | Edited by John Spartz, MD, & Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.

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Episode 146 - NTG In RVMI With Matt Wilkinson-Stokes

MCHD Paramedic Podcast

Play Episode Listen Later Dec 19, 2022 36:03

Special guest alert!! We're lucky to have superstar Aussie medic and University of Melbourne Ph.D. candidate Matt Wilkison-Stokes, on this episode to discuss his recent paper looking at the risk of hypotension with nitroglycerin administration in acute MI. Where is NTG really more likely to cause hypotension in AMI? When is it safest? How often do isolated RVMI's occur, and what are the correct diagnostic criteria? Dr. Patrick changed his practice based on Matt's work and knowledge. See if you might do the same. REFERENCES 1. Wilkinson-Stokes M, Betson J, Sawyer S. Adverse events from nitrate administration during right ventricular myocardial infarction: a systematic review and meta-analysis. Emerg Med J. 2022 Sep 30:emermed-2021-212294. 2. Ferguson JJ, Diver DJ, Boldt M, et al. Significance of nitroglycerin-induced hypotension with inferior wall acute myocardial infarction. Am J Cardiol 1989;64:311–4. 3. matt.wilkinsonstokes@student.unimelb.edu.au

Podcast 835: Syncope Review

diversity md electrical emergency medicine hb qt differential hypoglycemia summarized emm syncope brugada neurogenic emerg med j

Play Episode Listen Later Dec 5, 2022 6:22

Contributor: Meghan Hurley, MD Educational Pearls: Syncope is defined as a loss of consciousness with an immediate return to baseline Differential is broad Cardiogenic Structural (aortic stenosis, HOCUM, etc.) Electrical (long QT syndrome, Brugada, etc.) Neurogenic/neurovascular (brain bleed, etc.) Seizure Everything else Hypoglycemia, anemia, and bleeding into the abdominal cavity are some potential causes to rule out Vasovagal Diagnosis of exclusion Work Up EKG Good H&P Labs especially Hb and glucose References Morris J. Emergency department management of syncope. Emerg Med Pract. Jun 2021;23(6):1-24. Reed MJ. Approach to syncope in the emergency department. Emerg Med J. Feb 2019;36(2):108-116. doi:10.1136/emermed-2018-207767 Summarized by Mark O'Brien, MS4 | Edited by John Spartz, MD, & Erik Verzemnieks, MD In an effort to promote diversity, equity, and inclusion in Emergency Medicine, The Emergency Medical Minute is proud to present our 2nd annual Diversity and Inclusion Award. We support increasing the representation of underrepresented groups in medicine and extend this award to individuals applying to emergency medicine residencies during the 2022-2023 cycle. For information on award eligibility and the application process, visit https://emergencymedicalminute.com/edi-award/ Donate to EMM today!

Podcast Folge 43 – August 2022

Hauptfolge – pin-up-docs – don't panic

Play Episode Listen Later Aug 31, 2022 196:15

Journalclub Paula https://pubs.asahq.org/anesthesiology/article/135/6/976/117564/Carbon-Footprint-of-General-Regional-and-Combined Johannes und Thorben Zwaans JJM, Raven W, Rosendaal AV, Van Lieshout EMM, Van Woerden G, Patka P, Haagsma JA, Rood PPM. Non-sterile gloves and dressing versus sterile gloves, dressings and drapes for suturing of traumatic wounds in the emergency department: a non-inferiority multicentre randomised controlled trial. Emerg Med J. 2022 Sep;39(9):650-654. doi: 10.1136/emermed-2021-211540. Epub 2022 Jul 26. […] Der Beitrag Podcast Folge 43 – August 2022 erschien zuerst auf pin-up-docs - don't panic.

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DESI EM PROJECT - EPISODE 15 - "THE ONE WITH STEWART'S APPROACH TO BLOOD GASES"

THE DESI EM PROJECT

Play Episode Listen Later Jul 20, 2022 19:48

What an academic feast organized by the SEMI-WB on the weekend of 16-17th July 2022 for the academic residents of emergency medicine. I start of the episode by talking about the EZECON. Also the 24th Annual Conference of SEMI is happening in Kerala from 23-27th November. Do register for it. In this episode I give an insight towards dealing with acid base disorders using the modified stewart's approach. Following are the references you can go through to understand more and change your practice - 1. https://emcrit.org/wp-content/uploads/acid_base_sheet_2-2011.pdf 2. Story DA. Stewart Acid-Base: A Simplified Bedside Approach. Anesth Analg. 2016 Aug;123(2):511-5. doi: 10.1213/ANE.0000000000001261. PMID: 27140683. 3. Jones NL. A quantitative physicochemical approach to acid-base physiology. Clin Biochem. 1990 Jun;23(3):189-95. doi: 10.1016/0009-9120(90)90588-l. PMID: 2115411. 4. Mallat J, Michel D, Salaun P, Thevenin D, Tronchon L. Defining metabolic acidosis in patients with septic shock using Stewart approach. Am J Emerg Med. 2012 Mar;30(3):391-8. doi: 10.1016/j.ajem.2010.11.039. Epub 2011 Jan 28. PMID: 21277142. 5. Morgan TJ. The Stewart approach--one clinician's perspective. Clin Biochem Rev. 2009 May;30(2):41-54. PMID: 19565024; PMCID: PMC2702213. 6.Kaplan LJ, Kellum JA. Initial pH, base deficit, lactate, anion gap, strong ion difference, and strong ion gap predict outcome from major vascular injury. Crit Care Med. 2004 May;32(5):1120-4. doi: 10.1097/01.ccm.0000125517.28517.74. PMID: 15190960. 7. Malatesha G, Singh NK, Bharija A, Rehani B, Goel A. Comparison of arterial and venous pH, bicarbonate, PCO2 and PO2 in initial emergency department assessment. Emerg Med J. 2007 Aug;24(8):569-71. doi: 10.1136/emj.2007.046979. PMID: 17652681; PMCID: PMC2660085. 8. Kelly AM, McAlpine R, Kyle E. Venous pH can safely replace arterial pH in the initial evaluation of patients in the emergency department. Emerg Med J. 2001 Sep;18(5):340-2. doi: 10.1136/emj.18.5.340. PMID: 11559602; PMCID: PMC1725689. 9. Byrne AL, Bennett M, Chatterji R, Symons R, Pace NL, Thomas PS. Peripheral venous and arterial blood gas analysis in adults: are they comparable? A systematic review and meta-analysis. Respirology. 2014 Feb;19(2):168-175. doi: 10.1111/resp.12225. Epub 2014 Jan 3. PMID: 24383789.

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DESI EM PROJECT - EPISODE 10 - THE ONE WITH "MYTHS IN EMERGENCY MEDICINE PART 1"

THE DESI EM PROJECT

Play Episode Listen Later Apr 30, 2022 9:04

In today's episode, I've discussed some myths that are still prevalent in emergency medicine practices across the world. They are still taught even if some clinicians do not practice it. do you own research. Don't take my word for it. Change your practice accordingly. You can go through some of the following references - 1. SELLICK BA. Cricoid pressure to control regurgitation of stomach contents during induction of anaesthesia. Lancet (London, England). 1961; 2(7199):404-6. PMID:13749923 2. Birenbaum A, Hajage D, Roche S, et al. Effect of Cricoid Pressure Compared With a Sham Procedure in the Rapid Sequence Induction of Anesthesia: The IRIS Randomized Clinical Trial. JAMA surgery. 2018; PMID:30347104 3. Allman KG. The effect of cricoid pressure application on airway patency. Journal of clinical anesthesia. 1995; 7(3):197-9. PMID:7669308 4. Ellis DY, Harris T, Zideman D. Cricoid pressure in emergency department rapid sequence tracheal intubations: a risk-benefit analysis. Annals of emergency medicine. 2007; 50(6):653-65. PMID:17681642 5. Neilipovitz DT, Crosby ET. No evidence for decreased incidence of aspiration after rapid sequence induction. Canadian journal of anaesthesia = Journal canadien d'anesthesie. 2007; 54(9):748-64. PMID:17766743 6. Palmer JH, Ball DR. The effect of cricoid pressure on the cricoid cartilage and vocal cords: an endoscopic study in anaesthetised patients. Anaesthesia. 2000; 55(3):263-8. PMID:10671846 7. Byrne AL, Bennett M, Chatterji R, Symons R, Pace NL, Thomas PS. Peripheral venous and arterial blood gas analysis in adults: are they comparable? A systematic review and meta-analysis. Respirology. 2014 Jan 3. PMID: 24383789. 8. Kelly AM, McAlpine R, Kyle E. Venous pH can safely replace arterial pH in the initial evaluation of patients in the emergency department. Emerg Med J. 2001 Sep;18(5):340-2. PMID 11559602 9. Middleton P, Kelly AM, Brown J, Robertson M. Agreement between arterial and central venous values for pH, bicarbonate, base excess, and lactate. Emerg Med J. 2006 Aug;23(8):622-4. PMID16858095 10. Klein LR, Cole JB. Ketamine: Focusing on the Facts and Forgetting the Fiction. Ann Emerg Med. 2021 Jul;78(1):132-139. doi: 10.1016/j.annemergmed.2021.03.039. PMID: 34167728. 11. Godoy DA, Badenes R, Pelosi P, Robba C. Ketamine in acute phase of severe traumatic brain injury "an old drug for new uses?". Crit Care. 2021 Jan 6;25(1):19. doi: 10.1186/s13054-020-03452-x. PMID: 33407737; PMCID: PMC7788834. 12. Schofer JM. Premedication during rapid sequence intubation: a necessity or waste of valuable time? Cal J Emerg Med. 2006 Dec;7(4):75-9. PMID: 20505811; PMCID: PMC2872531. 13. Robinson N, Clancy M. In patients with head injury undergoing rapid sequence intubation, does pretreatment with intravenous lignocaine/lidocaine lead to an improved neurological outcome? A review of the literature. Emerg Med J 200;8:453-7.

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Podcast April 2022 – Folge 39

Hauptfolge – pin-up-docs – don't panic

Play Episode Listen Later Apr 30, 2022 265:30

Wir präsentieren: Die April-Folge 2022. Es erwartet euch unser Journal-Club, alles zum perioperativen Temperaturmanagement und viele spannende Fakten zum hämodynamischen Monitoring Viel Spaß beim hören! Kommentare https://link.springer.com/article/10.1007/s00134-002-1298-2 https://pubmed.ncbi.nlm.nih.gov/782280/ https://pubmed.ncbi.nlm.nih.gov/3535567/ Vermischtes 13. Notfallsymposium der AGNN in Lübeck-Travemünde Journal Club Johannes: Association between delays to patient admission from the emergency department and all-cause 30-day mortality. Emerg Med J. 2022 Mar;39(3):168-173. doi: 10.1136/emermed-2021-211572. […] Der Beitrag Podcast April 2022 – Folge 39 erschien zuerst auf pin-up-docs - don't panic.

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Episódio 130: Caso Clínico de Tontura

Ta de Clinicagem

Play Episode Listen Later Mar 23, 2022 49:45

Faça sua pré-inscrição no CURSO TdC de Pronto-atendimento e receba BÔNUS exclusivos: https://cursotdc.com.br/ Iago apresenta um caso de tontura para o Pedro e Kaue, com um foco na investigação da tontura e no exame físico direcionado (HINTS). Vídeo do HINTS comentado por Kaue e Pedro: https://youtu.be/keqwC-36HmM Referências: 1. Newman-Toker DE, Edlow JA. TiTrATE: a novel approach to diagnosing acute dizziness and vertigo. Neurol Clin 2015;33(3):577-599. doi:10.1016/j.ncl.2015.04.011 2. Edlow JA, Gurley KL, Newman-Toker DE. A new diagnostic approach to the adult patient with acute dizziness. J EmergMed 2018;54(4):469-483. doi:10.1016/j.jemermed.2017.12.024 3. Bisdorff AR, Staab JP, Newman-Toker DE. Overview of the international classification of vestibular disorders. Neurol Clin 2015;33:541-550. doi:10.1016/j.ncl.2015.04.010 4. Kerber KA. Episodic positional dizziness. Continuum (Minneap Minn) 2021; 27(2, Neuro-otology):348-368. 5. Newman-Toker DE, Cannon LM, Stofferahn ME, et al. Imprecision in patient reports of dizziness symptom quality: a cross-sectional study conducted in an acute care setting. Mayo Clin Proc 2007;82(11):1329-1340. doi:10.4065/82.11.1329 6. Steenerson KK. Acute vestibular syndrome. Continuum (Minneap Minn) 2021; 27(2, Neuro-otology):402-419. 7. Wasay M, Dubey N, Bakshi R. Dizziness and yield of emergency head CT scan: is it cost effective? Emerg Med J 2005;22(4):312. doi:10.1136/ emj.2003.012765 8. Huang CY, Yu YL. Small cerebellar strokes may mimic labyrinthine lesions. J Neurol Neurosurg Psychiatry. 1985; 48(3):263–5. 9. Chalela JA, Kidwell CS, Nentwich LM, Luby M, Butman JA, Demchuk AM, Hill MD, Patronas N, Latour L, Warach S. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet. 2007; 369(9558):293–8. 10. Oppenheim C, Stanescu R, Dormont D, Crozier S, Marro B, Samson Y, Rancurel G, Marsault C. False-negative diffusion-weighted MR findings in acute ischemic stroke. AJNR Am J Neuroradiol. 2000; 21(8):1434–40.

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Podcast 764: Myth or Merit: Beta-Blockers for Cocaine Chest Pain

The World’s Okayest Medic Podcast

Play Episode Listen Later Mar 15, 2022 3:24

Contributor: Chris Holmes, MD Educational Pearls: Many are taught that patients with cocaine chest pain should not receive beta-blockers due to unopposed alpha agonism, but is this true? 363 consecutive admissions for chest pain with positive cocaine on urine toxicology were reviewed in a retrospective cohort study 60 patients in this cohort received a beta-blocker and multivariate analysis demonstrated a reduction in myocardial infarction risk Another retrospective cohort study demonstrated no association of negative outcomes with beta-blocker administration in those with a recent positive result on cocaine urine toxicology Two more recent meta-analyses were performed finding no association between adverse clinical outcomes and beta-blocker administration for cocaine chest pain No prospective randomized-controlled trials have been performed to evaluate the use of beta-blockers for treatment of cocaine chest pain in the ED setting References Dattilo PB, Hailpern SM, Fearon K, Sohal D, Nordin C. Beta-blockers are associated with reduced risk of myocardial infarction after cocaine use [published correction appears in Ann Emerg Med. 2008 Jul;52(1):90]. Ann Emerg Med. 2008;51(2):117-125. doi:10.1016/j.annemergmed.2007.04.015 Rangel C, Shu RG, Lazar LD, Vittinghoff E, Hsue PY, Marcus GM. Beta-blockers for chest pain associated with recent cocaine use. Arch Intern Med. 2010;170(10):874-879. doi:10.1001/archinternmed.2010.115 Pham D, Addison D, Kayani W, et al. Outcomes of beta blocker use in cocaine-associated chest pain: a meta-analysis. Emerg Med J. 2018;35(9):559-563. doi:10.1136/emermed-2017-207065 Lo KB, Virk HUH, Lakhter V, et al. Clinical Outcomes After Treatment of Cocaine-Induced Chest Pain with Beta-Blockers: A Systematic Review and Meta-Analysis. Am J Med. 2019;132(4):505-509. doi:10.1016/j.amjmed.2018.11.041 Richards JR, Hollander JE, Ramoska EA, et al. β-Blockers, Cocaine, and the Unopposed α-Stimulation Phenomenon. J Cardiovasc Pharmacol Ther. 2017;22(3):239-249. doi:10.1177/1074248416681644 Lange RA, Cigarroa RG, Flores ED, et al. Potentiation of cocaine-induced coronary vasoconstriction by beta-adrenergic blockade. Ann Intern Med. 1990;112(12):897-903. doi:10.7326/0003-4819-112-12-897 Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account. Donate to EMM today!

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Episodio 25. El Diamante letal en trauma

99% Emergencias

Play Episode Listen Later Feb 9, 2022 8:23

En este nuevo episodio hablo del Diamante letal en trauma. Pasamos de la triada letal con la acidosis, coagulopatía e hipotermia y añadimos hipocalcemia en el manejo al paciente con trauma grave. Espero que os guste. Bibliografía consultada: - Ditzel, Ricky, Anderson, Justin, Eisenhart, William, Rankin, Cody, DeFeo, Devin, Oak, Sangki, et al. (2020). A review of transfusion- and trauma-induced hypocalcemia: Is it time to change the lethal triad to the lethal diamond?. Journal of Trauma and Acute Care Surgery, 88, 434-439. https://doi.org/10.1097/TA.0000000000002570 - Bjerkvig CK, Strandenes G, Eliassen HS, Spinella PC, Fosse TK, Cap AP, Ward KR. "Blood failure" time to view blood as an organ: how oxygen debt contributes to blood failure and its implications for remote damage control resuscitation. Transfusion. 2016;56(Suppl 2):S182-S189. - Dyer M, Neal MD. Defining the lethal triad. In: Pape HC, Peitzman A, Rotondo M, Giannoudis P, eds. Damage Control Management in the Polytrauma Patient. Cham, Switzerland: Springer; 2017:41-53. - Dobson GP, Letson HL, Sharma R, Sheppart FR, Cap AP. Mechanisms of early trauma-induced coagulopathy: the clot thickens or not? J Trauma. 2015;79(2):301-309. - Eddy VA, Morris JA Jr., Cullinane DC. Hypothermia, coagulopathy, and acidosis. Surg Clin North Am. 2000;80(3):845-854. - Niles SE, McLaughlin DF, Perkins JG, Wade CE, Li Y, Spinella PC, Holcomb JB. Increased mortality associated with the early coagulopathy of trauma in combat casualties. J Trauma. 2008;64(6):1459-1465. - Martini WZ, Holcomb JB. Acidosis and coagulopathy: the differential effects on fibrinogen synthesis and breakdown in pigs. Ann Surg. 2007;246(5):831-835. - Armand R, Hess JR. Treating coagulopathy in trauma patients. Transfus Med Rev. 2003;17(3):223-231. - Hastbacka J, Pettila V. Prevalence and predictive value of ionized hypocalcemia among critically ill patients. Acta Anaesthesiol Scand. 2003;47:1264-1269. - Cherry RA, Bradburn E, Carney DE, Shaffer ML, Gabbay RA, Cooney RN. Do early ionized calcium levels really matter in trauma patients? J Trauma. 2006;64(4):774-779. - Holcomb JB, Jenkins D, Rhee P, et al. Damage control resuscitation: directly addressing the early coagulopathy of trauma. J Trauma. 2007;62(2):307-310. - Lier H, Krep H, Schroeder S, Stuber F. Preconditions of hemostasis in trauma: a review. The influence of acidosis, hypocalcemia, anemia, and hypothermia on functional hemostasis in trauma. J Trauma. 2008;65(4):951-960. - Hoffman M, Monroe DM. Coagulation 2006: a modern view of hemostasis. Hematol Oncol Clin North Am. 2007;21:1-11. - Hoffman M. A cell-based model of coagulation and the role of factor VIIa. Blood Rev. 2003;17(suppl 1):S1-S5. - Ho KM, Leonard AD. Concentration-dependent effect of hypocalcaemia on mortality of patients with critical bleeding requiring massive transfusion: a cohort study. Anaesth Intensive Care. 2011;39(1):46-54. - Magnotti LJ, Bradburn EH, Webb DL, Berry SD, Fischer PE, Zarzaur BL, Schroeppel TJ, Fabian TC, Croce MA. Admission ionized calcium levels predict the need for multiple transfusions: a prospective study of 591 critically ill trauma patients. J Trauma. 2011;70(2):391-397. - Kornblith LZ, Howard BM, Cheung CK, et al. The whole is greater than the sum of its parts: hemostatic profiles of whole blood variants. J Trauma Acute Care Surg. 2014;77(6):818-827. - Li K, Xu Y. Citrate metabolism in blood transfusions and its relationship due to metabolic alkalosis and respiratory acidosis. Int J Clin Exp Med. 2015;8(4):6578-6584. - Giancarelli A, Liu-Deryke X, Birrer K, Hobbs B, Alban R. Hypocalcemia in trauma patients receiving massive transfusion. J Surg Res. 2016;202:182-187. - Webster S, Todd S, Redhead J, Wright C. Ionised calcium levels in major trauma patients who received blood in the emergency department. Emerg Med J. 2016;33(8):569-572. - Kyle T, Greaves I, Beynon A, Whittaker V, Brewer M, Smith J. Ionised calcium levels in major trauma patients who received blood en route to a military medical treatment facility. Emerg Med J. 2017;35(3):176-179. - MacKay EJ, Stubna MD, Holena DN, Reilly PM, Seamon MJ, Smith BP, Kaplan LJ, Cannon JW. Abnormal calcium levels during trauma resuscitation are associated with increased mortality, increased blood product use, and greater hospital resource consumption: a pilot investigation. Anesth Analg. 2017;125(3):895-901. - Shackelford SA, Del Junco DJ, Powell-Dunford N, Mazuchowski EL, Howard JT, Kotwal RS, Gurney J, Butler FK Jr., Gross K, Stockinger ZT. Association of prehospital blood product transfusion during medical evacuation of combat casualties in Afghanistan with acute and 30-day survival. JAMA. 2017;318(16):1581-1591. - DailyMed - Teruflex blood bag system anticoagulant citrate phosphate dextrose adenine (CPDA-1) - anticoagulant citrate phosphate dextrose adenine (cpda-1) solution. US National Library of Medicine. 2012. - Cap AP, Gurney J, Spinella PC, et al. Damage Control Resuscitation (CPG ID:18). Joint Trauma Service Clinical Practice Guideline. Joint Trauma System, the Department of Defense Center of Excellence for Trauma. 2019. - Pedersen KO. Binding of calcium to serum albumin. II. Effect of pH via competitive hydrogen and calcium ion binding to the imidazole groups of albumin. Scand J Clin Lab Invest. 1972;29(1):75-83. - Maxwell MJ, Wilson MJ. Complications of blood transfusion. BJA Educ. 2006;6(6):225-229. - Lang RM, Fellner SK, Neumann A, Bushinsky DA, Borow KM. Left ventricular contractility varies directly with blood ionized calcium. Ann Intern Med. 1988;108(4):524-529.

Christmas Clinical

Play Episode Listen Later Dec 20, 2021

Carley, S. (2004). Suicide at Christmas. EMJ Online. Available at http://emj.bmj.com/content/emermed/21/6/716.full.pdf CDC. (2004). Fall-Related Injuries During the Holiday Season --- United States, 2000–2003. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5348a1.htm Long, Brit. (2018). EM@3AM: Esophageal Foreign Bodies. EMDocs Blog. Available at http://emdocs.net/em3am-esophageal-foreign-bodies/ Rohrer-Mirtschink S, Forster N, Giovanoli P, Guggenheim M. Major burn injuries associated with Christmas celebrations: a 41-year experience from Switzerland. Ann Burns Fire Disasters. 2015;28(1):71-75. Shaw, et. al. (2018). Death and readmissions after hospital discharge during the Dec holiday period. BMJ, 363. Shuja, Winston, Rahman, Mitty, Jaber, & Keo. Esophageal food impaction during cultural holidays and national athletic events. Gasteroenterology Report, 5(1). Smith, Allan, Greenlaw, Findlay, & Isles. (2013). EM admissions., deaths ant weekends and the public holiday effect. Emerg Med J, 31(1). This podcast is hosted by ZenCast.fm

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Episodio 19. Shock index

99% Emergencias

Play Episode Listen Later Nov 4, 2021 5:06

En este nuevo episodio realizo un repaso muy breve del shock index o índice de shock. Espero que les guste y sea de utilidad. Referencias: - Café Club del Conocimiento. Antonio Pérez Alonso y Susana Simo. Shock. - Lee YT, Bae BK, Cho YM, Park SC, Jeon CH, Huh U, Lee DS, Ko SH, Ryu DM, Wang IJ. Reverse shock index multiplied by Glasgow coma scale as a predictor of massive transfusion in trauma. Am J Emerg Med. 2021 Aug;46:404-409. doi: 10.1016/j.ajem.2020.10.027. Epub 2020 Oct 20. PMID: 33143960. - Kimura, A., Tanaka, N. El índice de choque inverso multiplicado por la puntuación de la escala Coma de Glasgow (rSIG) es una medida simple con alta capacidad discriminante para el riesgo de mortalidad en pacientes traumatizados: un análisis del Banco de Datos de Trauma de Japón. Crit Care 22,87 (2018). https://doi.org/10.1186/s13054-018-2014-0 - El-Menyar A, Goyal P, Tilley E, Latifi R. The clinical utility of shock index to predict the need for blood transfusion and outcomes in trauma. J Surg Res. 2018 Jul;227:52-59. doi: 10.1016/j.jss.2018.02.013. Epub 2018 Mar 12. PMID: 29804862. - Marín Barboza, L., & Muñoz, R. (2020). Índice de choque. Revista Ciencia Y Salud Integrando Conocimientos, 4(4), Pág. 31–38. https://doi.org/10.34192/cienciaysalud.v4i4.168 - NAEMT. Manual proveedor PHTLS. Ed. 9. 2018. - Olaussen A, Blackburn T, Mitra B, Fitzgerald M. Review article: Shock Index for prediction of critical bleeding post-trauma: A systematic review: Shock Index for Critical Bleeding. Emerg Med Australas. junio de 2014;26(3):223-8. - Mitra B, Fitzgerald M, Chan J. The utility of a shock index≥1 as an indication for pre-hospital oxygen carrier administration in major trauma. Injury. enero de 2014;45(1):61-5. - Al Jalbout N, Balhara KS, Hamade B, Hsieh Y-H, Kelen GD, Bayram JD. Shock index as a predictor of hospital admission and inpatient mortality in a US national database of emergency departments. Emerg Med J. mayo de 2019;36(5):293-7. - Edla S, Reisner AT, Liu J, Convertino VA, Carter R, Reifman J. In reply to “Utility of shock index calculation in hemorrhagic trauma”. Am J Emerg Med. julio de 2015;33(7):978-9. - Saffouri E, Blackwell C, Laursen SB, Laine L, Dalton HR, Ngu J, et al. The Shock Index is not accurate at predicting outcomes in patients with upper gastrointestinal bleeding. Aliment Pharmacol Ther [Internet]. 23 de octubre de 2019 [citado 31 de octubre de 2019]; Disponible en: http://doi.wiley.com/10.1111/apt.15541 - Campos-Serra A, Montmany-Vioque S, Rebasa-Cladera P, Llaquet-Bayo H, Gràcia-Roman R, Colom-Gordillo A, et al. Aplicación del Shock Index como predictor de hemorragia en el paciente politraumático. Cir Esp. octubre de 2018;96(8):494-500. - Kristensen AKB, Holler JG, Hallas J, Lassen A, Shapiro NI. Is Shock Index a Valid Predictor of Mortality in Emergency Department Patients With Hypertension, Diabetes, High Age, or Receipt of β- or Calcium Channel Blockers? Ann Emerg Med. enero de 2016;67(1):106-113.e6. - Abe N, Miura T, Miyashita Y, Hashizume N, Ebisawa S, Motoki H, et al. Long-Term Prognostic Implications of the Admission Shock Index in Patients With Acute Myocardial Infarction Who Received Percutaneous Coronary Intervention. Angiology. abril de 2017;68(4):339-45. - Yu T, Tian C, Song J, He D, Sun Z, Sun Z. Derivation and Validation of Shock Index as a parameter for Predicting Long-term Prognosis in Patients with Acute Coronary Syndrome. Sci Rep. diciembre de 2017;7(1):11929.1.2.3.4.5.6.7.8.9. - Kobayashi A, Misumida N, Luger D, Kanei Y. Shock Index as a predictor for In-hospital mortality in patients with non-ST-segment elevation myocardial infarction. Cardiovasc Revasc Med. junio de 2016;17(4):225-8. - El-Menyar A, Sulaiman K, Almahmeed W, Al-Motarreb A, Asaad N, AlHabib KF, et al. Shock Index in Patients Presenting With Acute Heart Failure: A Multicenter Multinational Observational Study. Angiology. noviembre de 2019;70(10):938-46. - Middleton, Smith, Bedford, Neilly, Myint. Shock Index Predicts Outcome in Patients with Suspected Sepsis or Community-Acquired Pneumonia: A Systematic Review. J Clin Med. 31 de julio de 2019;8(8):1144. - Acker SN, Ross JT, Partrick DA, Tong S, Bensard DD. Pediatric specific shock index accurately identifies severely injured children. J Pediatr Surg. febrero de 2015;50(2):331-4. - Nordin A, Shi J, Wheeler K, Xiang H, Kenney B. Age-adjusted shock index: From injury to arrival. J Pediatr Surg. mayo de 2019;54(5):984-8. - Strutt J, Flood A, Kharbanda AB. Shock Index as a Predictor of Morbidity and Mortality in Pediatric Trauma Patients: Pediatr Emerg Care. febrero de 2019;35(2):132-7. - Hashmi A, Rhee P, Pandit V, Kulvatunyou N, Tang A, O’Keeffe T, et al. Shock Index Predicts Mortality in Geriatric Trauma Patients: An Analysis of The National Trauma Data Bank. J Surg Res. febrero de 2014;186(2):687. - Chung J-Y, Hsu C-C, Chen J-H, Chen W-L, Lin H-J, Guo H-R, et al. Shock index predicted mortality in geriatric patients with influenza in the emergency department. Am J Emerg Med. marzo de 2019;37(3):391-4. - Kuo SCH, Kuo P-J, Hsu S-Y, Rau C-S, Chen Y-C, Hsieh H-Y, et al. The use of the reverse shock index to identify high-risk trauma patients in addition to the criteria for trauma team activation: a cross-sectional study based on a trauma registry system. BMJ Open. junio de 2016;6(6): e011072. - Jiang L, Caputo ND, Chang BP. Respiratory adjusted shock index for identifying occult shock and level of Care in Sepsis Patients. Am J Emerg Med. marzo de 2019;37(3):506-9.10.11.12.13.14.15.16.17.18.19.38 - Laura Pariente Juste, Maylin Koo Gómez, Antonia Bonet Burguera, Raquel Reyes García, Lourdes Pérez García, Irene Macía Tejada Índices de shock prehospitalario y hospitalario como predictores de transfusión masiva en la atención inicial del paciente politraumático Emergencias 2021;33:29-34

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But Why EMS Podcast

Play Episode Listen Later Sep 29, 2021 65:22

For paramedics, click here for CE credits. Brought to you by Urgent Admin which is an intuitive one-touch solution that connects in-field clinicians and medical directors in real-time, this episode covers the challenge of the prehospital airway. The But Why team covers unique ways to secure the airway that include "Ghosting the Airway" and "Romantic Hands." Hear the But Why EMS Podcast team discuss this situation with: Dr. Robert Stephens Emergency Medicine Resident at Washington University Click here to check it out today! Thank you for listening! Hawnwan Philip Moy MD Gina Pellerito EMT-P John Reagan EMT-P Noah Bernhardson MD References: 1. Sakles JC, Chiu S, Mosier J, et al. The importance of first pass success when performing orotracheal intubation in the emergency department. Acad Emerg Med 2013;20(1):71-78. 2. Sakles JC, Mosier J, Stolz U. In reply. Acad Emerg Med 2013;20(9):966. 3. Limkakeng A, Broder JS, Theiling BJ. Chicken or egg? Risks of misattribution of cause-effect relationships in studies of association. Acad Emerg Med 2013;20(9):965. 4. Kajino K, Iwami T, Kitamura T, et al. Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest. Crit Care 2011;15(5):R236. 5. Clemency BM, Roginski M, Lindstrom HA, et al. Paramedic intubation: patient position might matter. Prehosp Emerg Care 2014;18(2):239-243. 6. Murphy DL, Rea TD, McCoy AM, et al. Inclined position is associated with improved first pass success and laryngoscopic view in prehospital endotracheal intubations. Am J Emerg Med 2019;37(5):937-941. 7. Turner JS, Ellender TJ, Okonkwo ER, et al. Feasibility of upright patient positioning and intubation success rates At two academic EDs. Am J Emerg Med 2017;35(7):986-992. 8. Levitan RM, Kinkle WC, Levin WJ, et al. Laryngeal view during laryngoscopy: a randomized trial comparing cricoid pressure, backward-upward-rightward pressure, and bimanual laryngoscopy. Ann Emerg Med 2006;47(6):548-555. 9. Snider DD, Clarke D, Finucane BT. The "BURP" maneuver worsens the glottic view when applied in combination with cricoid pressure. Can J Anaesth 2005;52(1):100-104. 10. Tournadre JP, Chassard D, Berrada KR, et al. Cricoid cartilage pressure decreases lower esophageal sphincter tone. Anesthesiology 1997;86(1):7-9. 11. Chassard D, Tournadre JP, Berrada KR, et al. Cricoid pressure decreases lower oesophageal sphincter tone in anaesthetized pigs. Can J Anaesth 1996;43(4):414-417. 12. Garrard A, Campbell AE, Turley A, et al. The effect of mechanically-induced cricoid force on lower oesophageal sphincter pressure in anaesthetised patients. Anaesthesia 2004;59(5):435-439. 13. Heath KJ, Palmer M, Fletcher SJ. Fracture of the cricoid cartilage after Sellick's manoeuvre. Br J Anaesth 1996;76(6):877-878. 14. Notcutt W. Oesophageal rupture and cricoid pressure. Anaesthesia 1991;46(5):424-425. 15. Savino PB, Reichelderfer S, Mercer MP, et al. Direct Versus Video Laryngoscopy for Prehospital Intubation: A Systematic Review and Meta-analysis. Acad Emerg Med 2017;24(8):1018-1026. 16. Messa MJ, Kupas DF, Dunham DL. Comparison of bougie-assisted intubation with traditional endotracheal intubation in a simulated difficult airway. Prehosp Emerg Care 2011;15(1):30-33. 17. Driver BE, Prekker ME, Klein LR, et al. Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. JAMA 2018;319(21):2179-2189. 18. Driver B, Dodd K, Klein LR, et al. The Bougie and First-Pass Success in the Emergency Department. Ann Emerg Med 2017;70(4):473-478 e471. 19. Latimer AJ, Harrington B, Counts CR, et al. Routine Use of a Bougie Improves First-Attempt Intubation Success in the Out-of-Hospital Setting. Ann Emerg Med 2021;77(3):296-304. 20. Braude D, Richards M. Rapid Sequence Airway (RSA)--a novel approach to prehospital airway management. Prehosp Emerg Care 2007;11(2):250-252. 21. Braude D, Southard A, Bajema T, et al. Rapid sequence airway using the LMA-Supreme as a primary airway for 9 h in a multi-system trauma patient. Resuscitation 2010;81(9):1217. 22. Moss R, Porter K, Greaves I, et al. Pharmacologically assisted laryngeal mask insertion: a consensus statement. Emerg Med J 2013;30(12):1073-1075.

chicken comparison risks rapid references ghosting jama fracture eds paramedic emergency departments bougie anesthesiology burp airway feasibility resuscitation inclined anaesthesia laryngeal hospital setting sellick ann emerg med am j emerg med acad emerg med emerg med j br j anaesth naemsp cricoid prehosp emerg care can j anaesth

Podcast 698: Empathy, Burnout, and Patient Satisfaction

burnout patients empathy summarized emm synergistic patient satisfaction ama pra category emerg med j

Play Episode Listen Later Jul 27, 2021 2:36

Contributor: Aaron Lessen, MD Educational Pearls: Survey of EM physicians to self-report empathy and burnout levels and correlated with patient satisfaction scores Patient satisfaction was not affected by what the physicians thought about their level of empathy or burnout Patient satisfaction was affected by the patient's perception of empathetic behavior by the physician References Byrd J, Knowles H, Moore S, et al. Synergistic effects of emergency physician empathy and burnout on patient satisfaction: a prospective observational study [published online ahead of print, 2020 Nov 25]. Emerg Med J. 2020;emermed-2019-209393. doi:10.1136/emermed-2019-209393 Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at www.emergencymedicalminute.org/cme-courses/ and create an account. Donate to EMM today!

Nasopharyngeal Airway, The Truth!

Tim's Take Away on EMS and Education related topics

Play Episode Listen Later Jun 1, 2021 10:59

In this episode, we dive into looking at the controversy behind the use of the Nasopharyngeal Airway. We close out the episode with what the literature actually says about this simple life-saving device. References: Text Books Pre Hospital Trauma Life Support 9th Ed. 2019 AAOS Emergency Care and Transportation of the Sick and Injured, 12th Ed, 2021 Journals: Stat Pearls, Nasopharyngeal Airway. https://www.ncbi.nlm.nih.gov/books/NBK513220/ Roberts, K., Whallet, H., Bleetman, A.;Emerg Med J 2005;22:394–396. doi: 10.1136/emj.2004.021402 Thangavel AR, Panneerselvam S, Rudingwa P, Sivakumar RK. Nasopharyngeal airway size selection and its implication in the management of pediatric difficult airway. J Anaesthesiol Clin Pharmacolg 2020;36:565-6. Seo., et.al. Severe Spastic Trismus without Generalized Spasticity after Unilateral Brain Stem Stroke https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3309321/#:~:text=However%2C%20trismus%20after%20brain%20stem,brain%20injury%20is%20relatively%20common. The opinions expressed are those of the host and do not represent the opinions or views of the host's employers. The information contained in the podcasts does not constitute medical or legal advice.

sick seo transportation injured airway emerg med j

The 2 View: Episode 3

Play Episode Listen Later Mar 11, 2021 62:02

Welcome to episode 3 of The 2 View, the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 3 of The 2 View Pancreatitis Mederos MA, Reber HA, Girgis MD. Acute Pancreatitis: A Review. JAMA. Published January 26, 2021. Accessed February 3, 2021. https://jamanetwork.com/journals/jama/article-abstract/2775452 Besinger, B, Stehman, C. Pancreatitis and Cholecystitis. McGraw-Hill Medical. Accessed February 3, 2021. https://accessmedicine.mhmedical.com/content.aspx?bookid=2353§ionid=189593288 Singh VK, Wu BU, Bollen TL, et al. Early Systemic Inflammatory Response Syndrome is Associated with Severe Acute Pancreatitis. Clin Gastroenterol Hepatol. Published 2009. Accessed February 3, 2021. https://www.cghjournal.org/article/S1542-3565(09)00774-5/pdf#:~:text=Second%2C%20patients%20with%203%20or,care%2C%20and%2013%25%20died. Mofidi R, Duff MD, Wigmore SJ, Madhavan KK, Garden OJ, Parks RW. Association between early systemic inflammatory response, severity of multiorgan dysfunction and death in acute pancreatitis. Br J Surg. Published June 2006. Accessed February 3, 2021. https://pubmed.ncbi.nlm.nih.gov/16671062/ Murali, N. Pancreatic Disease. EM:RAP CorePendium. Emrap.org. Updated January 13, 2021. Accessed February 3, 2021. https://www.emrap.org/corependium/chapter/recNUBEcCXS86j9qX/Pancreatic-Disease Cast Cutter Roberts M, Roberts JR. The Proceduralist. https://www.theproceduralist.org/. Accessed February 3, 2021. Frosch, D, Knott, P. Cast Cutter. ScienceDirect. Published 2007. Accessed February 3, 2021. https://www.sciencedirect.com/topics/nursing-and-health-professions/cast-cutter Questions Local Reactions, Systemic Reactions, Adverse Events, and Serious Adverse Events: Pfizer-BioNTech COVID-19 Vaccine. Cdc.gov. Published January 14, 2021. Accessed February 3, 2021. https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/reactogenicity.html Local Reactions, Systemic Reactions, Adverse Events, and Serious Adverse Events: Moderna COVID-19 Vaccine. Cdc.gov. Published December 22, 2020. Accessed February 3, 2021. https://www.cdc.gov/vaccines/covid-19/info-by-product/moderna/reactogenicity.html Information on COVID-19 treatment, prevention and research. Nih.gov. Accessed February 3, 2021. https://www.covid19treatmentguidelines.nih.gov/ Targett C, Harris T. Towards evidence-based emergency medicine: Best BETs from the Manchester Royal Infirmary. BET 3: Can metronomes improve CPR quality? Emerg Med J. Published 2014. Accessed February 3, 2021. https://emj.bmj.com/content/31/3/251 Headaches/Migraine Volpi-Abadie J, Kaye AM, Kaye AD. Serotonin Syndrome. Ochsner J. Published Winter 2013. Accessed February 3, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865832/ Roberts, J. InFocus: The Best Three Treatments for Migraine. Emergency Medicine News. Published January 2018. Accessed February 3, 2021. https://journals.lww.com/em-news/Fulltext/2018/01000/InFocus_TheBestThreeTreatmentsforMigraine.8.aspx Roberts, J. InFocus: The Miserable, Misunderstood Migraine. Emergency Medicine News. Published December 2017. Accessed February 3, 2021. https://journals.lww.com/em-news/Fulltext/2017/12000/InFocus_TheMiserable,MisunderstoodMigraine.8.aspx Your resource for headache info. Americanheadachesociety.org. Published May 17, 2016. Accessed February 3, 2021. https://americanheadachesociety.org/

covid-19 vaccines cdc pac bet published headaches cpr nih msn jama best bets migraine knott frosch fulltext adverse events murali pancreatitis published may cholecystitis serotonin syndrome em rap emerg med j manchester royal infirmary

Telemedicine Part 1: Express Care

EM Pulse Podcast™

Play Episode Listen Later Feb 18, 2021 30:40

In our recent episode in the future of emergency medicine, several of our guests pointed to technological advances, including telemedicine, as key pieces in the evolution of our specialty. And, thanks in large part to the pandemic, the development and implementation of telemedicine has accelerated over the past year. In this episode, Dr. Josh Elder, Medical Director of Express Care at UC Davis, shares his experience creating a virtual urgent care. We discuss some of the advantages and disadvantages for both patients and providers, and explore how this service has proved to be a safe and efficient way to meet patients where they’re at. Have you tried telemedicine, either as a patient of provider? Share your experience with us via social media, @empulsepodcast, or through our website, ucdavisem.com. Stay tuned for next month’s episode when we explore another side of telemedicine - specialty consults for physicians! ***Please rate us and leave us a review on iTunes! It helps us reach more people.*** Hosts: Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis Guest: Dr. Josh Elder, Assistant Professor of Emergency Medicine and Medical Director of Express Care at UC Davis Health. Resources: Express Care at UC Davis Health Zimiles, A. Four new statistics that prove telemedicine isn’t just a pandemic fad. Medical Economics. Jul 8 2020 Chou E, Hsieh YL, Wolfshohl J, Green F, Bhakta T. Onsite telemedicine strategy for coronavirus (COVID-19) screening to limit exposure in ED. Emerg Med J. 2020 Jun;37(6):335-337. Golinelli, D., Boetto, E., Carullo, G., Landini, M. P., & Fantini, M. P. (2020). How the COVID-19 pandemic is favoring the adoption of digital technologies in healthcare: a rapid literature review. medRxiv. May 18, 2020. Bokolo Anthony Jnr. Use of Telemedicine and Virtual Care for Remote Treatment in Response to COVID-19 Pandemic. J Med Syst. 2020 Jun 15;44(7):132. *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

covid-19 pandemic care associate professor express assistant professor medical director uc davis emergency medicine telemedicine onsite virtual care hosts dr pediatric emergency medicine fantini uc davis department emerg med j josh elder

Pharmacy Phriday #8: Atropine with Ketamine for Conscious Sedation of Pediatrics

conscious edited pharmacy pediatrics pediatric ketamine epub pmid sedation summarized atropine am j emerg med emerg med j

Play Episode Listen Later Jan 29, 2021 3:00

Educational Pearls: Atropine has been shown to reduce hypersalivation as well as nausea and vomiting induced by ketamine sedation. Atropine can increase the occurrence of a transient rash, as well as tachycardia. There are no guidelines that recommend for or against atropine use in pediatric patients undergoing ketamine induced sedation. Ultimately, it is the providers decision to include atropine when performing ketamine sedation. Pediatric dosing for atropine is 0.01mg/kg IM. References Heinz P, Geelhoed GC, Wee C, Pascoe EM. Is atropine needed with ketamine sedation? A prospective, randomised, double blind study. Emerg Med J. 2006 Mar;23(3):206-9. doi: 10.1136/emj.2005.028969. PMID: 16498158; PMCID: PMC2464444. Chong JH, Chew SP, Ang AS. Is prophylactic atropine necessary during ketamine sedation in children? J Paediatr Child Health. 2013 Apr;49(4):309-12. doi: 10.1111/jpc.12149. Epub 2013 Mar 15. PMID: 23495827. Shi J, Li A, Wei Z, Liu Y, Xing C, Shi H, Ding H, Pan D, Ning G, Feng S. Ketamine versus ketamine pluses atropine for pediatric sedation: A meta-analysis. Am J Emerg Med. 2018 Jul;36(7):1280-1286. doi: 10.1016/j.ajem.2018.04.010. Epub 2018 Apr 5. PMID: 29656945. Presented and Summarized by Devan Naughton, 4th year pharmacy student | Edited by Ruben Marrero-Vasquez

Podcast 634: D10 for Hypoglycemia

Play Episode Listen Later Jan 25, 2021 4:28

Contributor: Dylan Luyten, MD Educational Pearls: D10 may be a better alternative to D50 in correcting hypoglycemia Risks of D50: Can cause extravasation injury Risk of rebound hypoglycemia D10 does not have the same risks and has no significant difference in reversal time of hypoglycemia compared to D50 References Kiefer MV, Gene Hern H, Alter HJ, Barger JB. Dextrose 10% in the treatment of out-of-hospital hypoglycemia. Prehosp Disaster Med. 2014 Apr;29(2):190-4. doi: 10.1017/S1049023X14000284. Epub 2014 Apr 15. PMID: 24735872. Moore C, Woollard M. Dextrose 10% or 50% in the treatment of hypoglycaemia out of hospital? A randomised controlled trial. Emerg Med J. 2005 Jul;22(7):512-5. doi: 10.1136/emj.2004.020693. PMID: 15983093; PMCID: PMC1726850. Summarized by John Spartz, MS3 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at www.emergencymedicalminute.com/cme-courses/ and create an account.

risk risks epub pmid hypoglycemia summarized dextrose ama pra category emerg med j d50

The 2 View: Episode 1

Pediatric Emergency Playbook

Play Episode Listen Later Jan 12, 2021 61:19

View the show notes in Google Docs here: http://bit.ly/3bFS43j Gonorrhea Updates Gonorrhea Treatment and Care. Centers for Disease Control and Prevention Website. https://www.cdc.gov/std/gonorrhea/treatment.htm. Published December 14, 2020. Accessed January 11, 2021. CDC No Longer Recommends Oral Drug for Gonorrhea Treatment. Centers for Disease Control and Prevention. https://www.cdc.gov/nchhstp/newsroom/2012/gctx-guidelines-pressrelease.html. Published August 9, 2012. Accessed January 11, 2021. Recurrent UTI Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2019). American Urological Association. https://www.auanet.org/guidelines/recurrent-uti?fbclid=IwAR1TwSTQNHv8PDWLfW7WjsDan46D_9b6Qs1ptJxaXr6YFnDpBeptpW3BY. Published 2019. Accessed January 11, 2021. Combo Ibuprofen and Acetaminophen / Pain Advil® Dual Action. GSK Expert Portal. https://www.gskhealthpartner.com/en-us/pain-relief/brands/advil/products/dual-action/?utmsource=google&utmmedium=cpc&utmterm=ibuprofen+acetaminophen&utmcampaign=GS+-+Unbranded+Advil+DA+-+Alone+-+PH. Accessed January 11, 2021. FDA approves GSK's Advil Dual Action with Acetaminophen for over-the-counter use in the United States. GSK. https://www.gsk.com/en-gb/media/press-releases/fda-approves-gsk-s-advil-dual-action-with-acetaminophen-for-over-the-counter-use-in-the-united-states/. Published March 2, 2020. Accessed January 11, 2021. Tanner T, Aspley S, Munn A, Thomas T. The pharmacokinetic profile of a novel fixed-dose combination tablet of ibuprofen and paracetamol. BMC clinical pharmacology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2906415/. Published July 5, 2010. Accessed January 11, 2021. Searle S, Muse D, Paluch E, et al. Efficacy and Safety of Single and Multiple Doses of a Fixed-dose Combination of Ibuprofen and Acetaminophen in the Treatment of Postsurgical Dental Pain: Results From 2 Phase 3, Randomized, Parallel-group, Double-blind, Placebo-controlled Studies. The Clinical journal of pain. https://pubmed.ncbi.nlm.nih.gov/32271183/. Published July 2020. Accessed January 11, 2021. 1000 mg versus 600/650 mg Acetaminophen for Pain or Fever: A Review of the Clinical Efficacy. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK373467/. Published June 17, 2016. Accessed January 11, 2021. Motov S. Is There a Limit to the Analgesic Effect of Pain Medications? Medscape. https://www.medscape.com/viewarticle/574279. Published June 17, 2008. Accessed January 11, 2021. Motov, Sergey. Faculty Forum: A Practical Approach to Pain Management. YouTube. https://www.youtube.com/watch?v=lJSioPsGw3A. The Center for Medical Education. Published December 2, 2020. Accessed January 1, 2021. Wuhrman E, Cooney MF. Acute Pain: Assessment and Treatment. Medscape. https://www.medscape.com/viewarticle/735034_4. Published January 3, 2011. Accessed January 11, 2021. Social Pain Dewall CN, Macdonald G, Webster GD, et al. Acetaminophen reduces social pain: behavioral and neural evidence. Psychological science. https://pubmed.ncbi.nlm.nih.gov/20548058/. Published June 14, 2010. Accessed January 11, 2021. Mischkowski D, Crocker J, Way BM. From painkiller to empathy killer: acetaminophen (paracetamol) reduces empathy for pain. Social cognitive and affective neuroscience. https://pubmed.ncbi.nlm.nih.gov/27217114/. Published May 5, 2016. Accessed January 11, 2021. Other / Recurrent liner notes Center for Medical Education. https://courses.ccme.org/. Accessed January 11, 2021. Roberts M, Roberts JR. The Proceduralist. https://www.theproceduralist.org/. Accessed January 11, 2021. The Procedural Pause by James R. Roberts, MD, & Martha Roberts, ACNP, PNP. Emergency Medicine News. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx. Accessed January 11, 2021. The Skeptics' Guide to Emergency Medicine. sgem.ccme.org. https://sgem.ccme.org/. Accessed January 11, 2021. Trivia Question: Send answers to 2viewcast@gmail.com Please note that you must answer the 2 part question to win a copy of the EMRA Pain Guide. “What controversial drug was given a black box warning for prolonged QT and torsades in 2012 and now has been declared by WHICH organization to be an effective and safe treatment use for nausea, vomiting, headache and agitation?” Practical Pain Management in Acute Care Setting Handout Sergey Motov, MD @painfreeED • Pain is one of the most common reasons for patients to visit the emergency department and other acute care settings. Due to the extensive number of visits related to pain, clinicians and midlevel providers should be aware of the various options, both pharmacological and nonpharmacological, available to treat patients with acute pain. • As the death toll from the opioid epidemic continues to grow, the use of opioids in the acute care setting as a first-line treatment for analgesia is becoming increasingly controversial and challenging. • There is a growing body of literature that is advocating for more judicious use of opioids and well as their prescribing and for broader use of non-pharmacological and non-opioid pain management strategies. • The channels/enzymes/receptors targeted analgesia (CERTA) concept is based on our improved understanding of the neurobiological aspect of pain with a shift from a symptom-based approach to pain to a mechanistic approach. This targeted analgesic approach allows for a broader utilization of synergistic combinations of nonopioid analgesia and more refined and judicious (rescue) use of opioids. These synergistic combinations result in greater analgesia, fewer side effects, lesser sedation, and shorter LOS. (Motov et al 2016) General Principles: Management of acute pain in the acute care setting should be patient-centered and pain syndrome-specific by using multimodal approach that include non-pharmacological modalities and pharmacological ones that include non-opioid and opioid analgesics. Assessment of acute pain should be based on a need for analgesics to improve functionality, rather than patients-reported pain scores. Brief pain inventory short form BPI-SF is better than NRS/VAS as it assesses quantitative and qualitative impact of pain (Im et al 2020). ED clinicians should engage patients in shared decision-making about overall treatment goals and expectations, the natural trajectory of the specific painful condition, and analgesic options including short-term and long-term benefits and risks of adverse effects. If acute pain lasting beyond the expected duration, complications of acute pain should be ruled out and transition to non-opioid therapy and non-pharmacological therapy should be attempted. Non-Pharmacologic Therapies • Acute care providers should consider applications of heat or cold as well as specific recommendations regarding activity and exercise. • Music therapy is a useful non-pharmacologic therapy for pain reduction in acute care setting (music-assisted relaxation, therapeutic listening/musical requests, musical diversion, song writing, and therapeutic singing (Mandel 2019). • The use of alternative and complementary therapies, such as acupuncture, guided imagery, cognitive-behavioral therapy, and hypnosis have not been systemically evaluated for use in the Acute care setting including ED. (Dillan 2005, Hoffman 2007) • In general, their application may be limited for a single visit, but continued investigation in their safety and efficacy is strongly encouraged. • Practitioners may also consider utilization of osteopathic manipulation techniques, such as high velocity, low amplitude techniques, muscle energy techniques, and soft tissue techniques for patients presenting to the acute care setting with pain syndromes of skeletal, arthroidal, or myofascial origins. (Eisenhart 2003) Opioids • Acute Care providers are uniquely positioned to combat the opioid epidemic by thoughtful prescribing of parenteral and oral opioids in inpatient setting and upon discharge, and through their engagement with opioid addicted patients in acute care setting. • Acute Care providers should make every effort to utilize non-pharmacological modalities and non-opioid analgesics to alleviate pain, and to use opioid analgesics only when the benefits of opioids are felt to outweigh the risks. (not routinely) • When opioids are used for acute pain, clinicians should combine them with non-pharmacologic and non-opioid pharmacologic therapy: Yoga, exercise, cognitive behavioral therapy, complementary/alternative medical therapies (acupuncture); NSAID's, Acetaminophen, Topical Analgesics, Nerve blocks, etc. • When considering opioids for acute pain, Acute Care providers should involve patients in shared decision-making about analgesic options and opioid alternatives, risks and benefits of opioid therapies, and rational expectations about the pain trajectory and management approach. • When considering opioids for acute pain, acute care providers should counsel patients regarding serious adverse effects such as sedation and respiratory depression, pruritus and constipation, and rapid development of tolerance and hyperalgesia. • When considering administration of opioids for acute pain, acute care providers should make every effort to accesses respective state's Prescription Drug Monitoring Program (PDMP). The data obtained from PDMP's to be used to identify excessive dosages and dangerous combinations, identify and counsel patients with opioid use disorder, offer referral for addiction treatment. • PDMPs can provide clinicians with comprehensive prescribing information to improve clinical decisions around opioids. However, PDMPs vary tremendously in their accessibility and usability in the ED, which limits their effectiveness at the point of care. Problems are complicated by varying state-to-state requirements for data availability and accessibility. Several potential solutions to improving the utility of PDMPs in EDs include integrating PDMPs with electronic health records, implementing unsolicited reporting and prescription context, improving PDMP accessibility, data analytics, and expanding the scope of PDMPs. (Eldert et al, 2018) • Parenteral opioids when used in titratable fashion are effective, safe, and easily reversible analgesics that quickly relieve pain. • Acute care clinicians should consider administering these analgesics for patients in acute pain where the likelihood of analgesic benefit is judged to exceed the likelihood of harm. • Parenteral opioids must be titrated regardless of their initial dosing regimens (weight-based or fixed) until pain is optimized to acceptable level (functionality status) or side effects become intolerable. • When parenteral opioids are used, patients should be engaged in shared-decision making regarding the route of administration, as repetitive attempts of IV cannulation and intramuscular injections are associated with pain. In addition, intramuscular injections are associated with unpredictable absorption rates, and complications such as muscle necrosis, soft tissue infection and the need for dose escalation. (Von Kemp 1989, Yamanaka 1985, Johnson 1976) • Morphine sulfate provides better balance of analgesic efficacy and safety among all parenteral opioids. a. Dosing regimens and routes: b. IV: 0.05-0.1mg/kg to start, titrate q 10-20 min c. IV: 4-6 mg fixed, titrate q 10-20 min d. SQ: 4-6 mg fixed, titrate q 20 min e. Nebulized: 0.2 mg/kg or 10-20 mg fixed, repeat q 15-20 min f. PCA: prone to dosing errors g. IM: should be avoided (pain, muscle fibrosis, necrosis, increase in dosing requirements) • Hydromorphone should be avoided as a first-line opioid due to significant euphoria and severe respiratory depression requiring naloxone reversal. Due to higher lipophilicity, Hydromorphone use is associated with higher rates of euphoria and subsequent development of addiction. Should hydromorphone be administered in higher than equi-analgesic morphine milligram equivalents, close cardiopulmonary monitoring is strongly recommended. Dosing h. IV: 0.2-0.5 mg initial, titrate q10-15 min i. IM: to be avoided (pain, muscle fibrosis, necrosis, increase in dosing requirements) j. PCA: prone to dosing errors (severe CNS and respiratory depression) k. Significantly worse AE profile in comparison to Morphine l. Equianalgesic IV conversion (1 mg HM=8mg of MS) m. Overprescribed in >50% of patients n. Inappropriately large dosing in EM literature: 2 mg IVP o. Abuse potential (severely euphoric due to lipophilicity) • Fentanyl is the most potent opioid, short-acting, requires frequent titration. Dosing: p. IV: 0.25-0.5 μg/kg (WB), titrate q10 min q. IV: 25-50 μg (fixed), titrate q10 min r. Nebulization: 2-4 μg/kg, titrate q20-30 min s. IN: 1-2 μg/kg, titrate q5-10min t. Transbuccal: 100-200μg disolvable tablets u. Transmucosal: 15-20 mcg/kg Lollypops • Opioids in Renal Insufficiency/Renal Failure Patients-requires balance of ORAE with pain control by starting with lower-than-recommended doses and slowly titrate up the dose while extending the dosing interval. (Dean 2004, Wright 2011) • Opioid-induced pruritus is centrally mediated process via μ-opioid receptors as naloxone, nalbuphine reverse it, and can be caused by opioids w/o histamine release (Fentanyl). Use ultra-low-dose naloxone of 0.25 -1 mcg/kg/hr with NNT of 3.5. (Kjellberg 2001) • When intravascular access is unobtainable, acute care clinicians should consider utilization of intranasal (fentanyl), nebulized (fentanyl and morphine), or transmucosal (rapidly dissolvable fentanyl tablets) routes of analgesic administration for patients with acute painful conditions. • Breath actuated nebulizer (BAN): enclosed canister, dual mode: continuous and on-demand, less occupational exposures. a. Fentanyl: 2-4 mcg//kg for children, 4 mcg/kg for adults: titration q 10 min up to three doses via breath-actuated nebulizer (BAN): systemic bioavailability of 50-60% of IV route. (Miner 2007, Furyk 2009, Farahmand 2014) b. Morphine: 10-20 mg g10 min up to 3 doses via breath-actuated nebulizer (BAN)-Systemic bioavailability (concentration) of 30-35% of IV Route. (Fulda 2005, Bounes 2009, Grissa 2015) c. Intranasal Fentanyl: IN via MAD at 1-2 mcg/kg titration q 5 min (use highly concentrated solution of 100mcg/ml for adults and 50 mcg/ml for children)- systemic bioavailability of 90% of IV dosing. (Karisen 2013, Borland 2007, Saunders 2010, Holdgate 2010) d. IN route: shorter time to analgesia, titratable, comparable pain relief to IV route, minimal amount of side effects, similar rates of rescue analgesia, great patients and staff satisfaction. Disadvantages: requires highly concentrated solutions that not readily available in the ED, contraindicated in facial/nasal trauma. Oral Opioids • Oral opioid administration is effective for most patients in the acute care setting, however, there is no appreciable analgesic difference between commonly used opioids (oxycodone, hydrocodone and morphine sulfate immediate release (MSIR). • When oral opioids are used for acute pain, the lowest effective dose and fewest number of tablets needed should be prescribed. In most cases, less than 3 days' worth are necessary, and rarely more than 5 days' worth are needed. • If painful condition outlasts three-day supply, re-evaluation in health-care facility is beneficial. Consider expediting follow-up care if the patient's condition is expected to require more than a three-day supply of opioid analgesics. • Only Immediate release (short-acting) formulary are to be prescribed in the acute care setting and at discharge. • Clinicians should not administer or prescribe long-acting, extended-release, or sustained-release opioid formulations, which include both oral and transdermal (fentanyl) medications in the acute care setting. These formulations are not indicated for acute pain and carry a high risk of overdose, particularly in opioid-naïve patients. • Acute care providers should counsel patients about safe medication storage and disposal, as well as the consequences of failure to do this; potential for abuse and misuse by others (teens and young adults), and potential for overdose and death (children and teens). • Oxycodone is no more effective than other opioids (hydrocodone, MSIR). Oxycodone has highest potential for abuse, misuse and diversion as well as increased risks of overdose, addiction and death. Oxycodone should be avoided as a first-line oral opioid for acute pain. ( Strayer 2016) • If still prescribed, lowest dose (5mg) in combination with acetaminophen (lowest dose of 325 mg) should be considered as it associated with less abuse and diversion (in theory). Potential for acetaminophen overdose exist though with combination. • Hydrocodone is three times more prescribed than oxycodone, but three times less used for non-medical purpose. Combo with APAP (Vicodin)-Use lowest effective dose for hydrocodone and APAP (5/325). (Quinn 1997, Adams 2006) • Immediate release morphine sulfate (MSIR) administration is associated with lesser degree of euphoria and consequently, less abuse potential (Wightman 2012). ED providers should consider prescribing Morphine Sulfate Immediate Release Tablets (MSIR) (Wong 2012, Campos 2014) for acute pain due to: o Similar analgesic efficacy to Oxycodone and Hydrocodone o Less euphoria (less abuse potential) o Less street value (less diversion) o More dysphoria in large doses o Less abuse liability and likeability • Tramadol should not be used in acute care setting and at discharge due to severe risks of adverse effects, drug-drug interactions, and overdose. There is very limited data supporting better analgesic efficacy of tramadol in comparison to placebo, or better analgesia than APAP or Ibuprofen. Tramadol dose not match analgesic efficacy of traditional opioids. (Juurlink 2018, Jasinski 1993, Babalonis 2013) • Side effects are: o Seizures o Hypoglycemia o Hyponatremia o Serotonin syndrome o Abuse and addiction • Codeine and Codeine/APAP is a weak analgesic that provides no better pain relief than placebo. Codeine must not be administered to children due to: o dangers of the polymorphisms of the cytochrome P450 iso-enzyme: o ultra-rapid metabolizers: respiratory depression and death o poor metabolizers: absent or insufficient pain relief • Transmucosal fentanyl (15 and 20 mcg/kg lollypops) has an onset of analgesia in 5 to 15 minutes with a peak effect seen in 15 to 30 minutes (Arthur 2012). • Transbuccal route can be used right at the triage to provide rapid analgesia and as a bridge to intravenous analgesia in acute care setting. (Ashburn 2011). A rapidly dissolving trans-buccal fentanyl (100mcg dose) provides fast pain relief onset (median 10 min), great analgesics efficacy, minimal need for rescue medication and lack of side effects in comparison to oxycodone/acetaminophen tablet (Shear 2010) • Morphine Milligram Equivalent (MME) is a numerical standard against which most opioids can be compared, yielding a comparison of each medication's potency. MME does not give any information of medications efficacy or how well medication works, but it is used to assess comparative potency of other analgesics. • By converting the dose of an opioid to a morphine equivalent dose, a clinician can determine whether a cumulative daily dose of opioids approaches an amount associated with increased risk of overdose and to identify patients who may benefit from closer monitoring, reduction or tapering of opioids, prescribing of naloxone, and other measures to reduce risk of overdose. • Opioid-induced hyperalgesia: o opioid-induced hyperalgesia (OIH) is a rare syndrome of increasing pain, often accompanied by neuroexcitatory effects, in the setting of increasing opioid therapy. o Morphine is by far the most common opiate implicated in OIH. Hydromorphone and oxycodone, members of the same class of opiate as morphine (phenanthrenes), can also cause OIH. Fentanyl, a synthetic opioid in the class of phenylpiperidine, is less likely to precipitate OIH. Existing data suggests that OIH is caused by multiple opioid-induced changes to the central nervous system including: -Activation of N-methyl-D-aspartate (NMDA) receptors -Inhibition of the glutamate transporter system -Increased levels of the pro-nociceptive peptides within the dorsal root ganglia -Activation of descending pain facilitation from the rostral ventromedial medulla -Neuroexcitatory effects provoked by metabolites of morphine and hydromorphone • OIH can be confused with tolerance as in both cases patients report increased pain on opioids. The two conditions can be differentiated based on the patient's response to opioids. In tolerance, the patient's pain will improve with dose escalation. In OIH, pain will worsen with opioid administration. This paradoxical effect is one of the hallmarks of the syndrome. Non-opioid analgesics • Acetaminophen is indicated for management of mild to moderate pain and as a single analgesic and has modest efficacy at most. Addition of Acetaminophen to Ibuprofen does not provide better analgesia for patients with acute low back pain. The greatest limitation to the use of intravenous (IV) versus oral acetaminophen is the nearly 100-fold cost differential, which is likely not justified by any marginal improvement in pain relief. Furthermore, IV APAP provide faster onset of analgesia only after an initial dose. (Yeh 2012, Serinken 2012) • NSAIDs should be administered at their lowest effective analgesic doses both in the ED and upon discharge and should be given for the shortest appropriate treatment course. Caution is strongly advised when NSAIDs are used in patients at risk for renal insufficiency, heart failure, and gastrointestinal hemorrhage, as well as in the elderly. Strong consideration should be given to topical NSAID's in managing as variety of acute and chronic painful Musculo-skeletal syndromes. The analgesic ceiling refers to the dose of a drug beyond which any further dose increase will not result in additional analgesic efficacy. Thus, the analgesics ceiling for ibuprofen is 400 mg per dose (1200 mg/24 h) and for ketorolac is 10 mg per dose (10 mg/24 h). These doses are less than those often prescribed for control of inflammation and fever. When it comes to equipotent doses of different NSAIDs, there is no difference in analgesic efficacy. • Ketamine, at sub-dissociative doses (also known as low-dose ketamine or analgesic dose ketamine) of 0.1 to 0.4 mg/kg, provided effective analgesia as a single agent or as an adjunct to opioids (reducing the need for opioids) in the treatment of acute traumatic and nontraumatic pain in the ED. This effective analgesia, however, must be balanced against high rates of minor adverse side effects (14%–80%), though typically short-lived and not requiring intervention. In addition to IV rout, ketamine can be administered via IN,SQ, and Nebulized route. • Local anesthetics are widely used in the ED for topical, local, regional, intra-articular, and systemic anesthesia and analgesia. Local anesthetics (esters and amides) possess analgesic and anti-hyperalgesic properties by non-competitively blocking neuronal sodium channels. o Topical analgesics containing lidocaine come in patches, ointments, and creams have been used to treat pain from acute sprains, strains, and contusions as well as variety of acute inflammatory and chronic neuropathic conditions, including postherpetic neuralgia (PHN), complex regional pain syndromes (CRPS) and painful diabetic neuropathy (PDN). o UGRA used for patients with lower extremity fractures or dislocations (eg, femoral nerve block, fascia iliaca compartment block) demonstrated significant pain control, decreased need for rescue analgesia, and first-attempt procedural success. In addition, UGRA demonstrated few procedural complications, minimal need for rescue analgesia, and great patient satisfaction. o Analgesic efficacy and safety of IV lidocaine has been evaluated in patients with renal colic and acute lower back pain. Although promising, this therapy will need to be studied in larger populations with underlying cardiac disease before it can be broadly used. o knvlsd • Antidopaminergic and Neuroleptics are frequently used in acute care settings for treatment of migraine headache, chronic abdominal pain, cannabis-induced hyperemesis. • Anti-convulsant (gabapentin and pregabalin) are not recommended for management of acute pain unless pain is of neuropathic origin. Side effects, particularly when combined with opioids (potentiation of euphoria and respiratory depression), titration to effect, and poor patients' compliance are limiting factors to their use. (Peckham 2018) References: Chang HY, Daubresse M, Kruszewski SP, et al. Prevalence and treatment of pain in EDs in the United States, 2000 to 2010. Am J Emerg Med 2014;32(5):421–31. Green SM. There is oligo-evidence for oligoanalgesia. Ann Emerg Med 2012;60: 212–4. Strayer RJ, Motov SM, Nelson LS. Something for pain: Responsible opioid use in emergency medicine. Am J Emerg Med. 2017 Feb;35(2):337-341. Smith RJ, Rhodes K, Paciotti B, Kelly S,et al. Patient Perspectives of Acute Pain Management in the Era of the Opioid Epidemic. Ann Emerg Med. 2015 Sep;66(3):246-252 Meisel ZF, Smith RJ. Engaging patients around the risks of opioid misuse in the emergency department. Pain Manag. 2015 Sep;5(5):323-6. Wightman R, Perrone J. (2017). Opioids. In Strayer R, Motov S, Nelson L (Eds.), Management of Pain and Procedural Sedation in Acute Care. http://painandpsa.org/opioids/ Motov S, Nelson L, Advanced Concepts and Controversies in Emergency Department Pain Management. Anesthesiol Clin. 2016 Jun;34(2):271-85. doi: 10.1016/j.anclin.2016.01.006. Ducharme J. Non-opioid pain medications to consider for emergency department patients. Available at: http://www.acepnow.com/article/non-opioid-painmedications- consider-emergency-department-patients/. 2015. Wightman R, Perrone J, Portelli I, et al. Likeability and Abuse Liability of Commonly Prescribed Opioids. J Med Toxicol. September 2012. doi: 10.1007/s12181-012-0263-x Zacny JP, Lichtor SA. Within-subject comparison of the psychopharmacological profiles of oral oxycodone and oral morphine in non-drug-abusing volunteers. Psychopharmacology (Berl) 2008 Jan;196(1):105–16. Hoppe JA, Nelson LS, Perrone J, Weiner SG, Prescribing Opioids Safely in the Emergency Department (POSED) Study Investigators. Opioid Prescribing in a Cross Section of US Emergency Departments. Ann Emerg Med. 2015;66(3):253–259. Baehren DF, Marco CA, Droz DE, et al. A statewide prescription monitoring program affects emergency department prescribing behaviors. Ann Emerg Med. 2010; 56(1):19–23 Weiner SG, Griggs CA, Mitchell PM, et al. Clinician impression versus prescription drug monitoring program criteria in the assessment of drug-seeking behavior in the emergency department. Ann Emerg Med 2013;62(4):281–9. Greenwood-Ericksen MB, Poon SJ, Nelson LS, Weiner SG, et al. Best Practices for Prescription Drug Monitoring Programs in the Emergency Department Setting: Results of an Expert Panel. Ann Emerg Med. 2016 Jun;67(6):755-764 Patanwala AE, Keim SM, Erstad BL. Intravenous opioids for severe acute pain in the emergency department. Ann Pharmacother 2010;44(11):1800–9. Bijur PE, Kenny MK, Gallagher EJ. Intravenous morphine at 0.1 mg/kg is not effective for controlling severe acute pain in the majority of patients. Ann Emerg Med 2005; 46:362–7. Birnbaum A, Esses D, Bijur PE, et al. Randomized double-blind placebo- controlled trial of two intravenous morphine dosages (0.10 mg/kg and 0.15 mg/kg) in emergency department patients with moderate to severe acute pain. Ann Emerg Med. 2007;49(4):445–53. Patanwala AE, Edwards CJ, Stolz L, et al. Should morphine dosing be weight based for analgesia in the emergency department? J Opioid Manag 2012; 8(1):51–5. Lvovschi V, Auburn F, Bonnet P, et al. Intravenous morphine titration to treat severe pain in the ED. Am J Emerg Med 2008;26:676–82. Chang AK, Bijur PE, Napolitano A, Lupow J, et al. Two milligrams i.v. hydromorphone is efficacious for treating pain but is associated with oxygen desaturation. J Opioid Manag. 2009 Mar-Apr;5(2):75-80. Sutter ME, Wintemute GJ, Clarke SO, et al. The changing use of intravenous opioids in an emergency department. West J Emerg Med 2015;16:1079-83. Miner JR, Kletti C, Herold M, et al. Randomized clinical trial of nebulized fentanyl citrate versus i.v. fentanyl citrate in children presenting to the emergency department with acute pain. Acad Emerg Med 2007;14:895–8. Furyk JS, Grabowski WJ, Black LH. Nebulized fentanyl versus intravenous morphine in children with suspected limb fractures in the emergency department: a randomized controlled trial. Emerg Med Australas 2009;21:203–9. Borland M, Jacobs I, King B, et al. A randomized controlled trial comparing intranasal fentanyl to intravenous morphine for managing acute pain in children in the emergency department. Ann Emerg Med 2007;49:335–40 Im DD, Jambaulikar GD, Kikut A, Gale J, Weiner SG. Brief Pain Inventory-Short Form: A New Method for Assessing Pain in the Emergency Department. Pain Med. 2020 Sep 11:ppnaa269. doi: 10.1093/pm/pnaa269. Epub ahead of print. PMID: 32918473. Mandel SE, Davis BA, Secic M. Patient Satisfaction and Benefits of Music Therapy Services to Manage Stress and Pain in the Hospital Emergency Department. J Music Ther. 2019 May 10;56(2):149-173. Piatka C, Beckett RD. Propofol for Treatment of Acute Migraine in the Emergency Department: A Systematic Review. Acad Emerg Med. 2020 Feb;27(2):148-160. Tzabazis A, Kori S, Mechanic J, Miller J, Pascual C, Manering N, Carson D, Klukinov M, Spierings E, Jacobs D, Cuellar J, Frey WH 2nd, Hanson L, Angst M, Yeomans DC. Oxytocin and Migraine Headache. Headache. 2017 May;57 Suppl 2:64-75. doi: 10.1111/head.13082. PMID: 28485846. Yeh YC, Reddy P. Clinical and economic evidence for intravenous acetaminophen. Pharmacotherapy 2012;32(6):559–79. Serinken M, Eken C, Turkcuer I, et al. Intravenous paracetamol versus morphine for renal colic in the emergency department: a randomised double-blinded controlled trial. Emerg Med J 2012;29(11):902–5. Wright JM, Price SD, Watson WA. NSAID use and efficacy in the emergency department: single doses of oral ibuprofen versus intramuscular ketorolac. Ann Pharmacother 1994;28(3):309–12. Turturro MA, Paris PM, Seaberg DC. Intramuscular ketorolac versus oral ibuprofen in acute musculoskeletal pain. Ann Emerg Med 1995;26(2):117–20. Catapano MS. The analgesic efficacy of ketorolac for acute pain [review]. J Emerg Med 1996;14(1):67–75 Dillard JN, Knapp S. Complementary and alternative pain therapy in the emergency department. Emerg Med Clin North Am 2005; 23:529–549. Hoffman BM, Papas RK, Chatkoff DK, Kerns RD. Meta-analysis of psychological interventions for chronic low back pain. Health Psychol 2007;26:1–9. Eisenhart AW, Gaeta TJ, Yens DP. Osteopathic manipulative treatment in the emergency department for patients with acute ankle injuries. J Am Osteopath Assoc 2003;103:417–421.

united states music social guide pain care ms benefits management local single yoga safety md treatments phase abuse breath studies engaging adams wright prevention fda iv era pac limit responsible best practices similar published clinical psychological centers increased mad opioids practitioners headaches caution hoffman parallel disease control campos existing addition miners national center fentanyl saunders activation controversies combo placebos wb msn ban clinicians nerve acute combination hm emergency medicine ketamine google docs nurse practitioners efficacy pain management skeptics topical eds prevalence np cns epub oxytocin ae manage stress medical education emergency departments opioid epidemic certa complementary qt disadvantages pca sergey physician assistants gsk mandel pmid morphine suppl bmc dosing nsaids sq peckham ibuprofen randomized expert panel pnp mme shear ashburn inhibition yeh crps medscape acute care fulda likeability osteopathic intravenous nsaid borland codeine acetaminophen pharmacotherapy tramadol dillan patient satisfaction propofol nmda oxycodone inappropriately wightman strayer pdn pain medications apap king b parenteral mar apr cross section patient perspectives analgesic published may published march phn nnt opioid prescribing kjellberg published july musculo p450 published august jasinski american urological association furyk advanced concepts hydrocodone ann emerg med eisenhart am j emerg med procedural sedation pdmp acad emerg med nebulized j emerg med emerg med j oih emerg med clin north am

Prostate Pro Tips

Urgent Care RAP

Play Episode Listen Later Oct 17, 2020 14:18

This free iTunes segment is just one tiny snippet of the fully-loaded 3-hour monthly Urgent Care RAP show. Earn CME on your commute while getting the latest practice-changing urgent care information: journal article breakdowns, evidence-based topic reviews, critical guideline updates, conversations with experts, and so much more. Sign up for the full show at hippoed.com/UCRAPPOD When someone comes in with prostate related symptoms and infection, it’s hard to know if we’re working with prostatitis vs prostate abscess. How can we improve our prostate game? Tarlan Hedayati, MD schools Matthieu DeClerck, MD, and Neda Frayha, MD with her prostate pro-tips. Pearls: Think about acute bacterial prostatitis when someone presents with symptoms of acute prostatitis AND has the following characteristics: immunocompromised, symptoms > 36 hours, progressive urinary retention, recent antibiotics for prostatitis. Avoid prostate exams in people with neutropenia given theoretical risk of seeding bacteria. Distinguishing between acute bacterial prostatitis and prostate abscess can be difficult because patients will look sick (fever, tachycardia, abdominal pain) in both cases Suprapubic pain Abdominal pain Urinary retention History of having had prostatitis in the past Pain with defecation or with prolonged sitting Immunocompromised patient Protracted symptoms > 36 hours Progressive urinary retention Patients who have received antibiotics for prostatitis but are getting worse Overlap symptom: Physical exam and CT scan ultimately will help rule out deadly abscess or other Things to make you think more about abscess: Pearl: do not send a PSA during acute prostatitis. Leads to unnecessary worry and future monitoring of PSA levels. Prostate exam tips: Start with palpation of the anal-rectal junction to get a sense if discomfort is coming from the exam itself versus the prostate and examine if there a rectal abscess Palpate the prostate last to feel for bogginess, tenderness Prostate massage is supposed to increase the sensitivity of urine culture by squeezing bacteria out of the prostate into the urethra. However given the discomfort, probably not needed in the emergency or even primary care setting → it should be a quick exam Pearl: avoid prostate exam in people with neutropenia given theoretical risk of seeding bacteria Categories of prostatitis: A urinalysis, gram stain and culture should not have any bacteria Patients have been dealing with for a longer time and are non-toxic appearing Chronically have WBC’s in the urine with no symptoms Diagnosed by biopsy Acute bacterial prostatitis Chronic bacterial prostatitis Chronic prostatitis or chronic pelvic pain (90% of prostatitis) Asymptomatic inflammatory prostatitis Treatment: E-coli is the bacteria you’re treating against → check your local antibiogram for resistance patterns Prostate abscess 5th or 6th decade of life Immunosuppression End stage renal disease Indwelling catheter Any recent instrumentation of the prostate Potential complication of inflammatory prostatitis At most 2.5% of patients Risk factors: REFERENCE: Carroll DE, Marr I, Huang GKL, Holt DC, Tong SYC, Boutlis CS. Staphylococcus aureus Prostatic abscess: a clinical case report and a review of the literature. BMC Infect Dis. 2017 Jul 21;17(1):509. Datillo WR, Shiber J. Prostatitis or prostatic abscess. J of Emerg Med. 2013; 44(1):e121-e122 Hsieh MJ, Yen ZS. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 1: Is there a role for serum prostate-specific antigen level in the diagnosis of acute prostatitis? Emerg Med J. 2008 Aug;25(8):522-3. Khan FU, Ihsan AU, Khan HU, Jana R, Wazir J, Khongorzul P, Waqar M, Zhou X. Comprehensive overview of prostatitis. Biomed Pharmacother. 2017 Oct;94:1064-1076.

history pain risk patients md leads progressive bet psa chronic bets diagnosed comprehensive acute wbc pro tips prostate distinguishing abdominal overlap indwelling chronically urinary asymptomatic staphylococcus immunocompromised protracted prostatitis prostatic emerg med j manchester royal infirmary neda frayha palpate

Episódio 41: Polêmicas da Sepse

Ta de Clinicagem

Play Episode Listen Later May 27, 2020 49:36

Fred, Pedro, Rapha e João selecionaram quatro tópicos polêmicos de sepse para discutir nesse episódio! Um tema relevante para todos. Ficou com alguma dúvida, quer mandar alguma sugestão ou crítica? Entra em contato com a gente através do Instagram ou Twitter @tadeclinicagem ou e-mail tadeclinicagem@gmail.com. Assina nossa Newsletter semanal com os temas mais interessantes da clínica médica! O link está disponível no Instagram e no Twitter. MINUTAGEM Em breve REFERÊNCIAS 1. FUJII, Tomoko et al. Effect of vitamin C, hydrocortisone, and thiamine vs hydrocortisone alone on time alive and free of vasopressor support among patients with septic shock: the vitamins randomized clinical trial. Jama, v. 323, n. 5, p. 423-431, 2020 2. DE GROOTH, Harm-Jan; ELBERS, Paul WG; VINCENT, Jean-Louis. Vitamin C for Sepsis and Acute Respiratory Failure. Jama, v. 323, n. 8, p. 792-792, 2020 3. TRUWIT, Jonathon D. et al. Effect of vitamin C infusion on organ failure and biomarkers of inflammation and vascular injury in patients with sepsis and severe acute respiratory failure: the CITRIS-ALI randomized clinical trial. Jama, v. 322, n. 13, p. 1261-1270, 2019 4. CHANG, Ping et al. Combined treatment with hydrocortisone, vitamin C, and thiamine for sepsis and septic shock (HYVCTTSSS): A randomized controlled clinical trial. Chest, 2020 5. VENKATESH, Balasubramanian et al. Adjunctive glucocorticoid therapy in patients with septic shock. New England Journal of Medicine, v. 378, n. 9, p. 797-808, 2018. 6. ANNANE, Djillali et al. Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. Intensive care medicine, v. 43, n. 12, p. 1751-1763, 2017. 7. ROCHWERG, Bram et al. Corticosteroids in sepsis: an updated systematic review and meta-analysis. Critical care medicine, v. 46, n. 9, p. 1411-1420, 2018 8. ANTAL, Oana, et al. "Initial Fluid Resuscitation Following Adjusted Body Weight Dosing in Sepsis and Septic Shock." The Journal of Critical Care Medicine 5.4 (2019): 130-135 9. SEYMOUR, Christopher W., et al. "Time to treatment and mortality during mandated emergency care for sepsis." New England Journal of Medicine 376.23 (2017): 2235-2244 10. OUELLETTE, Daniel R., and Sadia Z. Shah. "Comparison of outcomes from sepsis between patients with and without pre-existing left ventricular dysfunction: a case-control analysis." Critical Care 18.2 (2014): R79 11. RAJDEV, Kartikeya, et al. "Fluid resuscitation in patients with end-stage renal disease on hemodialysis presenting with severe sepsis or septic shock: A case control study." Journal of critical care 55 (2020): 157-162 12. BHATTACHARJEE, Poushali, Dana P. Edelson, and Matthew M. Churpek. "Identifying patients with sepsis on the hospital wards." Chest 151.4 (2017): 898-907 13. HAYDAR, Samir, et al. "Comparison of QSOFA score and SIRS criteria as screening mechanisms for emergency department sepsis." The American journal of emergency medicine 35.11 (2017): 1730-1733 14. JIANG, Jianjun, et al. "Head-to-head comparison of qSOFA and SIRS criteria in predicting the mortality of infected patients in the emergency department: a meta-analysis." Scandinavian journal of trauma, resuscitation and emergency medicine 26.1 (2018): 56 15. GOULDEN, Robert, et al. "qSOFA, SIRS and NEWS for predicting inhospital mortality and ICU admission in emergency admissions treated as sepsis." Emerg Med J 35.6 (2018): 345-349

Ludwig's Angina

EMGuidewire's podcast

Play Episode Listen Later Jan 30, 2020 12:10

Join the EMGuideWire Crew from CMC EM Residency Program as they discuss Ludwig's Angina and the management Priorities!!! BACKGROUND Angina = “Strangling” Bilateral infection of submental, submandibular, and sublingual spaces 70-85% of cases arise from odontogenic source Periapical abscesses of mandibular molars Piercings (frenulum) URI more common cause in children Source of infection often polymicrobial Most commonly viridans; also Staphylococcus and Bacteroides species Patients usually 20-60 years-old; more common in males1 Mortality in treated Ludwig’s Angina = 8%7 ***Airway compromise = leading cause of death8 Who Is At Risk? Diabetes mellitus Chronic alcohol abuse IVDA HIV/AIDS Malnutrition Poor oral hygiene Smokers Anatomy & Pathophysiology Mylohyoid subdivides submandibular space: Sublingual space Submaxillary (submylohyoid) space Infection extends posteriorly and superiorly, elevating tongue against hypopharynx If left untreated, can extend inferiorly to retropharyngeal space and into superior mediastinum3 Clinical Signs & Symptoms Dysphagia Odynophagia Trismus Edema of upper midline neck and floor of mouth Raised tongue "Woody" or brawny texture to floor of mouth with visible swelling and erythema Late Findings Drooling Tongue protrusion Trismus Dysphonia Cyanosis Acute laryngospasm Stridor Patients may demonstrate signs of systemic toxicity → fever, tachycardia, and hypotension How Do I Make the Diagnosis? Clinically! Consider CT head/neck Can help evaluate extent of infection if clinical situation persists CBC Chemistry Lactate Blood Cultures Management Emergent ENT/OMFS consult for I&D in OR and extraction of dentition if source is dental abscess Airway Management Intubation will be VERY difficult due to trismus and posterior pharyngeal extension Ideal situation = awake fiberoptic intubation in OR ALWAYS have a surgical airway ready as your back up plan Blind insertion devices (e.g. intubating LMA) are NOT recommended Management - Antibiotics Must cover typical polymicrobial oral flora Immunocompetent 3rd-generation Cephalosporin + (Clindamycin or Metronidazole) Ampicillin/Sulbactam Penicillin G + Metronidazole Clindamycin (allergic to penicillin) Immunocompromised → *Need MRSA and GNR coverage!3 Cefepime + Metronidazole Meropenem Piperacillin-tazobactam Add Vancomycin if concern for MRSA risk factors Steroids Dexamethasone 10 mg IV Thought to chemically decompress for airway protection and increase antibiotic penetration6 Nebulized epinephrine Resuscitation and pain control Complications Intracranial infections (e.g. CST, brain abscess) IJ thrombophlebitis (Lemirre’s Syndrome) Mediastinitis Mandibular osteomyelitis Empyema Pearls Three characteristics of Ludwig’s angina can be remembered as the 3 Fs: Feared Often Fatal Rarely Fluctuant ABCs—Sit upright Early notification of ENT/OMFS and anesthesia to facilitate definitive airway management Arrange for the patient to be admitted to ICU Priorities!!! Secure the airway EARLY! Prepare and be ready for a difficult airway — expect that the patient will require a surgical airway Prevent the development of septic shock and multi-organ failure — give antibiotics early References Lin HW, O’Neil A, Cunningham MJ. Ludwig’s Angina in the Pediatric Population. Clin Pediatr (Phila) 2009;48:583-7. Baez-Pravia, Orville V. et al. “Should We Consider IgG Hypogammaglobulinemia a Risk Factor for Severe Complications of Ludwig Angina?: A Case Report and Review of the Literature.” Medicine. 2017;96(47):e8708. Pandey M, Kaur M, Sanwal M, Jain A, Sinha SK. Ludwig’s Angina in children anesthesiologist’s nightmare: Case series and review of literature. J Anaesthesiol Clin Pharmacol. 2017 Jul-Sep;33(3):406-409. Botha A, Jacobs F, Postma C. Retrospective analysis of etiology and comorbid diseases associated with Ludwig’s Angina Ann Maxillofac Surg. 2015 Jul-Dec;5(2):168-73. Parhiscar A, Har-El G. Deep neck abscess: a retrospective review of 210 cases. Ann Otol Rhinol Laryngol 110: 1051, 2001. Saifeldeen K, R Evans. Ludwig’s Angina. Emerg Med J 2004; 21: 242-243 Nanda N, Zalzal HG, Borah Gl. Negative-Pressure Wound Therapy for Ludwig’s Angina: A Case Series.Plast Reconstr Surg Glob Open2017 Nov 7;5(11):e1561. Pak S, Cha D, Meyer C, Dee C, Fershko A.Ludwig’s Angina. Cureus. 2017 Aug 21;9(8):e1588.

education deep medicine patients medical blind id emergency raised ideal priorities secure literature prevent chronic compromise retrospective infection woody ludwig mortality piercings risk factors uri arrange mrsa airway gnr resuscitation ij staphylococcus angina lma bacteroides nebulized emerg med j jul sep how do i make

EP 166. Sepsis 2019

Contagium's podcast

Play Episode Listen Later Sep 15, 2019 20:53

El 13 de septiembre ha sido instituido como Día Mundial de la Sepsis, con el objetivo de crear conocimiento y conciencia sobre esta patología que todavía buscamos definir e identificar de forma mas precisa. Así que en nuestro episodio de esta semana vamos a interrumpir la serie que veníamos realizando sobre resistencia y vamos a dedicarlo a la sepsis. La idea es mencionar aspectos novedosos e interesantes sobre este concepto que han surgido sobre los últimos dos años. Referencias: Goulden R, Hoyle M-C, Monis J y Colaboradores. qSOFA, SIRS and NEWS for predicting inhospital mortality and ICU admission in emergency admissions treated as sepsis. Emerg Med J 2018;35:345–349. Usman OA y colaboradores. Comparison of SIRS, qSOFA, and NEWS for the early identification of sepsis in the Emergency Department. American Journal of Emergency Medicine 37 (2019) 1490–1497. Hernandez G y colaboradores. Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock The ANDROMEDA-SHOCK Randomized Clinical Trial. JAMA. 2019;321(7):654-664. doi:10.1001/jama.2019.0071. Semler MW y colaboradores. Balanced Crystalloids versus Saline in Critically Ill Adults. N Engl J Med 2018; 378:829-839. Self WH y colaboradores. Balanced Crystalloids versus Saline in Noncritically Ill Adults. N Engl J Med 2018; 378:819-828. Permpikul C y colaboradores. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER). A Randomized Trial. Am J Resp Crit Care Med 2019; 199 (9): 1097-1105. Annane D y colaboradores. Hydrocortisone plus Fludrocortisone for Adults with Septic Shock. New Engl j Med 2018; 378:809-18. La Frase de la Semana: Esta semana la tomamos de Jean-Paul Sartre nacido el 21 de junio de 1905 en París, Francia, y fallecido el 15 de abril de 1980 en París. Fue novelista, dramaturgo y exponente francés del existencialismo, una filosofía que aclama la libertad del ser humano individual. Fue galardonado con el Premio Nobel de Literatura en 1964, pero lo rechazó. La Frase dice: “Como todos los soñadores, confundí el desencanto con la verdad”

Intraosseous Devices

Play Episode Listen Later Sep 1, 2019 46:27

https://www.youtube.com/watch?v=cQVKIpLc8bk Selected References Barnard, et al. Rapid sequence induction of anaesthesia via the intraosseous route: a prospective observational study. Emerg Med J. 2014; Jun 24. pii: emermed-2014-203740. Jousi M, Saikko S, Nurmi J. Intraosseous blood samples for point-of-care analysis: agreement between intraosseous and arterial analyses. Scand J Trauma Resusc Emerg Med. 2017;25(1):92. Published 2017 Sep 11. doi:10.1186/s13049-017-0435-4 Knuth, et al. Intraosseous Injection of Iodinated Computed Tomography Contrast Agent in an Adult Blunt Trauma Patient. Annals of Emergency Medicine. 2011; 57 (4) 382-386 Miller LJ. et al A new study of intraosseous blood for laboratory analysis.Arch Pathol Lab Med. 2010 Sep;134(9):1253-60. Miller, et al. Utility of an intraosseous vascular system to deliver contrast dye using a power injector for computerized tomography studies. Annals of Emergency Medicine. 2011; 58 (4) 240-241.

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Stroke; Roadside to Resus

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Play Episode Listen Later Jul 15, 2019 45:13

Stroke is a common presentation to all Emergency Health care providers, with around 150,000 strokes occurring in the UK each year! Our impact and treatment can be hugely significant and in this podcast we’re going to conver the topic in some depth, and importantly cover some of the new Guidance published by NICE in their ‘Stroke and transient ischaemic attack in the over 16’s diagnosis and initial management’ document that was published in May of this year. We'll be running through Definition Pathophysiology Territories Risk factors Assessment; both prehospitally and in hospital Stroke mimics Investigations As always we’d love to hear any thoughts or comments you have on the website and via twitter. Enjoy! Simon, Rob & James References Stroke & Dizziness; PHEMCAST RCEMLearning; RCEM Belfast Vertigo Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. NICE guideline.Published: 1 May 2019 Acute Stroke Lecture notes; LITFL Stroke Thrombolysis; LITFL Are you at risk of a Stroke; Stroke Association Modifiable Risk Factors for Stroke and Strategies for Stroke Prevention.Hill VA. Semin Neurol. 2017 A systematic review of stroke recognition instruments in hospital and prehospital settings. Rudd M. Emerg Med J. 2016 Acute Stroke Diagnosis.Kenneth S. Yew. Am Fam Physician. 2009 Imaging of acute stroke prior to treatment: current practice and evolving techniques.G Mair. Br J Radiol. 2014 Should CT Angiography be a Routine Component of Acute Stroke Imaging?Vanja Douglas. Neuro hospitalist. 2015 Comparative Sensitivity of Computed Tomography vs. Magnetic Resonance Imaging for Detecting Acute Posterior Fossa Infarct. David Y Hwang. J Emerg Med. 2013 Posterior circulation ischaemic stroke. A Merwick BMJ 2014 Prehospital stroke scales as screening tools for early identification of stroke and transient ischemic attack (Review)Zhelev Z, Walker G, Henschke N, Fridhandler J, Yip S. 2019. Cochrane.

Ep 138 - Traumatic Cardiac Arrest with Prof Jason Smith RN

The St.Emlyn's Podcast

Play Episode Listen Later Jun 7, 2019 25:33

This is the podcast that accompanies the recent blog post on Jason's latest research on traumatic cardiac arrest and closed chest compressions. This discussion is more wider ranging and explores how the management of TCA has changed, and is changing as we begin to gain a better understanding of the physiological mechanisms underpinning our resuscitation strategies. Read the blog here. http://www.stemlynsblog.org/jc-should-we-use-chest-compressions-in-traumatic-cardiac-arrest-st-emlyns/ Key references Closed chest compressions reduce survival in an animal model of haemorrhage-induced traumatic cardiac arrest.Watts S, Smith JE, Gwyther R, Kirkman E. Resuscitation. 2019 May 9;140:37-42. doi: 10.1016/j.resuscitation.2019.04.048. [Epub ahead of print] Paediatric traumatic cardiac arrest: the development of an algorithm to guide recognition, management and decisions to terminate resuscitation. Vassallo J, Nutbeam T, Rickard AC, Lyttle MD, Scholefield B, Maconochie IK, Smith JE; PERUKI (Paediatric Emergency Research in the UK and Ireland). Emerg Med J. 2018 Nov;35(11):669-674. doi: 10.1136/emermed-2018-207739. Epub 2018 Aug 28. 5. Paediatric traumatic cardiac arrest: a Delphi study to establish consensus on definition and management. Rickard AC, Vassallo J, Nutbeam T, Lyttle MD, Maconochie IK, Enki DG, Smith JE; PERUKI (Paediatric Emergency Research in the UK and Ireland). Emerg Med J. 2018 Jul;35(7):434-439. doi: 10.1136/emermed-2017-207226. Epub 2018 Apr 28. The outcome of patients in traumatic cardiac arrest presenting to deployed military medical treatment facilities: data from the UK Joint Theatre Trauma Registry. Barnard EBG, Hunt PAF, Lewis PEH, Smith JE. J R Army Med Corps. 2018 Jul;164(3):150-154. doi: 10.1136/jramc-2017-000818. Epub 2017 Oct 6. Smith JE, Rickard A, Wise D. Traumatic cardiac arrest. J R Soc Med. January 2015:11-16. doi:10.1177/0141076814560837 May N. Traumatic Cardiac Arrest. St Emlyn's. http://www.stemlynsblog.org/traumatic-cardiac-arrest/. Published 2012. Accessed 2019.

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Podcast # 467: Cauda Equina Syndrome

trauma symptoms delays mri emergent cauda equina syndrome pubmed pmid emerg med j

Play Episode Listen Later May 9, 2019 2:50

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, hematoma, disc rupture/herniation can cause this - basically anything that can cause pressure and fill space Symptoms can include saddle anesthesia, lower extremity pain, numbness, incontinence, and constipation Post-void residual that is abnormally high may be an indicator MRI is diagnostic modality of choice Emergent surgical decompression is treatment References Jalloh I, Minhas P. Delays in the treatment of cauda equina syndrome due to its variable clinical features in patients presenting to the emergency department. Emerg Med J. 2007 Jan;24(1):33-4. doi: 10.1136/emj.2006.038182. PubMed PMID: 17183040; PubMed Central PMCID: PMC2658150.

Podcast # 456 Hypoglycemia: Not feeling so sweet

Play Episode Listen Later Apr 12, 2019 4:13

Author: Jared Scott, MD Educational Pearls: Beta-blockers can mask the effects of hypoglycemia Prolonged/refractory hypoglycemia should raise a suspicion for sulfonylurea (or other oral hypoglycemic) overdose Interventions to reverse hypoglycemia include feeding the patient, IV dextrose, glucagon Octreotide can be used as an antidote with sulfonylurea ingestion Editor’s note: Here is an interesting case report on using steroids for severe hypogylcemia caused by insulin overdose. Perhaps another treatment modality to keep in your back pocket? References Alsahli M, Gerich JE. Hypoglycemia. Endocrinol Metab Clin North Am. 2013 Dec;42(4):657-76. doi: 10.1016/j.ecl.2013.07.002. Review. PubMed PMID: 24286945. Moore C, Woollard M. Dextrose 10% or 50% in the treatment of hypoglycaemia out of hospital? A randomised controlled trial.Emerg Med J. 2005 Jul;22(7):512-5. PubMed PMID: 15983093; PubMed Central PMCID: PMC1726850. Fasano CJ, O'Malley G, Dominici P, Aguilera E, Latta DR. Comparison of octreotide and standard therapy versus standard therapy alone for the treatment of sulfonylurea-induced hypoglycemia. Ann Emerg Med. 2008 Apr;51(4):400-6. Epub 2007 Aug 30. PubMed PMID: 17764782. Summarized by Will Dewispelaere, MS3 | Edited by Erik Verzemnieks, MD

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Podcast #447: IV Tylenol

md iv tylenol epub intravenous summarized pubmed pmid emerg med j

Play Episode Listen Later Mar 20, 2019 3:06

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 While the actual acquisition cost of these drugs are not significant, the cost multipliers that are passed onto patients lead to real dollars With the significant cost of IV acetaminophen, it may not be the best choice given the lack of superiority to other formulations References: Furyk J, Levas D, Close B, Laspina K, Fitzpatrick M, Robinson K, Vangaveti VN, Ray R. Intravenous versus oral paracetamol for acute pain in adults in the emergency department setting: a prospective, double-blind, double-dummy, randomised controlled trial.Emerg Med J. 2018 Mar;35(3):179-184. doi: 10.1136/emermed-2017-206787. Epub 2017 Dec 15. PubMed PMID: 29247042. Summarized by Will Dewsipelaere, MS3 | Edited by Erik Verzemnieks, MD

Podcast #406: PO vs. IV Tylenol

md edited tylenol epub intravenous current evidence may jun ms4 pubmed pmid emerg med j

Play Episode Listen Later Nov 19, 2018 2:45

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 a lack of additional evidence to support intravenous over oral formulations solely for pain control Oral Tylenol appears to be at least equally efficacious, though with a slightly slower onset of action References: Furyk J, Levas D, Close B, Laspina K, Fitzpatrick M, Robinson K, Vangaveti VN, Ray R. Intravenous versus oral paracetamol for acute pain in adults in the emergency department setting: a prospective, double-blind, double-dummy, randomised controlled trial. Emerg Med J. 2018 Mar;35(3):179-184. doi: 10.1136/emermed-2017-206787. Epub 2017 Dec 15. PubMed PMID: 29247042. Jibril F, Sharaby S, Mohamed A, Wilby KJ. Intravenous versus Oral Acetaminophen for Pain: Systematic Review of Current Evidence to Support Clinical Decision-Making. Can J Hosp Pharm. 2015 May-Jun;68(3):238-47. Review. PubMed PMID: 26157186; PubMed Central PMCID: PMC4485512. Summary by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD

Episode 16 - Congestive Heart Failure Part 2 - Nitro, Nitro, Nitro

MCHD Paramedic Podcast

Play Episode Listen Later Jun 25, 2018 16:48

Patients with acute pulmonary edema need rapid preload and afterload reduction and often their volume status is difficult to ascertain. Casey Patrick and Brad Ward discuss a novel approach to using our old friend nitroglycerin in these patients along with the other cornerstones of their care. References 1. Cotter G, Metzkor E, Kaluski E, et al. Randomised trial of high-dose isosorbide dinitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema. Lancet. 1998;351(9100):389-93. 2. Levy P, Compton S, Welch R, et al. Treatment of severe decompensated heart failure with high-dose intravenous nitroglycerin: a feasibility and outcome analysis. Ann Emerg Med. 2007;50(2):144-52. 3. Wilson SS, Kwiatkowski GM, Millis SR, et al. Use of nitroglycerin by bolus prevents intensive care unit admission in patients with acute hypertensive heart failure. Am J Emerg Med. 2017;35(1):126-31. 4. Peacock WF et al. Morphine and Outcomes in Acute Decompensated Heart Failure: An ADHERE Analysis. Emerg Med J 2008; 25: 205 – 209.

patients treatments outcomes lancet nitro morphine congestive heart failure randomised ann emerg med brad ward am j emerg med emerg med j

Catching Pee in the ED

EM Pulse Podcast™

Play Episode Listen Later Jun 3, 2018 6:52

Catching Pee in the ED In this Heartbeat we go over two alternatives to cathing that infant in your ED. If you had an infant who needed to be cathed, ever seen an infant cathed, or even heard a child cathed, you know it is less than fun. Here are two different, published methods that we attempted, back to back, on an infant…then we ended up doing the cath anyway! Join the conversation on Social Media @empulsepodcast or at ucdavisem.com Host: Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis. Guest: Keyon Mitchell, UC Davis Medical School Graduate Class of 2018. Resources: Hall-million S, Howard PK. Does Suprapubic Stimulation in Infants Facilitate Collection of a Clean Catch Urine Specimen? Adv Emerg Nurs J. 2017 Oct/Dec;39(4):236-239. https://www.ncbi.nlm.nih.gov/pubmed/29095174 Kaufman J, Tosif S, Fitzpatrick P, Hopper SM, Bryant PA, Donath SM, Babi FE. Quick Wee: a novel non-invasive urine collection method. Emerg Med J. 2017 jan;34(1):63-64. https://www.ncbi.nlm.nih.gov/pubmed/27565196 Kaufman J, Fitzpatrick P, Tosif S, Hopper SM, Donath SM, Vryant PA, Babe FE. Faster clean catch urine collection (Quick-Wee method) from infants: randomized controlled trial. BMJ 2017 Apr 7; 356:j1341. https://www.ncbi.nlm.nih.gov/pubmed/28389435 Labrosse M, Levy A, Autmizguine J, Gravel J. Evaluation of a New Strategy for Clean-Catch Urine in Infants. Pediatrics. 2016 Sep;138(3). pie:e20160573. https://www.ncbi.nlm.nih.gov/pubmed/27542848 Ray S, Forbes O. Quick-Wee is an effective technique for urine collection in infants. Arch Dis Child Edu Pract Ed. 2017 Oct 9. https://www.ncbi.nlm.nih.gov/pubmed/28993431 Tran A, Fortier C, Giovanni-chami L, demnchy D, Caci H, Desmontilis J, Montaudie-Dumas I, Bensaid R, Haas H, Berard E. Evaluation of the Bladder Stimulation Technique to Collect Midstream Urine in Infants in a Pediatric Emergency Department. PLoS one. 2016 mar 31;11(3):e0152598. https://www.ncbi.nlm.nih.gov/pubmed/?term=Evaluation+of+the+Bladder+Stimulation+technique+to+collect+midstream+urine Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

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Episode 17 – Managing Shoulder Injuries in the Emergency Department Fracture, Dislocation, and Overuse

EMplify by EB Medicine

Play Episode Listen Later Jun 1, 2018

Join hosts Jeff Nusbaum, MD, and Nachi Gupta, MD on this episode of EMplify as they take you through the June 2018 issue of Emergency Medicine Practice: Managing Shoulder Injuries in the Emergency Department Fracture, Dislocation, and Overuse. This month, Richard Pescatore, director of clinical research at Crozer-Keystone Health System and clinical assistant professor at the Rowan University School of Osteopathic Medicine, along with Andrew Nyce, vice chairman and associate professor at cooper medical school of Rowan University reviewed just over 100 articles to come up with their evidence-based recommendations. Their recommendations were then edited by John Munyak of Maimonides and Mark Silverberg of SUNY Downstate and Kings County Hospital. Most Important References * Ponce BA, Kundukulam JA, Pflugner R, et al. Sternoclavicular joint surgery: how far does danger lurk below? J Shoulder Elbow Surg. 2013;22(7):993-999. (Prospective cohort; 49 patients) * Slaven EJ, Mathers J. Differential diagnosis of shoulder and cervical pain: a case report. J Man Manip Ther. 2010;18(4):191-196. (Case report) * Helfen T, Ockert B, Pozder P, et al. Management of prehospital shoulder dislocation: feasibility and need of reduction. Eur J Trauma Emerg Surg. 2016;42(3):357-362. (Retrospective review; 70 patients) * Lenza M, Belloti JC, Andriolo RB, et al. Conservative interventions for treating middle third clavicle fractures in adolescents and adults. Cochrane Database Syst Rev. 2014(5):CD007121. (Systematic review; 3 trials, 354 patients) * Neer CS, 2nd. Displaced proximal humeral fractures: part I. Classification and evaluation. 1970. Clin Orthop Relat Res. 2006;442:77-82. (Review article) * Sholsberg J, Jackson R. Best evidence topic report. Intra-articular corticosteroid injections in acute rheumatoid monoarthritides. Emerg Med J. 2004;21(2):204. (Systematic review; 1 study, 137 patients)

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Episode 17 - Managing Shoulder Injuries in the Emergency Department Fracture, Dislocation, and Overuse

EMplify by EB Medicine

Play Episode Listen Later Jun 1, 2018

25 - Salt Water

Bedside Rounds

Play Episode Listen Later Aug 1, 2017 21:07

Intravenous or IV fluids are a ubiquitous treatment in medicine, and one of the most cost-effective treatments that we have, costing less than a cup of coffee in the developing world. But it wasn’t always this way. In this episode, called Salt Water, we go back to the second great cholera epidemic, where a young doctor developed IV fluids to help fight this mysterious disease, only to see his invention abandoned for over half a century. We also have a new #AdamAnswers about bloodletting. So join us for another rollicking adventure of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine! Sources: Foex B. How the cholera epidemic of 1831 resulted in a newtechnique for fluid resuscitation. Emerg Med J 2003;20:316–318. Gill G. William O’Shaughnessy and the forgotten cure for cholerain the 1832 British epidemic. Letter from Lord Cavendish: Online at: http://mssweb.nottingham.ac.uk/elearning/view-text.asp?resource=HealthHousing&ref=pwh287&theme=3&view=text&page=1 O'Shaughnessy, W.B. (1838–40). "Case of Tetanus, Cured by a Preparation of Hemp (the Cannabis indica.)". Transactions of the Medical and Physical Society of Bengal. 8: 462–469. Chan C, et al. Historical Epidemiology of the Second Cholera Pandemic: Relevance to Present Day Disease Dynamics. PLOS One: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0072498 BB4: Diary of an Epidemic. Online at: http://www.bbc.co.uk/radio4/history/longview/longview_20030415.shtml Kresta R. The Origin of IV Fluids. Discover Magazine. Online at: http://blogs.discovermagazine.com/bodyhorrors/2016/05/31/intravenous-fluids-cholera/#.WX9z4JdtmUl Prasad V and Cifu A, Medical Reversal: Why We Must Raise the Bar Before Adopting New Technologies. Yale J Biol Med. 2011 Dec; 84(4): 471–478. Further reading: r/AskHistorians thread: https://www.reddit.com/r/AskHistorians/comments/6nzbfz/if_bloodletting_was_rubbish_why_was_it_considered/ Ending Medical Reversal by Cifu and Prasad. On Amazon at: https://www.amazon.com/Ending-Medical-Reversal-Improving-Outcomes/dp/1421417723

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Should EM clinicians be allowed to RSI?

Play Episode Listen Later Dec 5, 2016 22:40

RSI delivered by EM clinicians is common place throughout the globe, in the UK however it still seems a contentious topic, with recent data showing only 20% of ED RSIs being performed by EM clinicians. I was lucky enough to be asked to talk at the ICS SoA 2016 conference on the topic of EM doctors carrying out RSI's in the UK and this podcast is a copy of that talk. I hope it provides some context both to UK practitioners and also to those from other countries, who may not understand what the big deal is all about. Simon References A randomized controlled trial on the effect of educational interventions in promoting airway management skill maintenance.Randomized controlled trial. Kovacs G, et al. Ann Emerg Med. 2000 Acute airway management in the emergency department by non-anesthesiologists. Review article. Kovacs G, et al. Can J Anaesth. 2004 Achieving house staff competence in emergency airway management: results of a teaching program using a computerized patient simulator. Mayo PH, et al. Crit Care Med. 2004 The who, where, and what of rapid sequence intubation: prospective observational study of emergency RSI outside the operating theatre. Reid C, et al. Emerg Med J. 2004 Rapid sequence induction of anaesthesia in UK emergency departments: a national census. Benger J, et al. Emerg Med J. 2011. Tracheal intubation in an urban emergency department in Scotland: a prospective, observational study of 3738 intubations. Kerslake D, et al. Resuscitation. 2015 Systematic review and meta-analysis of first-pass success rates in emergency department intubation: Creating a benchmark for emergency airway care. Park L, et al. Emerg Med Australas. 2016 Scottish Intensive Care Society: RSI Difficult Airway Society Guidelines RCOA Anaesthesia in the Emergency Department Guidelines; Chapter 6.1 John Hinds on RSI at RCEM 2015 Belfast Draft; AAGBI Guidelines: Safer pre-hospital anaesthesia 2016 AAGBI Pre-hospital Anaesthesia Guideline 2009

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October 2016; papers of the month

references papers etco2 emerg med j

Play Episode Listen Later Oct 1, 2016 28:54

This month we cover a paper looking at the role of early craniectomy for raised intracranial pressure, the outcomes associated with advanced airway managements in prehospital cardiac arrest and lastly at the utility on ETCO2 and consider if it's application decreases adverse respiratory events. This month our great sponsors ADPRAC our giving away a £30 iTunes voucher to spend on education/entertainment to support your work life balance! All you need to do is click the link on our home page through to the ADPRAC website and answer the question relating to the podcast, good luck! References and Links Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension. Hutchinson PJ, N Engl J Med. 2016 Sep Capnography for procedural sedation in the ED: a systematic review. Dewdney C, Emerg Med J. 2016 The role of prehospital advanced airway management on outcomes for out-of-hospital cardiac arrest patients: a meta-analysis. Jeong S. Am J Emerg Med. 2016 Jul TheBottomLine - RESCUEicp ICS State of the Art Conference 2016: Find out more here

June 2016; papers of the month