The Emergency Medical Minute Brewcast

 The Emergency Medical Minute Presents the Inaugural

Join us on Wednesday, March 1st 2017 for our very first Brewcast – Cardiac Arrest: Stories of Survival and Best Practices – while enjoying a tasting of three different beers with the brewmaster!

When: 7pm-10pm

Where: Dead Hippie Brewing

3701 S Santa Fe Dr Unit 7, Sheridan, CO 80110

We Are Sold Out!

Keep an eye out in the next few months for a post about our next Brewcast and keep on listening!

Podcast #184: Frostbite

Run Time: 3 minutes

Author: Michael Hunt M.D.

Educational Pearls:

• Frostbite injuries are graded by the severity of tissue depth.
• A Grade 1 injury has no cyanosis of the tissue, and usually just redness is present.
• A Grade 2 injury has acral cyanosis.
• A Grade 3 injury has cyanosis past the mid phalanx of the digits, resulting in a high chance of amputation.
• A Grade 4 injury has cyanosis beyond metacarpal/metatarsal phalangeal joints, and almost certain amputation.
• Treatment for frostbite is gradual rewarming in water of 100-104 degrees fahrenheit. If a patient has injuries to all 4 extremities the entire patient can be placed into a warm bath.
• It is suggested that IV or intra arterial tPA can also be used to improve salvage of the digits because ice crystals form in the tissues when frostbite occurs, and when the patient is rewarmed they can be subjected to clotting.
• The tPA must be started within 24hrs of rewarming – the time that the patient suffered the frostbite injury is not as important.

Link to Podcast: http://medicalminute.madewithopinion.com/frostbite/

References: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3440898/

Podcast #183: Ventriculoperitoneal Pediatric Shunt Malfunctions

Run Time:  1:56

Author: Dr. Iverson

Educational Pearls:

• Placement of a VP shunt is associated with premature delivery, hydrocephalus, or some other kind of injury as a means of draining excess CSF
• A malfunctioning VP shunt presents with vomiting, headache, altered mental status
• Workup includes the “shunt series”: xrays, head CT/rapid MRI
• In rapid MRI, need to take into consideration whether the VP shunt is programmable because the MRI could erase the programming
• Special attention needs to be given to patients that present with increased ICP.  You can give these patients 3% saline as a bridging measure but they need to be taken to the OR as soon as possible.

Link to Podcast: http://medicalminute.madewithopinion.com/pediatric-vp-shunt-malfunction/

References: http://www.healthline.com/health/ventriculoperitoneal-shunt

https://www.youtube.com/watch?v=Yb9dSjDykpI

Podcast #182: Syncope and PE

Run Time: 3:44 minutes

Author: Aaron Lessen, MD

Educational Pearls:

• A new Italian study has been released, which looks at the prevalence of Pulmonary Embolism (PE) in patients admitted for syncope.
• This study examined all patients admitted with syncope, regardless of their clinical picture, and worked them up for PE, which included wells score, D-dimer, and CT
• Study demonstrated 1 out of 6 pts admitted for syncope had a PE.
• Despite the headlines this study is making in the news, it is difficult to make conclusions. The study was not perfect, and mainly looked at a sick population of patients (only those who warranted admission) who had many comorbidities.  Until further studies are conduction, current practice should be to only work up syncope patients for a PE if they are exhibiting related signs and symptoms.

Link to Podcast: http://medicalminute.madewithopinion.com/syncope-and-pe/

References: http://www.heart.org/HEARTORG/Conditions/Arrhythmia/SymptomsDiagnosisMonitoringofArrhythmia/Syncope-Fainting_UCM_430006_Article.jsp

Podcast #181: Electrolyte Emergency

Run Time: 5 minutes

Author: Peter Bakes, MD

Educational Pearls:

• Calcium is ubiquitous ion in the body necessary for bone, muscle, and nerve function
• Hypocalcemia is associated with tetany (elicit Chvostek’s sign and Trousseau’s sign) and irritability
• Hypocalcemia can progress to seizures and prolonged QT which can cause cardiac arrest
• Hypocalcemia can be caused by vitamin D deficiency
• Patients with malabsorption are at risk of vitamin deficiencies

Link to Podcast: http://medicalminute.madewithopinion.com/electrolyte-emergency/

References: http://emedicine.medscape.com/article/241893-overview

http://www.mayoclinic.org/diseases-conditions/short-bowel-syndrome/basics/definition/con-20037215

Podcast #180: Aortic Dissection

Run Time:  4 minutes

Author: Jared Scott, MD

Educational Pearls:

• Aortic dissection = separation between 2 layers of vessel wall (usually intima and media)
• Aortic Aneurysm = cystic dilation of the aorta
• Aortic dissection associated with severe HTN or connective tissue disorders (Marfan’s, Ehlers-Danlos, etc.)
• AAA associated with HTN, DM, HLD, smoking (same risks for MI)
• Aortic dissection starts proximal in chest and peels down
• AAA confined to abdomen and can rupture. 90% mortality.

Link to Podcast: http://medicalminute.madewithopinion.com/aortic-dissection/

References: http://www.mayoclinic.org/diseases-conditions/aortic-dissection/basics/definition/con-20032930

Podcast #179: Concussions

Run Time: 1 minute

Author: Aaron Lessen M.D.

Educational Pearls:

• Patients with concussions are frequently seen in the ED, and generally are given good home health care precautions.
• A new study for post concussion management looked at driving performance after a concussion.
• The study showed that 48 hours after symptoms had resolved, patients who were diagnosed with a concussion did worse on a standard performance test than people without a concussion.

Link to Podcast: http://medicalminute.madewithopinion.com/concussions/

References: http://psycnet.apa.org/journals/neu/24/4/493/

http://emedicine.medscape.com/article/92095-overview

Podcast #178: Lupus Myocarditis

Run Time:  3 minutes

Author: Gretchen Hinson M.D.

Educational Pearls:

• Case presentation: a 44 year-old male after a syncope was found to have a heart rate of 261 wide complex tachycardia and a SBP in the 80s for EMS in the field. The patient was given adenosine on arrival to the ED, but with no resolution of the tachycardia, but after electrocardioversion the patient’s heart rate converted to 100 but still in a wide complex tachycardia.
• The missing piece of history for this patient is a diagnosis of lupus with previous pulmonary complications and systemic skin changes.
• Lupus can also cause myocarditis and conduction abnormalities along with the more common skin changes and renal complications.

Link to Podcast: http://medicalminute.madewithopinion.com/lupus-myocarditis/

References: http://rheumatology.oxfordjournals.org/content/45/suppl_4/iv8.full

Podcast #177: Rectal Prolapse

Run Time:  3 minutes

Author: Jared Scott M.D.

Educational Pearls:

• The true incidence of rectal prolapse is unknown because patients, understandably, under report.
• Rectal prolapse is most common in patients between 40-70s, but children generally under the age of 3 can have rectal prolapse as well.
• Women older than 50 are 6 times more likely to have rectal prolapse, but 35% of those patients have never had children. In males there is usually an underlying bowel dysfunction.
• Applying sugar to prolapsed rectum acts as a desiccant and takes out some of the tissue edema, which reduces the size of the prolapse and helps reduce the rectum.
• Theoretically any desiccant can be used, but most case reports suggest sugar. Desiccants can also be used to reduce colostomies and ileostomies.

Link to Podcast: http://medicalminute.madewithopinion.com/rectal-prolapse/

References: http://emedicine.medscape.com/article/2026460-overview

Podcast #176: Football Injuries

Run Time:  4 minutes

Author: Michael Hunt M.D.

Educational Pearls:

• Stinger – a stretch of cervical nerves from a lateral blow to the head and causes immediate pain and numbness in the arm. There is no specific treatment, and symptoms last seconds to minutes or as long as a few days. A small percentage of stingers result in significant neurologic damage.
• Hip pointer – a contusion of the pelvis most commonly at the iliac crest.
• Sports hernia – a soft tissue injury (muscle, ligament, tendon) that is torn or damaged in the groin or pelvic area. Some more serious tears may require surgery.
• Turf toe – hyperextension of the great toe that puts stress on MTP joint and causes a strain or sprain of the tendons. Categorized into grades 1, 2, & 3 based on severity from least serious to most serious.

Link to Podcast: http://medicalminute.madewithopinion.com/football-injuries/

References: http://www.stopsportsinjuries.org/STOP/Prevent_Injuries/Football_Skating_Injury_Prevention.aspx