Podcast #96: BRUE in Infants

Run Time: 2 minutes

Author: Dr. Suzanne Chilton

Educational Pearls:

• The American Academy of Pediatrics changed terminology for ALTE – Apparent Life Threatening Event in infants. The new term is BRUE – Brief Resolved Unexplained Event, which is much less scary. These children are also now divided into high and low risk categories.
• BRUE encompasses any event of cyanosis or pallor, decreased respiratory drive, and a change in tone or level of consciousness in any child less than one year of age.
• High risk BRUE has to meet the criteria of less than two months of age, less than 32 gestation, and lengthy or multiple episodes.
• Low risk BRUE has to meet the criteria of greater than two months of age, greater than 32 weeks of gestation, and only one episode.

Link to Podcast:  http://medicalminute.madewithopinion.com/brue-in-infants/

References:  http://pediatrics.aappublications.org/content/early/2016/04/21/peds.2016-0591

Podcast #59: The Zika Virus

Run Time: 5 minutes

Author: Dr. Suzanne Chilton

Educational Pearls:

• Zika originated in 1947 in a Risus monkey in Uganda, the first human case was in 1952 – spread by the Aedea aeygpti and the Aedes albopictus mosquitoes.
• For adults symptoms are mild – maculopapular rash, conjunctivitis, fever, and joint pain for several days to a week.
• Numerous birth defects for a child if a pregnant woman gets the Zika virus – it is not known what stage of pregnancy is most affected.
• The states that will be most affected by the Zika virus will likely be Texas and Florida, due to political and environmental factors.
• 3.5 millions people in Puerto Rico will have Zika within the next year.

Link to Podcast:  http://medicalminute.madewithopinion.com/the-zika-virus/

References:  http://www.who.int/mediacentre/factsheets/zika/en/

Podcast #56: 420! A Marijuana Podcast

Run Time: 16 minutes

Author: Dr. Donald Stader

Educational Pearls:

• Marijuana originally is from Asia and first used medically in China in 2400 B.C.
• 3 active metabolites in Marijuana: THC (tetrahydrocannabinol), Cannabidiol, Cannabigerol.
• Cannabidiol at low concentrations helps nausea, but at high concentrations induces nausea and vomiting.
• Cannabigerol has a pro-nausea effect.
• One study shows that Haldol can improve nausea in people with cannabis hyperemesis syndrome.
• Marijuana today has 3 times more THC content than even 30 year ago – which leads to anxiety in some patients.
• Children can get extremely ill when they come in contact with THC– seizures or coma state needing intubation and ICU admission.

Link to Podcast:  http://medicalminute.madewithopinion.com/420-marijuana-podcast/

References:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576702/

http://www.ncbi.nlm.nih.gov/pubmed/25393073

Podcast #51: Diverticulitis

Run Time: 3 minutes

Author: Dr. Michael Hunt

Educational Pearls:

• Diverticulitis is the inflammation of diverticula or projecting pockets coming off of the colon.
• 2-4% of the population have this and 15-30% have recurrences of diverticulitis. Most of these cases do not have any complications.
• Flagyl and ciprofloxacin are given normally to treat the infection in the United States. This can cause antibiotic related complications like Clostridium difficile.
• Certain European countries have altered their treatment plan to not prescribe antibiotics for non-complicated diverticulitis.
• The criteria for non-complicated are: health, no white count, no sepsis, no perforation, no abscess, and no peritonitis.

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

References: http://www.ncbi.nlm.nih.gov/pubmed/27053254

 

Podcast #45: No More NPO

Run Time: 3 minutes

Author: Dr. Mark Kozlowski

Educational Pearls:

• NPO or nil per os is a medical instruction meaning the patient should not have any food or drink orally.
• At Vanderbilt Medical Center, the nursing staff initiated a change in the NPO status from everyone has to be NPO to no one needs to be NPO in the emergency department.
• Patients are usually kept NPO because they may need surgery. The number of people who come in alert and oriented and end up in surgery is incredibly low. As well as this, anesthesia guidelines recommend NPO status for two hours prior to surgery.
• If the patient has normal mental status, have not had a stroke, and they are able to swallow they should be able to drink water and have ice chips.

Link to Podcast: http://medicalminute.madewithopinion.com/no-more-npo-1/

References: http://www.jenonline.org/article/S0099-1767(14)00530-3/abstract

Podcast #42: Andexanet for Xarelto?!

Run Time: 2 minutes

Author: Rachael Duncan, PharmD BCPS

Educational Pearls:

• Eliquis and Xarelto are oral anticoagulants that inhibit the clotting cascade.
• Currently prothrombin complex concentrate or PCC can be used to reverse the effects of Xarelto or Eliquis by overpowering the inhibition of the clotting cascade.
• Andexanet is a medication currently in phase III trials that is purposed with sequestering the anticoagulant effects of Xarelto and Eliquis, instead of simply overpowering the inhibition of the clotting cascade as PCC does.

Link to Podcast: http://medicalminute.madewithopinion.com/adexanet-for-xeralto/

References: http://www.nejm.org/doi/full/10.1056/NEJMoa1510991

 

Podcast #25: Care of a Transgender Patient

Run Time: 3 minutes

Author: Dr. Mark Kozlowski

Educational Pearls:

• There are 700,000 transgender people in US – 20-30% avoid coming to the ER because they feel uncomfortable in the ER and 25-30% are victims of some kind of abuse.
• It is important to refer to a transgender person by their preferred identity to improve their comfort in the ER and not by their appearance nor what they were born as – no “he-she” or “it” discussion should occur.
• The ER visit should be focused on the visit and the complaint not the fact that the patient is transgender – 90% of visits have nothing to do with being transgender.
• Do not assume that transgender person has gone through surgery – most have not.

Link to Podcast:  http://medicalminute.madewithopinion.com/care-of-transgender/

Podcast #7: Heroin Overdose and OTC Narcan

Run Time: 4 minutes

Author: Dr. Donald Stader

Educational Pearls:

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

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

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

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