Emergency Medical Minute

Contributor: Aaron Lessen, MD

Educational Pearls:

• Prehospital seizures are typically managed with intramuscular midazolam (Versed)
• Seizures theoretically involve the NMDA pathway, and ketamine is a potent NMDA antagonist
• A recent retrospective cohort study analyzed a Florida EMS protocol that uses ketamine in seizures refractory to midazolam
  • One group received two doses of midazolam for seizure control
  • The other group rec...

Contributor: Alec Coston, MD

Educational Pearls:

For patients presenting to the emergency room with hypertension, clinicians should determine if it is isolated and uncomplicated, or involves comorbidities with more complex underlying pathophysiology. 

For uncomplicated and isolated hypertension, first-line treatment is thiazide diuretics. 

How do thiazide diuretics work to treat hypertension?

• Thiazide diuretics work by blockin...
  

Contributor: Taylor Lynch, MD
Educational Pearls:

How do we risk-stratify chest-pain patients?

• One option is the HEART score
  • This score predicts a patient’s 6-week risk of a major adverse cardiac event.
    • Ex. Cath procedure, CABG, PCI, death
• H stands for History
  • Ask 1) Was the patient diaphoretic? 2) Did they have nausea and/or vomiting? 3) Did the pain radiate down the right or left arm? 4) Was it e...

Contributor: Aaron Lessen, MD
Educational Pearls:

• A prospective study at the Mayo Clinic Rochester was conducted to examine whether patients actively using their phones on initial assessment in the ED was associated with higher discharge rates
• The study included 292 patients, and only about 15% of patients were on their phone
  • The patients on their phone tended to be a younger demographic
• Scribes were trained to rec...

Contributor: Travis Barlock MD
Educational Pearls

• Frank’s sign is a curious physical exam finding first described in the literature in 1973
  • Bilateral earlobe creases are recognized as a marker of coronary artery disease and cerebrovascular disease
• Some studies have found an increase in all-cause mortality in patients with bilateral diagonal earlobe creases
• The pathophysiology is still not fully understood
  • One ...

Contributor: Taylor Lynch, MD
Educational Pearls:

The KLM Flight Disaster, also known as the Tenerife Airport Disaster, occurred on 27 March 1977. It involved the collision of two Boeing 747 passenger jets from KLM and Pan Am Airlines, resulting in 583 fatalities. 

What fell through the cracks to cause this incident?

• The captain of the KLM flight believed he had received clearance from air traffic control to take off, when in ...

Contributor: Aaron Lessen, MD
Educational Pearls:

How do we take care of kids in severe pain?

• There are many non-pharmacologic options for pain (i.e. ice, elevation) as well as more conventional medication options (i.e. acetaminophen, NSAIDS) but in severe pain stronger medications might be indicated.
• These stronger medications include options such as IV morphine, a subdissociative dose of ketamine, as well as intranasal fenta...

Contributor: Travis Barlock, MD
Educational Pearls:

• Wheezing is classically heard in asthma and COPD, but it can be the result of a wide range of processes that cause airflow limitation
  • Narrowed bronchioles lead to turbulent airflow → creates the wheezing
• Crackles (rales) suggest pulmonary edema which is often due to heart failure
• Approximately 35% of heart failure patients have bronchial edema, which can also prod...

Contributor: Jorge Chalit-Hernandez, OMS3
Educational Pearls:

• Psychedelics are being studied for their therapeutic effects in mental illnesses, including major depressive disorder, post-traumatic stress disorder, anxiety, and many others
• Classic psychedelics include compounds like psilocybin, LSD, and ayahuasca
  • MDMA and ketamine are often included in psychedelic research, but have a different mechanism of action than the ...

Contributor: Ricky Dhaliwal, MD
Educational Pearls:

What factors are considered in a COVID-19 infection?

• The viral load: Understood as the impact of SARS-CoV-2 viral particles infecting host cell tissue itself (utilizing ACE-2 receptors).
• Pro-Inflammatory Response: Post-infection, the body's downstream systemic cytokine release (can be both normal or hyperactive, aka “cytokine storm”).

What cardiac impacts have been obse...

Contributor: Aaron Lessen, MD

Educational Pearls:

What is a Rescue Inhaler?

• A rescue inhaler is a medication for people with asthma to quickly reverse the symptoms of an asthma attack. 

• Historically albuterol (Short Acting Beta Agonist (SABA)) monotherapy has been...

Contributor: Geoff Hogan MD

Educational Pearls:

• Penicillin allergies are relatively uncommon despite their frequent reports

• 10% of the population reports a penicillin allergy but only 5% of these cases are clinically significant

Contributor: Travis Barlock, MD

Educational Pearls:

• Key clinical considerations when managing heart transplant patients due to their unique pathophysiology

• 1. Arrhythmias

• A transplanted heart is denervated, m...

Contributor: Taylor Lynch, MD

Educational Pearls:

• Pediatric febrile seizures are defined as seizures that occur between the ages of six months to five years in the presence of a fever greater than or equal to 38.0 ºC (100.4 ºF). It is the most common pediatric convulsive disorder, with an incidence between 2-5%

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