Emergency Medical Minute

Discover the innovative use of intranasal fentanyl for managing severe pain in children. Learn about its fast-acting effects and lower adverse effects compared to traditional pain medications. The discussion highlights effective dosing techniques and emphasizes that intranasal options may simplify administration in emergency settings. Additionally, explore other important pain management strategies, including non-pharmacologic methods and alternative medications.

Explore the intriguing concept of cardiac asthma, a condition often confused with COPD. Discover how narrowing bronchioles lead to wheezing and the significance of crackles indicating pulmonary edema. Learn that about 35% of heart failure patients may experience bronchial edema, complicating diagnosis and treatment. Find out why it's essential to differentiate between COPD and heart failure wheezing for effective management, including the role of bedside ultrasounds and treatment strategies like diuresis and BiPAP.

The podcast dives into the therapeutic potential of psychedelics for mental health issues like depression and PTSD. It discusses classic psychedelics like psilocybin and LSD, as well as MDMA and ketamine. A key focus is a study revealing that recreational use of psychedelics significantly raises the risk of developing schizophrenia. The findings show a stark contrast in hazard ratios when compared to alcohol and cannabis. The conversation emphasizes the need to weigh the benefits against the risks, especially in emergency medical contexts.

Delve into the surprising cardiac effects of COVID-19. Learn how viral infection can lead to arrhythmias and the role of a hyperactive immune response. The prevalence of bradycardia among severe cases raises questions about long-term impacts. Atrial fibrillation emerges as a major concern, increasing the risk of strokes. Discover how inflammation may cause cardiac tissue fibrosis, contributing to ongoing arrhythmias even after recovery. This informative discussion shines a light on the hidden risks associated with the virus and the importance of monitoring.

Discover the latest in asthma management with combination rescue inhalers. These innovative inhalers not only deliver fast relief but also include a corticosteroid to combat chronic inflammation. Learn about the benefits of this new approach, including research findings that highlight reduced severe episodes. However, the cost and potential side effects like thrush pose challenges. Tune in to understand why global guidelines now favor this treatment for adults and adolescents.

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 90-95% of patients may tolerate a rechallenge after appropriate allergy evaluation Penicillin Allergy Decision Rule (PEN-FAST) on MD Calc Useful tool to assess patients for penicillin allergies Five years or less since reaction = 2 points (even if unknown) Anaphylaxis or angioedema OR Severe cutaneous reaction = 2 points  Treatment required for reaction (e.g. epinephrine) = 1 point (even if unknown) A score of 0 on PEN-FAST indicates a less than 1% risk of a positive penicillin allergy test A score of 1 or 2 indicates a 5% risk of a positive penicillin allergy test A low score on PEN-FAST should prompt clinicians to proceed with the best empiric antibiotic for the patient’s infection References Broyles AD, Banerji A, Barmettler S, et al. Practical Guidance for the Evaluation and Management of Drug Hypersensitivity: Specific Drugs [published correction appears in J Allergy Clin Immunol Pract. 2021 Jan;9(1):603. doi: 10.1016/j.jaip.2020.10.025.] [published correction appears in J Allergy Clin Immunol Pract. 2021 Jan;9(1):605. doi: 10.1016/j.jaip.2020.11.036.]. J Allergy Clin Immunol Pract. 2020;8(9S):S16-S116. doi:10.1016/j.jaip.2020.08.006 Piotin A, Godet J, Trubiano JA, et al. Predictive factors of amoxicillin immediate hypersensitivity and validation of PEN-FAST clinical decision rule [published correction appears in Ann Allergy Asthma Immunol. 2022 Jun;128(6):740. doi: 10.1016/j.anai.2022.04.005.]. Ann Allergy Asthma Immunol. 2022;128(1):27-32. doi:10.1016/j.anai.2021.07.005 Shenoy ES, Macy E, Rowe T, Blumenthal KG. Evaluation and Management of Penicillin Allergy: A Review. JAMA. 2019;321(2):188-199. doi:10.1001/jama.2018.19283 Trubiano JA, Vogrin S, Chua KYL, et al. Development and Validation of a Penicillin Allergy Clinical Decision Rule. JAMA Intern Med. 2020;180(5):745-752. doi:10.1001/jamainternmed.2020.0403 Summarized & edited by Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/  

Delve into the fascinating world of heart transplants where unique physiological changes like the absence of vagal tone lead to an increased heart rate. Discover how transplant patients face atypical symptoms during rejection, such as fatigue instead of chest pain. Immunosuppressants raise infection risks, adding complexity to patient care. Plus, a surprising study reveals that radiographic cardiomegaly doesn't necessarily indicate heart failure, challenging conventional wisdom.

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% What are the types of seizures? Simple: Tonic-clonic seizure, duration 15 minutes, requires medication to stop the seizing, multiple occurrences in a 24-hour period, PRESENCE of focal features, PRESENCE of Todd’s paralysis What are the causes? Caused by infectious agents leading to fever. Seen with common childhood infections.  It is debated whether the absolute temperature of the fever or the rate of change of temperature incites the seizure, but current evidence points to the rate of change of the temperature being the primary catalyst What are the treatment considerations? For simple febrile seizures, work-up is similar to any pediatric patient presenting with a fever between the ages of six months and five years Thorough physical exam to rule out any potential of meningeal or intracranial infections Prophylactic antipyretics are not believed to prevent the occurrence of febrile seizures Disposition?  If the patient has returned to normal baseline behavior following a simple febrile seizure, and the physical exam is reassuring, the patient can be discharged home.  Additional labs, electroencephalogram, or lumbar punctures are not indicated in simple febrile seizures as long as the physical exam is completely normal Any evidence of a complex seizure requires further workup Fast Facts:  Patients with a familial history of febrile seizures and developmental delays have a higher risk of developing febrile seizures If a child has one febrile seizure, there is a 30-40% chance of another febrile seizure by age 5 Only 2-7% of children with febrile seizures go on to develop epilepsy References:  1. Berg AT, Shinnar S, Hauser WA, Alemany M, Shapiro ED, Salomon ME, et al. A prospective study of recurrent febrile seizures. N Engl J Med. 1992 Oct 15;327(16):1122–7.  2. Schuchmann S, Vanhatalo S, Kaila K. Neurobiological and physiological mechanisms of fever-related epileptiform syndromes. Brain Dev. 2009 May;31(5):378–82.  3. Nilsson G, Westerlund J, Fernell E, Billstedt E, Miniscalco C, Arvidsson T, et al. Neurodevelopmental problems should be considered in children with febrile seizures. Acta Paediatr. 2019 Aug;108(8):1507–14.  4. Subcommittee on Febrile Seizures, American Academy of Pediatrics. Neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics. 2011 Feb;127(2):389–94.  5. Pavlidou E, Panteliadis C. Prognostic factors for subsequent epilepsy in children with febrile seizures. Epilepsia. 2013 Dec;54(12):2101–7.  6. Huang CC, Wang ST, Chang YC, Huang MC, Chi YC, Tsai JJ. Risk factors for a first febrile convulsion in children: a population study in southern Taiwan. Epilepsia. 1999 Jun;40(6):719–25.  7. Hashimoto R, Suto M, Tsuji M, Sasaki H, Takehara K, Ishiguro A, et al. Use of antipyretics for preventing febrile seizure recurrence in children: a systematic review and meta-analysis. Eur J Pediatr. 2021 Apr;180(4):987–97.  Summarized by Dan Orbidan, OMS1 | Edited by Dan Orbidan & Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/

Contributor: Aaron Lessen, MD Educational Pearls: Point-of-care ultrasound (POCUS) is used to assess cardiac activity during cardiac arrest and can identify potential reversible causes such as pericardial tamponade Ultrasound could be beneficial in another way during cardiac arrest as well: pulse checks Manual palpation for detecting pulses is imperfect, with false positives and negatives Doppler ultrasound can be used as an adjunct or replacement to manual palpation for improved accuracy Options for Doppler ultrasound of carotid or femoral pulses during cardiac arrest: Visualize arterial pulsation Use color doppler Numerically quantify the flow and correlate this to a BP reading - slightly more complex Doppler ultrasound is much faster than manual palpation for pulse check Can provide information almost instantaneously without waiting the full 10 seconds for a manual pulse check The main priority during cardiac arrest resuscitation is to maintain quality compressions If pulses are unable to be obtained through Doppler within the 10-second window, resume compressions and try again during the next pulse check References Cohen AL, Li T, Becker LB, Owens C, Singh N, Gold A, Nelson MJ, Jafari D, Haddad G, Nello AV, Rolston DM; Northwell Health Biostatistics Unit. Femoral artery Doppler ultrasound is more accurate than manual palpation for pulse detection in cardiac arrest. Resuscitation. 2022 Apr;173:156-165. doi: 10.1016/j.resuscitation.2022.01.030. Epub 2022 Feb 4. PMID: 35131404. Summarized by Meg Joyce, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/

Discover the intriguing method of Hoover's Sign, a physical exam techique that distinguishes between organic and functional leg weakness. Learn how it works and its impressive diagnostic sensitivity and specificity. Delve into the fascinating world of neurological disorders and the role of brain signaling in functional neurologic dysfunction. Plus, explore a fun fact about the pulmonary Hoover’s Sign related to COPD, adding depth to your understanding of these critical assessments in medical practice.