Emergency Medical Minute

Discover the intriguing debate over oral and temporal thermometers in pediatric and adult patients. A recent study reveals 26% of children show significant differences, with temporal readings consistently lower. Adults aren't exempt, with 36% affected too, impacting clinical decisions. Factors like room temperature and perfusion inaccuracies contribute to errors. Understand how these discrepancies can hinder sepsis identification, stressing the need for accurate measurements. Ultimately, the discussion champions oral thermometers for their reliability despite being a bit more cumbersome in practice.

Contributor: Taylor Lynch, MD Educational Pearls: Delusional parasitosis is a subtype of the psychiatric condition delusional disorder Defined as a fixed, false belief of infestation by parasites or other organisms A somatic type of delusional disorder Primary delusional parasitosis Occurs in the absence of other psychiatric or medical conditions Secondary delusional parasitosis Causes include methamphetamine use disorder, schizophrenia, neurologic diseases, or medical conditions such as thyroid disease Pathophysiology Poorly understood Upregulation of striatal dopamine system is implicated Management Form a strong therapeutic alliance and do not discredit the patient immediately Perform a full physical exam This helps reassure the patient and strengthen the therapeutic alliance Some day there may be a patient in whom this is not a delusion Treatment & Management Discontinuation of substances if substance-induced Antipsychotic medications like risperidone or olanzapine References Lepping P, Russell I, Freudenmann RW. Antipsychotic treatment of primary delusional parasitosis: systematic review. Br J Psychiatry. 2007;191:198-205. doi:10.1192/bjp.bp.106.029660 Moriarty N, Alam M, Kalus A, O'Connor K. Current Understanding and Approach to Delusional Infestation. Am J Med. 2019;132(12):1401-1409. doi:10.1016/j.amjmed.2019.06.017 Skelton M, Khokhar WA, Thacker SP. Treatments for delusional disorder. Cochrane Database Syst Rev. 2015;2015(5):CD009785. Published 2015 May 22. doi:10.1002/14651858.CD009785.pub2 Summarized and Edited by Jorge Chalit, OMS4 Donate: https://emergencymedicalminute.org/donate/

Dive into the complexities of Alzheimer's treatment as advancements in anti-amyloid therapies come to light. Learn how these monoclonal antibodies aim to reduce amyloid plaques but come with risks like amyloid-related imaging abnormalities (ARIA). These side effects can mimic stroke symptoms, complicating emergency treatment. The discussion reveals the importance of MRI for detection and the critical need to check a patient's medication history before proceeding with stroke interventions.

A dramatic case unfolds as a 17-year-old girl suffers a severe epidural hematoma after a car crash. Rapid decompensation leads to urgent intervention when traditional tools aren't available. Ingeniously, an Intraosseous drill is repurposed to create a burr hole, resulting in immediate improvement in her condition. The discussion highlights critical insights on the importance of timely evacuation of hematomas to improve survival rates. Listeners gain practical advice tailored for rural emergency departments facing such challenges.

Explore the intriguing world of nursemaid's elbow, a common elbow condition in young children caused by sudden tugs on their arms. Learn how to identify it without x-rays, as kids usually just hold their arm close and avoid using it. Discover two reduction techniques: hyperpronation and flexion-supination, with hyperpronation boasting better success rates. Plus, find out what to do if reduction isn't effective. It's a valuable listen for anyone curious about pediatric emergencies and quick treatments!

Learn about the nuances of ACE inhibitor-induced angioedema and how it differs from anaphylaxis. Discover why traditional treatments like antihistamines fall short and the importance of timely airway management. Explore innovative therapies such as bradykinin antagonists and the potential role of fresh frozen plasma. The episode dives into clinical presentations, emphasizing the common symptoms and urgent treatment strategies for patients experiencing swelling.

Join forth-year medical student Jeffrey Olson as he presents captivating medical cases to Dr. Barlock. They dive into a 25-year-old man's severe chest pain, initially misdiagnosed as heartburn, revealing the critical process of diagnosis and the need for thorough imaging. The discussion extends to assessing shock symptoms in elderly patients, highlighting the role of family history. They also tackle complex trauma scenarios, emphasizing swift interventions and community engagement in emergency medicine education.

Dive into the intriguing world of meningitis retention syndrome, a rare condition linking aseptic meningitis and urinary retention. The discussion reveals clinical presentations like fever and stiff neck, typically appearing with urinary issues about a week later. Explore the potential immune-mediated dysfunction that affects the central nervous system and the implications for treatment, including supportive care and bladder decompression. The episode features fascinating case studies that illustrate this unique phenomenon.

Dive into the complexities of hepatic encephalopathy, a condition linked to liver dysfunction and characterized by confusion and cognitive decline. Discover why ammonia levels aren't reliable for diagnosis and the significance of clinical evaluation. Learn about the role of lactulose in treatment, which helps eliminate ammonia from the body while providing a laxative effect. The discussion also highlights the importance of ruling out other conditions when assessing neuropsychiatric symptoms in patients with cirrhosis.

Contributor: Taylor Lynch, MD Educational Pearls: What is atrial fibrillation with rapid ventricular response (AFib with RVR) and how does it differ from atrial fibrillation (AFib)? AFib is an abnormal heart rhythm in which the heart has disorganized atrial electrical activity. This causes the atria to quiver with only select signals being conducted through the Atrioventricular (AV) Node to reach the ventricles and result in ventricular contraction. Often described as "irregularly irregular", a patient's EKG will present with no discernible P-waves, and irregular R-R intervals. AFib with RVR is distinguished from AFib when the patient's ventricular rate is greater than 100-110 beats per minute in AFib with RVR. What is the treatment for AFib with RVR? Diltiazem is considered one of the first line therapeutic agents in the treatment of AFib with RVR. Diltiazem inhibits L-Type calcium channels in the AV Node, reducing the amount of signals conducted to the ventricles, thus reducing the ventricular rate. Why pretreat patients receiving Diltiazem for AFib with RVR with calcium? While diltiazem inhibits cardiac calcium channels, it may also cause peripheral vasodilation, resulting in diltiazem-induced hypotension. A recent study found that this hypotension can be blunted by pretreating with 1-2g IV Calcium Chloride (IV Calcium Gluconate can be used in the ED). Calcium is thought to peripherally stabilize the vascular smooth muscle, preventing vasodilation without impacting the desired calcium channel blocker action at the AV node. Key takeaways? In combination with slower pushes of diltiazem for patients in AFib with RVR (AFib with ventricular rate >100-110 bpm) with borderline low blood pressures, 1-2 g of IV Calcium Gluconate can combat diltiazem induced hypotension peripherally without negating the cardiac effect of diltiazem to reduce the heart rate. References 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024;149(1):e1-e156. doi:10.1161/CIR.0000000000001193 Az A, Sogut O, Dogan Y, et al. Reducing diltiazem-related hypotension in atrial fibrillation: Role of pretreatment intravenous calcium. Am J Emerg Med. 2025;88:23-28. doi:10.1016/j.ajem.2024.11.033 Summarized by Dan Orbidan, OMS2 | Edited by Dan Orbidan and Jorge Chalit, OMS4 Get your tickets to Tox Talks Event, Sept 11, 2025: https://emergencymedicalminute.org/events-2/ Donate: https://emergencymedicalminute.org/donate/