Emergency Medical Minute

Contributor: Aaron Lessen, MD Educational Pearls: Recorded March 2025 What is the best treatment for a fever? Tylenol? Ibuprofen? Combined? Alternating the two? The journal Pediatrics aimed to answer this question with a meta-analysis of 31 randomized controlled trials including 5,009 febrile children. Results showed that both combined and alternating acetaminophen/ibuprofen regimens were significantly more effective at reducing fever at 4 and 6 hours compared with acetaminophen alone, with numbers needed to treat (NNT) of 3 and 4, respectively. High-dose ibuprofen alone also offered modest benefit (NNT 8). What dose should I use? Oral acetaminophen 10 to 15 mg/kg Every 4–6 hours as needed Do not exceed 75 mg/kg/day (or 4,000 mg/day maximum for older/larger kids) Oral ibuprofen 5 to 10 mg/kg Every 6–8 hours as needed Do not exceed 40 mg/kg/day (or 2,400 mg/day maximum for older/larger kids) References De la Cruz-Mena JE, Veroniki AA, Acosta-Reyes J, Estupiñán-Bohorquez A, Ibarra JA, Pana MC, Sierra JM, Florez ID. Short-term Dual Therapy or Mono Therapy With Acetaminophen and Ibuprofen for Fever: A Network Meta-Analysis. Pediatrics. 2024 Oct 1;154(4):e2023065390. doi: 10.1542/peds.2023-065390. PMID: 39318339. Summarized by Jeffrey Olson, MS4 | Edited by Jeffrey Olson and Jorge Chalit, OMS4 Get your tickets to Tox Talks Event, Sept 11, 2025: https://emergencymedicalminute.org/events-2/ Donate: https://emergencymedicalminute.org/donate/

Discover the cutting-edge wrist-clamping shoulder-lifting technique for reducing shoulder dislocations. This innovative method eliminates the need for sedation and shows impressive success in a study involving 36 patients. Learn how emergency medical providers can safely perform this procedure with no complications. It's a fascinating look at emergency medicine that combines simplicity and effectiveness!

Discover the alarming world of heavy metal toxicity, from the gastrointestinal upset caused by acute exposure to the long-term risks of cancer and kidney failure. Learn about the common sources of lead, mercury, arsenic, and cadmium lurking in everyday items. The discussion highlights how older homes and certain fish can pose serious health risks. Treatment options like chelation therapy are also covered, providing insights into managing different types of heavy metal poisoning and their specific antidotes.

Contributor: Taylor Lynch, MD Educational Pearls: Dilutional Hyponatremia: Occurs when there is an excess of free water relative to sodium in the body. Causes a falsely low sodium concentration without a true change in total body sodium. Commonly seen in DKA: Hyperglycemia raises plasma osmolality. Water shifts from the intracellular to extracellular space. This dilutes serum sodium, creating apparent hyponatremia. Corrected sodium calculation: Use tools like MDCALC, or apply this formula: Add 1.6 mEq/L to the measured sodium for every 100 mg/dL increase in glucose above 100. Clinical relevance: Considering corrected sodium in DKA is crucial, as the lab value may not be reflective of actual sodium depletion. True severe hyponatremia can lead to complications like seizures May require treatment with hypertonic saline. References: Fulop M. Acid–base problems in diabetic ketoacidosis. Am J Med Sci. 2008;336(4):274-276. doi:10.1097/MAJ.0b013e318180f478 Palmer BF, Clegg DJ. Electrolyte and Acid–Base Disturbances in Patients with Diabetes Mellitus. N Engl J Med. 2015;373(6):548-559. doi:10.1056/NEJMra1503102 Spasovski G, Vanholder R, Allolio B, et al. Diagnosis and management of hyponatremia: a review. JAMA. 2014;312(24):2640–2650. doi:10.1001/jama.2014.13773 Summarized by Ashley Lyons, OMS3 | Edited by Ashley Lyons & Jorge Chalit, OMS4 Donate: https://emergencymedicalminute.org/donate/

Explore military-inspired trauma protocols like rapid hemorrhage control, vital for saving lives in prehospital settings. Discover the innovative prolonged field care model, designed for delayed evacuations in rural areas. Learn about the transformative STAR Program, pairing paramedics with social workers to tackle behavioral health crises without police intervention. Dive into the impressive outcomes of ECMO in cardiac arrest cases and gain insights on recognizing human trafficking in healthcare, rounding off with essential training resources for responders.

Explore the ins and outs of acetaminophen toxicity, including the critical toxic dose and the wide-ranging symptoms that emerge within the first few days. Learn about the life-saving role of activated charcoal and the importance of timing in treatment. Discover the intricacies of administering N-acetylcysteine, including dosing protocols and when to use the Rumack–Matthew nomogram. This discussion is packed with essential information for anyone in the medical field dealing with potential overdoses.

The discussion dives into the nuances of oxygen administration in trauma patients. A major study reveals no significant difference in outcomes between those on a restrictive oxygen strategy and those on a liberal one. This raises questions about the necessity of high-flow oxygen via non-rebreather masks. Ultimately, it suggests that many trauma patients might not need oxygen unless they're showing signs of hypoxia or shortness of breath. It's a thought-provoking exploration of common practices in emergency medicine.

Discover the intriguing world of prehospital seizure management, focusing on the roles of midazolam and ketamine. A recent study reveals that combining ketamine with midazolam significantly increases the chances of halting seizures before reaching the hospital. The findings show an impressive 94.4% resolution rate for patients receiving both medications, compared to 82% for those on midazolam alone. Delve into the implications of these results and examine the potential limitations of the study in this exciting discussion.

In this discussion, the focus is on managing high blood pressure in the emergency room. It highlights thiazide diuretics as the first-line treatment for uncomplicated cases, explaining their mechanism of promoting diuresis by blocking sodium absorption in the kidneys. The conversation also delves into benefits of hydrochlorothiazide, including its cost-effectiveness and lower side effects. For more complex situations like heart failure, ACE inhibitors play a crucial role in blood pressure regulation by disrupting the RAAS system.

Discover how the HEART score helps emergency providers assess chest pain. The scoring system covers history, EKG results, age, risk factors, and troponin levels. Learn how to interpret scores from 0 to 10, predicting the likelihood of major cardiac events. Points can lead to different patient management strategies, from discharge to intensive care. It's a crucial tool that enhances decision-making in high-pressure situations!