Emergency Medical Minute

Contributor: Sue Chilton, MD Educational Pearls: More intracardiac devices and injection drug abuse are thought to be increasing incidence of endocarditis Classic signs of endocarditis have included: Osler nodes (painful hemorrhagic lesions on hands and feet), Janeway lesions (painless hemorrhagic lesions on the hands and feet), and splinter hemorrhages in the nail beds Other classic findings like fever and murmur are variable More non-specific symptoms can include flu-like symptoms Patients who inject drugs are at higher risk for this diagnosis References Pant S, Patel NJ, Deshmukh A, Golwala H, Patel N, Badheka A, Hirsch GA, Mehta JL Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States from 2000 to 2011. J Am Coll Cardiol. 2015;65(19):2070. Infective endocarditis. Cahill TJ, Prendergast BD Lancet. 2016;387(10021):882. Epub 2015 Sep 1. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Contributor: Don Stader, MD Educational Pearls: It can be difficult to distinguish between central and peripheral causes of vertigo. Cerebellar stroke should be considered with any dizzy patient. Signs and symptoms that suggest stroke as the cause of vertigo include: ataxia, cranial nerve deficits, and rapid onset of symptoms When cerebellar stroke is being considered, MRI is the imaging modality of choice since CT does not adequately visualize the posterior fossa. References Kim J, Lee H. Vertigo due to posterior circulation stroke. Semin Neurol. 2013 Jul;33(3):179-84. doi: 10.1055/s-0033-1354600. Epub 2013 Sep 21.

Husband and wife Pete and Katie Bakes, both emergency physicians in the Denver-Metro area, reflect on their upbringings, the many lessons learned over their twenty year careers, and how they've evolved as physicians and as a couple in this very special episode of UnfilterED. Time Stamps: 00:25 - Intros 03:05 - How did you two meet? 08:20 - (P) How have you seen Katie develop and change over the course of her medical career? 12:00 - (K) As a young woman, how did you balance your professional aspirations with your desire to start a family? 17:04 - (K) How have you seen Pete develop and change over the course of his medical career? 21:41 - Fostering and maintaining empathy over the course of a medical career 33:55 - How has medicine impacted the way you raise your children? 38:55 - Pete's experience as a 1st generation American 53:04 - How medicine has shaped Katie's faith and spirituality 1:00:24 - What is the purpose of suffering? 1:05:02 - Community vs. Academic medicine 1:09:40 - "The Award Winning Dr. Bakes" 1:12:40 - Extra-Clinical Pursuits Intro Music: Backbay Lounge Kevin MacLeod (incompetech.com) Licensed under Creative Commons: By Attribution 3.0 License http://creativecommons.org/licenses/by/3.0/

Contributor: John Winkler, MD Educational Pearls: Vaping-related lung injury initially presents with flu-like symptoms and can progress to respiratory failure requiring aggressive resuscitation including ECMO It is thought to be related to the contents of homemade vaping fluid, mostly in THC-containing products ("brands" include DankVapes, PaxPen) Ask patients with vague constitutional or respiratory symptoms about their vape use References What are the respiratory effects of e-cigarettes? Gotts JE, Jordt SE, McConnell R, Tarran R BMJ. 2019;366:l5275. Epub 2019 Sep 30. Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin - Preliminary Report.Layden JE, Ghinai I, Pray I, Kimball A, Layer M, Tenforde M, Navon L, Hoots B, Salvatore PP, Elderbrook M, Haupt T, Kanne J, Patel MT, Saathoff-Huber L, King BA, Schier JG, Mikosz CA, Meiman J N Engl J Med. 2019; Vaping-Associated Acute Lung Injury: A Case Series. Triantafyllou GA, Tiberio PJ, Zou RH, Lamberty PE, Lynch MJ, Kreit JW, Gladwin MT, Morris A, Chiarchiaro J. Am J Respir Crit Care Med. 2019; Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Author: Jared Scott, MD Educational Pearls: A hyphema is blood in the anterior chamber of the eye, typically caused by trauma While there is a spectrum of disease, blurred vision and eye pain are common presenting complaints after direct trauma to the eye Hyphema are graded between Grade 1 and Grade 5, depending on the amount of blood in the anterior chamber. Higher grades are associated with worse outcomes and more complications Other important diagnoses to consider include globe rupture and retrobulbar hematoma Complications of a hyphema can include glaucoma and vision loss References Brandt MT, Haug RH.Traumatic hyphema: a comprehensive review. J Oral Maxillofac Surg. 2001 Dec;59(12):1462-70. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Contributor: Peter Bakes, MD Educational Pearls: Peri-arrest patients present a particular challenge to ED providers, as the differential is broad and time is critical The differential for near cardiac arrest includes the "H's and T's", just as in true cardiac arrest The 6 H's include: hypoxia, hypo/hyperkalemia, hypovolemia (including shock states), hydrogen (acidosis), hypothermia The 6 T's include: tension pneumothorax, cardiac tamponade, thrombus (PE/MI), toxins, trauma Use your history skills to narrow down this list (i.e renal failure leads to hyperkalemia, trauma leads to tension pneumothorax or tamponade) Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

From DU's 1st annual Colorado Behavioral Health and Wellness Summit: Contributor: Michael Miller, Strategic Initiatives Coordinator, Jefferson County Public Health

From DU's 1st annual Colorado Behavioral Health and Wellness Summit: Contributors: Judith Shlay, MD, MSPH, Associate Director, Denver Public Health, and Brooke Bender, MPH, Center for Addiction Medicine Planner, Denver Health

From DU's 1st annual Colorado Behavioral Health and Wellness Summit: Contributor: Christopher Urbina, MD, MPH, Colorado Consortium for Prescription Drug Abuse Prevention

From DU's 1st annual Colorado Behavioral Health and Wellness Summit: Contributor: Jason Vitello, MSW, Behavioral Health Coordinator, Denver Public Health/CPHA