Emergency Medical Minute

Author: Don Stader, M.D. Educational Pearls Common pathologies include cholecystitis, choledocholithiasis, and in concerningly ascending cholangitis. Cholecystitis is obstruction at the cystic duct leading to inflammation of gallbladder wall, while choledocholithiasis is a distal obstruction of the biliary tree, and ascending cholangitis is an ascending infection of the biliary tree secondary to obstruction. Risk factors for Cholecystitis are the 5 F's (Fat, Forty, Female, Fertile, Family Hx). Classic symptoms seen in ascending cholangitis are Charcot's Triad of fever, RUQ pain, and jaundice, or Reynold's pentad which is more severe and has the addition ofaltered mental status and hypotension. Porcelain gallbladder is a radiographic finding showing calcification of the gallbladder that is associated with cancer of the gallbladder. References: Kimura Y, Takada T, Kawarada Y, et al. (2007). "Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines". J Hepatobiliary Pancreat Surg. Strasberg, SM (26 June 2008). "Clinical practice. Acute calculous cholecystitis". The New England Journal of Medicine. 358 (26): 2804–11.

Since the tragic overdose of his son, Admiral Winnefeld has developed an intriguing strategy on how to combat the Opioid Epidemic.

Sam Quinones, American journalist and author of the critically acclaimed book, Dreamland: The True Tale of America's Opiate Epidemic, shares the story of how he discovered the truth about the Opiate Epidemic.

Lisa Raville, executive director of The Harm Reduction Action Center in Denver, shares tales from her perspective as a Harm Reductionist.

Emergency Medical Minute's very own Donald Stader, MD explains Medicine's contribution to the catastrophe that is the Opioid Epidemic.

Dr. Robert Valuck, director of the Colorado Consortium, presents 10 fallacies that have fueled the Opioid Epidemic.

The Honorable Alby Zweig shares his impactful first-hand experience with addiction, recovery and triumph.

Admiral James Winnefeld and Mary Winnefeld speak publicly for the first time about the tragic overdose of their son, Jonathon, and how 'No Family is S.A.F.E...yet'.

Author: Peter Bakes, M.D. Educational Pearls Probiotics are living bacteria that are taken as an oral supplement. Most of the data to support their use is in the prevention of antibiotic-related diarrhea and the reduction of the symptoms of ulcerative colitis (UC). Some studies have some a reduction of the incidence of antibiotic-related diarrhea in children of up to 12% with the use of probiotics. There may be a reduction of up to 60% in the incidence of antibiotic-related C. diff infection in adults with probiotic use Studies have shown a 10% or more reduction in the duration and severity of the symptoms of UC with probiotic use. Proposed mechanisms of probiotics include a decrease in gut permeability and a decrease in pathogenic gut bacteria due to resource competition. References: http://www.cochrane.org/CD006095/IBD_use-probiotics-prevent-clostridium-difficile-diarrhea-associated-antibiotic-use

Author: Chris Holmes, M.D. Educational Pearls It's estimated that about 25 million people died during the Black Plaque. Researchers have confirmed this number by assessing how much old, broken pottery was buried in front of homes and churches from that time period. Traditional thinking has been that the Black Plague was spread primarily by flea bites. However, using mathematical modeling, researchers have theorized that person-to-person spread was more common. References: https://www.washingtonpost.com/news/speaking-of-science/wp/2016/05/24/broken-pottery-reveals-the-sheer-devastation-caused-by-the-black-death/