1,037 episodes

Our near daily podcasts move quickly to reflect current events, are inspired by real patient care, and speak to the true nature of what it’s like to work in the Emergency Room or Pre-Hospital Setting. Each medical minute is recorded in a real emergency department, by the emergency physician or clinical pharmacist on duty – the ER is our studio and everything is live.

Emergency Medical Minute Emergency Medical Minute

    • Health & Fitness
    • 4.8 • 223 Ratings

Our near daily podcasts move quickly to reflect current events, are inspired by real patient care, and speak to the true nature of what it’s like to work in the Emergency Room or Pre-Hospital Setting. Each medical minute is recorded in a real emergency department, by the emergency physician or clinical pharmacist on duty – the ER is our studio and everything is live.

    Episode 895: Indications for Exogenous Albumin

    Episode 895: Indications for Exogenous Albumin

    Contributor: Travis Barlock MD
    Educational Pearls:
    There are three indications for IV albumin in the ED
    Spontaneous bacterial peritonitis (SBP)
    Patients with SBP develop renal failure from volume depletion
    Albumin repletes volume stores and reduces renal impairment
    Albumin binds inflammatory cytokines and expands plasma volume
    Reduced all-cause mortality if IV albumin is given with antibiotics
    Hepatorenal syndrome
    Cirrhosis of the liver causes the release of endogenous vasodilators
    The renin-angiotensin-aldosterone system (RAAS) fails systemically but maintains vasoconstriction at the kidneys, leading to decreased renal perfusion
    IV albumin expands plasma volume and prevents failure of the RAAS
    Large volume paracentesis
    Large-volume removal may lead to circulatory dysfunction
    IV albumin is associated with a reduced risk of paracentesis-associated circulatory dysfunction
    There are many other FDA-approved conditions for which to use exogenous albumin but the data are conflicted about the benefits on mortality
    References
    1. Arroyo V, Fernandez J. Pathophysiological basis of albumin use in cirrhosis. Ann Hepatol. 2011;10(SUPPL. 1):S6-S14. doi:10.1016/s1665-2681(19)31600-x
    2. Bai Z, Wang L, Wang R, et al. Use of human albumin infusion in cirrhotic patients: a systematic review and meta-analysis of randomized controlled trials. Hepatol Int. 2022;16(6):1468-1483. doi:10.1007/s12072-022-10374-z
    3. Batool S, Waheed MD, Vuthaluru K, et al. Efficacy of Intravenous Albumin for Spontaneous Bacterial Peritonitis Infection Among Patients With Cirrhosis: A Meta-Analysis of Randomized Control Trials. Cureus. 2022;14(12). doi:10.7759/cureus.33124
    4. Kwok CS, Krupa L, Mahtani A, et al. Albumin reduces paracentesis-induced circulatory dysfunction and reduces death and renal impairment among patients with cirrhosis and infection: A systematic review and meta-analysis. Biomed Res Int. 2013;2013. doi:10.1155/2013/295153
    5. Sort P, Navasa M, Arroyo V, et al. Effect of Intravenous Albumin on Renal Impairment and Mortality in Patients with Cirrhosis and Spontaneous Bacterial Peritonitis. N Engl J Med. 1999;341(6):403-409.
    Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit
     

    • 2 min
    Episode 894: DKA and HHS

    Episode 894: DKA and HHS

    Contributor: Ricky Dhaliwal, MD
    Educational Pearls:
    What are DKA and HHS?
    DKA (Diabetic Ketoacidosis) and HHS (Hyperosmolar Hyperglycemic State) are both acute hyperglycemic states.
    DKA
    More common in type 1 diabetes.
    Triggered by decreased circulating insulin.
    The body needs energy but cannot use glucose because it can’t get it into the cells.
    This leads to increased metabolism of free fatty acids and the increased production of ketones.
    The buildup of ketones causes acidosis.
    The kidneys attempt to compensate for the acidosis by increasing diuresis.
    These patients present as dry and altered, with sweet-smelling breath and Kussmaul (fast and deep) respirations.
    HSS
    More common in type 2 diabetes.
    In this condition there is still enough circulating insulin to avoid the breakdown of fats for energy but not enough insulin to prevent hyperglycemia.
    Serum glucose levels are very high – around 600 to 1200 mg/dl.
    Also presents similarly to DKA with the patient being dry and altered.
    Important labs to monitor
    Serum glucose
    Potassium
    Phosphorus
    Magnesium
    Anion gap (Na - Cl - HCO3)
    Renal function (Creatinine and BUN)
    ABG/VBG for pH
    Urinalysis and urine ketones by dipstick
    Treatment
    Identify the cause, i.e. Has the patient stopped taking their insulin?
    Aggressive hydration with isotonic fluids.
    Normal Saline (NS) vs Lactated Ringers (LR)?
    LR might resolve the DKA/HHS faster with less risk of hypernatremia.
    Should you bolus with insulin?
    No, just start a drip.
    0.1-0.14 units per kg of insulin.
    Make sure you have your potassium back before starting insulin as the insulin can shift the potassium into the cells and lead to dangerous hypokalemia.
    Should you treat hyponatremia?
    Make sure to correct for hyperglycemia before treating. This artificially depresses the sodium.
    Should you give bicarb?
    Replace if the pH Don’t intubate, if the patient is breathing fast it is because they are compensating for their acidosis.
    References
    Andrade-Castellanos, C. A., Colunga-Lozano, L. E., Delgado-Figueroa, N., & Gonzalez-Padilla, D. A. (2016). Subcutaneous rapid-acting insulin analogues for diabetic ketoacidosis. The Cochrane database of systematic reviews, 2016(1), CD011281. https://doi.org/10.1002/14651858.CD011281.pub2
    Chaithongdi, N., Subauste, J. S., Koch, C. A., & Geraci, S. A. (2011). Diagnosis and management of hyperglycemic emergencies. Hormones (Athens, Greece), 10(4), 250–260. https://doi.org/10.14310/horm.2002.1316
    Dhatariya, K. K., Glaser, N. S., Codner, E., & Umpierrez, G. E. (2020). Diabetic ketoacidosis. Nature reviews. Disease primers, 6(1), 40. https://doi.org/10.1038/s41572-020-0165-1
    Duhon, B., Attridge, R. L., Franco-Martinez, A. C., Maxwell, P. R., & Hughes, D. W. (2013). Intravenous sodium bicarbonate therapy in severely acidotic diabetic ketoacidosis. The Annals of pharmacotherapy, 47(7-8), 970–975. https://doi.org/10.1345/aph.1S014
    Modi, A., Agrawal, A., & Morgan, F. (2017). Euglycemic Diabetic Ketoacidosis: A Review. Current diabetes reviews, 13(3), 315–321. https://doi.org/10.2174/1573399812666160421121307
    Self, W. H., Evans, C. S., Jenkins, C. A., Brown, R. M., Casey, J. D., Collins, S. P., Coston, T. D., Felbinger, M., Flemmons, L. N., Hellervik, S. M., Lindsell, C. J., Liu, D., McCoin, N. S., Niswender, K. D., Slovis, C. M., Stollings, J. L., Wang, L., Rice, T. W., Semler, M. W., & Pragmatic Critical Care Research Group (2020). Clinical Effects of Balanced Crystalloids vs Saline in Adults With Diabetic Ketoacidosis: A Subgroup Analysis of Cluster Randomized Clinical Trials. JAMA network open, 3(11), e2024596. https://doi.org/10.1001/jamanetworkopen.2020.24596
    Summarized by Jeffrey Olson MS2 | Edited by Meg Joyce & Jorge Chalit, OMSII

    • 7 min
    Episode 893: Home Treatments for Button Battery Ingestion

    Episode 893: Home Treatments for Button Battery Ingestion

    Contributor: Aaron Lessen MD
    Educational Pearls:
    Button batteries cause alkaline corrosion and erosion of the esophagus when swallowed
    Children swallow button batteries, which create a medical emergency as they can perforate the esophagus
    A recent study compared various home remedies as first-aid therapy for button battery ingestion
    Honey, jam, normal saline, Coca-Cola, orange juice, milk, and yogurt
    The study used a porcine esophageal model to assess resistance to alkalinization with the different home remedies
    Honey and jam demonstrated a significantly lower esophageal tissue pH compared with normal saline
    Histologic changes in the tissue samples appeared 60 minutes later with honey and jam compared with normal saline
    These treatments do not preclude medical intervention and battery removal
    References
    1. Chiew AL, Lin CS, Nguyen DT, Sinclair FAW, Chan BS, Solinas A. Home Therapies to Neutralize Button Battery Injury in a Porcine Esophageal Model. Ann Emerg Med. 2023:1-9. doi:10.1016/j.annemergmed.2023.08.018
    Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit
     

    • 2 min
    Episode 892: Tourniquets

    Episode 892: Tourniquets

    Contributor: Ricky Dhaliwal, MD
    Educational Pearls:
    What can you do to control bleeding in a penetrating wound?
    Apply direct pinpoint pressure on the wound as well as proximal to the wound.
    Build a compression dressing.
    How do you build a compression dressing?
    Think about building an upside-down pyramid with the gauze.
    Consider coagulation agents such as an absorbent gelatin sponge material, microporous polysaccharide hemispheres, oxidized cellulose, fibrin sealants, topical thrombin, or tranexamic acid.
    What are the indications to use a tourniquet?
    The Stop The Bleed campaign recommends looking for the following features of “life-threatening” bleeding.
    Pulsatile bleeding.
    Blood is pooling on the ground.
    The overlying clothes are soaked.
    Bandages are ineffective.
    Partial or full amputation.
    And if the patient is in shock.
    How do you put on a tourniquet?
    If using a Combat Application Tourniquet (C-A-T) tourniquet, apply it proximal to the wound, then rotate the plastic rod until the bleeding stops. Then secure the plastic rod with a clip and make sure the Velcro is in place.
    Mark the time - generally, there is a spot on the tourniquet to write.
    Have a plan for the next steps. Does the patient need emergent surgery? Do they need to be transfered?
    How long can you leave a tourniquet on?
    Less than 90 minutes.
    What are the risks?
    Nerve injury.
    Ischemia.
    References
    Latina R, Iacorossi L, Fauci AJ, Biffi A, Castellini G, Coclite D, D'Angelo D, Gianola S, Mari V, Napoletano A, Porcu G, Ruggeri M, Iannone P, Chiara O, On Behalf Of Inih-Major Trauma. Effectiveness of Pre-Hospital Tourniquet in Emergency Patients with Major Trauma and Uncontrolled Haemorrhage: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2021 Dec 6;18(23):12861. doi: 10.3390/ijerph182312861. PMID: 34886586; PMCID: PMC8657739.
    Martinson J, Park H, Butler FK Jr, Hammesfahr R, DuBose JJ, Scalea TM. Tourniquets USA: A Review of the Current Literature for Commercially Available Alternative Tourniquets for Use in the Prehospital Civilian Environment. J Spec Oper Med. 2020 Summer;20(2):116-122. doi: 10.55460/CT9D-TMZE. PMID: 32573747.
    Resources poster booklet. (n.d.). Stop the Bleed. https://www.stopthebleed.org/resources-poster-booklet/
    Summarized by Jeffrey Olson MS2 | Edited by Meg Joyce & Jorge Chalit, OMSII
     

    • 5 min
    Pharmacy Phriday #11: Riddles, Medical Jargon, NNT, and Time Travel

    Pharmacy Phriday #11: Riddles, Medical Jargon, NNT, and Time Travel

    Contributors: Kali Olson PharmD, Travis Barlock MD, Jeffrey Olson MS2
    Summary:
    In this episode of Pharmacy Phriday, Dr. Kali Olson joins Dr. Travis Barlock and Jeffrey Olson in studio to discuss a variety of interesting topics in the form of a segment show. Dr. Kali Olson earned her Doctorate of Pharmacy from the University of Colorado, Skaggs School of Pharmacy and completed a PGY1 residency at Detroit Receiving Hospital and a PGY2 residency in Emergency Medicine at Denver Health. She now works as an Emergency Medicine Pharmacist at Denver Health. 
    In segment one of the show, Kali and Travis answer the Get-To-Know-You questionnaire. In segment two, they work together to answer a series of pharmacy-based riddles. In segment three they play a “Balderdash” like game in which they guess the definitions of medical jargon. In segment four they play the Number Needed to Treat game, invented by the AFP podcast. And in segment five they work together to answer a question about a far-out scenario involving medications and time travel!
     
    References
    ·       American Family Physician Podcast, https://www.aafp.org/pubs/afp/multimedia/podcast.html
    ·       Gragnolati, A. (2022, May 5). The Yuzpe method of emergency contraception. GoodRx. https://www.goodrx.com/conditions/emergency-contraceptive/yuzpe-method
    ·       Manikandan S, Vani NI. Holiday reading: Learning medicine through riddles. CMAJ. 2010 Dec 14;182(18):E863-4. doi: 10.1503/cmaj.100466. PMID: 21149530; PMCID: PMC3001539.
    ·       Riddle Me This: Mixing Medicine, https://peimpact.com/riddle-me-this-mixing-medicine/
    ·       https://thennt.com/nnt/corticosteroids-treatment-kawasaki-disease-children/
    ·       https://thennt.com/nnt/aspirin-acute-ischemic-stroke/
    ·       https://thennt.com/nnt/tranexamic-acid-treatment-epistaxis/
    ·       https://thennt.com/nnt/antibiotics-culture%e2%80%90positive-asymptomatic-bacteriuria-pregnant-women/
     
    Produced, Hosted, Edited, and Summarized by Jeffrey Olson MS2 | Additional editing by Jorge Chalit, OMSII
     

    • 43 min
    Episode 891: Hypothermia

    Episode 891: Hypothermia

    Contributor: Taylor Lynch MD
    Educational Pearls
    Hypothermia is defined as a core body temperature less than 35 degrees Celsius or less than 95 degrees Fahrenheit 
    Mild Hypothermia: 32-35 degrees Celsius
    Presentation: alert, shivering, tachycardic, and cold diuresis
    Management: Passive rewarming i.e. remove wet clothing and cover the patient with blankets or other insulation
    Moderate Hypothermia: 28-32 degrees Celsius
    Presentation: Drowsiness, lack of shivering, bradycardia, hypotension
    Management: Active external rewarming
    Severe Hypothermia: 24-28 degrees Celsius
    Presentation: Heart block, cardiogenic shock, no shivering
    Management: Active external and internal rewarming
    Less than 24 degrees Celsius
    Presentation: Pulseless, ventricular arrhythmia
    Active External Rewarming
    Warm fluids are insufficient for warming due to a minimal temperature difference (warmed fluids are maintained at 40 degrees vs. a patient at 30 degrees is not a large enough thermodynamic difference)
    External: Bear hugger, warm blankets
    Active Internal Rewarming
    Thoracic lavage (preferably on the patient’s right side)
    Place 2 chest tubes (anteriorly and posteriorly); infuse warm IVF anteriorly and hook up the posterior tube to a Pleur-evac
    Warms the patient 3-6 Celsius per hour
    Bladder lavage
    Continuous bladder irrigation with 3-way foley or 300 cc warm fluid
    Less effective than thoracic lavage due to less surface area
    Pulseless patients
    ACLS does not work until patients are rewarmed to 30 degrees
    High-quality CPR until 30 degrees (longest CPR in a hypothermic patient was 6 hours and 30 minutes)
    Give epinephrine once you reach 35 degrees, spaced out every 6 minutes
    ECMO is the best way to warm these patients up (10 degrees per hour)
    Pronouncing death must occur at 32 degrees or must have potassium > 12
    References
    1. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care - Part 1: Introduction. Circulation. 2005;112(24 SUPPL.). doi:10.1161/CIRCULATIONAHA.105.166550
    2. Brown DJA, Burgger H, Boyd J, Paal P. Accidental Hypothermia. N Engl J Med. 2012;367:1930-1938. doi:10.1136/bmj.2.5543.51-c
    3. Dow J, Giesbrecht GG, Danzl DF, et al. Wilderness Medical Society Clinical Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2019 Update. Wilderness Environ Med. 2019;30(4S):S47-S69. doi:10.1016/j.wem.2019.10.002
    4. Kjærgaard B, Bach P. Warming of patients with accidental hypothermia using warm water pleural lavage. Resuscitation. 2006;68(2):203-207. doi:10.1016/j.resuscitation.2005.06.019
    5. Lott C, Truhlář A, Alfonzo A, et al. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances. Resuscitation. 2021;161:152-219. doi:10.1016/j.resuscitation.2021.02.011
    6. Plaisier BR. Thoracic lavage in accidental hypothermia with cardiac arrest - Report of a case and review of the literature. Resuscitation. 2005;66(1):99-104. doi:10.1016/j.resuscitation.2004.12.024
    Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit, OMSII
     

    • 4 min

Customer Reviews

4.8 out of 5
223 Ratings

223 Ratings

ggarcia.ur ,

Fantastic podcast

The information provided is fantastic for medical/emergency providers. I enjoy the briefness of each episode. Will continue listening!

hnhhk ,

review

As someone who is passionate about the topic, I was overjoyed to discover a podcast that not only offers insightful information, but also does so in an interesting and amusing manner.

Every episode demonstrates the host's passion for the topic and his expertise of it. They invite industry professionals as guests, who share their knowledge, insights, and opinions to offer a balanced and thorough examination of the issue.

Ryan Novoa ,

A bit dense

There is likely a lot of good vocabulary that would be useful in medicine, but these terms are not given much context. One would have to be a medical student or physician to get a considerable amount of value out of this. For pre-meds like myself, this would mostly give insight into what medical jargon and reasoning sounds like.

Top Podcasts In Health & Fitness

Huberman Lab
Scicomm Media
ZOE Science & Nutrition
ZOE
The School of Greatness
Lewis Howes
On Purpose with Jay Shetty
iHeartPodcasts
Nothing much happens: bedtime stories to help you sleep
iHeartPodcasts
Passion Struck with John R. Miles
John R. Miles

You Might Also Like

Core EM - Emergency Medicine Podcast
Core EM
Emergency Medicine Cases
Dr. Anton Helman
EM Clerkship
Zack Olson, MD and Michael Estephan, MD
FOAMcast -  An Emergency Medicine Podcast
FOAMcast
EMCrit FOAM Feed
Scott D. Weingart, MD FCCM
Critical Care Scenarios
Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM