Emergency Medical Minute

Hosts: Don Stader, Nate Novotny, Travis Barlock, and Jeffrey Olson
In this episode, we reminice about the first 1000 medical minutes presented by EMM and what the next 1000 might hold. Below are all of the episodes referenced in this episode. Please go back and give them all a listen.
Segment 1- Recap and Facts
1st medical minute
o   April 29, 2016. Almost exactly 10 years ago.
o   Diverticulitis and Antibiotics by Dr. Chris Holmes
1000th Medical Minute
o   March 30, 2026
o   Treatment of burns by Aaron Lessen
o   Edited by Ashley Lyons and published by Jorge Chalit
Favorite sub-topics have included:
o   Cardiovascular topics- 150 episodes
o   Pharmacology- 97 episodes
o   Toxicology- 85 episodes
o   Neurology- 75 episodes
The "Hunting for…" cinematic universe. -Michael Hunt
o   399: Hunting for Pancreatitis
o   424: Hunting for Measles
o   432: Hunting for UTIs
o   445: Hunting for the Endotracheal Tube
o   455: Hunting for PeeCP
o   460: Hunting for PE in Syncope
o   487: Hunting for Epiglottitis
Obsession with 1966- Chris Holmes
o   120: The State of Sepsis in 1966
o   125: Old School CPR - 1966
o   138: Bromide Toxicity - 1966
o   147: GI Bleed - 1966
o   675: CHF like it's 1966
Favorite drug: naloxone/narcan (9)
o   7: Heroin Overdose and OTC Narcan
o   464: Narcan't?
o   516: Narcan and Pulmonary Edema
o   931: Naloxone in Cardiac Arrest
Favorite disease state: Sepsis (13)
o   22: Sepsis Sofa
o   219: History of Sepsis
o   244: Fever in Sepsis
o   263: Early Antibiotics in Sepsis
o   272: More on Temperature in Sepsis
o   287: Sepsis Bundles
o   544: C is for Sepsis
Unhinged title combinations
o   84: Hypothermia and Lightning Strike: Code Blue
o   203: Wine, Milk and… Vaccines!?
o   216: Roller Coasters and Kidney Stones
o   299: Black Death, Lice, Math, and Pottery
o   427: Cookie Dough is Delicious
o   670: Operation Tat-Type
o   695: Einstein and Cellophane
o   777: Grass, weed and ancient Rome
o   781: Foxglove, dropsy, and Salvador Dali
o   959: The KLM Flight Disaster and Lessons in Healthcare Communication
Most frequent contributors
-          Aaron Lessen- 192
-          Don Stader- 84
-          Jarod Scott- 83
-          Peter Bakes- 53
-          Samuel Killian- 45
-          Dylan Luyten- 41
-          Erik Verzemnieks- Dozens
-          Michael Hunt- 34
-          Travis Barlock- 30
-          Ricky Dhaliwal- 25
Top female voices
o   Rachael Duncan, PharmD
o   Rachel Beham, PharmD
o   Meghan Hurley
o   Gretchen Hinson
o   Suzanne Chilton
o   Katie Sprinkle
Most listened to
-          8. Podcast 835: Syncope Review
-          7. Podcast 766: Truth about Tramadol
-          6. Podcast 839: Causes of Pancreatitis
-          5. Podcast 760: Why Fentanyl is the Worst
-          4. Podcast 844: Dental Infections
-          3. Podcast 846: Early Repolarization vs. Anterior STEMI
-          2. Podcast 845: Hyperkalemic Cardiac Arrest
-          1. Podcast 847: ECMO CPR
Mini-game: who has actually seen our most rare diagnoses?
o   18: Lemierre's Syndrome – Septic thrombophlebitis of the internal jugular vein after oropharyngeal infection leading to septic emboli.
o   139: Locked-in Syndrome – Ventral pontine lesion causing quadriplegia and inability to speak with preserved consciousness and eye movements.
o   144: Moyamoya Disease – Progressive stenosis of intracranial carotids with development of fragile collateral vessels causing strokes.
o   221: Cotard Delusion (Walking Corpse Syndrome) – Psychiatric disorder where patients believe they are dead or do not exist.
o   240: Pott's Puffy Tumor – Frontal bone osteomyelitis with subperiosteal abscess from sinusitis causing forehead swelling.
o   277: Mucormycosis (Rhizopus) – Angioinvasive fungal infection in immunocompromised patients causing rapid tissue necrosis.
o   293: Transient Global Amnesia – Sudden, transient loss of ability to form new memories that resolves within 24 hours.
o   329: Hypokalemic Periodic Paralysis – Episodic muscle weakness due to intracellular potassium shifts.
o   374: Iliac Artery Endofibrosis – Exercise-induced fibrosis of the iliac artery causing claudication in athletes.
o   466: Subacute Sclerosing Panencephalitis (SSPE) – Progressive, fatal neurodegenerative disease from persistent measles infection.
o   477: Postpolypectomy Electrocoagulation Syndrome – Transmural burn of the colon after polypectomy causing localized peritonitis without perforation.
o   578: Brown-Séquard Syndrome – Hemisection of the spinal cord causing ipsilateral motor/proprioception loss and contralateral pain/temperature loss.
o   697: Kounis Syndrome – Acute coronary syndrome triggered by allergic reaction causing coronary vasospasm or plaque rupture.
o   973: Meningitis Retention Syndrome – Acute urinary retention due to sacral nerve dysfunction during meningitis.
Segment 2- Individual Interviews
Segment 3- Looking forward
Segment 4- Trivia
Podcast 38, what is significant about diphtheria and March 18th?
o   On March 18th, the Iditarod is run in Alaska to commemorate a sled dog team, led by Balto, that ran from Nome to Anchorage and back to provide children in Nome with the diphtheria anti-toxin serum.
Podcast 52: Syphilis the Great Imitator. The study of Syphilis or "Syphilology" evolved into the field of what?
o   Dermatology
Podcast 121:  The Poor Man's Methadone. What is the poor man's methadone?
o   Imodium
Podcast 136:  James Lind, conducted the first clinical trial in 1747 and proved that what cure what? Hint: think vitamins.
o   Citrus fruits cure scurvy.
Podcast #213: --- and Potatoes. What food has been shown to lower LDL?
o   Oats
Podcast #216: Roller Coasters and Kidney Stones. A study used a model of a kidney and ureter with different sized stones and put it on ------ roller coaster in Disney World.
o   Thunder Mountain
Podcast #261. ---- was introduced to treat ACE-inhibitor induced angioendema. but later, better-powered studies showed that it had no benefit compared to standard treatment.
o   Icatibant
Podcast #304: ---. ---- was a formal medical diagnosis, and one that dates back to 17th century when soldiers had longing for home and melancholy with a constellation of symptoms including lethargy, sadness, disturbed sleep, heart palpitations, GI complaints, and/or skin findings for which the only cure was to return home.
o   Nostalgia
Podcast # 351: Steakhouse Syndrome. What is steakhouse syndrome?
o   Impacted food bolus 2/2 esophageal stricture
Podcast # 362: Giant Hogweed. What can Giant Hogweed cause.
o   Photosensitivity, severe blisters, and burns
Podcast #398:  Who is gonna fail your antibiotic plan? What vital sign abnormality at triage had the highest odds ratio for treatment failure for the treatment of cellulitis with antibiotics.
o   Tachypnea
Podcast # 458: A Tylenol a Day Keeps the ---- Away? A recent study investigated the effect of scheduled IV acetaminophen on the incidence of ---- in post-CABG patients in the ICU
o   Delerium
Podcast 554: Sleeping Away Alzheimer's. What is the difference between white noise and pink noise?
o   White noise is all the surrounding sound frequencies mixed together that your brain tunes down so you don't get distracted while you're sleeping
o   Pink noise, or deep soothing noises, is the accentuated bass sounds like falling rain or waves crashing your brain keys into while sleeping.
o   Pink noise during sleep has been shown to increase stage 4, creating more CSF washout of beta amyloid.
Podcast 580:  Origin of PPE. Why were rubber gloves invented?
o   The invention of surgical gloves are credited to surgeon William Halsted. He developed gloves because one of his assistants (and later wife), Carol Hampton, was having severe irritation due to a caustic pre-op disinfecting process. They developed the rubber glove for Hampton which garnered popularity, and by the early 20th century, half of surgeons were using rubber gloves.
Podcast 587:  Puppies Preventing Burnout? Puppies lower stress, what activity in that study increased stress?
o   Coloring, because they were denied a chance to play with a puppy
Podcast 596: Weather Can be a Headache. What are the three weather events that can increase the frequency of headaches?
o   High temp
o   Low humidity
o   High air pollution
Podcast 612: Origin of Vaccines. Guess both diseases. The potential of vaccinations was first observed in the late 1600s when Jenner observed people who had cowpox never contracted ----. Years later, Louis Pasteur inoculated chickens with ---- after his assistant accidently created the first live attenuated vaccine by creating a weakened bacteria when he left the bacteria out while he went on vacation
o   Smallpox, cholera
Podcast 670: Operation Tat-Type. In 1951, Operation Tat-Type began tattooing adults with their ---- in an effort to prepare for ---- in the time of the Cold War and the Korean War
o   Blood type, rapid transfusions
Podcast 695: Einstein and Cellophane. Albert Einstein had ----- as a middle-aged man. Dr. Rudolph Nissen, founder of the Nissen fundoplication, performed exploratory surgery for this pain and found a ----
-          The only treatment for an AAA at that time was to----, causing a fibrotic response to prevent rupture
-          Einstein died 7 years after this surgery, likely from his leaking abdominal aortic aneurysm
o   chronic abdominal pain
o   AAA
o   wrap the vessel in cellophane
Podcast 748: -----. Whale blubber, honey, home fermented foods, homemade wine (especially the wine made in prison), and improperly stored canned food can all contain the toxin
o   Botulism
Podcast 777: Grass, Weed, and Ancient Rome. Wine and wormwood and white hellborn were used in ancient rome to treat ----.
o   Nausea, sea sickness
Podcast 821: EKGs in Syncope. Travis suggests a mnemonic for remembering additional EKG findings to look for in syncope
o   WOBBLER
§  Wolff-Parkinson-White (WPW)
§  Obstructed AV node
§  Brugada syndrome
§  Bifascicular block
§  Left Ventricular Hypertrophy (LVH)
§  Epsilon waves
§  Repolarization abnormalities
Podcast 890: Outdoor Cold Air for Croup A 2023 study, published in the Journal of Pediatrics, investigated whether a 30-minute exposure to outdoor cold air could improve mild to moderate croup symptoms before the onset of steroid effects. In what country was this study conducted.
o   Switzerland
Podcast 925: Pediatric Tongue Entrapment. Case study of a peds patient with his/her tongue stuck in a drinking cap. What was the substance that finally set it free?
o   Table sugar
Podcast 960: Frank's Sign - A Marker for Coronary Artery Disease. What is Frank's Sign?
o   Bilateral earlobe crease
Thank you to all that make the EMM awesome!
Hosted and editted by Jeffrey Olson MS4 | Additional editting by Jorge Chalit, OMS4
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Contributor: Aaron Lessen, MD
Educational Pearls:
Burns range in complexity from minor first-degree burns to more severe full-thickness burns.
Initial basic burn management: Run the burn under cool running water for 20 minutes.
Do not scrub the skin.
Do not use ice water.
Ideally initiated as soon as possible, but no later than 3 hours after injury.
Applicable to all burns ranging from superficial to full thickness.

Then apply a non-adherent dressing or sterile gauze.
Can be done at home or upon presentation to the emergency department.
These steps decrease pain and minimize tissue damage.
A study published in Annals of Emergency Medicine found that, out of 371 EMS and emergency medicine providers, 90% had not heard of the recommendation to run burns under cool water for 20 minutes.
The majority of providers interviewed expressed motivation to implement this burn cooling practice but cited barriers such as: Difficulty immersing certain body parts (e.g., chest).
Critically ill patients requiring other urgent interventions.


References:
Holbert MD, Singer Y, Palmieri T, et al. Cool Running Water as a First Aid Treatment for Burn Injuries. Annals of Emergency Medicine. 2025;S0196-0644(25)01138-2. doi:10.1016/j.annemergmed.2025.08.003.
Olawoye OA, Isamah CP, Ademola SA, et al. Effect of Prehospital Topical Application of Water and Other Agents on Outcome in Burn Injured Patients: A Prospective Study. Burns. 2025;51(2):107357. doi:10.1016/j.burns.2024.107357.
Summarized by Ashley Lyons, OMS3 | Edited by Ashley Lyons & Jorge Chalit, OMS4
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Contributor: Travis Barlock, MD
Educational Pearls:
What is an internal jugular catheter (IJ) and when do we use it?
IJs are catheters that can be placed in either the left or the right internal jugular vein to provide central venous catheter (CVC) access. CVCs can be placed in other locations other than the internal jugular vein (i.e. subclavian vein or femoral veins).
IJs are used when the patient may require long-term venous access or have to receive hyperosmolar solutions (such as solutions with high glucose content for parenteral nutrition); solutions with extreme pHs (9); or vesicant drugs (drugs that can cause tissue necrosis with extravasation).
They are not to be confused with EJs (external jugular vein catheters) which can be placed in difficult to peripherally catheterize patients. EJs function similarly to a peripheral IV.
The advantage of IJs is their location in larger veins brings them closer to direct access to the heart (i.e. the right internal jugular vein will provide immediate/quicker access to the right atrium to the heart.)
What are concerns of using a right internal jugular catheter versus one in the left?
The right internal jugular vein provides quick access to the heart via the right atrium, making it ideal in critically ill patients who may require vasopressor support.
However it is also the site commonly used for additional cannulation procedures such as hemodialysis, pulmonary artery pressure measurements, extracorporeal membrane oxygenation (ECMO) and transvenous pacemaker placement.
These procedures are not uncommon in critically ill patients who also required a CVC for initial hemodynamic support via vasopressors.
Gharaibeh et al. found that patients who received a right IJ and hemodialysis had a higher need for re-insertion of the hemodialysis catheter (40% compared to 2.6% in the left IJ group).
Furthermore, it was found that with a right IJ, hemodialysis catheters had to be exchanged by a guidewire in 23% of those with a right IJ as opposed to 0.9% in the left IJ group (a guidewire exchange is often considered a salvage technique to try and maintain access).
Big Takeaway?
If you are able to obtain an IJ on the right, you can likely obtain one on the left, and if considering longitudinal care for your patient, consider obtaining an IJ on the left to allow for future critical access in the right IJ.
References
Gharaibeh KA, Abdelhafez MO, Guedze KEB, Siddiqi H, Hamadah AM, Verceles AC. Impact of initial jugular vein insertion site selection for central venous catheter placement on hemodialysis catheter complications. Journal of Critical Care. 2025;87:155011. doi:10.1016/j.jcrc.2024.155011
Gallieni M, Pittiruti M, Biffi R. Vascular access in oncology patients. CA: A Cancer Journal for Clinicians. 2008;58(6):323-346. doi:10.3322/CA.2008.0015
Summarized by Dan Orbidan, OMS2 | Edited by Dan Orbidan & Jorge Chalit, OMS4
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Contributor: Aaron Lessen, MD
Educational Pearls:
How long do we need to watch patients with a presumed overdose who were treated with naloxone in the field?
A 2025 study in the Annals of Emergency Medicine took a look at this question
Methods Prospective, multi-institutional cohort study
Included ED patients with suspected acute opioid overdose with biologic testing to confirm substances.
This paper performed a secondary analysis evaluating the risk of "delayed intubation," defined as intubation occurring >4 hours after ED arrival.

Results 1,591 patients with presumed opioid overdose were included.
Delayed intubation occurred in only 9 patients (0.6%).
8 of the 9 cases had non-respiratory causes contributing to intubation.
Only 1 patient had respiratory-related deterioration, presenting with respiratory acidosis after receiving 6.4 mg naloxone prior to intubation.

Key Takeaway Delayed respiratory deterioration requiring intubation after 4 hours of ED monitoring is extremely rare, suggesting prolonged monitoring may not be necessary for most stabilized overdose patients.

How else can we mitigate risk?
Give patients take-home naloxone at discharge and educate them on how to use it (See Episode 673: Leaving the ED with Naloxone).
When are naloxone drips necessary?
If a patient requires repeated naloxone boluses, consider a drip
To get the dose, take the total naloxone dose that restored adequate breathing and give two-thirds of that dose per hour
Typically these patients are admitted to the ICU
References
McCabe DJ, Gibbs H, Pratt AA, Culbreth R, Sutphin AM, Abston S, Li S, Wax P, Brent J, Campleman S, Aldy K, Falise A, Manini AF; ToxIC Fentalog Study Group. Risk of Delayed Intubation After Presumed Opioid Overdose in the Emergency Department. Ann Emerg Med. 2025 Jun;85(6):498-504. doi: 10.1016/j.annemergmed.2025.01.022. Epub 2025 Mar 4. PMID: 40047773; PMCID: PMC12955731.
Summarized and edited by Jeffrey Olson MS4
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Contributor: Travis Barlock, MD
Educational Pearls:
D-dimer: fibrin degradation product used to evaluate for clot formation and breakdown Threshold: Elevated D-dimer indicates recent or ongoing intravascular coagulation and fibrinolysis

YEARS score: algorithm to assess PE risk using three clinical criteria Criteria: signs of DVT, hemoptysis, and PE as the most likely diagnosis
YEARS score of 0 with D-dimer YEARS score of ≥1 with D-dimer A study found that YEARS score accurately predicted the presence or absence of PE in 80% of enrolled patients with 90% sensitivity and 65% specificity

D-dimer may also help exclude aortic dissection: Aortic Dissection Detection Risk Score (ADD-RS) When ADD-RS = 0 or 1 and D-dimer When ADD-RS >1, patients are considered high probability for aortic dissection and CT should be performed

References
Fayiad, H., Moussa, H., Nosair, Y. et al. Predictive accuracy of years score in diagnosis of pulmonary embolism. Egypt J Bronchol 18, 18 (2024). https://doi.org/10.1186/s43168-024-00269-y
Weitz JI, Fredenburgh JC, Eikelboom JW. A Test in Context: D-Dimer. J Am Coll Cardiol. 2017 Nov 7;70(19):2411-2420. doi: 10.1016/j.jacc.2017.09.024. PMID: 29096812.
Yichao Ma,Zhenjiang Ding,Yunong Zhao,Paijiao Zhang,Bo Du,Ye Shen,Junmei Hu,Luqi Zhu,Honghong Zhao,Chunrong Jin,Yuhong Wang,Lizhen Gao,Research progress on multi-marker detection technology for cardiovascular diseases (review), Journal of Electroanalytical Chemistry, 1008, (119969), (2026).
Summarized by Meg Joyce, MS2 | Edited by Meg Joyce & Jorge Chalit, OMS4
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