2 View: Emergency Medicine PAs & NPs

Welcome to Episode 33 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants!

Show Notes for Episode 33 of “The 2 View” – Walking Boots, Jones Fracture: A Review, and a Few Procedures: Penile Foreign Body Removal and Keloid Removal.

Walking Boots

Infraorbital Nerve Block Courtesy of Jessica Mason MD. Dropbox. Accessed January 24, 2024. https://www.dropbox.com/scl/fi/r6ite1ior1wdcg63jcect/Infraorbital-Nerve-Block-Courtesy-of-Jessica-Mason-MD.mp4?rlkey=o5aiz60qmcvpqlnz2z62q8vkz&dl=0

Jones Fracture: A Review

Jones J, Datir A. Jones fracture. In: Radiopaedia.org. Radiopaedia.org; 2008. Revised October 20, 2023. Accessed January 24, 2024. https://radiopaedia.org/articles/jones-fracture-1?lang=us

Metzl JA, Bowers MW, Anderson RB. Fifth Metatarsal Jones Fractures: Diagnosis and Treatment. J Am Acad Orthop Surg. Published February 15, 2022. Accessed January 24, 2024. https://journals.lww.com/jaaos/Fulltext/2022/02150/Fifth_Metatarsal_Jones_Fractures__Diagnosis_and.6.aspx

Michigan Foot Doctors. 5th Metatarsal Jones Fracture [Recovery, Treatment & Surgery]. YouTube. Published April 22, 2020. Accessed January 24, 2024. https://www.youtube.com/watch?v=8f0ECP1FtCc

A Few Procedures: Penile Foreign Body Removal and Keloid Removal

Memariani H, Memariani M, Moravvej H, Shahidi-Dadras M. Emerging and Novel Therapies for Keloids: A compendious review. Sultan Qaboos Univ Med J. NIH: National Library of Medicine, National Center for Biotechnology Information. Published February 2021. Accessed January 24, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7968901/

Roberts JR. Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care, 7th Edition; 2018. Accessed January 24, 2024. https://www.us.elsevierhealth.com/roberts-and-hedges-clinical-procedures-in-emergency-medicine-and-acute-care-9780323354783.html

Roberts JR, Roberts M. The Curse of the Keloid. Emergency Medicine News. Published February 28, 2018. Accessed January 24, 2024. https://journals.lww.com/em-news/blog/theproceduralpause/pages/post.aspx?PostID=79

The Proceduralist. Foreign body in the shaft of the penis removal using dorsal nerve block. YouTube. Published January 11, 2024. Accessed January 24, 2024. https://www.youtube.com/watch?v=71PesnLDl-0

The Proceduralist. Keloid. YouTube. Published February 9, 2018. Accessed January 24, 2024. https://www.youtube.com/watch?v=wRBstgCULBc

Weech D, Ameer MA, Ashurst JV. Anatomy, Abdomen and Pelvis, Penis Dorsal Nerve. StatPearls Publishing. NIH: National Library of Medicine, National Center for Biotechnology Information. Updated August 8, 2023. Accessed January 24, 2024. https://www.ncbi.nlm.nih.gov/books/NBK525966/

Recurring Sources

Center for Medical Education. Ccme.org. http://ccme.org

The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org

The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx

The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com

Trivia Question: Send answers to [email protected]

Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at [email protected] and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Welcome to Episode 32 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants!

Show Notes for Episode 32 of “The 2 View” – EMTALA, provider-in-triage positions, head injuries, appendicitis

EMTALA / Head Injuries / Provider In Triage

Latner A. Man Escorted Out of Hospital Without Being Seen: Is This an EMTALA Violation? Clinicaladvisor.com. Published April 11, 2023. Accessed January 21, 2024. https://www.clinicaladvisor.com/home/my-practice/legal-advisor/man-escorted-out-of-hospital-emtala-violation/

Centers for Medicare and Medicaid Services. Emergency Medical Treatment & Labor Act (EMTALA). Cms.gov. Accessed January 21, 2024. https://www.cms.gov/medicare/regulations-guidance/legislation/emergency-medical-treatment-labor-act

MDCalc. Canadian CT Head Injury/Trauma Rule. Mdcalc.com. Accessed January 21, 2024. https://www.mdcalc.com/calc/608/canadian-ct-head-injury-trauma-rule

Appendicitis

Latner A. PA and NP Fail to Diagnose Appendicitis. Clinicaladvisor.com. Published December 6, 2023. Accessed January 21, 2024.

Roberts M, Sharma M. 29 - Toxoplasmosis, the OPAL trial, medical marijuana, appendicitis, and colchicine. The 2 View: EM PA & NP Podcast. Published November 20, 2023. Published October 13, 2023. Accessed January 21, 2024. https://2view.fireside.fm/29

Recurring Sources

Center for Medical Education. Ccme.org. http://ccme.org

The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org

The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx

The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com

Trivia Questions: Send answers to [email protected]

Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at [email protected] and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Dengue

CDC. Clinical assessment. Centers for Disease Control and Prevention. Cdc.gov. https://www.cdc.gov/dengue/training/cme/ccm/page73112.html

CDC. Dengue. Centers for Disease Control and Prevention. Published August 15, 2023. https://www.cdc.gov/dengue/index.html

Rigby J. First Pill for Dengue Shows Promise in Human Challenge Trial. Medscape: Emergency Medicine. Published October 23, 2023. https://www.medscape.com/s/viewarticle/997558?ecd=wnl_sci_tech_231101_MSCPEDIT_etid6007373&uac=255848DR&impID=6007373

Schnirring L. California confirms 2nd local dengue case. Center for infectious disease research and policy. University of Minnesota. Umn.edu. Published November 2, 2023. https://www.cidrap.umn.edu/dengue/california-confirms-2nd-local-dengue-case

Penis Pain

Lizza E. Peyronie Disease. Medscape.com. Published August 17, 2023. https://emedicine.medscape.com/article/456574-overview

Malloy M, Sinert R. Dysuria and Discharge After a New Sexual Partner. Medscape. Published November 20, 2023. https://reference.medscape.com/viewarticle/847159

Promethazine

2018-2019 Targeted Medication Safety Best Practices for Hospitals. Ismp.org. https://www.ismp.org/sites/default/files/attachments/2019-01/TMSBP-for-Hospitalsv2.pdf

Drug Shortage Detail: Promethazine Injection. Ashp.org. Updated November 21, 2023. https://www.ashp.org/drug-shortages/current-shortages/drug-shortage-detail.aspx?id=872

Fass O. Antiemetics and QT prolongation. Clinicalcorrelations.org. Published January 15, 2021. https://www.clinicalcorrelations.org/2021/01/15/antiemetics-and-qt-prolongation/

Ozempic

Korte C. Ozempic side effects could lead to hospitalization — and doctors warn that long-term impacts remain unknown. CBS News. Published June 10, 2023. https://www.cbsnews.com/news/ozempic-side-effects-weight-loss-drugs-wegovy-mounjaro-doctors-warn/

Krishnan L, Dhatariya K, Gerontitis D. No clinical harm from a massive exenatide overdose – a short report. Clin Toxicol (Phila). Clinical Toxicology. Published December 11, 2012. https://www.tandfonline.com/doi/pdf/10.3109/15563650.2012.752495

MedWatch: The FDA Safety Information and Adverse Event Reporting Program. FDA: U.S. Food and Drug Administration. Published September 15, 2022. https://www.fda.gov/medwatch

Nakanishi R, Hirose T, Tamura Y, et.al. Attempted suicide with liraglutide overdose did not induce hypoglycemia. Diabetes Research and Clinical Practice. Diabetesresearchclinicalpractice.com. Published November 12, 2012. https://www.diabetesresearchclinicalpractice.com/article/S0168-8227(12)00384-1/fulltext

Ozempic® (semaglutide) injection for Type 2 Diabetes. Ozempic.com. https://www.ozempic.com/

Hearing Loss

Ahmed OH, Gallant SC, Ruiz R, Wang B, Shapiro WH, Voigt EP. Validity of the Hum Test, a Simple and Reliable Alternative to the Weber Test. Ann Otol Rhinol Laryngol. NIH: National Library of Medicine: National Center for Biotechnology Information. Published June 2018.

Clinical Practice Guideline: Sudden Hearing Loss (Update). American Academy of Otolaryngology – Head and Neck Surgery. Entnet.org. https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/

Hearing loss in adults: assessment and management. National Guideline Centre (UK). Immediate, Urgent and Routine Referral. National Institute for Health and Care Excellence; 2018. NIH: National Library of Medicine: National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK536553/#:~:text=If%20the%20hearing%20loss%20developed,service%20or%20an%20emergency%20department.

Mroz M. Do you know the three main types of hearing loss? Healthy Hearing. Published April 17, 2014.

Recurring Sources

Center for Medical Education. Ccme.org. http://ccme.org

The Proceduralist. theproceduralist.org. http://www.theproceduralist.org

The Procedural Pause. Emergency Medicine News. lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx

The Skeptics Guide to Emergency Medicine. thesgem.com. http://www.thesgem.com

Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at [email protected] and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Welcome to Episode 30 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants!

Show Notes for Episode 30 of “The 2 View” – oral phenylephrine, visual diagnosis plans, and NSVT.

Oral Phenylephrine

Myers Z. FDA panel: Many oral allergy meds don’t work. WTTV CBS4Indy. Published October 15, 2023. Accessed October 17, 2023. https://cbs4indy.com/news/fda-panel-many-oral-allergy-meds-dont-work/

Neurosyphilis Review

Hamill MM, Ghanem KG, Tuddenham S. State of the art review: neurosyphilis. Clin Infect Dis. Published August 18, 2023. Accessed November 1, 2023. doi: 10.1093/cid/ciad437

Visual Diagnosis - Behcet’s Disease

Behcet’s Disease. Vasculitis Foundation. Published July 18, 2012. Accessed October 17, 2023. https://www.vasculitisfoundation.org/education/behcets-disease/

ACEP Clinical Policy on Ischemic Stroke

Clinical Policies – Acute Ischemic Stroke. ACEP. Published May 2023. Accessed November 2, 2023. https://www.acep.org/patient-care/clinical-policies/acute-ischemic-stroke

The VAN Assessment to Identify Large Vessel Occlusion Strokes. Core EM. Published May 17, 2018. Accessed November 2, 2023. https://coreem.net/journal-reviews/the-van-assessment/

Los Angeles Motor Scale (LAMS). MDCalc. Accessed November 2, 2023. https://www.mdcalc.com/calc/3959/los-angeles-motor-scale-lams

Rapid Arterial oCclusion Evaluation (RACE) Scale for Stroke. MDCalc. Accessed November 2, 2023. https://www.mdcalc.com/calc/3941/rapid-arterial-occlusion-evaluation-race-scale-stroke

NSVT: Non-Sustained Ventricular Tachycardia

Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. Published August 1, 2018. Accessed October 17, 2023. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000549

Farzam K, Tivakaran VS. QT Prolonging Drugs. StatPearls Publishing; 2023. Accessed October 17, 2023. https://www.ncbi.nlm.nih.gov/books/NBK534864/

Foth C, Gangwani MK, Ahmed I, Alvey H. Ventricular Tachycardia. StatPearls Publishing; 2023. Accessed October 17, 2023. https://www.ncbi.nlm.nih.gov/books/NBK532954/

Ep 1 Lady G and Courage Under Fire. Burnt. Published January 27, 2021. Accessed November 2, 2023. https://podcasts.apple.com/us/podcast/ep-1-lady-g-and-courage-under-fire/id1551194920?i=1000506903956

Glaucomflecken. Will and Kristin’s Cardiac Arrest Story with Paramedic Lieutenant Aaron Gregg. Published August 22, 2023. Accessed October 17, 2023. https://www.youtube.com/watch?v=CQtYoKPNsrM

Laslett DB, Cooper JM, Greenberg RM, et al. Electrolyte Abnormalities in Patients Presenting With Ventricular Arrhythmia (from the LYTE-VT Study). Am J Cardiol. PubMed. NIH: National Library of Medicine: National Center for Biotechnology Information. Published August 15, 2020. Accessed October 17, 2023. https://pubmed.ncbi.nlm.nih.gov/32565090/

Nonsustained ventricular tachycardias. Bmj.com. BMJ Best Practice. Accessed October 25, 2023. https://bestpractice.bmj.com/topics/en-us/831

PVCs and Nonsustained VT: When to Worry? How to Treat? - Penn Physician VideoLink.; 2015. Published January 7, 2015. Accessed October 17, 2023. https://videolink.pennmedicine.org/videos/pvcs-and-nonsustained-vt-when-to-worry-how-to-treat

TualatinValleyFire. Dr. Will Flanary - Cardiac Arrest Survivor. Published February 16, 2021. Accessed October 17, 2023. https://www.youtube.com/watch?v=wu9uAwnSrJU

Recurring Sources

Center for Medical Education. Ccme.org. http://ccme.org

The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org

The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx

The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com

Trivia Question: Send answers to [email protected]

Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at [email protected] and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Show Notes for Episode 29 of “The 2 View” – Toxoplasmosis, the OPAL trial, medical marijuana, appendicitis, and colchicine.

CDC - Toxoplasmosis

CDC – Parasites – Toxoplasmosis (Toxoplasma infection). Cdc.gov. Published June 9, 2023. Accessed September 26, 2023. https://www.cdc.gov/parasites/toxoplasmosis/index.html

OPAL RCT for Opioids in Back Pain

Jones C, O’Day R, Koes B, et. al. Opioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomised placebo-controlled trial. The Lancet. Thelancet.com. Published July 22, 2023. Accessed September 26, 2023. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00404-X/fulltext

Sikina M, Kiel J. Re-evaluating Red Flags for Back Pain. Acep.org. Sports Med. Published August 17, 2022. Accessed September 26, 2023. https://www.acep.org/sportsmedicine/newsroom/newsroom-articles/august2022/re-evaluating-red-flags-for-back-pain

Medical Marijuana

Brooks M. Is Medical Cannabis the Answer to the Opioid Crisis? Medscape Emergency Medicine. Published October 3, 2022. Accessed September 26, 2023. https://www.medscape.com/viewarticle/981767?ecd=wnl_infocu4_broad_broad_persoexpansion-editorial_20230603&uac=106964SV&impID=5490911

Novak S. Physicians Aren’t Asking Enough Questions About Cannabis Use. Medscape Emergency Medicine. Published August 29, 2023. Accessed September 26, 2023. https://www.medscape.com/viewarticle/995954?ecd=WNL_trdalrt_pos1_230904_etid5820671&uac=106964SV&impID=5820671

Appendicitis

Appendicitis. Acep.org. Accessed September 26, 2023. https://www.acep.org/patient-care/clinical-policies/appendicitis

Dora-Laskey A. Acute pain control. EM. Accessed September 26, 2023. https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m3-curriculum/group-acute-pain-control/acute-pain-control

Hidayat AI, Purnawan I, Mulyaningrat W, et al. Effect of Combining Dhikr and Prayer Therapy on Pain and Vital Signs in Appendectomy Patients: A Quasi-Experimental Study. NIH: National Library of Medicine. J Holist Nurs. Accessed September 26, 2023. https://pubmed.ncbi.nlm.nih.gov/37277995/

Smink D, Soybel D. Management of acute appendicitis in adults. UpToDate. Uptodate.com. Updated February 15, 2023. Accessed September 26, 2023. https://www.uptodate.com/contents/management-of-acute-appendicitis-in-adults

Colchicine

Chiabrando JG, Bonaventura A, Vecchié A, et al. Management of Acute and Recurrent Pericarditis: JACC State-of-the-Art Review. J Am Coll Cardiol. ScienceDirect. Published January 2020. Accessed September 26, 2023. https://www.sciencedirect.com/science/article/pii/S0735109719384840?via%3Dihub

Gout clinical practice guidelines. American College of Rheumatology. Rheumatology.org. Accessed September 26, 2023. https://rheumatology.org/gout-guideline

Telmesani A, Moss E, Chetrit M. The Use of Colchicine in Pericardial Diseases. American College of Cardiology. Published December 5, 2019. Accessed September 26, 2023. https://www.acc.org/Latest-in-Cardiology/Articles/2019/12/04/08/22/The-Use-of-Colchicine-in-Pericardial-Diseases

Recurring Sources

Center for Medical Education. Ccme.org. http://ccme.org

The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org

The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx

The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com

Trivia Question: Send answers to [email protected]

Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at [email protected] and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Show Notes for Episode 28 of “The 2 View” – Live from Vegas, Fungal Meningitis Outbreak, NPs Sue for "Doctor" Title, Guest Chip Lange.

When Medical Tourism Goes Wrong

CDC. Fungal Meningitis Outbreak Social Media Toolkit. Centers for Disease Control and Prevention. Published July 18, 2023. Accessed July 25, 2023. https://www.cdc.gov/fungal/infections/HAI-fungal-meningitis-toolkit.html

Evaluating and Treating Patients for Fungal Meningitis. For both symptomatic and asymptomatic patients: perform lumbar puncture (LP) to evaluate CSF for fungal meningitis* Abnormal LP results Normal initial LP results Counsel patient to monitor for symptoms for 30 days following initial LP Consider scheduling repeat LP two weeks after initial LP Normal repeat LP results. Funguseducationhub.org. Accessed July 25, 2023. https://funguseducationhub.org/wp-content/uploads/2023/06/FM-algorithm_edited.pdf

Fungal Meningitis Outbreak Associated with Procedures Performed under Epidural Anesthesia in Matamoros, Mexico. Cdc.gov. Published August 11, 2023. Accessed July 25, 2023. https://www.cdc.gov/hai/outbreaks/meningitis-epidural-anesthesia.html

PA Title Change / Nurse Practitioners Sue California to use the Title “Doctor.”

Taylor M. Nurse practitioners sue California over restricted use of “doctor.” Beckershospitalreview.com. Published July 18, 2023. Accessed July 25, 2023. https://www.beckershospitalreview.com/hospital-physician-relationships/nurse-practitioners-sue-california-over-restricted-use-of-doctor.html

Title Change Rationale. Aapa.org. Accessed July 25, 2023. https://www.aapa.org/title-change/general-faqs/

Malaria Contracted in the US

Bendix A, Alexander B. New malaria case in Florida brings national total to 8, the first U.S. acquired cases in 20 years. NBC News. Published July 18, 2023. Accessed July 25, 2023. https://www.nbcnews.com/health/health-news/new-malaria-case-florida-brings-national-total-8-first-us-cases-20-yea-rcna94899

Locally Acquired Malaria Cases Identified in the United States. Health Alert Network (HAN) - 00494. Cdc.gov. Published June 26, 2023. Accessed July 25, 2023. https://emergency.cdc.gov/han/2023/han00494.asp

Meat allergy. ACAAI Public Website. Published October 30, 2020. Accessed July 25, 2023. https://acaai.org/allergies/allergic-conditions/food/meat/

Reliability of Fingerstick Glucometers

Media H. Picking cherries leads to a case of pseudohyperglycemia. Clinical Advisor. Published December 12, 2016. Accessed July 25, 2023. https://www.clinicaladvisor.com/home/case-files/picking-cherries-leads-to-a-case-of-pseudohyperglycemia/

Olansky L, Kennedy L. Finger-stick Glucose Monitoring. Diabetes Care. Published April 2010. Accessed July 25, 2023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2845057/

Special Guest Chip Lange, PA-C, and His Story of Going into Myasthenia Crisis

About us. PRACTICAL POCUS. Accessed July 25, 2023. https://www.practicalpocus.com/aboutus.html

Cautionary Drugs. Drugs to avoid or use with caution in MG. Myasthenia.org. Accessed July 25, 2023. https://myasthenia.org/Portals/0/Cautionary%20Drugs.pdf

Colton, K. Myasthenia Gravis. EM:RAP CorePendium. EM:RAP CorePendium. Updated December 2, 2022. Accessed July 25, 2023. https://www.emrap.org/corependium/chapter/recrDWsB2k1uYPL9U

Libsyn, iTunes. Medical professionals. TOTAL EM. Accessed July 25, 2023. https://www.totalem.org/emergency-professionals

Something Sweet

Woodall AJ, McCrohan CR. Excitatory actions of propofol and ketamine in the snail Lymnaea stagnalis. Comp Biochem Physiol C. ScienceDirect. Comparative Biochemistry and Physiology Part C: Pharmacology, Toxicology and Endocrinology. Volume 127, Issue 3. Pages 297-305. Published December 2000. Accessed July 25, 2023. https://www.sciencedirect.com/science/article/abs/pii/S0742841300001559?via%3Dihub

Recurring Sources

Center for Medical Education. Ccme.org. http://ccme.org

The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org

The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx

The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com

Trivia Question: Send answers to [email protected]

Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at [email protected] and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Show Notes for Episode 27 of “The 2 View” – Brain abscesses, torsion, and delirium.

Brain Abscesses

Accorsi EK, Hall M, Hersh AL, Shah SS, Schrag SJ, Cohen AL. Notes from the Field: Update on Pediatric Intracranial Infections - 19 States and the District of Columbia, January 2016-March 2023. MMWR Morb Mortal Wkly Rep. CDC, Centers for Disease Control and Prevention.

Brook I. Clinical Case. Brain Abscess Clinical Presentation. Medscape.com.

Goodman B. Doctors watching for more cases after mysterious cluster of brain infections strikes kids in southern Nevada. CNN. CNN Health.

The Center for Medical Education. 23 - Dear Doctor, Skin Closures, and Wound Management. 2 View: Emergency Medicine PAs & NPs.

What’s “ordinary negligence”? //Missed brain abscess//Special offer. Mad Mimi. Medical Malpractice Insights: Learning from Lawsuits.

Testicular Torsion

Lukosiute-Urboniene A, Nekrosius D, Dekeryte I, Kilda A, Malcius D. Clinical risk factors for testicular torsion and a warning against falsely reassuring ultrasound scans: a 10-year single-centre experience. Emerg Med J. BMJ Journals.

Mellick LB, Watters BC. The Torsed Testicle Traction Technique and 2 Case Reports. Pediatr Emerg Care.

Sessions AE, Rabinowitz R, Hulbert WC, Goldstein MM, Mevorach RA. Testicular torsion: direction, degree, duration and disinformation. J Urol. PubMed. NIH: National Library of Medicine. National Center for Biotechnology Information.

Ovarian Torsion

Long B, Koyfman A, Gottlieb M. Dispelling 5 Ovarian Torsion Myths. ACEP Now.

Ovarian Torsion. Acep.org. ACEP Emergency Ultrasound Section.

Spinelli C, Piscioneri J, Strambi S. Adnexal Torsion in Adolescents: Update and review of the literature.

Swenson DW, Lourenco AP, Beaudoin FL, Grand DJ, Killelea AG, McGregor AJ. Ovarian torsion: Case-control study comparing the sensitivity and specificity of ultrasonography and computed tomography for diagnosis in the emergency department. European Journal of Radiology. ScienceDirect.

Delirium

ACEP’s Position on Hyperactive Delirium. American College of Emergency Physicians.

Hatten BW, Bonney C, Dunne RB, et al. ACEP Task Force Report on Hyperactive Delirium with Severe Agitation in Emergency Settings, Approved by the ACEP Board of Directors, June 23, 202. American College of Emergency Physicians.

Hayes BD, O’Brien M. Should Diphenhydramine be included in an Acute Agitation Regimen? AliEM: Academic Life in Emergency Meedicine.

Psychiatric Patient. American College of Emergency Physicians.

Reuben. Emergency Department Agitated Patient Treatment Map. Emergency Medicine Updates.

Veraart JKE, Smith-Apeldoorn SY, Bakker IM, et al. Pharmacodynamic Interactions Between Ketamine and Psychiatric Medications Used in the Treatment of Depression: A Systematic Review. Int J Neuropsychopharmacol. Oxford Academic.

Prescription Drug Monitoring Programs

D’Souza RS, Lang M, Eldrige JS. Prescription Drug Monitoring Program. StatPearls Publishing. NIH: National Library of Medicine. National Center for Biotechnology Information.

Something Sweet

Brito C. Bobi, the world’s oldest dog, turns 31 years old. CBS News.

Recurring Sources

Center for Medical Education. http://ccme.org

The Proceduralist. http://www.theproceduralist.org

The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx

The Skeptics Guide to Emergency Medicine. Thesgem.com.

Trivia Question: Send answers to [email protected]

Welcome to Episode 26 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants!

Show Notes for Episode 26 of “The 2 View” – Save time charting & code accurately, dementia, PE in pregnancy, and the PCN shortage.

PCN Shortage

Ault, A. FDA Drug Shortages. Current and Resolved Drug Shortages and Discontinuations Reported to FDA. FDA issues new rule on drug shortages. Community Oncology, 9(1), 34. U.S. Food & Drug. Published April 26, 2023. Accessed May 9, 2023. https://doi.org/10.1016/j.cmonc.2011.12.003

Bendix, A. Shortage of penicillin limits access to the go-to drug for syphilis. NBC News. Published April 27, 2023. Accessed May 9, 2023. https://www.nbcnews.com/health/health-news/shortage-penicillin-limits-access-go-drug-syphilis-rcna81777

Global shortages of penicillin. Shortages of benzathine penicillin. Global Sexually Transmitted Infections Programme. World Health Organization. Who.int. Accessed May 9, 2023. https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/stis/treatment/shortages-of-penicillin

Dementia

Alzheimer’s Disease Fact Sheet. Alzheimer’s Disease and Related Dementias: Basics of Alzheimer’s Disease and Dementia. National Institute on Aging. Accessed May 9, 2023. https://www.nia.nih.gov/health/alzheimers-disease-fact-sheet

Home. Alzheimer’s Disease and Dementia. Alzheimer’s Association. Accessed May 9, 2023. https://www.alz.org/

Silbert, L, Erten-Lyons, D. Memory Loss, Confusion in a 51-Year-Old Fired From Her Job. Medscape. Published March 2, 2023. Accessed May 9, 2023. https://reference.medscape.com/viewarticle/850363

PE in Pregnancy

Negaard M. YEARS Algorithm for pulmonary embolism (PE). MDCalc. Accessed May 9, 2023. https://www.mdcalc.com/calc/4067/years-algorithm-for-pulmonary-embolism-pe

Stals MAM, Moumneh T, Ainle FN, et al. Noninvasive diagnostic work-up for suspected acute pulmonary embolism during pregnancy: a systematic review and meta-analysis of individual patient data. J Thromb Haemost. 2023;21(3):606-615. NIH: National Library of Medicine: National Center for Biotechnology Information. PubMed. Published December 22, 2022. Accessed May 9, 2023. https://pubmed.ncbi.nlm.nih.gov/36696189/

Thromboembolism in Pregnancy. ACOG: The American College of Obstetricians and Gynecologists. Acog.org. Practice Bulletin, Number 196. Published July 2018. Accessed May 9, 2023. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2018/07/thromboembolism-in-pregnancy

Charting & Coding

2023 Emergency Department Evaluation and Management Guidelines. ACEP: American College of Emergency Physicians. Acep.org. Last Updated: October 2022. Accessed May 9, 2023. https://www.acep.org/administration/reimbursement/reimbursement-faqs/2023-ed-em-guidelines-faqs

American Medical Association. 2023 Emergency Medicine Coding Guide. MDCalc. Accessed May 9, 2023. https://www.mdcalc.com/calc/10454/2023-emergency-medicine-coding-guide

CPT Evaluation and Management (E/M) Code and Guideline Changes. AMA: American Medical Association. Ama-assn.org. Accessed May 9, 2023. https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf

ICD-10-CM Coding for Social Determinants of Health. AHA: American Hospital Association – Advancing Health in America. Aha.org. Published January 2022. Accessed May 9, 2023. https://www.aha.org/system/files/2018-04/value-initiative-icd-10-code-social-determinants-of-health.pdf

Level of MDM (based on 2 of 3 elements of MDM) number and complexity of problems addressed. ACEP: American College of Emergency Physicians – Advancing Emergency Care. ERCODER. Acep.org. Accessed May 9, 2023. https://www.acep.org/siteassets/sites/acep/media/reimbursement/acep---2023-ed-mdm-grid.pdf

Recurring Sources

Center for Medical Education. Ccme.org. http://ccme.org

The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org

The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx

The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com

Trivia Question: Send answers to [email protected]

Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at [email protected] and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Welcome to Episode 25 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants!

Show Notes for Episode 25 of “The 2 View”

Pediatric Nurse Practitioners Are Not Okay

Della Volpe K. We Are Not Ok, Say Pediatric NPs. Clinical Advisor. Published March 17, 2023. Accessed March 27, 2023. https://www.clinicaladvisor.com/home/meeting-coverage/napnap-2023/pediatric-nps-not-ok/?utm_source=newsletter&utm_medium=email&utm_campaign=NWLTR_CAD_CONF_NAPNAP_MODERNA_032023_RM&hmEmail=1f%2FJfEV7hN5vJr6vg%2FQRqK0NA6IXtyO3&sha256email=092493d8223fdfa40d9e995176d13e5fc5b5211674db9deb440c025fd462c80c&hmSubId=&NID=1639413404&elqTrackId=31abe541d69a4ca587368d18c07e2aeb&elq=24134fa5abd64addafddd14ad54e8f8d&elqaid=13088&elqat=1&elqCampaignId=10964&fbclid=IwAR2YZErTgA9ET7Yzib3bPYuhD68VDtGA_ayIfQ2bu398LBTX6xEmLjZX3EY

Sarjoo A. Pediatricians: We Can’t Bear the Burden of Teen Angst. Medscape. Published March 13, 2023. Accessed March 27, 2023. https://www.medscape.com/viewarticle/989552

New TASER

Bleetman A, Hepper AE, Sheridan RD. The use of TASER devices in UK policing: an update for clinicians following the recent introduction of the TASER 7. BMJ Journals. Emerg Med J. Published 2023. Accessed March 27, 2023. https://emj.bmj.com/content/40/2/147.long

Taser Injuries. Emergency Central. Unboundmedicine.com. Accessed March 27, 2023. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307682/all/Taser_Injuries

Vilke G, Chan T, Bozeman WP, Childers R. Emergency Department Evaluation After Conducted Energy Weapon Use: Review of the Literature for the Clinician. NIH National Library of Medicine: National Center for Biotechnology Information. PubMed. J Emerg Med. Published September 26, 2019. Accessed March 27, 2023. https://pubmed.ncbi.nlm.nih.gov/31500994/

Hyperacute T-Waves

Dr. Smith’s ECG blog. Blogspot.com. Published March 2023. Accessed March 27, 2023. http://hqmeded-ecg.blogspot.com/search/label/hyperacute%20T-waves

Koechlin L, Strebel I, Zimmermann T, et al. Hyperacute T Wave in the Early Diagnosis of Acute Myocardial Infarction. Ann Emerg Med. PubMed. NIH: National Library of Medicine. National Center for Biotechnology Information. Published online February 9, 2023. Accessed March 27, 2023. https://pubmed.ncbi.nlm.nih.gov/36774205/

Writing Committee, Kontos MC, de Lemos JA, et al. 2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. Published November 2022. Accessed March 27, 2023. https://www.jacc.org/doi/10.1016/j.jacc.2022.08.750

DEA Updates – Segment with Dr. Rick Bukata

Criteria for Furnishing Number Utilization by Nurse Practitioners. State of California, DCA (Department of Consumer Affairs). Board of Registered Nursing. Rn.ca.gov. Accessed March 27, 2023. https://www.rn.ca.gov/pdfs/regulations/npr-i-16.pdf

DEA Announces Proposed Rules for Permanent Telemedicine Flexibilities. Drug Enforcement Administration (DEA). Published February 24, 2023. Accessed March 27, 2023. https://www.dea.gov/press-releases/2023/02/24/dea-announces-proposed-rules-permanent-telemedicine-flexibilities

Mid-Level Practitioners Authorization by State. US Department of Justice. Drug Enforcement Administration. Diversion Control Division. Usdoj.gov. Accessed March 27, 2023. https://www.deadiversion.usdoj.gov/drugreg/practioners/

Removal of DATA Waiver (X-Waiver) Requirement. SAMHSA. Substance Abuse and Mental Health Services Administration. Samhsa.gov. Last Updated January 25, 2023. Accessed March 27, 2023. https://www.samhsa.gov/medications-substance-use-disorders/removal-data-waiver-requirement

Statutory Changes in Pharmacy Law. Pharmacy.ca.gov. Published December 9, 2022. Accessed March 27, 2023. https://www.pharmacy.ca.gov/laws_regs/new_laws.pdf

Recurring Sources

Center for Medical Education. Ccme.org. http://ccme.org

The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org

The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx

The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com

Trivia Question: Send answers to [email protected]

Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at [email protected] and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Welcome to the 2 View - Episode 24

Welcome to Episode 24 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants!

Show Notes for Episode 24 of “The 2 View” – New street drug xylazine/"tranq," app for EM coding changes, FPL injuries, hemorrhoids.

Molnupiravir

Butler CC, Hobbs FDR, Gbinigie OA, et al. Molnupiravir plus usual care versus usual care alone as early treatment for adults with COVID-19 at increased risk of adverse outcomes (PANORAMIC): an open-label, platform-adaptive randomised controlled trial. Lancet. PubMed. NIH: National Library of Medicine, National Center for Biotechnology Information. Published January 28, 2023. Accessed February 21, 2023. https://pubmed.ncbi.nlm.nih.gov/36566761/

Molnupiravir. COVID-19 Treatment Guidelines. NIH. Last Updated: September 26, 2022. Accessed February 21, 2023. https://www.covid19treatmentguidelines.nih.gov/therapies/antivirals-including-antibody-products/molnupiravir/

Easy Emergency Medicine Coding Calculator

American Medical Association. 2023 Emergency Medicine Coding Guide. MDCalc. Accessed February 21, 2023. https://www.mdcalc.com/calc/10454/2023-emergency-medicine-coding-guide

CPT Evaluation and Management (E/M) Code and Guideline Changes. Ama-assn.org. AMA: American Medical Association. Accessed February 21, 2023. https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf

Graham. 2023 Emergency Medicine Level of Service/Billing Guidelines Overview. Published December 31, 2022. Accessed February 21, 2023. https://www.youtube.com/watch?v=WuV8O3SuXJI

The Center for Medical Education. Documentation Changes that Can Help Your Practice. Published August 16, 2022. Accessed February 21, 2023. https://www.youtube.com/watch?v=gHLBjzQt4vo

Xylazine

DEA Joint Intelligence Report. The Growing Threat of Xylazine and its Mixture with Illicit Drugs. U.S. Department of Justice Drug Enforcement Administration. Dea.gov. Published October 2022. Accessed February 21, 2023. https://www.dea.gov/sites/default/files/2022-12/The%20Growing%20Threat%20of%20Xylazine%20and%20its%20Mixture%20with%20Illic

FDA warns about the risk of xylazine exposure in humans. Fda.gov. FDA. Published November 8, 2022. Accessed February 21, 2023. https://www.fda.gov/media/162981/download

Hoffman J. Tranq dope: Animal Sedative Mixed with Fentanyl Brings Fresh Horror to U.S. Drug Zones. The New York Times. Published January 7, 2023. Accessed February 21, 2023. https://www.nytimes.com/2023/01/07/health/fentanyl-xylazine-drug.html.

National Institute on Drug Abuse. Xylazine. National Institute on Drug Abuse: Advancing Addiction Science. Published April 21, 2022. Accessed February 21, 2023. https://nida.nih.gov/research-topics/xylazine

Overdose C on O. Toxicity of Xylazine and How It Impacts People Who Use Drugs by Dr. Joseph D’Orazio. Published June 15, 2022. Accessed February 21, 2023. https://www.youtube.com/watch?v=Rqpf0jIuyCo

Flexor Pollicis Longus and Other Thumb Injuries

Gault D. A review of repaired flexor tendons. J Hand Surg Br. ScienceDirect. Published October 1987. Accessed February 21, 2023. https://www.sciencedirect.com/science/article/abs/pii/0266768187901811

Urbaniak JR. Repair of the flexor pollicis longus. Hand Clin. Europe PMC. Published February 1, 1985. Accessed February 21, 2023. https://europepmc.org/article/med/3912396

Hemorrhoids

Procedure Review: Thrombosed Hemorrhoids. EM:RAP. EM:RAP.ORG. Published April 2018. Accessed February 21, 2023. https://www.emrap.org/episode/emrapliveapril/procedurereview

Zuber TJ. Hemorrhoidectomy for Thrombosed External Hemorrhoids. Am Fam Physician. AAFP. Published 2002. Accessed February 21, 2023. https://www.aafp.org/pubs/afp/issues/2002/0415/p1629.html

Recurring Sources

Center for Medical Education. Ccme.org. http://ccme.org

The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org

The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx

The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com

Trivia Question: Send answers to [email protected]

Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at [email protected] and tell us who you want to give a shout-out to.

Be sure to listen in and see what we have to share!