Emergency Medical Minute

Contributor: Travis Barlock, MD

Educational Pearls:

Caffeine Geography and Types:

• Caffeine is found throughout the world and has evolved independently in various plants that are not evolutionarily related through direct lineage, but rather demonstrate convergent evolution (i.e. different species evolve the same traits).

• These plants use caffeine as an insecticide.

• Examples of caffeine sources include coffee, tea, yerba-mate, guaraná, cacao, and yaupon holly.

• Roughly 85% of Americans are estimated to consume caffeine daily.

Caffeine Pharmacology in Humans:

• In humans, caffeine is a nonselective competitive antagonist (blocker) of adenosine receptors (A1 and A2A).

• During waking hours, neuronal metabolic activity consumes ATP, and a byproduct of ATP hydrolysis is created: adenosine.

• Adenosine proceeds to build a "sleep pressure".

• Acting on A1 and A2A adenosine receptors to induce sleep (on A1, it suppresses neuronal "wakefulness" and on A2A it is believed to be an inducer of sleep).

• Caffeine, by blocking those receptors, blunts sleep induction and feelings of being tired.

• Caffeine has a half-life of around 6 hours, and a quarter life of approximately 12 hours, which is when the caffeine will off-load and adenosine can once again occupy those receptors, potentially causing a "crash".

• Thus, for shift-workers, it is important to time caffeine intake roughly 10 hours before target bed time.

• Caffeine exerts other effects on the body.

• It is methylxanthine similar to theophylline, which works as a bronchodilator (via phosphodiesterase and adenosine pathways). Caffeine has clinical use to promote bronchodilation in pre-term infants.

• Caffeine exerts diuretic effects as well (blocking proximal renal tubule reabsorption).

• Recent ingestion of caffeine may blunt therapeutic use of adenosine in patients with SVT.

Key Takeaway?

• Caffeine exerts a wide variety of effects beyond making us feel more awake. It has cardiovascular, pulmonary, and renal implications in its pharmacodynamics.

References

1. Benarroch EE. Adenosine and its receptors: multiple modulatory functions and potential therapeutic targets for neurologic disease. Neurology. 2008;70(3):231-236. doi:10.1212/01.wnl.0000297939.18236.ec

2. Mitchell DC, Knight CA, Hockenberry J, Teplansky R, Hartman TJ. Beverage caffeine intakes in the U.S. Food Chem Toxicol. 2014;63:136-142. doi:10.1016/j.fct.2013.10.042

3. Bruschettini M, Brattström P, Russo C, Onland W, Davis PG, Soll R. Caffeine dosing regimens in preterm infants with or at risk for apnea of prematurity - Bruschettini, M - 2023 | Cochrane Library. Accessed May 23, 2026. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013873.pub2/full?cookiesEnabled

4. Huang R, O'Donnell AJ, Barboline JJ, Barkman TJ. Convergent evolution of caffeine in plants by co-option of exapted ancestral enzymes. Proc Natl Acad Sci U S A. 2016;113(38):10613-10618. doi:10.1073/pnas.1602575113

5. Cabalag MS, Taylor DM, Knott JC, Buntine P, Smit D, Meyer A. Recent caffeine ingestion reduces adenosine efficacy in the treatment of paroxysmal supraventricular tachycardia. Acad Emerg Med. 2010;17(1):44-49. doi:10.1111/j.1553-2712.2009.00616.x

Summarized by Dan Orbidan, OMS2 | Edited by Dan Orbidan & Ahmed Abdel-Hafiz, NREMT-P

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Contributor: Travis Barlock, MD

Educational Pearls:

Endocannabinoid System: THC binds CB1 and CB2 receptors in neurons and immune cells

• Δ9-Tetrahydrocannabinol (THC) is the main psychoactive compound in cannabis

• CB1 and CB2 receptors typically bind endogenously-produced 2-arachidonoylglycerol (2-AG) and anandamide (AEA) to regulate pain, stress, and inflammation

• THC similarly binds CB1 and CB2, leading to the cannabinoid high: euphoria, paranoia, anxiety, analgesia, anti-inflammation, and appetite, among a variety of others

• Ingestion via edibles, vice inhalation via smoking, leads to chemical modification of Δ9-THC to 11-hydroxy-Δ9-THC, which more easily crosses the blood-brain barrier and binds CB1 with higher affinity, leading to increased psychoactivity

Cannabinoid Hyperemesis Syndrome (CHS): Chronic THC use leading to the classic presentation of persistent nausea and intense, frequent vomiting

• Chronic activation of CB1 receptors in brain builds a tolerance and dependence on THC, in addition to chronic activation of the capsaicin and vanilloid receptor TRPV1, which binds capsaicin or is activated by heat

• Treatment by warm showers works due to TRPV1 activation by heat

• Treated with benzodiazepines, fluids, and gastro-intestinal or central nervous system agents according to patient presentation

Over 200 synthetic cannabinoids have been created (K2, spice, black mamba, mojo, etc), which are more dangerous and can lead to a variety of etiologies

Acetaminophen binds CB1 receptors to reduce inflammatory pain

References

1. Loganathan P, Gajendran M, Goyal H. A Comprehensive Review and Update on Cannabis Hyperemesis Syndrome. Pharmaceuticals (Basel). 2024;17(11):1549. Published 2024 Nov 18. doi:10.3390/ph17111549

2. Wall ME, Sadler BM, Brine D, Taylor H, Perez-Reyes M. Metabolism, disposition, and kinetics of delta-9-tetrahydrocannabinol in men and women. Clin Pharmacol Ther. 1983 Sep;34(3):352-63. doi: 10.1038/clpt.1983.179. PMID: 6309462.

3. Mills B, Yepes A, Nugent K. Synthetic Cannabinoids. Am J Med Sci. 2015 Jul;350(1):59-62. doi: 10.1097/MAJ.0000000000000466. PMID: 26132518.

4. Klinger-Gratz PP, Ralvenius WT, Neumann E, et al. Acetaminophen Relieves Inflammatory Pain through CB1 Cannabinoid Receptors in the Rostral Ventromedial Medulla. J Neurosci. 2018;38(2):322-334. doi:10.1523/JNEUROSCI.1945-17.2017

Summarized by Sam Pahl | Edited by Sam Pahl & Ahmed Abdel-Hafiz, NREMT-P

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Contributor: Aaron Lessen, MD

Educational Pearls:

• There has long been many questions about which IV fluid is best for ED resuscitation

• Multiple adult studies have shown no clear benefit of balanced fluid vs normal saline

• A large pediatric randomized clinical trial published in April compared balanced fluid vs normal saline in children with septic shock

• The study included about 9,000 patients from 47 emergency departments in five countries

• Patients with septic shock were randomized to receive either balanced fluid or normal saline

• The primary outcome was adverse kidney event (death, dialysis, or persistent kidney dysfunction) at 30 days or hospital discharge

• Results showed no difference in any safety outcomes and no adverse events occurred

• The key takeaway is that early fluid resuscitation matters more than which crystalloid you choose

References

1. Balamuth F, Weiss SL, Long E, et al. Balanced Fluid or 0.9% Saline in Children Treated for Septic Shock. New England Journal of Medicine. Published online April 23, 2026. doi:https://doi.org/10.1056/nejmoa2601969

Summarized by Meg Joyce, MS3 | Edited by Meg Joyce & Ahmed Abdel-Hafiz, NREMT-P

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Carepoint Journal Club is a quarterly series with discussions about a medical topic, brought to you by Carepoint's Emergency Physicians.

Contributor: Taylor Lynch, MD

Educational Pearls:

Conduction abnormalities are a common and clinically significant complication in patients who undergo transcatheter aortic valve replacement (TAVR)

Clinical Features

• The most common abnormalities include high grade AV block and new onset LBBB

• Due to the close proximity of the aortic annulus to the AV node and His-Purkinje system

• More common in males, the elderly, and those with pre-existing conduction disease (RBBB or LBBB)

• Sinus pauses and sinus arrest are a rare post-TAVR rhythm disturbances

• Temporary failure of sinus node firing with absent P waves, followed by return of sinus rhythm

• Sinus Pauses: Typically last

• Sinus Arrest: Typically last > 3 seconds

• Not due to direct mechanical injury from the valve, but may occur in patients as a result of pre-existing disease or other external factors:

• Medications

• Beta blockers, calcium channel blockers, digoxin

• Pre-existing damage to the SA node

• Fibrosis from a previous MI

Treatment

• If the patient is asymptomatic, provide ongoing surveillance

• If the patient is symptomatic, treatment should be aimed at the underlying cause:

• For medication-induced abnormalities, stop the offending medication

• For acute, unstable bradycardia:

• Medications: Atropine, Dopamine Infusion, Epinephrine Infusion

• If cardiology is not immediately available, initiate transcutaneous pacing or insert a temporary transvenous pacemaker

• Definitive treatment: Pacemaker

• ~10–15% of patients may develop a bradyarrhythmia post TAVR, with ~8-15% later requiring a pacemaker

Due to the risk of conduction abnormalities post TAVR, many patients are discharged with ambulatory rhythm monitoring such as a ZioPatch or Holter monitor, and may present to the emergency department for evaluation of rhythm disturbances.

References:

1. Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay. Heart Rhythm. 2019;16(9):e128-e226.

2. Lilly, S, Deshmukh, A, Epstein, A. et al. 2020 ACC Expert Consensus Decision Pathway on Management of Conduction Disturbances in Patients Undergoing Transcatheter Aortic Valve Replacement: A Report of the American College of Cardiology Solution Set Oversight Committee. JACC. 2020 Nov, 76 (20) 2391–2411.

https://doi.org/10.1016/j.jacc.2020.08.050

1. Sammour, Y, Krishnaswamy, A, Kumar, A. et al. Incidence, Predictors, and Implications of Permanent Pacemaker Requirement After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol Intv. 2021 Jan, 14 (2) 115–134.

https://doi.org/10.1016/j.jcin.2020.09.063

1. Tarakji KG, Patel D, Krishnaswamy A, et al. Bradyarrhythmias detected by extended rhythm recording in patients undergoing transcatheter aortic valve replacement (Brady-TAVR Study). Heart Rhythm. 2022;19(3):381-388.

Summarized by Ashley Lyons, OMS3 | Edited by Ashley Lyons & Ahmed Abdel-Hafiz, NREMT-P

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Contributor: Alec Coston, MD

Educational Pearls:

What are nasal intubations and when do we use them?

• Nasal intubations function similarly to oral intubations with the end goal of passing an endotracheal tube (ETT) through vocal cords and into the trachea to allow for a patent and secure airway, but differ in the main access point for the ETT (nare v.s. mouth).

• Nasal Intubations are seldom preferred to oral intubations as they carry risk for inducing bleeding from trauma to the nasal passages.

• Indications for nasal intubations include:

• Anatomical abnormalities that may make access through the mouth difficult (i.e. tumors, macroglossia, or rare dental hardware that clenches the jaw shut).

• Physiological states such as severe angioedema.

• Nasal intubations are often done with the patient awake and could be advantageous if the patient is presenting in a severely hypoxic state such that prolonged hypoxia in a traditional RSI protocol may be detrimental.

• A 2023 retrospective analysis in Germany found that nasal intubations were associated with requiring less sedation than oral intubations and had more spontaneous breathing during hospitalization than oral intubations.

How is a nasal intubation performed?

• Consider the use of an anxiolytic medication such as versed to calm the patient down but not fully sedate them.

• If there is adequate time without immediate patient compromise, consider glycopyrrolate to reduce airway secretions and dry up the mucous membranes.

• Consider the use of Afrin or other local vasoconstrictor in target nare to minimize epistaxis.

• Use 5% lidocaine ointment and lubricate an NPA and place it into the target nare. This will allow for local anesthesia as well as help to open up the nare slightly more.

• Take 5% lidocaine ointment and place it on a tongue depressor and move it around the back of the tongue, allowing it to further anesthetize the oropharynx.

• Remove the NPA and atomize/nebulize 4% lidocaine liquid into the nare and into the oropharynx for further anesthesia.

• Insert the ETT without the bronchoscope through the nare and allow it to pass about 10 cm until visible in the oropharynx. This allows for a "clean" plastic tunnel to pass the bronchoscope through.

• Advance both the ETT and bronchoscope, spraying lidocaine through the bronchoscope while advancing to allow for continued numbing.

• Pass the ETT through the cords and inflate.

• At this point, stronger sedation medications such as ketamine and propofol may be considered but the use of a paralytic like succinylcholine and rocuronium may not be needed to allow the patient to maintain their own negative pressure ventilation.

Which nare is the best to go through?

• Most patients will have their right nare be the best (away from the septal deviation) according to a meta-analysis by Tan et al.

• The right nare was generally associated with less epistaxis and lower intubation times.

• However, do not always default to the right nare, and test which nare is more patent by occluding one nare at a time and assessing which one is less resonant (less resonant = more patent).

Key Takeaway?

• Nasal intubations are rarer than oral intubations and can be more technically difficult, but may offer advantages in patients with difficult oral airways, but should never be first line.

References:

1. Grensemann J, Gilmour S, Tariparast PA, Petzoldt M, Kluge S. Comparison of nasotracheal versus orotracheal intubation for sedation, assisted spontaneous breathing, mobilization, and outcome in critically ill patients: an exploratory retrospective analysis. Sci Rep. 2023;13:12616. doi:10.1038/s41598-023-39768-1

2. Tan YL, Wu ZH, Zhao BJ, Ni YH, Dong YC. For nasotracheal intubation, which nostril results in less epistaxis: right or left?: A systematic review and meta-analysis. Eur J Anaesthesiol. 2021;38(11):1180-1186. doi:10.1097/EJA.0000000000001462

3. Holzapfel L. Nasal vs oral intubation. Minerva Anestesiol. 2003;69(5):348-352.

Summarized by Dan Orbidan, OMS2 | Edited by Dan Orbidan & Ahmed Abdel-Hafiz, NREMT-P

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Contributor: Aaron Lessen, MD

Educational Pearls:

What are the common causes of agitation in the elderly?

• Baseline dementia causing a behavioral disturbance
• Delirium precipitated by an acute medical problem such as a UTI, pneumonia, overdose/side effect of home medications, urinary retention, constipation, pain, hypoxia, electrolyte abnormality, etc.
• Exacerbation of a primary psychotic condition such as schizophrenia or bipolar disorder.

What environmental changes can help reduce agitation?

• Maintain a quiet, calm, uncluttered environment
• Dim the lights
• Ensure the patient has their glasses, hearing aids, and dentures
• Avoid excessive lines such as foleys
• Minimize restraints and other forms of immobilization
• Reassure the patient frequently and have the family check in with the patient

What are the best options if medications are required?

• If the patient is unsafe or non-pharmacologic measures fail, consider a second-generation ("atypical") antipsychotic using the lowest effective dose:
  • Olanzapine
  • Risperidone
  • Quetiapine
• One special consideration is Dementia with Lewy Bodies, which can be very sensitive to antipsychotics.
  • In this case, Quetiapine is the preferred agent.

Avoid when possible:

• Diphenhydramine and other anticholinergics, which can worsen delirium (including urinary retention and sedation)
• Benzodiazepines, which may worsen confusion, falls, and respiratory depression
• Haloperidol, which has a higher risk of extrapyramidal symptoms and QT prolongation than many atypicals

References

1. Badwal K, Kiliaki SA, Dugani SB, Pagali SR. Psychosis Management in Lewy Body Dementia: A Comprehensive Clinical Approach. J Geriatr Psychiatry Neurol. 2022 May;35(3):255-261. doi: 10.1177/0891988720988916. Epub 2021 Jan 19. PMID: 33461372.
2. Kurlan R, Cummings J, Raman R, Thal L; Alzheimer's Disease Cooperative Study Group. Quetiapine for agitation or psychosis in patients with dementia and parkinsonism. Neurology. 2007 Apr 24;68(17):1356-63. doi: 10.1212/01.wnl.0000260060.60870.89. PMID: 17452579.
3. Shenvi C, Kennedy M, Austin CA, Wilson MP, Gerardi M, Schneider S. Managing Delirium and Agitation in the Older Emergency Department Patient: The ADEPT Tool. Ann Emerg Med. 2020 Feb;75(2):136-145. doi: 10.1016/j.annemergmed.2019.07.023. Epub 2019 Sep 26. PMID: 31563402; PMCID: PMC7945005.

Summarized and edited by Jeffrey Olson, MS4

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Contributor: Aaron Lessen, MD

Educational Pearls:

• Patients with pulmonary embolism (PE) are divided into three risk categories
  • Low risk (non-massive PE): patients are stable
    • Treatment: prescribe anticoagulants and discharge home
  • Intermediate risk (submassive PE): patients are stable but display evidence of clot burden such as elevated troponin, elevated BNP, and/or right heart strain
    • Treatment is controversial
  • High risk (massive PE): patients are unstable with hypotension, hypoxia, and/or respiratory distress
    • Treatment: IV thrombolysis to prevent decompensation
• A recent randomized controlled trial evaluated treatment of intermediate risk PE patients
  • Patients were randomized to receive either thrombectomy with anticoagulation or anticoagulation alone
  • The primary outcome evaluated changes in right ventricular enlargement at 48 hours
    • A controversial primary outcome because it does not speak to mortality or incidence of other necessary aggressive interventions
    • Low clinical significance
  • The study found that thrombectomy significantly reduced right ventricular enlargement faster than anticoagulation alone. However, there was no statistical difference in mortality or need for other treatments
• Treatment for intermediate risk PE patient remains controversial
• The same study will have second follow-up at 90 days to see if there are other benefits

References

1. Lookstein RA, Konstantinides SV, Weinberg I, Dohad SY, Rosol Z, Kopeć G, Moriarty JM, Parikh SA, Holden A, Channick RN, McDonald B, Nagarsheth KH, Yamada K, Rosovsky RP; STORM-PE Trial Investigators. Randomized Controlled Trial of Mechanical Thrombectomy With Anticoagulation Versus Anticoagulation Alone for Acute Intermediate-High Risk Pulmonary Embolism: Primary Outcomes From the STORM-PE Trial. Circulation. 2026 Jan 6;153(1):21-34. doi: 10.1161/CIRCULATIONAHA.125.077232. Epub 2025 Nov 3. PMID: 41183181.

Summarized by Meg Joyce, MS2 | Edited by Meg Joyce & Jorge Chalit, OMS4

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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:

1. 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.
2. 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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