From DU's 1st annual Colorado Behavioral Health and Wellness Summit:

Contributors:

Marion Rorke, MPH, Substance Use Resource Coordinator, City and County of Denver, and Maggie Kauffman, MPH, Health Equity Data Analyst, City and County of Denver, and Jean Finn, RN, Substance Misuse Manager, City and County of Denver

From DU's 1st annual Colorado Behavioral Health and Wellness Summit:

Contributors:

Lesley Brooks, MD, Chief Medical Officer, Sunrise Community Health Center; Medical Director – Quality, North Colorado Health Alliance, and Heather Ihrig, RN, CO-SLAW Program Director, North Colorado Health Alliance, and Meredith Silverstein, PhD, Sr. Research Associate, Butler Institute for Families, Graduate School of Social Work, University of Denver, and Kali Jefferson, MSW, Research Assistant, Butler Institute for Families, Graduate School of Social Work, University of Denver

From DU's 1st annual Colorado Behavioral Health and Wellness Summit:

Contributor: Khara Croswaite Brindle, MA, LPC, ACS, Croswaite Counseling, PLLC

From DU's 1st annual Colorado Behavioral Health and Wellness Summit:

Contributor: Steven Wright, MD, Colorado Consortium for Prescription Drug Abuse Prevention

Contributor: John Winkler

Educational Pearls:

• There is increasing resistance to antimalarial drugs, especially in P. falciparum. This trend started with chloroquine, but is now spreading to the other first-line drugs.
• Resistant strains have been identified in Cambodia and Thailand
• 220 million people were infected last year
• The best treatment of malaria is prevention from bites - DEET and permethrin are typical effective options.
• Permethrin may be applied to clothing items before travel, and will last through 6-8 wash cycles.
• While malaria is rare in the US, it should be considered in those having recently travelled

References

Hamilton WL, Amato R, van der Pluijm RW, et al. Evolution and expansion of multidrug-resistant malaria in southeast Asia: a genomic epidemiology study. Lancet Infect Dis. 2019;19(9):943–951. doi:10.1016/S1473-3099(19)30392-5

Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Contributor: Jared Scott, MD

Educational Pearls

• In a 4 yr period at 2 hospital systems, unprofessional behavior of surgeons was monitored via a complaint system. Number of complaints was compared with surgical complications.
• In 13000 patients over this period, the number of surgical complications was found to vary with the number of complaints. Surgeons with with zero complaints had a 10% complication rate, 1-3 complaints had a 14% rate, and those with >4 and an 11.9% rate.
• There was statistical significance that persisted after adjustment for a variety of patient factors
• It never hurts to be professional!

References

Cooper WO, Spain DA, Guillamondegui O, et al. Association of Coworker Reports About Unprofessional Behavior by Surgeons With Surgical Complications in Their Patients. JAMA Surg. 2019;154(9):828–834. doi:https://doi.org/10.1001/jamasurg.2019.1738

Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Contributor: Dylan Luyten, MD

Educational Pearls:

• Bag-valve masks (BVM) typically have a port to connect O2 to. Unfortunately room air becomes entrained in the mask, reducing the FiO2 delivered to the patient. This can be overcome by using a PEEP (positive end-expiratory pressure) valve on the BMV
• PEEP valves function by keeping alveoli open in the lungs at the end of expiration. This increases the oxygen diffusing ability of the lungs, keeping patients' oxygen saturations higher.
• Patients who are critically ill can become quickly hypoxic after RSI meds due to reduced functional residual lung capacity - an issue that can be overcome with a PEEP valve
• PEEP also will reduce work of breathing in COPD and CHF patients

References

Bucher JT, Cooper JS. Bag Mask Ventilation (Bag Valve Mask, BVM) [Updated 2019 Jul 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441924/

Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

Lisa Raville and Dr. Josh Blum, two pioneers of harm reduction in Denver, discuss the addiction crisis, the current state of harm reduction and how it will evolve in the future.

Intro Music:

Backbay Lounge Kevin MacLeod (incompetech.com) Licensed under Creative Commons: By Attribution 3.0 License http://creativecommons.org/licenses/by/3.0/

Contributor: Erik Verzemnieks, MD

Educational Pearls:

• Important to realize complications can occur in the post-opioid overdose patient regardless of cause
• Narcan administration has been associated with non-cardiogenic pulmonary edema, although the mechanism of this is not quite known
• Symptoms include progressive shortness of breath and hypoxia.
• Treatment is with positive-pressure ventilation and diuresis, similar to cardiogenic causes
• Though rare, it would appear this typically resolves with treatment

Reference

Jiwa N, Sheth H, Silverman R. Naloxone-Induced Non-Cardiogenic Pulmonary Edema: A Case Report. Drug Saf Case Rep. 2018;5(1):20. Published 2018 May 10. doi:10.1007/s40800-018-0088-x

All by Erik Verzemnieks, MD

Contributor: Jared Scott, MD

Educational Pearls:

• Non-accidental trauma (NAT) to children is commonly missed by medical providers
• Try to remember TEN-4-FACES as a useful aide for concerning patterns that may reflect NAT:
• • Torso, ears, neck and any bruising in child 4 months or longer
  • Frenulum, angle of the mandible, cheek, eyes, sclera

References

Pierce MC, Magana JN, Kaczor K, Lorenz DJ, Meyers G, Bennett BL, Kanegaye JT. The Prevalence of Bruising Among Infants in Pediatric Emergency Departments. Ann Emerg Med. 2016 Jan;67(1):1-8. PMID: 26233923.

Pierce MC, Kaczor K, Aldridge S, O'Flynn J, Lorenz DJ. Bruising characteristics discriminating physical child abuse from accidental trauma. Pediatrics. 2010 Jan;125(1):67-74. PMID: 19969620.

Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD