More on Migraine Headaches

What does a cotton swab and nose have in common? (photos from WikiCommons)

In August I posted on the common presenting complaint: migraine headaches…but there’s more.

Dr. Michelle Lin talks about anti-dopaminergic agents, triptans, IV fluids, routes of administration and steroid use. And who thought a cotton swab was your instrument of choice when treating a migraine headache? I didn’t. Check out the Lin Session: Migraine podcast from the EM:RAP November edition to add more skills to your headache arsenal.

Then add a chaser with Paper Chase #4 from the same edition which talks about parenteral acetaminophen (paracetamol). You’ll be surprised by the mechanism of action.

Who knew? The cotton swab is a tool invented in the 1920s by Leo Gerstenzang after he watched his wife attach wads of cotton to toothpicks. His product, which he named “Baby Gays“, went on to become the most widely sold brand name, “Q-tips”, with the Q standing for “quality”. (Wikipedia)

Time to Charge Your Battery…

With a jolt of information on button battery ingestions by pediatrician Ilene Claudius. The November 2017 EM:RAP edition has a podcast sure to shock you. From one end of the tail to the other, your patient outcomes can range from benign ingestion and passage over a few days to death.

A variety of button batteries found in toys. (Photo from Wikimedia Commons.)

The leakage of alkaline materials will cause liquefaction necrosis rapidly. (Photo from Wikimedia Commons.)

Button battery or coin? Read the EMRAP PDF or listen to the podcast to learn how to differentiate. (Photo from http://www.radiologypics.com)

 

The National Capital Poison Center posted the NBIH Button Battery Ingestion Triage and Treatment Guideline: https://www.poison.org/battery/guideline

Battery ingestions are no laughing matter but I can’t end without one bad joke: What did the depleted battery say to the judge? “Feel free to charge me.”

 

Dizziness-The Facts Will Sway You

“Doctor, I am dizzy.”

Dizziness is a common presenting patient complaint. When is it serious and when is it benign. For back pocket HINTS on how to differentiate Posterior Circulation Strokes from weak and dizzy listen to this September podcast. It’s available using your CMES thumbdrives or CMES-Pi.

Posterior Circulation Stroke vs. No Big Deal (THE HINTS EXAM) Anand Swaminathan MD and Evie Marcolini MD 

Standard Oxygen Therapy Ignites Controversy

Does oxygen therapy make a difference in heart attack patients?The European Society of Cardiology, news release, Aug. 28, 2017 cited this Swedish study which found no difference in patient outcomes.

EM:RAP has up-to-date information about using oxygen therapy in the acute setting. So hold your breath and check out these podcasts:

Paper Chase 2: The Oxygen Middle Path by Sanjay Arora MD and Michael Menchine MD

Introduction: Flush Rate Oxygenation by Rob Orman MD and Anand Swaminathan MD

Did you know?  Oxygen was discovered independently by Carl Wilhelm Scheele, in Uppsala, Sweden in 1773 or earlier, and Joseph Priestley in Wiltshire, England in 1774, but Priestley is often given priority because his work was published first. Priestly fled to America in 1793 to escape political persecution. The Joseph Priestley museum is in my hometown Northumberland, Pennsylvania USA…I’ve never been there.

 

 

Fishing for Anaphylaxis Treatment

First up…a really bad pun to get your creative energy flowing: What was the cause of the tech-guru’s most recent seafood reaction?
A new shell-phone!

Log into CMES and scratch up the June 2017 EM:RAP podcast called The Case of the Funky Fish by Stuart Swadron MD and Billy Mallon MD for up-to-date information on the treatment of acute anaphylaxis.

Now challenge your colleagues with a similar case. Which drug do you reach for first? Is epinephrine given in the arm or thigh or doesn’t it matter? Do they use both H1 and H2 blockers and where is the evidence these work? Have steroids even been scientifically proven to help in acute allergic reactions?

The life of your patient may depend on your knowledge of these questions and how quickly you start treatment…hopefully faster than edema swells their airway shut.

Read more

Mind the Migraines

A shift would not be complete without one headache patient. I would wager that is the same wherever you practice because I treated migraine headache patients from remote Himalayan villages to tropical islands in the Caribbean.

The worrisome causes of headaches such as pregnant + hypertension + headache; new onset after age 50; headache + fever, headache + altered mental status; abrupt onset headache; and headache + painful red eye to name a few should prompt investigation and immediate treatment.

But for the treatment of one of the most common types of headache, the migraine, check out the EM:RAP August Pharmacology Rounds: What Works for Acute Migraine? by Rob Orman MD and Bryan Hayes PharmD.

Migraines have been recorded in medical history for a long time, the first found documentation in the Ebers Papyrus written around 1500 BCE. For you language buffs the word migraine is derived from the Greek word hemikrania. This term was corrupted into hemigranea and the common word comes from the French translation, migraine.

Dr. Shankar Rai Praises CMES

Kirtipur Hospital in Nepal is situated on the upper slopes of the southern Kathmandu Valley with a mesmerizing view of the Himalayan Mountains from the walkways. The hospital, part of Phect-Nepal, had been operating since 12 April 2006 as a 15-bed outreach hospital of phect-NEPAL/KMH with a special focus on maternity services. Recently it has been upgraded to a 100-bed hospital with additional specialized services. The hospital provides 24-hour emergency services and outpatient department.

One of the specialized services is the Department of Plastic & Reconstructive Surgery headed by Dr. Shankar Rai. Many of you know him as a world leader in innovative surgery techniques. The hospital offers Burn and Plastic Surgery, Nepal Cleft and Burn Center, Acute Burn Care, Nepal Skin Bank, and Wound Clinic.

Dr. Shankar is an original supporter for CMES and even with his years of experience and expert knowledge…had this to say:

I really appreciate your kind help for the improvement of our emergency medical service in Nepal. I have personally used your system and have found useful material for my own education on hand injuries.”

Thank you, Dr. Shankar, for your support.

 

 

EM:RAP – Super Suture Lectures

Last October 2016, I gave a suture lecture at Kathmandu Model Hospital, Grande International Hospital and both CIWEC hospitals in Kathmandu and Pokhara. Although doctors approach suturing in a myriad of ways based on education, preference, and experience, the one thing we agreed on was…reviewing the basics and yearly updates are helpful.

CMES participants can download the excellent suture lecture from the March and April 2017 EM:RAP archives. Share your knowledge and learn from your colleagues by giving a lecture at your institution on wound repair.

March:

Wound Repair Part 1 – Wound Prep

Brian Lin, MD and Zach Shinar, MD
April:

Wound Repair Part 2 – Eversion and Simple Interrupted

Jonathan Kantor, MD, Zach Shinar, MD, and Brian Lin, MD
1 2 3 4 5