Episode 160.0 – Measles

04/08/19 • 12 min

In this episode, we discuss the recent measles outbreak and how ED providers can best prepare to treat this almost vanquished foe.

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Measles_Final_Cut.mp3 Download One Comment Tags: Infectious Diseases, Pediatrics

Show Notes

Episode Produced by Audrey Bree Tse, MD

References:

CDC Measles for Health Care Providers. https://www.cdc.gov/measles/hcp/index.html#lab.

Gladwin M, Trattler B. Orthomyxo and Paramyxoviridae. In: Clinical Microbiology Made Ridiculously Simple. 4th ed. Miami, FL: MedMaster, Inc; 2009: 240-243.

Hussey G, Klein M. A Randomized, Controlled Trial of Vitamin A in Children with Severe Measles. N Engl J Med. 1990; 323: 160-164.doi: 10.1056/NEJM199007193230304.

Nir, Sarah Mailin and Gold, Michael. “An Outbreak Spreads Fear: Of Measles, of Ultra-Orthodox Jews, of Anti-Semitism.” New York Times [New York City] 03/29/2019. https://www.nytimes.com/2019/03/29/nyregion/measles-jewish-community.html

A massive thanks to:

Shweta Iyer, MD: NYU Langone 3rd year Pediatric Emergency Medicine Fellow.

Jennifer Lighter, MD: Assistant Professor of Pediatric Infectious Diseases, NYU School of Medicine.

Michael Mojica, MD: Associate Professor of Pediatric Emergency Medicine, NYU Langone Medical Center.

Michael Phillips, MD: Chief Hospital Epidemiologist, NYU Langone Medical Center.

In this episode, we discuss the recent measles outbreak and how ED providers can best prepare to treat this almost vanquished foe.

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Measles_Final_Cut.mp3 Download One Comment Tags: Infectious Diseases, Pediatrics

Show Notes

Episode Produced by Audrey Bree Tse, MD

References:

CDC Measles for Health Care Providers. https://www.cdc.gov/measles/hcp/index.html#lab.

Gladwin M, Trattler B. Orthomyxo and Paramyxoviridae. In: Clinical Microbiology Made Ridiculously Simple. 4th ed. Miami, FL: MedMaster, Inc; 2009: 240-243.

Hussey G, Klein M. A Randomized, Controlled Trial of Vitamin A in Children with Severe Measles. N Engl J Med. 1990; 323: 160-164.doi: 10.1056/NEJM199007193230304.

A massive thanks to:

Shweta Iyer, MD: NYU Langone 3rd year Pediatric Emergency Medicine Fellow.

Jennifer Lighter, MD: Assistant Professor of Pediatric Infectious Diseases, NYU School of Medicine.

Michael Mojica, MD: Associate Professor of Pediatric Emergency Medicine, NYU Langone Medical Center.

Michael Phillips, MD: Chief Hospital Epidemiologist, NYU Langone Medical Center.

Previous Episode

Episode 159.0 – Acute Decompensated Heart Failure

In this episode, we discuss acute decompensated heart failure and how to best manage these dyspneic patients in the ED.

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_ADHF.mp3 Download Leave a Comment Tags: Cardiology, Respiratory

Show Notes

Features that increase the probability of heart failure. (Wang 2005)
B-lines seen in pulmonary edema.
Positioning of ultrasound probe in BLUE protocol. (Lichtenstein 2008)

Episode 161.0 – Opioid Epidemic

A look at the opioid epidemic and what ED providers can do to combat this formidable foe.

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Opioid_Epidemic.mp3 Download Leave a Comment Tags: Opioid Dependence, Opioid Free ED

Show Notes

Consider alternatives to opiates for acute pain
- NSAIDs
- Subdissociative ketamine
- Nerve blocks
Curb misuse and diversion through prescribing a short supply and perform I-STOP checks
Narcan is not just for acute overdose treatment by EMS or within the ED anymore
- We can equip patients, family members and friends with Narcan kits prior to discharge
- In New York state, can prescribe Narcan to patients with near fatal overdoses or who screen positive for an opioid use disorder
- Intranasal formulation is cheaper and more commonly prescribed than IM
Buprenorphine induction can be done in the ED for patients in active withdrawal, as calculated by the COWS score.
- MDcalc calculator: https://www.mdcalc.com/cows-score-opiate-withdrawal
- Providers do not need an X-waiver to give a dose of Buprenorphine in the ED for 3 days
Home induction can be considered for patients not actively withdrawing but would like to enter medication assisted treatment
- Some considerations:
  - Contraindicated in patients with severe liver dysfunction and with hypersensitivity reaction to drug
  - Oversedation can occur with concurrent use of benzodiazepines and alcohol
  - Will precipitate withdrawal if concurrently using full opioid agonists
- Longitudinal care has to be established for patients started on Buprenorphine
  - SAMHSA’s Buprenorphine practitioner locator site: https://www.samhsa.gov/medication-assisted-treatment/practitioner-program-data/treatment-practitioner-locator
  - Buprenorphine Induction Pamphlet