{"id":1363,"date":"2017-03-22T23:49:30","date_gmt":"2017-03-23T03:49:30","guid":{"rendered":"https:\/\/www.roshreview.com\/?p=1363"},"modified":"2017-03-22T23:49:30","modified_gmt":"2017-03-23T03:49:30","slug":"ep-20-cocaine-chest-pain-migraines-hypothermia-salicylate-overdose-toxoplasmosis-labyrinthitis","status":"publish","type":"post","link":"https:\/\/www.roshreview.com\/blog\/ep-20-cocaine-chest-pain-migraines-hypothermia-salicylate-overdose-toxoplasmosis-labyrinthitis\/","title":{"rendered":"Podcast Ep 20: Cocaine Chest Pain, Migraines, Hypothermia, &amp; More"},"content":{"rendered":"\n<figure class=\"wp-block-audio\"><audio controls src=\"https:\/\/media.blubrry.com\/thereveal\/s\/media.blubrry.com\/roshcast\/s\/content.blubrry.com\/roshcast\/Ep_20_Roshcast_Emergency_Board_Review.mp3\"><\/audio><\/figure>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\"><p>As knowledge increases, wonder deepens.<\/p><cite>-Charles Morgan<\/cite><\/blockquote>\n\n\n\n<h6 class=\"wp-block-heading\">Welcome back to Episode 20! We have a great episode lined up for you this week, again covering topics that run the gamut of Emergency Medicine. We are excited to say that we have&nbsp;covered over 100 questions in approximately five hours of Roshcast over six months! As always, send us any feedback or suggestions to <a href=\"mailto:roshcast@roshreview.com\">roshcast@roshreview.com<\/a>. Let\u2019s get going with this week&#8217;s content!<\/h6>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"201\" height=\"74\" src=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/RapidReview-2-e1475624722961.png\" alt=\"\" class=\"wp-image-818\" \/><\/figure><\/div>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>TTP<\/strong> is treated with <strong>plasmapheresis<\/strong>. If plasmapheresis cannot be performed expediently, <strong>FFP can be used<\/strong> as a temporizing measure.<\/li><li>For any patient on <strong>warfarin<\/strong> with a life-threatening bleed, <strong>FFP, PCC, or Recombinant factor VIIa<\/strong> should be given. For a patient on <strong>aspirin<\/strong> with a life-threatening bleed, <strong>DDAVP<\/strong> should be given in addition to <strong>platelets<\/strong>.<\/li><li>For patients with <strong>intracranial hemorrhages<\/strong>, new evidence from the <strong>PATCH trial<\/strong> suggests that platelets may actually increase the risk of death and dependence, so such patients should <strong>only<\/strong> be given <strong>DDAVP<\/strong>.<\/li><li>Both <strong>Hemophilia A and B<\/strong> are <strong>X-linked recessive<\/strong> disorders.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Now onto this week\u2019s podcast<\/strong><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Question 1<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 23-year-old man presents with chest tightness after intranasal cocaine use. Vital signs are HR 133, BP 155\/95, and oxygen saturation 95%. ECG reveals sinus tachycardia with no ischemic changes. What medication should be administered?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>A. Benzodiazepine<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>B. Beta-blocker<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>C. Calcium channel blocker<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>D. Naloxone<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep20-benzodiazepine-mechanism-of-action-GABA-copy.png\">Teaching Image 1<\/a><br><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep20-Sympathomimetic-toxidrome-cocaine-copy.png\">Teaching Image 2<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Question 2<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following is the most common type of migraine headache?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>A. Basilar-type migraine <\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>B. Migraine with aura<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>C. Migraine without aura<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>D. Ophthalmoplegic migraine<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep20-Migraine-Headache-copy.png\">Teaching Image&nbsp;<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Question 3<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 59-year-old man is found naked under a bridge. He is unresponsive and does not respond to painful stimulation. His rectal temperature is 32\u00baC. The patient is intubated for airway protection, warm blankets are placed, and active internal rewarming measures are initiated. The patient\u2019s temperature slowly rises to 35\u00baC, but then begins to fall. Which of the following is most likely responsible for this phenomenon?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>A. Cooling of blood during cardiopulmonary circulation <\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>B. Equipment failure<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>C. Paradoxical splanchnic vasoconstriction<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>D. Return of cold blood to core from periphery<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep20-Afterdrop-hypothermia-rewarming-copy.png\">Teaching Image<\/a>&nbsp;<\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Question 4<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following statements regarding drug exposure and overdose in pregnancy is true?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>A. Gastric decontamination with charcoal or whole-bowel irrigation should be avoided in pregnancy<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>B. Iron crosses the placenta and causes direct fetal toxicity<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>C. Most antidotes should not be given in pregnancy due to the risk of fetal harm<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>D. Salicylate overdose is associated with poor fetal outcomes<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>E. The threshold to treat carbon monoxide poisoning is the same in pregnant and nonpregnant women<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep20-Indications-for-Emergent-Hemodialysis-in-Aspirin-toxicity-salicylate-overdose-copy.png\">Teaching Image<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Question 5<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 32-year old woman with HIV presents for the evaluation of a headache. She denies fever and her neurologic examination is normal. A CT scan of the head is performed and shown above. Which of the following is true regarding the finding on the CT scan?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>A. It is caused by reactivation of a previous infection<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>B. It is transmitted through dog feces<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>C. The CD4 count is typically less than 50 cells\/mm<sup>3<\/sup><\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>D. The organism is a common cause of meningitis<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep20-Cerebral-Toxoplasmosis-AIDS-copy.png\">Teaching Image<\/a>&nbsp;<\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Question 6<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A woman suffers from an acute attack of vertigo, nausea, and vomiting. You suspect viral labyrinthitis. Which of the following medications is the best choice in treating the vertigo?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>A. Acyclovir<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>B. Phentermine<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>C. Prednisolone<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span>D. Prochlorperazine<\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Ep20-Labyrinthitis-Vestibular-neuritis-copy.png\">Teaching Image<\/a>&nbsp;<\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img loading=\"lazy\" decoding=\"async\" width=\"201\" height=\"74\" src=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/RapidReview-2-e1475624722961.png\" alt=\"\" class=\"wp-image-818\" \/><\/figure><\/div>\n\n\n\n<ul class=\"wp-block-list\"><li>In the <strong>PATCH trial<\/strong>, <strong>platelets<\/strong> were shown to <strong>increase the risk of death<\/strong> in <strong>acute intracranial hemorrhage<\/strong> in patients on<strong> aspirin<\/strong>.<\/li><li><strong>Cocaine chest pain<\/strong> should be treated with <strong>benzodiazepines<\/strong> to both <strong>relieve vasospasm<\/strong> and <strong>decrease sympathetic surge<\/strong>.<\/li><li><strong>Beta-blockers<\/strong> should be <strong>avoided<\/strong> in those with <strong>cocaine chest pain<\/strong> due to <strong>unopposed alpha<\/strong> agonism.<\/li><li>The <strong>most common<\/strong> type of <strong>migraine<\/strong> is a migraine <strong>without an aura<\/strong>.<\/li><li>The classic <strong>migraine<\/strong> is a <strong>slow onset, unilateral, pulsating<\/strong>, headache with moderate to severe intensity. It may be associated with <strong>nausea, vomiting, photophobia, or phonophobia<\/strong>.<\/li><li><strong>Migraines<\/strong> affect <strong>women<\/strong> twice as often as they affect men.<\/li><li>The most <strong>typical<\/strong> <strong>migraine auras<\/strong> are <strong>visual<\/strong>.<\/li><li>When actively <strong>rewarming<\/strong> a patient, a <strong>decrease in core temperature<\/strong> is common as <strong>cold blood returns from the periphery<\/strong>.<\/li><li>In <strong>hypothermia<\/strong>, expect a 2% <strong>increase in the hematocrit<\/strong> for every 1 degree Celsius drop in temperature.<\/li><li><strong>Salicylate overdoses<\/strong> are associated with <strong>poor fetal outcomes<\/strong> as salicylates readily <strong>cross<\/strong> <strong>the placenta<\/strong>, causing acidosis, kernicterus, and prematurely closure of&nbsp;the ductus arteriosus.<\/li><li>The <strong>treatment<\/strong> for a <strong>salicylate overdose<\/strong> is <strong>gastric decontamination<\/strong>, <strong>urinary alkalization<\/strong>, and <strong>hemodialysis<\/strong>.<\/li><li>Indications for <strong>dialysis<\/strong> in a <strong>salicylate overdose<\/strong> are <strong>altered mental status, renal failure, pulmonary edema, rising levels<\/strong> despite alkalinization, <strong>coma, <\/strong>or<strong> clinical deterioration<\/strong>.<\/li><li>In <strong>carbon monoxide poisoning in pregnancy<\/strong>, the threshold for initiating hyperbaric oxygen therapy is lower as the <strong>half-life of carbon monoxide<\/strong> is almost 5 times <strong>longer<\/strong> <strong>in<\/strong> the <strong>fetus<\/strong> than in the mother.<\/li><li><strong>Toxoplasmosis<\/strong> occurs due to <strong>reactivation<\/strong> of a prior infection in patients with HIV and a <strong>CD4 count less than 100<\/strong>. It is transmitted through <strong>cat feces<\/strong> and can cause <strong>encephalitis<\/strong>. Treatment is with <strong>pyrimethamine, sulfadiazine, and folinic acid<\/strong>.<\/li><li><strong>Viral labyrinthitis<\/strong> should be treated with <strong>rest, hydration, antiemetics, vestibular depressants, and corticosteroids<\/strong>. Benzodiazepines may also be used.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">That wraps up Episode 20. Don\u2019t forget to follow us on Twitter <a href=\"https:\/\/twitter.com\/roshcast\">@Roshcast<\/a> for updates and high-yield EM pearls in 140 characters or less. We will primarily be posting on material that we have already covered on the podcast to add yet another element of spaced repetition. Be sure to take full advantage!&nbsp;And&nbsp;take a look at our new <a href=\"https:\/\/www.roshreview.com\/tag\/teaching-image\/\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\"Teaching Image (opens in a new tab)\">Teaching Image<\/a> series on the blog. The first three posts are already up: <a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"https:\/\/www.roshreview.com\/blog\/teaching-image-cardiac-tamponade\/\" target=\"_blank\">Cardiac Tamponade<\/a>, <a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"https:\/\/www.roshreview.com\/blog\/teaching-image\/teaching-image-tinea-versicolor\/\" target=\"_blank\">Tinea Versicolor<\/a>, and <a rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\" href=\"https:\/\/www.roshreview.com\/blog\/teaching-image-basilar-skull-fracture\/\" target=\"_blank\">Basilar Skull Fracture<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Until next time,<br>Jeff and Nachi<\/p>\n","protected":false},"excerpt":{"rendered":"<p>As knowledge increases, wonder deepens. -Charles Morgan Welcome back to Episode 20! We have a great episode lined up for you this week, again covering topics that run the gamut of Emergency Medicine. We are excited to say that we have&nbsp;covered over 100 questions in approximately five hours of Roshcast over six months! As always, <a href=\"https:\/\/www.roshreview.com\/blog\/ep-20-cocaine-chest-pain-migraines-hypothermia-salicylate-overdose-toxoplasmosis-labyrinthitis\/\">read more&#8230;<\/a><\/p>\n","protected":false},"author":11,"featured_media":851,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"categories":[2025,1999],"tags":[2196,2204,2233,2238,2322,2323,2335,2339,2405,2406,2591,2678,2696,2764,2768,2810,2849,2894,2934,3035,3178,3241,3320,3370,3422,3466,3502,3503,3580,3600,3670,3715],"coauthors":[],"class_list":["post-1363","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-emergency-medicine","category-podcast","tag-aspirin","tag-aura","tag-benzodiazepine","tag-beta-blocker","tag-carbon-monoxide","tag-carbon-monoxide-poisoning","tag-cat","tag-cd4","tag-cocaine","tag-cocaine-chest-pain","tag-encephalitis","tag-folinic-acid","tag-gastric-decontamination","tag-hematocrit","tag-hemodialysis","tag-hiv","tag-hypothermia","tag-intracranial-hemorrhage","tag-labyrinthitis","tag-migraine","tag-overdose","tag-patch-trial","tag-platelets","tag-pregnancy","tag-pyrimethamine","tag-rewarming","tag-salicylate-overdose","tag-salicylates","tag-steroids","tag-sulfadiazine","tag-toxoplasmosis","tag-urinary-alkalinization"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.4 (Yoast SEO v28.6) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Welcome to RoshCast (Ep. 20), the first question and answer style emergency medicine podcast. 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