Core EM - Emergency Medicine Podcast

This week we review anaphylaxis, the importance of epinephrine/adrenaline and how to use it properly. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_52_0_Final_Cut.m4a Download One Comment Tags: Allergic Reactions, Allergy, Anaphylaxis, Epinephrine Show Notes Anaphylaxis Definition Read More Tran TP, Muelleman RL: Allergy, Hypersensitivity, Angioedema, and Anaphylaxis, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2010, (Ch) 119: p 1543-1560. YouTube: Epinephrine Auto-Injector Use The SGEM: #57: Should I Stay or Should I Go (Biphasic Anaphylactic Response) Core EM: Biphasic reactions in emergency department patients with allergic reactions or anaphylaxis   References Grunau BE et al. Incidence of clinically important biphasic reactions in emergency department patients with allergic reactions or anaphylaxis. Ann Emerg Med 2014; 63(6): 736-44. PMID: 24239340 Grunau BE et al. Emergency Department Corticosteroid Use for Allergy or Anaphylaxis is Not Associated with Decreased Relapses. Ann Emerge Med 2015; 66(4): 381-9. PMID: 25820033 Read More

This week we dive into a recent article on pain control in renal colic and how it affects our management. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_51_0_Final_Cut.m4a Download Leave a Comment Tags: Analgesia, Kidney Stones, Renal Colic, Urology Show Notes Read More Core EM: Optimal First Line Analgesia in Ureteric Colic ALiEM: Top 10 reasons NOT to order a CT scan for suspected renal colic REBEL EM: Does Use of Tamsulosin in Renal Colic Facilitate Stone Passage Core EM: Medical Expulsive Therapy (MET) in Renal Colic Wang RC. Managing Urolithiasis. Ann Emerg Med 2015 PMID: 26616536 References Pathan SA et al. Delivering safe and effective analgesia for management of renal colic in the emergency department: a double-blind, multi group, randomized controlled trial. Lancet 2016. PMID: 26993881 Read More

This week we look at the rarely used, but potentially life-saving, procedure of gastric lavage. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_50_0_Final_Cut.m4a Download Leave a Comment Tags: Gastric Emptying, Gastric Lavage, Toxicology Show Notes Gastric Lavage Indications (Goldfrank’s Toxicologic Emergencies Ch 7) Gastric Lavage Risk Assessment (Goldfrank’s Toxicologic Emergencies Ch 7) Gastric Lavage Placement (Goldfrank’s Toxicologic Emergencies Ch 7) References Adams BK et al. Prolonged gastric emptying half-time and gastric hypo motility after drug overdose. Am J Emerg Med 2004; 22: 548-554. PMID: 15666259 Benson BE et al. Position paper update: gastric lavage for gastrointestinal decontamination. Clin Tox 2013; 51: 140-6. PMID: 23418938 Gude AB, Hoegberg LCG. Chapter 7. Techniques Used to Prevent Gastrointestinal Absorption. In: Nelson LS, Lewin NA, Howland M, Hoffman RS, Goldfrank LR, Flomenbaum NE. eds. Goldfrank’s Toxicologic Emergencies, 9e . New York, NY: McGraw-Hill; 2011. Hoffman RS. Does consensus equal correctness? Clin Tox 2000; 38(7): 689-90. PMID: 11192453 Kulig K et al. Management of acutely poisoned patients without gastric emptying. Ann Emerg Med 1985; 14(6): 562-9. PMID: 2859819 Merigian KS et al. Prospective evaluation of gastric emptying in the self-poisoned patient. Am J Emerg Med 1990; 8: 479-83. PMID: 1977400 Pond SM et al. Gastric emptying in acute overdose: a prospective randomised controlled trial. Med J Aus 1995; 163: 34-9. PMID: 7565257 Read More

This week we take a look at alcohol withdrawal with a focus on recognition and management. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_49_0_Final_Cut.m4a Download Leave a Comment Tags: Alcohol Withdrawal, Ativan, Benzodiazipines, Delirium Tremens, Ethanol, Thaimine, Valium Show Notes Yip L. Chapter 77. Ethanol. In: Nelson LS, Lewin NA, Howland M, Hoffman RS, Goldfrank LR, Flomenbaum NE. eds. Goldfrank’s Toxicologic Emergencies, 9e. New York, NY: McGraw-Hill; 2011. EmCrit Podcast: Delirium Tremens Life in the Fast Lane: Alcohol Withdrawal The Poison Review: CPC: alcohol withdrawal with delirium tremens and a significant missed diagnosis EM Updates: Avoid Alcohol Withdrawal Admissions MDCalc: CIWA Read More

This week we delve into the anticholinergic toxidrome with a focus on management and the use of physostigmine. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_48_0_Final_Cut.m4a Download Leave a Comment Tags: Anticholinergic, Diphenhydramine, Physostigmine, TCA, Toxicology Show Notes Howland M. Antidotes in Depth (A12): Physostigmine Salicylate. In: Nelson LS, Lewin NA, Howland M, Hoffman RS, Goldfrank LR, Flomenbaum NE. eds. Goldfrank’s Toxicologic Emergencies, 9e . New York, NY: McGraw-Hill; 2011. Velez LI, Feng SY: Anticholinergics, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2010, (Ch) 150: p 1970-5. Anticholinergic Infographic (BrianandKloss.com) Drugs Exhibiting Anticholinergic Toxicity (Rosen’s) Read More

This week we review mandible dislocations and reduction approahces focusing on the new "syringe" technique. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_47_0_Final_Cut.m4a Download Leave a Comment Tags: Mandible Dislocation, Oral Surgery, Syringe Technique Show Notes Read More ALiEM: Tick of the Trade: Extra-oral reduction technique of anterior mandible dislocation Gorchynski J et al.  The “syringe” technique: a hands-free approach for the reduction of acute nontraumatic temporomandibulardislocations in the emergency department.  J Emerg Med. 2014; 47(6):676-81. PMID 25278137   Syringe Technique Step 1 Syringe Technique Step 2 Syringe Technique Step 3 Read More

This week, the podcast features a full length talk from our Grand Rounds series. This talk was given by Ilene Claudius on pediatric SOB https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_46_0_Final_Cut.m4a Download Leave a Comment Tags: Asthma, Atropine, Bronchiolitis, Croup, Magnesium, RSI Show Notes Irazuzta JE et al. High-dose magnesium sulfate infusion for severe asthma in the emergency department: efficacy study. Crit Care Med 2016; 17: e29-e33. PMID: 26649938 Read More

This week we review a number of controversial topics in SSTI management with a focus on the role of antibiotics in abscess management. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_45_0_Final_Cut.m4a Download Leave a Comment Tags: Abscess, Cellulitis, Controversy, I+D, Irrigation, TMP-SMX Show Notes Core EM: Predictors of failed outpatient cellulitis treatment EM Nerd: The Case of the Pragmatic Wound REBEL EM: Trimethoprim-sulfamethoxazole for uncomplicated skin abscesses EM Lyceum: Abscess, “Answers” References Peterson D et al. Predictors of Failure of Empiric Outpatient Antibiotic Therapy in Emergency Department Patients with Uncomplicated Cellulitis. Acad Emerg Med 2014; 21: 526-31. PMID: 24842503 Talan DA et al. Trimethoprim-Sulfamethoxazole versus placebo for uncomplicated skin abscesses. NEJM 2016; 374(9): 823-32. PMID: 26962903 Chinnock B, Hendey GW. Irrigation of cutaneous abscesses does not improve treatment success. Ann Emerg Med 2016; 67(3): 379-83. PMID: 26416494 Read More

This week we touch on some pearls and pitfalls on diagnosis and management of tick borne illnesses. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_44_0_Final_Cut.m4a Download One Comment Tags: Babesiosis, Ehrlichiosis, Lyme Disease, RMSF, Rocky Mountain Spotted Fever, Tick Show Notes CDC: Ticks CDC: Tick Borne Illnesses of the United States Read More

This week we review delayed ICH in patients with head trauma on blood thinners and discuss the role of repeat imaging and admission. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_43_0_Final_Cut.m4a Download 2 Comments Tags: Clopidogrel, Delayed Intracranial Hemorrhage, Head Trauma, Plavix, Warfarin Show Notes Nishijima DK et al. Immediate and delayed traumatic intracranial hemorrhage in patients with head trauma and perjury warfarin or clopidogrel use. Ann Emerge Med 2012; 59(6): 460-8. PMID: 22626015 Menditto VG et al. Management of minor head injury in patients receiving oral anticoagulant therapy: a prospective study of a 24-hour observation protocol. Ann Emerg Med 2012; 59(6): 451-5. PMID: 22244878 Miller J et al. Delayed intracranial hemorrhage in the anticoagulated patient: a systematic review. J Trauma Acute Care Surg 2015; 79: 310-3. PMID: 26218702 Read More