Core EM - Emergency Medicine Podcast

Explore essential strategies for managing acute pulmonary edema with high-dose nitroglycerin for rapid effects. Delve into the nuances of delayed sequence intubation for tough cases. Gain insights on subarachnoid hemorrhage, emphasizing the importance of timely imaging and recognizing headache red flags. Learn how to handle caustic ingestions, focusing on the need for readiness in airway management as conditions can deteriorate quickly. These pearls are vital for any emergency practitioner!

This week we discuss some recent publications relevant to EM: ADRENAL, Idarucizumab and Time to Furosemide. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_141_0_Final_Cut.m4a Download Leave a Comment Tags: ADRENAL, CHF, Corticosteroids, Furosemide, Idarucizumab, Journal Club, Journal Update, Sepsis Show Notes Read More Core EM: Idarucizumab for Reversal of Dabigitran Core EM: Idarucizumab for Reversal of Dabigitran II First10EM: Idarucizumab: Plenty of Optimism, Not Enough Science EM Lit of Note: The Door-to-Lasix Quality Measure EMS MED: When It’s More Complicated Than A Tweet: Door-To-Furosemide And EMS REBEL EM: Door to Furosemide (D2F) in Acute CHF . . . Really? emDocs.net: Furosemide in the Treatment of Acute Pulmonary Edema Core EM: Door-to-Furosemide Time References Pollack et al. Idarucizumab for dabigitran reversal – full cohort analysis. NEJM 2017; 377(5): 431-41. PMID: 28693366 Matsue Y et al. Time-to-Furosemide Treatment and Mortality in Patients Hospitalized with Acute Heart Failure J Am Coll Cardiol 2017; 69(25): 3042-51. PMID: 28641794 Read More

This week we discuss the disutility of orthostatic vital signs as a diagnostic tool in patients with suspected volume loss. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_140_0_Final_Cut.m4a Download Leave a Comment Tags: Cardiology, Orthostatic Hypotension Show Notes Summary: Based on the limited available evidence, it’s unlikely orthostatic vital sign measurement can be used to determine which patients have volume loss and which do not. The baseline prevalence of orthostatic vital signs is common and patients will not always develop orthostatic vital signs in response to volume loss. Therefore, there will both be patients who are orthostatic by numbers without volume loss and there will be patients with volume loss who are not orthostatic by numbers. Symptoms, with the exception of inability to stand to have orthostatics performed, are not useful either. Bottom Line: Based on the low overall sensitivity of orthostatic vital sign measurements, they should not be used to influence clinical decision making. Read More REBEL EM: Orthostatic Hypotension in Volume Depletion References: Skinner JE et al. Orthostatic heart rate and blood pressure in adolescents: reference ranges. J Child Neuro 2010; 25(10): 1210-5. PMID: 20197269 Stewart JM. Transient orthostatic hypotension is common in adolescents. J Pediatr 2002; 140: 418-24. PMID: 12006955 Ooi WL et al. Patterns of orthostatic blood pressure change and the clinical correlates in a frail, elderly population. JAMA 1997; 277: 1299-1304. PMID: 9109468 Aronow WS et al. Prevalence of postural hypotension in elderly patients in a long-term health care facility. Am J Cardiology 1988; 62(4): 336-7. PMID: 3135742 Witting MD et al. Defining the positive tilt test: a study of healthy adults with moderate acute blood loss. Ann Emerg Med 1994; 23(6): 1320-3. PMID: 8198307 McGee S et al. The rational clinical examination. Is this patient hypovolemic. JAMA 1999; 281(11): 1022-9. PMID: 10086438 Johnson DR et al. Dehydration and orthostatic vital signs in women with hyper emesis gravidarum. Acad Emerg Med 1995; 2(8): 692-7. PMID: 7584747 Read More

In this engaging discussion, Andy Little, an emergency physician from Doctors Hospital in Columbus, Ohio, shares his expertise on ear foreign body removal. He dives into the importance of this skill and categorizes different types of foreign bodies. Andy describes a vital four-step removal approach and offers tips for handling live insects and challenging cases, like small beads in children. He also recounts some unusual cases, leaving listeners with key takeaways to enhance their emergency management techniques.

This week we review pearls from the EEMCrit conference back in January 2018. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_138_0_Final_Cut.m4a Download Leave a Comment Tags: BRASH, Hyperkalemia, TTP, Ventricular Tachycardia, VTach Show Notes Show Notes Core EM: Procainamide vs Amiodarone in Stable Wide QRS Tachydysrhythmias (PROCAMIO) PulmCrit: Myth-Buesting: Lactated Ringers is Safe in Hyperkalemia, and Is Superior to NS PulmCrit: BRASH Syndrome Read More

This podcast discusses an 8 step process for building better presentations. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_137_0_Final_Cut.m4a Download One Comment Show Notes Resources: P Cubed Presentations Presentation Zen Presentation Zen: Simple Ideas on Presentation Design and Delivery Keynotable Read More

This week we discuss some pearls and pitfalls when caring for HIV+ patients in the ED. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_136_0_Final_Cut.m4a Download One Comment Tags: AIDS, HIV, Infectious Diseases, PCP, TB, Tuberculosis Show Notes HIV Associated Infections Based on CD4 Count (cooperhealth.org) Total Lymphocyte Count  = (% lymphocytes x WBC count)/100 TLC 1200 cells/mm3 correlated with CD4 count of < 200 cells/mm3 with a maximal sensitivity of 72.2%, and specificity of 100% TLC1500 cells/mm3 correlated with CD4 count of 200 – 499 cells/mm3 with a maximal sensitivity of 96.7% and specificity of 100% TLC 1900 cells/mm3 correlated with CD4 count of ≥ 500 cells/mm3 with a maximal sensitivity of 98.5% and specificity of 100% Show Notes REBEL EM: REBEL Cast Episode 1 – Total Lymphocyte Count as a Surrogate Marker for CD4 Count LITFL: HIV and AIDS References Obirikorang C et al. Total Lymphocyte Count as a Surrogate Marker for CD4 Count in Resource-Limited. BMC Infectious Diseases Journal 2012; 12 (128): 1 – 5. PMID: 22676809 Read More

Explore the intriguing challenges of treating hypotensive patients who don’t respond to vasopressors. The discussion dives into vital pathologic factors like metabolic acidosis and myxedema coma. Understand the critical role of swift interventions and the significance of comprehensive patient reassessments. Anaphylaxis management also takes center stage, emphasizing epinephrine's importance and the latest steroid research in critical care. Discover how hypocalcemia can complicate treatment and why rapid ultrasound evaluations are crucial.

This installment dives into altered mental status, stressing the importance of categorizing potential causes. There’s a focus on children, highlighting the rarity of primary psychosis and the need to consider toxic ingestions. Discussing hyperleukocytosis in patients with acute lymphoblastic leukemia, it emphasizes timely intervention with hematology. Finally, the urgency of managing severe hyponatremia is explored, detailing treatment protocols to avoid complications. A wealth of practical insights for emergency medicine practitioners awaits!

Carl Prickshitis, a fourth-year medical student and trauma assessment blogger, shares invaluable insights on evaluating trauma efficiently. He emphasizes the importance of a systematic approach for minimizing missed injuries. The conversation covers pre-arrival information from EMS, the distinction between blunt and penetrating trauma, and the critical ABCDE primary survey method. Carl highlights effective airway assessments, circulation checks, and the role of the AMPLE mnemonic for focused history-taking. He also critiques the routine use of the digital rectal exam in trauma care.