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    Core EM – Emergency Medicine Podcast

    Core EM Emergency Medicine Podcast

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    Copyright: © Core EM

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    Latest Episodes:
    Episode 157.0 – Farewell Aug 13, 2018
    Show notes https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_157_0_Final_Cut.m4a Download 5 Comments
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    Episode 156.0 – Updates in Community Acquired Pneumonia Jul 30, 2018
    Show notes

    This week we dive into a recent article highlighting a major update in the treatment of community acquired pneumonia (CAP)

    https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_156_0_Final_Cut.m4a Download Leave a Comment Tags: CAP, Macrolides, Pulmonary

    Show Notes

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    REBEL EM: Update in Community Acquired Pneumonia (CAP) Treatment – Macrolide Resistance

    Moran GJ, Talan, DA; Pneumonia, 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) 76: p 978-89.

    Haran JP et al. Macrolide resistance in cases of community-acquired bacterial pneumonia in the emergency department. J Emerg Med 2018. PMID: 29789175

    Mandell LA et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44(Suppl 2):S27–72. PMID: 17278083

    Arnold FW et al. A worldwide perspective of atypical pathogens in community-acquired pneumonia. AmJ Respir Crit Care Med 2007;175:1086–93. PMID: 17332485


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    Episode 155.0 – Journal Update Jul 23, 2018
    Show notes

    This week we discuss three recent articles looking at esmolol in refractory VF, c-spine clearance and antibiotics after abscess drainage

    https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_155_0_Final_Cut.m4a Download Leave a Comment Tags: Cardiac Arrest, Cervical Spine, Esmolol, I+D, Infectious Diseases, Journal Club, MRSA, Refractory VF, Trauma

    Show Notes

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    REBEL EM: Trimethoprim-Sulfamethoxazole for Uncomplicated Skin Abscesses

    Bryan Hayes at ALiEM: Sulfamethoxazole-Trimethoprim for Skin and Soft Tissue Infections: 1 or 2 Tablets BID?

    The SGEM: SGEM#164: Cuts Like a Knife

    Core EM: Antibiotics in the Treatment of Smaller Abscesses

    EM Nerd: The Case of the Pragmatic Wound

    REBEL EM: Refractory ventricular fibrillation

    Resus.ME: Esmolol for Refractory VF


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    Episode 154.0 – Femoral Shaft Fractures Jul 16, 2018
    Show notes

    This week we review femoral shaft fractures with a focus on assessment and analgesia

    https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_154_0_Final_Cut.m4a Download Leave a Comment Tags: Femoral Nerve Blocks, Orthopedics

    Show Notes

    Read More

    Orthobullets Femoral Shaft Fracture

    Rosen’s Emergency Medicine Concepts and Clinical Practice(link)

    Tintinalli’s Emergency Medicine(link)

    Femoral Nerve Block video (link)


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    Episode 153.0 – Morning Report Pearls VI Jul 09, 2018
    Show notes

    More amazing pearls from our Bellevue morning report series.

    https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_153_0_Final_Cut.m4a Download Leave a Comment Tags: Alcohol Intoxication, Discitis, ESRD, Necrotizing Fasciitis

    Show Notes

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    Core EM: Spinal Epidural Abscess

    REBEL EM: Cauda Equina Syndrome

    Radiopaedia: Discitis

    LITFL: Necrotizing Fasciitis

    REBEL Cast: Episode 50 – Intoxicated Patients Can Equal Badness


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    Episode 152.0 – Penetrating Neck Trauma Jul 02, 2018
    Show notes

    This week, we discuss penetrating neck trauma and some pearls and pitfalls in management.

    https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_152_0_Final_Cut.m4a Download One Comment Tags: Neck Trauma, Trauma

    Show Notes

    REBEL EM: Penetrating Neck Injuries

    Zone 1

    Zone 2

    Zone 3

    Anatomic Landmarks

    Clavicle/Sternum to Cricoid Cartilage

    Cricoid Cartilage to the Angle of the Mandible

    Superior to the Angle of the Mandible

    Anatomic Structures in Zone

    Proximal Common Carotid Artery

    Carotid Artery

    Vertebral Artery

    Subclavian Artery

    Vertebral Artery

    Distal Carotid Artery

    Vertebral Artery

    Jugular Vein

    Distal Jugular Vein

    Lung Apices

    Pharynx

    Salivary and Parotid Glands

    Trachea

    Trachea

    Cranial Nerves IX – XII

    Thyroid

    Esophagus

    Spinal Cord

    Esophagus

    Larynx

    Thoracic Duct

    Vagus Nerve

    Spinal Cord

    Recurrent Laryngeal Nerve

    Spinal Cord

    Hard + Soft Signs of Major Aerodigestive or Neurovascular Injury

    Hard Signs

    Soft Signs

    Airway Compromise

    Hemoptysis

    Expanding or Pulsatile Hematoma

    Oropharyngeal Blood

    Active, Brisk Bleeding

    Dyspnea

    Hemorrhagic Shock

    Dysphagia

    Hematemesis

    Dysphonia

    Neurologic Deficit

    Nonexpanding Hematoma

    Massive Subcutaneous Emphysema

    Chest Tube Air Leak

    Air Bubbling Through Wound

    Subcutaneous or Mediastinal Air

    Vascular Bruit or Thrill

    Crepitus

    WTA Management Algorithm for Penetrating Neck Injury (Sperry 2013)


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    Episode 151.0 – Cauda Equina Syndrome Jun 25, 2018
    Show notes

    This week we discuss the difficult to diagnose and high morbidity cauda equina syndrome.

    https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_151_0_Final_Cut.m4a Download Leave a Comment Tags: Back Pain, Cauda Equina

    Show Notes

    Take Home Points

    • Cauda equina syndrome is a rare emergency with devastating consequences
    • Early recognition is paramount as the presence of bladder dysfunction portends bad functional outcomes
    • The presence of bilateral lower extremity weakness or sensory changes should alert clinicians to the diagnosis. Saddle anesthesia (or change in sensation) and any bladder/bowel changes in function should also raise suspicion for the disorder
    • MRI is the diagnostic modality of choice though CT myelogram can be performed if necessary
    • Prompt surgical consultation is mandatory for all patients with cauda equina syndrome regardless of symptoms at presentation

    Read More

    EM Cases: Best Case Ever 11: Cauda Equina Syndrome

    OrthoBullets: Cauda Equina Syndrome

    Radiopaedia: Cauda Equina Syndrome

    Perron AD, Huff JS: Spinal Cord Disorders, 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) 106: p 1419-30.

    References

    Lavy C et al. Cauda Equina Syndrome. BMJ 2009; 338: PMID: 19336488

    Todd NV. Cauda equina syndrome: the timing of surgery probably does influence outcome. Br J Neurosurg 2005;19:301-6 PMID: 16455534


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    Episode 150.0 – Journal Update Jun 18, 2018
    Show notes

    This week we review some recent publications on steroids in pharyngitis and the VAN assessment in stroke.

    https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_150_0_Final_Cut.m4a Download Leave a Comment Tags: Pharyngitis, Steroids, VAN Assessment

    Show Notes

    Read More

    The SGEM: SGEM #203: Let Me Clear My Sore Throat with a Corticosteroid

    Core EM: Corticosteroids in Pharyngitis – Systematic Review + Meta-Analysis

    REBEL EM: Does it Take a VAN to Identify Emergency Large Vessel Occlusion (EVLO) in Ischemic Stroke?

    REBEL EM: Stroke Workflow in 2018

    Stroke Workflow 2017 (REBEL EM)

    References

    Sadeghirad B et al. Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials BMJ 2017; 358 :j3887. PMID: 28931508

    Teleb MS et al. Stroke vision, aphasia, neglect (VAN) assessment – a novel emergent large vessel occlusion screening tool: pilot study and comparison with current clinical severity indices. J Neurointervent Surg 2017; 9(2): 122-6. PMID: 26891627


    Read More
    Episode 149.0 – Simplified Approach to Peds Trauma Jun 11, 2018
    Show notes

    This week the podcast features a lecture from Dr. Frosso Admakos - Assistant Residency Director at Metropolitan Hospital in NYC

    https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_149_0_Final_Cut.m4a Download One Comment Tags: All NYC EM, Pediatrics, Trauma

    Show Notes

    Take Home Points

    1. While peds traumas and severe traumas are uncommon, stay cool and collected – you’ve run many resuscitations in the past and resuscitating a kid is no different. You’ve got this
    2. When it comes to access, think 1, 2 IO. 2 shots at a peripheral line and if you don’t get it, go to IO
    3. Tachycardia should be assumed to be compensated shock until proven otherwise. Don’t write tachycardia off as anxiety
    4. Failed airway approach – place an 18 gauge catheter into the neck – hopefully through the cricothyroid membrane and bag through that. If you still have difficult getting an airway from above, consider a retrograde intubation over a wire

    Read More

    University of Maryland EM: Retrograde Intubation


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    Episode 148.0 – ACEP VTE Clinical Policy 2018 Jun 04, 2018
    Show notes

    This episode reviews the highlights from the recent ACEP clinical policy on acute VTE management in the ED.

    https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_148_0_Final_Cut.m4a Download Leave a Comment Tags: Deep Venous Thrombosis, DVT, PE, Pulmonary Embolism, VTE

    Show Notes

    Take Home Points

    1. The PERC risk stratifies low risk PE patients (~10%) to a level low enough (1.9%) as to obviate the need for additional testing.
    2. Age-adjusted D-dimers are ready for use and it doesn’t matter if your assay uses FEU (cutoff 500) or DDU (cutoff 250). For FEU use an upper limit of 10 X age and for DDU use an upper limit of 5 X age.
    3. For now, subsegmental PEs should continue to routinely be anticoagulated even in the absence of a DVT. Keep an eye out for more research on this area.
    4. Although outpatient management of select PE patients (using sPESI or Hestia criteria) may be standard practice, the evidence wasn’t strong enough for ACEP to give it’s support
    5. Patients with DVT can be started on a NOAC and discharged from the ED

    sPESI Tool (MDCalc.com)

    PERC Decision Tool (MDCalc.com)

    Read More

    • REBEL EM: ACEP Clinical Policy on Acute VTE 2018
    • Core EM: PE Rule-Out Criteria RCT
    • Core EM: Age-Adjusted D-dimer (Using D-dimer Units)
    • Core EM: Age Adjusted D-dimer in PE – The ADJUST-PE Trial
    • REBEL EM: Is It PROER to PERC It Up

    References

    1. ACEP Clinical Policies Subcommittee. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department with Suspected Acute Venous Thromboembolic Disease. Ann Emerg Med 2018; 71(5): e59-109. PMID: 29681319
    2. Jaconelli T, Eragat M, Crane S. Can an age-adjusted D-dimer level be adopted in managing venous thromboembolism in the emergency department? A retrospective cohort study. European journal of emergency medicine : official journal of the Eur Soc Emerg Med. 2017. PMID: 28079562
    3. Freund Y et al. Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial. JAMA 2018; 319(6): 559-66. PMID: 29450523

    Read More
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