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Core EM – Emergency Medicine Podcast — Government & Organizations
Core EM – Emergency Medicine Podcast

Core EM Emergency Medicine Podcast

Copyright: © Core EM

Latest Episodes:

Episode 147.0 – Salicylate Toxicity May 28, 2018
Show notes

This episode reviews the identification and management of patients with salicylate toxicity.
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_147_0_Final_Cut.m4a Download 4 Comments Tags: Aspirin, Salicylate, Toxicology
Show Notes

Take Home Points

Always consider salicylate toxicity:

In patients with tachypnea, hyperpnea, AMS and clear lungs

In the presence of an anion gap metabolic acidosis with a respiratory alkalosis

Treat salicylate toxicity by alkalinizing the blood and urine to increase excretion

Avoid intubation until absolutely necessary. If you do have to intubate, minimize apneic time and consider awake intubation and nake sure your ventilator settings match the patient’s necessary high minute ventilation

Think about chronic salicylate toxicity in unexplained altered mental status, tachypnea or metabolic acidosis in elderly

Know indications for hemodialysis in salicylate toxic patients

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REBEL EM: Salicylate Toxicity

LITFL: Salicylates

Wiki EM: Salicylate Toxicity

Rebel EM: Acute Salicylate Toxicity, Mechanical Ventilation, and Hemodialysis

Mosier JM et al. The Physiologically Difficult Airway. The western journal of emergency medicine. 16(7):1109-17. 2015. PMID: 26759664

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Episode 146.0 – Morning Report Pearls V May 21, 2018
Show notes

More pearls from our fantastic morning report series at Bellevue.
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_146_0_Final_Cut.m4a Download Leave a Comment Tags: Endocarditis, Ludwig's Angina, Penetrating Neck Trauma
Show Notes

Take Home Points

In patients with neck pain, consider Ludwig’s angina particularly if they have any swelling, fever, truisms or respiratory difficulty. Consider early airway management and get your consultants involved early for operative management

Endocarditis is a tricky diagnosis and will often be subtle. Any patient with a prosthetic valve and a fever has endocarditis until proven otherwise. Suspect it in any patient with fever and a murmur, get lots of cultures and remember that TEE is the gold standard but, TTE is highly specific

Finally, penetrating neck trauma. Patients with hard signs – airway compromise, ongoing brisk bleeding, an expanding/pulsatile hematoma, neurologic compromise, shock or hematemesis should go directly to the OR and don’t probe the wounds!

Hard Signs in Penetrating Neck Injury (Sperry 2013)

Management Algorithm for Penetrating Neck Injury (Sperry 2013)

Read More

LITFL: Ludwig’s Angina

Core EM: Infective Endocarditis

EM Cases: Endocarditis and Blood Culture Interpretation

Sperry JL et al. Western Trauma Association Critical Decisions in Trauma: Penetrating Neck Trauma. J Trauma Acute Care Surg 2013; 75(6): 936-41. PMID: 24256663 [OPEN ACCESS]

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Episode 146.0 – Morning Report Pearls V May 21, 2018
Show notes

More pearls from our fantastic morning report series at Bellevue.
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_146_0_Final_Cut.m4a Download Leave a Comment Tags: Endocarditis, Ludwig's Angina, Penetrating Neck Trauma
Show Notes

Take Home Points

In patients with neck pain, consider Ludwig’s angina particularly if they have any swelling, fever, truisms or respiratory difficulty. Consider early airway management and get your consultants involved early for operative management

Endocarditis is a tricky diagnosis and will often be subtle. Any patient with a prosthetic valve and a fever has endocarditis until proven otherwise. Suspect it in any patient with fever and a murmur, get lots of cultures and remember that TEE is the gold standard but, TTE is highly specific

Finally, penetrating neck trauma. Patients with hard signs – airway compromise, ongoing brisk bleeding, an expanding/pulsatile hematoma, neurologic compromise, shock or hematemesis should go directly to the OR and don’t probe the wounds!

Hard Signs in Penetrating Neck Injury (Sperry 2013)

Management Algorithm for Penetrating Neck Injury (Sperry 2013)

Read More

LITFL: Ludwig’s Angina

Core EM: Infective Endocarditis

EM Cases: Endocarditis and Blood Culture Interpretation

Sperry JL et al. Western Trauma Association Critical Decisions in Trauma: Penetrating Neck Trauma. J Trauma Acute Care Surg 2013; 75(6): 936-41. PMID: 24256663 [OPEN ACCESS]

Read More

Episode 145.0 – All NYC EM 14 Pearls May 14, 2018
Show notes

This week we discuss some pearls from the 14th All NYC EM Conference.
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_145_0_Final_Cut.m4a Download Leave a Comment Tags: Documentation, Major Trauma, Massive Transfusion Protocol
Show Notes

All NYC EM Conference

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Core EM: Episode 77.0 – Give TXA Now!

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Episode 144.0 – Acute Rhinosinusitis May 07, 2018
Show notes

This week we dive into rhinosinusitis exploring the recommendations of who needs antibiotics and who doesn't.
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_144_0_Final_Cut.m4a Download Leave a Comment Tags: Acute Bacterial Sinusitis, ENT, Sinusitis
Show Notes

Take Home Points

Acute rhinosinusitis is a clinical diagnosis

The vast majority of acute rhinosinusitis cases are viral in nature and do not require antibiotics

Consider the use of antibiotics in select groups with severe disease or worsening symptoms after initial improvement.

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Core EM: Acute Rhinosinusitis

TheNNT.com: Antibiotics for Clinically Diagnosed Acute Sinusitis in Adults

TheNNT.com: Antibiotics for Radiologically-Diagnosed Acute Maxillary Sinusitis

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Episode 143.0 – Testicular Torsion Apr 30, 2018
Show notes

This week we review the presentation, examination and diagnosis of testicular torsion.
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_143_0_Final_Cut.m4a Download Leave a Comment Tags: Acute Scrotal Pain, Torsion, Urology
Show Notes

Take Home Points

Consider the diagnosis of testicular torsion in all patients with acute testicular pain

Testicular torsion is a surgical emergency that requires immediate urologic consultation to increase the rate of tissue salvage.

History, physical examination and ultrasound are all flawed in making the diagnosis. The gold standard is surgical exploration

Consider manual detorsion in patients where consultation will be delayed

Show Notes

Core EM: Testicular Torsion

Ben-Israel T et al. Clinical predictors for testicular torsion as seen in the pediatric ED. Am J Emerg Med 2010; 28:786-789.

Sidler D et al. A 25-year review of the acute scrotum in children. S Afr Med J. 1997;87(12) 1696-8. PMID:

Mellick LB. Torsion of the testicle: It is time to stopping tossing the dice. Pediatric Emer Care 2012; 28: 80-6. PMID:

Ban KM, Easter JS: Selected Urologic Problems; in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2014, (Ch) 99: p 1326-1356.

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Episode 142.0 – Morning Report Pearls IV Apr 23, 2018
Show notes

This week we discuss more pearls from our morning report conference on APE, SAH and caustic ingestions.
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_142_0_Final_Cut.m4a Download Leave a Comment Tags: APE, Cardiology, Caustic Ingestions, CHF, SAH, SCAPE, Subarachnoid Hemorrhage, Toxicology
Show Notes

Take Home Points

In patients with APE, give high-dose nitro to decrease after load and preload quickly. 400-500 mcg/min for the first 4-5 minutes is my standard approach

Consider DSI to facilitate pre-oxygenation. Ketamine is your go to drug here

A NCHCT performed within 6 hours of symptom onset is extremely sensitive for ruling out SAH but, nothing is 100%. If you’ve got a high-risk patient, you should still consider LP

Patients with caustic ingestions can have rapidly deteriorating airways. Prepare early and be ready to take over the airway at a moments notice

Read More

Core EM: Acute Pulmonary Edema

EMCrit: Sympathetic Crashing Acute Pulmonary Edema (SCAPE)

EMCrit: Delayed Sequence Intubation

Core EM: Setting Up Non-Invasive Ventilation

The SGEM: Thunderstruck (Subarachnoid Hemorrhage)

Friedman BW. Managing Migraine. Ann Emerg Med 2017; 69(2): 202-7. PMID: 27510942

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Episode 141.0 – Journal Update Apr 16, 2018
Show notes

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

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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

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Episode 140.0 Disutility of Orthostatics in volume Loss Apr 09, 2018
Show notes

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

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Episode 139.0 – Ear Foreign Body Removal Apr 02, 2018
Show notes

This week we welcome back Andy Little from Doctors Hospital in Columbus, Ohio to chat about ear foreign body removal.
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_139_0_Final_Cut.m4a Download Leave a Comment Tags: ENT, Foreign Body
Show Notes

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DiMuzio J, Deschler, DG. Emergency department management of foreign bodies of the external ear canal in children. Otol Neurotol. 2002; 23(4):473-5. PMID: 12170148

Leffler S et al. Chemical immobilization and killing of intra-aural roaches: an in-vitro comparative study. Ann Emerg Med. 1993; 22(12):1795-8. PMID: 8239097

ALiEM: Trick of the Trade: Ear Foreign Body Removal with Modified Suction Setup

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Episode 138.0 – EEMCrit Pearls Mar 26, 2018
Show notes

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

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