EM Pulse Podcast™

Latest Episodes:

Sickle Cell in the ED: Part 3 Feb 19, 2024

Show notes

People living with sickle cell disease can experience severe “pain crises”, or vaso-occlusive episodes (VOE), and are at increased risk for infections, strokes, heart failure, and other serious disease processes. When patients are out sickle cell present to the ED, it is crucial to initiate their evaluation and treatment as soon as possible. So what does this mean practically for us as clinicians? Hematologist and Sickle Cell expert, Dr. Bimpe Adesina, and Emergency Physician and researcher, Dr. Bryn Mumma, join us to explore this topic in depth. In part 1, we delved into assessment and management of patients presenting with VOE. In part 2, we spoke with Dr. Chris Rees about the benefits of early opioid pain control for kids presenting with VOE. In the final episode of our series we’re back with Dr. Mumma and Dr. Adesina to discuss the management of other emergent presentations related to sickle cell disease. Did this episode change your practice? Let us know on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Guests: Dr. Oyebimpe Adesina, Assistant Professor of Hematology and Oncology and Co-Director of the Adult Sickle Cell Clinical Program at UC Davis Dr. Bryn Mumma, Professor of Emergency Medicine and Leader of the Research Subcommittee of CARPE DIEM at UC Davis Resources: ACEP Emergency Department Sickle Cell Care Coalition Resources CHOP Emergency Department Clinical Pathway for Evaluation/Treatment of Children with Sickle Cell Disease with Fever DeBaun MR, Jordan LC, King AA, et al. American Society of Hematology 2020 guidelines for sickle cell disease: prevention, diagnosis, and treatment of cerebrovascular disease in children and adults. Blood Adv. 2020 Apr 28;4(8):1554-1588. doi: 10.1182/bloodadvances.2019001142. PMID: 32298430; PMCID: PMC7189278.. Chou ST, Alsawas M, Fasano RM, et al. American Society of Hematology 2020 guidelines for sickle cell disease: transfusion support. Blood Adv. 2020 Jan 28;4(2):327-355. doi: 10.1182/bloodadvances.2019001143. PMID: 31985807; PMCID: PMC6988392.

Sickle Cell in the ED: Part 2 Feb 05, 2024

Show notes

People living with sickle cell disease can experience severe “pain crises”, or vaso-occlusive episodes (VOE), and are at increased risk for infections, strokes, heart failure, and other serious disease processes. In this 3 part series, we’re talking with experts to learn more about sickle cell disease and its complications and how we can best advocate for and treat these patients in the ED. In part 1, we delved into assessment and management of patients presenting with VOE. In this episode, we focus specifically on kids presenting with VOE. We know these patients have usually exhausted their home pain control options and are still in excruciating pain when they arrive in the ED. We interviewed Dr. Chris Rees about his recent paper on the benefits of treating kids with VOE with an initial dose of intranasal fentanyl. The results are pretty impressive! Stay tuned for Part 3 of our series where we’ll explore the management of other emergent presentations related to sickle cell disease! Did this episode change your practice? Let us know on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Guests: Dr. Chris Rees, Assistant Professor of Pediatrics and Emergency Medicine at Emory University Resources: Rees CA, Brousseau DC, Ahmad FA, et al; SCD Arginine Study Group and PECARN. Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. Am J Hematol. 2023 Apr;98(4):620-627. doi: 10.1002/ajh.26837. Epub 2023 Feb 6. PMID: 36606705; PMCID: PMC10023395.. Pediatric Emergency Care Applied Research Network (PECARN) ACEP Emergency Department Sickle Cell Care Coalition Resources ***** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Sickle Cell in the ED: Part 1 Jan 17, 2024

Show notes

People living with sickle cell disease can experience severe “pain crises”, or vaso-occlusive episodes (VOE), and are at increased risk for infections, strokes, heart failure, and other serious disease processes. When patients are out sickle cell present to the ED, it is crucial to initiate their evaluation and treatment as soon as possible. So what does this mean practically for us as clinicians? Hematologist and Sickle Cell expert, Dr. Bimpe Adesina, and Emergency Physician and researcher, Dr. Bryn Mumma, join us to explore this topic in depth. In part 1, we delve into assessment and management of patients presenting with VOE. Stay tuned for parts 2 and 3, where we’ll explore the use of intranasal fentanyl and the management of other emergent presentations related to sickle cell disease! Did this episode change your practice? Let us know on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Guests: Dr. Oyebimpe Adesina, Assistant Professor of Hematology and Oncology and Co-Director of the Adult Sickle Cell Clinical Program at UC Davis Dr. Bryn Mumma, Professor of Emergency Medicine and Leader of the Research Subcommittee of CARPE DIEM at UC Davis Resources: ACEP Emergency Department Sickle Cell Care Coalition Resources CHOP Emergency Department Clinical Pathway for Evaluation/Treatment of Children with Sickle Cell Disease with Fever DeBaun MR, Jordan LC, King AA, et al. American Society of Hematology 2020 guidelines for sickle cell disease: prevention, diagnosis, and treatment of cerebrovascular disease in children and adults. Blood Adv. 2020 Apr 28;4(8):1554-1588. doi: 10.1182/bloodadvances.2019001142. PMID: 32298430; PMCID: PMC7189278.. Chou ST, Alsawas M, Fasano RM, et al. American Society of Hematology 2020 guidelines for sickle cell disease: transfusion support. Blood Adv. 2020 Jan 28;4(2):327-355. doi: 10.1182/bloodadvances.2019001143. PMID: 31985807; PMCID: PMC6988392. NIH Expert Panel Report, 2014: Evidence Based Management of Sickle Cell Disease

Push Dose Pearls: RSI Jan 08, 2024

Show notes

This is the next episode of our Push Dose Pearls miniseries with ED Clinical Pharmacist, Chris Adams. In this ongoing series we’ll dig into some of the questions we all have about medications we commonly see and use in the ED. This episode focuses on RSI (rapid sequence intubation) meds - stuff every ED doc needs to know! What has changed and what are the latest recommendations? We’ll answer these questions and more! Did this episode change your practice? Let us know on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Guests: Christopher Adams, PharmD, Emergency Department Senior Clinical Pharmacist and Assistant Professor at UC Davis Resources: Acquisto NM, Mosier JM, Bittner EA, Patanwala AE, Hirsch KG, Hargwood P, Oropello JM, Bodkin RP, Groth CM, Kaucher KA, Slampak-Cindric AA, Manno EM, Mayer SA, Peterson LN, Fulmer J, Galton C, Bleck TP, Chase K, Heffner AC, Gunnerson KJ, Boling B, Murray MJ. Society of Critical Care Medicine Clinical Practice Guidelines for Rapid Sequence Intubation in the Critically Ill Adult Patient. Crit Care Med. 2023 Oct 1;51(10):1411-1430. doi: 10.1097/CCM.0000000000006000. Epub 2023 Sep 14. PMID: 37707379. Engstrom K, Brown CS, Mattson AE, Lyons N, Rech MA. Pharmacotherapy optimization for rapid sequence intubation in the emergency department. Am J Emerg Med. 2023 Aug;70:19-29. doi: 10.1016/j.ajem.2023.05.004. Epub 2023 May 10. PMID: 37196592. Bennett BL, Scherzer D, Gold D, Buckingham D, McClain A, Hill E, Andoh A, Christman J, Shonk A, Spencer SP. Optimizing Rapid Sequence Intubation for Medical and Trauma Patients in the Pediatric Emergency Department. Pediatr Qual Saf. 2020 Sep 25;5(5):e353. doi: 10.1097/pq9.0000000000000353. PMID: 33062904; PMCID: PMC7523837.. *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

The ins and outs of EMTALA Dec 18, 2023

Show notes

If you work in an ED, you’ve probably heard of EMTALA, or the Emergency Medical Treatment and Active Labor Act. But how much do you really know about this law? When does it apply and when does it not? EMTALA expert, Dr. Sophie Terp, helps us understand the history of EMTALA and what we need to know to ensure we provide the best care for our ED patients. Do you have more questions about EMTALA? Have you ever witnessed a violation? Share your thoughts with us on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Guests: Dr. Sophie Terp, Associate Clinical Professor of Emergency Medicine at the Keck Schoo of Medicine at the University if Southern California, and Quintiles Clinical Fellow at the Schaeffer Center for Health Policy and Economics Resources: The EMTALA origin story U.S. Center for Medicare and Medicaid Services Interpretive Guidelines Terp S, Seabury SA, Arora S, et al. Enforcement of the Emergency Medical Treatment and Labor Act, 2005 to 2014. Ann Emerg Med. 2017 Feb;69(2):155-162.e1. doi: 10.1016/j.annemergmed.2016.05.021. Epub 2016 Aug 2. PMID: 27496388; PMCID: PMC7176068.. ****** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Express Care Now Dec 04, 2023

Show notes

We first explored the world of Telehealth back in February of 2021 in parts 1 and 2 of our telemedicine series. Telehealth has exploded since then, even after hospitals and clinics opened fully again when COVID restrictions loosened. Drs. Jenny McCormick and Kelly Owen join us to give an update on our very successful telehealth program at UC Davis, Express Care. How is it working for patients? How do physicians like it? Listen to find out! Do you have Telehealth programs where you work? Who staffs it? Let us know on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Guests: Dr. Jenny McCormick, Professor of Emergency Medicine and Associate Director of Express Care at UC Davis Health Dr. Kelly Owen, Professor of Emergency, Medical Director Express Care, and Emergency Department Outpatient Operations Director at UC Davis Health Resources: UC Davis Health Express Care Epic: On-Demand Virtual Care Offers Patients Convenience and Value, by Celia Groff Thomas D, Garate D, Fu S, Bashir A, Moss N, Nair M. Telehealth reform post-public health emergency: crucial next steps. Proc (Bayl Univ Med Cent). 2022 Dec 6;36(2):269-271. doi: 10.1080/08998280.2022.2153323. PMID: 36876246; PMCID: PMC9980665.. ***** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Push Dose Pearls: Antibiotic Update Nov 17, 2023

Show notes

This is the next episode of our Push Dose Pearls miniseries with ED Pharmacist, Chris Adams. In this ongoing series we’ll dig into some of the questions we all have about medications we commonly see and use in the ED. This episode again focuses on common antibiotics we use in the ED. What has changed and what are the latest recommendations? We’ll answer these questions and more! Did this episode change your practice? Let us know on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Guests: Christopher Adams, PharmD, Emergency Department Senior Clinical Pharmacist and Assistant Professor at UC Davis Resources: CDC STI Treatment Guidelines Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-e67. doi: 10.1164/rccm.201908-1581ST. PMID: 31573350; PMCID: PMC6812437. ACEP EMRA Antibiotic Guide. *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

ED Post Roe Nov 06, 2023

Show notes

In 2022, the U.S. Supreme Court ruled that the Constitution does not confer a right to abortion. This decision, known as the Dobbs decision, Overturned Roe v. Wade and ended the right to abortion that had been upheld for decades. In the wake of this decision, many states have passed laws banning or severely restricting abortion. So how does this affect our patients and the care we provide in the ED? How is it different in protected estates compared to restricted states? Join us for a deep dive into the health implications of recent changes in reproductive health policy with expert, Dr. Amy Paris. Please note that the opinions expressed in this episode are our own and do not necessarily represent the position of our employers or institutions. How have things changed in your state and your ED? Share your stories with us on social media, @empulsepodcast, or through our website, ucdavisem.com. ***Please rate us and leave us a review on iTunes! It helps us reach more people.*** ~ Our episodes are now closed captioned! ~ Hosts: Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Guest: Dr. Amy Paris, OB/Gyn and Complex Family Planning Subspecialist in New Hampshire Resources: Care Post Roe - UCSF The Ryan Program Reproductive Health Access Project State Facts About Abortion - The Guttmacher Institute *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Communicating About Child Abuse Oct 18, 2023

Show notes

***Trigger warning: this episode includes discussion of child abuse*** In our last episode, Identifying abuse: the LCAST app, we talked about recognizing subtle signs concerning for child abuse and how to use the new LCAST app to determine the risk of non-accidental trauma. But identifying potential abuse is just the first step in a long and often emotionally taxing process. How do you approach parents or caregivers with your concerns? What do you do if a caregiver doesn’t want to cooperate with your extended work-up? What information should you share with them? And how do we avoid bringing our own biases into the room? These are tough conversations. Our guest experts, Dr. Emily Fain and Dr. Elena Duma, and our own Dr. Julia Magaña are experts in this field. They walk us through how to approach these conversations in a compassionate and straightforward manner, centering the safety of the child as everyone’s primary concern. How do you approach these challenging conversations? Share what’s worked for you (or what hasn’t) with us via social media, @empulsepodcast, or through our website, ucdavisem.com. ***Please rate us and leave us a review on iTunes! It helps us reach more people.*** ~ Our episodes are now closed captioned! ~ Hosts: Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Guest: Dr. Emily Fain, Assistant Professor of Pediatric Emergency Medicine at Monroe Carell Jr. Children's Hospital at Vanderbilt in Nashville, TN Dr. Elena Duma, Associate Professor of Pediatric Emergency Medicine at Cincinnati Children’s Hospital in Cincinnati, OH Resources: Riney L, Frey T, Fain E, Duma E, Chambers P. Improving Communication With Families for Evaluation of Child Abuse. J Patient Exp. 2020 Dec;7(6):827-829. doi: 10.1177/2374373520950987. Epub 2020 Aug 20. PMID: 33457503; PMCID: PMC7786754. . EIIC Pediatric Education and Advocacy Kit (PEAK): Child Abuse *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

Identifying abuse: the LCAST app Oct 04, 2023

Show notes

In March of this year, we published a Rebeat of one of our most powerful episodes, It Could Have Been Different. We took a deep dive into one of the most difficult aspects of our jobs as emergency physicians - recognizing and managing child abuse, or non-accidental trauma (NAT). Signs of abuse can often be subtle, but there are some very specific findings that should make us consider NAT. Our guest expert, Dr. Mary Clyde Pierce, helped us learn to identify NAT using the TEN-4 FACESp clinical prediction rule. In this episode, Dr. Pierce returns to discuss the new LCAST app developed by Lurie Children’s Hospital to help clinicians identify NAT. We love this app! It’s quick and easy to use - and it’s even better than using the decision rule alone. Listen to the episode to hear why! Have you tried the LCAST app? Share your experience with us via social media, @empulsepodcast, or through our website, ucdavisem.com. ***Please rate us and leave us a review on iTunes! It helps us reach more people.*** Hosts: Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Guest: Dr. Mary Clyde Pierce, Professor of Pediatric Emergency Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine. Resources: LCAST App - Lurie Children’s Child Injury Plausibility Assessment Support Tool EIIC PEAK Toolkit for Child Abuse EM Pulse Podcast: It Costs You Nothing Pierce MC, Kaczor K, Lorenz DJ, Bertocci G, Fingarson AK, Makoroff K, Berger RP, Bennett B, Magana J, Staley S, Ramaiah V, Fortin K, Currie M, Herman BE, Herr S, Hymel KP, Jenny C, Sheehan K, Zuckerbraun N, Hickey S, Meyers G, Leventhal JM. Validation of a Clinical Decision Rule to Predict Abuse in Young Children Based on Bruising Characteristics. JAMA Netw Open. 2021 Apr 1;4(4):e215832. doi: 10.1001/jamanetworkopen.2021.5832. *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

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