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EMplify by EB Medicine — Education
EMplify by EB Medicine

Take a deeper dive into our peer-reviewed emergency medicine content with the EMplify podcast. Join hosts Sam Ashoo, MD and T.R. Eckler, MD for educational, conversational reviews of current evidence guaranteed to help you make your best clinical decisions. Each high-yield episode gives you practical, time-tested guidance from practicing emergency medicine clinicians and subject-matter experts. Listen and learn!

Latest Episodes:

Infective Endocarditis-Associated Stroke Apr 03, 2023

Show notes

Announcements:

The interactive Clinical Pathways have launched and they are available for free!

In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the March 2023 Emergency Medicine Practice article on Emergency Department Management of Infective Endocarditis-Associated Stroke

Epidemiology

Pathophysiology

Populations at Risk

Complications

Intracranial hemorrhage
Aneurysms
Heart block

Prehospital Care

ED History and Examination

Imaging

Antibiotic Therapy

Surgical Treatment

Special Populations

Summary

Pediatric Electrolyte Emergencies Mar 01, 2023

Show notes

Announcements:

The interactive Clinical Pathways have launched and they are available for free!

—

In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the February 2023 Pediatric Emergency Medicine Practice article on Pediatric Electrolyte Emergencies: Recognition and Management in the Emergency Department

—

History

Point-of-care testing

I/O lines

Presentation, differential, and treatment of:

Hyponatremia
Hypernatremia
Hypokalemia
Hyperkalemia
Hypocalcemia
Hypercalcemia
Hypomagnesemia
Hypophosphatemia

Opioids in Children and Adolescents Feb 02, 2023

Show notes

Announcements:

The interactive Clinical Pathways have launched and they are available for free!

___

In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the January 2023 Pediatric Emergency Medicine Practice article on the Responsible and Safe Use of Opioids in Children and Adolescents in the Emergency Department

DEA-X Waiver Repeal:

Opioids in Children and Adolescents:

Introduction

Epidemiology and Statistics

Medication safety at home

Escalation of pain meds at home

Naloxone prescriptions

Medications in children

Codeine
Tramadol
NSAIDs
Local anesthetics and nerve blocks
Intranasal meds: Ketamine and fentanyl

Opioids and sedation

Regional anesthesia

Chronic pain

Allergic Reactions and Anaphylaxis Jan 17, 2023

Show notes

Announcements:

The interactive Clinical Pathways have launched and they are available for free!

—

In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the July 2022 Emergency Medicine Practice article on the Management of Allergic Reactions and Anaphylaxis in the Emergency Department.

Intro

The number of ED visits and hospitalizations
Studies show up to 57% of anaphylactic reactions are not recognized, and epinephrine is not administered in up to 80% of cases.

Criteria

2006 Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network (NIAID/FAAN)
WAO revised the criteria in 2020
Delphi group and Brown et al

Pathophysiology

Epidemiology

Most common causes in children and adults
More than half of deaths from anaphylaxis occur within the first hour of symptom onset

Prehospital Care

Give epi, H1 blockers
Mainstay = recognition

ED Care

Airway
Epinephrine
Decontamination
H1 and H2 blockers
Corticosteroids
Biphasic reactions
Glucagon

Special Cases

Alpha-gal
Scombroid
Kounis syndrome

Pediatric Septic Shock Jan 03, 2023

Show notes

Announcements:

1) The interactive Clinical Pathways have launched and they are available for free!

2) 2023 E/M coding guidelines are in effect. See the summary here.

___

In this episode, Sam Ashoo, MD, interviews Ara Festekjian, MD, one of the authors of the November 2022 Pediatric Emergency Medicine Practice article on Pediatric Septic Shock in the Emergency Department

Introduction: How common is sepsis in kids and what is the mortality rate in the US?

Definitions

Septic shock
Sepsis associated organ dysfunction
Sepsis-3
Compensated vs uncompensated shock

Etiology

Neonate
Central line and VP shunts
Asplenia
Immunocompromised children

Differential Diagnosis

Prehospital Care

ED Evaluation

History
Examination
Septic shock + cardiogenic shock
Warm vs cold shock
Evolution of physical exam findings

Diagnostics

Labs
Imaging

Treatment

IV/IO placement
Fluid boluses
Antibiotics
Pressors
Airway management

Special Populations

Febrile neutropenia
Newborns with septic shock

Controversies

Fluid volume
Fluid type
Antibiotic timing
Corticosteroids

Influenza Dec 12, 2022

Show notes

In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the December 2022 Evidence-Based Urgent Care article on Influenza in Urgent Care.

Epidemiology

Historical data
Since COVID, tracking "influenza-like illness" has been complicated
Influenza deaths and age
Annual mortality

Outbreaks

Transmission

Classification

Influenza A, B, and C
Hemagglutinin and neuraminidase subgroups
Antigenic drift and shift

Pathophysiology

Transmission
Incubation
Secondary infection
H3N2

Vaccines

Egg-based, cell-based, and recombinant influenza vaccines
CDC recommendations
Patients aged >65 years

Differential Diagnosis

Complications

Testing

When is it indicated?
What types of tests are available?
Testing in periods of low and high prevalence

Treatment

High-risk conditions that suggest treatment
Antiviral medications
Oseltamivir: NNT and NNH
Resistance patterns

Billing and Coding

Angioedema Dec 01, 2022

Show notes

In this episode, Sam Ashoo, MD, interviews Prayag Mehta, MD, and Nikola Milanko, MD, two of the authors of the October 2022 Emergency Medicine Practice article on Angioedema in the Emergency Department

Pathophysiology: Non-pitting edema of respiratory or GI tract

Histamine meditated, bradykinin mediated, or idiopathic
Acquired, inherited, or idiopathic
Do they present differently? (Urticaria, speed of onset)

Histamine Mediated

Most common form: 40%-70%
Can be triggered by NSAIDs
Can be induced by physical mechanism like cold, vibration
Is rash a reliable method of distinguishing the types?

Bradykinin Mediated

May progress slowly
Can be inherited or acquired
Common triggers include ACE inhibitors and TPA

Table 1 Differential Diagnosis

Prehospital Care

Protect airway
Epi, steroids, antihistamines
Avoid CPAP

ED History

Figure 2: Distinguishing characteristics of histamine vs bradykinin mediated

ED Exam

Importance of repetitive exams
Airway examination
Laryngoscopy?

Diagnostics

Figure 6: Flow diagram of ED workup
Labs
Imaging

Treatment

Airway: Intubation
Medication

Special Populations

Pediatric
Pregnant/lactating patients

Controversies

TXA

Disposition

Pediatric Ocular Trauma Nov 03, 2022

Show notes

In this episode, Sam Ashoo, MD, interviews Ami Shah, MD, MPH, and Don Walker, MD, about eye injuries in the pediatric population.

Why ocular injuries? Why did you pick this topic?

What kind of injuries are included and at what age are they most common?

Injury zones and terminology

Differential Diagnosis

What should we keep in mind when we are confronted with an ocular injury? (Table 3)

Prehospital Care

What do our EMS colleagues need to keep in mind when transporting a child with an ocular injury?
How can they help us in the ED?

ED Evaluation

History: What's important to know?
Physical: Visual acuity and eye exam
Diagnostics: Slit lamp, ocular pressure, US, CT, MRI

Treatment

Lid lacerations: Who repairs and when?
Orbital fractures: What should we be looking for? Why is it different in children? When does repair typically occur?
Corneal abrasions
Corneal foreign body
Chemical injuries: Irrigate with what and for how long?
Traumatic hyphema: Treatment, disposition
Traumatic iritis: Treatment, outcome
Open globe injuries
Retrobulbar hematoma - First 10 EM

Special Populations

Hemophilia, Von Willebrand disease
Sickle cell and trait
Neonates and infants
Contact lenses

Controversies and Cutting Edge

Ketamine
Tetanus
NSAIDs, topical?
Topical anesthetics
Visual acuity apps

Career Disillusionment Oct 18, 2022

Show notes

In this episode of EMplify: Conversation, Sam Ashoo, MD talks with Rob Orman, MD, founder of Orman Physician Coaching, about career disillusionment.

Career Disillusionment: What is it? How do we combat it? Should we combat it?
A frog in boiling water...
Burnout
Two questions to ask yourself
How coaching can help
The advice trap
A framework to explore your career and life goals

More at Orman Physician Coaching.

Pediatric Firearm Injuries to the Extremity Oct 02, 2022

Show notes

In this episode, Sam Ashoo, MD interviews Rawad Rayes, MD and Eva Tovar Hirashima, MD, MPH – two of the authors of the August 2022 PEMP article on Pediatric Firearm Injuries to the Extremity: Management in the Emergency Department.

Episode Outline:

How common are pediatric firearm injuries?

What is the most common location of these injuries?

Is there much literature published on this topic?

Epidemiology

What’s been the trend in pediatric firearm injuries over the past 10 years?
Do we have any idea how/why these are occurring (ie, accidental, intentional, etc)

Terminology: For those unfamiliar with firearms (table 1)

Ballistics: Mechanisms of damage.

Pre-hospital care

Trauma center transport
Prehospital hemorrhage control -- Combat application tourniquet, anything else?

ED Evaluation

SIPA -- What is it and why use it?
Primary survey -- Tachycardia -> delayed cap refill -> hypotension in children?
Secondary Survey
Diagnostic Studies:
Damage Control Resuscitation
Wound Care -- Do we remove projectiles? Can they stay in?
Antibiotics
Joint Involvement
Compartment Syndrome -- 3 As vs 6 Ps
Rhabdomyolysis

Controversies

CTA for all injuries?
Hemostatic devices -- Any role for these in the ED?

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