Stimulus – Learn Tools to Crush It in Your Medical Career

Do you work in medicine and love patient care but feel like parts of the job don’t measure up? Stimulus equips you with tools, mindset shifts, and strategies they didn’t teach you in training—so you can practice medicine like a boss, flourish in your career, and not let it crush your soul. Emergency physician and executive coach Rob Orman, MD, goes in-depth with thought leaders on how to avoid burnout, improve communication, lead without drama, and stay calm amidst the storm. Don’t just suck it up, think differently.

Latest Episodes:

Thrombolytics for Frostbite Jan 07, 2019

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Managing frostbite is both simple and complex. It's been around since human skin met the cold but research within the past few decades and even the past few years has dramatically changed how we care for thermal cold injury. in this episode, frostbite expert and burn surgeon Dr. Anne Wagner discusses frostbite diagnosis, simple and advanced management.

The Chest Pain Summit Dec 02, 2018

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A consensus summit with world experts and primary researchers focused on the question, “After a negative ED evaluation for ACS, is an expedited outpatient evaluation a safe alternative to admission?” Featuring Colin Kaide, MD, Mike Palacci, MD, Barbara Backus, MD, Erik Hess, MD, Ezra Amsterdam, MD, Douglas Van Fossen, MD, Rob Orman, MD, Mike Weinstock, MD, and Cam Berg, MD

Evidence Based Hyperkalemia Management Nov 07, 2018

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Hyperkalemia is one of, if not the most, common electrolyte abnormalities we see. But much of what we do in treatment is what someone told us to do when we were young learners. In this episode we debunk hyperkalemia myths and discuss an evidence based approach to management. For more great content check out

https://www.hippoed.com/em/ercast/

When to call a code in the field-Essentials of EM Nov 01, 2018

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Corey Slovis, MD from Essentials of EM 2016 breaking down when to call a prehospital code, and when to keep the resus going.Check it out https://www.essentialsofem.com/

Las Vegas Mass Casualty: How one ED made order out of chaos Oct 08, 2018

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A first hand account of the emergency department response to the 2017 Las Vegas strip shooting that left 59 dead and over 800 wounded. Discussion of preparation with 20 minutes warning, how to keep patients flowing as they enter the hospital as well as once they’re in the treatment area, effective triage, critical steps to simultaneously resuscitating large numbers of trauma patients.

Emergency Complications of Cirrhosis Sep 04, 2018

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Britt Long, MD and Rob Orman, MD discuss emergency department management of patients with complications of cirrhosis.

The Dying Asthmatic Aug 06, 2018

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Few patients are more challenging in the ED than the asthmatic in extremis who is recalcitrant to standard therapy. Asthma is different than other causes of severe respiratory distress. And there are different forms of asthma as well.
Besides cricoid pressure, magnesium, and slowing down ventilations, how else might the provider try to reduce the consequences of breath stacking is this case?
- Weingart prefers noninvasive positive pressure ventilation to BVM early on in the management.
- In the rare cases of severe asthma with a ‘stone chest’ that is incredibly difficult to bag, you need to proceed to immediate RSI and get the tube in as quickly as possible. It’s the only way to safely provide the airway pressures you need.
- - Prolonged bagging with high pressures carries the risk of gastric insufflation and aspiration.
  - Failed attempts at intubation are especially risky in these patients. As their hypoxia worsens, they may get more acidotic, running a very real risk of cardiac arrest peri-intubation.

Why Epi Might (and might not) Work in Cardiac Arrest Jul 01, 2018

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The pendulum never seems to stop swinging when it comes to the efficacy of epinephrine in cardiac arrest.

20-25 years ago, the push was to use escalating doses of epinephrine starting at 1 mg and increasing to 3 mg, then 5 mg, and continuing at 5 mg as needed. Some protocols started directly with 5 mg and continued with 5 mg thereafter. These protocols were based on early studies which suggested that higher doses of epi resulted in improved survival to hospital admission.

Subsequent analyses, 5-10 years later, showed that many of the people who got high doses of epi were dying at the same rate, or perhaps even higher rate. Also, amongst the survivors, the neurologic outcome was worse.

Over the past few years, a few studies have reported that epi, even in 1 mg doses, could be potentially harmful and not helpful.

The most recent literature seems to be coming back to a middle zone whereby there probably is some benefit to epinephrine, but only if given in a certain time period. These studies suggest that epi is most beneficial if given in the first 15-20 minutes after cardiac arrest. Continued dosing of epi beyond the 20 minute mark (post cardiac arrest) seems to produce more rapid deterioration and is not supported by the literature.

Internal Medicine in the Emergency Department Jun 03, 2018

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Internist Neda Freyha sprinkles some IM in the ED - how to interpret TSH levels and why aspirin is no longer recommended for a-fib thromboprophylaxis.

Massive GI Bleed on Anticoagulants May 04, 2018

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Rob and Tom Deloughery discuss management of actively bleeding patients who have been prescribed anticoagulation medications.

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