Illinois College of Emergency Physicians

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**Illinois College of Emergency Physicians**

Advancing Emergency Care

Latest Episodes:

ICEP EM on Tap Podcast: Ep 05 – COVID-19 Preparedness for ED Leaders March 26, 2020 Webinar Apr 03, 2020

Show notes

This episode of ICEP EM on Tap features:

COVID-19 Preparedness for ED Leaders

Ernest Wang, MD, FACEP

Audio only of webinar presented on March 26, 2020, by ICEP President Dr. Wang to share his experiences and data leading a large 4-hospital ED system through the evolving outbreak.

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The post ICEP EM on Tap Podcast: Ep 05 – COVID-19 Preparedness for ED Leaders March 26, 2020 Webinar first appeared on Illinois College of Emergency Physicians.

The post ICEP EM on Tap Podcast: Ep 05 – COVID-19 Preparedness for ED Leaders March 26, 2020 Webinar appeared first on Illinois College of Emergency Physicians.

ICEP EM on Tap Podcast: Episode 04 – 2019 Resident Competition Apr 24, 2019

Show notes

Congratulations to the winners of the 2019 Resident Podcast Competition! This episode of ICEP EM on Tap features the top three entries:

1st Place

Res EM Podcast: Trends in Drug Culture

Evan Sands, MD
Casey Collier, MD, FACEP
AMITA Health Resurrection Medical Center, Chicago, IL

2nd Place

Dual Sequential Defibrillation for Refractory Ventricular Fibrillation

Jonathan Alterie, DO
Nicholas Gross, DO
Midwestern University, Chicago, IL

3rd Place

The Algo-rhythm Series: Routine Wound Management and Tetanus Prophylaxis

Karan Thakkar, MS4
Nova Southeastern University College of Osteopathic Medicine, Plantation, FL

Show Notes:

Res EM Podcast: Trends in Drug Culture

In this edition of the Res EM Podcast, we explore some of the recent changes in the ever-evolving world of mainstream drug culture and how it shapes the practice of emergency medicine. Dr. Evan Sands discusses a wide range of topics, including:

MDMA and its derivatives
Kratom
Cathinones, or “bath salts”
The advancement and complexity of heroin

Dual Sequential Defibrillation for Refractory Ventricular Fibrillation

This podcast will discuss the use of dual sequential defibrillation in refractory ventricular
fibrillation. We will address the proper setup and pad placement for dual sequential
defibrillation, the theories on why it works, the research behind it, and the patient
populations that would most likely benefit.

How does it work – It’s simple! It requires two defibrillators, for a total of four pads,
placed in either anterior-posterior plus anterior-lateral, or both in the anterior-lateral
positions. Just make sure they are not touching. Charge both machines as you would
normally, and push the discharge buttons at the same time.

Which patient population benefit from dual sequential defibrillation? – A small
percentage of patients who go into ventricular fibrillation go on to develop refractory
ventricular fibrillation, a stubborn, deadly arrhythmia that you’ll likely come face to face
with in your practice. Most authors agree that the definition of refractory ventricular
fibrillation is ventricular fibrillation that persists or recurs despite standard pharmacologic
therapy and at least 3 attempts of defibrillation. These patients who go into refractory
ventricular fibrillation are those you may want to use dual sequential defibrillation onhowever,
there are no strict guidelines or recommendations at this time.

What does the research show – There are no great meta-analyses or large prospective
studies for this topic. The initial studies were done by cardiologist on canines in the
1980’s. They concluded that sequential shocks with different vectors reduce both the
energy and the voltage required to terminate an arrythmia. Since then, there have been
case studies and retrospective reviews in the Emergency Medicine and prehospital
world that show some evidence of terminating refractory ventricular fibrillation, which
has a mortality of 97%. Dual sequential defibrillation has shown improvement in
termination of the arrhythmia, but no significant change in mortality. Future research
may investigate whether earlier use of dual sequential defibrillation is more beneficial,
as most studies have utilized dual sequential defibrillation only after 3 attempts using a
single unit defibrillator.

The Algo-rhythm Series: Routine Wound Management and Tetanus Prophylaxis

In this podcast series titled “Algo-Rhythm”, Karan breaks down diagnostic and treatment algorithms and layers them over self-produced instrumentals in which musical elements are introduced in a stepwise fashion, in parallel with the algorithm being taught. In this special edition of Algo-Rhythm, Karan reviews common terms and indications for the administration of Td, Tdap, and TIG, simplifying routine wound management for students approaching clinical vignettes or seeing a patient presenting to the ED after suffering a physical insult to the skin.

The post ICEP EM on Tap Podcast: Episode 04 – 2019 Resident Competition first appeared on Illinois College of Emergency Physicians.

The post ICEP EM on Tap Podcast: Episode 04 – 2019 Resident Competition appeared first on Illinois College of Emergency Physicians.

ICEP EM on Tap Podcast: Episode 03 – 2018 Resident Competition Nov 24, 2018

Show notes

Congratulations to the winners of the 2018 Resident Podcast Competition! This episode of ICEP EM on Tap features the top two entries:

1st Place

“Doctor, We’re All Out!” An Old But New Approach to Alcohol Withdrawal in Our World of Shortages

Jessica Zahn, DO
University of Illinois, Chicago, IL

2nd Place

Emerging: Post-Shift Conversations by New Emergency Physicians – Episode 1: Why Wellness

Stephen Cooper, MD
RJ Sontag, MD
Cook County Health, Chicago, IL
UT Health San Antonio, TX

Shownotes:

“Doctor, We’re All Out!” An Old But New Approach to Alcohol Withdrawal in Our World of Shortages

We have all been faced with an alcohol abuse patient in the ED in many forms: acutely intoxicated patients too drunk to go home to the other end of the spectrum of chronic abusers that are actively withdrawing.Medication shortages have affected our ability to treat our patients, requiring us to dig deep into our brains and pockets for alternative treatment measures. Phenobarbital provides a treatment that is superior for our patients while at the same time reducing our need for the elusive benzodiazepine.

Emerging: Post-Shift Conversations by New Emergency Physicians – Episode 1: Why Wellness

In this episode, we introduce ourselves, and our podcast to the emergency medicine world. The goal of our podcast is to discuss some of the non-clinical conversations that physicians and specifically residents are having amongst themselves. Whether this is in regard to various aspects of life as a young doctor, public policy, or more serious matters such as mental health issues. This episode discusses in depth the statistics and consequences regarding physician burnout. Residents have a high rate of depression and suicidal ideation. This includes the alarming rates of attempted physician suicide plaguing our community. But it isn’t all dark clouds and doom; we end our podcast discussing ways to help prevent burnout/suicide. It is important to have these after shift conversations, to reach out, and to help our fellow residents/physicians.

References

Amanda. I’m tired of people romanticizing over-exertion [Internet]. runningmandz.tumblr.com 2015 [cited 2017 Apr 12]

A Meaningful Work. Vital Signs. Winter 2017. Vol 39, No 1. https://medicine.wright.edu/about/news-and-events/vital-signs/article/a-meaningful-work

Doty C, Lee J, Ahuja, M. 2017 Mar 8. Academic Life in Emergency Medicine: The Wellness Think Tank – Mental Health for Residents [Audio podcast]. Retrieved from https://soundcloud.com/academic-life-in-em/the-wellness-think-tank-mental-health.

Goebert et al. Depressive Symptoms in Medical Students and Residents: A Multischool Study. Academic Medicine. Feb 2009 http://journals.lww.com/academicmedicine/pages/articleviewer.aspx?year=2009&issue=02000&article=00034&type=fulltext

Guille C, Zhao Z, Krystal J, Nichols B, Brady K, Sen S. Web-Based Cognitive Behavioral Therapy Intervention for the Prevention of Suicidal Ideation in Medical Interns: A Randomized Clinical Trial. JAMA Psychiatry. 2015 Dec;72(12):1192-8. doi: 10.1001/jamapsychiatry.2015.1880.

Miller MN, Mcgowen KR, Quillen JH. The Painful Truth: Physicians Are Not Invincible. South Med J 2000;93:1–5.

Peckham C. Emergency Medicine Lifestyle Report 2016: Bias and Burnout. Medscape. [Internet]. http://www.medscape.com/features/slideshow/lifestyle/2016/emergency-medicineJanuary 13, 2016 [cited 2017 Apr 12].

Poznanski S. Emotional Embrace: How Can We Turn Our Profession Inside Out? [Internet]. FeminEM. https://feminem.org/2015/12/01/emotional-embrace/ 2015 [cited 2017 Apr 24]

Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, West CP, Sloan J, Oreskovich MR. Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population. Arch Intern Med. 2012;172(18):1377-1385. doi:10.1001/archinternmed.2012.3199

Tabner A. Physician Suicide [Internet]. Life in the Fast Lane. https://lifeinthefastlane.com/predict-protect-prevent-physician-suicide/. [cited 2017 Apr 12]

Wible, P. Why Doctors Kill Themselves [Video]. TED MED 2015. http://www.tedmed.com/talks/show?id=528918 [cited 2017 Apr 24]

The post ICEP EM on Tap Podcast: Episode 03 – 2018 Resident Competition first appeared on Illinois College of Emergency Physicians.

The post ICEP EM on Tap Podcast: Episode 03 – 2018 Resident Competition appeared first on Illinois College of Emergency Physicians.

ICEP EM on Tap Podcast: Episode 02 – Toxicology Rants and Pain Management in the ED Feb 27, 2018

Show notes

This episode of ICEP EM on Tap features:

Toxicology Rants – Consultant’s Corner

Adam Rodos, MD
George Hughes, MD

“Activated Charcoal and Its Use in Ingestion Overdoses”
Guest: Dr. Frank Paloucek

Clinical Pharmacologist, University of Illinois
Member, Toxikon Consortium

Pain Management in the Emergency Department

Dallas Holladay, DO
Jon Alterie, DO

Shownotes:

Toxicology Rants – Consultant’s Corner

In this episode of Consultant’s Corner, special guest Dr. Frank Paloucek, Clinical Pharmacologist at the University of Illinois and longtime member of the Toxikon Consortium, joins Dr. Rodos and Dr. Hughes to separate myth from fact regarding the role of activated charcoal in the poisoned patient:

Have you ever asked yourself if your patient should receive activated charcoal beyond the 2-hour window? And where does that 2-hour window come from?
In which patients should you consider multiple dose activated charcoal?
Are there some poisoned patients who shouldn’t receive activated charcoal at all?

Listen in as Dr. Paloucek answers all these questions and more in this episode.

Pain Management in the ED

An overview of ED visits published in 2011 by the Healthcare Cost and Utilization Project listed head injury, open wounds, non-specific chest pain, abdominal pain and back pain as the most common complaints among discharged patients so it’s safe to say ED docs are frequently responsible for managing pain. This podcast can’t cover every analgesic under the sun but will cover the most used analgesics in the ED and some cutting-edge pain relievers, including:

Ketamine
Lidocaine
Codeine
Tramadol
Morphine
Dilaudid
Fentanyl
Acetaminophen
NSAIDs

View full Pain Management show notes

The post ICEP EM on Tap Podcast: Episode 02 – Toxicology Rants and Pain Management in the ED first appeared on Illinois College of Emergency Physicians.

The post ICEP EM on Tap Podcast: Episode 02 – Toxicology Rants and Pain Management in the ED appeared first on Illinois College of Emergency Physicians.

ICEP EM on Tap Podcast: Episode 01 – Introduction & Resident Competition Jun 19, 2017

Show notes

ICEP EM on Tap is the Illinois College of Emergency Physicians’ podcast for all things emergency medicine. ICEP EM on Tap provides an online resource of up-to-date and relevant information as it pertains to the practice of emergency medicine: literature review, procedural techniques, current topics of interest, and more. The goal of ICEP EM on Tap is to harness the wealth of academic emergency medicine potential in Illinois while offering a resource of insightful feedback and dialogue from the ICEP community.

Sit back as Dr. Christopher Colbert and Dr. Dan Robinson introduce the program. Then, let the knowledge flow in with the 3 winners of the spring 2017 Resident Podcast Competition:

1st Place

Ultrasound to Confirm Endotracheal Tube Placement

Jonathan D. Alterie, DO PGY-1
Dallas Holladay, DO PGY-4
Midwestern University

2nd Place

The History of Sepsis: What Do the Trials Show?

Racheal A. Gilmer, MD
Michael Ward, MD
University of Chicago

3rd Place

Project REVISE: A Novel Approach to Pediatric Fever

Orhay Mirzapolos, DO
Midwestern University Emergency Medicine Residency

Shownotes:

Ultrasound to Confirm Endotracheal Tube Placement

I. What we discuss in this podcast: We will be discussing the use of ultrasound in confirming endotracheal tube placement. This topic has been touched upon as early as 1994 when it was mentioned by American College of Emergency Physicians as one of the modalities to confirming ETT placement, and it has been reviewed numerous times by ACEP.

II. Why is this important? There are already a number of well-established methods for confirming ET tube placement. These include the classics like condensation in the tube, bilateral breath sounds, lack of epigastric gurgling, colorimetric CO2 confirmation as well as end-tidal CO2 and of course, the gold standard: visualizing the tube passing through the cords. However, these all have limitations. The use of US for ETT placement confirmation is a great method to confirm tube placement, with sound evidence supporting its use. With some US practice, you can begin to implement this into your own armamentarium and use it for quick placement confirmation.

III. Who to use it on and who not to use it on is discussed.

IV. How to use US for ETT placement is explained; however, we recommend using the cited sources below to view images of the different techniques. And as always, you can visit our Midwestern University EM page for more ultrasound technique videos!
http://emergencymed.wixsite.com/mwuem

Thank you so much for listening and be on the look out for more podcasts! If you have any questions or comments you can email either one of us at jalterie66@midwestern.edu or Dallas.Holladay@gmail.com or on Twitter: @JonathanDominck @Dallas_Holladay

Download complete show notes with article references

The History of Sepsis: What Do the Trials Show?

This podcast is a 10-minute history lesson all things sepsis. We will discuss how and why sepsis had to be defined with such scrutiny. We identify who created the definitions for sepsis and septic shock and why. We discuss the key trails surrounding sepsis treatment past and future. If you want to know how we got to where we are today, listen to this podcast!

Project REVISE: A Novel Approach to Pediatric Fever

Project REVISE: Reducing Excessive Variability in Infant Sepsis Evaluation is an ongoing study organized by the Value in Pediatrics network (VIP), a subset of the American Academy of Pediatrics.

No change in the management of well appearing infants >29 days.
- Partial septic work up with a respiratory viral panel and CXR only if respiratory symptoms are present and +/- an LP.
- With a benign work up, these patients can be discharged home with follow up in 24 hours and no empiric antibiotics.
Infants <7 days old, have a greater than 10% incidence of bacterial infections.
- Obtain a full septic work up including CBC, Blood culture, UA, respiratory panel, CXR and LP (including a PCR for HSV).
- Admission and empiric antibiotics are indicated.
THE CHANGE: Well appearing infants 7-28 days old.
- Only 10% febrile infants in this age group will have bacterial infection. Most have UTI, only 1% have meningitis.
- Obtain UA, CBC, Blood culture, respiratory panel, CRP or procalcitonin, and CXR if respiratory symptoms are present.
- Determine if child meets Low Risk Criteria:
  - Born full-term, or >37 weeks gestation
  - No prior hospitalizations
  - No prolonged newborn nursery course
  - WBC 5-15,000
  - <15 bands
  - UA negative for leukesterase and nitrites with <5 WBCs on the micro
  - Negative CRP or procalcitonin
  - No chronic illnesses
  - No prior antibiotics
  - No unexplained hyperbilirubinemia
- If all of these criteria are met, the infant is low risk and the incidence of meningitis is <0.5% so no LP is indicated.
  - Admit with no empiric antibiotics until cultures are negative.
  - If they test positive for a respiratory virus, discharged after 24 hours of negative cultures.
  - If the respiratory panel is negative, discharged after 24-36 hours of negative cultures.
  - If empiric antibiotics are started, then an LP should be performed prior to the administration of antibiotics.
A free mobile app from Children’s Mercy Hospital called CMPeds is available and walks you through this algorithm in a step by step approach.

Downoad shownotes – PDF

The post ICEP EM on Tap Podcast: Episode 01 – Introduction & Resident Competition first appeared on Illinois College of Emergency Physicians.

The post ICEP EM on Tap Podcast: Episode 01 – Introduction & Resident Competition appeared first on Illinois College of Emergency Physicians.

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