Core Em Podcast

This week we discuss upper GI bleeding pearls from a workshop we did in our weekly conference. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_72_0-UGIB_Final_Cut.m4a Download Leave a Comment Tags: Aortoenteric Fistula, Gastric Ulcer, Gastrointestinal, GI, UGIB, Variceal Bleeding Show Notes Take Home Points Respect the UGIB. These patients can bleed a lot. Even if they’re not actively hemorrhagic in front of you, realize that they can open up at any time and decompensate Get your consultants on board early. A skilled endoscopist is your friend as they can get control of bleeding. Don’t forget IR for TIPS in variceal bleeds and general surgery in bleeding ulcers. Activate your massive transfusion protocol if the patient is unstable and give the patien

This week we feature a lecture from Anand Swaminathan at our weekly conference on the ED management of acute pulmonary edema https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_71_0_Final_Cut.m4a Download 9 Comments Tags: Acute Decompensated Heart Failure, Acute Pulmonary Edema, ADHF, APE, Cardiovascular Show Notes Read More Core EM: Acute Pulmonary Edema EMCrit: Podcast 1 – Sympathetic Crashing Acute Pulmonary Edema REBEL EM: Morphine Kills in Acute Decompensated Heart Failure emDocs:

This week we discuss the rare, but life-threatening baclofen withdrawal. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_70_0_Final_Cut.m4a Download Leave a Comment Tags: Baclofen, Critical Care, Toxicology, Withdrawal Syndromes Show Notes Take Home Points Baclofen withdrawal is a rare complication of intrathecal baclofen pumps. It’s presentation mimics sepsis and alcohol withdrawal and is characterized by hemodynamic instability, hyperthermia, increased spasticity, confusion, altered mental status and seizures. Patients can develop rhabdo from the spasticity and, eventually, can develop multi system organ dysfunction. Treating baclofen withdrawal with oral baclofen is unlikely to work even at large oral doses because only a tiny amount gets

This week we discuss why we use antibiotics in COPD exacerbations and whether we should continue to do so. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_69_0_Final_Cut.m4a Download Leave a Comment Tags: Antibiotics, COPD, COPD Exacerbation, Pulmonary Show Notes Take Home Points Most COPD exacerbations are caused by infectious etiologies. While these can be viral, there’s also a decent chance it was caused by an overgrowth of bacteria that chronically colonize these patients. Strong evidence from systematic reviews demonstrates that antibiotic use reduces in-hospital mortality and decreases treatment failure The GOLD group recommends antibiotics be given to patients who have increased dyspnea, increased sputum volume and increased sputum purulence o

This week we discuss the workup and management of hiccups in the ED https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_68_0_Final_Cut.mp3 Download One Comment Tags: Hiccups, Singultus Show Notes Take Home Points Hiccups, or singultus, are caused by a reflex arc involving the vagus nerve, CNS and phrenic nerve.  If you remember the path of these nerves, you can remember that possible bad pathologies that could cause a patient to present with prolonged hiccups. Physical maneuvers are the first line for solving the hiccups.  Try things that will interrupt respiration or stimulate the vagus nerve.  We like the modified valsalva in which the patient blows on a syringe, because it’s pretty easy to get the patient to do. Last, medication options for hiccups in

This week we review pearls from our Grand Rounds from George Willis, MD talking about feedback. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_67_0_Final_Cut.m4a Download Leave a Comment Tags: Resident Education Show Notes Read More St. Emlyn’s: #TTCNYC Resources for Feedback Talk Read More

This week, we discuss Boerhaave syndrome focusing on making the diagnosis and managing the patient. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_66_0_Final_Cut.m4a Download One Comment Tags: Chest Pain, Pulmonary Show Notes Take Home Points Keep esophageal rupture on your differential for deadly causes of chest, epigastric or back pain.  We don’t see it often, but it’s a real thing.  Boerhaave Syndrome is the spontaneous rupture of the esophagus that is caused by a sudden increase in intraesophageal pressure, as seen in forceful vomiting.  So, if the patient presents with the right symptoms and any vomiting in their history, keep this diagnosis in mind.  Other causes you might see, though less common, are childbirth, seizure, prolonged cou

This week we discuss the diagnosis and management of pericarditis with a focus on not missing the hidden STEMI. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_65_0_Final_Cut.m4a Download Leave a Comment Tags: ACS, Cardiology, Cardiovascular, Colchicine, Pericarditis, STEMI Show Notes Read More ECG Case of the Week (Amal Mattu): Acute STEMI vs. Pericarditis Part 1 + Part 2 REBEL EM: Colchicine for Treatment of Pericarditis SOCMOB: Pericarditis: Treatment and Diagnosis Pocket Card FOAMcast: Episode 54 – The Pericardium Core EM: Pericarditis

This week we discuss an age-old debate: Calcium Channel Blockers or Beta Blockers for rate control in atrial fibrillation. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_64_0_Final_Cut.m4a Download Leave a Comment Tags: Atrial Fibrillation, Beta Blocker, Calcium Channel Blocker, Cardiology, Rate Control Show Notes CoreEM: Recent Onset Atrial Fibrillation ALiEM: Atrial Fibrillation Rate Control in the ED: Calcium Channel Blockers or Beta Blockers? ALiEM: Beta Blockers vs Calcium Channel Blockers for Atrial Fibrillation Rate Control: Thinking Beyond the ED Fromm C, et al. Diltiazem vs. Metoprolol in the Management of Atrial Fibrillation or Flutter with Rapid Ventricular Rate in the Emergency Department. J Emerg Med. 2015 Apr 22. PMID 25913166

This week we discuss a recent article looking at the relevance of d/c glucose levels to patient revisits and subsequent hospitalization https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_63_0_Final_Cut.m4a Download Leave a Comment Show Notes Driver BE et al. Discharge glucose is not associated with short-term adverse outcomes in emergency department patients with moderate to severe hyperglycemia. Ann Emerg Med 2016. PMID: 27353284 Read More

This week we discuss the ED management of cardiac arrest with VFib and pulseless VTach. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_62_0_Final_Cut.m4a Download One Comment Tags: Cardiac Arrest, Dual Defibrillation, OHCA, Ventricular Dysrhythmias, Ventricular Fibrillation, Ventricular Tachycardia Show Notes Take Home Points In cardiac arrest, the most important interventions are to deliver electricity quickly when it’s indicated and to administer good high-quality compressions with minimal interruptions to maximize your compression fraction. Medications like epinephrine and amiodarone have never been shown to improve good neurologic outcomes in the ACLS recommended doses. Don’t focus on them. Consider pre-charging your defibrillator to minimize p

This week we discuss the presentation and treatment of hypokalemia. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_61_0_Final_Cut.m4a Download Leave a Comment Show Notes Take Home Points Hypokalemia has a wide variety of presentations ranging from generalized weakness, to paralysis, to cardiac arrhythmia or cardiac arrest. When you discover hypokalemia, be sure to check and EKG. Think about underlying causes of hypokalemia, because it is rarely a solo event. Treat with oral potassium supplementation of 40-60 orally every 4-6 hours for mild hypokalemia and 10-20 mEq/hour IV for severe or symptomatic hypokalemia. Additional Reading LITFL: Hypokalemia LITFL: Hypokalemic Periodic Paralysis Core EM: Hypokalemia Read More

This week we discuss how to aggressively resuscitate patients with DKA as well as dispelling some dogmatic teachings on the topic. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_60_0_Final_Cut.m4a Download Leave a Comment Tags: Cerebral Edema, DKA, Hypokalemia, Insulin, Resuscitation Show Notes Take Home Points DKA should be suspected in any patient with altered mental status and hyperglycemia. Get a VBG (ABG not necessary) to confirm the diagnosis. Hypokalemia kills in DKA. Aggresively replete potassium and consider holding insulin, which drops serum potassium, until K is greater than 3.5 The insulin bolus isn’t necessary and appears to cause more episodes of hypokalemia. Just start insulin as an infusion at 0.14 units/kg Be vigilant about

This week we discuss the recognition, diagnosis and treatment of severe decompensated hyperthyroidism or thyroid storm. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_59_0_Final_Cut.m4a Download Leave a Comment Tags: Thyroid Diseases, Thyroid Storm Show Notes Take Home Points Decompensated hyperthyroidism is a rare, life-threatening condition.  It can develop in patients with long-standing untreated hyperthyroidism and is often precipitated by another event such as an infection, surgery, or trauma. Patients present with tachycardia, fever, altered mental status and GI symptoms.  Keep thyroid storm in mind if a patient has a history of hyperthyroidism or if things just aren’t making sense with your patient, you can’t find a fever source, the

This week we discuss severe hyponatremia - presentation and treatment. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_58_0_Final_Cut.m4a Download Leave a Comment Tags: Electrolytes, Hypertonic Saline, Hyponatremia Show Notes EM Cases: Podcast 60: Emergency Management of Hyponatremia References Adrogue HJ, Maidas NE. Hyponatremia. NEJM 2000; 342(21): 1581-9. PMID: 10824078 Moritz ML, Ayus JC. 100 cc 3% sodium chloride bolus: a novel treatment for hyponatremic encephalopathy. Metab Brain Dis 2010; 25: 91-6. PMID: 20221678 Read More

This week we discuss the role of phenobarbital in the management of severe alcohol withdrawal. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_57_0_Final_Cut.m4a Download One Comment Tags: Alcohol Withdrawal, Phenobarbital, Toxicology Show Notes References Riggan MA et al. Regarding “Phenobarbital for acute alcohol withdrawal: a prospective randomized double-blind placebo controlled study.” J Emerg Med 2016; 50 (6): 895-8. PMID: 27221017 Rosenson J et al. Phenobarbital for acute alcohol withdrawal: a prospective randomized double-blind placebo controlled study. J Emerg Med 2013; 44(3): 592-8. PMID: 2299978 Read More

This week we discuss pearls from a talk from Reuben Strayer on sedation of the agitated patient focusing on patient and staff safety. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_56_0_Final_Cut.m4a Download 3 Comments Tags: Agitation, Droperidol, Excited Delirium, Haloperidol, Lorazepam, Midazolam Show Notes

This week we dive into the PATCH trial investigating the role of platelet transfusions in patients with spontaneous ICH on antiplatelet meds https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_55_0_Final_Cut.m4a Download Leave a Comment Tags: Intracerebral Hemorrhage, PATCH Trial, Platelets Show Notes Read More REBEL EM: The PATCH Trial: Hold the Platelets in Spontaneous Intracerebral Hemorrhage? St. Emlyn’s: JC – Platelets for Intracranial Haemorrhage EM Lit of Note: Put the Platelets Away in ICH References Baharoglu MI et al.

This week we discuss some of the critical issues in preparation, preoxygenation and positioning in RSI. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_54_0_Final_Cut.m4a Download Leave a Comment Tags: 7 Ps, High-flow Nasal Cannula, Intubation, Preoxygenation, RSI Show Notes Read More EM Updates: Intubation Checklist Core EM: Episode 4.0 – Perimortem C-section, Procedural Sedation and Airway Pearls Core EM: Episode 6.0 – Airway Workshops Sales JC et al. The Importance of First Pass Success When Performing Orotracheal Intubation in the Emergency Department. Acad Emerg Med 2013; 20(1): 71-8. PMID: 23574475

This week we discuss a recent study published in the NEJM on low-dose tPA vs standard-dose in acute ischemic stroke. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_53_0_Final_Cut.m4a Download Leave a Comment Tags: Alteplast, CVA, Ischemic Stroke, The ENCHANTED Trial, tPA Show Notes Read More Anderson CS et al. Low-dose versus standard-dose intravenous alteplase in acute ischemic stroke. NEJM 2016. PMID: 27161018 EMNerd: The Case of the Non-Inferior Inferiority Continues REBEL EM: The ENCHANTED Trial: Is Low-Dose the Right Dose for Intravenous tPA in Acute Ischemic Stroke? EMCrit: Podcast 116 – the tPA for Ischemic Stroke Debate EMNerd: A Secondary Examination of the Adventure of the Cardboard Box SMART EM: Thrombolytics for Acute Stroke