Core EM - Emergency Medicine Podcast

In this discussion, Anne Levine, a former chief resident and now a simulation fellow, teams up with Brian Gilberti to delve into the complexities of capacity assessment in emergency departments. They highlight the balance between patient autonomy and the ethical need for safety. Real-world examples, like intoxicated patients and those facing serious health decisions, showcase the nuanced decision-making involved. The conversation also unpacks the vital pillars of capacity assessment and the legal ramifications of failing to properly evaluate a patient's decision-making capability.

Join Sadakat Chowdhury, an emergency medicine physician specializing in ARDS and trauma, as he uncovers the urgent complexities of blast crisis in chronic myeloid leukemia. Discover the critical symptoms stemming from pancytopenia and leukostasis, impacting multiple systems from neurological to cardiopulmonary. Chowdhury discusses key management strategies in emergency care and navigates the ethical dilemmas that arise, emphasizing the balance between aggressive treatment and patient autonomy. A must-listen for insights into this oncologic emergency!

Ula Hwang, a full professor at NYU and a trailblazer in geriatric emergency medicine, discusses the growing importance of specialized emergency care for older adults. She highlights the unique challenges faced by these patients, such as polypharmacy and functional decline. The conversation delves into essential screening tools to identify at-risk seniors and emphasizes customized care strategies. Ula also covers the need for multidisciplinary teams in emergency settings to ensure safe transitions and optimal outcomes for geriatric patients.

Smoke inhalation injuries can lead to serious complications, including airway obstruction from thermal injury. Key symptoms to watch for include facial burns and altered mental status. Carbon monoxide toxicity is a critical concern, requiring immediate oxygen treatment and potential hyperbaric therapy. Cyanide poisoning poses a lethal risk, affecting cellular respiration, but can be countered with hydroxocobalamin. Quick recognition and targeted interventions are crucial for effective management.

Benjamin Friedman, a full professor in emergency medicine at Montefiore, specializes in headache and back pain management. He dives into the complexities of evaluating acute back pain, emphasizing the need to differentiate benign pain from serious pathology. The discussion covers effective imaging guidelines, the cautious use of NSAIDs and muscle relaxants, and the innovative use of ultrasound in assessments. Friedman shares insights on managing acute pain in emergency settings, highlighting the importance of personalized treatment strategies.

The discussion centers on the significant impact of allowing family members during resuscitations. Historically, this practice gained traction in 1987 but remains inconsistent in pediatrics. It tackles common myths like the interference of families during procedures and potential legal repercussions, revealing that studies show minimal disruption. Notably, evidence suggests that family presence can help mitigate PTSD symptoms and enhance the grieving process, advocating for a more inclusive approach in emergency medicine.

This discussion dives into the critical aspects of necrotizing fasciitis, a severe and rapidly progressive infection. Learn about the different types, including polymicrobial and monomicrobial forms, and specific challenges like Fournier’s gangrene. The hosts emphasize the importance of early detection and prompt surgical intervention to improve outcomes. They break down risk factors and clinical presentations, making it clear how quickly this condition can escalate. Insights on treatment and recovery highlight the need for vigilance in emergency care.

Marlis Gnirke, a toxicologist and assistant professor at NYU Bellevue, dives deep into the complexities of acetaminophen toxicity. She highlights the surprising presence of acetaminophen in various over-the-counter products, leading to unintentional overdoses. Gnirke discusses the formation of the toxic metabolite NAPQI and its devastating effects on the liver. The conversation also touches on the pivotal role of N-acetylcysteine (NAC) as an antidote and introduces the Rumack-Matthew Nomogram for effective treatment planning.

Avir Mitra, an associate professor of emergency medicine and seasoned podcaster, dives into the world of sexually transmitted infections, shedding light on the latest in diagnosis and treatment. The conversation highlights the prevalence and complications of chlamydia, emphasizing the need for accurate testing across different anatomical sites. They also discuss the complexities of syphilis, including its stages and the importance of early detection. Additionally, Mitra addresses emerging STIs like mycoplasma genitalium and updates on treatment protocols for gonorrhea and HIV.

Benjamin Friedman, a full professor in emergency medicine at Montefiore, shares his extensive expertise on migraines. He discusses how to differentiate between primary headaches and secondary causes, emphasizing the importance of thorough patient history. Friedman highlights effective acute treatments, such as anti-dopaminergic medications and nerve blocks, while cautioning against common misconceptions about medications like diphenhydramine. He also covers strategies for managing refractory migraines and the need for effective post-discharge care to prevent recurrences.