Core EM - Emergency Medicine Podcast

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.

Delve into the world of Immune Checkpoint Inhibitors (ICIs) and discover how these innovative drugs revolutionize cancer treatment by enhancing the immune system's ability to attack cancer cells. Learn about the significant risks associated with ICIs, including autoimmune reactions that can present like infections. The discussion highlights the challenges emergency departments face in diagnosing and managing side effects such as pneumonitis and endocrinopathies. Effective strategies for early intervention are also explored, emphasizing collaboration with oncology teams for optimal care.

Explore the critical evaluation of pediatric ataxia through the lens of a troubling case involving an 18-month-old boy. Discover the common and rare causes of ataxia, like acute cerebellar ataxia and Guillain-Barre syndrome. Dive into the significance of history-taking and physical exams in diagnosis. Learn about essential diagnostic tests, including neuroimaging, and treatment strategies centered on identifying underlying conditions. It's a masterclass in pediatric emergency medicine and the art of thorough assessment.

Delve into hypernatremia, defined as elevated serum sodium levels over 145 mEq/L, and its wide-ranging symptoms from nausea to coma. Discover the risk factors and diagnostic prerequisites essential for vulnerable patients. Explore management strategies that consider the type and duration of hypernatremia, while avoiding the dangers of overcorrection. Learn practical advice on fluid administration and monitoring practices to ensure safe treatment in emergency scenarios.

Explore the challenges of recognizing and managing acute agitation in emergency medicine. Discuss terminology shift and multifactorial causes of agitation. Learn about assessing severity, pharmacologic management, and tailored interventions for specific patient populations.