Core EM - Emergency Medicine Podcast

This week we dive into some advanced topics in RSI including patient positioning and pre-intubation resuscitation. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_110_0_Final_Cut.m4a Download One Comment Show Notes Take Home Points Bed up head elevated position for intubation may reduce intubation related complications. Patients who are hypotensive or at risk of hypotension should be aggressively resuscitation prior to intubation with fluids and liberal use of pressors Shock patients would be intubated with decreased induction agent dose, preferably ketamine, and increased paralytic dose. Bed-Up-Head-Elevated Positioning Show Notes EMCrit: Podcast 104 – Laryngosocpe as a Murger Weapon (LAMW) Series – Hemodynamic Kills Life in the Fastlane: Intubation, hypotension and shock Core EM: Bed Up Head Elevated Position for Airway Management Video REBEL EM: Critical Care Updates: Resuscitation Sequence Intubation – Hypotension Kills (Part 1 of 3) ALiEM: The Dirty Epi Drip: IV Epinephrine When You Need It emDocs: Roc Rocks and Sux Sucks! Why Rocuronium is the Agent of Choice for RSI Swaminathan A, Mallemat H. Rocuronium Should Be the Default Paralytic in Rapid Sequence Intubation. Ann Emerg Med 2017. PMID: 28601274 Khandelwal N et al. Head-Elevated Patient Positioning Decreases Complications of Emergent Tracheal Intubation in the Ward and Intensive Care Unit. Anesth Analg 2016; 122(4): 1101-7. PMID: 26866753 Read More

This week we discuss some quick pearls from our conference covering an array of renal and GU pathologies. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_109_0_Final_Cut.m4a Download Leave a Comment Tags: GU, Renal, Urology Show Notes Read More Core EM: Testicular Torsion Core EM: Podcast Episode 92.0 – Dialysis Emergencies Al Sacchetti: ED Repair of Bleeding Dialysis Shunt EM: RAP: Episode 107 – Dialysis Emergencies EMBlog Mayo Clinic: How to Stop a Post-Dialysis Site Bleeding emDocs: Managing Fistula Complications in the Emergency Department References Mellick LB. Torsion of the testicle: It is time to stopping tossing the dice. Pediatric Emer Care 2012; 28: 80-6. PMID: 22217895 Read More

Should we intubate patients in cardiac arrest? We discuss this topic and some basics of running a good arrest. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_108_0_Final_Cut.m4a Download Leave a Comment Tags: Advanced Airway Management, Cardiac Arrest, Critical Care, Resuscitation Show Notes Take Home Points Intra-arrest intubation does not appear to improve outcomes. For most patients, support with BVM, or possibly an LMA, is adequate. Instead of securing an advanced airway, focus on the two things that clearly make a difference in outcomes – good compressions and defibirillation Good compressions should be fast and hard and you must minimize interruptions in compressions to minimize interruptions in perfusion Don’t forget that a great resuscitation requires great preparation. Take whatever time you have to discuss with your team and assign roles. Read More Rebel EM: In-hospital Cardiac Arrest – The First 15 Minues Core EM: Proper Defibrillator Pad Placement + Dual Sequential Defibrillation REBEL EM: Beyond ACLS: Cognitively Offloading During a Cardiac Arrest REBEL EM: Beyond ACLS: POCUS in Cardiac Arrest REBEL EM: Beyond ACLS: CPR, Defibrillation and Epinephrine REBEL EM: Beyond ACLS: Pre-Charging the Defibrillator Read More

Prompted by the recent CAMEO trial publication on icatibant, we dive into angioedema with a focus on airway management. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_107_0_Final_Cut.m4a Download Leave a Comment Tags: ACE Inhibitors, Allergy/Immunology, Angioedema, Icatibant Show Notes Take Home Points Airway management is paramount, expect a challenging intubation and consider controlling the airway early When controlling the airway, consider an awake approach and fiberoptics if available. Always be prepared for the can’t intubate, can’t oxygenate scenario with a double set up. If the patient has urticaria and pruritus, the process is likely histamine mediated and will respond to typical anaphylaxis treatment Finally, observe the patient for progression of swelling and don’t forget to stop the inciting medication Read More Core EM: Angioedema EMCrit: Podcast 145 – Awake Intubation Lecture from SMACC ERCast: Angioedema REBEL EM: Icatibant Doesn’t Improve Outcomes in ACE-I Induced Angioedema The SGEM: Icatibant Bites the Dust – For ACE-I Induced Angioedema Read More

This week we drop into some of the nitty gritty on PSA including preparation and patient assessment as well as discuss some common pitfalls. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_106_0_Final_Cut.m4a Download Leave a Comment Tags: Pitfalls, Procedural Sedation, PSA Show Notes Take Home Points Always perform a full pre-PSA evaluation including an airway assessment. Time of last meal shouldn’t delay your sedation based on the best available evidence. Always do a complete setup including consideration of different agents, dosage calculations, preparation of airway equipment and reversal agents. PSA serious adverse events are rare but you still must be prepared for them. Careful agent selection and dosing can help prevent issues but, know your outs. If apnea develops, do some basic maneuvers before you reach for the BVM or laryngoscope. Remember OOPS as in “oops, my patient went apneic.” Oxygen on, pull the mandible forward and sit the patient up. This fixes most issues Show Notes Core EM: Procedural Sedation and Analgesia Resources EM Updates:Emergency Department Procedural Sedation Checklist v2 REBEL EM: Complications of Procedural Sedation Bellolio MF et al. Incidence of adverse events in adults undergoing procedural sedation in the emergency department: a systematic review and meta-analysis. Acad Emerg Med 2016; 23: 119-34. PMID: 26801209 Read More

This week we dissect a JAMA article on the whether it's necessary to add TMP-SMX to cephalexin in the treatment of uncomplicated cellulitis https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_105_0_Final_Cut.m4a Download Leave a Comment Tags: Cellulitis, IDSA, Infectious Diseases, MRSA Show Notes SSTI Flow Diagram (Stevens 2014) EM Lit of Note: Double Coverage, Cellulitis Edition Pharm ER Tox Guy: Uncomplicated Cellulitis? Consider Strep-Only Coverage Core EM: Cellulitis Stevens DL et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis 2014; 59(2): e10-52. PMID: 24973422 Read More

This week we dive into the various common agents used in procedural sedation and analgesia in the ED. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_104_0_Final_Cut.m4a Download 2 Comments Tags: Anesthesia, Critical Care, Procedural Sedation, PSA Show Notes Show Notes Core EM : Parenteral Benzodiazepines Core EM: Procedural Sedation and Analgesia Resources EM Updates: Ketamine Brain Continuum First 10 EM: Managing laryngospasm in the emergency department Read More

This week we talk about priapism focusing on emergency department management. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_103_0_Final_Cut.m4a Download One Comment Tags: GU, Priapism, Urology Show Notes Read More Dr. Mutara Jubara: Ultrasound Guided Dorsal Penile Nerve Block McCollough M, Sharieff GQ: Genitourinary and Renal Tract Disorders; in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2014, (Ch) 174: p 2205-2223. Davis JE, Silverman MA. Urologic Procedures; in Roberts JR: Roberts and Hedges’ Clinical Procedures in Emergency Medicine, ed 6. 2014, (Ch) 55: p 1113-1154 Govier FE et al. Oral terbutaline for the treatment of priapism. J Urol 1994;151: 878-9. PMID: 8126815 Priyadarshi S. Oral terbutaline in the management of pharmacologically induced prolonged erection. Int J Impot Res. 2004;16:424-426. PMID: 14999218 Read More

This week we welcome Andy Little onto the show to discuss the modified Valsalva maneuver for breaking SVT. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_102_0-AVNRT_Final_Cut.m4a Download Leave a Comment Tags: Adenosine, AVNRT, Cardiology, SVT, Tachydysrhythmia Show Notes Read More Rebel EM: The REVERT Trial – A Modified Valsalva Maneuver to Convert SVT SGEM: This is a SVT and I’m Gonna Revert It Using a Modified Valsalva Manoeuvre Appelboam A et al. Postural Modification to the Standard Valsalva Manoeuvre for Emergency Treatment of Supraventricular Tachycardias (REVERT): A Randomised Controlled Trial. Lancet 2015. PMID: 26314489 Read More

This week we dive into some of the initial considerations in the resuscitation of major burn patients. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_101_0_Final_Cut.m4a Download Leave a Comment Tags: Carbon Monoxide, Cyanide, Major Burns, Trauma Show Notes Take Home Points Be prepared to intubate early, the patency of the airway can decline quickly and without warning. If there is any concern for burns to face/neck or smoke inhalation, consider taking control of the airway early. Review the rule of 9s and the parkland formula to direct your large volume fluid resus.  Remember the parkland formula directs you to use 4 mL x %TBSA x weight (kg).  Half in the first 8 hours and the second half over the next 16 hours.  Given the large volume here it’s probably best to use LR or another balanced solution. Do a thorough trauma eval to make sure you don’t miss any other injuries and be sure to watch for developing compartment syndrome And last, consider the need to treat for CO and/or cyanide poisoning.  Poor cardiac function, cardiac arrest or a high lactate can be clues to cyanide poisoning and just start 100% O2 while you wait for a co-ox, since CO tox is pretty likely. Rule of 9’s Read More MD Calc: Parkland Formula for Burns LITFL: Trauma! Major Burns LITFL: Releasing the Roman Breast Plate Parvizi D et al. The potential impact of wrong TBSA estimations on fluid resuscitation in patients suffering from burns: things to keep in mind. Burns 2014; 40: 241-5. PMID: 24050977 Hettiaratchy S, Dziewulski P. ABC of Burns: Introduction. BMJ 2004; 328: 1366-8. PMID: 15178618 Hettiaratchy S, Papini R. ABC of Burns: Initial Management of a Major Burn: I – Overview. BMJ 2004; 328: 1555-7. PMID: 15217876 Hettiaratchy S, Papini R. ABC of Burns: Initial Management of a Major Burn II – Assessment and Resuscitation . BMJ 2004; 329: 101-3. PMID: 15242917 Read More