
Core EM - Emergency Medicine Podcast
Core EM Emergency Medicine Podcast
Latest episodes

Jun 5, 2017 • 0sec
Episode 100.0 – Our 100th Episode!
It's been 2 years and 100 podcasts. Jenny and Swami take a minute to talk about the Core EM project and our future directions.
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_100_0_Final_Cut.m4a
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May 29, 2017 • 0sec
Episode 99.0 – Journal Update
This week we discuss 3 articles recently reviewed in our conference - LOV-ED study, Validation of Step-By-Step and Therapeutic Hypothermia.
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_99_0_Final_Cut.m4a
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Tags: ARDS, Cardiac Arrest, Lung Protective Ventilation, Mechanical Ventilation, OHCA, Step-By-Step Protocol, Therapeutic Hypothermia, TTM
Show Notes
Take Home Points
The step-by-step approach to managing febrile infants is a reliable decision instrument to identify patients at low risk for invasive bacterial infections. Caution in the group of patients 22-28 days of age.
The LOV-ED study shows an association between employing a lung-protective ventilation strategy in the ED and decreased complications from mechanical ventilation. Best available evidence says that we should embrace this approach in the ED.
Cooling to 33 degrees is no better than cooling to 36 degrees. However, shooting 36 degrees is more difficult than we may have thought. We have to continue to be vigilant about maintaining patients in the target temperature range and avoiding fever.
The Step-By-Step Algorithm
Lung-Protective Ventilation Protocol (LOV-ED Study)
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The SGEM: SGEM #171: Step-by-Step Approach to the Febrile Infant
REBEL EM: The Benefit of Lung Protective Ventilation in the ED Should Be LOV-ED
Taming the SRU: A Crack in the Ice? An In-Depth Breakdown of the TTM Trial
References
Gomez B et al. Validation of the Step-by-Step Approach in the Management of Young Febrile Infants. Pediatrics. 2016 Aug. PMID: 27382134
Fuller BM et al. Lung-Protective Ventilation Initiated in the Emergency Department (LOV-ED): A Quasi-Experimental, Before-After Trial. Ann Emerg Med 2017. PMID: 28259481
Bray JE et al. Changing target temperature from 33oC to 36oC in the ICU management of out-of-hospital cardiac arrest: a before and after study. Resuscitation 2017; 113: 39-43. PMID: 28159575
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May 22, 2017 • 0sec
Episode 98.0 – Cardioversion in Recent Onset AF
This week we delve into the argument for cardioversion in recent-onset AF as well as the logistics of getting it done.
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_98_0_Final_Cut.m4a
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Tags: Atrial Fibrillation, Atrial Flutter, Cardiology, Cardioversion
Show Notes
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Core EM: Podcast 64.0 – Rate Control in AF
Core EM: Recent Onset Atrial Fibrillation
Core EM: 30-Day Outcomes After Aggressive AF Management in the ED
The SGEM: SGEM#88: Shock Through the Heart (Ottawa Aggressive Atrial Fibrillation Protocol
References
Nuito I et al. Time to cardioversion for acute atrial fibrillation and thromboembolic complications. JAMA 2014; 312(6): 647-9. PMID: 25117135
Stiell IG et al. Association of the Ottawa aggressive protocol with rapid discharge of emergency department patients with recent-onset atrial fibrillation and flutter. Can J Emerg Med 2010; 12(3): 181-91. PMID: 20522282
Stiell IG et al. Outcomes for Emergency Department Patients with Recent-Onset Atrial Fibrillation and Flutter Treated in Canadian Hospitals. Ann Emerg Med 2017. PMID: 28110987
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May 15, 2017 • 0sec
Episode 97.0 – Methemoglobinemia
This week we discuss the rare but life-threatening methemoglobinemia with a focus on recognition and use of the antidote.
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_97_0_Final_Cut.m4a
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Tags: Methemoglobin, Toxicology
Show Notes
Take Home Points
MetHb –emia occurs as a results of various medications including amyl nitrite, dapsone, nitroprusside, phenazopyridine, sodium nitrite and topical anesthetics like benzocaine
Patients will present with cyanosis, short of breath, fatigue, dizziness, weakness and ultimately CNS depression and death at higher concentrations.
If you have a cyanotic/hypoxic patient that does not respond to supplemental oxygen, be concerned for MetHb and send a co-oximetry panel.
If the level is <25% and the patient is asymptomatic you can observe, but if the level is >25% or the patient is symptomatic, you will treat with the antidote methylene blue given as a bolus of 1-2 mg/kg over 5 minutes
And as always, make sure to call your local poison center to get your toxicologists involved. They can help with dosing, and they are also an important player of the public health component in cases such as these, to make sure this is an isolated incident and we don’t have a repeat of the 11 blue men situation.
Price DP. Chapter 127. Methemoglobin Inducers. In: Nelson LS, Lewin NA, Howland M, Hoffman RS, Goldfrank LR, Flomenbaum NE. eds. Goldfrank’s Toxicologic Emergencies, 9e New York, NY: McGraw-Hill; 2011. Accessed April 19, 2017.
Methemoglobinemia Signs and Symptoms
Methemoglobinemia Treatment
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May 8, 2017 • 0sec
Episode 96.0 – Carbon Monoxide Poisoning
This week we do a brief review on recognizing CO monoxide poisoning and expertly managing it.
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_96_0_Final_Cut.m4a
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Tags: CO, Inhaled Toxins, Toxicology
Show Notes
Take Home Points
CO poisoning happens most often from common are accidental exposures from faulty home heaters, camp stoves and indoor use of gas powered generators, structure fires and intentional exposure like in suicide attempts.
Patients with a mild exposure will present with symptoms like headache, nausea, vomiting, dizziness, vision blurring, palpitations, confusion or myalgias. More severe exposures may produce Altered mental status. seizures, coma, dysrythmias, myocardial ischemia, metabolic acidosis, syncope and vital sign abnormalities including hypotension and, eventually, cardiac arrest.
To help distinguish the vague symptoms of a patient who may have chronic exposure ask about things like whether symptoms improve in different environments or whether they have sick pets, as human viral illness generally don’t affect our dogs and cats.
If you’re concerned about CO send a co-ox panel. City dwellers may have a baseline carboxyhemoglobin of 1-2% and smokers around 6-10% but others should really have no carboxyhemoglobin.
Treatment is supplemental O2 which can be stopped when symptoms improve. For severe symptoms and for pregnant patients, consider hyperbarics to prevent long term sequelae and to protect the fetus. As always, consider discussing the case with your local poison center to help decide whether a patient warrants transfer for hyperbarics.
LITFL: Carbon Monoxide Poisoning
EMCrit: Podcast 122 – Cardiac Arrest after the Toxicology of Smoke Inhalation with Lewis Nelson
FOAMcast: Episode #1: EMCrit Episode #122 – Cyanide and Carbon Monoxide Toxicity
Nelson LS, Hoffman RS: Inhaled Toxins, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2010, (Ch) 159: p 2036-2045.
Tomaszewski C. Chapter 125. Carbon Monoxide. In: Nelson LS, Lewin NA, Howland M, Hoffman RS, Goldfrank LR, Flomenbaum NE. eds. Goldfrank’s Toxicologic Emergencies, 9e New York, NY: McGraw-Hill; 2011. Accessed April 19, 2017.
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May 1, 2017 • 0sec
Episode 95.0 – Local Anesthetic Systemic Toxicity (LAST)
This week we discuss the identification, prevention and treatment of local anesthetic systemic toxicity.
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_95_0_Final_Cut.m4a
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Tags: Antidote, Bupivicaine, Intralipid, Lidocaine, Toxicology
Show Notes
LITFL: Local Anesthetic Toxicity
Wiki EM: Local Anesthetic Systemic Toxicity
References:
Schwartz DR, Kaufman B. Local Anesthetics. In: Hoffman RS, Howland M, Lewin NA, Nelson LS, Goldfrank LR. eds. Goldfrank’s Toxicologic Emergencies, 10e New York, NY: McGraw-Hill; 2015. Link
Neal JM et al, American Society of Regional Anesthesia and Pain Medicine. American Society of Regional Anesthesia and Pain Medicine checklist for managing local anesthetic systemic toxicity: 2012 version. Reg Anesth Pain Med 2012;37:16–8. PMID: 22189574
Cao D et al. Intravenous lipid emulsion in the emergency department: a systematic review. J Emerg Med 2015; 48(3): 387-97. PMID: 25534900
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Apr 24, 2017 • 0sec
Episode 94.0 – Mammal Bites
Discover the ins and outs of mammal bites—from dogs to humans. Learn about the critical aspects of wound closure and effective antibiotic use. The dangers of rabies exposure are discussed, emphasizing tailored medical responses. Misconceptions around dog bite severity and treatment are debunked, providing clarity on wound management. Get insights into unique cases involving cat and bat bites, plus essential tips for recognizing deeper medical issues behind various bite patterns.

Apr 17, 2017 • 0sec
Episode 93.0 – Meningitis
This week we cover a workshop from our conference on CNS infections focusing on meningitis.
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_93_0_Final_Cut.m4a
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Tags: Bacterial Meningitis, CNS Infections, Infectious Diseases, Meningitis, Neurology
Show Notes
CSF Analysis (LITFL)
EM Lyceum: Viral Meningitis “Answers”
EM RAP: Meningitis
LITFL: Bacterial Meningitis
LITFL: CSF Analysis
The NNT: Glucocorticoid Steroids for Bacterial Meningitis
References
Attia J et al. Does this adult patient have acute meningitis. JAMA 1999; 281(2): 175-81. PMID: 10411200
Brouwer MC et al. Corticosteroids for acute bacterial meningitis (review). Cochrane Database Syst Rev 2015. PMID: 26362566
Cooper DD, Seupaul RA. Is adjunctive dexamethasone beneficial in patients with bacterial meningitis? Ann Emerg Med 2012; 59(3): 225-6. PMID: 22088494
de Gans J et al. Dexamethasone in adults with bacterial meningitis. NEJM 2012; 347(20): 1549-57. PMID: 12432041
Hasbun R et al. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. NEJM 2001; 345(24): 1727-34. PMID: 11742046
Sakushima K et al. Diagnostic accuracy of cerebrospinal fluid lactate for differentiating bacterial meningitis from aseptic meningitis: a meta-analysis. J Infection 2011; 62: 255-62. PMID: 21382412
Tunkel AR et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004; 39: 1267-84. PMID: 15494903
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Apr 10, 2017 • 0sec
Episode 92.0 – Dialysis Emegencies
This discussion dives into urgent dialysis-related emergencies encountered in the ED. It highlights the critical assessment of dialysis access sites, emphasizing detection of complications. Bleeding management techniques for dialysis fistulas are shared, along with essential strategies for addressing bacterial peritonitis in patients. The conversation also sheds light on dialysis disequilibrium syndrome, detailing its symptoms and initial treatment approaches. Overall, it's a must-listen for emergency professionals tackling these complex cases.

Apr 3, 2017 • 0sec
Episode 91.0 – Journal Update – AKI + IV Contrast
This week we discuss a recent article in Annals of EM on contrast induced nephropathy and whether the phenomena is real or dogma.
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_91_0_Final_Cut.m4a
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Tags: AKI, CIN, Contrast Induced Nephropathy, Journal Update
Show Notes
ACR Table on CIN – FOAMCast
FOAMCast: Episode 65 – Contrast Induced Nephropathy and Genitourinary Trauma
REBEL EM: Contrast Induced Nephropahty: Fact or Myth
Core EM: Acute Kidney Injury is not Associated with IV Contrast Use in the ED
EM Lit of Note: Punching Holes in CIN
EMCrit: Do CT Scans Cause Contrast Nephrophathy?
EM Lit of Note: Punching Holes in CIN
EM Docs: Contrast-Induced Nephropathy – Confounding Causation
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