Core EM - Emergency Medicine Podcast

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.

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 Download 3 Comments 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 Read More

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.

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 Download Leave a Comment 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 Read More

This week we dive into acute rhinosinusitis focusing on diagnosis and discussing the absence of utility for antibiotics in most patients. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_90_0_Final_Cut.m4a Download Leave a Comment Tags: ENT, Rhinosinusitis, Sinusitis, URI Show Notes Take Home Points Sinusitis is a clinical diagnosis. Patients typically present with purulent nasal discharge and facial pain or other URI symptoms. The vast majority of patients with acute rhino sinusitis will be viral in nature and will not benefit from antibiotics Patients with prolonged symptoms, more than 7-10 days, without improvement or continued fevers past 2-3 days should be considered for antibiotic treatment as should those who are immunocompromised. Show Notes Melio FR, Berge LR. Upper Respiratory Tract Infections, 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) 75: p 965-79. The NNT: Antibiotics for Clinically Diagnosed Acute Sinusitis in Adults The NNT: Antibiotics for Radiologically-Diagnosed Acute Maxillary Sinusitis Lemiengre MB et al. Antibiotics for clinically diagnosed acute rhinosinusitis in adults. Cochrane Database Syst Rev. 2012. PMID: 23076918 Ahovuo-Saloranta A et al. Antibiotics for acute maxillary sinusitis. Cochrane Database Syst Rev. 2008. PMID: 18425861 Read More

This discussion dives into the management of nosebleeds, focusing on both anterior and posterior types. Solid pressure is emphasized as the first step in treatment. Intriguing techniques are shared, including the use of oxymetazoline and lidocaine for packing. Topical tranexamic acid emerges as a notable option for persistent cases. The podcast also covers effective nasal packing methods and addresses the use of Foley catheters for brisk bleeds. Listeners will gain valuable insights into the art of stopping the flow!

This week, we review a simplified approach to determining the rhythm on an EKG with a tachydysrhythmia. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_88_0_Final_Cut.m4a Download One Comment Tags: Atrial Fibrillation, AVNRT, SVT, Tachycardias, Tachydysrhythias, Ventricular Tachycardia Show Notes Take Home Points When looking at a tachy rhythm that isn’t sinus tach, quickly differentiate by determining if the QRS complexes is narrow or wide and then determine if the rhythm is regular or irregular. This approach quickly drops the rhythm into 1 of 4 boxes and makes rhythm determination much easier Each of those 4 categories has a small set of rhythms included. Narrow and irregular – AF, Aflutter with variable block or MFAT. Narrow and regular – SVT or Aflutter. Wide and irregular – Torsades, VF, AF with aberrancy or a BBB. Wide and regular – VTach, SVT with aberrancy or SVT with a BBB. If you see wide and regular, the top 3 diagnoses are VT, VT and VT. Assuming VT and treating for that will almost never send you astray Read More EM: RAP: Episode 84 – Tachycardia Core EM: A Simplified Approach to Tachydysrhythmias Core EM: Atrioventricular Nodal Reentry Tachycardia Core EM: Ventricular Tachycardia Core EM: Recent-Onset Atrial Fibrillation Simplified Approach to Tachydysrhythmias Diagnosis Tachydysrhythmias Therapeutic Algorithm Torsades de Pointes Torsades de Pointes Read More

This week we discuss two recent journal articles - the POKER trial and the ketorlac analgesic ceiling https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_87_0_Final_Cut.m4a Download Leave a Comment Tags: Ketamine, Ketofol, ketorlac, POKER, Propofol, PSA Show Notes Take Home Points The POKER trial examined the difference between propofol and ketofol when it comes to adverse respiratory events.  They found no significant difference between the groups.  Given the increased risk of medication errors using two medication instead of one, you may want to avoid the mixture. Ketorolac has an analgesic ceiling effect lower than you may have thought.  When comparing IV doses of 10mg, 15mg and 30mg they found no difference in analgesic effect.  Given the risks of side effects may increase with higher doses, you may want to stick to the lower 10mg dose. RebelEM: The POKER Trial: Go All in on Ketofol? St. Emlyn’s: JC: Is Ketofol with the hassle? Core EM: Propofol vs. Ketofol in PSA EM: RAP: Just Enough Ketorlac RebelEM: The Ketorolac Analgesic Ceiling Core EM: Parenteral Ketorlac Dosing Propofol or Ketofol for Procedural Sedation and Analgesia in Emergency Medicine-The POKER Study: A Randomized Double-Blind Clinical Trial. PubMed ID: 27460905 Comparison of Intravenous Ketorolac at Three Single-Dose Regimens for Treating Acute Pain in the Emergency Department: A Randomized Controlled Trial. PubMed ID: 27993418 Read More

Do patients with 1st trimester bleeding need to get anti-D immunoglobulin if they're Rh negative? We dive into the topic this week. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_86_0_Final_Cut.m4a Download Leave a Comment Tags: Early Pregnancy, Obstetrics, RhoGam, Vaginal Bleeding Show Notes Take Home Points An Rh negative woman can become alloimmunized to Rh antigen if exposed to blood from an Rh positive fetus. Theoretically, this alloimmunization can occur even in early pregnancy While anti-D immune globulin has clearly been shown to be beneficial in preventing alloimmunization in 2nd and 3rd trimester pregnancy, there is no evidence supporting use specifically in the 1st trimester Despite the absence of evidence, RhoGam administration has become routine in many places. At this time, it’s advisable to follow local practice patterns regarding which patients should be given RhoGam. References ACOG Practice Bulletin. Prevention of Rh D Alloimmunization. Int J Gynaecol Obstet 1999; 66(1): 63-70. PMID: 10458556 Recommendations reaffirmed in 2016 Hahn SA et al. Clinical Policy: Critical Issues in the Initial Ealuation and Management of Patients Presenting to the Emergency Department in Early Pregnancy. Ann Emerg Med 2012; 60(3): 381-419. PMID: 22921048 Hannafin B et al. Do Rh-Negative Women with First Trimester Spontaneous Abortions Need Rh Immune Globulin. Am J Emerg Med 2006; 24: 487-9. PMID: 16787810 Visscher RD, Visscher HC. Do Rh-Negative Women with an Early Spontaneous Abortion Need Rh Immune Prophylaxis? Am J Obstet Gynecol 1972; 113(2): 158-65. PMID: 4623673 Read More

This discussion dives into three critical delivery complications: cord prolapse, nuchal cord, and shoulder dystocia. For cord prolapse, elevate the presenting part and prepare for an urgent c-section. Nuchal cords are common and typically manageable, but shoulder dystocia is a serious emergency requiring quick action. Techniques like the McRoberts maneuver and having an OR on standby can be lifesavers. The hosts emphasize the need for preparedness in these high-stakes situations—every second counts!