Core EM - Emergency Medicine Podcast

This week we discuss Lisfranc injuries with a focus on a diagnostic pathway and management. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_76_0_Final_Cut.m4a Download Leave a Comment Tags: Lisfranc Fracture, Lisfranc Injury, Orthopedics, Trauma Show Notes Take Home Points A Lisfranc injury is a midfoot injury that results in displacement of one or more of the metatarsal bones from tarsus.  XR will show widening of the space between the 1st and 2nd metatarsals. Getting contralateral XR may help you identify this. Even if you don’t see that widening on the XR, the patient could still have a Lisfranc injury. If they cannot walk due to pain, get a weight bearing XR or CT scan to look further. Once the injury is identified, the patient must be strict non-weightbearing. Place them in a posterior splint and get orthopedics involved either in the ED or for prompt follow up as the patient will probably need surgery. Foot Bones (Google Images) Normal Foot X-ray Series (Case courtesy of Dr Andrew Dixon, Radiopaedia.org. From the case rID: 36688) Lisfranc Injury AP X-ray (Radiopaedia Image #1: Case courtesy of Dr Alexandra Stanislavsky, Radiopaedia.org. From the case rID: 10919) Divergent Lisfranc Injury Read More LITFL: Eponymous Fractures Radiopaedia: Lisfranc Injury Core EM: Compartment Syndrome Read More

Explore the complexities of adrenal insufficiency and learn key management techniques that involve both volume expansion and steroid use. Discover the vital principles of fluid resuscitation and the importance of assessing fluid responsiveness, particularly in critical care settings. Delve into the risks associated with fluid management, emphasizing careful approaches to avoid the pitfalls of aggressive resuscitation strategies. This insightful discussion is packed with relevant guidelines and practical applications for improving patient outcomes.

This week we review some pearls in the diagnosis and management of acid reflux. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_74_0_GERD_Final_Cut.m4a Download Leave a Comment Tags: Acid Reflux, Gastrointestinal, GERD, GI Show Notes Take Home Points GERD pain can mimic or co-exist with the more deadly causes of chest pain.  Be sure to consider all the serious causes of chest pain, get an EKG and maybe a chest XR while you go about symptom management. Respond to a treatment doesn’t prove a diagnosis.  GERD pain may get better with nitro and ACS pain may get better with a GI cocktail.  Keep an open mind while seeing these patients. Standard treatment for GERD includes an antacid and H2 blocker and maybe a PPI.  Keep in mind that a PPI takes a while to work, so be sure to give something faster acting in the ED And last, for these patients, take those few extra minutes for some counseling on lifestyle modifications.  All medications come with side effects, so be sure to address things like diet, smoking and weight loss while you have a captive audience. Read More

This week we dive into the controversies surrounding the PESIT study looking at the prevalence of PE in admitted patients with syncope https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_73_0_Final_Cut.m4a Download Leave a Comment Tags: Cardiovascular, Journal Club, PE, Pulmonary, Pulmonary Embolism, Syncope Show Notes Read More EMLit of Note: The Impending Pulmonary Embolism Apocolypse St. Emlyn’s: JC – Prevelance of PE in Patients with Syncope EM Nerd (EMCrit): The Case of the Incidental Bystander Pulm CCM: PESIT Investigators: The Incidence of PE in Those Hospitalized Following First Syncope References Hutchinson BD et al. Overdiagnosis of pulmonary embolism by pulmonary CT angiography. Am J Rad 2015; 205(2):271-7. PMID: 26204274 Read More

This week we discuss upper GI bleeding pearls from a workshop we did in our weekly conference. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_72_0-UGIB_Final_Cut.m4a Download Leave a Comment Tags: Aortoenteric Fistula, Gastric Ulcer, Gastrointestinal, GI, UGIB, Variceal Bleeding Show Notes Take Home Points Respect the UGIB. These patients can bleed a lot. Even if they’re not actively hemorrhagic in front of you, realize that they can open up at any time and decompensate Get your consultants on board early. A skilled endoscopist is your friend as they can get control of bleeding. Don’t forget IR for TIPS in variceal bleeds and general surgery in bleeding ulcers. Activate your massive transfusion protocol if the patient is unstable and give the patient PRBCs, FFP and platelets as indicated. Reverse any anticoagulants as well. Give all patients with confirmed or suspected variceal bleeding antibiotics – typically, ceftriaxone. This intervention saves lives and decreases morbidity. Read More LITFL: EBM Upper GI Haemorrhage EMCrit: Episode 5: Upper GI Bleed Guidelines EMCrit: Intubating the Critical GI Bleeder The NNT: Prophylactic Antibiotics for Cirrhotics with Upper GI Bleed The NNT: Somatostatin Analogues (Octreotide) for Acute Variceal Bleeding EMRAP HD: Placement of a Blakemore Tube for Bleeding Varices Read More

This week we feature a lecture from Anand Swaminathan at our weekly conference on the ED management of acute pulmonary edema https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_71_0_Final_Cut.m4a Download 9 Comments Tags: Acute Decompensated Heart Failure, Acute Pulmonary Edema, ADHF, APE, Cardiovascular Show Notes Read More Core EM: Acute Pulmonary Edema EMCrit: Podcast 1 – Sympathetic Crashing Acute Pulmonary Edema REBEL EM: Morphine Kills in Acute Decompensated Heart Failure emDocs: Furosemide in the Treatment of Acute Pulmonary Edema Read More

Dive into the complexities of baclofen withdrawal, a rare but dangerous condition associated with intrathecal pumps. Symptoms can mirror both sepsis and alcohol withdrawal, leading to serious complications like hemodynamic instability and seizures. Traditional oral treatments often prove ineffective, necessitating emergent interventions such as benzodiazepines and propofol. Surgical consultation is often required to correctly address the underlying device issues. This discussion highlights the urgency and intricacies of managing this critical condition.

This week we discuss why we use antibiotics in COPD exacerbations and whether we should continue to do so. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_69_0_Final_Cut.m4a Download Leave a Comment Tags: Antibiotics, COPD, COPD Exacerbation, Pulmonary Show Notes Take Home Points Most COPD exacerbations are caused by infectious etiologies. While these can be viral, there’s also a decent chance it was caused by an overgrowth of bacteria that chronically colonize these patients. Strong evidence from systematic reviews demonstrates that antibiotic use reduces in-hospital mortality and decreases treatment failure The GOLD group recommends antibiotics be given to patients who have increased dyspnea, increased sputum volume and increased sputum purulence or require non-invasive or invasive ventilation for their exacerbation. Finally, a short course of antibiotics – either ampicillin, doxycycline or azithromycin is adequate for management. Read More GOLD Reports: Diagnosis, Management and Prevention 2016 Berg RMG, Plovsing RR. The hardships of being a Sith Lord: implications of the biopsychosocial model in a space opera. Adv Physiol Educ 2016; 40: 234-6. PMID: 27105743 Johannes M et al. Antibiotics in Addition to Systemic Corticosteroids for Acute Exacerbations of Chronic Obstructive Pulmonary Disease. Am J Resp Crit Care Med 2010; 181(2): 150-7. PMID: 19875685 Quon BS et al. Contemporary management of acute exacerbations of COPD: a systematic review and metaanalysis. Chest 2008; 133:756-66. PMID: 18321904 Ram FS et al. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2006:CD004403 PMID: 16625602 Rothberg MB et al. Antibiotic Therapy and Treatment Failure in Patients Hospitalized for Acute Exacerbations of Chronic Obstructive Pulmonary Disease. JAMA 2010; 303(20): 2035-2042 PMID: 20501925 Vollenweider DJ et al. Antibiotics for exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2012: CD010257 PMID: 23235687 The Podcasting Course Read More

This podcast dives into the unusual yet fascinating topic of hiccups, discussing their medical classification and a remarkable case of a patient with 70 years of hiccups. It explores the physiology behind hiccups, including the involved nerves and potential underlying conditions. The hosts share effective physical maneuvers and medication options for treatment, highlighting the importance of patient history in managing prolonged hiccups. It’s a mix of essential medical insight and entertaining anecdotes that bring this quirky phenomenon to life.

This week we review pearls from our Grand Rounds from George Willis, MD talking about feedback. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_67_0_Final_Cut.m4a Download Leave a Comment Tags: Resident Education Show Notes Read More St. Emlyn’s: #TTCNYC Resources for Feedback Talk Read More