Core EM - Emergency Medicine Podcast

This week we discuss pearls from a talk from Reuben Strayer on sedation of the agitated patient focusing on patient and staff safety. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_56_0_Final_Cut.m4a Download 3 Comments Tags: Agitation, Droperidol, Excited Delirium, Haloperidol, Lorazepam, Midazolam Show Notes EM Updates: The Ketamine Brain Continuum LITFL: Behavioral Emergencies Core EM: Parenteral Benzodiazepines References Calver L et al. The safety and effectiveness of droperidol for sedation of acute behavioral disturbance in the Emergency Department. Ann Emerg Med 2015; 66(3): 230-8. PMID: 25890395 Read More

This week we dive into the PATCH trial investigating the role of platelet transfusions in patients with spontaneous ICH on antiplatelet meds https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_55_0_Final_Cut.m4a Download Leave a Comment Tags: Intracerebral Hemorrhage, PATCH Trial, Platelets Show Notes Read More REBEL EM: The PATCH Trial: Hold the Platelets in Spontaneous Intracerebral Hemorrhage? St. Emlyn’s: JC – Platelets for Intracranial Haemorrhage EM Lit of Note: Put the Platelets Away in ICH References Baharoglu MI et al. Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral hemorrhage associated with anti platelet therapy (PAtCH): a randomized, open-label, phase 3 trial. Lancet 2016. ePub Read More

This discussion dives deep into the vital role of airway management in emergency settings. The importance of achieving first-attempt success in intubation is revealed, along with strategies to minimize risks associated with multiple attempts. Listeners learn effective mnemonics for airway evaluation and the essence of clear communication within medical teams. Key preparations for intubation are emphasized, including pre-oxygenation techniques and readiness for complications. It's a lively exploration of how preparation and teamwork improve outcomes in critical situations.

This week we discuss a recent study published in the NEJM on low-dose tPA vs standard-dose in acute ischemic stroke. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_53_0_Final_Cut.m4a Download Leave a Comment Tags: Alteplast, CVA, Ischemic Stroke, The ENCHANTED Trial, tPA Show Notes Read More Anderson CS et al. Low-dose versus standard-dose intravenous alteplase in acute ischemic stroke. NEJM 2016. PMID: 27161018 EMNerd: The Case of the Non-Inferior Inferiority Continues REBEL EM: The ENCHANTED Trial: Is Low-Dose the Right Dose for Intravenous tPA in Acute Ischemic Stroke? EMCrit: Podcast 116 – the tPA for Ischemic Stroke Debate EMNerd: A Secondary Examination of the Adventure of the Cardboard Box SMART EM: Thrombolytics for Acute Stroke Read More

This week we review anaphylaxis, the importance of epinephrine/adrenaline and how to use it properly. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_52_0_Final_Cut.m4a Download One Comment Tags: Allergic Reactions, Allergy, Anaphylaxis, Epinephrine Show Notes Anaphylaxis Definition Read More Tran TP, Muelleman RL: Allergy, Hypersensitivity, Angioedema, and Anaphylaxis, 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) 119: p 1543-1560. YouTube: Epinephrine Auto-Injector Use The SGEM: #57: Should I Stay or Should I Go (Biphasic Anaphylactic Response) Core EM: Biphasic reactions in emergency department patients with allergic reactions or anaphylaxis   References Grunau BE et al. Incidence of clinically important biphasic reactions in emergency department patients with allergic reactions or anaphylaxis. Ann Emerg Med 2014; 63(6): 736-44. PMID: 24239340 Grunau BE et al. Emergency Department Corticosteroid Use for Allergy or Anaphylaxis is Not Associated with Decreased Relapses. Ann Emerge Med 2015; 66(4): 381-9. PMID: 25820033 Read More

This week we dive into a recent article on pain control in renal colic and how it affects our management. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_51_0_Final_Cut.m4a Download Leave a Comment Tags: Analgesia, Kidney Stones, Renal Colic, Urology Show Notes Read More Core EM: Optimal First Line Analgesia in Ureteric Colic ALiEM: Top 10 reasons NOT to order a CT scan for suspected renal colic REBEL EM: Does Use of Tamsulosin in Renal Colic Facilitate Stone Passage Core EM: Medical Expulsive Therapy (MET) in Renal Colic Wang RC. Managing Urolithiasis. Ann Emerg Med 2015 PMID: 26616536 References Pathan SA et al. Delivering safe and effective analgesia for management of renal colic in the emergency department: a double-blind, multi group, randomized controlled trial. Lancet 2016. PMID: 26993881 Read More

This week we look at the rarely used, but potentially life-saving, procedure of gastric lavage. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_50_0_Final_Cut.m4a Download Leave a Comment Tags: Gastric Emptying, Gastric Lavage, Toxicology Show Notes Gastric Lavage Indications (Goldfrank’s Toxicologic Emergencies Ch 7) Gastric Lavage Risk Assessment (Goldfrank’s Toxicologic Emergencies Ch 7) Gastric Lavage Placement (Goldfrank’s Toxicologic Emergencies Ch 7) References Adams BK et al. Prolonged gastric emptying half-time and gastric hypo motility after drug overdose. Am J Emerg Med 2004; 22: 548-554. PMID: 15666259 Benson BE et al. Position paper update: gastric lavage for gastrointestinal decontamination. Clin Tox 2013; 51: 140-6. PMID: 23418938 Gude AB, Hoegberg LCG. Chapter 7. Techniques Used to Prevent Gastrointestinal Absorption. 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. Hoffman RS. Does consensus equal correctness? Clin Tox 2000; 38(7): 689-90. PMID: 11192453 Kulig K et al. Management of acutely poisoned patients without gastric emptying. Ann Emerg Med 1985; 14(6): 562-9. PMID: 2859819 Merigian KS et al. Prospective evaluation of gastric emptying in the self-poisoned patient. Am J Emerg Med 1990; 8: 479-83. PMID: 1977400 Pond SM et al. Gastric emptying in acute overdose: a prospective randomised controlled trial. Med J Aus 1995; 163: 34-9. PMID: 7565257 Read More

This week we take a look at alcohol withdrawal with a focus on recognition and management. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_49_0_Final_Cut.m4a Download Leave a Comment Tags: Alcohol Withdrawal, Ativan, Benzodiazipines, Delirium Tremens, Ethanol, Thaimine, Valium Show Notes Yip L. Chapter 77. Ethanol. 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. EmCrit Podcast: Delirium Tremens Life in the Fast Lane: Alcohol Withdrawal The Poison Review: CPC: alcohol withdrawal with delirium tremens and a significant missed diagnosis EM Updates: Avoid Alcohol Withdrawal Admissions MDCalc: CIWA Read More

This week we delve into the anticholinergic toxidrome with a focus on management and the use of physostigmine. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_48_0_Final_Cut.m4a Download Leave a Comment Tags: Anticholinergic, Diphenhydramine, Physostigmine, TCA, Toxicology Show Notes Howland M. Antidotes in Depth (A12): Physostigmine Salicylate. 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. Velez LI, Feng SY: Anticholinergics, 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) 150: p 1970-5. Anticholinergic Infographic (BrianandKloss.com) Drugs Exhibiting Anticholinergic Toxicity (Rosen’s) Read More

This week we review mandible dislocations and reduction approahces focusing on the new "syringe" technique. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_47_0_Final_Cut.m4a Download Leave a Comment Tags: Mandible Dislocation, Oral Surgery, Syringe Technique Show Notes Read More ALiEM: Tick of the Trade: Extra-oral reduction technique of anterior mandible dislocation Gorchynski J et al.  The “syringe” technique: a hands-free approach for the reduction of acute nontraumatic temporomandibulardislocations in the emergency department.  J Emerg Med. 2014; 47(6):676-81. PMID 25278137   Syringe Technique Step 1 Syringe Technique Step 2 Syringe Technique Step 3 Read More