Core EM - Emergency Medicine Podcast

Stefanie Biondi, a dedicated senior resident, shares her insights on the rising concern of nitrous oxide toxicity. She discusses a compelling case study of a young man whose symptoms escalated due to recreational use of the gas. The conversation dives into the misconceptions surrounding nitrous oxide, particularly its perceived safety. Additionally, Stefanie highlights the significant neurological consequences of frequent use and the critical need for awareness and early diagnosis to prevent long-term health issues.

Exploration of threatened abortion in early pregnancy, initial assessment priorities, broad differentials, diagnostic tests like HCG level and urinalysis, importance of interpreting HCG values, use of ultrasound imaging, patient counseling on prognosis and psychosocial support, and follow-up strategies for management.

The podcast discusses the approach to syncope in children, including initial workup similarities for children and adults, the rule of 50s for dextrose administration, and the importance of ECG analysis for diagnosing dysrhythmias. Topics covered include long QT syndrome, Brugada syndrome, and Wolff-Parkinson-White syndrome, emphasizing the need for a comprehensive evaluation and management in pediatric syncope cases.

The podcast discusses the treatment of rapid atrial fibrillation (afib with RVR) including stability assessment, ACLS protocols, rate vs. rhythm control strategies, limitations in chronic AF, and identifying pre-excitation syndromes. It explores the challenges and limitations of current treatments and emphasizes the importance of a thoughtful approach for patients with AFib and suspected critical illness.

The podcast discusses Electrical Storm (VT storm) and the management of ventricular tachycardia. They explore the causes, diagnostic considerations, and importance of ECGs. They also discuss the management of unstable patients, including cardioversion and sedation options. The podcast explores different treatment options for ventricular arrhythmias in patients experiencing an electrical storm.

This podcast episode explores the topic of hyperkalemia, discussing its causes, symptoms, and associated EKG changes. It also covers various treatment strategies, including shifting agents and diuretics. The use of fluids, Lokelma, and dialysis in managing hyperkalemia is discussed, along with management strategies for severe cases and limited dialysis access.

Catherine Jamin, Associate professor of Emergency Medicine at NYU Langone Health, talks about the essential use of vasopressors in the ED to increase blood pressure, improve organ function, and optimize metabolic status. She discusses the commonly used vasopressors, their mechanisms, dosages, and situational preferences. The podcast also covers the diagnosis of underlying pathology, the use of vasopressin and phenylephrine, and the escalation strategy for refractory shock.

Explore the differential diagnosis of joint pain in children, distinguishing between transient synovitis and septic arthritis. Learn about the diagnostic work-up, including blood tests and imaging studies. Understand the management strategies for septic arthritis, such as joint drainage and targeted antibiotic therapy. Discover the organisms that cause septic joint in different age groups and the importance of prompt treatment to prevent complications.

A quick primer on hypocalcemia in the ED. Hosts: Joseph Offenbacher, MD Audrey Bree Tse, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/hypocalcemia.mp3 Download 4 Comments Tags: calcium, Critical Care, Endocrine Show Notes Swami’s CoreEM Post Hypocalcemia Repletion: IV calcium supplementation with 100-300 mg Ca2+ raises serum Ca2+ by 0.5 – 1.5 mEq For acute but mild symptomatic hypocalcemia: 200-1000mg calcium chloride IV or 1-2g IV calcium gluconate over 2 hours  For severe hypocalcemia: 1g calcium chloride IV or 1-2g IV calcium gluconate IV over 10 minutes repeated q 60 min until symptoms resolve References: Cooper MS, Gittoes NJ. Diagnosis and management of hypocalcaemia. BMJ 2008; 336:1298. ​​Desai TK, Carlson RW, Geheb MA. Prevalence and clinical implications of hypocalcemia in acutely ill patients in a medical intensive care setting. Am J Med 1988; 84:209. Goltzman, D. Diagnostic approach to hypocalcemia. UpToDate. UpToDate; Jul 17, 2020. Accessed April 29, 2022. https://www.uptodate.com/contents/plantar-fasciitis Kelly A, Levine MA. Hypocalcemia in the critically ill patient. J Intensive Care Med 2013; 28:166. Pfenning CL, Slovis CM: Electrolyte 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) 125: p 1636-53. Swaminathan, A. (2016, January 27). Hypocalcemia. CoreEM. Retrieved April 29, 2022, from https://coreem.net/core/hypocalcemia/ Vantour L, Goltzman D. Regulation of calcium homeostasis. In: rimer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, 9th ed, Bilezikian JP (Ed), Wiley-Blackwell, Hoboken, NJ 2018. p.163. Read More

How and when to reverse anticoagulation in the bleeding EM patient. Hosts: Joe Offenbacher, MD Audrey Bree Tse, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/AC_reversal.mp3 Download 3 Comments Tags: Anticoagulation, Critical Care, Resuscitation Show Notes Coagulation Cascade:   Algorithm for Anticoagulated Bleeding Patient in the ED:     Indications for Anticoagulation Reversal:   References:  Baugh CW, Levine M, Cornutt D, et al. Anticoagulant Reversal Strategies in the Emergency Department Setting: Recommendations of a Multidisciplinary Expert Panel. Ann Emerg Med. 2020;76(4):470-485. doi:10.1016/j.annemergmed.2019.09.001 Eikelboom JW, Quinlan DJ, van Ryn J, Weitz JI. Idarucizumab: The Antidote for Reversal of Dabigatran. Circulation. 2015 Dec 22;132(25):2412-22. doi: 10.1161/CIRCULATIONAHA.115.019628. PMID: 26700008. Fariborz Farsad B, Golpira R, Najafi H, et al. Comparison between Prothrombin Complex Concentrate (PCC) and Fresh Frozen Plasma (FFP) for the Urgent Reversal of Warfarin in Patients with Mechanical Heart Valves in a Tertiary Care Cardiac Center. Iran J Pharm Res. 2015;14(3):877-885. Fariborz Farsad B, Golpira R, Najafi H, et al. Comparison between Prothrombin Complex Concentrate (PCC) and Fresh Frozen Plasma (FFP) for the Urgent Reversal of Warfarin in Patients with Mechanical Heart Valves in a Tertiary Care Cardiac Center. Iran J Pharm Res. 2015;14(3):877-885. Palta S, Saroa R, Palta A. Overview of the coagulation system. Indian J Anaesth. 2014;58(5):515-523. doi:10.4103/0019-5049.144643 Siegal DM, Curnutte JT, Connolly SJ, Lu G, Conley PB, Wiens BL, Mathur VS, Castillo J, Bronson MD, Leeds JM, Mar FA, Gold A, Crowther MA. Andexanet Alfa for the Reversal of Factor Xa Inhibitor Activity. N Engl J Med. 2015 Dec 17;373(25):2413-24. doi: 10.1056/NEJMoa1510991. Epub 2015 Nov 11. PMID: 26559317. Read More