Core EM - Emergency Medicine Podcast

In this episode, we discuss the recent measles outbreak and how ED providers can best prepare to treat this almost vanquished foe. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Measles_Final_Cut.mp3 Download One Comment Tags: Infectious Diseases, Pediatrics Show Notes Episode Produced by Audrey Bree Tse, MD           References: CDC Measles for Health Care Providers.  https://www.cdc.gov/measles/hcp/index.html#lab. Gladwin M, Trattler B.  Orthomyxo and Paramyxoviridae.  In: Clinical Microbiology Made Ridiculously Simple.  4th ed.  Miami, FL: MedMaster, Inc; 2009: 240-243. Hussey G, Klein M.  A Randomized, Controlled Trial of Vitamin A in Children with Severe Measles.  N Engl J Med.  1990; 323: 160-164.doi: 10.1056/NEJM199007193230304. Nir, Sarah Mailin and Gold, Michael.  “An Outbreak Spreads Fear: Of Measles, of Ultra-Orthodox Jews, of Anti-Semitism.”  New York Times [New York City] 03/29/2019. https://www.nytimes.com/2019/03/29/nyregion/measles-jewish-community.html A massive thanks to: Shweta Iyer, MD: NYU Langone 3rd year Pediatric Emergency Medicine Fellow. Jennifer Lighter, MD: Assistant Professor of Pediatric Infectious Diseases, NYU School of Medicine. Michael Mojica, MD: Associate Professor of Pediatric Emergency Medicine, NYU Langone Medical Center. Michael Phillips, MD: Chief Hospital Epidemiologist, NYU Langone Medical Center. Read More

In this episode, we discuss acute decompensated heart failure and how to best manage these dyspneic patients in the ED. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_ADHF.mp3 Download Leave a Comment Tags: Cardiology, Respiratory Show Notes Features that increase the probability of heart failure. (Wang 2005) B-lines seen in pulmonary edema. Positioning of ultrasound probe in BLUE protocol. (Lichtenstein 2008) Read More

In this episode, we discuss Boxer's fractures and how to best manage them in the ED. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Boxer_s_Fracture_eq.m4a Download One Comment Tags: Orthopedics, Trauma Podcast Video https://youtu.be/UreET5eLHas Show Notes Background: 40% of all hand fractures A metacarpal fracture can occur at any point along the bone (head, neck, shaft, or base) “Boxer’s” fractures classically at neck Most common mechanism: direct axial load with a clenched fist Most common metacarpal injured is the 5th A majority of these injuries are isolated injuries, closed and stable Examination: Ensure that this is an isolated injury May note a loss of knuckle contour or shortening A thorough evaluation of the skin is important Patients may also have fight bites and require irrigation and antibiotics Tender along the dorsum of the affected metacarpal Evaluate the range of motion as the commonly seen shortening results in extension lag For every 2 mm of shortening there is going to be a 7 degree decrease in ability to extend the joint Check rotational alignment of digits with the MCP and PIP at 50% flexion. Partially clench their fist and ensure that the axis of each digit converges near the scaphoid pole / mid wrist Deformity is often seen due to the imbalance of volar and dorsal forces Dorsal angulation AP, lateral and oblique views should be obtained on XR The degree of angulation is estimated with the lateral view NB: Normal angle between the metacarpal head and neck is 15 degrees Management: Most may be splinted with an ulnar gutter splint Must be closed, not significantly angulated, and not malrotated When splinting, place the wrist in slight extension, MCP (knuckles) at 90 degrees and the DIP and PIP in a relaxed, slightly flexed position A closed reduction is indicated if there is significant angulation “20, 30, 40” rule If angulation is more than: 20 in the middle finger metacarpal 30 in the ring finger metacarpal 40 in the pinky finger metacarpal Analgesia with a hematoma block or ulnar nerve block Reduction technique: https://www.aliem.com/2013/01/trick-of-trade-reducing-metacarpal/ Referral: May have mild deformity or decreased functionality and strength in hand grip after this injury Emergent evaluation if: Open fracture Neurovascular compromise Follow up: Refer to hand specialist Within 1 week if fractures of 4thand 5thmetacarpals with angulation 3 to 5 days if the 2ndand 3rd metacarpalsare affected Immobilized for three to four weeks in splint Healing may take up to six weeks Take Home Points: This is one of the most common fractures we will see as emergency physicians When evaluating these patients, ensure that this are no other more severe, life-threatening injuries, and pay particular attention to the skin exam so that you do not miss a fight-bite Reductions may be required if there is significant angulation, which is guided by the 20, 30, 40 rule Finally, emergent specialist evaluation is indicated if there is an open fracture or evidence of neurovascular compromise Read More

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This week we dive into a recent article highlighting a major update in the treatment of community acquired pneumonia (CAP) https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_156_0_Final_Cut.m4a Download Leave a Comment Tags: CAP, Macrolides, Pulmonary Show Notes Read More REBEL EM: Update in Community Acquired Pneumonia (CAP) Treatment – Macrolide Resistance Moran GJ, Talan, DA; Pneumonia, 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) 76: p 978-89. Haran JP et al. Macrolide resistance in cases of community-acquired bacterial pneumonia in the emergency department. J Emerg Med 2018. PMID: 29789175 Mandell LA et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44(Suppl 2):S27–72. PMID: 17278083 Arnold FW et al. A worldwide perspective of atypical pathogens in community-acquired pneumonia. AmJ Respir Crit Care Med 2007;175:1086–93. PMID: 17332485 Read More

This week we discuss three recent articles looking at esmolol in refractory VF, c-spine clearance and antibiotics after abscess drainage https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_155_0_Final_Cut.m4a Download Leave a Comment Tags: Cardiac Arrest, Cervical Spine, Esmolol, I+D, Infectious Diseases, Journal Club, MRSA, Refractory VF, Trauma Show Notes Read More REBEL EM: Trimethoprim-Sulfamethoxazole for Uncomplicated Skin Abscesses Bryan Hayes at ALiEM: Sulfamethoxazole-Trimethoprim for Skin and Soft Tissue Infections: 1 or 2 Tablets BID? The SGEM: SGEM#164: Cuts Like a Knife Core EM: Antibiotics in the Treatment of Smaller Abscesses EM Nerd: The Case of the Pragmatic Wound REBEL EM: Refractory ventricular fibrillation Resus.ME: Esmolol for Refractory VF Read More

This week we review femoral shaft fractures with a focus on assessment and analgesia https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_154_0_Final_Cut.m4a Download Leave a Comment Tags: Femoral Nerve Blocks, Orthopedics Show Notes Read More Orthobullets Femoral Shaft Fracture Rosen’s Emergency Medicine Concepts and Clinical Practice(link) Tintinalli’s Emergency Medicine(link) Femoral Nerve Block video (link) Read More

Dive into thrilling insights from Bellevue's morning report series! Discover the vital signs to watch for in immunocompromised patients, particularly with end-stage renal disease. Learn about the urgency and treatment of Fournier's gangrene—a life-threatening infection that demands swift action. Explore the necessity of thorough evaluations for intoxicated patients, especially those with head trauma, alongside essential imaging practices. This podcast is packed with critical knowledge for emergency medicine!

This week, we discuss penetrating neck trauma and some pearls and pitfalls in management. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_152_0_Final_Cut.m4a Download One Comment Tags: Neck Trauma, Trauma Show Notes REBEL EM: Penetrating Neck Injuries Zone 1 Zone 2 Zone 3 Anatomic Landmarks Clavicle/Sternum to Cricoid Cartilage Cricoid Cartilage to the Angle of the Mandible Superior to the Angle of the Mandible Anatomic Structures in Zone Proximal Common Carotid Artery Carotid Artery Vertebral Artery Subclavian Artery Vertebral Artery Distal Carotid Artery Vertebral Artery Jugular Vein Distal Jugular Vein Lung Apices Pharynx Salivary and Parotid Glands Trachea Trachea Cranial Nerves IX – XII Thyroid Esophagus Spinal Cord Esophagus Larynx Thoracic Duct Vagus Nerve Spinal Cord Recurrent Laryngeal Nerve Spinal Cord Hard + Soft Signs of Major Aerodigestive or Neurovascular Injury Hard Signs Soft Signs Airway Compromise Hemoptysis Expanding or Pulsatile Hematoma Oropharyngeal Blood Active, Brisk Bleeding Dyspnea Hemorrhagic Shock Dysphagia Hematemesis Dysphonia Neurologic Deficit Nonexpanding Hematoma Massive Subcutaneous Emphysema Chest Tube Air Leak Air Bubbling Through Wound Subcutaneous or Mediastinal Air Vascular Bruit or Thrill Crepitus WTA Management Algorithm for Penetrating Neck Injury (Sperry 2013) Read More

This week we discuss the difficult to diagnose and high morbidity cauda equina syndrome. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_151_0_Final_Cut.m4a Download Leave a Comment Tags: Back Pain, Cauda Equina Show Notes Take Home Points Cauda equina syndrome is a rare emergency with devastating consequences Early recognition is paramount as the presence of bladder dysfunction portends bad functional outcomes The presence of bilateral lower extremity weakness or sensory changes should alert clinicians to the diagnosis. Saddle anesthesia (or change in sensation) and any bladder/bowel changes in function should also raise suspicion for the disorder MRI is the diagnostic modality of choice though CT myelogram can be performed if necessary Prompt surgical consultation is mandatory for all patients with cauda equina syndrome regardless of symptoms at presentation Read More EM Cases: Best Case Ever 11: Cauda Equina Syndrome OrthoBullets: Cauda Equina Syndrome Radiopaedia: Cauda Equina Syndrome Perron AD, Huff JS: Spinal Cord 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., 2010, (Ch) 106: p 1419-30. References Lavy C et al. Cauda Equina Syndrome. BMJ 2009; 338: PMID: 19336488 Todd NV. Cauda equina syndrome: the timing of surgery probably does influence outcome. Br J Neurosurg 2005;19:301-6 PMID: 16455534 Read More