Core EM - Emergency Medicine Podcast

By Core EM

Core EM Emergency Medicine Podcast... more

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How many episodes does Core EM - Emergency Medicine Podcast have?

The podcast currently has 215 episodes available.

Core EM - Emergency Medicine Podcast episodes:

October 24, 2016Episode 69.0 – Antibiotics in COPD Exacerbations
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

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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.
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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

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8min
October 17, 2016Episode 68.0 – Hiccups
This week we discuss the workup and management of hiccups in the ED

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Tags: Hiccups, Singultus

Show Notes

Take Home Points
Hiccups, or singultus, are caused by a reflex arc involving the vagus nerve, CNS and phrenic nerve. If you remember the path of these nerves, you can remember that possible bad pathologies that could cause a patient to present with prolonged hiccups.
Physical maneuvers are the first line for solving the hiccups. Try things that will interrupt respiration or stimulate the vagus nerve. We like the modified valsalva in which the patient blows on a syringe, because it’s pretty easy to get the patient to do.
Last, medication options for hiccups include antipsychotics, anticonvulsants, muscle relaxers and dopamine agonist. Generally, we start with chlorpromazine 25-50 mg PO or IM.
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Steger M et al. Systemic review: the pathogenesis and pharmacological treatment of hiccups. Aliment Pharmacol Ther 2015; 42(9):1037-50. PMID 26307025

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8min
October 10, 2016 Episode 67.0 – Feedback

This week we review pearls from our Grand Rounds from George Willis, MD talking about feedback.

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Tags: Resident Education

Show Notes

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St. Emlyn’s: #TTCNYC Resources for Feedback Talk

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8min
October 03, 2016Episode 66.0 – Boerhaave Syndrome
This week, we discuss Boerhaave syndrome focusing on making the diagnosis and managing the patient.

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_66_0_Final_Cut.m4a

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Tags: Chest Pain, Pulmonary

Show Notes

Take Home Points
Keep esophageal rupture on your differential for deadly causes of chest, epigastric or back pain. We don’t see it often, but it’s a real thing.
Boerhaave Syndrome is the spontaneous rupture of the esophagus that is caused by a sudden increase in intraesophageal pressure, as seen in forceful vomiting. So, if the patient presents with the right symptoms and any vomiting in their history, keep this diagnosis in mind. Other causes you might see, though less common, are childbirth, seizure, prolonged coughing or laughing, or weightlifting.
ED management is essentially ABCs and broad spectrum antibiotics, and maybe even antifungals.
As soon as you make this diagnosis, get you CT surgeon on board as the length of time to definitive treatment is directly related to mortality.
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Radiopaedia: Boerhaave Syndrome
LITFL: Roast Duck and Juniper Beer

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19min
September 26, 2016 Episode 65.0 – Pericarditis

This week we discuss the diagnosis and management of pericarditis with a focus on not missing the hidden STEMI.

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_65_0_Final_Cut.m4a

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Tags: ACS, Cardiology, Cardiovascular, Colchicine, Pericarditis, STEMI

Show Notes

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ECG Case of the Week (Amal Mattu): Acute STEMI vs. Pericarditis Part 1 + Part 2
REBEL EM: Colchicine for Treatment of Pericarditis
SOCMOB: Pericarditis: Treatment and Diagnosis Pocket Card
FOAMcast: Episode 54 – The Pericardium
Core EM: Pericarditis
Pericarditis PV Card (Chris Bond (socmob.org)
References
Brady W et al. Electrocardiographic ST-segment elevation: the diagnosis of acute myocardial infarction by morphologic analysis of the ST segment. Acad Emerg Med 2001;8:961–7. PMID: 11581081
Bischof JE et al. ST depression in lead aVL differentiates inferior ST-elevation myocardial infarction from pericarditis. Am J Emerg Med 2015 PMID: 26542793

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10min
September 19, 2016 Episode 64.0 – Rate Control in Atrial Fibrillation

This week we discuss an age-old debate: Calcium Channel Blockers or Beta Blockers for rate control in atrial fibrillation.

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_64_0_Final_Cut.m4a

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Tags: Atrial Fibrillation, Beta Blocker, Calcium Channel Blocker, Cardiology, Rate Control

Show Notes

CoreEM: Recent Onset Atrial Fibrillation
ALiEM: Atrial Fibrillation Rate Control in the ED: Calcium Channel Blockers or Beta Blockers?
ALiEM: Beta Blockers vs Calcium Channel Blockers for Atrial Fibrillation Rate Control: Thinking Beyond the ED
Fromm C, et al. Diltiazem vs. Metoprolol in the Management of Atrial Fibrillation or Flutter with Rapid Ventricular Rate in the Emergency Department. J Emerg Med. 2015 Apr 22. PMID 25913166

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10min
September 12, 2016 Episode 63.0 – Discharge Glucose Levels

This week we discuss a recent article looking at the relevance of d/c glucose levels to patient revisits and subsequent hospitalization

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_63_0_Final_Cut.m4a

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Show Notes

Driver BE et al. Discharge glucose is not associated with short-term adverse outcomes in emergency department patients with moderate to severe hyperglycemia. Ann Emerg Med 2016. PMID: 27353284

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7min
September 05, 2016Episode 62.0 – VFib and Pulseless VTach
This week we discuss the ED management of cardiac arrest with VFib and pulseless VTach.

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_62_0_Final_Cut.m4a

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Tags: Cardiac Arrest, Dual Defibrillation, OHCA, Ventricular Dysrhythmias, Ventricular Fibrillation, Ventricular Tachycardia

Show Notes

Take Home Points
In cardiac arrest, the most important interventions are to deliver electricity quickly when it’s indicated and to administer good high-quality compressions with minimal interruptions to maximize your compression fraction.
Medications like epinephrine and amiodarone have never been shown to improve good neurologic outcomes in the ACLS recommended doses. Don’t focus on them.
Consider pre-charging your defibrillator to minimize pauses in CPR and maximize your chance for ROSC
Finally, remember that as Emergency Physicians, we are specialists in the resuscitation of cardiac arrests. ACLS is just a starting point. Push your understanding of taking care of these patients so you can deliver the best care possible
Additional Reading
Core EM: Ventricular Tachycardia
Core EM: A Simplified Approach to Tachydysrhythmias
Core EM: Amiodarone, Lidocaine or Placebo in OHCA
emDocs.net: Epinephrine in Cardiac Arrest
REBEL EM: Beyond ACLS: Pre-Charging the Defibrillator
ACLS VFib and VTach Algorithm
References
Driver BE et al. Use of esmolol after failure of standard cardiopulmonary resuscitation to treat patients with refractory ventricular fibrillation. Resuscitation 2014; 85(10): 1337-41. PMID: 25033747
Kudenchuk PJ et al. Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest. NEJM. 2016; PMID: 27043165
Laina A et al. Amiodarone and Cardiac Arrest: Systematic Review and Meta-Analysis. Int J Cardiol 2016; 221: 780-8. PMID: 27434349

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10min
August 29, 2016Episode 61.0 – Hypokalemia
This week we discuss the presentation and treatment of hypokalemia.

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_61_0_Final_Cut.m4a

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Show Notes

Take Home Points
Hypokalemia has a wide variety of presentations ranging from generalized weakness, to paralysis, to cardiac arrhythmia or cardiac arrest.
When you discover hypokalemia, be sure to check and EKG. Think about underlying causes of hypokalemia, because it is rarely a solo event.
Treat with oral potassium supplementation of 40-60 orally every 4-6 hours for mild hypokalemia and 10-20 mEq/hour IV for severe or symptomatic hypokalemia.
Additional Reading
LITFL: Hypokalemia
LITFL: Hypokalemic Periodic Paralysis
Core EM: Hypokalemia

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11min
August 22, 2016Episode 60.0 – Aggressive Resuscitation of Diabetic Ketoacidosis
This week we discuss how to aggressively resuscitate patients with DKA as well as dispelling some dogmatic teachings on the topic.

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_60_0_Final_Cut.m4a

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Tags: Cerebral Edema, DKA, Hypokalemia, Insulin, Resuscitation

Show Notes

Take Home Points
DKA should be suspected in any patient with altered mental status and hyperglycemia. Get a VBG (ABG not necessary) to confirm the diagnosis.
Hypokalemia kills in DKA. Aggresively replete potassium and consider holding insulin, which drops serum potassium, until K is greater than 3.5
The insulin bolus isn’t necessary and appears to cause more episodes of hypokalemia. Just start insulin as an infusion at 0.14 units/kg
Be vigilant about cerebral edema. Any change or deterioration in mental status should prompt treatment and evaluation. Mannitol in the euvolemic, normotensive patient and 3% hypertonic saline in the hypotensive/hypovolemic patient
Finally, don’t forge to always hunt down the underlying cause of the DKA. Infection and non-compliance is the most common so liberally administer broad spectrum antibiotics if you’ve got even a hint of infection brewing
https://www.youtube.com/watch?v=P9sKk4JZmso
Additional Reading
LITFL: EBM Diabetic Ketoacidosis
Core EM: DKA
Core EM: Episode 13.0 – Diabetic Ketoacidosis: A Case
emDocs: Myths in DKA Management
REBEL EM: Is There Any Benefit to an Initial Insulin Bolus in Diabetic Ketoacidosis?
References
Aurora S et al. Prevalence of hypokalemia in ED patients with diabetic ketoacidosis. Am J Emerg Med 2012; 30: 481-4. PMID: 21316179
Boyd JC et al. Relationship of potassium and magnesium concentrations in serum to cardiac arrhythmias. Clin Chem 1984; 30(5): 754-7. PMID: 6713638
Duhon B et al. Intravenous sodium bicarbonate therapy in severely acidotic diabetic ketoacidosis. Ann Pharmacother 2013; 47: 970-5. PMID: 23737516
Fagan MJ et al. Initial fluid resuscitation for patients with diabetic ketoacidosis: how dry arethey? Clin Ped 2008; 47(9): 851-6. PMID:
Goyal N et al. Utility of Initial Bolus insulin in the treatment of diabetic ketoacidosis. J Emerg Med 2010; 38(4): 422-7. PMID: 18514472
Green SM et al. Failure of adjunctive bicarbonate to improve outcome in severe pediatric diabetic ketoacidosis. Ann Emergency Medicine 1998; 31: 41-48. PMID: 9437340
Kitabchi AE et al. Is a priming dose of insulin necessary in a low-dose insulin protocol for the treatment of diabetic ketoacidosis? Diabetes Care. 2008;31(11):2081. PMID: 18694978
Lebovitz HE: Diabetic ketoacidosis. Lancet 1995; 345: 767-772. PMID: 7891491
Morris LR et al. Bicarbonate therapy in severe diabetic ketoacidosis. Ann Intern Med 1986;105(6):836. PMID: 3096181
Muir AB et al. Cerebral edema in childhood diabetic ketoacidosis: natural history, radiographic findings, and early identification. Diabetes Care 2004; 27(7):1541-6. PMID: 15220225
Okuda Y et al. Counterproductive effects of sodium bicarbonate in diabetic ketoacidosis. J Clinical Endocrinology Metabolism 1996; 81: 314-320. PMID: 8550770
Savage MW et al. Joint British Diabetes Societies guideline for the management of diabetic ketoacidosis. Diabet Med. 2011 May;28(5):508-15. PMID: 21255074
Villon A et al. Does bicarbonate therapy improve management of severe diabetic ketoacidosis? Crit Care Med 1999; 27: 2690-2693. PMID: 10628611

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11min

FAQs about Core EM - Emergency Medicine Podcast:

How many episodes does Core EM - Emergency Medicine Podcast have?

The podcast currently has 215 episodes available.

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