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 214 episodes available.

Core EM - Emergency Medicine Podcast episodes:

March 08, 2019Episode 158.0 – Boxer’s Fracture
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

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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

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6min
August 13, 2018 Episode 157.0 – Farewell

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_157_0_Final_Cut.m4a

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3min
July 30, 2018 Episode 156.0 – Updates in Community Acquired Pneumonia

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

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Tags: CAP, Macrolides, Pulmonary

Show Notes

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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

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6min
July 23, 2018 Episode 155.0 – Journal Update

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

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Tags: Cardiac Arrest, Cervical Spine, Esmolol, I+D, Infectious Diseases, Journal Club, MRSA, Refractory VF, Trauma

Show Notes

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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

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13min
July 16, 2018 Episode 154.0 – Femoral Shaft Fractures

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

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Tags: Femoral Nerve Blocks, Orthopedics

Show Notes

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Orthobullets Femoral Shaft Fracture
Rosen’s Emergency Medicine Concepts and Clinical Practice(link)
Tintinalli’s Emergency Medicine(link)
Femoral Nerve Block video (link)

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6min
July 09, 2018 Episode 153.0 – Morning Report Pearls VI

More amazing pearls from our Bellevue morning report series.

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_153_0_Final_Cut.m4a

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Tags: Alcohol Intoxication, Discitis, ESRD, Necrotizing Fasciitis

Show Notes

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Core EM: Spinal Epidural Abscess
REBEL EM: Cauda Equina Syndrome
Radiopaedia: Discitis
LITFL: Necrotizing Fasciitis
REBEL Cast: Episode 50 – Intoxicated Patients Can Equal Badness

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10min
July 02, 2018 Episode 152.0 – Penetrating Neck Trauma

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

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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)

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15min
June 25, 2018Episode 151.0 – Cauda Equina Syndrome
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

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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
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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

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6min
June 18, 2018 Episode 150.0 – Journal Update

This week we review some recent publications on steroids in pharyngitis and the VAN assessment in stroke.

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_150_0_Final_Cut.m4a

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Tags: Pharyngitis, Steroids, VAN Assessment

Show Notes

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The SGEM: SGEM #203: Let Me Clear My Sore Throat with a Corticosteroid
Core EM: Corticosteroids in Pharyngitis – Systematic Review + Meta-Analysis
REBEL EM: Does it Take a VAN to Identify Emergency Large Vessel Occlusion (EVLO) in Ischemic Stroke?
REBEL EM: Stroke Workflow in 2018
Stroke Workflow 2017 (REBEL EM)
References
Sadeghirad B et al. Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials BMJ 2017; 358 :j3887. PMID: 28931508
Teleb MS et al. Stroke vision, aphasia, neglect (VAN) assessment – a novel emergent large vessel occlusion screening tool: pilot study and comparison with current clinical severity indices. J Neurointervent Surg 2017; 9(2): 122-6. PMID: 26891627

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9min
June 11, 2018Episode 149.0 – Simplified Approach to Peds Trauma
This week the podcast features a lecture from Dr. Frosso Admakos - Assistant Residency Director at Metropolitan Hospital in NYC

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_149_0_Final_Cut.m4a

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Tags: All NYC EM, Pediatrics, Trauma

Show Notes

Take Home Points
While peds traumas and severe traumas are uncommon, stay cool and collected – you’ve run many resuscitations in the past and resuscitating a kid is no different. You’ve got this
When it comes to access, think 1, 2 IO. 2 shots at a peripheral line and if you don’t get it, go to IO
Tachycardia should be assumed to be compensated shock until proven otherwise. Don’t write tachycardia off as anxiety
Failed airway approach – place an 18 gauge catheter into the neck – hopefully through the cricothyroid membrane and bag through that. If you still have difficult getting an airway from above, consider a retrograde intubation over a wire
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University of Maryland EM: Retrograde Intubation

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16min

FAQs about Core EM - Emergency Medicine Podcast:

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

The podcast currently has 214 episodes available.

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