Core EM - Emergency Medicine Podcast

By Core EM

Core EM Emergency Medicine Podcast... more

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FAQs about Core EM - Emergency Medicine Podcast:

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

The podcast currently has 214 episodes available.

Core EM - Emergency Medicine Podcast episodes:

January 15, 2018 Episode 128.0 – Hip Dislocations

This week, we sit down with Billy Goldberg - senior faculty at NYU/Bellevue, to discuss some nuances of hip dislocation management.

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_128_0_Final_Cut.m4a

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Tags: Orthopedics, Trauma

Show Notes

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Core EM: Hip Dislocation
OrthoBullets: Hip Dislocation
EMin5: Hip Dislocation

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18min
January 08, 2018Episode 127.0 – Idiopathic Intracranial Hypertension
This week we talk about the subacute headache and the dangerous, can't miss diagnoses of cerebral venous thrombosis and IIH

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_127_0_Final_Cut.m4a

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Tags: Cerebral Venous Sinus Thrombosis, Headache, Neurology

Show Notes

Take Home Points
Keep IIH and CVST on the differential for patient’s coming in with a subacute headache, particularly if they have visual or neuro symptoms.
Consider an ocular ultrasound! It’s quick, shockingly easy to do, and can help point you toward a diagnosis you may have otherwise overlooked. I have made it my practice now to include a quick look in the physical exam of my patients with a concerning sounding headache or a headache with neurologic symptoms.
Consider IIH particularly in an overweight female of child bearing age with a subacute headache, but remember patients outside that demographic can have IIH as well.
Consider CVST in a patient with a thrombophilic process like cancer, pregnancy or the use of OCPs or androgens or in a patient with a recent facial infection like sinusitis or cellulitis.
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WikEM: Idiopathic Intracranial Hypertension
WikEM: Ocular Ultrasound
Sinai EM Ultrasound – Pseutotumor Cerebri

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15min
December 18, 2017Episode 126.0 – Flexor Tenosynovitis
This week we discuss the uncommon but must make diagnosis of flexor tenosynovitis

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_126_0_Final_Cut.m4a

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Tags: Hand, Kanavel Signs, Orthopedics, Soft Tissue Infections

Show Notes

Take Home Points
Think about flexor tenosynovitis in a patient with atraumatic finger pain. They may have any combination of these signs:
Tenderness along the course of the flexor tendon
Symmetrical swelling of the finger – often called the sausage digit
Pain on passive extension of the finger and
Patient holds the finger in a flex position at rest for increased comfort
Give antibiotics to cover staph, strep and possibly gram negatives.
Get your surgeon to see the patient, while we can get the antibiotics started, these patients need admission and may require surgical intervention.
Infographic
by Dr. Y. Jay Lin
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Mailhot T, Lyn ET: Hand; 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) 50: p 534-571
OrthoBullets: Pyogenic Flexor Tenosynovitis
Ped EMMorsels: Flexor Tenosynovitis

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...more
9min
December 11, 2017 Episode 125.0 – Morning Report Pearls I

This week we discuss some critical pearls and teaching points from our morning report conference.

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_125_0_Final_Cut.m4a

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Tags: Fluoroquinolones, Pneumonia, Spleen

Show Notes

FOAMCast: Episode 17 – The Spleen!

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6min
December 04, 2017Episode 124.0 – Metformin-Associated Lactic Acidosis
This week we discuss a quick case leading into the management of MALA.

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_124_0_Final_Cut.m4a

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Tags: Metformin, Toxicology

Show Notes

Take Home Points
In patients with shortness of breath and clear lungs, consider metabolic acidosis with respiratory alkalis as a potential cause
Suspect MALA in any patient on metformin who presents with abdominal pain, nausea and vomiting and/or AMS
Patients with MALA will have a low pH, a high-anion gap metabolic acidosis and high lactate levels
Call your tox consultant to assist with management which will focus on fluid resuscitation with isotonic bicarbonate and dialysis
Read More
Bosse GM. Antidiabetics and Hypoglycemics. In: Hoffman RS, Howland M, Lewin NA, Nelson LS, Goldfrank LR. eds. Goldfrank’s Toxicologic Emergencies, 10e New York, NY: McGraw-Hill; 2015. Link Accessed October 31, 2017
LITFL: Metformin-Associated Lactic Acidosis
LITFL: Metformin
The Poison Review: 6 Pearls About Metformin and Lactic Acidosis

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6min
November 27, 2017Episode 123.0 – Paracentesis Journal Update
This week we dive into a recent journal article questioning whether we should tap all ascites.

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_123_0_Final_Cut.m4a

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Tags: Albumin, Cirrhosis, Paracentesis, SBP, Spontaneous Bacterial Peritonitis

Show Notes

Take Home Points
SBP is a difficult diagnosis to make clinically. While patients may have the triad of fever, abdominal pain and increasing ascites, they are far more likely to only have 1 or 2 of these symptoms
In patients admitted to the hospital with ascites, consider performing a diagnostic paracentesis on all patients as limited literature shows an association with decreased mortality and, the procedure is simple and low risk
Once you get the fluid, focus on the cell count: WBC > 500 or PMN > 250 should prompt treatment with a 3rd generation cephalosporin and albumin infusion
Gaetano et al. The benefit of paracentesis on hospitalized adults with cirrhosis and ascites. Journal of Gastroenterology and Hepatology 2016. PMID: 26642977
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EMRAP: C3 Live Paracentesis Video
LITFL: Spontaneous Bacterial Peritonitis
SinaiEM: SBP Pearls
REBEL EM: Should You Give Albumin in Spontaneous Bacterial Peritonitis (SBP)?
Approach to the Diagnosis and Treatment of SBP (University of Washington)

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7min
November 20, 2017Episode 122.0 – True Knee Dislocations
This week we discuss the tibio-femoral knee dislocation focusing on identification of the dangerous complications.

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_122_0_Final_Cut.m4a

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Tags: Knee Dislocation, Orthopedics, Popliteal Artery

Show Notes

Take Home Points
Up to 50% of true knee dislocations will spontaneously reduce prior to arrival. Be suspicious of a dislocation in any patient who describes the joint moving out of place or if they have significant swelling, joint effusion or ecchymosis despite normal X-rays
In all patients with suspected dislocation, perform a neurovascular exam immediately as popliteal artery injury is common. If they’ve got an absent DP or PT pulse, reduce immediately and get a CT angiogram as quickly as possible to assess for popliteal injuries
If distal pulses are intact, you can either do ABIs and if normal, observe and repeat them or get a CTA. If the ABI is abnormal or the patient had an absent or decreased pulse at any point, get the CTA
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OrthoBullets: Knee Dislocation
Radiopaedia: Knee Dislocation
EM: RAP: Obese Patient and Knee Dislocations
Core EM: True Knee and Patellar Dislocations

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...more
8min
November 13, 2017Episode 121.0 – Pancreatitis
This week we dive into the diagnosis and management of pancreatitis in the ED

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_121_0_Final_Cut.m4a

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Tags: Gastroenterology, GI, Pancreatitis

Show Notes

Ranson’s Criteria for Pancreatitis-Associated Mortality (Rosen’s)
Take Home Points
Pancreatitis is diagnosed by a combination of clinical features (epigastric pain with radiation to back, nausea/vomiting etc) and diagnostic tests (lipsae 3x normal, CT scan)
A RUQ US should be performed looking for gallstones as this finding significantly alters management
The focus of management is on supportive care. IV fluids, while central to therapy, should be given judiciously and titrated to end organ perfusion
Patients will mild pancreatitis who are tolerating oral intake and can reliably follow up, can be discharged home
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Hemphill RR, Santen SA: Disorders of the Pancreas; 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) 91: p 1205-1226
PulmCrit: The Myth of Large-Volume Resuscitation in Acute Pancreatitis
PulmCrit: Hypertriglyceridemic Pancreatitis: Can We Defuse the Bomb?

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14min
November 06, 2017Episode 120.0 – Bites and Stings
This week we discuss common bites, stings and envenomations.

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_120_0_Final_Cut.m4a

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Tags: Bee Sting, Black Widow, Brown Recluse Spider, Hymenoptera

Show Notes

Take Home Points
The most common bites and stings you will see are by bees and ants. These can present as a local reaction, toxic reaction, anaphylaxis or delayed reaction. For all of these, treat with local wound care and epinephrine for any systemic symptoms.
The brown recluse spider is found in the Midwest and presents as local pain and swelling but carries the risk of a necrotic ulcer
The black widow spider is found all around the US and presents with either localized or generalized muscle cramping, localized sweating and potentially tachycardia and hypertension. Treatment is symptom management with analgesics and benzos.
The bark scorpion usually presents with localized pain and swelling, but particularly in children, may present with a serious systemic presentation including jerking muscle movements, cranial nerve dysfunction, hypersalivation, ataxia and opsoclonus, which is the rapid, involuntary movement of the eyes in all directions. Treatment is supportive cares, but remember to call your poison center to ask about antivenin.
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WikEM: Brown Recluse Spider Bite
WikEM: Black Widdow Spider Bite
WikEM: Hymenoptera Stings

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9min
October 30, 2017Episode 119.0 – Journal Update
This week we review 4 articles discussed in our conference in the last month.

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_119_0_Final_Cut.m4a

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Tags: ACS, AMI, Cardiac Arrest, Cardiology, Oxygen, Pediatrics, POCUS, Syncope

Show Notes

Take Home Points
Tachycardia in peds patients at discharge was associated with more revisits but not with more critical interventions. If your workup is reassuring, isolated tachycardia in and of itself shouldn’t change your disposition.
Supplemental O2 is not necessary in the management of AMI patients with an O2 sat > 90% and, may be harmful
Until further study and prospective validation has been performed, we’re not going to recommend embracing the Canadian decision instrument on predicting dysrhythmias after a syncopal event.
Finally, our agreement on what cardiac standstill is isn’t great. We need a unified definition going forward to teach our trainees and for the purposes of research.
Read More
Core EM: ED POCUS in OHCA – The REASON Study
ALiEM: Management of Syncope
EM Nerd: The Case of the Liberated Radicals
ScanCrit: O2 Not Needed in Myocardial Infarction
Core EM: Predicting Dysrhythmia after Syncope
Gaspari R et al. Emergency Department Point-Of-Care Ultrasound in Out-Of-Hospital and in-ED Cardiac Arrest. Resuscitation 2016; 109: 33 – 39. PMID: 27693280
References
Wilson PM et al. Is Tachycardia at Discharge from the Pediatric Emergency Department a Cause for Concern? A Nonconcurrent Cohort Study.Ann Emerg Med. 2017. PMID: 28238501
Hofmann R et al. Oxygen Therapy in Suspected Acute Myocardial Infarction. NEJM 2017. PMID: 28844200
Thiruganasambandamoorthy V et al. Predicting short-term risk of arrhythmia among patients with syncope: the Canadian syncope arrhythmia risk score. Acad Emerg Med 2017. PMID: 28791782
Hu K et al. Variability in Interpretation of Cardiac Standstill Among Physician Sonographers. Ann Emerg Med 2017. PMID: 28870394

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14min

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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