EMplify - May 2021 Announcements: The Clinical Decision Making in the Emergency Department conference is June 23-27 live and virtual. More information here: https://clinicaldecisionmaking.com Be on the lookout for an announcement regarding the new EB Medicine app, coming to an App Store near you this summer !! Atrial Fibrillation : An Approach To Diagnosis And Management In The Emergency Department - An Interview with Dr Brian Millman Epidemiology Causes Prehospital treatment - careful with causes of the A Fib. ED Evaluation History - beware the causes Physical ECG Labs Imaging Echocardiography Treatment Rate control Calcium channel blockers Beta blockers Esmolol Magnesium Rhythm control Amiodarone Procainamide Cardioversion Watch and Wait Anticoagulation Disoposition 

EMplify - April 2021

Announcements

1. Traumatic Hemorrhage in the ED- with Dr Scott Weingart - April 13th, 8pm EST Free ! Register now: https://www.crowdcast.io/e/traumatic-hemorrhagic/register
2. Pandemic Preparedness publication is coming soon.
3. Mt Sinai COVID-19 Treatment Protocols have been updated and are available for free here: https://www.ebmedicine.net/topics/COVID-19/Protocols
4. The Clinical Decision Making in the Emergency Department conference is June 23-27 live and virtual. More information here: https://clinicaldecisionmaking.com

Management of Suspected Rabies Exposure in the Emergency Department - An Interview with Dr. Bess Storch

Epidemiology:

• Fatality rate of over 99%
• Half of cases occur in children
• 95% of cases are in resource limited countries, 35% in India
• 99% caused by infected dogs (worldwide)
• In the US, cases are predominantly bat variant

Why this topic?

• "In a recent survey of licensed physicians, less than half could identify rabies transmission routes, the correct PEP schedule, and the correct anatomic administration sites."

Pathophysiology:

• What causes it? The RNA virus Lyssavirus
• How is it transmitted?
• How does it reach the brain?

ED Evaluation:

• What does it look like clinically?
• 5 stages- incubation, prodrome, acute neurologic phase, coma death
• Why doesn’t everyone just get vaccinated?
• What patient medical history is important ? Steroids, chloroquine
• What animals are high risk?
• What about pets and quarantine?
• What about rodents ?
• Is there any role for labs or imaging ?
• What is the treatment regimen for those who are unvaccinated? And vaccinated?
• What about people who are immunosuppressed?
• Children?
• Pregnant?
• Recently traveled?

EMplify - March 2021

Management of Acute Urinary Retention in the Emergency Department

1. An algorithmic approach to urinary retention.
2. Relieve the obstruction 

• Foley
• Cudet cather
• Silicone catheter
• Suprapubic catheter

1. Determine the cause - 

• Structural
• Medications / Toxicologic
• Neurologic
• Infectious

1. Alpha blockers
2. Antibiotics
3. Slow vs rapid bladder decompression
4. Admit or discharge
5. Phimosis and Paraphimosis

Announcements:

1. New Airway Course Available: Current Topics in Airway Management: Mechanical Ventilation, Supraglottic Airway Devices, and Intubating Patients With COVID-19
2. Upcoming Live Course: Dr. Scott Weingart - Traumatic Hemorrhage - April 13th., 8-9pm, EST
3. Look for the "Key Points And Pearls From 2020" coming to your inbox or mailbox next month !

EMplify - February 2021

Community Acquired Pneumonia - An Interview with Dr. Matthew DeLaney, FACEP

1. Pneumonia and nomenclature : healthcare associated vs hospital associated

2. COVID-19 and antibiotics

3. Bacteriology - Strep is only 10-15% of hospitalized pneumonia, Viral pneumonia is about 20% (pre covid)

4. Conditions that predispose to pneumonia

• chronic lung disease (chronic obstructive pulmonary disease, bronchiectasis)
• smoking
• older age
• immuno-compromise
• proton-pump inhibitors, H2 blockers, and antipsychotic agents

5. Is there a historical or exam item most likely to be indicative of pneumonia?

6. How good is a CXR?

7. When should I consider a CT if the CXR is normal?

8. Procalcitonin

9. Blood cultures, sputum cultures, urine antigens- are these helpful?

10. CURB-65 vs PSI

11. Antibiotics- table 3 major and minor, history of prior infection, and doxy for everyone !

12. Duration - 5 days works

13. A walk through the pathway

EMplify January 2021

Evaluation and Management of ST-Segment Elevation Myocardial Infarction in the Emergency Department

Authors

Marshall Frank, DO, MPH, FACEP

Carson Sanders, BS, NRP, CCEMT-P

Bryan P. Berry, MD, BCEM, FACEP

Topics

Epidemiology

Pathophysiology

Prehospital care

Emergency Dept Evaluation

• History
• Physical

Imaging

Labs

Electrocardiogram

• aVR
• Posterior Leads
• LBBB
• Serial ECGs
• Reciprocal Changes
• Pericarditis vs STEMI

Treatment

• Oxygen
• Opioids
• Antiplatelet Agents
• Nitroglycerin
• Beta Blockers
• Reperfusion
• PCI
• Thrombolytics
• Dysrhythmias
• Anticoagulants

Transfers

Special Circumstances

• Gender
• Age
• Cocaine

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