In this episode, Jocelyn and Dr Lokesh interview Dr Francis Lee about the exciting topic of Lung Ultrasound in the ED! Tune in to learn about when to do lung ultrasound, tips for how to improve your lung ultrasound skills, and what’s potentially in the future for lung ultrasound. 

Timestamps: 

3:00 Lung US basics 

8.31 Conditions and scenarios where Lung US is useful

12:14 BLUE protocol 

19:11 Tips for EPs hoping to improve in Lung US skills

21:13 Future Directions for Lung US in ED  

Credits

Music: Life-line by Colorful Sound via Pixabay 

SGH Podcast Studio

References

Lichtenstein DA. Lung ultrasound in the critically ill. Ann Intensive Care. 2014 Jan 9;4(1):1. doi: 10.1186/2110-5820-4-1. PMID: 24401163; PMCID: PMC3895677.

Any comments or feedback? Suggestions for future episodes? Send us a message!

https://semspodcast.buzzsprout.com/

In this episode, Matthew and Elizabeth interview Dr Mok Shao Feng about Feedback in Education and Entrustable Professional Activities (EPAs). Tune in to learn more about what EPAs are, what they mean to the frontline clinician, and how to apply principles of good feedback to do workplace based assessments well. 

Shownotes can be found at: https://tinyurl.com/EPAshownotes 

Timestamps

01:01 What is an EPA

03:42 How do you use the data from EPA based assessments? 

08:14 Models of Feedback

10:33 Following up on the Action Plan 

12:38 Grading the EPA for Straightforward cases

14:11 Take home points

Credits

Music: Life-line by Colorful Sound via Pixabay 

SGH Podcast Studio

Any comments or feedback? Suggestions for future episodes? Send us a message!

https://semspodcast.buzzsprout.com/

In this episode, Jocelyn and Elizabeth interview Dr Nicolas Lim (@POCUSclub) about his unique journey through both Emergency Medicine and Intensive Care training. Tune in to hear about his motivations, inspirations, challenges, and experiences! 

Credits:

Music -  Life-line by Colorful Sound via Pixabay/ Best Day by OctoSound via Pixabay SEMS

Dr Nicolas’s Recording Studio 

Note: This episode was recorded in Dec 2024 

All recordings should not be taken by users/ audience as medical advice. Everyone is encouraged to see their physicians for proper medical consultation.

Any comments or feedback? Suggestions for future episodes? Send us a message!

https://semspodcast.buzzsprout.com/

In this episode, Jocelyn and Elizabeth interview Dr Nicolas Lim (@POCUSclub) about Ultrasound in Shock! Tune in to find out more about how to utilize POCUS in patients in shock in the ED, as well as how to integrate your findings into clinical decision making! 

Timestamps

01:47 Ultrasound in the ED and how it has evolved over the years

04:29 RUSH protocol 

06:45 Volume Responsiveness & Volume Tolerance

09:45 Integration of findings into clinical decision making

12:44 Tips for EPs hoping to improve on our POCUS skills

Credits

Music: Life-line by Colorful Sound via Pixabay/ Best Day by OctoSound via Pixabay 

SEMS

Dr Nicolas’s Recording Studio 

Note: This episode was recorded in Dec 2024 

References

1. Kenny JS, Prager R, Rola P, Haycock K, Basmaji J, Hernández G. Unifying Fluid Responsiveness and Tolerance With Physiology: A Dynamic Interpretation of the Diamond-Forrester Classification. Crit Care Explor. 2023 Dec 12;5(12):e1022. doi: 10.1097/CCE.0000000000001022. PMID: 38094087; PMCID: PMC10718393.
2. https://www.youtube.com/@pocusclub5411 

All recordings should not be taken by users/ audience as medical advice. Everyone is encouraged to see their physicians for proper medical consultation. 

Any comments or feedback? Suggestions for future episodes? Send us a message!

https://semspodcast.buzzsprout.com/

In this episode, Jocelyn and Elizabeth interview Prof Phua Dong Haur about the exciting topic of Plant Toxicology! Interested to find out what makes plant poisoning unique, what are the common toxidromes and clinical features as well as management? Tune in to find out more! 

References 

1. D Frohne Et Al.Poisonous Plants: A Handbook For Pharmacists, Doctors, Toxicologists, Biologists And Veterinarians, 2nd Edition 2005
2. Kent R. Olson, Et Al. Poisoning & Drug Overdose, 7th Ed.
3. Neal Flomenbaum, Et Al. Goldfrank's Toxicologic Emergencies, Eighth Edition
4. Phua DH, Cham G, Seow E. Two instances of Chinese herbal medicine poisoning in Singapore. Singapore Med J. 2008 May;49(5):e131-3. PMID: 18465037.
5. Fuchs J, Rauber-Lüthy C, Kupferschmidt H, Kupper J, Kullak-Ublick GA, Ceschi A. Acute plant poisoning: analysis of clinical features and circumstances of exposure. Clin Toxicol (Phila). 2011 Aug;49(7):671-80. doi: 10.3109/15563650.2011.597034. Epub 2011 Aug 2. PMID: 21809910.
6. Krenzelok EP, Mrvos R. Friends and foes in the plant world: a profile of plant ingestions and fatalities. Clin Toxicol (Phila). 2011 Mar;49(3):142-9. doi: 10.3109/15563650.2011.568945. PMID: 21495882.

Credits

Music: Life-line by Colorful Sound via Pixabay, Best Day by OctoSound via Pixabay/ SGH Podcast Studio/ SEMS

All recordings should not be taken by users/ audience as medical advice. Everyone is encouraged to see their physicians for proper medical consultation. 

Any comments or feedback? Suggestions for future episodes? Send us a message!

https://semspodcast.buzzsprout.com/

In this episode, Dr Liu Zhenghong interviews Dr Koh Shao Hui about Sepsis in the ED, including definitions, the Marik and Rivers studies, treatment principles and goals as well as the evidence behind them, and future directions. 

Timestamps:
01:51 Sepsis definitions (SOFA, qSOFA, NEWS, Sepsis 3, Septic shock)

09:37 Treatment principles and goals: Fluid Resuscitation 

11.03 POCUS directed fluid resuscitation & Passive Leg Raise

14:23 Vasopressors in Sepsis

17:57 Time to Antibiotics 

20:29 Steroids in Sepsis 

21:36 Marik & Rivers studies 

25:30 Target Hb/ Glucose control 

28:43 Intubating a septic patient

30:22 (More about) POCUS in septic patients 

33.41 Disposition 

36:21 Future Directions

For more on use of vasopressors in shock, check out Episode 8. Keen listeners may find some differences in nuances across episodes; we strive to represent this diversity and complexity in our field, and encourage listeners to engage with the evidence and contextualise it to their own practice.

References:

1. Evans et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Critical Care Medicine 49(11):p e1063-e1143, November 2021. 
2. Bannard-Smith J et al. The efficacy, safety and effectiveness of hyperoncotic albumin solutions in patients with sepsis: A systematic review and meta-analysis. J Intensive Care Soc. 2024;25(3):308-318. 
3. Deng J et al. Efficacy and Safety of Hydrocortisone, Ascorbic Acid, and Thiamine Combination Therapy for the Management of Sepsis and Septic Shock: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Int Arch Allergy Immunol. 2024;185(10):997-1018. 
4. Fernando SM et al. Methylene Blue in Septic Shock: A Systematic Review and Meta-Analysis. Crit Care Explor. 2024;6(7):e1110.
5. Killu K et al. The association between integrating echocardiography use in the management of septic shock patients and outcomes in the intensive care unit: a systematic review and meta-analysis. J Ultrasound. 2024 Oct 17. 

Credits: 

Music: Life-line by Colorful Sound via Pixabay

SGH Podcast Studio

SEMS 

Any comments or feedback? Suggestions for future episodes? Send us a message!

https://semspodcast.buzzsprout.com/

In this episode, Dr Elizabeth Tan and Dr Lenard Cheng interview Dr Tallie Chua about Vasopressors. We discuss a recent article published in The Journal of Emergency Medicine 2024 entitled: A Clinical Review of Vasopressors in Emergency Medicine. 

Timestamps

• 02:03 Case Scenario (Hypothetical) 
• 05:52 Hypovolemic Shock
• 07:04 CENSER
• 08:14 CLOVERS
• 09:23 SOAP II 
• 09:43 Second line Vasopressors 
• 10:54 Peripheral vasopressors
• 16:37 Push Dose pressors 
• 20:14 Optimal MAP
• 22:29 Cardiogenic Shock 
• 26:10 Obstructive Shock 
• 28:37 Vasopressor unresponsive shock - PACT
• P = pH (acidosis)
• A= adrenal insufficiency
• C = hypocalcemia
• T - Hypothyroidism

References

1. Stampfl M, DeBlieux P. A Clinical Review of Vasopressors in Emergency Medicine. J Emerg Med. 2024 Jul;67(1):e31-e41. doi: 10.1016/j.jemermed.2024.03.004. Epub 2024 Mar 12. PMID: 38789351.
2. Permpikul C, Tongyoo S, Viarasilpa T, Trainarongsakul T, Chakorn T, Udompanturak S. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER). A Randomized Trial. Am J Respir Crit Care Med. 2019 May 1;199(9):1097-1105. doi: 10.1164/rccm.201806-1034OC. PMID: 30704260.
3. National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Clinical Trials Network; Shapiro NI, Douglas IS, Brower RG, Brown SM, Exline MC, Ginde AA, Gong MN, Grissom CK, Hayden D, Hough CL, Huang W, Iwashyna TJ, Jones AE, Khan A, Lai P, Liu KD, Miller CD, Oldmixon K, Park PK, Rice TW, Ringwood N, Semler MW, Steingrub JS, Talmor D, Thompson BT, Yealy DM, Self WH. Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. N Engl J Med. 2023 Feb 9;388(6):499-510. doi: 10.1056/NEJMoa2212663. Epub 2023 Jan 21. PMID: 36688507; PMCID: PMC10685906.
4. De Backer D, Biston P, Devriendt J, Madl C, Chochrad D, Aldecoa C, Brasseur A, Defrance P, Gottignies P, Vincent JL; SOAP II Investigators. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010 Mar 4;362(9):779-89. doi: 10.1056/NEJMoa0907118. PMID: 20200382.
5. Hawn JM, Bauer SR, Yerke J, Li M, Wang X, Reddy AJ, Mireles-Cabodevila E, Sacha GL. Effect of Phenylephrine Push Before Continuous Infusion Norepinephrine in Patients With Septic Shock. Chest. 2021 May;159(5):1875-1883. doi: 10.1016/j.chest.2020.11.051. Epub 2020 Dec 13. PMID: 33316239. 

Credits

Music: Life-line by Colorful Sound via Pixabay/Best Day by OctoSound via Pixabay 

SGH Podcast Studio

SEMS

All recordings should not be taken by users/ audience as medical advice. Everyone is encouraged to see their physicians for proper medical consultation.

Any comments or feedback? Suggestions for future episodes? Send us a message!

https://semspodcast.buzzsprout.com/

In this episode, Elizabeth and Matthew discuss Paracetamol Toxicity with Dr Ng Mingwei. We cover the 2 Bag versus 3 Bag regimens, when to stop NAC, RSTI, what to do for anaphylactoid reactions, massive paracetamol OD, and the paracetamol multiplication product.

Timestamps 

01:57 Case #1

03:01 Mechanism of Toxicity 

04:00 Risk profiling and Rumack-Matthew Nomogram 

06:20 Case #2 

08.25: NAC/ 2 bag vs 3 bag regimen 

11:24 Paracetamol Guidelines

12:56 Paracetamol Multiplication Product* 

*Note: The study quoted was in a population treated with NAC. 

14:53 Anaphylactoid reactions

15:37 When to cease NAC

16:24 RSTI

18:04 Massive Paracetamol OD

19:58 Liver transplant

20:47 3 Takeaways 

Thank you for listening!

Credits

Music: Life-line by Colorful Sound via Pixabay

SGH Podcast Studio

SEMS

Dr Mong Rupeng for reviewing this episode

References

1. Chiew AL, Reith D, Pomerleau A, Wong A, Isoardi KZ, Soderstrom J, Buckley NA. Updated guidelines for the management of paracetamol poisoning in Australia and New Zealand. Med J Aust. 2020 Mar;212(4):175-183. doi: 10.5694/mja2.50428. Epub 2019 Dec 1. PMID: 31786822.
2. Wong A, Isbister G, McNulty R, Isoardi K, Harris K, Chiew A, Greene S, Gunja N, Buckley N, Page C, Graudins A. Efficacy of a two bag acetylcysteine regimen to treat paracetamol overdose (2NAC study). EClinicalMedicine. 2020 Mar 19;20:100288. doi: 10.1016/j.eclinm.2020.100288. PMID: 32211597
3. Wong A, Sivilotti MLA, Graudins A. Accuracy of the paracetamol-aminotransferase multiplication product to predict hepatotoxicity in modified-release paracetamol overdose. Clin Toxicol (Phila). 2017 Jun;55(5):346-351. doi: 10.1080/15563650.2017.1290253. Epub 2017 Feb 15. PMID: 28421844. 

All recordings should not be taken by users/ audience as medical advice. Everyone is encouraged to see their physicians for proper medical consultation. 

Any comments or feedback? Suggestions for future episodes? Send us a message!

https://semspodcast.buzzsprout.com/

Ever had a busy shift where you had to teach at the same time, and wondered how to juggle it all, or a less busy shift where you wondered how to teach without an abundance of clinical material? In this episode, we talk with Dr Derek Heng about ways to teach more effectively on shift! 

Timestamps 

• 03:09 What is a good teaching shift? 
• 07:01 How to go about it? 
• 07:36 Setting expectations
• 11:18 Tailoring to patient acuity 
• 23:30 Metacognition 
• 25:49 Wrapping up
• 28:16 Enjoying the process - the secret sauce? 

Credits:

• SEMS
• SGH Podcast Studio
• Music: Life-line by Colorful Sound via Pixabay

All recordings should not be taken by users/ audience as medical advice. Everyone is encouraged to see their physicians for proper medical consultation. 

https://semspodcast.buzzsprout.com/

Any comments or feedback? Suggestions for future episodes? Send us a message!

https://semspodcast.buzzsprout.com/

In Part 1 of this episode, Elizabeth and Jocelyn go through a brief Introduction to Toxicology with the RRSIDEAD approach and common toxidromes, and in Part 2, Matthew and Elizabeth interview Dr Loo Kee Vooi about the exciting topic of Methemoglobinemia!
Thank you for listening!

Timestamps
Introduction to Toxicology
01:45 RRSIDEAD
05:55 MDAC (ABCDQ Mnemonic)
06:45 Dialyzable toxins (PLASMA TV) 
07:33 Antidote Quiz
10:11 Toxidromes
10:38 Sedative Hypnotic
11:08 Anticholinergic Toxidrome
11:46 Cholinergic Toxidrome (SLUDGE/DUMBBELLS)
13:38 Sympathomimetic Toxidrome
14:39 Serotonin Syndrome
15:28 Neuroleptic Malignant Syndrome
15:56 Malignant Hyperthermia

Methemoglobinemia 
18:47 Overview and Case Scenario 
20:24 Initial Management and Diagnostic Clues
23:17 Why is the SpO2 85%?
24:06: Common causes
25:06 Diagnosis
28:13 Considerations when giving Methylene Blue

Credits
Music: Life-line by Colorful Sound via Pixabay/ Best Day by Octosound via Pixabay 
SGH Podcast Studio
SEMS
Dr Mong Rupeng for reviewing the Introduction to Tox Segment 

References
https://litfl.com/approach-to-acute-poisoning/
https://emcrit.org/ibcc/methemoglobinemia/ 
Toxicology Handbook by Jason Armstrong/ Ovidiu Pascu (4th Ed) 
Goldfrank’s Toxicologic Emergencies (11th Ed) 

All recordings should not be taken by users/ audience as medical advice. Everyone is encouraged to see their physicians for proper medical consultation. 

Any comments or feedback? Suggestions for future episodes? Send us a message!

https://semspodcast.buzzsprout.com/