Date: June 2, 2025

Dr. Andrew Tagg

Guest Skeptic: Dr. Andrew (Andy) Tagg is an Emergency Physician with a special interest in education and lifelong learning. He is the co-founder and website lead of Don’t Forget the Bubbles.

This is another SGEM Xtra that talks about what we can learn about being physicians from certain pop culture (TV and Movies). Past episodes include:

The SGEM will return with a structured critical appraisal of a recent publication. We will continue to strive to reduce the Knowledge Translation (KT) window from over ten years to less than one year, leveraging the power of social media.

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Dr. Wm. Ken Milne Emergency Medicine Physician Researcher/EBM Skeptic

The post PODCAST: Your Mission, Should You Choose to Accept It – To Be an EM Doc first appeared on האיגוד הישראלי לרפואה דחופה.

In this episode, Sam Ashoo, MD interviews Rob Orman, MD about ways to manage the trauma inflicted by the ER.

For more about Rob Orman and physician coaching: https://roborman.com/

Sam Ashoo, MD, FACEP,  is board certified in emergency medicine and clinical informatics. He serves as EB Medicine’s editor-in-chief of interactive clinical pathways and FOAMEd blog, and host of EB Medicine’s EMplify podcast. Follow him below for more…

The post PODCAST: Strategies for Keeping Trauma at Bay with Rob Orman, MD first appeared on האיגוד הישראלי לרפואה דחופה.

Phase One: CNS

Phase Two: Cardiopulmonary

Phase Three: Renal

Diagnosis:

Treatment:

The post PODCAST : summary EM clerkship CNS, Cardiopulmonary, Renal Diagnosis: first appeared on האיגוד הישראלי לרפואה דחופה.

Stephen Freedman on pediatric bloody diarrhea, S-TEC and hemolytic uremic syndrome (1:06)

Justin Morgenstern on the evidence for IM epinephrine in out of hospital cardiac arrest (27:04)

Matthew McArther on recognition and ED management of dengue fever (33:56)

Andrew Petrosoniak on imaging decision making in trauma in older patients (47:20)

Brit Long & Michael Gotlieb on recognition and management of TTP (59:10)

Podcast production, editing and sound design by Anton Helman

Podcast content, written summary & blog post by Brandon Ng, edited by Anton Helman, March, 2025

Cite this podcast as: Helman, A. Freedman, S. Morgenstern, J. McArther, M. Petrosoniak, A. Long, B. Gotlieb, M. EM Quick Hits 63 – S-TEC and HUS, IM Epinephrine in OHCA, Dengue, Geriatric Trauma Imaging, TTP. Emergency Medicine Cases. March, 2025. https://emergencymedicinecases.com/em-quick-hits-march-2025/. Accessed March 12, 2025.

Consider obtaining a stool specimen or rectal swab in the ED for PCR testing (not culture) to detect S-TEC, Salmonella, Shigella, and Campylobacter.

Which children with bloody diarrhea require bloodwork? Most children with blood in stool do not require blood work. Indications for bloodwork include:

When to suspect S-TEC?

Children generally do not require stool O&P for acute diarrhea but should be considered for chronic abdominal pain, chronic diarrhea, or failure to thrive.

When to test for C.difficile? There is a high carriage rate of C. diff (up to ~50% in children under 2 years old). Consider C. diff testing only in children with risk factors such as recent antibiotic use or hospitalization, or as a second line test on follow up if bloody diarrhea persists that is not noted to be from another bacterial etiology.

Why is it important to recognize S-TEC?

A complication of S-TEC infection is Hemolytic Uremic Syndrome (HUS), caused by Shiga toxin accumulation in the kidney which leads to the HUS triad: acute kidney injury, hemolysis, and thrombocytopenia.

How to risk stratify a positive STEC result:

How to manage high risk patients with confirmed S-TEC?

Bottom line: Obtain early stool testing to identify children who present with bloody diarrhea for STEC, as some are at high risk of developing complications such as HUS. Children with STEC and their hydration status should be closely monitored.

The Paper: Early intramuscular adrenaline administration is associated with improved survival from out-of-hospital cardiac arrest by Palatinus et al. Resuscitation 2024.

This before-and-after study suggests 5mg IM epinephrine may improve survival when given while IV access is being secured during an out of hospital cardiac arrest.

P: Adult patients with out-of-hospital cardiac arrest at a single-center urban setting

I (After): Single dose 5mg IM epinephrine prior IV/IO access in patient between November 2019 and May 2024

C (Before): Standard EMS ACLS protocol without IM epinephrine in patients between January 2010 and October 2019

O: Time to epi administration: 4.3 min in IM epi group, 7.8 min in standard protocol group. Survival to hospital admission: 37% in IM epi group, 32% in standard protocol group. Hospital survival: 11% in IM epi group, 7% in standard protocol group. Favourable neurological status at hospital discharge: 10% in IM epi group, 6% in standard protocol group

Limitations of this study:

Bottom line: There is insufficient evidence for early administration of IM epinephrine compared to standard ACLS protocols to improve outcomes in out of hospital cardiac arrest.

Background: Dengue is a mosquito-borne flavivirus (related to Zika and West Nile) which transmits between humans by mosquitos and is endemic to many countries in tropical and subtropical regions. It has been an increasing public health concern due to increasing outbreaks over the last decade. All 4 types of Dengue cause acute infections in humans but are not known to cause chronic infections.

75% of dengue infections are asymptomatic. However, 2-5% of dengue can progress to severe dengue.

There are 3 phases of dengue:

The updated WHO classification system for dengue includes dengue, dengue with warning signs, or severe dengue. Consider the diagnosis of dengue in patients coming from an endemic area who have fever and any 2 of: aches, rash, nausea, vomiting, leukopenia, and positive tourniquet test.

Warning signs for severe dengue:

Severe dengue = shock, clinically significant bleeding, or severe organ impairment

There are no specific therapies or vaccines for Dengue. Management is primarily supportive:

Bottom line: Dengue is self-limiting in most cases but can be life-threatening in 2-5% of patients. Management of dengue is primarily supportive with oral or IV fluid resuscitation.

Falls in the older patient can result in significant injuries despite seemingly minor mechanisms.

CT imaging considerations:

The Eastern Association for the Surgery of Trauma (EAST) developed an imaging decision algorithm for the evaluation of blunt trauma patients > 65 although it has not received external validation. They recommend:

Thrombotic thrombocytopenic purpura (TTP) is a rare but important disorder as it is associated with a mortality rate of 4-30%, even with early recognition and treatment.

In TTP, enzyme ADAMTS13 (responsible for cleaving large von Willebrand factor (vWF) becomes dysfunctional, resulting in large vWF multimers which accumulates in platelets, form clots, and destroys RBCs, leading to thrombocytopenia and hemolysis.

The classic pentad is seen in less than 7% of patients with TTP, and many of these findings can be transient:

Lab work for TTP

A PLASMIC Score ≥5 has a 99% sensitivity and 57% specificity for TTP (incorporates elements including platelet count, hemolysis, active cancer, solid organ or stem cell transplant, low MCV, INR <1.5, Cr <2mg/dL).

Management of TTP:

Bottom line: Patients with TTP may not present with all elements of the classic pentad. Early identification and therapy can significantly improve mortality. The PLASMIC score can be used to assist in identifying patients with TTP.

The post PODCAST: EM Quick Hits 63 S-TEC and HUS, IM Epinephrine in OHCA, Dengue, Geriatric Trauma Imaging, TTP first appeared on האיגוד הישראלי לרפואה דחופה.