TOTAL EM - Tools Of the Trade and Academic Learning in Emergency Medicine

Recently, Dr. Jeff Jarvis was published in the Annals of Emergency Medicine for a paper regarding a clinical bundle he developed to reduce complications during intubation. Specifically, his paper was to help reduce hypoxia in out-of-hospital intubation attempts. However, the pearls can be used by anyone managing the airway of a patient.

What happens when you have someone who is anticoagulated fall and have minor head trauma? They are talking to you, they appear neurologically intact, and they feel like they can go home. Do you let them or do you still encourage a CT scan of their head? There is a recent paper that may change your practice.

Firefighters are exposed to a number of dangers on a daily basis. With this being the anniversary of 9/11, we want to dedicate this blog and podcast to all the victims from that day. Most of us are already very familiar with issues that arise with firefighters such as PTSD and the impact on the body from long hours, overtime, and physical stress. Unfortunately, we often forget about the other needs and special scenarios that firefighters come across and will cover some of the key aspects in this blog and podcast.

At the request of listeners, we are covering some essential clinical topics such as deep neck infections including peritonsilar abscess (also known as "quinsy"). These are life-threatening conditions that require early recognition and intervention. Since peritonsilar infections are not of deep visceral spaces, this is technically separate but given their high incidence and at times coexistence with other deep neck infections they are often combined such as in discussion.

I​​ntraosseous (IO) devices are traditionally used in the initial stages of resuscitation when peripheral intravenous (IV) access is not readily obtainable. This can happen for a variety of reasons such as edema, burns, obesity, or IV drug abuse among others. Although ultrasound can be used to obtain peripheral or central venous access, the most rapid route is the IO. The device has been used both in adults and children with great success. It can safely facilitate the delivery of fluids, medications, and blood. There are very few contraindications and it is rare to have a complication.

It has been 100 podcasts since the last time Jim DuCanto talked about his SALAD (Suction Assisted Laryngoscopy Airway Decontamination) technique. Podcasts #8 and #9 were so long ago we wanted to have Jim back on to celebrate his achievements and talk more about the future of SALAD and other related projects.

Every year, we see drownings. In some cases people survive, but unfortunately sometimes they do not. However, there is confusion in both the medical community and the public regarding what is considered to be a drowning event. Dogma and myths are everywhere and one of the most common is "dry drowning" which is why we brought Michelle Perkins on to discuss this important issue.

We see changes in potassium levels all of the time in patients. However, what works and what does not? What is the evidence behind the management? Are there special pearls? These questions and much more are addressed in this podcast with Michelle Perkins.

Patients often come in complaining of a possible spider bite, but is this actually the cause of their symptoms? In this blog and podcast, we talk specifically about brown recluse bites, differentiating them from other causes, treatment, and other pearls.

Epinephrine (adrenaline) has been a hallmark of cardiac arrest management as an attempt to obtain a return of spontaneous circulation (ROSC). However, the evidence for epinephrine in out-of-hospital cardiac arrest (OHCA) as well as in the hospital (IHCA) has been conflicting. We review the largest trial to date just recently published in the New England Journal of Medicine (NEJM).