EM Basic (Steve Carroll, DO)

Syncope (or "passing out") is a chief complaint that we deal with a lot in the emergency department. While most causes of syncope are benign and need nothing more than reassurance, we need to be on the lookout for the serious causes of syncope. This episode will focus on the definition of syncope, how to get a complete history, catch the red flags, perform a targeted workup that doesn't keep the patient in the ED forever, and how to scrutinize an EKG for the deadly arrhythmias that we can't miss.

In addition, per a request from a podcast listener, there is a bonus section on how to effectively rehydrate patients in the ED. You may be surprised that there are other options besides putting an IV in everyone.

Ebola has been in the news for the past few months and it has taken on more urgency in the US as cases have arrived from outside the country  Within the past week, transmission to two healthcare workers outside of Africa has been reported.  Dr. Prabu Selvam, an intern at the Wright-Pratt Emergency Medicine Residency, provided the resources for today's episode on Ebola.  In this short episode we will discuss appropriate screening for Ebola, it's signs and symptoms, lab abnormalities, how to confirm infection with laboratory testing, treatment of Ebola, and how to properly isolate patients with this disease.  While now is not the time to panic and think that every fever and sniffle is Ebola, we should certainly be aware of how to properly screen, diagnose, and treat this deadly disease.

For the second part of trauma resuscitation, we'll discuss the various interventions that you may have to accomplish in the trauma bay. The first part is a continuation from the first episode and talks about the EFAST exam- a vital part of the secondary survey. The second part discusses the control of massive extremity hemorrhage and how to intervene on any airway, breathing, or circulation issue in the trauma bay.

Dr. Jordan Cramer joins Dan McCollum to discuss the management of hyperkalemia.  

• Learn key aspects of the history and physical
• Discuss the importance of an early ECG.
• Discover important details about a variety of treatment options.

Kawasaki:

Dr. Pushpa Shivaram, an assistant professor of pediatrics and pediatric cardiologist at the Medical College of Georgia, joins Dr. Zac Hodges and Sonal Dugar (M4) to discuss this very important topic in pediatric medicine.

What exactly is Kawasaki disease and why is this topic so important?

How do you make the diagnosis and what other diagnoses should you consider?

How can you diagnosis incomplete Kawasaki when the classic features are not all present?

What is the first-line treatment?

When should you get an echocardiogram?

When should you get your referral center involved?

All of this and more from the Department of Pediatrics and the Medical College of Georgia. 

Check out our website for detailed show-notes: https://www.augusta.edu/mcg/pediatrics/residency/podcast.php

Special thanks to Dr. Reda Bassali, Dr. Leizl Domingo and Dr. Julisa Patel for providing peer review for this episode.

Questions, comments, or feedback? Please email us at mcgpediatricpodcast@augusta.edu 

Further Reading? Check out the clinical practice guideline from the American Heart Association with citation below.

A week ago, I posted an airway review paper by Scott Weingart and Richard Levitan that I think is a must read. Today I decided to do a podcast reviewing the paper in order to really get it out there and talk about the major points. The best part of the paper is the description of the NO DESAT technique which virtually eliminates hypoxia during RSI and will make your next intubation a lot easier. While this podcast is a lot more advanced than the usual "basic" topics that I usually talk about, its important to know about these techniques. My 0.02- they will become the new standard of care in the near future but you can hear about them now.

Dr. Tony Zitek drops some knowledge on you about the deceptively complex topic of sore throats.  What diagnoses are important other than strep and viral pharyngitis?  Why should assess neck mobility during your physical examination?  How should you treat common causes of sore throat?  Join us for this and more on this episode! 

Infants with fever present a special challenge in the emergency department. Most of these children require large workups and admission to be sure that we aren't missing serious bacterial infections or meningitis. The risks are high here and we need to make sure that we do the right thing for our smallest and youngest patients. We'll talk about how to assess infants from the foot of the bed, how to get an effective history and physical, how to do a sepsis workup in this age group, and some tricks of the trade for how to do an LP on an infant.

There's also a bonus section on pediatric UTIs and how to use a glidescope.

Being able to run an effective trauma resuscitation is a necessary skill for any emergency medicine provider. In part 1 of this 2 part series, I'll go over how to properly assess a trauma patient who arrives to the ED. We'll go over how to prepare for the patient's arrival, how to perform the primary and secondary surveys, how to make sure we get a good report from the EMS crew, and how to avoid the pitfalls during these first few crucial minutes in the care of a trauma patient.

The bonus section is a rant on why you should get your trauma patients off the backboard as soon as possible.

Join Dan McCollum as he discusses COVID-19, the disease caused by the novel coronavirus.

• What are the symptoms of this disease?
• How is it spread?
• What personal protective equipment is needed?
• What are key elements of the history and physical exam?
• Are there any treatments that help?

This is a rapidly evolving topic, so please use multiple sources, stay informed, and follow your local hospital's guidance as this disease develops.

Join Dan McCollum and EM clinical pharmacist RJ LaCoursiere as they discuss the use of buprenorphine for the treatment of Opioid Use Disorder.

• Who should be considered for treatment with Medication-Assisted Treatment (MAT)?
• Why should it be avoided if the patient isn't in acute withdrawal?
• What is a DEA X waiver and why should you look into getting waivered?
• How can we reduce stigma for these patients?

Free training can be found at https://nhsc.hrsa.gov/loan-repayment/receive-medication-assisted-treatment-training . 

This podcast will be cross published with the Pharm So Hard podcast, so check them out for additional pharmacology pearls.

A special thanks to student doctor Michael Stephens for editing this podcast.

Being able to give a good ED patient presentation will not only help you get a good grade on your EM rotation, it will also make sure that nothing is missed in the patient's care.  In this episode, I'll discuss the nuts and bolts of forming and delivering a solid ED patient presentation that is complete and concise at the same time.  I'll also give a few example presentations so you can put it all together.  The show notes here are condensed down so you can carry them around with you on shift so you don't forget anything.  There is even a card sized version in the show notes for even further portability.  Feel free to take the Word format show notes and re-format them to fit your needs.

EM Basic is back with a brand new episode.  Today's episode was done by Dylan Norton and David Murphy, both 4th year medical students at the University of Colorado Medical School.  We see epistaxis a lot in the ED and while most of it is mild and self limiting, there are frequently cases that take a lot of skill to manage.  They'll talk about the basics of the history and physical with epistaxis, how to order the necessary lab tests, how to manage any case of epistaxis in a step-wise manner, and some newer areas of research.

Today’s episode is on the evaluation and management of sickle cell anemia in the Emergency Department. Dr Jared Walker, a third year EM resident at the University of Florida Jacksonville, has written and recorded this excellent review of sickle cell disease. This episode will discuss how to properly assess patients with sickle cell, how to order the right labs and imaging, what red flags to look out for, how to control sickle cell pain, how to catch the various complications of sickle cell, and proper patient disposition.

Hyponatremia (low serum sodium) is one of the most common electrolyte disorders encountered in the ED. Most of the time this electrolyte disorder requires us to do less- not more. However, if the patient is critically ill from their hyponatremia then we need to know how to quickly intervene and even be a little creative if we don't have the medications that we want. We'll review how to do the right thing for these patients, track down the cause of hyponatremia, and make the right decisions so we don't cause any harm.

This is an announcement instead of an episode.  Introducing the EM Basic Project.  If you are a senior resident or attending in emergency medicine- this is your chance to contribute to the podcast.  I will be accepting quality submissions for the podcast with help every step of the way.  I'm also looking for a webmaster to help spruce up the blog page.  In addition- if you have an idea for a blog or a podcast or don't even know where to start, email me and I can help.  Take a listen to hear all the details and stay calm- I will still be producing new material just like usual as the podcast enters it's third year of production.

Transfusion reactions are a dreaded complication in the ED.  Join emergency physicians Michael Samuels and Dan McCollum as they discuss the following and more!

• How do you recognize different types of transfusion reactions?
• How are different reactions managed?
• What infections can be seen with blood transfusion?
• Why is TRALI such a feared complication?

In today's episode we are going to talk about documentation in the ED.  It is very important that we are complete but concise in our documentation in order to provide an accurate record for the patient's ED patient to protect them and ourselves from problems down the road.  Good documentation is good patient care so we need to know how to do this efficiently.  We will review each part of the chart starting with the triage note and ending how to give good discharge instructions.  We'll also review some tips and tricks of the trade regarding abbreviations that will make your charting faster, how to document interactions with our consultants, and even what to do when you have to document a difficult situation with a consultant.

Join Zac Hodges, Chris Watson, and Dan McCollum as they discuss the management of pediatric diabetic ketoacidosis, or DKA.  What are key findings on the history and physical exam that point to DKA?  What is the initial management of these patients?  How is the management similar and different than the management of DKA in adults?  Join us for the answer to this and more.

Join Dr. Mike Wallace and Dan McCollum as they discuss the management of patients with gastrointestinal hemorrhage.

• What is the initial management of these patients?
• Who requires blood transfusions?
• Which patients require admission to the floor or the ICU?

Pearls and pitfalls in the management of these challenging patients are discussed.  Enjoy!

Join Jordan Nogle as she discusses how to deliver the very best care for possible victims of Human Trafficking.

• What are subtle signs that your patient may be a human trafficking victim?
• What is your initial approach?
• How can you give your patient multiple options on how to proceed?
• What resources can you use?

Join Jordan as she discusses this and much more!

In this episode, we'll talk about how to manage the airway in patients with anaphylaxis or any other upper airway obstruction.  These can be some of the most difficult airways to manage and we can run into trouble if we don't have a good plan ahead of time.  Some of this is a little "advanced" and "cutting edge" but it's important to have as many tools in your arsenal when dealing with these critical airways.  We'll review other options besides RSI to include awake intubation, delayed sequence intubation (DSI), and the awake cric.

Join Dr. Alex Koo as he discusses ear and nasal foreign bodies.  He'll give you a brief run-down of anatomy, history, and physical, before diving into comprehensive, key concepts of foreign body removal.  There will be some great tips and tricks shared!

-Where do foreign bodies commonly get stuck in the ear and nose?

-What important historical and physical examination features should you focus on for these foreign bodies?  What are considered dangerous objects that need immediate removal?

-What equipment and techniques can you use for helping visualize the foreign bodies?

-What techniques can you use for achieving a more cooperative patient?

-What equipment and techniques are available to extract these foreign bodies?

-What complications can happen from removal?

-Who should be referred for immediate or urgent consultation with an ENT specialist?

This episode is part 2 of the procedural sedation podcast. This episode focuses on the medications that we commonly use for procedural sedation. First, we'll review the use of oxygen during procedural sedation and then talk about basic airway maneuvers before we talk about individual medications. For each drug, the drug class, dosing, duration of action, and adverse effects will be discussed with the overall theme of patient safety.

Pediatric intensivist Dr. Will Cagle joins the show to discuss the AAP Maintenance IV fluid guidelines and considerations when choosing IV fluids for pediatric inpatients.

What do you need to know from the 2018 AAP maintenance IV fluid guideline? 

How common is hyponatremia in hospitalized patients and why does it matter to your practice? 

What is SIADH and how does it contribute to hyponatremia in acutely ill children? 

How can we prevent hyponatremia in our hospitalized patients? 

What are the differences between hypotonic and isotonic fluids? 

What are balanced solutions and why might they be preferred as compared to saline in some clinical settings? 

All of this and more from the Department of Pediatrics and the Medical College of Georgia. 

Check out our website for detailed show-notes: https://www.augusta.edu/mcg/pediatrics/residency/podcast.php

Special thanks to Dr. Asif Mansuri and Dr. Gene Fisher for providing peer review for this episode.

Questions, comments, or feedback? Please email us at mcgpediatricpodcast@augusta.edu 

Want Further Reading? Check out the clinical practice guideline from the AAP and our other references below.

• Feld LG,Neuspiel DR, Foster BA, et al. Clinical Practice Guideline: Maintenance Intravenous Fluids in Children. Pediatrics. 2018;142(6):e20183083. doi:10.1542/peds.2018-3083 
• Semler MW, Self WH, Wanderer JP, et al. Balanced Crystalloids versus Saline in CriticallyIll Adults. N Engl J Med. 2018;378(9):829-839. doi:10.1056/NEJMoa1711584 
• CuzzoB, Padala SA, Lappin SL. Vasopressin (Antidiuretic Hormone, ADH) [Updated 2020 Apr 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526069/ 
• Chowdhury, Abeed H. BSc, MRCS*; Cox, Eleanor F. PhD†; Francis, Susan T. PhD†; Lobo, Dileep N. DM, FRCS, FACS*A Randomized, Controlled, Double-Blind Crossover Study on the Effects of 2-L Infusions of 0.9% Saline and Plasma-Lyte® 148 on Renal Blood Flow Velocity and Renal Cortical Tissue Perfusion in Healthy Volunteers, Annals of Surgery: July 2012 - Volume 256 - Issue 1 - p 18-24 doi: 10.1097/SLA.0b013e318256be72 
• Peti-Peterdi J, Harris RC. Maculadensa sensing and signaling mechanisms of renin release. J Am Soc Nephrol. 2010;21(7):1093-1096. doi:10.1681/ASN.2009070759 
• Wilcox CS. Regulation of renal blood flow by plasma chloride.J Clin Invest. 1983;71(3):726-735. doi:10.1172/jci110820 

First trimester vaginal bleeding may not be as exciting as a GSW to the chest but it's something that we see a lot in the ED and we have the chance to make a positive impact even if the news isn't good. The workup can seem very cookbook at times but its important that we get it right. In this episode, we'll review the basic workup and disposition of first trimester vaginal bleeding. Just as important as the medicine, we'll also review how to talk to patients about this sensitive and worrisome diagnosis.

This is part 2 of the Heme Onc Emergencies series.  This episode will talk about common hematology emergencies that we see in the ED.  Sickle cell disease will be its own episode but this episode will talk about the approach to anemia in the ED, as well as the approach to hemophilias, ITP and TTP.  While you will see lots of anemic patients in the ED, the other diseases are rare but we have to be on the look out for them and know what to do.

This is the first of a two part series on Heme-Onc Emergencies.  In this episode, we'll discuss oncology emergencies to include neutropenic fever, tumor lysis syndrome, malignant spinal cord compression and malignant pericardial effusion.  Neutropenic fever is a common chief complaint for patients on chemotherapy so we have to be good at this chief complaint.

We encounter seizure disorders frequently in the ED.  In this episode, we'll review all the important points about seizures including the confusing and difficult topic of pseudosezures.  We'll also go in depth on the ED treatment of seizures and status epilepticus.

This is just a short announcement for the launch of the EM Basic App in the Apple App Store and the Android Amazon Marketplace.  Go to the blog post at embasic.org to see all the information about how to get this new app on your phone or mobile device.

We're back with a new episode of Essential Evidence.  This article is from Academic Emergency Medicine March 2009 and it talks about getting blood cultures in well appearing kids aged 3 to 36 months.  We used to get a lot of blood cultures in these well appearing kids with fever but this article was the final nail in the coffin that got us to stop doing that.  It's hard to believe that based on how we practice now but we needed this large study to show us that we are now doing the right thing.

We see patients with headache all the time in the ED. Most patients with headache don't have a life threatening diagnosis but its our job to pick up that small percentage of patients that do. In this episode we'll go through how to take a good headache history, how to catch the red flags, the workup, and treatment of headache in the ED. There's also an extended bonus section that will review how to do an LP along with a few tricks of the trade.

Today's episode talks about the diagnosis and management of Acetaminophen overdose.  This is another addition to the EM Basic Project written by Andrea Sarchi.

We encounter acetaminophen overdose frequently in the ED and we need to be on the look out for this because patients can be completely asymptomatic.  If we don't catch it, acetaminophen overdose can result in liver failure requiring transplant or even death unless we interevene early.  This episode will review how to properly workup a patient with a known or suspected acetaminophen overdose, what tests to order, and how to decide who needs antidote therapy.

This is a short episode on the EM podcasts and websites that I recommend to further your education. Since I take no money from anyone, these are my unbiased opinions of the best podcasts and websites out there. There are many more podcasts and websites out there- these are the ones that I like. If you have suggestions for podcasts or websites to add, please email me and I'll add them to the list.

A female with abdominal pain can turn into a very complicated patient, thus this chief complaint needs its very own podcast. We'll review the bread and butter basics go over some practical tips on how to avoid all the pitfalls with these patients.

All right- let's keep the laughter to a minimum...today's episode is talking about how to approach testicular pain in the ED.  You need to know how to approach this chief complaint because if you don't workup the patient correctly, they can lose their future fertility and possibly their testicle.  We'll review how to take a good history and do a rapid focused exam to make sure that we catch all those patients with torsion and don't delay their treatment.

Today we are breaking from the usual format and doing something a little different. If your patient doesn't have an adequate airway then we need to provide one. We are the experts in the emergent airway and there's a lot more to it than shouting out "20 of etomidate and 100 of suxs" like they used to do on the TV show ER. This podcast will go over why we intubate patients, how to prepare for an intubation, the commonly used medications for RSI, tricks of the trade (and maybe a war story or two), and post-intubation management. This is the first topic podcast that is a lot longer than the usual podcasts but airway is our number one priority so it deserves a little extra time.

Also- for the first time ever- a bonus section on a common medical myth. Should you use the D-word for pain from cholecystitis...as in Demerol? Stay tuned after the airway podcast for why this may not be a great idea and why you should just strike Demerol from your memory.

This episode will discuss the NEXUS study.  NEXUS was a study that studied thousands of patients to validate a set of rules so that we can "clinically clear" patients with possible c-spine injury without getting an x-ray. This study has helped us avoid radiation in certain low-risk patients, saved the cost of x-rays and CT scans, and speed these patients through the ED. We'll talk a lot about the statistical side of this study and how you can apply it in your everyday practice.

Today's episode is another installment in the EM Basic Project.  Dr. Sheyna Gifford took on the task of interviewing Dr. Les Zun, a nationally known speaker on the topic of psychiatric emergencies.  While we did an episode on psychiatric medical screening before, this episode will focus on some of the tougher situations we encounter in the ED.  For example- What do we do about the patient who is depressed but not suicidal?  How do we calm down agitated patients without reaching for medications?  These are tough questions but Dr. Zun goes througha methodical way of thinking about these issues and offers some real world practical advice that you can use on your next shift. 

EM Basic is back and ready for the new year.  We see various eye complaints a lot in the ED.  This episode will review common eye complaints, their treatments, and a bonus section on how to do a lateral canthotomy.

Join physicians Eric Ring, Zac Hodges, and Dan McCollum as they discuss how to properly care for the pediatric patient with sickle cell disease.  Dr. Eric Ring is a pediatric specialist in Hematology and Oncology at the Children's Hospital of Georgia in Augusta, GA.  What are the critical elements of a history of present illness?  What red flags should you look for on physical exam?  What are the dreaded complications of sickle cell disease that you should be wary of?  Join us for these questions and more!

Chest pain- its one of the most common chief complaints in the ED and we need to be the experts on this.  This podcast reviews how to get a good history of the patient's chest pain, the relevant physical exam findings, how to work it up, and how to talk effectively to your consultants.

Join emergency physician Dan Dworkis as he discusses with Dan McCollum how to remain cool under pressure.  Dan and Dan discuss

• The importance of being cool under pressure
• The fallacy of believing experience equals the ability to handle pressure.
• Strategies for junior learners to build sangfroid

This is a joint podcast between EM Basic and the Emergency Mind Podcast.  You can find dozens of other podcasts at https://www.emergencymind.com/ or pick up his excellent new book at https://www.amazon.com/dp/B094GY88RK/ .  Enjoy!

By popular demand, this episode will be dedicated to talking about prehospital issues. I've had several people write me and ask for my 0.02 on how EMS can better be our "eyes and ears" in the field so here's my take on this question. I'll also talk about how the ED staff can better interact with our EMS colleagues so we can both work together to deliver optimal care to our patients. Hopefully this will serve as a starting point for conversations between EMS providers and ED staff and I encourage anyone to post comments on these issues to the blog.

This is a quick announcement to let you know that EM Basic is now partnering with EB Medicine as our bandwidth sponsor.  EB Medicine publishes many resources in Emergency Medicine to include EM Practice, Pediatric EM Practice, as well as LLSA reviews.  These reviews are made by EM physicians for EM providers and provide the latest evidence based medicine reviews of common EM chief complaints.  Recent issues include management of seizures in the ED, hand injuries, and angioedema.  These are quick and to the point reviews that review everything you need to know and nothing that you don't.

For residents and students, you can get free electronic access to all of EB Medicine's issues for free- no obligation and no strings attached.  EB Medicine is so confident in the quality of their resources that they know you will want to subscribe once you are done training.  I started reading EB Medicine as a resident and it is one of the few resources that I read cover to cover each month.

For attendings and those needing CME- if you visit EB Medicine you will get a great discount and help support the EM Basic podcast with each subscription that is purchased.

In exchange for this, I'll be promoting EB Medicine's products at the end of each podcast.  These will be brief and they won't be intrusive.  In accordance with the previous disclaimer on EM Basic, it has been updated to reflect EB Medicine as our official bandwidth sponsor.  However, EM Basic has an always will be free from any outside influence on the content in the podcast.  EB Medicine or any other company will never have any influence on the educational content of the podcast.

In part 2, Dr Sheyna Gifford will discuss the how to differentiate opioid overdose from other causes of altered mental status, some special disposition situations (especially with methadone), and how we can quickly screen for opioid abuse and provide patients compassionate care, treatment, and referral.

This episode reviews the article that most people call the PECARN head CT rule or the Kupperman head CT rule (named for the first author). This is an easy to use clinical decision rule that can help us reduce the number of head CTs that we do on children with minor head injury. We owe it to our patients to spare them excess radiation, cost, and time in the ED and this rules helps us do this. In order to use this rule effectively, you need to read this article and understand how the study was done.  This allows us to understand the strengths and weaknesses of this rule and helps us apply it in our everyday practice.

EM Basic is back with a re-broadcast from the awesome podcast Pediatric Emergency Playbook by Dr. Tim Horeczko.  Tim is a double boarded in EM and Peds EM and works at Harbor-UCLA hospital.  This was the first episode he published at the beginning of September and it is pure gold.  Tim goes beyond the febrile neonate and talks about how to consider all possible causes for a sick infant- not just anchoring on sepsis the whole time!  Tim presents a rational and systematic approach on how to deal with these young sick patients that get our anxiety and our adrenaline levels through the roof.

This episode is a re-broadcast of the first sepsis episode in February 2012.  I am republishing the part of that episode that deals with the definitions of sepsis.  I think the new sepsis guidelines rely too much on clinician judgment and gestalt in identifying septic patients so this will be helpful to learners.  To be clear- the term severe sepsis is not in use any more- we only have sepsis and septic shock.  However, learning this stepwise progression (even if patient's don't follow it) will help you better understand how to recognize sepsis in the ED.

Join EM physicians Mike Samuels and Dan McCollum as they discuss different blood products that can be transfused. 

• Why don't we commonly use whole blood?
• Who needs to receive packed red blood cells?
• Are there any dangers to giving platelets?
• When is fresh frozen plasma needed? 

Episode 100 discussed potential complications, while this episode will discuss why you should be using these products.  Enjoy!

Today marks the 4th anniversary of the EM Basic podcast.  To celebrate this occasion, we are going to do a screencast on aortic dissection.  This is a very challenging disease to diagnose because patients have lots of different presentations that can make it difficult to diagnose.  We'll talk about the common presentations of dissection, the not-so-common presentations, how to order the right imaging, how to treat these patients in the ED, and how to get them to the right level of care.

The patient's blood pressure is 190/80 but they feel fine...how do we treat these patients in the ED?  Labs?  EKG? BP meds?  Admission???...but they are here for an ankle sprain!  Asymptomatic hypertension is a challenging complaint to deal with in the ED because of so many conflicting opinions and worries but it doesn't have to be difficult.  In this episode, we'll discuss a systematic and rational way to evaluate patients with asymptomatic HTN, do limited and targeting testing, and get them the right followup while calming the patient's fears and avoiding harm.

This is the first of two episodes on procedural sedation. In the ED we need to provide safe and effective procedural sedation and analgesia whenever we do painful procedures. It is our job to relieve anxiety and pain in our patients and we need to know how to do this right. This episode will focus on how to prepare for a procedural sedation. We will talk about how to make the decision as to who is an appropriate candidate for procedural sedation in the ED, the depth of sedation, and how to prepare all of our equipment so that we leave nothing to chance. This will be in preparation for the second episode where we will talk about the medications that we use in procedural sedation.

EM Basic is back with another episode of the EM Basic Project.  In today's episode Drs. Tim Peck and Colby Redfield review the chief complaint of shortness of breath with a focus on COPD.  Even though we did an episode on shortness of breath a while back, it's always great to get a new perspective on this chief complaint.  Today's episode also features a very special guest cameo by the name of Dr. Peter Rosen.  He pretty much started EM as a speciality and you may have seen his name on a textbook or two.

Join doctors Smitha Mathew, Kaitlin Verdone, Zac Hodges, and Dan McCollum as they navigate the difficult waters of pediatric sepsis.  What exactly is sepsis?  Are there any differences in the treatment of pediatric sepsis compared to adult sepsis?  What should I do if I see a septic child at a small community Emergency Department?  We discuss this and more in this episode!

Join Dr. Alex Koo as he discusses the management of crush injuries.

• What is crush syndrome?
• When should you be concerned about compartment syndrome?
• Why can you not wait for the 6 P's to develop before treating?
• How should you treat?

Join us for this and more!

Non-invasive ventilation is a great technique that we can use for just about any patient who is short of breath.  We can use it to avoid intubation in our patients who are close to respiratory failure.  In this episode, we'll talk about how non-invasive ventilation works, which patients we can use it on, and how to actually make it happen.  For that last part, I'll borrow from a post by Seth Treuger at his blog mdaware.org on how to start non-invasive ventilation quickly while keeping it comfortable for the patient.

Join ED clinical pharmacist Jimmy Pruitt and Dan McCollum as we discuss the reasons that the traditional "B52" cocktail of haloperidol, lorazepam, and diphenhydramine is badly in need of updating.

• Why this cocktail is slower than you think.
• Newer medications that are more effective.
• Smarter approaches to agitated patients.
• When ketamine should be used.

This podcast is being cross published with the "Pharm So Hard" podcast, an excellent podcast discussing many excellent clinical pharmacology topics.  

Join emergency physician Tony Zitek as he guides you through the diagnosis and management of urinary tract infections.  Which elements of the history and physical exam are key?  What are the pearls and pitfalls in the diagnosis of UTI?  When is a culture needed?  How do I obtain a disposition?  Join us for this and more as Dr. Zitek guides us through the surprisingly tricky management of this common disease.

Abdominal pain is one of the most common complaints in the ED. In this podcast we will review how to get a good history, how to do a solid abdominal exam, and a systematic method for figuring out how to effectively use imaging with to make a diagnosis or, at the very least, rule out "the badness".

Today's episode is on Croup- just in time for the middle of the croup season.  Your ED may even be filled with kids with a barking cough as we speak.  Today's episode was written by Taylor Fischer and Stewart Harsant, two physician assistants who have done an excellent job of summarizing this common pediatric disease process.  This episode will review the diagnosis of croup, how to risk stratify kids with croup, and how to treat and disposition them properly.  Most of the time, kids with croup do just fine with a little cold night air and some steroids but this episode will also help you figure out which kids are sicker and need much more attention and care.

In this episode we are going to talk about febrile seizures.  We see this chief complaint a lot in the ED so it's important that we know this topic really well.  Today's script was written by Dr. Andrea Sarchi and will review how to do a good history and physical, how to rule out serious pathology without overtesting, and how to talk with parents.  While simple febrile seizures don't cause any harm to the child, they are very scary for parents so it's important that we know the facts so we can re-assure them and prevent future worry.

Today I am handing over the podcast to FOAMcast by Drs. Lauren Westafer and Jeremy Faust.  A little more than a month ago, Dr. Nick Genes challenged twitter to create core content FOAM for hepatic emergencies.  Lauren and Jeremy did an excellent episode on this topic on FOAMcast so here it is- re-broadcasted on EM Basic.  They'll review common hepatic emergencies and their managementi in the ED and point you in the right direction to learn even more on this topic.  I haven't edited their episode at all- it's all Lauren and Jeremy's episode.  If you like what you hear, go to foamcast.org or look for FOAMcast on iTunes.

We're back with a podcast on...dizziness!  While weak and dizzy is almost never the most exciting chart in the rack, we see it a lot in the ED. This is a chief complaint where we have to be on the lookout for the serious causes of dizziness among the avalanche of not-so-serious causes of dizziness. First- what does the patient mean by "I feel dizzy"? This seems like a silly question because just about everyone has felt "dizzy" before but if you get it wrong, you'll go down the completely wrong diagnostic path.

One small self-promotion- The new academic year is just about to start so if you like the podcast, please tell your colleagues, classmates, and especially the new medical students and interns.

Today's episode is a quick review of Thyroid emergencies by Dr. Patrick Ng, a 3rd year EM resident in San Antonio, recorded by Jacob Schriner MS-3.  Thyroid emergencies can be difficult to recognize in the ED because they present in so many different ways.  Today's episode will review how to recognize these emergencies, order the right tests, and provide the correct critical treatments.

Introducing EM Basic Essential Evidence- your boot camp guide to emergency medicine literature. Each episode will review an important emergency medicine article from the ground up. We'll review the study's design, basic statistics, results, and wrap it up with some analysis to help you understand the study and how to put it into your everyday practice. The goal here is to provide a guide through the emergency medicine literature so you can read and understand the "must know" studies out there.

This is also the re-launch of EM Basic to a weekly podcast format.  Every monday morning, a new episode will be uploaded to start the week. Each week will alternate between a regular review episode and an essential evidence episode. For the essential evidence episodes, I will try to split up the episodes each month- one episode on a landmark article and one episode on a newer article that is making the rounds. I have a list of articles that I will be talking about but if there are any studies out there that you think I should cover, email me at steve@embasic.org.

For this first episode, we'll talk about the famous Rivers sepsis study that started the push to early goal directed therapy for sepsis in the ED. Although I talked about this study a lot on the sepsis podcast a while back, we'll talk more in depth about the study so you can really understand it.

This is the premiere of the first contribution to the EM Basic Project.  Dr. Brian Cohn from Washington University in Saint Louis, Missouri is on the podcast today talking about mono-articular arthritis.  He reviews the common physical exam findings, the appropriate lab work and medications, how to avoid common pitfalls in this diagnosis, some evidence based medicine pearls and even some relevant medical trivia.  Dr. Cohn is one of the authors of the EMJ club podcast which reviews common EM topics in a journal club style format.

It's no secret that we have a major opioid problem in the United States.  The number of people addicted to opioids has reached epidemic proportions and we are certainly seeing this everyday in the Emergency Department.  In this episode Dr. Sheyna Gifford discusses a few facts about the scope of this epidemic,  the basics of recognizing opioid overdose, and initial stabilization and treatment.  She'll discuss the many different ways of using naloxone (aka Narcan) that we can utilize to wake up patients safely and without precipitating acute withdrawal.

Today's episode of the podcast is a myth busting on all the media reports about first responders overdosing by being exposed to fentanyl in the field by incidental contact. This is physically impossible and the misinformation out there has scared a lot of people, cost us lots of money in the form of hazmat responses and shutting down hospitals, and prevented overdose patients from getting the timely care they need in an emergency. This episode will systematically go through every argument why fentanyl is NOT harmful via incidental exposure and debunk these myths to give first responders one less thing to worry about while they do their frequently dangerous yet vital work.

The last podcast on COPD led to some great discussion online about the use of oxygen in patients with COPD.  To address this, Drs. Tim Peck and Colby Redfield are back with a quick summary to clarify how to best use oxygen in patients with COPD.  There's also another cameo by the one and only Dr. Peter Rosen on how to suceede in emergency medicine.

This episode has been a long time in the making- presenting Pulmonary Embolism, part 1.  PE is a deadly diagnose that we frequently have to consider in the ED.  The presentations can be very varied but we need to know how to work up this disease while avoid unnecessary testing and harm to our patients.  In part 1, we will discuss risk factors for PE, symptoms that should make you suspicious for PE, and how to order the correct labs and imaging to diagnose this serious condition.

This is an article published in the last year in the British Medical Journal that looked at the sensitivity of modern CT scanners in detecting subarachnoid hemorrhage. This article made a lot of waves because it suggested that a head CT within 6 hours of headache onset is 100% sensitive for subarachnoid hemorrhage.  Some have called it a practice changer that allows us to avoid doing a lumbar puncture so its important to read it for yourself and decide if it should change your practice.

Hyperkalemia (high serum potassium) can be one of the most serious electrolyte disorders that we treat in the ED.  We'll review how to interpret hyperkalemia in light of the patient's clinical condition, how to rapidly evaluate a patient with hyperkalemia and how to quickly treat patients with severe hyperkalemia.

This is a topic episode on Diabetic Ketoacidosis (DKA). We'll discuss the diagnosis and treatment of this complex disease process and how to avoid pitfalls that can harm the patient. There will also be tons of clinical pearls including treatment of DKA's cousin Hyperglycemic Hyperosmolar State (HHS) and pediatric DKA considerations. Also, you can now follow EM Basic on Twitter- @embasic for news on the latest episodes and anything else interesting that I find related to emergency medicine. This episode is also the debut of a new microphone setup that gives a much higher audio quality for the podcast.

Back pain is not usually the most exciting chart in the rack but there are many serious diagnoses lurking out there that we have to look out for.  In this episode, we'll go over how to do a good back pain history and physical, catch the red flags, form a broad differential, order the right tests (not everyone need labs and films!), and treat the patient's pain effectively.

Today's Essential Evidence Episode discusses the paper that derived and validated the PE Rule-out Criteria or PERC rule.  This is a clinical decision aid that we can use to reliably exclude pulmonary embolism in emergency department patients without any further testing.  We'll talk about some background on diagnosing PE in the ED, the study design, how to use the PERC rule in your everyday practice, and some clinical pearls as well.

An introduction to the EM Basic Podcast and what it is all about

Today's episode is another installment for the EM Basic Project by Dr. Andrea Sarchi.  Salicylate overdose is a toxidrome that we have to be on the lookout for in the ED.  While some cases are obvious because the patient or EMS can tell us what they took, some cases are subtle and require vigilance to make the diagnosis.  In this episode we'll review the important history and physical points, how to order the right tests, manage the toxicity, and properly disposition the patient.

Join Dan McCollum and Michael Stephens as they discuss the new vaccines against COVID-19.  

• Are they studied well enough?
• How effective are they?
• What side effects occur, and are they serious?
• What do we NOT know about these vaccines?

The approved vaccines are safe, effective, and highly recommended.  Listen to this to find out more about the data behind them.

A special thanks goes to Michael Stephens for his invaluable help with recording and editing.

This podcast will discuss how to approach the patient with altered mental status. These patient present a special challenge because there are a ton of reasons why a patient may be altered. As always, we'll review the major points in the history and exam, the differential diagnosis, and a few points on management.

If you haven't done so already, please fill out the EM Basic survey and check out the results thus far on the website. Also in this episode is a reivew of a new emergency medicine iPhone App (palmEM) and an FYI concerning the last podcast on MI and ACS.

Join Christopher Watson, Zac Hodges, and Dan McCollum as they discuss the management of pediatric traumatic brain injury. 

• What should you look for on exam?
• When is intubation appropriate?
• How can you treat increased intracranial pressure?
• Where should you send your patient if you are at a community emergency department?

We go beyond the basics here, discussing a very challenging topic.  

Anaphylaxis is a potentially deadly diagnosis that requires quick action.  In this episode, we will discuss the diagnosis and management of the entire spectrum of allergic reactions from mild cutaneous reactions to life threatening anaphylaxis.  This is the first episode in a 2 part series.  Part 2 will discuss airway management in anaphylaxis and other upper airway obstructions situations.

This episode is a total revamp of the previous episode on sepsis.  A lot has changed with sepsis management since I published the sepsis episode in February 2012 so it was time for a complete overhaul.  The new sepsis guidelines have been out for about a year and I finally got around to updating the episode.  This episode will discuss the recognition of sepsis, how to do a good physical exam and ask the right history questions, order the right tests, and aggressively resuscitate these very sick patients.  There is a separate episode that discusses the old sepsis definitions and how you can use that framework to recognize sepsis.

This episode of EM Basic Essential Evidence will review the two articles that led to the adoption of therapeutic hypothermia as a treatment for survivors of cardiac arrest. This is a simple yet highly effective therapy that improves survival and neurological outcome in survivors of cardiac arrest so it is important that we know and understand these two articles.

Dr. Reda Bassali, professor of pediatrics and pediatric hospitalist at the Medical College of Georgia, joins Dr. Zac Hodges and Gavriella Mendel (M3) to discuss this very important topic in pediatric medicine.

What exactly is bronchiolitis and why is this topic so important?

How do you make the diagnosis and what other diagnoses should you consider?

What treatments work, and more importantly, which treatments do not?

What patients can go home and who needs to be admitted?

All of this and more from the Department of Pediatrics and the Medical College of Georgia. 

Check out our website for detailed show-notes: https://www.augusta.edu/mcg/pediatrics/residency/podcast.php

Special thanks to Dr. Kathryn McLeod for providing peer review for this episode.

Citation:

Hodges, Z. (Host). Bassali, R. (Host).  Mendel, G. (Host). McLeod, K. (Contributor). (2020, Nov 15). Bronchiolitis. (S1:18) [Audio Podcast Episode]. MCG Pediatric Podcast. Medical College of Georgia Augusta.

Questions, comments, or feedback? Please email us at mcgpediatricpodcast@augusta.edu 

Links: 

NoseFrida-- https://www.nosefrida.com 

Today's episode of EM Basic will review vaginal bleeding in patients who are not pregnant.  This is a much different workup from pregnant patients with vaginal bleeding so we have to know how to effectively manage this chief complaint.

This episode was written and recorded by Dr. Adaira Landry, an EM senior resident at NYU/Bellevue and Joe Kennedy, a 4th year medical student at Mayo who matched into EM just after this episode was recorded.  They'll review what vital signs to look out for, the important parts of this history and physical, what labs and imaging to order (if any), and the proper disposition of patients with this chief complaint.

Join Zac Hodges as he discusses MIS-C with two local experts. Dr. Pushpa Shivaram is a pediatric cardiologist and Dr. Julisa Patel is a pediatric rheumatologist.  They discuss

• What this syndrome is
• How to make this tough diagnosis
• Proper management of patients

This is a brand new disease that we all need a refresher on.

Today's episode will cover Tactical Combat Casualty Care (TCCC), aka Care Under Fire, aka Care in the Immediately Unsafe Environment.  Dr. Andy Bohn, a residency colleague, recorded today's episode to talk about the basics of taking care of any patient in an unsafe environment.  While the military connotations of this may make you uncomfortable, the techniques and protocols he discusses can be directly translated into any civilian mass casualty scenario such as the Boston Marathon bombing or the fertilizer plant explosion in West, Texas.  Andy will discuss how to stay safe in these hostile environments, how to perform the right interventions that will save lives while elimintating the useless interventions that won't (I'm looking at you- c-collars...), and how to get the casualty to the next level of care safely.

• What are the red flags we should be aware about for dental complaints?  
• What is the basic anatomy and nomenclature for numbering teeth?  
• What differential should be considered for traumatic and atraumatic dental complaints? 
• How should we treat dental pain? 
• How do I splint a tooth in the emergency department? 

In this episode, we'll talk about a recent article in Annals of Emergency Medicine that has a lot of people talking. This is a study that looked at patients on coumadin (warfarin) who had minor head injuries. The patients were admitted for 24 hours of observation and had a repeat head CT. The study looked at how many patients had bleeding on a repeat head CT and the conclusions were suprising. Should this be our new standard of care?  Maybe but maybe not.

This is a topic podcast on myocardial infarction (MI) and Acute Coronary Syndrome (ACS). There is a lot more to managing ACS then just recgonizing who has tombstone ST elevations on their EKG and activating the cath lab. In this episode, we'll go through the entire ACS spectrum from unstable angina, NSTEMI, and STEMI and how to keep it all straight. There's also a bonus section on cardiac risk factors- how useful are they in diagnosing patients with ACS in the ED? The answer may surprise you.

Also- please take a few minutes to fill out the EM Basic podcast survey. This is an IRB approved research project that will look at the educational impact of EM Basic but I'm also looking for your feedback on the podcast as well. The survey is only 10 questions long and it will go a long way towards improving the podcast and generating some original research. I will publish the results of the survey right here on embasic.org in the next two weeks but please fill it out ASAP since I have an abstract deadline of December 15th

This episode is something unlike anything I have ever done with EM Basic.  I had a case recently of a super sick patient who required a big resuscitation.  Fortunately, the patient did great and was gracious enough to give me her permission to share her case so that others can learn.  In this episode, we'll go over what happened with this patient step by step and I'll review some valuable teaching points on how to get things done in the resuscitation bay and how to think about treating critically ill patients.

Just a few days after the new EM interns start, today's episode will talk about my advice to new EM interns.  Think of this as the "big picture advice" or a 30,000 foot view of how to approach EM residency.  I'll talk about 4 major big picture points to keep in mind as you start your residency.  This will go way beyond arrive early, stay late, and always keep learning and expand on some big picture ideas of how to function well as a new intern.

This episode is on hyperthermia- just in time for the warmer weather.  However, hyperthermia has many different causes so this episode will review them all.  Dr. Andrea Sarchi wrote this script which was recorded by Jacob Schriner, MS-3 at Emory University School of Medicine.  This episode will review the necessary history and physical exam findings, ordering the right labs and tests, and how to treat this condition to ensure the best patient outcomes.

Since I refer to the neuro exam from the headache episode, I decided to take that part of the episode and make a supplement so you can easily review the "5 minute ED neuro exam." Let me know if there are any other topics that you would like me to make into a supplement like this.

Just in time for the midway point of the winter season, this is a podcast on management of hypothermia in the ED.  Dr. Andrea Sarchi wrote the script which was recorded by Jacob Schriner, a second year medical student at Emory University School of Medicine.  In this episode we'll review the basics of hypothermia diagnosis, history and physical exam pearls, treatment and disposition of these patients.  As always we'll start with the "not sick" patient and then work our way up to the critically ill patients.

This episode is part 2 of the PE podcast where we will discuss risk stratification and treatment of PE.  It's important that we accurately quanitfy the amount of clot burden that the patient has to order the right treatment and admit them (or maybe even discharge them) to the right location.  We'll talk about how to classify massive, sub-massive, and "non-massive" PEs and how to treat them. We'll also briefly talk about emergning evidence for the expanding role of thrombolytics and outpatient treatment of PE.