FOAMcast - An Emergency Medicine Podcast (FOAMcast)

We review FOAM (Free Open Access Medical education), SMART EM "Pseudoaxioms 2 and Literature Update," in which Dr. David Newman discussesthe lack of benefit for tamsulosin in most renal colic.  Then, we discuss core content urologic emergencies including:

• Bullous Myringitis
• Perforated Tympanic Membrane
• Auricular Hematoma
• Necrotizing Otitis Externa (Malignant Otitis Externa)

As always, visit foamcast.org  for show notes and the generously donated Rosh Review questions.

Key Texts:

Tintinalli's Emergency Medicine: A Comprehensive Study Guide (7e) Chapter 237

Rosen's Emergency Medicine(8e) Chapter 92

Thanks for listening!

-Jeremy Faust and Lauren Westafer

We cover this short video from EMRAP on lateral canthotomies.  This is one of those rare procedures that is vision saving; hence, it is worthy of frequent review.

Then, we delve into core content on orbital fractures, hyphemas, and ocular burns using Tintinalli and Rosen's Emergency Medicine as a guide.

Show notes and references at foamcast.org

Thanks for listening!

Jeremy Faust and Lauren Westafer

In this episode we review what we know about vaccine induced thrombotic thrombocytopenia (VITT), which has been associated with the COVID-19 viral vector vaccines by AstraZeneca and Johnson & Johnson.

Show notes/references: FOAMcast.org

Thanks for listening!
Lauren Westafer and Jeremy Faust

In this episode, we review new registry data from the ACIP meeting on pregnant people who received an mRNA COVID-19 vaccine and discuss, in general, what we know about the COVID-19 vaccines in pregnancy. 

Show notes: FOAMcast.org

Pregnancy Decision Aid

Thanks for listening!
Lauren Westafer and Jeremy Faust

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

We review a new meta-analysis from the WHO REACT group of steroids in critically ill patients with COVID-19 and 3 new randomized trials of steroids in COVID-19 published in JAMA on September 2:

• REMAP-CAP COVID-19 
• CoDEX
• CAPE Covid

Show notes (references/graphics): FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

We review a podcast from Dr. Tim Horeczko's Pediatric Emergency Playbook on elbow injuries including identifying normal ossification centers (CRITOE), radial head subluxation, and supracondylar fractures.

Then, we delve into core content on other elbow adjacent injuries including elbow dislocations, humerus fractures, and olecranon bursitis using Rosen’s Emergency Medicine (8th edition) Chapter  and Tintinalli’s Emergency Medicine (8th edition) Chapter  as a guide.

Thanks for listening!
Jeremy Faust and Lauren Westafer

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

We review the RECOVERY trial results on hydroxychloroquine for COVID-19 [pre-print by Hornby et al]

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

 We are at SMACC in Sydney, Australia, thanks to the Rosh Review, delivering updates from the conference to your earbuds. Today we cover resuscitation pearls.

Bougie vs Standard Stylet in emergency department (ED) rapid sequence intubation (RSI) - Brian Driver vs Rich Levitan

Rocuronium vs Succinylcholine Debate - Billy Mallon and Reuben Strayer

The Crashing Asthmatic - Haney Mallemat

Thanks for listening!

Lauren Westafer and Jeremy Faust

The VITAMINS trial by Fujii et al has been published in JAMA and provides insight into the performance of the "metabolic cocktail" (Vitamin C + thiamine + hydrocortisone) in ICU patients with septic shock. We review this trial in the context of prior literature.

Show notes and references at FOAMcast.org

Thanks for listening!
Jeremy Faust and Lauren Westafer

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

Vaccines for SARS-CoV-2 have been in development for only a few months, but several have published early results from Phase III efficacy trials in press releases. In this episode, we review these vaccines and what we know about them, and what we know about  them

Show notes (references/graphics): FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

We are at ACEP 2019 in Denver and do a deep dive on a topic introduced by Bryan Hayes (@PharmERToxGuy) in a talk on black boxed medications used in the ED.

We review the data underlying the FDA warning for olanzapine and benzodiazepines.

Thanks for listening!
Jeremy Faust and Lauren Westafer

In this episode covering the American College of Emergency Physicians (ACEP) 2019, we cover common black box warnings including

• fluoroquinolones
• midazolam
• droperidol
• NSAIDs
• and more

Thanks for listening!

Jeremy Faust and Lauren Westafer

We are in Berlin for #dasSMACC and have lots of pearls to share from the speakers at this amazing conference.  Talks will be released for free on the SMACC podcast over the next year, but this podcast holds some pearls that we thought couldn't wait.

We cover...

One of the major themes of #dasSMACC has been - we are more overconfident in our knowledge, skills, ability, and good behavior than we actually demonstrate. We cover the Dunning-Kruger effect and how to help combat the notion that "this happens to other people, not me." 

Drs. Jacob Avila and Ben Smith on Airway Ultrasound

Dr. James Rippey on Point of Care Ultrasound Incidental Findings

Dr. Jack Iwashyna on Critical Care Prognosis

Thanks for listening!

Jeremy Faust and Lauren Westafer

There is a global outbreak of human monkeypox virus cases. In this episode (the first of a 2 part series), we summarize some brief virology, epidemiology, and review the transmission of this virus. 

References/Show notes: FOAMcast.org

Thanks for listening!

Jeremy Faust & Lauren Westafer

This epsiode reviews the new clinical policy from the American College of Emergency Physicians (ACEP) on medication for acutely agitated patients needing parenteral sedation.

Show notes / references: FOAMcast.org

Thanks for listening!
Lauren Westafer

FOAMcast will be back shortly with regular core content-cutting edge mash ups; however, we wanted to take a moment to focus on a conference that inadvertently created FOAMcast...and is coming to Chicago in June 2015.

 SMACC - Chicago (#smaccUS) June 23-26, 2015. Registration begins Nov 5, 2014

There are too many core content lectures to choose from and they're available on iTunes.

Our favorites are listed on FOAMcast.org and here we review:

Dr. Haney Mallemat - The Art and Science of Fluid Responsiveness

Dr. Scott Weingart - Sepsis in New York: Our First 15,000 Patients

Dr. Cliff Reid - Resuscitation Dogmalysis

Dr. Rob Mac Sweeney - ARDS: An Evidence Based Update

Timing, Tribes, and STEMIs

There is a global outbreak of human monkeypox virus cases. In this episode we provide a quick summary of monkeypox to date. Check out our two more in-depth episodes on the topic. 

References/Show notes: FOAMcast.org

Thanks for listening!

Jeremy Faust & Lauren Westafer

A seminal single-center study in 2018 by Driver et al found a 98% first-pass success in patients undergoing endotracheal intubation in the Emergency Department. This multi-center randomized control trial examines bougie vs stylet in a wider array of settings

Show notes/references: FOAMcast.org

Thanks for listening!
Lauren Westafer

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

This episode is a literature potpourri 

• Outcomes in pregnancy (Knight et al - pre-print).
• Are EMS calls for strokes and STEMIs down during the pandemic? Holmes et al
• More pediatric hyperinflammatory /Kawasaki-esque cases from Italy Verdoni et al
• More Kawasaki Disease in Paris. (Toubiana et al)
• Aerosol boxes for intubation (Begley et al)
• Genomic sequencing reveals healthcare associated clusters (Meredith et al)

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded May 15, 2020

We review this blog post by Bryan Hayes, an ED pharmacist (@PharmERToxGuy), on the use of physostigmine in anticholinergic toxicity.

We then review anticholinergic toxidrome using Rosen's, Tintinalli's, and Goldfrank's as a guide.

Thanks for listening!

Lauren Westafer and Jeremy Faust

We review a FOAM post by Dr. Matthew MacPartlin on Rollcage Medic on flying after a pneumothorax.

Then we delve into a core content review of altitude sickness, high altitude pulmonary edema, high altitude cerebral edema, and altitude related problems using Tintinalli and Rosen's Emergency Medicine as a guide.

Thanks for listening!
-Jeremy Faust & Lauren Westafer

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks.

In this episode we review:

• guidance for pregnant and breastfeeding patients and healthcare workers
• experimental treatments that are all the craze: remdesivir, chloroquine, hydroxychloroquine, lopinavir-ritonavir

Show notes: FOAMcast.org

Thanks for listening!
Lauren Westafer and Jeremy Faust

In this special episode we review some of the top items of 2015*

David Newman:

• Opioids for back pain - falling out of favor.
• Risk stratifying (and testing) low risk chest pain.

Haney Mallemat:

• Peripheral vasopressors may be ready for prime time
• FAST guided resuscitative thoracotomy (No cardiac activity and no effusion? No thoracotomy).
• Movement towards less volume in sepsis (ex: in PROMISE trial average patient got 6L over 72 h)

Michelle Lin

• Merging of FOAM with traditional journals 
• Merging of FOAM resources into conglomerates
• More medical education FOAM (ex: ICEnet, EMin5)

Rob Orman

• Same as Haney (peripheral vasopressors + FAST in resuscitative thoracotomy)
• Sexual intercourse 3-4 times per week may aid in expulsion of distal kidney stones.

Thanks for listening!

Jeremy Faust and Lauren Westafer

*Chosen by people smarter than we are.

(nb: Lauren initially wrote "smarter than us," but I fixed it. You're welcome, universe. -JF)

In this mini FOAMcast, we introduce a new segment - statistics.  

We cover inter-rater reliability,\ or, the kappa coefficient, using the PECARN head trauma decision aid as a tool.

As always, visit foamcast.org for show notes and the generously donated Rosh Review questions.

Thanks y'all!

-Jeremy Faust and Lauren Westafer

We review gastroparesis treatment with haloperidol including a recent study by Ramirez and colleagues. This study had significant methodologic limitations but provides some interesting insight into a practice that many providers have adopted - using haloperidol for gastroparesis. A tiny RCT by Roldan and colleagues also looked at this practice and found promising results, although the study was very small.  Haloperidol has also been used in cannabinoid hyperemesis but literature on this is limited to case reports/series.

We also cover core content on biliary pathology using Tintinalli and Rosen's as guides.

Thanks for listening!
Jeremy Faust and Lauren Westafer

We cover some high yield, important, or frequently discussed recent articles.

Antibiotics and abscesses - Daum et al

FAST in hemodynamically stable patients -  Holmes et al

Haloperidol in gastroparesis - Roldan et al and Ramirez et al

Ignoring PERC - Buchanan et al

Steroids in non-asthma/COPD lower respiratory tract infections - Hay et al

Gender pay gap persists in academic EM (and it's not due to hours, rank, or roles) - Madsen et al

There's been a lot of excitement over various drugs for COVID-19, including anti-inflammatory drugs. Colchicine, a medication long used for gout, fits that bill. In this podcast, we review 3 trials of colchicine including COLCORONA, GRECCO-19, and a study by Lopes et al. 

Show notes: FOAMcast.org

Thanks for listening!

Jeremy Faust and Lauren Westafer

We review the evaluation and management of Community-Acquired Pneumonia (CAP) as well as the Infectious Disease Society of America (IDSA) / American Thoracic Society (ATS) 2019 guidelines for CAP.

Shownotes and references at FOAMcast.org

Thanks for listening!
Jeremy Faust and Lauren Westafer

We tackle some free open access medical education from the CDC on the flu vaccine, including:

• Recommendations that individuals with any severity of egg allergy (including anaphylaxis) receive the flu vaccine. The only modification that needs to occur is patients with a history of true anaphylaxis to eggs should be given the flu shot in a setting where they can be monitored by a healthcare professional if needed (i.e. a doctor's office).
• It is very unlikely that the flu vaccine causes Guillan-Barre Syndrome (GBS). If there is any increase as a result of the flu shot, it is 1-2 in 1,000,000.

We then dive into CDC recommendations on oseltamivir as well as contradictory data from the most recent Cochrane review.

Thanks for listening!

Jeremy Faust and Lauren Westafer

We cover ultrasound guided pericardiocentesis using the posts from EMin5, CoreEM, and the Ultrasound Podcast.

Then, we delve into core content on the pericardium using Rosen’s (8th ed) Chapter 82 and Tintinalli (8th ed) Chapter 55 covering pericardial effusions, pericarditis, and myocarditis.

Thanks for listening!

Jeremy Faust & Lauren Westafer

We cover Free Open Access Medical Education (FOAM) on mass casualty incidents, an unfortunate reality in the current United States climate (and elsewhere).  There is a must read (truly, emergency providers really should read this) in EP Monthly by Dr.Kevin Menes, “How One Las Vegas ED Saved Hundreds of Lives After the Worst Mass Shooting in U.S. History”. He details his process in running the Emergency Department that evening.

We cover pearls from other great resources include a post on the St. Emlyn's blog, "Mass Casualty Incidents: Lessons from the AAST" and a free EBMedicine article on ballistic injuries

Core Content: Chapter 192 Rosen's, Chapter 5 Tintinalli - Mass Casualty Incident Triage

Thanks for listening!
Jeremy Faust and Lauren Westafer

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

We review Spinner et al in JAMA 2020, an open label trial of remdesivir 5 days vs remdesivir 10 days vs 'standard of care' for the treatment of #COVID19

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

We are bringing y'all pearls from ACEP 2016 in Las Vegas.

Today we cover Bell's Palsy (are you sure it's not a stroke?), burn dogma, and some hot abstracts of the year.

Thanks for listening!

Jeremy Faust and Lauren Westafer

We review the FDA briefing document from Pfizer   as well as from the CDC Advisory Council on Immunization Practices that approved the Pfizer-BioNTech COVID-19 vaccine in children ages 5-11.

References and show notes: FOAMcast.org

Thanks for listening!
Lauren Westafer and Jeremy Faust

We review the FOAM from SMACC GOLD, Dr. David Story's "Is Chloride A Poison?" for a great primer on the Stewart method to acid-base.  The Strong Ion Difference (SID) is essentially Sodium minus Chloride (Na - Cl). Normal = 38; a higher SID indicates metabolic alkalosis and a lower SID indicates a metabolic acidosis.  "Normal Saline" has a whopping amount of chloride, which decreases the SID and has been associated with acidosis, renal insufficiency in critically ill patients, and, perhaps, mortality.

As always, visit foamcast.org for show notes and the generously donated Rosh Review questions.

Key Texts: Tintinalli (7e) Chapters 19,21 ; Rosen's (8e) Chapters 124, 125

FOAM Resources: Acid-Base ala EMCrit I/II/III/IV, Hyponatremia - EMBasic, Hyponatremia-ERCast, Hyponatremia - EMCrit

Thanks y'all!

-Jeremy Faust and Lauren Westafer

We discuss Medicated Assisted Treatment (MAT) for opioid use disorder (OUD) including buprenorphine initiated from the emergency department.

This show was sponsored by Figure 1, a free open access application for providers using images and cases

Thanks for listening!

Jeremy Faust and Lauren Westafer

References:

1. Berg ML, Idrees U, Ding R, Nesbit SA, Liang HK, and McCarthy ML. Evaluation of the use of buprenorphine for opioid withdrawal in an emergency department. Drug Alcohol Depend. 2007;86(2-3):239-44. doi:10.1016/j.drugalcdep.2006.06.014.
2. Mattick RP, Breen C, Kimber J, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2014;(2):CD00220
3. Pierce M, Bird SM, Hickman M, Marsden J, Dunn G, Jones A, and Millar T. Impact of treatment for opioid dependence on fatal drug-related poisoning: a national cohort study in England. Addiction. 2016;111(2):298-308. doi:10.1111/add.13193.
4. Clark RE, Samnaliev M, Baxter JD, and Leung GY. The evidence doesn't justify steps by state Medicaid programs to restrict opioid addiction treatment with buprenorphine. Health Aff (Millwood). 2011;30(8):1425-33. doi:10.1377/hlthaff.2010.0532
5. Martin SA, Chiodo LM, Bosse JD, Wilson A. The Next Stage of buprenorphine Care for Opioid Use disorder. Annal of Internal Medicine

We deliver pearls from the first day of #dasSMACC in Berlin.

We cover talks by Dr. Brian Burns on trauma, Dr. David Carr on endocarditis, Dr. Paul Young on statistics, and Dr. Jess Mason on sickle cell vaso-occlusive crisis.

Check out foamcast.org for show notes and pictographic summaries.

Thanks for listening and for the Rosh Review for sending us!

Jeremy Faust and Lauren Westafer

In this episode, we review a consensus guideline from the American College of Emergency Physicians on the use of topical anesthetics in corneal abrasions. 

Show notes and references: FOAMcast.org

Thanks for listening!

Jeremy Faust and Lauren WEstafer

This week we review Dr. Salim Rezaie's REBEL Cast Episode 1 on Biphasic Anaphylaxis

Then, we delve into core content allergy/immunology pearls on Anaphylaxis and Angioedema using Rosenalli (Rosen's Emergency Medicine and Tintinalli's Emergency Medicine: A Comprehensive Review Guide)

Key Texts: Tintinalli (7e): Ch 27; Rosen's (8e) Ch 119

As always, visit foamcast.org for show notes and the generously donated Rosh Review questions.

Thanks y'all!

-Jeremy Faust and Lauren Westafer

In this episode, we discuss important and "hot" articles thus far in 2019. These articles include:

• Testing for pulmonary embolism in pregnant patients

  • Van der pol LM, Tromeur C, Bistervels IM, et al. Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism. N Engl J Med. 2019;380(12):1139-1149.

    Langlois E, Cusson-dufour C, Moumneh T, et al. Could the YEARS algorithm be used to exclude pulmonary embolism during pregnancy? Data from the CT-PE-pregnancy study. J Thromb Haemost. 2019; In Press

• Asymptomatic bacteriuria guidelines from the Infectious Disease Society of America (IDSA)
  • Nicolle LE, Gupta K, Bradley SF, et al. Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2019.
• Dosing of benzodiazepines in seizures
  • Sathe AG, Tillman C, Coles LD, et al. Underdosing of benzodiazepines in patients with status epilepticus enrolled in Established Status Epilepticus Treatment Trial. Acad Emerg Med. 2019 Jun 4.
• Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in trauma patients
  • Joseph B et al. Nationwide analysis of resuscitative endovascular balloon occlusion of the aorta in civilian trauma. JAMA Surg 2019. Mar 20.
• Mortality following opioid overdose
  • Weiner SG, Baker O, Bernson D, Schuur JD. One-Year Mortality of Patients After Emergency Department Treatment for Nonfatal Opioid Overdose. Ann Emerg Med. 2019; In Press

Thanks for listening!

Jeremy Faust and Lauren Westafer

We bring you breaking news on the updated sepsis definition from the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine.

SIRS and Severe Sepsis?   Out.

qSOFA (HAT - Hypotension, AMS, Tachypnea)?  In.

Septic Shock?  Sepsis + Vasopressors needed to maintain MAP >65 mmHg + Lactate >2 mmol/L (*after adequate fluids)

We are in Berlin for #dasSMACC and have lots of pearls to share from the speakers at this amazing conference.  Talks will be released for free on the SMACC podcast over the next year, but this podcast holds some pearls that we thought couldn't wait.

We cover...

Dr. Leanne Harnett on Pulmonary Embolism with Right Heart Thrombus (PE with RHT)

Dr. Michele Domico on Pediatric Cardiology Emergencies

Dr. Haney Mallemat (@CriticalCareNow) on Transesophageal Echocardiography (TEE) during Cardiac Arrest

Thanks for listening!

Jeremy Faust and Lauren Westafer

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

This episode reviews a study published by Wang et al that received incredible press coverage for touting benefits of mask wearing in one's own home....if it started prior to symptoms. This study is problematic, and we discuss why.

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded May 29, 2020

FOAMcast is bringing you pearls from conferences we attend including SMACC.  (and next June 13-16, we'll bring you pearls from smaccDUB in Dublin, Ireland)

Today we discuss some pearls on shift work, analgesia (even without drugs), the perils of the Glasgow Coma Scale and more!

We review the FOAM video by Dr. Anna Pickens of EMin5.com on "Special Seizures" including hyponatremia, isoniazid toxcitiy, alcohol withdrawal, and eclampsia.

Then we review core content on seizures using Rosen's Emergency Medicine and Tintinalli's Emergency Medicine: A Comprehensive Review.

Thanks for listening!

Jeremy Faust and Lauren Westafer

We cover Free Open Access Medical Education on opioids.

• The Poison Review podcast reviews papers on the opioid epidemic, including a paper by Rudd et al demonstrating an increase in opioid-related deaths over the past five years as well as the following paper by Shah and colleagues.
• The Dantastic Mr. Tox and Howard, a new podcast on the scene, also covers multiple topics on opioids, including common misconceptions of tramadol.

Then we cover core content on opioid overdose and withdrawal using Rosen's Emergency Medicine (9th ed) Chapter 156 and Tintinalli's Emergency Medicine (8th ed), Chapter 186 as a guide.

Thanks for listening!
Jeremy Faust and Lauren Westafer

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

We review a retrospective evaluation of COVID-19 infections in employees after a protocol that increased the use of high flow nasal cannula (Westafer et al)

Show notes (references/graphics): FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

This episode discusses convalescent plasma, specifically a recent systematic review by Rajendran et al

• Shen et al
• Zhang et al
• Ye et al
• Ahn et al
• Duan et al
• Biegel et al (influenza A RCT)

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded May 6, 2020

Alcohol use disorder (AUD) is commonly encountered in the ED and visits related to alcohol are estimated to be ~4% of all ED visits in the US. Despite this, most EDs offer little support and harm reduction for patients with AUD. In this podcast, we review naltrexone, the first-line medication for patients with AUD, which is starting to be initiated in US EDs by emergency clinicians. 

AAEM position paper

References and show notes: FOAMcast.org

Thanks for listening!
Lauren Westafer

#smaccDUB day 2

Dr. Reuben Strayer - “Disruption, Danger, and Droperidol: Emergency Management of the Agitated Patient."  

Dr. Strayer presented a brilliant talk on dealing with the quintessential Emergency Medicine patient - the undifferentiated acutely agitated patient. These patients are high risk and require emergent stabilization and resuscitation.

Dr. Haney Mallemat - "The PEA Paradox"

The typical way we think about PEA, the "H's and T's," is overly complicated. Further, we are horrendous at pulse palpation (see this for more), and so what we think is PEA may not actually be PEA.  Dr. Mallemat proposed QRS duration as one way to think about PEA, although this has limitations.

Dr. Michele Dominico - "How Usual Resuscitative Maneuvers Can Kill Paediatric Cardiac Patients"

Interventions we jump to in sick patients - oxygenation, ventilation, vasopressors - these can kill pediatric patients with cardiac pathology. She gave examples of some high yield pearls in these already terrifying patients.

EM Literature update by Drs. Ashley Shreves and Ryan Radecki

• Antibiotics for uncomplicated diverticulitis? May not be necessary
• Antibiotics for appendicitis? Maybe an option for some, but it may just be delaying an appendectomy.
• Tamsulosin for ureteral stones? Not necessarily indicated unless there are large (>5mm), distal stones.

Interesting and Ridiculous Research Pearls from Drs. Ashley Shreves and Ryan Radecki

• Perception of dyspnea and pulmonary function tests change with stress - and rollercoaster rides.  Rietveld S, van Beest I. Rollercoaster asthma: when positive emotional stress interferes with dyspnea perception. Behaviour research and therapy. 45(5):977-87. 2007. [pubmed]
• Cured pork for epistaxis? Possibly. Researchers will try everything, especially if it involves bacon. Humphreys I, Saraiya S, Belenky W, Dworkin J. Nasal packing with strips of cured pork as treatment for uncontrollable epistaxis in a patient with Glanzmann thrombasthenia. The Annals of otology, rhinology, and laryngology. 120(11):732-6. 2011. [pubmed]

We are at ACEP 2016 summarizing the hottest pearls

Today we cover placebos in the ED for back pain, nausea, and upper respiratory tract infections as well as atrial fibrillation management controversies and vaccine side effects.

Thanks for listening!

Jeremy Faust and Lauren Westafer

Outpatient management of pulmonary embolism for low-risk patients has been encouraged for several years. However, little is known about pulmonary embolism diagnosed and managed exclusively in the outpatient setting. In this study, Vinson et al describe the course of patients diagnosed with PE and managed in the outpatient setting in an integrated healthcare delivery system.

Shownotes/References: FOAMcast.org

Thanks for listening!
Lauren Westafer

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check us*

In this episode, we cover the Society of Critical Care Medicine, Surviving Sepsis Guidelines for COVID-19

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

FOAMcast is bringing you pearls from conferences we attend including SMACC.  

The overarching theme to Day 1 at SMACC?  Use your team-to check you and for feedback.  Dr. Cliff Reid reminded us to follow up our patients and outcomes and learn from it all, without letting our egos get in the way.   Dr. Simon Carley (St. Emlyn's) gave a powerful talk on learning from mistakes later in the day; you will definitely want to listen to these when they come out.

We cover trauma pearls from Dr. Scott Weingart, pain pearls from Dr. Reuben Strayer, tox pearls form Dr. David Juurlin, and a bunch of sepsis goodness. 

The FOAM realm has teamed with interest in a randomized trial in the ICU by Semler et al, the FELLOW trial. This week we cover some aspects of this trial, such as statistical power, highlighted in some of the following Free Open Access Medical Education (FOAM) posts

• EMCrit
• The Bottom Line
• EM Literature of Note
• St. Emlyn's
• REBEL EM

Then, we delve into core content on epistaxis and sinusitis using Rosenalli (Tintinalli (7e) Chapter 239, “Epistaxis, Nasal Fractures, and Rhinosinusitis.” Rosen’s  (8e) Chapter 75, “Upper Respiratory Infection.", "Otolaryngology") as a guide.

Thanks for listening,

Jeremy Faust and Lauren Westafer

We have previously covered epistaxis on FOAMcast , including the use of tranexamic acid (TXA). Now, we cover a new, large RCT, the NoPac trial by Reuben et al, on TXA for epistaxis.

Show notes: FOAMcast.org

Thanks for listening!
Lauren Westafer and Jeremy Faust

We have previously podcasted on tachyarrythmias (Episode 34 Tachyarrhythmias), but in this episode, we focus specifically on the treatment of supraventricular tachycardia  (SVT),  specifically paroxysmal SVT.

We discuss the treatment options of adenosine and calcium channel blockers, weighing in with the evidence, the guidelines, and some opinion.

Thanks for listening!
Lauren Westafer and Jeremy Faust

Thanks to Figure 1 for supporting this episode. We do not make money off of this podcast, this support is just for operational costs associated with the podcast.

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

This episode discusses cutaneous manifestations of COVID-19 including "COVID toes"

• Recalcati
• Manalo
• Duong et al
• Nieto
• Piccolo et al
• Alrantham  et al
• Kolivras et al

And the more serious lesions

• Zhang et al
• Zhang et al

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded 4.28.20

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

Monoclonal antibodies have received significant attention over the past month and we previously podcasted on antibodies that target SARS-CoV-2. In this episode, we review several recent studies on a different "mab", tocilizumab,  which targets inflammation mediated by interleukin-6 that is overly ramped up. 

We review:

Stone et al  ( RCT)

Hermine et al (RCT)

Salvarani et al. (RCT)

STOP-COVID (observational)

Show notes (references/graphics): FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

On this FOAMcastini (A tiny FOAMcast), we summarize our summaries of core content and free open access medical education (FOAM), covering:

Episode 1 - Cyanide and Carbon Monoxide Toxicity

Episode 2 - All things GU (Renal colic, urinary retention, infected stones)

Episode 3 - ENT (Bullous myringitis, ruptured tympanic membranes, auricular hematomas, and more).

This is our attempt at remembering these things ourselves and encouraging some spaced repetition. Thanks for listening and just remember, no need to FOAM it alone.

-Jeremy Faust and Lauren Westafer

We bring you pearls from the American College of Emergency Physicians (ACEP) 2018 Scientific Assembly in San Diego, CA.

In this episode we highlight:

• Severe pediatric brain injury, tips for management and preventing badness
• Aortic dissection diagnostics
• Chest tube pearls

Thanks for listening!
Jeremy Faust and Lauren Westafer

Subsegmental pulmonary embolism (SSPE) is a controversial entity as they have uncertain clinical significance. As a result, the Chest Guidelines  and ACEP guidelines state that a very select group of patients with isolated SSPE and no deep vein thrombosis may be managed with surveillance rather than anticoagulation. In this podcast we review SSPE and a new prospective study by Le Gal and colleagues.

Show notes and references: FOAMcast.org

Thanks for listening!

Lauren Westafer

FOAMcast is bringing you pearls from conferences we attend and, first up, the American College of Emergency Physicians annual meeting, ACEP14.  However, Jeremy and I both worked overnights so we got into town a little late.  Our friends and ACEP luminaries, Drs. Justin Hensley, Howie Mell, and Todd Slesinger.

For updates, follow #ACEP14

Thanks for listening, y'all!

Jeremy Faust and Lauren Westafer

This week we're covering Dr. Jacob Avila's post on ultrasound for small bowel obstruction (SBO)  located at Ultrasound of the week.  He has an accompanying video on 5minSono.

The Bread and Butter

We cover key points on SBO and Acute Mesenteric Ischemia from Rosenalli, that’s Tintinalli (7e) Chapter 86; Rosen’s (8e) Chapter 92.  But, don’t just take our word for it.  Go enrich your fundamental understanding yourself.

As always, visit foamcast.org for show notes and the generously donated Rosh Review questions.

Thanks y'all!

-Jeremy Faust and Lauren Westafer

We review the FOAM from The RAGE podcast (The Resuscitationist's Awesome Guide to Everything), "Episode 4" ,on impact apnea, the right heart and more.  Then we discuss the core content related to right ventricular myocardial infarctions and heart failure.

As always, visit foamcast.org  for show notes and the generously donated Rosh Review questions.

Key Texts:  Tintinalli (7e) Chapters 53, 57; Rosen’s (8e) Chapters 78, 81

Thanks for listening!

-Jeremy Faust and Lauren Westafer

We bring you highlights from ACEP2016 in Las Vegas.

Today we focus on the care of the transgender patient and some pearls on caring appropriately for our diverse patients.

We also cover active shooters and lawsuit pearls

Thanks for listening!
Jeremy Faust and Lauren Westafer

We review the post by Bryan Hayes, PharmD, FAACT on Academic Life in Emergency Medicine,  Sulfamethoxazole-Trimethoprim for Skin and Soft Tissue Infections: 1 or 2 Tablets BID? 

Then, we delve into core content pearls on cellulitis and abscesses, necrotizing skin infections, and Erythema Multiforme/Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis using the IDSA guidelines, Tintinalli, and Rosen's as a guide. 

As always, visit foamcast.org for show notes and the generously donated Rosh Review questions.

Thanks y'all!

-Jeremy Faust and Lauren Westafer

For years studies have questioned whether pulse oximeters perform as well in non-White patients as in White patients. This is particularly important now as disposition decisions in patients with COVID-19 are often made based on pulse oximetry readings.

We discussed an article by Sjoding et al in NEJM 

Show notes at FOAMcast.org

Thanks for listening!
Lauren Westafer and Jeremy Faust

ACEP released an updated clinical policy on the use of tPA for acute ischemic stroke in June 2015.  We reviewed this on a prior episode. While we are not an interview based show, we had to seize the opportunity to talk with those with more experience. 

In this episode, Jeremy interviews Dr. Jerry Hoffman, a notorious tPA critic.

We shall return to regular core content soon.

-Jeremy Faust and Lauren Westafer

This episode reviews guideline recommendations and literature on the management of acute, uncomplicated diverticulitis - highlighting the recommendations to only prescribe antibiotics to select patients.

References/Show Notes: FOAMcast.org

Thanks for listening!
Lauren WEstafer

This episode is slightly different.  We review some of our favoite pearls from the last year including our favorite mnemonics and memory aids (and some that we think bombed).

Thanks, y'all, for listening, providing feedback, and continuing to inspire us to look through FOAM and Rosenalli to enhance our emergency medicine education.

-Jeremy Faust and Lauren Westafer

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

In this episode, Dr. Rory Spiegel (@EMNerd_) and I discuss risk stratification tools in COVID-19

• Zhou et al.
• Gong et al 

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded 4.10.20

In this episode we cover The Skeptic's Guide to Emergency Medicine Episode on Regional Anesthesia for hip and femoral neck fractures.

Then we delve into core content on Rosen's and Tintinalli (Rosenalli) on core content pearls on compartment syndrome.

Thanks for listening!

Jeremy and Lauren

The US Food and Drug Administration (FDA) recently released another warning for fluoroquinolones, this time regarding aortic dissection and aneurysm.  We review the evidence behind this warning, including the following studies:

Lee CC  Risk of Aortic Dissection and Aortic Aneurysm in Patients Taking Oral Fluoroquinolone. JAMA Intern Med. 2015;175(11):1839-47.

Lee CC Oral Fluoroquinolone and the Risk of Aortic Dissection. J Am Coll Cardiol. 2018;72(12):1369-1378.

Pasternak B Fluoroquinolone use and risk of aortic aneurysm and dissection: nationwide cohort study. BMJ. 2018;360:k678.

We then review the ACEP clinical policy on aortic dissection covering risk scores, d-dimers, and management of aortic dissection

Thanks for listening!

Jeremy Faust and Lauren Westafer

A lot of good literature came out in 2016 so we wanted to mention a couple of our favorite articles of the year.

Sepsis 3.0

Singer M, Deutschman CS, Seymour CW, et al: The Sepsis Definitions Task Force The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).

The quick SOFA score (qSOFA) also came out in hopes it "provides simple bedside criteria to identify adult patients with suspected infection who are likely to have poor outcomes."  It is not part of the sepsis definition 

Back Up Head Elevated Intubation

Khandelwal et al. Head-elevated Patient Positioning Decreases Complications of Emergent Tracheal Intubation in the Ward and Intensive Care Unit. Anesthesia and Analgesia. Apr 2016.

Ketorolac Dose

Motov, S, Yasavolian, M, Likourezos, A, et al. Comparison of Intravenous Ketorolac at Three Single-Dose Regimens for Treating Acute Pain in the Emergency Department. .Ann Emerg Med. 2016 Dec 16.

Out of Hospital Cardiac Arrest Prognostication

Jabre et al. Early Identification of Patients With Out-of-Hospital Cardiac Arrest With No Chance of Survival and Consideration for Organ Donation.   Intern Med. 2016 Dec 6;165(11):770-778

Thanks for listening!

Jeremy Faust and Lauren Westafer

We cover top pearl from the American College of Emergency Physicians (ACEP) Scientific Assembly 2017.

Dr. Michael Winters - Critical Care Updates

Dr. Tim Horeczko - Pediatric Pitfalls

Thanks for listening!
Jeremy Faust and Lauren Westafer

In this episode, we discuss ivermectin as a potential therapeutic for COVID-19 and review available randomized trials evaluating this drug.

• Chaccour et al E-Clinical Medicine
• Lopez-Medina et al. JAMA
• Schwartz et al (not yet published)
• IDSA guidelines
• NIH Treatment guidelines

Show notes: FOAMcast.org

Thanks for listening!
Jeremy Faust and Lauren Westafer

We cover some top articles of 2019, including the following: 

Roc vs Sux:  Guihard B et al. Effect of rocuronium vs succinylcholine on endotracheal intubation success rate among patients undergoing out-of-hospital rapid sequence intubation: A randomized clinical trial. JAMA 2019 Dec 17; 322:2303. (https://doi.org/10.1001/jama.2019.18254)

Targeted Temperature Management after Cardiac Arrest: Lascarrou JB, Merdji H, Le gouge A, et al. Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm. N Engl J Med. 2019.

Pulmonary Embolism - a new D-dimer cut off Kearon C, De wit K, Parpia S, et al. Diagnosis of Pulmonary Embolism with d-Dimer Adjusted to Clinical Probability. N Engl J Med. 2019;381(22):2125-2134.

Pulmonary Embolism in Pregnancy: Van der pol LM, Tromeur C, Bistervels IM, et al. Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism. N Engl J Med. 2019;380(12):1139-1149.

TXA in head injury The CRASH-3 Trial Collaborators. Effects of Tranexamic Acid on Death, Disability, Vascular Occlusive Events and Other Morbidities in Patients with Acute Traumatic Brain Injury (CRASH-3): A Randomised, Placebo-Controlled Trial. Lancet 2019

We review EMCrit Episode #122 in which Drs. Weingart and Nelson review a case of cyanide poisoning in a patient presenting in PEA arrest after a house fire.

Show notes and Rosh Review questions at foamcast.org

Key Texts:

Cyanide: Tintinalli (7e) Ch 198; Rosen's (8e) Ch 159

Carbon Monoxide: Tintinalli (7e) Ch 217; Rosen's (8e) Ch 159

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

Monoclonal antibodies have received significant attention over the past couple of weeks. In this episode, we review what we know, as of October 9, 2020, about monoclonal antibodies as a therapy for COVID-19. 

Show notes (references/graphics): FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

We are at #smacc in Australia thanks to the Rosh Review!

The opening session this morning was amazing and we can't do it justice on the podcast. Gill Hicks (@MadForPeace), a victim in the July 7, 2005 bombing attack on a London train spoke on how impactful everyone in the healthcare delivery system can be (from medics to detectives to nurses to physical therapists to physicians). Dr. Dara Kass delivered a powerful talk on vulnerability, responsibility, and lack of knowledge even in a super health care literate individual.....what it means to be a provider and a patient (and a mom and a medical home for the family and a wife) in her story of donating part of her liver to her son.

David Carr on anti-NMDA receptor encephalitis

 Anti-NMDA receptor encephalitis is the most common cause of encephalitis in young people (<30 years old), with an average age of ~20. We review the presentation, diagnosis, and treatment of this disease

Thanks for listening!
Jeremy Faust and Lauren Westafer

We bring you pearls from the American College of Emergency Physicians (ACEP) 2018 Scientific Assembly in San Diego, CA.

In this episode we highlight:

• Problems with CYA (Cover your a$$) medicine such as admissions
• Problems with lactate, procalcitonin, and other biomarkers

Thanks for listening!
Jeremy Faust and Lauren Westafer

We cover Free Open Access Medical Education (FOAM) from a recent Emergency Medicine Cases podcast and First10inEM blog post by Dr. Justin Morganstern regarding urinary tract infections (UTIs).   This podcast and blog tackle common issues in UTI diagnosis and treatment, including the following points:

• UTI is a clinical diagnosis, a dirty urine does not mean the patient has a UTI
• Urinalyses are more complicated to interpret than we probably understand

Then we cover core content from Rosen’s Emergency Medicine (8th ed), Chapter 99; Tintialli's Emergency Medicine (8th ed), Chapter 91; IDSA Guidelines for Treatment and Asymptomatic Bacteriuria

Thanks for listening!

Jeremy Faust and Lauren Westafer

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

This episode reviews a study published by Mehra et al in the Lancet with concerning methods and data anomalies, leading to the possibility and likelihood of falsified data. This came to light after an open letter by Watson et al  detailing major issues. The Lancet issued a correction, which did not address many of the major issues and resulted in significant changes to Table S3 in the supplement. Concerningly, this group also authored the NEJM study on ACE-I/ARBs in COVID-19. 

Note: This is an evolving story

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded June 1, 2020

This episode is inspired by a tweet from Dr. Nick Genes who queried why there wasn't more focus on hepatic emergencies in FOAM  (Free Open Access Medical education).  

We review the FOAM from Maryland's Critical Care Project ,"Chyle- coming to a paracentesis near you," on chylous ascites.  Then, we discuss core content liver emergencies, focusing on Spontaneous Bacterial Peritonitis, Hepatic Encephalopathy, and a smattering of hepatotoxic drugs.

As always, visit foamcast.org  for show notes and the generously donated Rosh Review questions.

Key Texts: Tintinalli's Emergency Medicine: A Comprehensive Board Review(7e) Chapter83, Rosen’s Emergency Medicine (8e) Chapter 90

Thanks for listening!

-Jeremy Faust and Lauren Westafer

In this tiny episode we do something a little different.

Dr. Paul Young (@dogICUma) and colleagues published two papers in JAMA and NEJM, SPLIT and HEAT, respectively.  

SPLIT is an RCT looking at balanced crystalloid vs 0.9% NaCl and AKI, an ever popular topic in FOAM.

HEAT is an RCT of acetaminophen in ICU patients.

We'll be back with regular episodes, soon.

-Jeremy Faust and Lauren Westafer

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

This episode reviews a study published by Goldman et al dissecting a study on remdesivir - 5 day vs 10 day course.

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded May 30, 2020

We cover FOAM on the WOMAN trial of tranexamic acid (TXA) in post-partum hemorrhage including BroomeDocs, EMlitofnote, and The Bottom Line

Then we delve into core content on non-pregnant vaginal bleeding using Rosen's and Tintinalli's as a guide.

Show notes are available at FOAMcast.org

Thanks for listening!
Lauren Westafer & Jeremy Faust

In this episode, we review cannabinoid hyperemesis syndrome and two recent randomized controlled trials on treatments

• Haloperidol - Ruberto et al  (Annals of Emergency Medicine, In Press)
• Capsaicin - Dean et al. Acad Emerg Med 2020.

Show notes (references, graphics) at FOAMcast.org

Thanks for listening!

Jeremy Faust and Lauren Westafer

We cover the emergency department care of lactating patients including

Medications during breastfeeding - who should "pump and dump"? (spoiler: very few people, check LactMed or InfantRisk)

Mastitis & Breast Abscesses

Emergency Department Support

Thanks for listening!
Jeremy Faust and Lauren Westafer

We are at ACEP 2019 in Denver and cover pearls from interesting lectures. Today, that included concussion and VP shunts.

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

In this episode, Dr. Rory Spiegel (@EMNerd_) and I discuss the "switch" from early intubation to aggressive non-invasive modalities and our respiratory protocols including what we know about the evidence behind...

• Early intubation recommendations
• High flow nasal cannula in COVID-19
• Self/awake proning

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded 4.17.20

Prior randomized trials of convalescent plasma in COVID-19 have had disappointing results. However, these trials included patients with severe illness who were many days (if not weeks) into the course of their illness. To date, it was hypothesized, but unknown, that the benefit would be in patients very early in the course of their illness. We cover an RCT by Libster et al in NEJM on convalescent plasma in older patients with mild COVID-19.

Show notes/references: FOAMcast.org

Thanks for listening!

Lauren Westafer and Jeremy Faust

We review this post from Dr. Scott Weingart's EMCrit podcast on Thyroid Storm.

Then, we delve into core even more content pearls on the thyroid including differentiating different hyperthyroid states and mxyedema coma.  We do this using Tintinalli and Rosen's as guides. 

As always, visit foamcast.org for show notes and the generously donated Rosh Review questions.

Thanks y'all!

-Jeremy Faust and Lauren Westafer

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check us*

Recorded 3.23.20

In this episode, we cover

• Anosmia / dysgeusia
• Gastrointestinal symptoms
• Policy updates

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

We cover FOAM on transvenous pacing from Ultrasound Podcast, Dr. Jason Nomura, and Dr. Al Sachetti

Then, we delve into basics on bradycardias using Rosen's Emergency Medicine and Tintinalli's as a guide.

Thanks for listening!
Jeremy Faust and Lauren Westafer

We review the Anorectal emergencies: WSES-AAST guidelines on complicated hemorrhoids that include some practice-changers

References: FOAMcast.org

Thanks for listening!
Lauren Westafer

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check us*

Recorded 3.25.20

In this episode, we cover

• Incubation period
• Disease timeline
• Viral shedding
• Re-infection

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

This week we review Mount Sinai Emergency Medicine Residency's blog post on Ebola.

Then, we delve into core content infectious disease pearls on Airborne and Droplet isolation and infectious agents such as varicella using Tintinalli as our predominant reference.

Key Texts: Tintinalli (7e): Ch 148, Ch 157; The CDC

As always, visit foamcast.org for show notes and the generously donated Rosh Review questions.

Thanks y'all!

-Jeremy Faust and Lauren Westafer

In this tiny episode, Jeremy gives his bottom line pearls for FOAMcast episodes 4-14.  You know, because spaced repetition is a good thing.  We've got anaphylaxis, heart failure, ebola, acid-base, and more.

As always, visit foamcast.org for show notes and the generously donated Rosh Review questions.

Thanks y'all!

-Jeremy Faust and Lauren Westafer