Em Basic

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.

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.

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.

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.

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.

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.

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.

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.

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.

In this episode, we will discuss how to perform medical screening for patients with psychiatric complaints.  While most of these workups are routine, we have to be able to catch the small percentage of patients who have a medical cause to their psychiatric complaint.  Don't think it can't happen to you- it almost happened to me twice during residency!  We'll discuss how to stay safe while evaluating psychiatric patients, how to get the entire history, how to do appropriate testing, catch the red flags, and make the appropriate disposition. In the bonus section, a community ED doctor wrote me to tell me his thoughts on testicular pain and why we may not need an ultrasound on every patient.  As you'll hear, the answer is far from settled and not without controversy.

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.

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.

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.

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.

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.

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.

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 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.

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 s

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.