Em Basic

In this episode, we will discuss the diagnosis and treatment of stroke and transient ischemic attack (TIA). The ED is the front line in stroke care so we need to know how to work up this chief complaint. We'll go over how to recognize the signs and symptoms of a stroke, how to get a rapid and complete history, how to screen patients for contraindications to thrombolytics, and how to catch a few stroke mimics.

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.

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.

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.

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.

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.

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.

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.

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.

Shortness of breath is a chief complaint that we encounter each day in the ED.  This chief complaint encompasses a huge differential and this is a long podcast.  As always, I'll break this chief complaint down into the diagnoses that we can't miss and how to treat the underlying causes of shortness of breath for both kids and adults.

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.

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.

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.

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.

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 1

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.

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.

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.

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 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.