There are a variety of anorectal emergencies that present to the emergency department.  Recently, there were updated guidelines made by the World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST).  In this post, we review some of the updated guidelines including for anorectal abscess, perineal necrotizing fasciitis (Fournier's gangrene), bleeding anorectal varices, complicated rectal prolapse (irreducible or strangulated), and retained anorectal foreign bodies.

There are a variety of anorectal emergencies that present to the emergency department.  Recently, there were updated guidelines made by the World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST).  In this post, we review some of the updated guidelines including for anorectal abscess, perineal necrotizing fasciitis (Fournier's gangrene), bleeding anorectal varices, complicated rectal prolapse (irreducible or strangulated), and retained anorectal foreign bodies.

Podcast #244 - Updated Guidelines on Anorectal Emergencies

We are back to providing our ATLS content and we are picking up where we left off.  Our last ATLS podcast was on spine and spinal cord trauma.  Somewhat similar in nature is musculoskeletal trauma.  This is a very common form of trauma.  However, delayed recognition and  treatment can result in life-threatening hemorrhage or limb loss.

We are back to providing our ATLS content and we are picking up where we left off.  Our last ATLS podcast was on spine and spinal cord trauma.  Somewhat similar in nature is musculoskeletal trauma.  This is a very common form of trauma.  However, delayed recognition and  treatment can result in life-threatening hemorrhage or limb loss.

Podcast #243 - ATLS Episode 8: Musculoskeletal Trauma

Cluster headaches are often considered one of the most painful human experiences.  They are short (lasting usually 15-180 minutes), frequent (up to 8 a day), unilateral headaches behind or around the eye often with ipsilateral autonomic symptoms and restlessness.  While migraines and tension headaches are seen frequently in the emergency department, cluster headaches are much less frequently seen and often are harder to identify as a result.  There are certain points to remember with patients that are experiencing cluster headaches and we list 10 of them here.

Cluster headaches are often considered one of the most painful human experiences.  They are short (lasting usually 15-180 minutes), frequent (up to 8 a day), unilateral headaches behind or around the eye often with ipsilateral autonomic symptoms and restlessness.  While migraines and tension headaches are seen frequently in the emergency department, cluster headaches are much less frequently seen and often are harder to identify as a result.  There are certain points to remember with patients that are experiencing cluster headaches and we list 10 of them here.

Podcast #242 - 10 Key Pearls for Cluster Headaches

The use of tranexamic acid (TXA) has expanded with growing evidence in its use for a variety of clinical situations.  However, not all evidence is created equal and not all applications show benefit.  In this blog and podcast we discuss the various uses of TXA and the surrounding evidence.

The use of tranexamic acid (TXA) has expanded with growing evidence in its use for a variety of clinical situations.  However, not all evidence is created equal and not all applications show benefit.  In this blog and podcast we discuss the various uses of TXA and the surrounding evidence.

Podcast #241 - TXA in the Prehospital Setting

For decades, there has been a major name debate regarding the appropriate title for PAs.  However, on May 24, 2021 the American Academy of PAs (AAPA) House of Delegates (HOD) came to a vote.  Over 100 possible titles were considered, but ultimately the winning vote was for "physician associate" which has led to a significant amount of discussion.  What is the history behind this decision and why now?  What has been the response?  We discuss this and more in this new blog and podcast.

For decades, there has been a major name debate regarding the appropriate title for PAs.  However, on May 24, 2021 the American Academy of PAs (AAPA) House of Delegates (HOD) came to a vote.  Over 100 possible titles were considered, but ultimately the winning vote was for "physician associate" which has led to a significant amount of discussion.  What is the history behind this decision and why now?  What has been the response?  We discuss this and more in this new blog and podcast.

Podcast #240 - PAs are Associates?

There are countless guides and references that can be used in emergency medicine.  However, some books prove to be better resources than others and it is vital to identify them.  In this post, we review one of the books you should seriously consider having if you work in emergency medicine.

There are countless guides and references that can be used in emergency medicine.  However, some books prove to be better resources than others and it is vital to identify them.  In this post, we review one of the books you should seriously consider having if you work in emergency medicine.

Podcast #239 - Book Review: The Resuscitation Crisis Manual (RCM)

Last year, the American Heart Association (AHA) provided updates to their basic life support (BLS), advanced cardiac life support (ACLS), and pediatric advanced life support (PALS) programs.  Mike Sharma is helping again by reviewing some of the key updates and changes to guidelines.  We also provide some additional feedback and information to consider with these new guidelines.

Last year, the American Heart Association (AHA) provided updates to their basic life support (BLS), advanced cardiac life support (ACLS), and pediatric advanced life support (PALS) programs.  Mike Sharma is helping again by reviewing some of the key updates and changes to guidelines.  We also provide some additional feedback and information to consider with these new guidelines.

Podcast #238 - AHA 2020 Updates for BLS, ACLS, and PALS

March is Women's History Month and we wanted to celebrate some of the accomplishments of women in medicine.  While there are countless women that could be mentioned, we wanted to focus on a few that have been seen as pioneers in medicine.

March is Women's History Month and we wanted to celebrate some of the accomplishments of women in medicine.  While there are countless women that could be mentioned, we wanted to focus on a few that have been seen as pioneers in medicine.

Podcast #237 - Celebrating Women in Medicine

Recently there was commentary in a forum that suggested the Pulmonary Embolism Rule-Out Criteria (PERC Rule) was essentially useless for detecting a pulmonary embolism (PE).  It started with an anecdote, which is a logical fallacy (post hoc ergo propter hoc) and went wild from there.  This led to the realization that many still do not understand how to use the Wells' Criteria for Pulmonary Embolism (referred to from here simply as the Wells' Criteria) and the PERC Rule.

Recently there was commentary in a forum that suggested the Pulmonary Embolism Rule-Out Criteria (PERC Rule) was essentially useless for detecting a pulmonary embolism (PE).  It started with an anecdote, which is a logical fallacy (post hoc ergo propter hoc) and went wild from there.  This led to the realization that many still do not understand how to use the Wells' Criteria for Pulmonary Embolism (referred to from here simply as the Wells' Criteria) and the PERC Rule.

Podcast #236 - Understanding Wells' Criteria for Pulmonary Embolism and the PERC Rule

Injuries to the spine can occur both in blunt and penetrating trauma.  They can also be with or without neurological deficits.  For this reason, they should be considered in all patients with multiple injuries.  In this podcast, Chip Lange and Mike Sharma review the pearls and pitfalls of this disease process.

Injuries to the spine can occur both in blunt and penetrating trauma.  They can also be with or without neurological deficits.  For this reason, they should be considered in all patients with multiple injuries.  In this podcast, Chip Lange and Mike Sharma review the pearls and pitfalls of this disease process.

Podcast #235 - ATLS Episode 7: Spine and Spinal Cord Trauma (Chapter 7)

We are a FOAMED project devoted to providing TOTAL care everywhere. This is done by sharing the Tools Of the Trade and Academic Learning in Emergency Medicine (TOTAL EM). We believe in education for emergency medicine professionals and the public.

Great variety and always engaging. The guest posts and themed series have been great.

Variety of EM Topics

Excellent podcast for anybody interested in Emergency Medicine! I highly recommend!

Perfect

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

Yes, that oh so common complaint that brings patients into the ER.   With acute back pain, everyone seems to have their own cocktail for treatment, but what has been shown to work?  In this reviewed of a trial in JAMA published October 20, 2015 we review a randomized control trial that looked into just this issue.

Yes, that oh so common complaint that brings patients into the ER.   With acute back pain, everyone seems to have their own cocktail for treatment, but what has been shown to work?  In this reviewed of a trial in JAMA published October 20, 2015 we review a randomized control trial that looked into just this issue.

Podcast #4 - Acute Back Pain

It is time for another EB Medicine special.  The febrile young infant can be one of the scarier patients for a variety of reasons.  They are so young they are unable to communicate, they have very real and serious pathogens that can have deadly consequences, and the family as well as other individuals taking care of the patient can be nervous or scared creating increased stress.  In this post, we cover EB Medicine's recent article on this topic to better improve your practice.

It is time for another EB Medicine special.  The febrile young infant can be one of the scarier patients for a variety of reasons.  They are so young they are unable to communicate, they have very real and serious pathogens that can have deadly consequences, and the family as well as other individuals taking care of the patient can be nervous or scared creating increased stress.  In this post, we cover EB Medicine's recent article on this topic to better improve your practice.

Podcast #174 - EB Medicine: The Febrile Young Infant

​There have been recent requests for further discussion of the neurological exam.  Specifically, how to do a brief neurological exam in the emergency department, how to perform a HINTS exam, and documenting the exams performed. 

​There have been recent requests for further discussion of the neurological exam.  Specifically, how to do a brief neurological exam in the emergency department, how to perform a HINTS exam, and documenting the exams performed.

Podcast #70 - Neurological Exam Including HINTS and Documentation

You have waited long enough!  It is time for some real information and that has come in the form of a paper I find very important.  The REACT-2 study was published online with The Lancet on June 28, 2016.  I started looking at it right away but did not get the chance to actually post about the topic until now.  Listen to the podcast, read the blog, but do not forget to read the original paper, too!

You have waited long enough!  It is time for some real information and that has come in the form of a paper I find very important.  The REACT-2 study was published online with The Lancet on June 28, 2016.  I started looking at it right away but did not get the chance to actually post about the topic until now.  Listen to the podcast, read the blog, but do not forget to read the original paper, too!

Podcast #3 - The REACT-2 Trial

Michelle Perkins

Acutely decompensated CHF can be a highly dangerous condition and one that needs immediate management.  Previous Resuscitation Leadership Academy (RLA) student Michelle Perkins comes on for her debut to discuss management of this condition.

Acutely decompensated CHF can be a highly dangerous condition and one that needs immediate management.  Previous Resuscitation Leadership Academy (RLA) student Michelle Perkins comes on for her debut to discuss management of this condition.

Podcast #37 - Acute Decompensated CHF with Michelle Perkins

Everyone talks about airway all the time, and I was at first reluctant to give this talk.  However, I believe it is time to talk about this important subject in a slightly different way.  The last time we talked about airway management in regards to intubation was with Kris Maday (from the PAINE Podcast) in Podcast #18 where we went over the basics (a great review to listen to first if needed).  There we talked mostly about rapid sequence intubation (RSI).  Although commonly used, this is not for every patient.  Today, we talk about RTI, which is what we need in most patients.

Everyone talks about airway all the time, and I was at first reluctant to give this talk.  However, I believe it is time to talk about this important subject in a slightly different way.  The last time we talked about airway management in regards to intubation was with Kris Maday (from the PAINE Podcast) in Podcast #18 where we went over the basics (a great review to listen to first if needed).  There we talked mostly about rapid sequence intubation (RSI).  Although commonly used, this is not for every patient.  Today, we talk about RTI, which is what we need in most patients.

Podcast #57 - Resuscitate Then Intubate (RTI) Approach Saves Lives

In the later half of 2018, the American College of Emergency Physicians (ACEP) published their guidelines with non-ST-elevation myocardial infarction (NSTEMI) patients.  These guidelines were beneficial to support some current practices based on current evidence.  In this post, we review the guidelines and some of the supporting evidence.

In the later half of 2018, the American College of Emergency Physicians (ACEP) published their guidelines with non-ST-elevation myocardial infarction (NSTEMI) patients.  These guidelines were beneficial to support some current practices based on current evidence.  In this post, we review the guidelines and some of the supporting evidence.

Podcast #145 - ACEP Guidelines on NSTEMI

​Fever can be scary.  It brings in many parents and even adults no matter the time of day.  However, there is a lot of misinformation regarding fevers which brings about this important discussion.  Using available evidence, we are going to talk about fevers and some of the main myths versus the actual evidence.  As always, with topics like these, it is worth remembering that this does not replace clinical judgment and is meant to be informational.  Any time there is concern, it should be appropriately evaluated and managed.

​Fever can be scary.  It brings in many parents and even adults no matter the time of day.  However, there is a lot of misinformation regarding fevers which brings about this important discussion.  Using available evidence, we are going to talk about fevers and some of the main myths versus the actual evidence.  As always, with topics like these, it is worth remembering that this does not replace clinical judgment and is meant to be informational.  Any time there is concern, it should be appropriately evaluated and managed.

Podcast #86 - Fever Phobia and Myths with Michelle Perkins

David Fifer

To celebrate the Fourth of July, David Fifer joined us to talk about heat exhaustion, heat stroke, and the dogma around these conditions.  This topic is one that is frequently misunderstood and David helps us understand the key pearls and pitfalls with heat stress emergencies.

To celebrate the Fourth of July, David Fifer joined us to talk about heat exhaustion, heat stroke, and the dogma around these conditions.  This topic is one that is frequently misunderstood and David helps us understand the key pearls and pitfalls with heat stress emergencies.

Podcast #154 - Dogmalysis of Heat Exhaustion and Heat Stroke with David Fifer

The department is busy and you want to keep the flow running smoothly.  It is easy to cut corners when it comes to imaging.  After all, a radiologist will be reviewing those images.  If you are lucky, those images will be read within minutes of them being taken.  Why then, should you review those images that you ordered?

The department is busy and you want to keep the flow running smoothly.  It is easy to cut corners when it comes to imaging.  After all, a radiologist will be reviewing those images.  If you are lucky, those images will be read within minutes of them being taken.  Why then, should you review those images that you ordered?

Podcast #125 - Check All Images

Kris Maday

Sometimes we have to go back to the basics.  Airway management has its many advanced methods but with all the great FOAMed out there, very little of it covers the basic approach.  We wish to remedy this with guest Kris Maday, PA-C.  He is another PA with a podcast.  His is called the PAINE Podcast and can be easily found.

Sometimes we have to go back to the basics.  Airway management has its many advanced methods but with all the great FOAMed out there, very little of it covers the basic approach.  We wish to remedy this with guest Kris Maday, PA-C.  He is another PA with a podcast.  His is called the PAINE Podcast and can be easily found.

Podcast #18 - Basic Approach to Airway Management with Kris Maday

Acute bronchiolitis is another condition that will start showing more this time of year.  In some parts of the country, it is already being diagnosed.  It is important to know the current recommendations for this common and potentially dangerous condition.

Acute bronchiolitis is another condition that will start showing more this time of year.  In some parts of the country, it is already being diagnosed.  It is important to know the current recommendations for this common and potentially dangerous condition.

Podcast #123 - The ABCs of Bronchiolitis

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

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

Podcast #107 - Emergent Management of Hyperkalemia

How have you taken ACLS?  Most of us will have taken a course in person but what if you are not able to do the course in person before your license expires?  Do you take an online course and if so which one?  In this podcast we review one option, HeartCode ACLS, and discuss the pros/cons of the course.  As always, there is nothing to disclose as any of the courses and organizations mentioned do not have any financial ties with this author.

How have you taken ACLS?  Most of us will have taken a course in person but what if you are not able to do the course in person before your license expires?  Do you take an online course and if so which one?  In this podcast we review one option, HeartCode ACLS, and discuss the pros/cons of the course.  As always, there is nothing to disclose as any of the courses and organizations mentioned do not have any financial ties with this author.

Podcast #26 - HeartCode ACLS: Worth It?

Mike Weinstock

Some of us do it well, some of us do not do it at all, but we all could use improvement.  The medical decision making (MDM) portion of the chart is one area we all can work on.  It is quite possibly the single most important portion of the chart for multiple reasons including acting as a "hard stop" in decision making, explaining course of care and management, reviewing highlights of the visit, and even potentially helping in a legal situation.  Today, we have Mike Weinstock joining us on this very important podcast.

Some of us do it well, some of us do not do it at all, but we all could use improvement.  The medical decision making (MDM) portion of the chart is one area we all can work on.  It is quite possibly the single most important portion of the chart for multiple reasons including acting as a "hard stop" in decision making, explaining course of care and management, reviewing highlights of the visit, and even potentially helping in a legal situation.  Today, we have Mike Weinstock joining us on this very important podcast.

Podcast #62 - Improve Your MDM with Mike Weinstock

Pediatric Anaphylaxis

Anaphylaxis is a life-threatening condition that requires early recognition and appropriate treatment for the best outcomes.    In pediatric cases, this can be more challenging for a variety of reasons including the barriers to obtaining a history and physical, knowing the appropriate dosing of medications, and the general stress of managing sick pediatric patients.  We discuss how to manage such patients in this EB Medicine special.

Anaphylaxis is a life-threatening condition that requires early recognition and appropriate treatment for the best outcomes.    In pediatric cases, this can be more challenging for a variety of reasons including the barriers to obtaining a history and physical, knowing the appropriate dosing of medications, and the general stress of managing sick pediatric patients.  We discuss how to manage such patients in this EB Medicine special.

Podcast #170 - EB Medicine: Pediatric Anaphylaxis

Brian Lin

Brian Lin is back for the second part of our conversation with him from the 2017 SEMPA 360 conference, but this time we are talking about two subjects with a lot of dogma: the Golden Period for wound closure and dog bite closure.  This brief review is designed to remind you of some of the key components in order to better care for your patients.

Brian Lin is back for the second part of our conversation with him from the 2017 SEMPA 360 conference, but this time we are talking about two subjects with a lot of dogma: the Golden Period for wound closure and dog bite closure.  This brief review is designed to remind you of some of the key components in order to better care for your patients.

Podcast #46 - The Golden Period of Wound Closure and Closing Dog Bites with Brian Lin

We are having a special episode to add to what we did with Salim Rezaie on REBEL Cast recently as a guest.  While we were there, we talked a lot about the TOAST trial and reviewed our own clinical use of dexamethasone.  It is definitely worth your time to visit his page and listen to that podcast.  However, we wanted to add our own little supplement to the #FOAMed world by adding a detailed analysis of the paper in true BEEM fashion.  Please check all of this out for a more thorough understanding of the topic.

We are having a special episode to add to what we did with Salim Rezaie on REBEL Cast recently as a guest.  While we were there, we talked a lot about the TOAST trial and reviewed our own clinical use of dexamethasone.  It is definitely worth your time to visit his page and listen to that podcast.  However, we wanted to add our own little supplement to the #FOAMed world by adding a detailed analysis of the paper in true BEEM fashion.  Please check all of this out for a more thorough understanding of the topic.

Podcast #53 - Oral Dexamethasone for Sore Throats: A Bonus to a REBEL Cast Post

For this round of EM ID, Patrick Bafuma interviews Dr. Sandra Gompf who specializes in infectious disease and has Gompf's ID Pearls.  They focus primarily on delirium, indwelling Foley catheters, and callbacks.

For this round of EM ID, Patrick Bafuma interviews Dr. Sandra Gompf who specializes in infectious disease and has Gompf's ID Pearls.  They focus primarily on delirium, indwelling Foley catheters, and callbacks.

Podcast #158 - EM ID: Asymptomatic Bacteriuria versus UTI with Dr. Gompf

It is that time of year.  It is cold and croup is in the air.  There is a spectrum of patients that present ranging from the mild to the life threatening.  We discuss how to manage these patients.

It is that time of year.  It is cold and croup is in the air.  There is a spectrum of patients that present ranging from the mild to the life threatening.  We discuss how to manage these patients.

Podcast #121 - Acute Management of Croup

The best podcast episodes of the most interesting stories and things. From skyping someone while they're in space, to tracking down and meeting a telephone scammer in person, to the story of a Galapagos. These episodes will keep you and all your friends entertained and captivated for hours. Learn something new in every episode! Add episodes you're interested into your queue below!

Best Episodes: Interesting Stories & Things

The best self improvement podcast episodes. From improving productivity, to finding purpose in your life to what constitutes freedom, this topic is on anything and everything that can help people to improve their lives. Add episodes you're interested into your queue below!