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Core EM - Emergency Medicine Podcast

Updated 3 days ago

Health & Fitness
Medicine
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Core EM Emergency Medicine Podcast

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Core EM Emergency Medicine Podcast

iTunes Ratings

115 Ratings
Average Ratings
100
5
8
0
2

Quick, efficient and practical review

By Sher Ali Khan - Jul 30 2018
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Very ice Job. I am intense medicine and I enjoy listening to it for my Hospital based practice in residency

PA-c

By cs1245 - Nov 10 2017
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I really enjoy concise info on pertinent topics for ER providers. Thanks

iTunes Ratings

115 Ratings
Average Ratings
100
5
8
0
2

Quick, efficient and practical review

By Sher Ali Khan - Jul 30 2018
Read more
Very ice Job. I am intense medicine and I enjoy listening to it for my Hospital based practice in residency

PA-c

By cs1245 - Nov 10 2017
Read more
I really enjoy concise info on pertinent topics for ER providers. Thanks
Cover image of Core EM - Emergency Medicine Podcast

Core EM - Emergency Medicine Podcast

Latest release on Feb 17, 2020

The Best Episodes Ranked Using User Listens

Updated by OwlTail 3 days ago

Rank #1: Episode 82.0 – ED Management of Seizures

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This week we discuss the ED management of seizures focusing on treatment and workup particularly of a 1st seizure episode. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_82_0_Final_Cut.m4a Download Leave a Comment Tags: Neurology, Seizure, Status Epilepticus

Show Notes

Take Home Points

  1. Get a detailed history to tease out whether the patient had a seizure or a syncopal event. Regardless, get an EKG on 1st time seizures in case it was actually syncope.
  2. BZDs are first line therapy for seizure termination. If you don’t have IV access, go with 10 mg of midazolam or 2-4 mg of lorazepam IM
  3. Always review the 5 main categories for causes of seizures in order to make sure you’re not missing anything. Those categories once again are vital sign abnormalities, CNS infections, toxic/metabolic issues, CNS space occupying lesions including masses and bleeds and finally epilepsy.
  4. In patients with a first time seizure without a particular cause and return to baseline neurologic status, there’s unlikely to be any benefit to a NCHCT or to starting an AED. Scheduling close follow up with a neurologist is very reasonable. The key is to do a thorough examination and make sure you’re not missing a subtle abnormality.
  5. Finally, in status epilepticus hit the patient with 2-3 hefty doses of BZDs and if the seizure is still ongoing, strongly consider moving to propofol and intubation in order to rapidly control the seizure activity.

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Core EM: Parenteral Benzodiazepines

LITFL: Seizure

EMCrit: Podcast 155 - Status Epilepticus with Tom Bleck

First10EM: Management of Status Epilepticus in the Emergency Department

Huff SJ et al. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department with Seizures. Ann Emerg Med 2014; 43(5): 605-25. PMID: 15111920


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Jan 30 2017

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Rank #2: Episode 71.0 – Acute Pulmonary Edema

Nov 07 2016

22mins

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Rank #3: Episode 20.0 – AVNRT

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On this podcast we review some background on AVNRT and focus on Emergency Department management. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_20_0_Final.m4a Download 2 Comments Tags: AVNRT, PSVT, REVERT Trial, Tachydysrhythmias

Show Notes

AVNRT with Aberrancy vs. VT

REBEL EM: SVT with Aberrancy Versus VT

Amal Mattu’s ECG Case of the Week: August 26th, 2013

Valsalva Maneuver

ALiEM: Tricks of the Trade: Valsalva Maneuver By Using a 10cc Syringe

St. Emlyn’s: JC The REVERT Trial

Adenosine in AVNRT

Larry Mellick: Treating SVT with Adensoine

ALiEM: Trick of the Trade: Combining Adenosine with the Flush

Verapamil in AVNRT

RAGE Podcast: Rage Session Two

ERCast Podcast: How to run a code

Appleboam A et al. Postural mdodification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): a randomised trial. Lancet 2015. PMID: 26314489


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Nov 02 2015

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Rank #4: Episode 49.0 – Alcohol Withdrawal

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This week we take a look at alcohol withdrawal with a focus on recognition and management. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_49_0_Final_Cut.m4a Download Leave a Comment Tags: Alcohol Withdrawal, Ativan, Benzodiazipines, Delirium Tremens, Ethanol, Thaimine, Valium

Show Notes

Yip L. Chapter 77. Ethanol. In: Nelson LS, Lewin NA, Howland M, Hoffman RS, Goldfrank LR, Flomenbaum NE. eds. Goldfrank's Toxicologic Emergencies, 9e. New York, NY: McGraw-Hill; 2011.

EmCrit Podcast: Delirium Tremens

Life in the Fast Lane: Alcohol Withdrawal

The Poison Review: CPC: alcohol withdrawal with delirium tremens and a significant missed diagnosis

EM Updates: Avoid Alcohol Withdrawal Admissions

MDCalc: CIWA


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May 30 2016

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Rank #5: Episode 17.0 – Asthma and COPD

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Pearls from our weekly conference discussing severe asthma and COPD exacerbations. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_17_0_Final.m4a Download 4 Comments Tags: Asthma, BPAP, COPD, NIPPV, Respiratory

Show Notes

Shownotes

EMCrit: Delayed Sequence Intubation

REBEL EM: The Crashing Asthmatic

EM:RAP: The Rule of 2s

Abdo WF, Heunks LM. Oxygen-induced hypercapnia in COPD: myths and facts. Critical Care 16(5):323. PMID: 23106947
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Oct 12 2015

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Rank #6: Episode 48.0 – Anticholinergic Poisoning

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This week we delve into the anticholinergic toxidrome with a focus on management and the use of physostigmine. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_48_0_Final_Cut.m4a Download Leave a Comment Tags: Anticholinergic, Diphenhydramine, Physostigmine, TCA, Toxicology

Show Notes

Howland M. Antidotes in Depth (A12): Physostigmine Salicylate. In: Nelson LS, Lewin NA, Howland M, Hoffman RS, Goldfrank LR, Flomenbaum NE. eds. Goldfrank's Toxicologic Emergencies, 9e . New York, NY: McGraw-Hill; 2011.

Velez LI, Feng SY: Anticholinergics, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2010, (Ch) 150: p 1970-5.

[caption id="attachment_3127" align="aligncenter" width="640"] Anticholinergic Infographic (BrianandKloss.com)[/caption] [caption id="attachment_3128" align="aligncenter" width="573"] Drugs Exhibiting Anticholinergic Toxicity (Rosen's)[/caption]
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May 23 2016

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Rank #7: Episode 121.0 – Pancreatitis

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This week we dive into the diagnosis and management of pancreatitis in the ED https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_121_0_Final_Cut.m4a Download Leave a Comment Tags: Gastroenterology, GI, Pancreatitis

Show Notes

[caption id="attachment_6188" align="aligncenter" width="593"] Ranson's Criteria for Pancreatitis-Associated Mortality (Rosen's)[/caption]

Take Home Points

  • Pancreatitis is diagnosed by a combination of clinical features (epigastric pain with radiation to back, nausea/vomiting etc) and diagnostic tests (lipsae 3x normal, CT scan)
  • A RUQ US should be performed looking for gallstones as this finding significantly alters management
  • The focus of management is on supportive care. IV fluids, while central to therapy, should be given judiciously and titrated to end organ perfusion
  • Patients will mild pancreatitis who are tolerating oral intake and can reliably follow up, can be discharged home

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Hemphill RR, Santen SA: Disorders of the Pancreas; in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2010, (Ch) 91: p 1205-1226

PulmCrit: The Myth of Large-Volume Resuscitation in Acute Pancreatitis

PulmCrit: Hypertriglyceridemic Pancreatitis: Can We Defuse the Bomb?


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Nov 13 2017

13mins

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Rank #8: Episode 84.0 – Traumatic ICH Management

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This week we look at TBI and discuss some of the pitfalls and pearls in early management of traumatic ICH. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_84_0_Final_Cut.m4a Download 2 Comments Tags: Head Injury, Hyperosmolar Therapy, ICH, Resuscitation, RSI, TBI, Trauma

Show Notes

Take Home Points
  1. If you get a heads up from EMS on an incoming trauma, take the lead time you get to clearly delineate everyone’s roles to help ensure the resuscitation runs smoothly.
  2. In the severe TBI patient, the key is in preventing secondary injury to the brain. We do this by guarding against hypoxia, hypercarbia, hypotension and aspiration. Max your pre-ox, get the ETT in quickly to prevent oxygenation and ventilation issues and keep the head up if possible
  3. Hypotension is rarely seen in isolated head trauma. If the patient is or becomes hypotensive, reassess for any sources of hemorrhagic shock that may have been missed and consider whether the meds you gave may have caused the problem.
  4. Hypertension is much more common and despite extensive research, we haven’t shown that dropping the patient to normal levels is beneficial. Keeping the SBP < 180 seems reasonable but check your local protocol as well.
  5. If the patient’s ICP spikes or your concerned about herniation, administer mannitol or hypertonic saline and get your neurosurgeon to the bedside since the patient is gonna need decompression
  6. Finally, make sure to reverse any anticoagulant the patient may have on board as this will hopefully prevent hematoma expansion.

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emDocs: Roc Rocks and Sux Sucks! Why Rocuronium is the Agent of Choice for RSI

Core EM: Podcast 31.0 - Rocuronium vs. Succinylcholine

Core EM: Intensive Blood Pressure Lowering in Intracerebral Hemorrhage (ATACH-2 Trial)

PulmCCM: Hyperosmolar Therapy for Increased Intracranial Pressure (Review)

EM Cases: Episode 89 - DOACs Part 2: Bleeding and Reversal Agents

Hopper AH. Hyperosmolar therapy for raised intracranial pressure. NEJM 2012; 367(8): 746-52. PMID: 22913684

Wang X et al. Ketamine does not increase intracranial pressure compared with opioids: meta-analysis of randomized controlled trials. J Anesth 2014; 28(6): 821-7. PMID: 24859931

Zeiler FA et al. The ketamine effect on ICP in traumatic brain injury. Neurocrit Care 2014; 21(1): 163-73. PMID: 24515638


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Feb 13 2017

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Rank #9: Episode 8.0 – Chest Pain

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Recapping pearls from our weekly conference. This week, we discussed pearls on chest pain. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Core_EM_Podcast_Episode_8.m4a Download Leave a Comment Tags: ACS, Chest Pain

Show Notes

How to Build a Great Talk

Chest Pain Workshop

[caption id="attachment_1587" align="aligncenter" width="510"] The HEART Pathway (Mahler 2015)[/caption]

Journal Update

  • Goldberg H et al. Oral steroids for actue radiculopathy due to a herniated disk - a randomized clinical trial. JAMA 2015; 313(19): 1915-23. PMID: 25988461

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Aug 10 2015

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Rank #10: Episode 23.0 – SBO

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Nov 23 2015

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Rank #11: Episode 83.0 – Lumbar Radiculopathy

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This week we discuss a bit about back pain and specifically, lumbar radiculopathy with a focus on causes and red flags. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_83_0_Final_Cut.m4a Download One Comment Tags: Back Pain, Low Back Pain, Musculoskeletal, Steroids

Show Notes

Read More

St. Emlyn’s: Back to Basics: Back Pain in the ED

Edlow JA. Managing nontraumatic acute back pain. Ann Emerg Med 2015; 66: 148-53. PMID: 25578887

Goldberg H et al. Oral steroids for acute radiculopathy due to a herniated lumbar disk: a randomized clinical trial. JAMA 2015; 313 (19): 1915-23. PMID: 25988461

Friedman BW et al. Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for treating acute low back pain: a randomized clinical trial. JAMA 2015; 314 (15): 1572-80. PMID: 26501533


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Feb 06 2017

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Rank #12: Episode 39.0 – Killer Back Pain

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This podcast reviews highlights from a grand rounds talk given by Michael Bond on Killer back pain. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_39_0_Final_Cut.m4a Download Leave a Comment Tags: AAA, Back Pain, Epidural Abscess, Vertebral Osteomyelitis

Show Notes

Edlow JA. Managing Nontraumatic Acute Back Pain. Ann Emerg Med 2015; 66: 148-53. PMID: 25578887


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Mar 21 2016

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Rank #13: Episode 52.0 – Anaphylaxis

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This week we review anaphylaxis, the importance of epinephrine/adrenaline and how to use it properly. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_52_0_Final_Cut.m4a Download Leave a Comment Tags: Allergic Reactions, Allergy, Anaphylaxis, Epinephrine

Show Notes

[caption id="attachment_3303" align="aligncenter" width="624"] Anaphylaxis Definition[/caption] Read More Tran TP, Muelleman RL: Allergy, Hypersensitivity, Angioedema, and Anaphylaxis, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2010, (Ch) 119: p 1543-1560.

YouTube: Epinephrine Auto-Injector Use

The SGEM: #57: Should I Stay or Should I Go (Biphasic Anaphylactic Response)

Core EM: Biphasic reactions in emergency department patients with allergic reactions or anaphylaxis

References

Grunau BE et al. Incidence of clinically important biphasic reactions in emergency department patients with allergic reactions or anaphylaxis. Ann Emerg Med 2014; 63(6): 736-44. PMID: 24239340

Grunau BE et al. Emergency Department Corticosteroid Use for Allergy or Anaphylaxis is Not Associated with Decreased Relapses. Ann Emerge Med 2015; 66(4): 381-9. PMID: 25820033


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Jun 27 2016

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Rank #14: Episode 93.0 – Meningitis

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This week we cover a workshop from our conference on CNS infections focusing on meningitis. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_93_0_Final_Cut.m4a Download 3 Comments Tags: Bacterial Meningitis, CNS Infections, Infectious Diseases, Meningitis, Neurology

Show Notes

[caption id="attachment_5041" align="aligncenter" width="948"] CSF Analysis (LITFL)[/caption]

EM Lyceum: Viral Meningitis “Answers”

EM RAP: Meningitis

LITFL: Bacterial Meningitis

LITFL: CSF Analysis

The NNT: Glucocorticoid Steroids for Bacterial Meningitis

References

Attia J et al. Does this adult patient have acute meningitis. JAMA 1999; 281(2): 175-81. PMID: 10411200

Brouwer MC et al. Corticosteroids for acute bacterial meningitis (review). Cochrane Database Syst Rev 2015. PMID: 26362566

Cooper DD, Seupaul RA. Is adjunctive dexamethasone beneficial in patients with bacterial meningitis? Ann Emerg Med 2012; 59(3): 225-6. PMID: 22088494

de Gans J et al. Dexamethasone in adults with bacterial meningitis. NEJM 2012; 347(20): 1549-57. PMID: 12432041

Hasbun R et al. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. NEJM 2001; 345(24): 1727-34. PMID: 11742046

Sakushima K et al. Diagnostic accuracy of cerebrospinal fluid lactate for differentiating bacterial meningitis from aseptic meningitis: a meta-analysis. J Infection 2011; 62: 255-62. PMID: 21382412

Tunkel AR et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004; 39: 1267-84. PMID: 15494903


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Apr 17 2017

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Rank #15: Episode 7.0 – Hyperkalemia + Rate Control in AFib

Aug 03 2015

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Rank #16: Episode 24.0 – Hepatic Encephalopathy

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This podcast is a brief discussion on hepatic encephalopathy: How it presents, the utility of ammonia levels and what else to look out for. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_24_0_Final_Cut.m4a Download Leave a Comment Tags: Ammonia, AMS, Hepatic Encephalopathy
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Nov 30 2015

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Rank #17: Episode 13.0 – Diabetic Ketoacidosis: A Case

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Lily Abrukin (Chief Resident) and Swami discuss the care of a critically ill patient with DKA. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_13_0_Final.m4a Download 5 Comments Tags: DKA, Hyperkalemia

Show Notes

Diabetic Ketoacidosis

LITFL: EBM Diabetic Ketoacidosis

emDocs: Myths in DKA Management

REBEL EM: Is There Any Benefit to an Initial Insulin Bolus in Diabetic Ketoacidosis?

Hyperkalemia

LITFL: Hyperkalaemia

Core EM: Hyperkalemia

Core EM: Podcast 7.0

Intubation in Severe Metabolic Acidosis

EMCrit: Podcast 3 - Laryngoscope as a Murder Weapon Series - Ventilatory Kills - Intubating the Patient with Severe Metabolic Acidosis

Core EM: Podcast 4.0


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Sep 14 2015

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Rank #18: Episode 75.0 – Fluid Responsiveness + Resuscitation

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This week we do a little spaced repetition on adrenal insufficiency and then discuss fluid responsiveness and resuscitation. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_75_0_Final_Cut.m4a Download Leave a Comment Tags: Adrenal Insufficiency, Critical Care, Fluid Responsiveness, Fluid Resuscitation, Sepsis, Septic Shock

Show Notes

Read More

Marik PE. Fluid responsiveness and the six guiding principles of fluid resuscitation. Crit Care Med 2016. PMID: 26571187

LITFL: Adrenal Insufficiency

EMCrit: Podcast 64 - Assessing Fluid Responsiveness with Dr. Paul Marik

Core EM: Adrenal Crisis

Core EM: Episode 15.0 - Adrenal Crisis

References

Cavallaro F et al. Diagnostic accuracy of passive leg raising for prediction of fluid responsiveness in adults: systemic review and meta-analysis of clinical studies. Intensive Care Med. 2010:36(9):1475-83. PMID: 20502865.

Cecconi M et al. Fluid challenges in intensive care: the FENICE study: A global inception cohort study. Intensive Care Med. 2015:41(9):1529-37. PMID: 26162676.

Landesberg G et al. Diastolic dysfunction and mortality in severe sepsis and septic shock. Eur Heart J. 2012:33(7):895-903. PMID: 21911341.

Lee CV et al. Development of a fluid resuscitation protocol using inferior vena cava and lung ultrasound. J Crit Care. 2016:31(1):96-100. PMID: 26475100.

Marik PE. Noninvasive cardiac output monitors: a state-of the-art review. Cardiothorac Vasc Anesth. 2013:27(1):121-34. PMID: 22609340.


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Dec 05 2016

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Rank #19: Episode 133.0 – Initial Trauma Assessment

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This week we dive in to the initial trauma assessment. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_133_0_Final_Cut.m4a Download Leave a Comment Tags: ABCDEs, Trauma

Show Notes

Take Home Points
  1. Development of a systematic approach is essential to rapidly assessing the wide diversity of trauma patients and minimizes missed injures
  2. Prepare with whatever information is available before the patient arrives and remember to get a good handoff from the pre-hospital team
  3. Complete the primary survey (ABCDEs) and address immediate life threats
  4. Round out your assessment with a good medical history and remember to complete a comprehensive head-to-toe exam

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Shlamovitz GZ, et al. Poor test characteristics for the digital rectal examination in trauma patients. Ann Emerg Med. 2007;50(1):25-33, 33.e1. PMID: 17391807

ER Cast: Gunshot to the Groin with Kenji Inaba

EM:RAP: Do We Still Need The C-Collar?

YouTube: Death of the Dinosaur: Debunking Trauma Myths by Dr. S.V. Mahadevan

REBEL EM: Is ATLS wrong about palpable blood pressure estimates?

Life in the Fast Lane: Digital rectal exam (DRE) in trauma


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Feb 19 2018

18mins

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Rank #20: Episode 88.0 – Simplified Approach to Tachydysrhythmias

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This week, we review a simplified approach to determining the rhythm on an EKG with a tachydysrhythmia. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_88_0_Final_Cut.m4a Download One Comment Tags: Atrial Fibrillation, AVNRT, SVT, Tachycardias, Tachydysrhythias, Ventricular Tachycardia

Show Notes

Take Home Points

  1. When looking at a tachy rhythm that isn’t sinus tach, quickly differentiate by determining if the QRS complexes is narrow or wide and then determine if the rhythm is regular or irregular. This approach quickly drops the rhythm into 1 of 4 boxes and makes rhythm determination much easier
  2. Each of those 4 categories has a small set of rhythms included. Narrow and irregular - AF, Aflutter with variable block or MFAT. Narrow and regular - SVT or Aflutter. Wide and irregular - Torsades, VF, AF with aberrancy or a BBB. Wide and regular - VTach, SVT with aberrancy or SVT with a BBB.
  3. If you see wide and regular, the top 3 diagnoses are VT, VT and VT. Assuming VT and treating for that will almost never send you astray

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EM: RAP: Episode 84 - Tachycardia

Core EM: A Simplified Approach to Tachydysrhythmias

Core EM: Atrioventricular Nodal Reentry Tachycardia

Core EM: Ventricular Tachycardia

Core EM: Recent-Onset Atrial Fibrillation

[caption id="attachment_1697" align="aligncenter" width="1003"] Simplified Approach to Tachydysrhythmias Diagnosis[/caption] [caption id="attachment_1700" align="aligncenter" width="1543"] Tachydysrhythmias Therapeutic Algorithm[/caption] [caption id="attachment_4740" align="aligncenter" width="904"] Torsades de Pointes[/caption] [caption id="attachment_4741" align="aligncenter" width="865"] Torsades de Pointes[/caption]
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Mar 13 2017

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