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FOAMcast - Emergency Medicine Core Content

Updated 8 days ago

Education
Courses
Health & Fitness
Medicine
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We believe in the educational merits of Free Open Access Medical education (FOAM), which includes podcasts, blogs, articles on PubMed Central, conferences streamed for free and more. As a result, we would like to encourage others to move beyond quoting podcasts and into the realm of tying “cutting edge” FOAM to the core content. We’ll provide some review and references for listeners to go read. Why, indeed, should we FOAM it alone when FOAM can inspire us to go, read, think, and be excellent?

Read more

We believe in the educational merits of Free Open Access Medical education (FOAM), which includes podcasts, blogs, articles on PubMed Central, conferences streamed for free and more. As a result, we would like to encourage others to move beyond quoting podcasts and into the realm of tying “cutting edge” FOAM to the core content. We’ll provide some review and references for listeners to go read. Why, indeed, should we FOAM it alone when FOAM can inspire us to go, read, think, and be excellent?

iTunes Ratings

151 Ratings
Average Ratings
138
8
2
1
2

Excellent review

By Grant010 - Aug 22 2017
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Concise, accurate, practical.

Great core content

By Lily122006 - Aug 10 2017
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This has been one of my favorite podcasts throughout residency, relevant and to the point. Thanks!

iTunes Ratings

151 Ratings
Average Ratings
138
8
2
1
2

Excellent review

By Grant010 - Aug 22 2017
Read more
Concise, accurate, practical.

Great core content

By Lily122006 - Aug 10 2017
Read more
This has been one of my favorite podcasts throughout residency, relevant and to the point. Thanks!
Cover image of FOAMcast -  Emergency Medicine Core Content

FOAMcast - Emergency Medicine Core Content

Latest release on Jan 17, 2020

Read more

We believe in the educational merits of Free Open Access Medical education (FOAM), which includes podcasts, blogs, articles on PubMed Central, conferences streamed for free and more. As a result, we would like to encourage others to move beyond quoting podcasts and into the realm of tying “cutting edge” FOAM to the core content. We’ll provide some review and references for listeners to go read. Why, indeed, should we FOAM it alone when FOAM can inspire us to go, read, think, and be excellent?

Rank #1: Episode 28 - Neuroleptic Malignant & Serotonin Syndrome

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We review thisa post from Dr. Charles Bruen of Resus Review on Malignant Hyperthermia and dantrolene.

Then, we delve into core content pearls on polypharmacy -  serotonin syndrome, neuroleptic malignant syndrome, and extrapyramidal side effects.  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

May 02 2015

19mins

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Rank #2: Episode 31 - Vasopressors

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This week we cover posts from the Wessex ICS site, The Bottom Line, which is an excellent source for breakdown of recent and important trials. We cover their post on a systematic review of peripheral pressor complications (Loubani et al) and then we delve into a recent prospective trial by Cardenas-Garcia and colleagues that came up at SMACC.

Then we review peripheral vasopressors using Tintinalli and Rosen's Emergency Medicine as a guide. 

We have Rosh Review questions and more available on our website, FOAMcast.org.

Thanks y'all!

-Jeremy Faust and Lauren Westafer

Jul 25 2015

17mins

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Rank #3: Episode 21 - Acute Kidney Injury

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This week we review Dr. Josh Farkas's PulmCrit blog posts, Renal microvascular hemodynamics in sepsis: a new paradigm and Renoresuscitation: Sepsis resuscitation designed to avoid long-term complications in which he posits that renal protection in sepsis may prove beneficial for patients.  

Then, we delve into core content pearls on acute kidney injury using Rosenalli (Rosen's Emergency Medicine and Tintinalli's Emergency Medicine: A Comprehensive Review Guide) 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

Dec 27 2014

20mins

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Rank #4: Episode 30 - Thyroid

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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

Jun 16 2015

18mins

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Rank #5: Episode 8 - Acid-Base and Hyponatremia

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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/IVHyponatremia - EMBasic, Hyponatremia-ERCastHyponatremia - EMCrit

Thanks y'all!

-Jeremy Faust and Lauren Westafer

Jul 17 2014

21mins

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Rank #6: FOAMcastini - The Left Shift

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This tiny episode covers a blog entry from BrownCoatNation.com (University of Illinois, Chicago), who has a new series entitled “Inconceivable.” The idea is to expose medical terminology that we tend to use incorrectly. The first installment is focused on the misuse of the term "left shift," and it's the focus of this FOAMcastini.

'Left shift" refers to the presence of banded (immature) neutrophils in the blood. It does not refer to an elevated white blood cell count with a high percentage of neutrophils. An elevated white blood cell count with an abnormally high percentage of neutrophils should be called "neutrophillic leukocytosis." Only the presence of immature neutrophils in the periphery (including bands) can accurately be called a "left shift." 

We will be back shortly with regular episodes, once their schedules coincide.

Thanks for listening!

Sep 25 2015

8mins

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Rank #7: Episode 15 - Atrial Fibrillation/Flutter

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This week we review a post by Brent Reed on Academic Life in EM, covering pharmacologic management of atrial fibrillation.  

Then, we delve into core content Emergency Medicine cardiology using Rosenalli (Rosen's Emergency Medicine and Tintinalli's Emergency Medicine: A Comprehensive Review Guide).  We cover atrial fibrillation, atrial flutter, and, everyone's favorite, multifocal atrial tachycardia.

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

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

Sep 20 2014

20mins

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Rank #8: Sepsis: Redefined

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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)

Feb 21 2016

19mins

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Rank #9: Episode 59 - Syncope (including the PESIT trial)

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The PESIT study in the New England Journal of Medicine stirred up controversy in the FOAM world earlier in October 2016.  In this episode we cover the following posts on this article on pulmonary embolism in syncope:

Then, We delve into core content on syncope usingRosen's Emergency Medicine (8th edition) and Tintinalli's Emergency Medicine (8th edition) Chapter 52

Thanks for listening!

-Jeremy Faust and Lauren Westafer

Oct 31 2016

23mins

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Rank #10: Episode 24 - Concussion/Mild Traumatic Brain Injury

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This week we review the Taming the SRU podcast, "Ketamine Cagematch" (iTunes) in which Drs. Minh Le Cong and Chris Zammit banter about the use of ketamine in patients with traumatic brain injury (TBI). 

Then, we delve into core content pearls on concussion/mild TBI including diagnosis, treatment, and complications using Tintinalli 254 but to be honest, Rosenalli is lacking on this topic so we've turned to the ACEP clinical policyAAN guidelinesOntario Pediatric Guidelines, and the  AAP guidelines on the topic.

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

Thanks y'all!

-Jeremy Faust and Lauren Westafer

Feb 19 2015

21mins

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Rank #11: Episode 33 - Hemoptysis

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This week we cover Dr. Ryan Radecki's post on Gestational Age Adjusted D-Dimer covering an article by Murphy et al.

Then we review the differential diagnosis and workup of hemoptysis using Rosen's Emergency Medicine and Tintinalli as a guide.

We have Rosh Review questions and more available on our website, FOAMcast.org.

Thanks y'all!

-Jeremy Faust and Lauren Westafer

Aug 30 2015

19mins

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Rank #12: Episode 16 - Headaches

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This week we review Dr. Rob Orman's ERCast episode, Is it really a sinus headache?

Then, we delve into core content headache pearls with an ophthalmology bent using Rosenalli (Rosen's Emergency Medicine and Tintinalli's Emergency Medicine: A Comprehensive Review Guide).  We cover temporal arteritis, acute angle closure glaucoma, idiopathic intracranial hypertension, and cerebral venous sinus thrombosis.

Key Texts: Tintinalli (7e): Ch 159; Rosen's (8e) Ch 20, 103

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

Thanks y'all!

-Jeremy Faust and Lauren Westafer

Sep 29 2014

19mins

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Rank #13: Episode 20 - Anticoagulation

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This week we review Dr. Rory Spiegel's EMNerd blog post, A Case of Identity Part Two, on dual antiplatelet therapy for ACS and MI. 

  • Dual antiplatelet therapy, often aspirin + P2Y12 inhibitors, although commonly used, do not affect mortality and have questionable benefit but are associated with risks of bleeding.

Then, we delve into core content pearls on anticoagulation including aspirin, ibuprofen, and novel oral anticoagulants using Rosenalli  (Rosen's Emergency Medicine and Tintinalli's Emergency Medicine: A Comprehensive Review Guide) and Goldrank (10th ed) Chapter 60 and EMPractice October 2013 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

Dec 06 2014

21mins

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Rank #14: Episode 23 - SBO and Acute Mesenteric Ischemia

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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

Jan 26 2015

17mins

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Rank #15: Episode 63 - Bradycardias

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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

Jan 24 2017

23mins

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Rank #16: Episode 58 - Ophthalmology Basics

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We cover an incredible ophthalmology resource, OphthoBook.com, by Dr. Tim Roots.  This resource has a free book and excellent free video lectures.  Specifically, we detail a hilarious video on eye exam tricks, especially targeting individuals who "can't see."

We previously reviewed eye trauma in this podcast. In this episode, we review ophthalmology basics using Tintinalli’s Emergency Medicine (8e), Chapter 241

Visit FOAMcast.org for more and Rosh Review questions. Thanks for listening! 

Jeremy Faust + Lauren Westafer

Oct 09 2016

24mins

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Rank #17: Episode 53 - Intracranial Hemorrhage

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We cover a post by Dr. Rory Spiegel, EMNerd: The Case of Differing Perspectives, on the results of the ATACH-2 trial on blood pressure control in intracranial hemorrhage (ICH). This study sought to determine the safety and efficacy of the

Population: adults (>18 y/o) with ICH on CT scan, GCS ≥ 5 and

Jul 17 2016

23mins

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Rank #18: Episode 69 - Urinary Tract Infection

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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

May 06 2017

29mins

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Rank #19: Episode 50 - Seizures

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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

May 25 2016

24mins

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Rank #20: Episode 46 - Pneumothorax

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We cover a podcast from HEFT EMcast  demonstrating that needle decompression at the 2nd intercostal space at the midclavicular line (2ICS MCL) is likely to fail.  They review a systematic review and meta-analysis by Laan et al in 2015 that suggests the fifth intercostal space at the anterior axillary line (5ICS AAL) is less likely to fail.

Then we delve into core content on pneumothoraces and empyemas using Tintinalli and Rosen's Emergency Medicine as a guide.

Thanks for listening,

Jeremy Faust and Lauren Westafer

Mar 20 2016

23mins

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VITAMINS Trial - Vitamin C, Thiamine, and Hydrocortisone in Septic Shock

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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

Jan 17 2020

22mins

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ACEP Headache Clinical Policy

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We review the American College of Emergency Physicians (ACEP) clinical policy on headache from June 2019, most of which revolves around the diagnosis of subarachnoid hemorrhage. 

Show notes and references at FOAMcast.org

Thanks for listening! Jeremy Faust and Lauren Westafer

Dec 18 2019

24mins

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Olanzapine + Benzodiazepines - What is the FDA warning about?

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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

Oct 29 2019

21mins

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Black Box Warnings for Common ED Medications

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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

Oct 29 2019

8mins

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Concussion and VP Shunts from ACEP 2019

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

Oct 27 2019

18mins

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Vaping Associated Lung Injury (VALI)

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Vaping associated lung injury (VALI) has become a frequent topic in the news in the United States (US). In this episode we review the epidemiology, presumed pathophysiology, and new recommendations from the Centers for Disease Control (CDC) in the US.

Thanks for listening! Jeremy Faust and Lauren Westafer

FOAMcast.org

References:

  1. Morbidity and Mortality Weekly Report (MMWR). 2019; 68(40)
  2. Layden JE, Ghinai I, Pray I, et al. Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin - Preliminary Report. N Engl J Med. 2019; Sept 6.
  3. Maddock SD, Cirulis MM, Callahan SJ, et al. Pulmonary Lipid-Laden Macrophages and Vaping. N Engl J Med. 2019;381:1488-1489.

Oct 11 2019

22mins

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Hyperkalemia Treatment - Insulin/Dextrose

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In this episode we briefly review hyperkalemia and the principles of emergent treatment. Then we explore, in-depth, the role of insulin and dextrose including the incidence of hypoglycemia and pearls to reduce this side effect.

Pearls:

  • 10-20% of patients treated with insulin/dextrose for hyperkalemia get hypoglycemic
  • Consider giving 5 units insulin instead of 10 units
  • Check the glucose for hours (dextrose lasts

Sep 30 2019

24mins

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Droperidol and Butyrophenones

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We discuss the US Food & Drug Administration's black box warning for droperidol and the evidence behind this warning.

We then discuss the use of butyrophenones such as droperidol and haloperidol for the treatment of agitation, headaches, nausea and vomiting, and gastroparesis/cannabinoid hyperemesis.

Thanks for listening! Jeremy Faust and Lauren Westafer 

Sep 01 2019

23mins

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Thromboelastography (TEG) Guided Resuscitation

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We discuss the coagulation test thromboelastography (TEG) / Rotational Thromboelastometry (ROTEM), reviewing the evidence behind the use of the tests as well as the clinical implications.

Show notes and graphics FOAMcast.org

Thanks for listening! Jeremy Faust and Lauren Westafer

Jul 31 2019

22mins

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2019 Mid-Year Literature Review

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

Thanks for listening!

Jeremy Faust and Lauren Westafer

Jul 09 2019

26mins

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Psychogenic Non-epileptic Attacks (PNEA)

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We review the entity formally known as pseudoseizures and psychogenic non-epileptic seizures (PNES), now referred to as psychogenic non-epileptic attacks (PNEA). 

We discuss the history of PNEA as well as relevant literature on the diagnosis and treatment of this entity.

Thanks for listening! Jeremy Faust and Lauren Westafer

May 24 2019

25mins

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Emergent Issues in Sickle Cell Disease

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We review myths and reality in the management of patients with Sickle Cell Disease (SCD) 

  • Are these patients typically opioid seeking? (No)
  • If the patient appears comfortable I should withhold proper analgesia. (No).
  • Should IV fluids be a routine part of the cocktail for vaso-occlusive pain episodes? (No)

We also review common emergencies in sickle cell disease that include

  • Infections
  • Acute chest syndrome
  • Anemia (Aplastic crisis, splenic sequestration)
  • Ischemia
    • Strokes
    • Avascular necrosis
    • Renal, pulmonary, splenic infarctions
  • Vaso-occlusive pain episodes

Thanks for listening! Lauren Westafer and Jeremy Faust

Apr 30 2019

27mins

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Mechanical CPR, Balloon Tamponade, and Advocacy

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We are at #SMACC in Sydney, Australia, thanks to the Rosh Review, delivering updates from the conference to your earbuds.

Advocacy in Emergency Medicine - Esther Choo and Hugh Montgomery

Mechanical CPR vs Manual CPR - Ken Milne vs Salim Rezaie

Super sick massive GI bleeds and balloon tamponade - Sara Gray

Thanks for listening! Jeremy Faust and Lauren Westafer

Mar 29 2019

14mins

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Roc vs Sux, Bougie vs Stylet, The Crashing Asthmatic at #SMACC

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 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

Mar 28 2019

16mins

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anti-NMDA receptor encephalitis and communicating with patients at #smacc

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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

Mar 27 2019

10mins

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Emergency Medicine Updates - 2019

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We co-hosted (with John Vassiliadis) the SMACC EM Updates half-day conference. We had amazing speakers. Salim Rezaie spoke on TXA for Everything, Ken Milne spoke on hot papers from 2018, and we learned about when ultrasound may be helpful in pediatric lumbar punctures. In addition, Jeremy spoke on what is usual care in sepsis and Lauren spoke on pulmonary embolism: the next generation. In this short podcast we highlight some of our other talks.

Aidan Baron (@Aidan_Baron) on Prehospital Updates in Cardiac Arrest

This talk focused on focusing on things that are most likely to make a difference in OHCA (bystander CPR and defibrillation) rather than on fun interventions like intubation and adrenaline (epinephrine). Aidan suggests that the future debates and questions in OHCA will be largely philosophical - what outcomes do we care about: neuro intact survival or ROSC or survival? 

  1. Jabre P, Penaloza A, Pinero D, et al. Effect of bag-mask ventilation vs endotracheal intubation during cardiopulmonary resuscitation on neurological outcome after out-of-hospital cardiorespiratory arrest a randomized clinical trial. JAMA -2018;319(8):779–87.
  2. Benger JR, Kirby K, Black S, et al. Effect of a Strategy of a Supraglottic Airway Device vs Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome: The AIRWAYS-2 Randomized Clinical Trial. JAMA. 2018;320(8):779-791.
  3. Wang HE, Schmicker RH, Daya MR, et al. Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA. 2018;320(8):769-778

Barbra Backus on the future of the HEART score

Modified Heart Score (redefining the T or troponin based on newer assays) results in a NPV of 99.8% and classifies 48% of patients as low-risk.

Clinically Relevant Adverse Cardiac Events (CRACE) is way less common than major adverse cardiac events (MACE). HEART score of ≤3 ? CRACE is 0.05%

Hot Literature in 2019

  1. Lemkes JS, Janssens GN, van der Hoeven NW, et al. Coronary Angiography after Cardiac Arrest without ST-Segment Elevation. N Engl J Med. 2019;NEJMoa1816897
  2. Pluymaekers NAHA, Dudink EAMP, Luermans JGLM, et al. Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation. N Engl J Med .2019;NEJMoa1900353.

Mar 27 2019

12mins

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Supraventricular Tachycardia Treatment Controversies

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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.

Feb 18 2019

28mins

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Fluoroquinolones and Aortic Pathology

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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

Jan 31 2019

25mins

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ACEP Non-ST Elevation Acute Coronary Syndrome Guidelines

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We cover the clinical policy from the American College of Emergency Physicians - Clinical Policy: Critical Issues in the Evaluation and Management of Emergency Department Patients With Suspected Non–ST-Elevation Acute Coronary Syndromes

In adult patients without evidence of ST-elevation acute coronary syndrome, can initial risk stratification be used to predict a low rate of 30-day major adverse cardiac events?

  • Use HEART score ≤3 

In adult patients with suspected acute non–ST-elevation acute coronary syndromes, can troponin testing within 3 hours of emergency department presentation be used to predict a low rate of 30-day major adverse cardiac events?

  • Negative conventional troponins at 0,3 hrs in low risk patients
  • High sensitivity troponin: undetectable initial troponin, no need for another. Negative initial troponin, repeat at 2 hours

In adult patients with suspected acute non–ST-elevation acute coronary syndromes in whom acute myocardial infarction has been excluded, does further diagnostic testing (eg, provocative, stress test, computed tomography [CT] angiography) for acute coronary syndrome prior to discharge reduce 30-day major adverse cardiac events?

  • No need to get provocative testing before discharge or within particular time frame

Should adult patients with acute non–ST-elevation myocardial infarction receive immediate antiplatelet therapy in addition to aspirin to reduce 30-day major adverse cardiac events?

  • antiplatelet therapy additional to aspirin can be given or delayed

Thanks for listening! Jeremy Faust and Lauren Westafer

Dec 27 2018

31mins

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Medicated Assisted Treatment (MAT)

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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

Nov 20 2018

26mins

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Excellent review

By Grant010 - Aug 22 2017
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Concise, accurate, practical.

Great core content

By Lily122006 - Aug 10 2017
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This has been one of my favorite podcasts throughout residency, relevant and to the point. Thanks!