Rank #1: Episode 133.0 – Initial Trauma Assessment
Show NotesTake Home Points
- Development of a systematic approach is essential to rapidly assessing the wide diversity of trauma patients and minimizes missed injures
- Prepare with whatever information is available before the patient arrives and remember to get a good handoff from the pre-hospital team
- Complete the primary survey (ABCDEs) and address immediate life threats
- Round out your assessment with a good medical history and remember to complete a comprehensive head-to-toe exam
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
EM:RAP: Do We Still Need The C-Collar?
Life in the Fast Lane: Digital rectal exam (DRE) in trauma
Rank #2: Episode 31.0 – Rocuronium vs. Succinycholine
Show Notes[caption id="attachment_2583" align="aligncenter" width="558"] Sydney HEMS Sux Contraindications[/caption] Read More: Strayer RJ. Rocuronium versus succinylcholine: Cochrane synopsis reconsidered. Ann Emerg Med 2011; 58(2): 217-8 Strayer RJ. Rocuronium vs. succinylcholine revisited. Ann Emerge Med 2010; 39(3): 345-6. Mallon WK et al. Response to Rocuronium vs. succinylcholine revisited. Ann Emerge Med 2010; 39(3): 346-7. Strayer RJ. (2010, January 14). Screencast: Rocuronium vs. Succinylcholine in 8 minutes. Retrieved from http://emupdates.com/2010/01/14/rocuronium-vs-succinylcholine/ References
- Sluga M, Ummenhofer W, Studer W, Siegemund M, Marsch SC. Rocuronium versus succinylcholine for rapid sequence induction of anesthesia and endotracheal intubation: a prospective, randomized trial in emergent cases. Anesth Analg 2005; 101:1356 – 61.
- McCourt KC, Salmela L, Mirakhur RK, et al. Comparison of rocuronium and suxamethonium for use during rapid sequence induction of anaesthesia. Anaesthesia 1998;53:867–71.
- Laurin EG, Sakles JC, Panacek EA, Rantapaa AA, Redd J. A comparison of succinylcholine and rocuronium for rapid-sequence intubation of emergency department patients. Acad Emerg Med 2000;7:1362–9.
- Herbstritt A. BET 3: Is rocuronium as effective as succinylcholine at facilitating laryngoscopy during rapid sequence intubation. Emerg Med J 2012; 29(3): 256-9.
- Taha SK et al. Effect of suxamethonium vs rocuronium on onset of oxygen desaturation during apnoea following rapid sequence induction. Anaesthesia 2010; 65: 358-61.
- Tang L et al. Desaturation following rapid sequence induction using succinylcholine vs. rocuronium in overweight patients. Acta Anaesthesiol Scand 2011; 55: 203-8.
Rank #3: Episode 2.0 – Sepsis, Ebola, Endocarditis and More!
Show Notes[caption id="attachment_717" align="alignleft" width="1800"] SIRS Criteria[/caption] Read More REBELCast: Sepsis Care in 2015 References Tattevin P et al. Does this patient have Ebola virus disease? Intensive Care Med 2014; 40(11): 1738-41. PMID: 25183574 Rivers E et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. NEJM 2001; 345(19): 1368-77. PMID: 11794169 The ProCESS Investigators. A randomized trial of protocol-based care for early septic shock. NEJM 2014; 370(18): 1683-93. PMID: 24635773 ARISE Investigators. Goal-directed resuscitation for patients with early septic shock. NEJM 2014; 371(16): 1496-506. PMID: 25272316 Mouncey PR et al. Trial of early, goal-directed resuscitation for septic shock. NEJM 2015; 327(14): 1301-11. PMID: 25776532
Rank #4: Episode 61.0 – Hypokalemia
Take Home Points
- Hypokalemia has a wide variety of presentations ranging from generalized weakness, to paralysis, to cardiac arrhythmia or cardiac arrest.
- When you discover hypokalemia, be sure to check and EKG. Think about underlying causes of hypokalemia, because it is rarely a solo event.
- Treat with oral potassium supplementation of 40-60 orally every 4-6 hours for mild hypokalemia and 10-20 mEq/hour IV for severe or symptomatic hypokalemia.
Core EM: Hypokalemia
Rank #5: Episode 71.0 – Acute Pulmonary Edema
Show NotesRead More
Core EM: Acute Pulmonary Edema
Rank #6: Episode 23.0 – SBO
Show Notes5 Minute Sono: Small Bowel Obstruction EM Lyceum: GI Imaging FOAMCast: Episode 23 – SBO and Mesenteric Ischemia
Rank #7: Episode 17.0 – Asthma and COPD
EMCrit: Delayed Sequence Intubation
REBEL EM: The Crashing Asthmatic
EM:RAP: The Rule of 2sAbdo WF, Heunks LM. Oxygen-induced hypercapnia in COPD: myths and facts. Critical Care 16(5):323. PMID: 23106947
Rank #8: Episode 121.0 – 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
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
Rank #9: Episode 38.0 – Sexually Transmitted Infections
EM Lyceum: PID Answers
Exposed: Why is Gonorrhea Called the Clap?
Rank #10: Episode 22.0 – Extra-Abdominal Causes of Abdominal Pain
Show NotesLife in the Fast Lane: Metabolic Causes of Abdominal Pain
Rank #11: Episode 88.0 – Simplified Approach to Tachydysrhythmias
Take Home Points
- 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
- 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.
- 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
EM: RAP: Episode 84 - 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]
Rank #12: Episode 46.0 – Grand Rounds (Ilene Claudius) – Pediatric SOB
Show NotesIrazuzta JE et al. High-dose magnesium sulfate infusion for severe asthma in the emergency department: efficacy study. Crit Care Med 2016; 17: e29-e33. PMID: 26649938
Rank #13: Episode 82.0 – ED Management of Seizures
Take Home Points
- 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.
- 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
- 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.
- 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.
- 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.
Core EM: Parenteral Benzodiazepines
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
Rank #14: Episode 144.0 – Acute Rhinosinusitis
Take Home Points
- Acute rhinosinusitis is a clinical diagnosis
- The vast majority of acute rhinosinusitis cases are viral in nature and do not require antibiotics
- Consider the use of antibiotics in select groups with severe disease or worsening symptoms after initial improvement.
Read MoreCore EM: Acute Rhinosinusitis
Rank #15: Episode 20.0 – AVNRT
AVNRT with Aberrancy vs. VT
REBEL EM: SVT with Aberrancy Versus VT
Amal Mattu’s ECG Case of the Week: August 26th, 2013
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
Rank #16: Episode 8.0 – Chest Pain
How to Build a Great Talk
- The Teaching Course Podcast: How to Build a Talk - Part I
- The Teaching Course Podcast: How to Build a Talk - Part II
Chest Pain Workshop
- Core EM: Chief Complaint - Chest Pain
- REBEL EM: Is it time to start using the HEART pathway in the Emergency Department?
- EMCast November 2014: Low Risk Chest Pain
- Backus BE et al. Risk Scores for Patients with Chest Pain: Evaluation in the Emergency Department. Curr Card Rev 2011; 7: 2-8. PMC: 3131711
- Mahler SA et al. The HEART Pathway Randomized Trial Identifying Emergency Department Patients With Acute Chest Pain for Early Discharge. Circ Cardiovasc Qual Outcomes March 2015; 8 (2): 195 – 203. PMID: 25737484
- 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
Rank #17: Episode 24.0 – Hepatic Encephalopathy
Rank #18: Episode 93.0 – Meningitis
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
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
Rank #19: Episode 58.0 – Hyponatremia
Adrogue HJ, Maidas NE. Hyponatremia. NEJM 2000; 342(21): 1581-9. PMID: 10824078
Moritz ML, Ayus JC. 100 cc 3% sodium chloride bolus: a novel treatment for hyponatremic encephalopathy. Metab Brain Dis 2010; 25: 91-6. PMID: 20221678
Rank #20: Episode 7.0 – Hyperkalemia + Rate Control in AFib
Show NotesCore EM: Hyperkalemia REBEL EM: Is Kayexalate Useful in the Treatment of Hyperkalemia in the Emergency Department? Core EM: Diltiazem vs. Metoprolol for Rate Control in Atrial Fibrillation