The medical podcast for your cortex and funny bone. Dr Mel Herbert, Dr Jess Mason and the FOOLYBOO team bring you a Medicine, Science, History and Humor Podcast that won't hurt a bit.
The medical podcast for your cortex and funny bone. Dr Mel Herbert, Dr Jess Mason and the FOOLYBOO team bring you a Medicine, Science, History and Humor Podcast that won't hurt a bit.
460: Understand How People See You. Heidi Grant Halvorson, author of "No One Understands You and What to Do About It," explains the science of perception.
543: Building Emotional Agility. Susan David, author of "Emotional Agility" and psychologist at Harvard Medical School, on learning to unhook from strong feelings.
#3 I Have Got Some People Waiting For Me. Aziz’s life has been a story of chance – and choice. As Michael pieces together Aziz’s journey from Sudan to Manus, he realises Aziz has been searching for a safe place for about eight years. So what gives him the ability, and the energy, to speak out? How has Aziz fought for so long, and what makes him want to be ‘the messenger’? ‘I’m pretending like I’m really happy, and laugh, and you know, smiling on the phones and doing stuff like that – so they feel like, “Oh, my son is really living in a good environment”. So they think like that, but the opposite is the truth.’ Aziz Aziz tells Michael, ‘I have got some people ...waiting for me. They love me, they want me to be with them.’ Haltingly, and sometimes with great difficulty, Aziz starts to share stories about his home, the family that he longs to see, and why he fled. Looking to find out more, Michael speaks to Sudan expert Anne Bartlett about the current situation there. As Aziz shares snapshots from his past, Anne talks Michael through the conflict in Sudan, which, despite leaving the headlines long ago, continues to unfold. Michael worries that he’s adding to Aziz’s trauma by digging up painful memories – ever aware of how hard it is to have these kinds of conversations in short, overlapping messages, without the benefit of reading someone’s signals face to face. Meanwhile, Aziz weighs up how much to tell his family about Manus, and explains to Michael why he’s sometimes tortured by regret. Warning: This episode of The Messenger includes graphic content and mentions self-harm. If you or someone you know needs help, you can contact one of Australia’s national 24/7 crisis services such as Lifeline on 13 11 14 or at lifeline.org.au, or the Suicide Call Back Service on 1300 659 467. Transcript Download a PDF transcript of this episode here. In this episode Abdul Aziz Muhamat Michael Green Associate Professor Anne Bartlett, University of New South Wales, President of the Sudan Studies Association Our theme music was composed by Raya Slavin. Music used in this episode includes: 'Blue Milk' by Stereolab, 'Up the Box' by Andy Stott, 'Feld' by To Rococo Rot, 'Firefly' and 'Four-Day Interval' by Tortoise, 'Cutting Branches for a Temporary Shelter' by Penguin Cafe Orchestra, 'Ending' by Kazumasa Hashimoto, 'Remedios the Beauty' by Oren Ambarchi, 'Lazyboat' and 'Vostok' by Triosk, 'Passages' by Bowery Electric, 'Self Seal Mishap' by Tennis and 'Ba Ba' by Sigur Rós. More information The Messenger is a co-production of Behind the Wire and the Wheeler Centre. It’s produced by Michael Green, André Dao, Hannah Reich and Bec Fary, with Jon Tjhia and Sophie Black at the Wheeler Centre.Narration by Michael Green. With reporting by Abdul Aziz Muhamat. Additional fact checking by the Guardian's Ben Doherty; transcription by Claire McGregor, Victoria Grey, Camilla Chapman, Lena Lettau and many more. This episode was edited and mixed by Bec Fary and Jon Tjhia. Thank you Dana Affleck, Angelica Neville and Sienna Merope. Also to Cameron Ford and Heidi Pett, and to Behind the Wire’s many participants and volunteers. Behind the Wire is supported by the Bertha Foundation.
#107: The Scariest Navy SEAL I've Ever Met...And What He Taught Me. Jocko Willink (@jockowillink) is one of the scariest human beings imaginable. He is a lean 230 pounds. He is a Brazilian jiu-jitsu expert who used to tap out 20 Navy SEALs per workout. He is a legend in the Special Operations world. His eyes look through you more than at you. He rarely does interviews, if ever. But a few weeks ago, Jocko ended up staying at my house and we had a caffeinated mind meld. Here's some background... Jocko enlisted in the Navy after high school and spent 20 years in the SEAL Teams, first as an enlisted SEAL operator and then as a SEAL officer. During his second tour in Iraq, he led SEAL Task Unit Bruiser in the Battle of Ramadi--some of the toughest and sustained combat in the SEAL Teams since Vietnam. Under his leadership, Task Unit Bruiser became the most highly decorated Special Operations Unit of the entire war in Iraq and helped bring stability to Ramadi. Jocko was awarded the Bronze Star and a Silver Star. Upon returning to the United States, Jocko served as the Officer-in-Charge of training for all West Coast SEAL Teams, designing and implementing some of the most challenging and realistic combat training in the world. So why is Jocko opening up? Well, in part, we have mutual friends. Second, he is the co-author of an incredible new book — Extreme Ownership: How U.S. Navy SEALs Lead and Win -- which I've been loving. Trust me. Buy it. This is his first mainstream interview and one you won't want to miss. Show notes and links for this episode can be found at www.fourhourworkweek.com/podcast. This podcast is brought to you by Wealthfront. Wealthfront is a massively disruptive (in a good way) set-it-and-forget-it investing service, led by technologists from places like Apple and world-famous investors. It has exploded in popularity in the last 2 years, and now has more than $2.5B under management. In fact, some of my good investor friends in Silicon Valley have millions of their own money in Wealthfront. Why? Because you can get services previously limited to the ultra-wealthy and only pay pennies on the dollar for them, and it’s all through smarter software instead of retail locations and bloated sales teams Check out wealthfront.com/tim, take their risk assessment quiz, which only takes 2-5 minutes, and they’ll show you—for free–exactly the portfolio they’d put you in. If you want to just take their advice and do it yourself, you can. Or, as I would, you can set it and forget it. Well worth a few minutes: wealthfront.com/tim. Mandatory disclaimer: Wealthfront Inc. is an SEC registered Investment Advisor. Investing in securities involves risks, and there is the possibility of losing money. Past performance is no guarantee of future results. Please visit Wealthfront dot com to read their full disclosure. This podcast is also brought to you by 99Designs, the world’s largest marketplace of graphic designers. Did you know I used 99Designs to rapid prototype the cover for The 4-Hour Body? Here are some of the impressive results. Click this link and get a free $99 upgrade. Give it a test run...
Rank #1: S1:E3 - The Epidemic. The Nox Virus gets released. We find out how an epidemic starts.
Rank #2: S1:E4 - Getting The Message. The Nox Virus spreads. We find out how much we rely on digital communication.
Rank #1: How to master CPR. Little things can make a big difference when it comes to running a code. EMS director and CPR aficionado Bill Reed gives a primer on High Performance CPR. High Performance CPR core principles Rate = 110 (100-120). Metronome set at 110. Depth = 2.0-2.5 inches. Full recoil (no leaning). Focus on rate & depth. Listen for 15 second countdown warning of upcoming compressor switch. Change compressors at 2-minute intervals/cycles. Whenever possible, compressions performed from patient’s right side and new compressor comes in from the previous compressors right side. Opposite is true for left sided compressions. New compressor to “hover” over chest during rhythm check and/or defibrillation. No more than 5 second pauses for compressor change or rhythm checks. Immediately resume CPR after defibrillation (no pulse checks) or when rhythm check is complete. Airway/Respiratory NRB or nasal cannula at max flow initially. BVM when available. Rate = 1 breath every 10 compressions (unsynchronized). Volume = no more than ½ ambu bag. ETI when feasible or if no ROSC by 6-8 minutes as resources allow. ETCO2 monitor connected as soon as feasible. ETI should be accomplished by a provider other than code lead. Hands off patient and/or airway device at 2-minute check. Monitor/Defibrillator Attach as soon as possible. Standard pad placement. If witnessed VF while pads were in place for another reason, immediate charge and defibrillate. Otherwise, ensure CPR for at least 30 seconds before delivering any defibrillations. Pre-charge defibrillator 15 seconds prior to 2-minute checks. If non-shockable rhythm at 2-minute check, “dump” charge by pressing the decrease energy selection button. If shockable rhythm at 2-minute check, immediately defibrillate & resume CPR (no pulse checks). If VF on rhythm check at 6 minutes (third cycle), immediately defibrillate, then roll patient 30 degrees towards new compressor, attach new posterior pad slightly below and medial to the patients left scapula, roll patient back and resume CPR. Attach new anterior pad over left superior chest. Connect new AP pads to new monitor/defibrillator. At 8 and 10-minute checks (fourth & fifth cycles), pre-charge and defibrillate with new AP pads & monitor/defibrillator set at max joules. At 12-minute check (sixth cycle), pre-charge both defibrillators to max joules and defibrillate both “simultaneously” if patient is still in VF. One operator, two fingers. Caveats Changing to AP pads and/or double sequential defibrillation (DSD) is only for refractory VF. If VF converts with standard pad placement, AP pad placement, or DSD, use that pad placement and energy setting for recurrent VF defibrillations Venous Access IO is faster than IV. IV can follow IO. Central venous access should be accomplished by a provider other than the code lead. Drugs Know your rhythm before giving drugs! That tachycardia might be SVT or something that might not take kindly to a bolus of epinephrine Epinephrine Goal is for 3 doses in first 10 minutes. Can give at 2,4, & 6-minute checks or whatever time interval is most easily accomplished. After 10 minutes, goal is for Epi every 5 minutes. Amiodarone (for VF) Goal is for 2 doses in first 10 minutes. 300mg first dose and 150mg second dose. Can give at 2 & 6-minute checks or whatever time interval is most easily accomplished. Code Lead & Code Scribe/Time Keeper Confirm/ensure metronome use & appropriate CPR depth & rate. Confirm/ensure appropriate BVM or BV ET Tube rate and volume. Confirm/ensure ETCO2 connected and documented. Notify team of impending compressor change and rhythm check 15 seconds prior to the end of the 2-minute cycle. Confirm/ensure defibrillator is pre-charged. Interpret rhythm. Instruct defibrillator operator to deliver shock (or deliver shock if code lead is the operator) after confirming no team member is touching the patient. Confirm/ensure resumption of CPR and BVM after rhythm check and/or defibrillation. Request and confirm drug delivery at appropriately intervals. Confirm/ensure documentation of rhythm(s) and drug doses. Ensure all pauses are less than or equal to 5 seconds (use 5 sec verbal count down).
Rank #2: ZDoggMD. Zubin Damania (ZDoggMD) is an internist and founder of Turntable Health, an innovative healthcare startup that was part of an urban revitalization movement in Las Vegas. During a decade-long hospitalist career at Stanford, he experienced our dysfunctional health care system firsthand leading to burnout and depression. He created videos under the pseudonym ZDoggMD as an outlet to find his voice. This launched a grassroots movement — half a billion youtube views and a passionate tribe dedicated to improving health care for everyone. ERcast 2.0 Launches May 1 Click hereto learn more Or hereto sign up and skip the details In this interview we cover a wide range of topics including Underwear How ZDogg went from hospitalist to rapper to Medicine 3.0evanaglist Meditation The Mind Illuminated The roots of anxiety Mental preparation before giving a talk ZDogg's response to criticism, antipathy, and negative feedback from the anti-vaccine movement Nurse practitioners A Smattering of Performance Improvement, Stress Management, and Wellness Episodes Finding the Joyin Your Job Performance Coach Jason Brooks Making Order Out of Chaos How to Not Freak Out When Consultants Give Bad Advice Beating Stress and the Hot Offload Mastering the Storm Full Video Interview Below https://www.youtube.com/watch?v=bujZmXEtuHA My Favorite Zdogg Song https://www.youtube.com/watch?v=NAlnRHicgWs
Rank #1: Episode 3: Affordable Care Act. Since March 2010, health care in the U.S. has been subject to the Affordable Care Act, also known as Obamacare. There is a significant amount of confusion about what exactly this law does or does not do. In this episode, we talk about the key provisions of the law and how it affects the delivery of healthcare in the U.S. We cover: the effect of the law on insurance subsidies the pre-exisiting conditions clause the mandatory coverage provision pharmaceutical pricing and other key requirements of the law. In this episode we refer to the following information: Insurance companies requesting rate reviews under Obamacare
Rank #2: Episode 94: Medicaid, Medicaid Expansion and the Uninsured. Medicaid is the subject of a lot of talk in today's political environment. Sadly much of what is said isn't based in fact, or it focuses on parts of the program that represent a tiny portion of its cost. Today, 2 Docs Talk about Medicaid, who it serves, and how it was affected (or, rather, supposed to be affected) by the Affordable Care Act.
Rank #1: #48: Hyponatremia Deconstructed. Step up your salt game. We deconstruct hyponatremia with expert tips from our Chief of Nephrology, Dr. Joel Topf aka @kidney_boy aka The Salt Whisperer. Topics include: true versus false hyponatremia, SIADH, tea and toast/beer potomania, safe rates of sodium correction, fluid restriction, salt tablets, IV fluid choice, DDAVP clamps, and more. Full show notes available at http://thecurbsiders.com/podcast Join our newsletter mailing list. Rate us on iTunes, recommend a guest or topic and give feedback at firstname.lastname@example.org. Case: 85yo F with anxiety, asthma, HTN (on a CCB), hypothyroidism with TSH of 3 on therapy. Sodium was 128 from previous values 134-137 mg/dL. She is more fatigued than usual. Time Stamps 00:00 Intro 03:00 Guest interview 06:45 Pick of the week w/Dr. Topf 15:50 Clinical case of hyponatremia 17:18 False hyponatremia normal osmolality 19:04 False hyponatremia high osmolality 20:06 Understanding why osmolality matters 22:58 Workup false hyponatremia 24:15 Recap of discussion so far 25:10 ADH dependent vs independent hyponatremia 26:30 Psychogenic polydipsia 28:45 Renal failure and hyponatremia 29:33 Tea and toast, and Beer Drinker’s potomania 34:42 ADH dependent hyponatremia 37:45 Volume versus osmolality 39:30 Volume status exam 44:44 Additional testing with urine lytes and uric acid 47:00 Treatment for SIADH 52:12 Discussion of the vaptans 57:51 Additional testing in SIADH 62:20 When to admit patient for hyponatremia 63:29 Clinical case of hyponatremia complications 68:26 Fluids and rate of correction 73:06 DDAVP clamp 76:00 Moderate hyponatremia 78:05 Diuretic dosing DOES matter! 81:29 Loop diuretics for SIADH 83:55 Take home points 86:55 Outro Tags: hyponatremia, salt, sodium, SIADH, ADH, vasopressin, fluids, electrolytes, kidney, nephrology, osmolality, urine, concentration, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, primary, physician, resident, student
Rank #2: #167 LIVE! Common CBC Abnormalities with Mary Kwok MD. Take a deep dive into common CBC abnormalities. We recorded LIVE at joint grand rounds between Walter Reed NMMC and Uniformed Services University with hematologist, Dr. Mary Kwok MD. Topics include: which parts of the complete blood count (CBC) are most important, interpreting the differential, when to order flow cytometry, who needs a hematology consult and simplified approaches to patients with leukocytosis, leukopenia, erythrocytosis and thrombocytopenia. Full show notes at https://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at email@example.com. Credits Written, Produced and Edited by: Matthew Watto MD, FACP Cover Art and Infographic by: Matthew Watto MD, FACP Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP Guest: Mary Kwok MD Sign Up for a course w/our Chief of POCUS, Dr. Renee Dversdal! ACP - acponline.org/pocus AIUM - Check out https://aium.org for upcoming events. TRUST (Train the Ultrasound Trainers) https://www.ultrasoundtraining.com.au/courses/category/train-the-ultrasound-trainer-trust Time Stamps 00:00 Intro; Paul shame’s the audience; Guest bio 03:17 Guest one-liner, book recommendation* -Emperor of All Maladies (book) by Siddhartha Mukherjee, When Breath Becomes Air (book) by Paul Kalanithi; Career advice -set goals for whatever you’re learning. 08:43 Picks of the week: John Wick 3 (film); The Movies That Made Me (podcast) by Joe Dante; The Tim Ferriss Podcast with Julie Rice of Soul Cycle; Infinity Chamber (film) by Travis Milloy 11:50 A case of asymptomatic leukocytosis; Red flags; Repeat the CBC until it’s normal 17:30 The peripheral smear; Leukemoid reaction 20:00 The physical exam; When to send flow cytometry? 22:18 A case of lymphopenia; benign ethnic neutropenia; What to look for in the history 27:10 A case of erythrocytosis; Checking EPO levels; JAK2 mutation; Differential Diagnosis; Therapeutic Phlebotomy; Physical findings of Polycythemia Vera 36:53 A case of thrombocytopenia; Lab workup; Differential diagnosis; Pathophysiology; Culprit meds 45:35 Advice for internists 46:36 Take Home Points 47:46 Dr. Kwok’s disclaimer 48:10 Outro and post credit scene
Rank #1: Episode 133.0 – Initial Trauma Assessment. 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 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 Read More 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 Read More
Rank #2: Episode 31.0 – Rocuronium vs. Succinycholine. This podcast is a recorded lecture from our conference on why Rocuronium should be the go to drug for RSI in the ED. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_31_0_Final_Cut.m4a Download 2 Comments Tags: Airway, Rocuronium, RSI, 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. Read More
Rank #1: Episode 71 ACLS Guidelines 2015 – Cardiac Arrest Controversies Part 1. A lot has changed over the years when it comes to managing the adult in cardiac arrest. As a result, survival rates after cardiac arrest have risen steadily over the last decade. With the release of the 2015 American Heart Association ACLS Guidelines 2015 online on Oct 16th, while there aren’t a lot a big changes, there are many small but important changes we need to be aware of, and there still remains a lot of controversy. In light of knowing how to provide optimal cardio-cerebral resuscitation and improving patient outcomes, in this episode we’ll ask two Canadian co-authors of The Guidelines, Dr. Laurie Morrison and Dr. Steve Lin some of the most practice-changing and controversial questions. The post Episode 71 ACLS Guidelines 2015 – Cardiac Arrest Controversies Part 1 appeared first on Emergency Medicine Cases.
Rank #2: Episode 4: Acute Congestive Heart Failure. Dr. Eric Letovsky and Dr. Brian Steinhart describe a practical way to approach patients with undifferentiated SOB and acute congestive heart failure, the utility of various symptoms and signs in the diagnosis of CHF, as well as the controversies surrounding the best use of BNP and Troponin in the ED. A discussion of the use of ultrasound for patients with SOB as well as the indications for formal Echo are reviewed. In the second part of the episode they discuss the management of acute congestive heart failure based on a practical EM model, as well as the difficulties surrounding disposition of patients with CHF. The post Episode 4: Acute Congestive Heart Failure appeared first on Emergency Medicine Cases.
Rank #1: SGEM Xtra: Walk of Life – Thrombolysis for Acute Ischemic Stroke. Date: February 18th, 2019Guest Skeptic: Dr. Shahriar Zehtabchi is a tenured professor and Vice Chair of Academic Affairs in the Department of Emergency Medicine at SUNY Downstate Medical Center & Kings County Hospital. He has been teaching evidence-base medicine for many years and currently is the editor-in-chief of the EBM website TheNNT.com. Shahriar also…
Rank #2: SGEM#196: Gastroparesis – I Feel Like Throwing Up. [display_podcast]Date: November 24th, 2017Reference: Roldan et al. Trial Comparing Haloperidol Combined With Conventional Therapy to Conventional Therapy Alone in Patients With Symptomatic Gastroparesis. AEM November 2017Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the Director of Simulation Education at Markham Stouffville Hospital in Ontario. He is the creator of the…
Rank #1: Episode 50 - Seizures. 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
Rank #2: Episode 41 - Vertigo. We cover two bits of FOAM,Emergency Medicine Literature of Note - Dr. Ryan Radecki - on the use of meclizine for vertigo and EMcrit - Dr. Scott Weingart on the HiNTs exam. Then we delve into some of the problems with the HiNTs exam including it can only be performed on patients with continuous vertigo and that external validity is a major issue with HiNTs. Then, we delve into core content on vertigo using Rosen’s Medicine (8e) Chapter 19, and Tintinalli’s Emergency Medicine: A Comprehensive Study Guide (7e) Chapter 164 “Vertigo and Dizziness." Thanks for listening! Jeremy Faust and Lauren Westafer
Rank #1: ALiEM EM Match Advice: ERAS. Advice for medical students applying into Emergency Medicine from a panel of program directors, Drs. Gene Hern, Laura Hopson, Josh Broder. Hosted by Drs. Michael Gisondi and Michelle Lin.Podcast Editor: David Yang
Rank #2: Management of Intracranial Hemorrhage with ED-neurointensivist Dr. Debbie Yi Madhok. Dr. Debbie Yi Madhok (https://twitter.com/DrDebbieYi), an emergency physician and neurointensivist, sat down with Dr. Derek Monette (https://twitter.com/DerekMonetteMD), the ALiEM Deputy Editor in Chief, to discuss updates in the management of intracranial hemorrhage. This is a podcast following up with her original popular 2017 ALiEM blog post entitled "Update on the ED Management of Intracranial Hemorrhage: Not All Head Bleeds Are the Same" (https://www.aliem.com/2017/09/intracranial-hemorrhage-management/)
Rank #1: 3 - Dark Winter. In episode 3 of Bedside Rounds, I talk about the human triumph of small pox vaccination, and discuss the government exercise called Dark Winter which simulated a bioterrorism attack on the United States.
Rank #2: 34 - The Physical. The physical exam has become a ritual of the modern doctor’s appointment, with pokes, prods, and strange tools. How did this become a normal thing to do? In this episode, I’ll discuss how the physical exam went from the medieval examination of a flask of urine to basically what we have today in just a few decades in early 19th century France, and how the exam is still developing in the 21st century. Plus, a brand new #AdamAnswers about why Americans insist on using the Hermes’ Staff as a symbol for medicine. All this and more in episode 34 of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine! Sources: Antic T, DeMay RM. “The fascinating history of urine examination,” Journal of the American Society of Cytopathology (2014) 3, 103e107 Ghasemzadeh N and Zafari AM, “A Journey into the History of the Arterial Pulse,” Cardiology Research and Practice Volume 2011 (2011). McGee S, Evidence Based Physical Diagnosis 4th edition. Amazon link: https://www.amazon.com/Evidence-Based-Physical-Diagnosis-Steven-McGee/dp/0323392768 Nicolson M, Commentary: Nicholas Jewson and the disappearance of the sick man from medical cosmology, 1770–1870. Int J Epidemiol 2009;38:622–33) Jewson ND. The disappearance of the sick-man from medical cosmology, 1770–1870, Sociology , 1976, vol. 10 (pg. 225-44) Robertson WE. Physical diagnosis from the time of Rontgen. Ann Med Hist. 1934;6:255–63 Rodgers MM, “Piorry on Pleximetry and Auscultation,” Boston Med Surg J 1852; 46:151-152 Tan SY and Hu M, “Josef Leopold Auenbrugger (1722 - 1809): father of percussion. Singapore Med J 2004 Vol 45(3):103 Walker HK, “The Origins of the History and Physical Examination,” Clinical Methods: The History, Physical, and Laboratory Examinations.Boston: Butterworths; 1990. Wallis F, Signs and Senses: Diagnosis and Prognosis in Early Medieval Pulse and Urine Texts. Social History of Medicine Vol. 13 No. 2 pp. 265-278. Wilcox RA et al, “The Symbol of Modern Medicine: Why One Snake Is More Than Two,” Ann Intern Med. 2003;138:673-677. Verghese et al, A History of Physical Examination Texts and the Conception of Bedside Diagnosis. Voswinkel P, From uroscopy to urinalysis. Clinica Chimica Acta 297 (2000) 5–16
Rank #1: Vomiting in the Young Child: Nothing or Nightmare. In the young child, vomiting is the great imitator:Gastrointestinal, Neurologic, Metabolic, Respiratory, Renal, Infectious, Endocrine, Toxin-related, even Behavioral.To help us organize, below is a review of can't-miss diagnoses by age.The Neonate: Malrotation with VolvulusIn children with malrotation, 50% present within the first month of life, with the majority occurring in the first week after birth. 90% of children with malrotation with volvulus will present by one year of age. This is a pre-verbal child’s disease – which makes it even more of a challenge to recognize quickly. The sequence of events usually is fussiness, irritability, and forceful vomiting. The vomit quickly turns bilious. Green vomit is a surgical emergency. Babies may also present unwell, with bloating and abdominal tenderness to palpation. Be aware that later stages of malrotation may present as shock – they present in hypovolemic shock due to third-spacing from necrotic bowel and/or septic shock from translocation or perforation. In the undifferentiated sick neonate, always consider a surgical emergency such as malrotation with volvulus. In the stable patient, get an upper GI contrast study. Rapid-fire word association for other vomiting emergencies in a neonate: Fever, irritability and vomiting? Think meningitis, UTI, or sepsis. Premature, unwell, and vomiting? Think necrotizing enterocolitis. Remember, 10% of cases of NEC can be full-term. Look for pneumatosis intestinalis. Systemically ill, afebrile, and vomiting for no other reason? Think inborn error of metabolism. Screen with a glucose, ammonia, lactate, and urine ketones. Others include congenital intestinal atresia or webs, meconium ileus, or severe GERDThe Infant: Non-Accidental TraumaAll that vomits is not necessarily from the gut. Abusive head injury is the most common cause of death from child abuse. Infants especially present with non-specific complaints like fussiness or vomiting. Up to 30% of infants with abusive head injury may be misdiagnosed on initial presentation. Louwers et al. in Child Abuse and Neglect developed and validated a six-question screening tool for use the in ED. The power of this tool was that it was validated for any chief complaint – it is not an injury evaluation checklist – it is a screen for potential abuse in the undifferentiated child: Is the history consistent? Was seeking medical help unnecessarily delayed? Does the onset of injury fit with the developmental level of the child? Is the behavior of the child and his interaction with his care-givers appropriate? Do the findings of the head-to-toe examination match the history? Are there any other red flags or signals that make you doubt the safety of the child or other family members? On multivariable analysis, if at least one of the questions was positive, there was an OR of 189 for abuse (CI 97 – 300). In other words, if any of those six questions are problematic, get your child protective team involved. Other important diagnoses in the infant: intussusception and pyloric stenosis (rapid review in audio).The Toddler: Diabetic Ketoacidosis (DKA)The important diagnosis not to miss in the vomiting toddler or early school age child is the initial presentation of diabetic ketoacidosis. Children under 5 (especially those under 2) and those from lower socioeconomic groups have a higher risk of DKA as their initial presentation of diabetes. This is true for any child that isn’t quite acting right – check a finger stick blood sugar as a screen. The International Society for Pediatric and Adolescent Diabetes (ISPAD) criteria for DKA: Hyperglycemia, with a blood glucose of >200 mg/dL (11 mmol/L) AND Evidence of metabolic acidosis, with a venous pH of less than 7.3 or a bicarbonate level of < 15 mEq/L AND Ketosis, found either in the urine or if directly checked in the blood. If you have access to checking a serum beta-hydroxybutryrate – the unsung ketone – it can help in diagnosis in unclear cases. Cerebral Edema Criteria: Minor criteria: headache, vomiting, irritability or lethargy; hypertension in the face of hypovolemia. Major criteria: change in mental status, including agitation or delirium; incontinence (especially if inappropriate for the child’s age); sluggish pupils and cranial nerve palsies; relative bradycardia (Cushing’s triad). Cerebral Edema Action Items: Immediately give mannitol, 1 g/kg over 15-20 minutes. May repeat it in 2 hours if needed. Hypertonic saline (3% NaCl) is second-line therapy. Put the head of the bed up 30 degrees. Alert your colleagues and counsel your parents. Make sure everyone knows what to watch out for. As you can see, vomiting in the young child can be really anything! Keep your differential broad, and think by age and by system. Differential Diagnosis of Vomiting in Children The general approach to the child with chiefly vomiting starts with the decision: sick or not sick. If ill appearing, establish rapid IV access, or if needed IO. Rapid blood sugar and if available a point of care pH and electrolytes. Be the detective in your history and doggedly go after any red flags as you go methodically by organ system. Do a careful physical exam. The general assessment is always helpful – is the child irritable, listless, agitated? What is his work of breathing? Effortless tachypnea may be a sign of acidosis or sepsis. Is the abdomen soft or is it tender or distended. Always look in the diaper area – is there a hernia, is there a high-riding, tender, discolored scrotum without cremasteric reflex? Ovarian torsion has been reported in infants as young as 7 months. Any skin signs? Look for petechiae, urticaria, purpura. In other words, use your best judgement, have the dangerous differentials in the back of your mind, and pull the trigger when red flags mount up. Otherwise, a good history and a good exam will get you where you need to be.Take home points for the young child with vomiting: Neonates are allowed to regurgitate (effortless reflux of stomach contents -- the happy spitter-upper). They are not allowed to vomit (forceful, unpleasant contraction of abdominal muscles). Consider surgical causes of forceful vomiting, especially if the child does not look anything other than well. Bilious is bad – green vomit is always a surgical emergency – do not pass go – get the surgeons involved early Not all vomiting is GI related – if it is not obviously benign, think methodically by organ system and adjust your targeted history and physical to pick up any leads. Match the tempo of your treatment to the tempo of the disease.ReferencesApplegate KE, Anderson JM, Klatte EC. Intestinal malrotation in children: a problem-solving approach to the upper gastrointestinal series. Radiographics. 2006; 26(5):1485-500. Glaser NS, Wootton-Gorges SL, Buonocore MH et al. Frequency of sub-clinical cerebral edema in children with diabetic ketoacidosis. Pediatr Diabetes. 2006 Apr;7(2):75-80. Louwers ECFM, Korfage IJ, Affourtit MJ et al. Accuracy of a screening instrument to identify potential child abuse in emergency departments. Child Abuse & Neglect. 2014; (38): 1275–1281. Lee HC, Pickard SS, Sridhar S et al. Intestinal Malrotation and Catastrophic Volvulus in Infancy. J Emerg Med. 2012; 43(1): e49–e51. Marcin JP, Glaser N, Barnett P et al. Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. J Pediatr. 2002; 141(6):793-7. Parashette KR, Croffie J. Intestinal Malrotation in Children: A Problem-solving Approach to the Upper Gastrointestinal. Pediatrics in Review. 2013; (34)7: 307-321. Wolfsdorf JI, Allgrove J, Craig ME et al. ISPAD Clinical Practice Consensus Guidelines 2014. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes. 2014 Sep;15 Suppl 20:154-79. This post and podcast are dedicated to Damian Roland, BMedSci (Hons), MB BS, MRCPCH, for his fervor in the care of children and his dedication to quality medical education. Nausea and Vomiting | Non-Accidental Trauma | DKA Powered by #FOAMed -- Tim Horeczko, MD, MSCR, FACEP, FAAP
Rank #2: The Fussy Infant. A Social Visit or Your Most Dangerous Presentation Tonight? [Details in Audio] This post and podcast are dedicated to Henry Goldstein, B.Pharm, MBBS for his tireless dedication to all things #FOAMed, #FOAMped, and #MedEd. You are awesome. Make sure to visit Don't Forget the Bubbles! References Cohen GM, Albertini LW. Colic. Pediatr Rev. 2012; 33(7):332-3. Friedman SB et al. The crying infant: diagnostic testing and frequency of serious underlying disease. Pediatrics. 2009; 123(3):841-8 Herman M, Le A. The crying infant. Emerg Med Clin North Am. 2007 Nov;25(4):1137-59. Poole SR. The infant with acute, unexplained, excessive crying. Pediatrics. 1991; 88 (3): 450-5. Prentiss KA, Dorfman DH. Pediatric Opthalmology in the Emergency Department. Emerg. Med. Clin. N. Am. 2008; 26: 181-198. Shope TR, Rieg TS, Kathiria NN. Corneal abrasions in young infants. Pediatrics. 2010 Mar;125(3):e565-9. Epub 2010 Feb 8.
Rank #1: REBEL Cast Episode 40: Research From the Past Year – Pain Control. Welcome back to Episode 40 of REBEL Cast. We have taken some time off but don’t worry, we are back. In this episode, we will... The post REBEL Cast Episode 40: Research From the Past Year – Pain Control appeared first on REBEL EM - Emergency Medicine Blog.
Rank #2: REBEL Core Cast 4.0 – RSI Cheat Codes. Take Home Points Bed Up Head Elevated (BUHE) position is a simple intervention that can reduce the rate of intubation-related complications. The bougie should be... The post REBEL Core Cast 4.0 – RSI Cheat Codes appeared first on REBEL EM - Emergency Medicine Blog.
Rank #1: Sudoku seizures.. A young man's near-death experience results in a very puzzling diagnosis on the season finale of DDx.
Rank #2: Extreme reactions to marijuana.. Chronic vomiting, a flushed complexion, and acute agitation: can cannabis be the cause? A growing consensus among doctors suggests cannabinoid hyperemesis syndrome is real and on the rise.
Rank #1: Abdominal pain. Abdominal pain is one of the most common complaints in the ED. In this podcast we will review how to get a good history, how to do a solid abdominal exam, and a systematic method for figuring out how to effectively use imaging with to make a diagnosis or, at the very least, rule out "the badness".
Rank #2: Seizures. We encounter seizure disorders frequently in the ED. In this episode, we'll review all the important points about seizures including the confusing and difficult topic of pseudosezures. We'll also go in depth on the ED treatment of seizures and status epilepticus.
Rank #1: Annals of Emergency Medicine January 2019 Summary. Summary of January 2019 issue of Annals of Emergency Medicine
Rank #2: Annals of Emergency Medicine December 2018 Summary. Summary of December 2018 issue of Annals of Emergency Medicine