FOAMcast - Emergency Medicine Core Content

In this episode, we discuss treatment of acute ischemic priapism, including some updates from the American Urological Association.    Show notes and references: FOAMcast.org

In this episode, we review a consensus guideline from the American College of Emergency Physicians on the use of topical anesthetics in corneal abrasions.  Show notes and references: FOAMcast.org Thanks for listening! Jeremy Faust and Lauren WEstafer

This episode covers emergency medicine-related recommendations from the American Heart Association's (AHA) clinical guideline on atrial fibrillation: 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation Circulation. 2023 Show notes and references: FOAMcast.org Thanks for listening! Lauren Westafer

The AABB recently published updated recommendations for blood transfusion thresholds. This podcast reviews these recommendations and a recent study, the MINT trial, in which patients with anemia and a myocardial infarction were randomized to a restrictive strategy or liberal transfusion strategy. Show notes / references: FOAMcast.org Thanks for listening! Lauren Westafer

This epsiode reviews the new clinical policy from the American College of Emergency Physicians (ACEP) on medication for acutely agitated patients needing parenteral sedation. Show notes / references: FOAMcast.org Thanks for listening! Lauren Westafer

In this episode, we review Resuscitative endovascular balloon occlusion of the aorta (REBOA), notably dissecting the recent Jansen et al trial in JAMA. Shownotes / References:  FOAMcast.org Thanks for listening! Jeremy Faust & Lauren Westafer

Alcohol use disorder (AUD) is commonly encountered in the ED and visits related to alcohol are estimated to be ~4% of all ED visits in the US. Despite this, most EDs offer little support and harm reduction for patients with AUD. In this podcast, we review naltrexone, the first-line medication for patients with AUD, which is starting to be initiated in US EDs by emergency clinicians.  AAEM position paper References and show notes: FOAMcast.org Thanks for listening! Lauren Westafer

Recommendations for the use of steroids in community-acquired pneumonia have been mixed. This episode reviews a large multicenter randomized trial in the New England Journal of Medicine by Dequin et al on hydrocortisone for severe community-acquired pneumonia.  References/show notes: FOAMcast.org Thanks for listening! Lauren Westafer

In this episode we review the CLOVERS trial, a randomized trial of early (first 24 hours) restrictive versus liberal fluids.  Show notes/references: FOAMcast.org Thanks for listening! Jeremy Faust + Lauren Westafer

This episode reviews guideline recommendations and literature on the management of acute, uncomplicated diverticulitis - highlighting the recommendations to only prescribe antibiotics to select patients. References/Show Notes: FOAMcast.org Thanks for listening! Lauren WEstafer

This episode reviews a shift from the "lethal triad" in trauma to the "diamond of death," exploring the role of calcium in hemostasis and critically ill patients. We review the literature that is available on hypocalcemia and trauma patients References/show notes: FOAMcast.org Thanks for listening! Lauren Westafer

This episode is a departure from the typical FOAMcast clinical content, we will be back with strictly clinical content soon. In May 2022, I came across a fellow passenger and stranger in cardiac arrest in the airport. A small team of strangers, including an emergency medicine resident, Dr. Jason Tanner, and an emergency department technician, Angel, assembled to treat this passenger. Billy Frolick, a writer and our patient that day, shares his perspective on his case with us.  In addition, we highlight important clinical pearls, notably the importance of continuous chest compressions and early defibrillation. For more on not doing pulse checks, see this podcast: https://foamcast.org/2022/09/04/pulse-checks-during-cardiopulmonary-resuscitation/ .  

This episode covers the 2022 American College of Emergency Physicians (ACEP) clinical policy on acute heart failure syndromes with a special focus on high dose nitrates References and Show Notes: FOAMcast.org Thanks for listening! Lauren Westafer

In this episode, we review the largest trial of double sequential external defibrillation (DSED) and vector change (VC) defibrillation for refractory ventricular fibrillation (VFib): Cheskes S, Verbeek PR, Drennan IR, et al. Defibrillation Strategies for Refractory Ventricular Fibrillation. N Engl J Med. 2022;387(21):1947-1956. Show notes, references, & infographics: FOAMcast.org Thanks for listening! Jeremy Faust & Lauren Westafer

The American College of Cardiology released a new consensus statement endorsing several signs on the electrocardiogram (ECG) as "STEMI Equivalents." In this podcast, we review these signs. Show notes / graphics / references: FOAMcast.org Thanks for listening! Lauren Westafer

Since 2010, the American Heart Association guidelines for cardiopulmonary resuscitation (CPR) have de-emphasized pulse checks - such that they recommend against routine pulse checks. Despite this recommendation, may individuals and institutions continue to perform pulse checks. This episode reviews the recommendations and the literature. References/show notes: FOAMcast.org Thanks for listening! Lauren Westafer

There is a global outbreak of human monkeypox virus cases. In this episode we provide a quick summary of monkeypox to date. Check out our two more in-depth episodes on the topic.  References/Show notes: FOAMcast.org Thanks for listening! Jeremy Faust & Lauren Westafer

There is a global outbreak of human monkeypox virus cases. In this episode (the second of a 2 part series), we summarize clinical manifestations, complications, and vaccination.  References/Show notes: FOAMcast.org Thanks for listening! Jeremy Faust & Lauren Westafer

There is a global outbreak of human monkeypox virus cases. In this episode (the first of a 2 part series), we summarize some brief virology, epidemiology, and review the transmission of this virus.  References/Show notes: FOAMcast.org Thanks for listening! Jeremy Faust & Lauren Westafer

We review the Anorectal emergencies: WSES-AAST guidelines on complicated hemorrhoids that include some practice-changers References: FOAMcast.org Thanks for listening! Lauren Westafer

Diphenhydramine (Benadryl) and other first-generation antihistamines are commonly used, despite decades of data that there are safer and effective alternatives.  In this podcast, we review the guidelines / data behind common indications. References at FOAMcast.org Thanks for listening! Lauren Westafer

In this episode we review acute urticaria and new guidelines related to the treatment of urticaria. We review additional relevant trials Palungwachira et al and Barniol et al.  References/Show notes: FOAMcast.org Thanks for listening! Jeremy Faust and Lauren Westafer

In this podcast we discuss onset of action of various intramuscular agents for chemical sedation for severely agitated patients. This includes a study by Barbic et al on ketamine, the onset of action of midazolam (and association with length of stay), and is droperidol really magic? (Cole et al)  Shownotes/References: FOAMcast.org Thanks for listening! Jeremy Faust and Lauren Westafer

Outpatient management of pulmonary embolism for low-risk patients has been encouraged for several years. However, little is known about pulmonary embolism diagnosed and managed exclusively in the outpatient setting. In this study, Vinson et al describe the course of patients diagnosed with PE and managed in the outpatient setting in an integrated healthcare delivery system. Shownotes/References: FOAMcast.org Thanks for listening! Lauren Westafer

The diagnostic algorithm for pulmonary embolism (PE) has evolved over the past few years to include probability or risk-adjusted D-dimer. The YEARS algorithm includes an elevated D-dimer threshold for some risk groups and has been found to be safe and reduce imaging in several studies, including in pregnant patients. Now, this multicenter trial by Freund et al evaluates use of YEARS and age-adjusted D-dimer compared with an age-adjusted approach alone. Shownotes/References: FOAMcast.org Thanks for listening! Lauren Westafer

A seminal single-center study in 2018 by Driver et al found a 98% first-pass success in patients undergoing endotracheal intubation in the Emergency Department. This multi-center randomized control trial examines bougie vs stylet in a wider array of settings Show notes/references: FOAMcast.org Thanks for listening! Lauren Westafer

Subsegmental pulmonary embolism (SSPE) is a controversial entity as they have uncertain clinical significance. As a result, the Chest Guidelines  and ACEP guidelines state that a very select group of patients with isolated SSPE and no deep vein thrombosis may be managed with surveillance rather than anticoagulation. In this podcast we review SSPE and a new prospective study by Le Gal and colleagues. Show notes and references: FOAMcast.org Thanks for listening! Lauren Westafer

We review the FDA briefing document from Pfizer   as well as from the CDC Advisory Council on Immunization Practices that approved the Pfizer-BioNTech COVID-19 vaccine in children ages 5-11. References and show notes: FOAMcast.org Thanks for listening! Lauren Westafer and Jeremy Faust

We previously covered the management of young febrile infants in a 2017 podcast  but now we have updated guidance from the AAP. In this podcast, we review the 2021 AAP Guidelines for the management of well-appearing febrile infants 8-60 days old, highlight practice-changing recommendations. Show notes/references: FOAMcast.org Thanks for listening! Lauren Westafer

In this episode, Jeremy discusses what we know about breakthrough infections in the delta variant era and what this may mean for COVID-19 vaccine boosters. Jeremy's takes can be found at Inside Medicine Show notes/references: FOAMcast.org Thanks for listening! Lauren Westafer and Jeremy Faust

In this episode, we discuss the current evidence (as of September 24, 2021) on COVID-19 vaccine boosters as well as the CDC recommendations and the details of the Advisory Council on Immunization Practices recommendations/vote. Show notes/References at FOAMcast.org Jeremy's takes can be found at Inside Medicine Thanks for listening! Lauren Westafer and Jeremy Faust

In this literature update podcast covering important papers of 2021, we cover Becattini et al on the assessment of right ventricular dysfunction in patients diagnosed with acute pulmonary embolism (PE). We review guidelines on PE risk stratification for severity and discuss this individual patient meta-analysis. Show notes/references: FOAMcast.org Thanks for listening! Lauren Westafer and Jeremy Faust  

This is a quick literature update on practice-changing literature from 2021. Here we discuss Pappal et al in Annals of Emergency Medicine on awareness during paralysis in mechanically ventilated patients Show notes / References: FOAMcast.org Thanks for listening! Lauren Westafer and Jeremy Faust

This is a quick literature update of important literature in 2021 covering take-home naloxone by Kilaru et al. In this episode, we discuss principles of harm reduction, including naloxone, as well as the study.  Show notes, references, and resources: FOAMcast.org Thanks for listening! Lauren Westafer and Jeremy Faust

This is a quick literature update of important literature in 2021 covering take home naloxone by Kilaru et al. In this episode, we discuss principles of harm reduction, including naloxone, as well as the study.  Show notes, references and resources: FOAMcast.org Thanks for listening! Lauren Westafer and Jeremy Faust

We review new clinical policy guidelines from SAEM on patients with recurrent (2 ED evaluations in 12 months) low risk (e.g. HEART score

In this episode, we review the data on the association between myocarditis and the mRNA COVID-19 vaccines. Show notes / References: FOAMcast.org Thanks for listening! Jeremy Faust and Lauren Westafer

In this quick literature update, we review a recent paper by Branch et al on early 'panscan' (head to pelvis CT scan ) in patients with return of spontaneous circulation after out of hospital cardiac arrest.  Show notes/ references: FOAMcast.org Thanks for listening! Lauren Westafer and Jeremy Faust

In this episode we review what we know about vaccine induced thrombotic thrombocytopenia (VITT), which has been associated with the COVID-19 viral vector vaccines by AstraZeneca and Johnson & Johnson. Show notes/references: FOAMcast.org Thanks for listening! Lauren Westafer and Jeremy Faust

In this podcast, we review Cerebral Vein Thrombosis (CVT) including clinical presentation, diagnosis, and management. Show notes: FOAMcast.org Thanks for listening! Lauren Westafer and Jeremy Faust

In this episode, we discuss ivermectin as a potential therapeutic for COVID-19 and review available randomized trials evaluating this drug. Chaccour et al E-Clinical Medicine Lopez-Medina et al. JAMA Schwartz et al (not yet published) IDSA guidelines NIH Treatment guidelines Show notes: FOAMcast.org Thanks for listening! Jeremy Faust and Lauren Westafer

In this episode, we review new registry data from the ACIP meeting on pregnant people who received an mRNA COVID-19 vaccine and discuss, in general, what we know about the COVID-19 vaccines in pregnancy.  Show notes: FOAMcast.org Pregnancy Decision Aid Thanks for listening! Lauren Westafer and Jeremy Faust

In this episode, we review the FDA briefing document on the Janssen (Johnson & Johnson) viral vector COVID-19 vaccine. Show notes: FOAMcast.org Thanks for listening! Lauren Westafer & Jeremy Faust

We have previously covered epistaxis on FOAMcast , including the use of tranexamic acid (TXA). Now, we cover a new, large RCT, the NoPac trial by Reuben et al, on TXA for epistaxis. Show notes: FOAMcast.org Thanks for listening! Lauren Westafer and Jeremy Faust

There's been a lot of excitement over various drugs for COVID-19, including anti-inflammatory drugs. Colchicine, a medication long used for gout, fits that bill. In this podcast, we review 3 trials of colchicine including COLCORONA, GRECCO-19, and a study by Lopes et al.  Show notes: FOAMcast.org Thanks for listening! Jeremy Faust and Lauren Westafer

Early studies of tocilizumab, a monoclonal antibody that binds interleukin-6 , were disappointing. However, the REMAP-CAP trial recently reported a benefit to tocilizumab in non-critically ill hospitalized patients with COVID-19. Now, from the RECOVERY trial (the trial that brought us dexamethasone), we have more good news for tocilizumab - which we cover in this podcast Show notes: FOAMcast.org Thanks for listening! Lauren Westafer and Jeremy Faust

As vaccinations role out, the news of SARS-CoV-2 variants with mutations to the spike protein have dominated news cycles. One unanswered question has been - do the current vaccines protect against these variants? We tackle this issue and look at a new paper [pre-print] by Wu et al. 

Prior randomized trials of convalescent plasma in COVID-19 have had disappointing results. However, these trials included patients with severe illness who were many days (if not weeks) into the course of their illness. To date, it was hypothesized, but unknown, that the benefit would be in patients very early in the course of their illness. We cover an RCT by Libster et al in NEJM on convalescent plasma in older patients with mild COVID-19. Show notes/references: FOAMcast.org Thanks for listening! Lauren Westafer and Jeremy Faust

In this quick literature update we review the new recommendations from the CDC for the treatment of gonococcal infections which include: Higher dose ceftriaxone (500 mg IM) or 1 gm IM if ≥150 kg patient No routine azithromycin Preference for doxycycline for co-treatment of presumed chlamydial infection Show notes and references: FOAMcast.org Thanks for listening! Lauren Westafer and Jeremy Faust

For years studies have questioned whether pulse oximeters perform as well in non-White patients as in White patients. This is particularly important now as disposition decisions in patients with COVID-19 are often made based on pulse oximetry readings. We discussed an article by Sjoding et al in NEJM  Show notes at FOAMcast.org Thanks for listening! Lauren Westafer and Jeremy Faust

Despite multiple Phase II/III vaccine trials of >30,000 participants, pregnant patients or those who are lactating have been largely excluded. In this podcast, we cover what we know (and what we don't know thus far). The Pfizer BNT162b2 trial data submitted for FDA Emergency Use Authorization does include information on a minuscule number of patients who were immunized and became pregnant. The Society for Maternal and Fetal Medicine has released statements on vaccines in SARS-CoV-2. In the United Kingdom, Public Health England has released guidance for their population on vaccination in pregnancy and breastfeeding which are rooted in the lack of data. Shownotes: FOAMcast.org Thanks for listening! Jeremy Faust and Lauren Westafer