TOTAL EM - Tools Of the Trade and Academic Learning in Emergency Medicine

There are a variety of anorectal emergencies that present to the emergency department.  Recently, there were updated guidelines made by the World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST).  In this post, we review some of the updated guidelines including for anorectal abscess, perineal necrotizing fasciitis (Fournier's gangrene), bleeding anorectal varices, complicated rectal prolapse (irreducible or strangulated), and retained anorectal foreign bodies.

We are back to providing our ATLS content and we are picking up where we left off.  Our last ATLS podcast was on spine and spinal cord trauma.  Somewhat similar in nature is musculoskeletal trauma.  This is a very common form of trauma.  However, delayed recognition and  treatment can result in life-threatening hemorrhage or limb loss.

Cluster headaches are often considered one of the most painful human experiences.  They are short (lasting usually 15-180 minutes), frequent (up to 8 a day), unilateral headaches behind or around the eye often with ipsilateral autonomic symptoms and restlessness.  While migraines and tension headaches are seen frequently in the emergency department, cluster headaches are much less frequently seen and often are harder to identify as a result.  There are certain points to remember with patients that are experiencing cluster headaches and we list 10 of them here.

The use of tranexamic acid (TXA) has expanded with growing evidence in its use for a variety of clinical situations.  However, not all evidence is created equal and not all applications show benefit.  In this blog and podcast we discuss the various uses of TXA and the surrounding evidence.

For decades, there has been a major name debate regarding the appropriate title for PAs.  However, on May 24, 2021 the American Academy of PAs (AAPA) House of Delegates (HOD) came to a vote.  Over 100 possible titles were considered, but ultimately the winning vote was for "physician associate" which has led to a significant amount of discussion.  What is the history behind this decision and why now?  What has been the response?  We discuss this and more in this new blog and podcast.

There are countless guides and references that can be used in emergency medicine.  However, some books prove to be better resources than others and it is vital to identify them.  In this post, we review one of the books you should seriously consider having if you work in emergency medicine.

Last year, the American Heart Association (AHA) provided updates to their basic life support (BLS), advanced cardiac life support (ACLS), and pediatric advanced life support (PALS) programs.  Mike Sharma is helping again by reviewing some of the key updates and changes to guidelines.  We also provide some additional feedback and information to consider with these new guidelines.

March is Women's History Month and we wanted to celebrate some of the accomplishments of women in medicine.  While there are countless women that could be mentioned, we wanted to focus on a few that have been seen as pioneers in medicine.

Recently there was commentary in a forum that suggested the Pulmonary Embolism Rule-Out Criteria (PERC Rule) was essentially useless for detecting a pulmonary embolism (PE).  It started with an anecdote, which is a logical fallacy (post hoc ergo propter hoc) and went wild from there.  This led to the realization that many still do not understand how to use the Wells' Criteria for Pulmonary Embolism (referred to from here simply as the Wells' Criteria) and the PERC Rule.

Injuries to the spine can occur both in blunt and penetrating trauma.  They can also be with or without neurological deficits.  For this reason, they should be considered in all patients with multiple injuries.  In this podcast, Chip Lange and Mike Sharma review the pearls and pitfalls of this disease process.

We are able to provide a sneak peak at some updated content with Practical POCUS.  Over the last few months, Practical POCUS has been working to improve its content with the plan to help further promote point of care ultrasound (POCUS) to a broader audience.  One audience in particular is with EMS.  This 10 minute video is an excerpt from the updated course worth 24 hours of CME.  Make sure  to check out PracticalPOCUS.com to learn more.

A little while back, we asked for help on getting out more content.  David Wright and Kate Randolph answered that call and provided a special podcast on osteogenesis imperfecta.  We hope you enjoy this unique podcast and encourage you to reach out if you want to contribute, as well.

Neonatal sepsis can be subtle, especially early on.  It can rapidly progress to multisystem organ failure, meningitis, and death.  Given the real dangers of neonatal sepsis, we will focus on 10 key points to remember when evaluating for this lurking terror.

Elevated intracranial pressure (ICP) was just discussed in our last podcast on head injuries.  However, we briefly mentioned how there is a certain amount of controversy on this subject.  This separate podcast is to act as a supplement to the Chapter 6 ATLS podcast on head trauma that was just covered.  We find this particularly important given how long our ATLS podcasts run in general.

The newest Advanced Trauma Life Support (ATLS) blog and podcast is here!  This time we talk about head trauma.  Get the key pearls and pitfalls as provided by Chip Lange and Mike Sharma.

We received quite a bit of feedback with the last podcast and requests to discuss specifically the variants and their potential impacts on the current COVID-19 vaccines.  It is worth noting that at the time of this publication there is still limited data but we discuss the key concepts and takeaways with the current knowledge we have on the topic.

There have already been many podcasts discussing COVID-19 vaccines, so what makes this one different and worth listening to now?  This podcast is more about some of the key highlights and frequent questions asked to help listeners get the right resources and information.

We are back at it again with our newest ATLS podcast.  This time we are focusing on the abdomen and pelvis which can be host to a wide range of severe pathology.  Given its many intricacies, we focused most on the highlights from ATLS Chapter 5 including the key "red text" that it emphasizes. 

Recently, the Centers for Disease Control (CDC) released updated guidelines for treating gonococcal infections.  Given the increase in antibiotic resistance, this provides an important change in the recommended management for not only gonorrhea but also chlamydia. 

2020 was a very different year and now it is time to start into 2021.  As always this time of year we want to provide everyone with an update and our plans.  This is especially true given how the last couple of months have been particularly challenging with COVID-19.

It has been a while (a month) since we last posted.  We apologize, but wanted to explain why and remind you that we are still here and ready to help.  Take a listen to the podcast to understand more.

We are finally back with another ATLS podcast.  Mike Sharma and Chip Lange together discuss the complex but important subject of thoracic trauma.  They break it down this time by addressing key aspects that come up during the primary and secondary assessments.  This topic also broaches how to manage the traumatic circulatory arrest patient without a pulse.

We have mentioned in previous podcasts that if you have questions or special requests to send them our way.  Another one of our listeners did just this after listening to part of our ATLS series.  This has been a very popular series and we are so glad you enjoy it so much.  The discussions that have been built off of this as a result has led to even more great podcasts.

With the recent release of the Butterfly iQ+, we wanted to provide everyone with comparison images and review some of the changes the new device and the original Butterfly iQ.  We will continue to work on comparing images and review cases with the new Butterfly iQ+ with Practical POCUS.

For the first time ever, we delayed our normal podcast release to coincide with a very special reveal by Butterfly Network: the new and improved version of their device called the Butterfly iQ+.  Practical POCUS was able to get their hands on the brand new device so that you can see what it looks like.  There are videos to help compare the two devices and the unboxing of the Butterfly iQ+.  Stay tuned for updates as videos come out demonstrating the improvements when comparing the original to the new device.

In resuscitation situations, such as trauma and sepsis, it is important to appropriately replace the patient's lost volume and be able to give medications in a quick and successful manner.  However, what is the best way to accomplish this and why?

Sam Ireland from FOAMfrat invited me on to their podcast to talk more about PAs in EMS.  This was a fantastic conversational piece that is well worth listening to in order to learn more about what it means to have PAs in EMS and the potential future of such as role.

There are many people who are still uncertain how point of care ultrasound (POCUS) can benefit them in their practice.  This podcast will give you five examples of how POCUS can significantly change your patient care (in a very positive way) and  what you can start doing to to improve your patient care by using POCUS.

On our last blog and podcast, part of the ATLS series, we covered shock.  In that last post, it was briefly mentioned how vasopressin could be used in hemorrhagic shock.  We want to build on that discussion today with a more detailed review on using vasopressin (and other vasopressors) in such a situation.

Shock, especially in trauma, is an absolute killer.  Defined as an abnormality of the circulatory system that results in inadequate organ perfusion and tissue oxygenation, shock must be recognized and treated accordingly.  Here to help us with this discussion is Mike Sharma.

Scaphoid fractures are often missed but important fractures due to their potential complications including non-union, post-traumatic osteoarthritis, and potential for avascular necrosis (AVN).  These complications can even lead to lawsuits which further emphasizes the need to identify and properly treat these fractures whenever possible.

Airway management is a commonly discussed topic in emergency medicine and there are some challenges that are unique with trauma.  Mike Sharma co-hosts again with our ATLS podcast series on this topic.  Take the time to listen both to better prepare for your ATLS course but also to better manage your future trauma patients.

To some, this may feel like spaced repetition.  However, the discussion with tramadol today is a common and recurring issue.  We will highlight the problems with tramadol and why it may be better to think of it as "tramadont" moving forward.

With the blast that occurred in Beirut earlier, this is a good time to do a rapid review on blast injuries.  This can be a rather complex topic but we will focus on conventional explosives.

Summer is often a time that people visit the beach for vacation.  While this may be different with the current COVID-19 pandemic, it is still worth learning how to manage one common injury at the beach: jellyfish stings.

It is time to dive into some core Advanced Trauma Life Support (ATLS) content.  Mike Sharma is back to co-host the podcast and help us cover the first chapter of ATLS which discusses the initial assessment and management of trauma patients.

This is probably one of the most niche blog and podcast that has been done for a while, but it is a special one given the work that has been put into this particular topic.  This has been a long term goal that has finally made some real progress recently.

Since the early stages of the COVID-19 pandemic, the use of masks has been discussed.  As this pandemic continues, there has been a great deal of debate on this issue.  This post is meant to help address some of the more common myths surrounding masks for COVID-19.

This is a project that has been in the works for a long time.  We have finally been able to coordinate and introduce a new podcast series covering ATLS.  This is only the beginning.

Surprisingly, we are back already to talk about dexamethasone.  Our last podcast, #204, covered the press release from the RECOVERY (Randomised Evaluation of COVid-19 thERapY) trial and their mentioning of results regarding dexamethasone.  Now, the study is available in a pre-print form.  It is important that this has not yet been peer-reviewed and is still preliminary, but we now have some real information that we can review!

By now you may have heard of a potential breakthrough in COVID-19 treatment: dexamethasone.  The steroid is well known and has been widely used.  It is inexpensive and readily available making it a great choice if it proves to be successful.  However, do we really have the evidence yet to support its use?

Law enforcement has used tear gas and pepper spray to help with crowd control.  Many of those exposed will require some form of treatment.  This post is meant to help provide some guidance in regards to the treatment of such injuries.

Given recent events and a longstanding concern for certain restraint positions causing positional asphyxia, we took the time to dive into this subject more by discussing how and why this occurs along with the surrounding evidence.

We have made it!  Another milestone to celebrate.  200 podcasts down and (hopefully) many more to come.  The format continues to change, but we hope to provide many great discussions and continue to educate as much as possible.  The goal moving forward is to continue to provide high quality content.

We celebrate another anniversary with this podcast.  This podcast marks the 200th one!  With every 50th podcast, we invite back Ken Milne from The SGEM.  When trying to decide what to discuss this time, Ken suggested we discuss the Peltzman Effect.  If you are not familiar, no problem!  Ken breaks it down for us and how it is applied to medicine, including the current COVID-19 pandemic.

We had an excellent opportunity that we had to turn into a video podcast.  The roundtable discussion is with Weill Cornell Medicine in New York City staff: a physician (Dr. McCarty), a PA (Matt), and a RN (Christina).  They cover their ED's response and how each of them took on new roles to better manage patients in this challenging time.  Their tips and tricks are worth listening to, especially if you have not yet seen a surge of patients.

Adrian Banning is back as our guest host this week.  Once again, she did a stellar job and performed a very interesting interview with David Allen.  As demonstrated on his Instagram account, he has become internationally renowned for his work as a tattoo artist.  He focuses most of his work on mastectomy scar coverage.  He has been published on JAMA and has been a speaker for medical conferences.   The unique skills and experiences have contributed to the discussion of this podcast.

Adrian Banning is acting as the host this week (and did a fantastic job!).  She interviewed Katherine (Katie) Thompson from IPV Educators regarding domestic violence surrounding the changes with COVID-19 and how we can still help these patients.  

If you have been to a healthcare facility recently or work in a hospital, chances are you have been screened as soon as you got to that location.  Sometimes, you are even screened prior to arrival.  The same strategies are being proposed to help us return to our "normal" lives.  While this may seem like a beneficial strategy, there is a significant problem with these screening protocols.

We are in a point of time where information is incredibly easy to access.  We also have the convenience to be able to rapidly share information.  We are also in a crisis from a pandemic.  We as a whole are in a dangerous situation where misinformation, rumors, and bias can play a major part in hurting ourselves, our loved ones, and the world as a whole.

We are back to talk more about POCUS with COVID-19.  This post covers the clinical course when using lung ultrasound, Q&A from someone who experienced it first hand, and how to disinfect your pocket ultrasound device.  We are joined in this discussion by Dr. Yale Tung Chen.