Podcasts about acad emerg med

How can we avoid errors associated with cognitive biases?  In retrospect, we can easily see these biases unfold, but how can we identify them as they happen? Check out the paper mentioned   Croskerry P. Achieving quality in clinical decision making: cognitive strategies and detection of bias. Acad Emerg Med. 2002 Nov;9(11):1184-204. doi: 10.1111/j.1553-2712.2002.tb01574.x. PMID: 12414468. Link to paper   Norman G, Pelaccia T, Wyer P, Sherbino J. Dual process models of clinical reasoning: The central role of knowledge in diagnostic expertise. J Eval Clin Pract. 2024 Aug;30(5):788-796. doi: 10.1111/jep.13998. Epub 2024 Jun 2. PMID: 38825755. Link to abstract   www.rnzcuc.org.nz podcast@rnzcuc.org.nz https://www.facebook.com/rnzcuc https://twitter.com/rnzcuc   Music licensed from www.premiumbeat.com Full Grip by Score Squad   This podcast is intended to assist in ongoing medical education and peer discussion for qualified health professionals.  Please ensure you work within your scope of practice at all times.  For personal medical advice always consult your usual doctor 

Welcome to Episode 44 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 44 of “The 2 View” – The Pitt, Cardiac Arrest in Young People, and Influenza Associated Encephalopathy. Segment 1 – Fraud and Conspiracy and Schemes, Oh My! Florida Physician Assistant Pleads Guilty to a $7.3 Million Health Care Fraud Conspiracy. United States Attorney's Office: District of New Hampshire. United States Department of Justice. Justice.gov. December 3, 2024. https://www.justice.gov/usao-nh/pr/florida-physician-assistant-pleads-guilty-73-million-health-care-fraud-conspiracy Nurse Practitioner Sentenced To Five Years In Prison For $11.2 Million Disability Loan Fraud Scheme. United States Attorney's Office: Sothern District of New York. United States Department of Justice. Justice.gov. February 5, 2025. https://www.justice.gov/usao-sdny/pr/nurse-practitioner-sentenced-five-years-prison-112-million-disability-loan-fraud The Board of Certification for Emergency Nursing. BCEN. February 17, 2023. http://www.bcen.org Segment 2 – Prehospital Tourniquet Application Rittblat M, Gendler S, Tsur N, Radomislensky I, Ziv A, Bodas M. The cost of saving lives: Complications arising from prehospital tourniquet application. WILEY Online Library. Acad Emerg Med. December 16, 2024. https://onlinelibrary.wiley.com/doi/10.1111/acem.15070 The Center for Medical Education. 2 View: Emergency medicine PAs & NPs: 41 - RCVS and CVT, CPR Care Science, Prehospital Tourniquets, Blood Pressure. 2 View: Emergency Medicine PAs & NPs. January 22, 2025. https://2view.fireside.fm/41 Segment 3 – Cardiac Arrest in Young People Chia MYC, Lu QS, Rahman NH, et al. Characteristics and outcomes of young adults who suffered an out-of-hospital cardiac arrest (OHCA). NIH: National Library of Medicine – National Center for Biotechnology Information. PubMed. Resuscitation. February 2017. https://pubmed.ncbi.nlm.nih.gov/27923113/ Parekh S. Teen athlete saved after cardiac arrest speaks out: What to know about lifesaving role of CPR, AEDs in schools. GMA. ABC News. September 6, 2024. https://www.goodmorningamerica.com/wellness/story/teen-athlete-saved-after-cardiac-arrest-speaks-lifesaving-113460919 The Center for Medical Education. 2 View: Emergency medicine PAs & NPs: 42 - Pink Cocaine, Holiday Heart Syndrome, Pertussis, Research Updates, and More! 2 View: Emergency Medicine PAs & NPs. February 12, 2025. https://2view.fireside.fm/42 Tseng Z, Nakasuka K. Out-of-Hospital Cardiac Arrest in Apparently Healthy, Young Adults. JAMA Network. Jamanetwork.com. February 20, 2025. https://jamanetwork.com/journals/jama/article-abstract/2830678 Segment 4 – Influenza Associated Encephalopathy Fazal A, Reinhart K, Huang S, et al. Reports of Encephalopathy Among Children with Influenza-Associated Mortality - United States, 2010-11 Through 2024-25 Influenza Seasons. CDC: Morbidity and Mortality Weekly Report (MMWR) Morb Mortal Wkly Rep. February 27, 2025. https://www.cdc.gov/mmwr/volumes/74/wr/mm7406a3.htm Surtees R, DeSousa C. Influenza virus associated encephalopathy. NIH: National Library of Medicine – National Center for Biotechnology Information. PMC: PubMed Central. Arch Dis Child. June 2006. https://pmc.ncbi.nlm.nih.gov/articles/PMC2082798/ Segment 5 – The Pitt Max. The Pitt | official trailer | Max. Accessed March 27, 2025. https://www.youtube.com/watch?v=ufR_08V38sQ The Pitt. Max. Accessed March 27, 2025. https://www.max.com/shows/pitt-2024/e6e7bad9-d48d-4434-b334-7c651ffc4bdf Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Contributor: Ricky Dhaliwal, MD Educational Pearls:  Ketorolac and ibuprofen are NSAIDs with equivalent efficacy for pain in the emergency department Oral ibuprofen provides the same relief as intramuscular ketorolac IM ketorolac is associated with the adverse effect of a painful injection IM ketorolac is slightly faster in onset but not significant Studies have assessed the two medications in head-to-head randomized-controlled trials and found no significant difference in pain scores IM ketorolac takes longer to administer and has a higher cost Ketorolac dosing Commonly given in 10 mg, 15 mg, and 30 mg doses However, higher doses are associated with more adverse effects Gastrointestinal upset, nausea, and bleeding risk Studies have demonstrated equal efficacy in pain reduction with lower doses References Motov S, Yasavolian M, Likourezos A, et al. Comparison of Intravenous Ketorolac at Three Single-Dose Regimens for Treating Acute Pain in the Emergency Department: A Randomized Controlled Trial. Ann Emerg Med. 2017;70(2):177-184. doi:10.1016/j.annemergmed.2016.10.014 Neighbor ML, Puntillo KA. Intramuscular ketorolac vs oral ibuprofen in emergency department patients with acute pain. Acad Emerg Med. 1998;5(2):118-122. doi:10.1111/j.1553-2712.1998.tb02595.x Summarized & Edited by Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/  

In this episode, Dr. Sergio Zanotti discuss the management of critically ill patients undergoing hyperglycemic emergencies. He is joined by Dr. George Willis, a practicing emergency medicine physician. Dr. Willis is an Associate Professor and Associate Program Director for Emergency Medicine at the University of Texas Health Science Center in San Antonio, where he also serves as Vice Chair of Faculty Affairs. A recognized clinical educator, he holds a particular interest in endocrine emergencies, vascular emergencies, procedural education, and medical education. Additional resources: Hyperglycemic Crises in Adults with Diabetes: A Consensus Report. GE Umpierez, et al. Diabetes Care 2024: https://diabetesjournals.org/care/article/47/8/1257/156808/Hyperglycemic-Crises-in-Adults-With-Diabetes-A Clinical Effects of Balanced Crystalloids vs Saline in Adults With Diabetic Ketoacidosis. WH Self, et al. JAMA 2020: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670314/ Evaluation and Management of the Critically Ill Adult with Diabetic Ketoacidosis. B Long, GC Willis, S Lentz, et al. J Emerg Med 2020: https://pubmed.ncbi.nlm.nih.gov/32763063/ The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis) Impacts on ED operational Metrics. Acad Emerg Med 2023: https://pubmed.ncbi.nlm.nih.gov/36775281/ Books mentioned in this episode: Kintsugi: Finding Strength in Imperfection. By Celine Santini: https://bit.ly/3NCdAYB

Welcome to Episode 39 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 38 of “The 2 View” – Water beads, CRHK Pneumonia, STD treatments, malingering, and more. Segment 1 - Water Beads Joynes HJ, Kistamgari S, Casavant MJ, Smith GA. Pediatric water bead-related visits to United States emergency departments. Am J Emerg Med. ScienceDirect. Published October 2024. https://www.sciencedirect.com/science/article/pii/S0735675724003711?via%3Dihub Warning: Popular water beads may cause intestinal blockages in kids. News. UC Davis Health. Children's Health. Published December 13, 2022. https://health.ucdavis.edu/news/headlines/a-warning-this-sensory-toy-is-life-threatening-if-swallowed/2022/12 Water Beads. United States Consumer Product Safety Commission. Cpsc.gov. https://www.cpsc.gov/Safety-Education/Safety-Education-Centers/Water-Beads-Information-Center Segment 2 - WHO Warns of Carbapenem-Resistant Hypervirulent Klebsiella pneumonia Antimicrobial Resistance, Hypervirulent Klebsiella pneumoniae - Global situation. Who.int. World Health Organization. Disease Outbreak News. Published July 31, 2024. https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON527 Choby JE, Howard-Anderson J, Weiss DS. Hypervirulent Klebsiella pneumoniae – clinical and molecular perspectives. J Intern Med. WILEY Online Library. Published November 2, 2019. https://onlinelibrary.wiley.com/doi/10.1111/joim.13007 Segment 3 - STD Treatments Apato A, Cruz SN, Desai D, Slocum GW. Doxycycline adherence for the management of Chlamydia trachomatis infections. Am J Emerg Med. ScienceDirect. Published July 2024. https://www.sciencedirect.com/science/article/abs/pii/S0735675724002250?via%3Dihub The Center for Medical Education. The 2 View: Episode 9. 2 View: Emergency Medicine PAs & NPs. Published September 17, 2021. https://2view.fireside.fm/9 Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. Recommendations and Reports. CDC. Published July 23, 2021. https://www.cdc.gov/mmwr/volumes/70/rr/rr7004a1.htm#chlamydialinfections Segment 4 - Full-dose challenge of moderate, severe, and unknown beta-lactam allergies in the emergency department Anderson AM, Coallier S, Mitchell RE, Dumkow LE, Wolf LM. Full‐dose challenge of moderate, severe, and unknown beta‐lactam allergies in the emergency department. Acad Emerg Med. Wiley Online Library. Published August 2024. https://onlinelibrary.wiley.com/doi/epdf/10.1111/acem.14893 Meghan Jeffres, et al. University of Colorado. Hypersensitivity Type. Beta-lactam allergy tip sheet. Unmc.edu. https://www.unmc.edu/intmed/_documents/id/asp/clinicpath-beta-lactam-cross-reaction-tip-sheet.pdf Milne K. SGEM#452: I'm Still Standing – After The Allergy Challenge. The Skeptics Guide to Emergency Medicine - Meet 'em, greet 'em, treat 'em and street 'em. Published September 14, 2024. https://thesgem.com/2024/09/sgem452-im-still-standing-after-the-allergy-challenge/ Segment 5 - Malingering Alozai UU, McPherson PK. Malingering. In: StatPearls. StatPearls Publishing. NIH. National Library of Medicine. National Center for Biotechnology Information. Last updated June 12, 2023. https://www.ncbi.nlm.nih.gov/books/NBK507837/ Forrest JS. Rapid Review Quiz: Recognizing Malingering. Medscape. Published August 21, 2024. https://reference.medscape.com/viewarticle/1001346?ecd=WNLrrq240912MSCPEDITetid6820181&uac=255848DR&impID=6820181 Kadaster AK, Schears MR, Schears RM. Difficult patients: Malingerers, Feigners, Chronic Complainers, and Real Imposters. Emerg Med Clin North Am. Published February 2024. https://www.emed.theclinics.com/article/S0733-8627(23)00067-6/abstract Sherman EMS, Slick DJ, Iverson GL. Multidimensional Malingering Criteria for Neuropsychological Assessment: A 20-Year Update of the Malingered Neuropsychological Dysfunction Criteria. Arch Clin Neuropsychol. NIH. National Library of Medicine. National Center for Biotechnology Information. Published September 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7452950/ Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share! Don't miss our upcoming EM Boot Camp this December in Las Vegas: https://courses.ccme.org/course/embootcamp/about

This is the next episode of our Push Dose Pearls miniseries with ED Clinical Pharmacist, Chris Adams. In this ongoing series we'll dig into some of the questions we all have about medications we commonly see and use in the ED. This episode focuses on naloxone. Naloxone is a staple in every ED docs toolbox but it can save more lives if it's immediately available in the community. We'll discuss ED based naloxone programs, why they are important, how to get funding, and which patients could benefit.  Do you give out naloxone in your ED? Is it readily available in your community? We'd love to hear your experience. Hit us up on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Guests: Christopher Adams, PharmD, Emergency Department Senior Clinical Pharmacist and former Assistant Professor at UC Davis Resources: Kids Considered Podcast - Naloxone and Opioid Overdose Sindhwani MK, Friedman A, O'Donnell M, Stader D, Weiner SG. Naloxone distribution programs in the emergency department: A scoping review of the literature. J Am Coll Emerg Physicians Open. 2024 May 8;5(3):e13180. doi: 10.1002/emp2.13180. PMID: 38726467; PMCID: PMC11079430. Jacka BP, Ziobrowski HN, Lawrence A, Baird J, Wentz AE, Marshall BDL, Wightman RS, Mello MJ, Beaudoin FL, Samuels EA. Implementation and maintenance of an emergency department naloxone distribution and peer recovery specialist program. Acad Emerg Med. 2022 Mar;29(3):294-307. doi: 10.1111/acem.14409. Epub 2021 Nov 23. PMID: 34738277.. *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Welcome to Episode 37 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 37 of “The 2 View” – Pitfalls in Managing Pain in the ED with Sergey M. Motov, MD, FAAEM. Segment 1 Bachhuber MA, Hennessy S, Cunningham CO, Starrels JL. Increasing Benzodiazepine Prescriptions and Overdose Mortality in the United States, 1996-2013. Am J Public Health. 2016;106(4):686-688. doi:10.2105/AJPH.2016.303061. https://pubmed.ncbi.nlm.nih.gov/26890165/ Bijur PE, Kenny MK, Gallagher EJ. Intravenous morphine at 0.1 mg/kg is not effective for controlling severe acute pain in the majority of patients. Ann Emerg Med. 2005;46(4):362-367. doi:10.1016/j.annemergmed.2005.03.010. https://pubmed.ncbi.nlm.nih.gov/16187470/ Evoy KE, Covvey JR, Peckham AM, Ochs L, Hultgren KE. Reports of gabapentin and pregabalin abuse, misuse, dependence, or overdose: An analysis of the Food And Drug Administration Adverse Events Reporting System (FAERS). Res Social Adm Pharm. 2019;15(8):953-958. doi:10.1016/j.sapharm.2018.06.018. https://pubmed.ncbi.nlm.nih.gov/31303196/ Kim HS, McCarthy DM, Hoppe JA, Mark Courtney D, Lambert BL. Emergency Department Provider Perspectives on Benzodiazepine-Opioid Coprescribing: A Qualitative Study. Acad Emerg Med. 2018;25(1):15-24. doi:10.1111/acem.13273. https://pubmed.ncbi.nlm.nih.gov/28791786/ Li Y, Delcher C, Wei YJ, et al. Risk of Opioid Overdose Associated With Concomitant Use of Opioids and Skeletal Muscle Relaxants: A Population-Based Cohort Study. Clin Pharmacol Ther. 2020;108(1):81-89. doi:10.1002/cpt.1807. https://pubmed.ncbi.nlm.nih.gov/32022906/ Peckham AM, Evoy KE, Covvey JR, Ochs L, Fairman KA, Sclar DA. Predictors of Gabapentin Overuse With or Without Concomitant Opioids in a Commercially Insured U.S. Population. Pharmacotherapy. 2018;38(4):436-443. doi:10.1002/phar.2096. https://pubmed.ncbi.nlm.nih.gov/29484686/ Smith RV, Havens JR, Walsh SL. Gabapentin misuse, abuse and diversion: a systematic review. Addiction. 2016;111(7):1160-1174. doi:10.1111/add.13324. https://pubmed.ncbi.nlm.nih.gov/27265421/ Suvada K, Zimmer A, Soodalter J, Malik JS, Kavalieratos D, Ali MK. Coprescribing of opioids and high-risk medications in the USA: a cross-sectional study with data from national ambulatory and emergency department settings. BMJ Open. 2022;12(6):e057588. Published 2022 Jun 16. doi:10.1136/bmjopen-2021-057588. https://pubmed.ncbi.nlm.nih.gov/35710252/ Segment 2 Caplan M, Friedman BW, Siebert J, et al. Use of clinical phenotypes to characterize emergency department patients administered intravenous opioids for acute pain. Clin Exp Emerg Med. 2023;10(3):327-332. doi:10.15441/ceem.23.018. https://pubmed.ncbi.nlm.nih.gov/37092185/ Connors NJ, Mazer-Amirshahi M, Motov S, Kim HK. Relative addictive potential of opioid analgesic agents. Pain Manag. 2021;11(2):201-215. doi:10.2217/pmt-2020-0048. https://pubmed.ncbi.nlm.nih.gov/33300384/ Fassassi C, Dove D, Davis A, et al. Analgesic efficacy of morphine sulfate immediate release vs. oxycodone/acetaminophen for acute pain in the emergency department. Am J Emerg Med. 2021;46:579-584. doi:10.1016/j.ajem.2020.11.034. https://pubmed.ncbi.nlm.nih.gov/33341323/ Irizarry E, Cho R, Williams A, et al. Frequency of Persistent Opioid Use 6 Months After Exposure to IV Opioids in the Emergency Department: A Prospective Cohort Study. J Emerg Med. Published online March 14, 2024. doi:10.1016/j.jemermed.2024.03.018. https://pubmed.ncbi.nlm.nih.gov/38821847/ Sapkota A, Takematsu M, Adewunmi V, Gupta C, Williams AR, Friedman BW. Oxycodone induced euphoria in ED patients with acute musculoskeletal pain. A secondary analysis of data from a randomized trial. Am J Emerg Med. 2022;53:240-244. doi:10.1016/j.ajem.2022.01.016. https://pubmed.ncbi.nlm.nih.gov/35085877/ Wightman R, Perrone J, Portelli I, Nelson L. Likeability and abuse liability of commonly prescribed opioids. J Med Toxicol. 2012;8(4):335-340. doi:10.1007/s13181-012-0263-x. https://pubmed.ncbi.nlm.nih.gov/22992943/ Segment 3 Anshus AJ, Oswald J. Erector spinae plane block: a new option for managing acute axial low back pain in the emergency department. Pain Manag. 2021;11(6):631-637. doi:10.2217/pmt-2021-0004. https://pubmed.ncbi.nlm.nih.gov/34102865/ Chauhan G, Burke H, Srinivasan SK, Upadhyay A. Ultrasound-Guided Erector Spinae Block for Refractory Abdominal Pain Due to Acute on Chronic Pancreatitis. Cureus. 2022;14(11):e31817. Published 2022 Nov 23. doi:10.7759/cureus.31817. https://pubmed.ncbi.nlm.nih.gov/36579238/ Dove D, Fassassi C, Davis A, et al. Comparison of Nebulized Ketamine at Three Different Dosing Regimens for Treating Painful Conditions in the Emergency Department: A Prospective, Randomized, Double-Blind Clinical Trial. Ann Emerg Med. 2021;78(6):779-787. doi:10.1016/j.annemergmed.2021.04.031. https://pubmed.ncbi.nlm.nih.gov/34226073/ Elkoundi A, Eloukkal Z, Bensghir M, Belyamani L, Lalaoui SJ. Erector Spinae Plane Block for Hyperalgesic Acute Pancreatitis. Pain Med. 2019;20(5):1055-1056. doi:10.1093/pm/pny232. https://pubmed.ncbi.nlm.nih.gov/30476275/ Finneran Iv JJ, Gabriel RA, Swisher MW, Berndtson AE, Godat LN, Costantini TW, Ilfeld BM. Ultrasound-guided percutaneous intercostal nerve cryoneurolysis for analgesia following traumatic rib fracture -a case series. Korean J Anesthesiol. 2020 Oct;73(5):455-459. doi: 10.4097/kja.19395. Epub 2019 Nov 5. PMID: 31684715; PMCID: PMC7533180. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533180/ Finneran JJ, Swisher MW, Gabriel RA, et al. Ultrasound-Guided Lateral Femoral Cutaneous Nerve Cryoneurolysis for Analgesia in Patients With Burns. J Burn Care Res. 2020;41(1):224-227. doi:10.1093/jbcr/irz192. https://pubmed.ncbi.nlm.nih.gov/31714578/ Gabriel RA, Finneran JJ, Asokan D, Trescot AM, Sandhu NS, Ilfeld BM. Ultrasound-Guided Percutaneous Cryoneurolysis for Acute Pain Management: A Case Report. A A Case Rep. 2017;9(5):129-132. doi:10.1213/XAA.0000000000000546. https://pubmed.ncbi.nlm.nih.gov/28509777/ Herring AA, Stone MB, Nagdev AD. Ultrasound-guided abdominal wall nerve blocks in the ED. Am J Emerg Med. 2012;30(5):759-764. doi:10.1016/j.ajem.2011.03.008. https://pubmed.ncbi.nlm.nih.gov/21570238/ Kampan S, Thong-On K, Sri-On J. A non-inferiority randomized controlled trial comparing nebulized ketamine to intravenous morphine for older adults in the emergency department with acute musculoskeletal pain. Age Ageing. 2024;53(1):afad255. doi:10.1093/ageing/afad255. https://pubmed.ncbi.nlm.nih.gov/38251742/ Mahmoud S, Miraflor E, Martin D, Mantuani D, Luftig J, Nagdev AD. Ultrasound-guided transverse abdominis plane block for ED appendicitis pain control. Am J Emerg Med. 2019;37(4):740-743. doi:10.1016/j.ajem.2019.01.024. https://pubmed.ncbi.nlm.nih.gov/30718116/ McCahill RJ, Nagle C, Clarke P. Use of Virtual Reality for minor procedures in the Emergency Department: A scoping review. Australas Emerg Care. 2021;24(3):174-178. doi:10.1016/j.auec.2020.06.006. https://pubmed.ncbi.nlm.nih.gov/32718907/ Nguyen T, Mai M, Choudhary A, et al. Comparison of Nebulized Ketamine to Intravenous Subdissociative Dose Ketamine for Treating Acute Painful Conditions in the Emergency Department: A Prospective, Randomized, Double-Blind, Double-Dummy Controlled Trial. Ann Emerg Med. Published online May 2, 2024. doi:10.1016/j.annemergmed.2024.03.024. https://pubmed.ncbi.nlm.nih.gov/38703175/ Sikka N, Shu L, Ritchie B, Amdur RL, Pourmand A. Virtual Reality-Assisted Pain, Anxiety, and Anger Management in the Emergency Department. Telemed J E Health. 2019;25(12):1207-1215. doi:10.1089/tmj.2018.0273. https://pubmed.ncbi.nlm.nih.gov/30785860/ Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Dr. Lacey Shiue, emergency ultrasound faculty, sits down with Alex and Venk to talk through ultrasound guided nerve blocks and plane blocks. We talk through key differences in commonly used medications, how to manage toxicity from those medications as well as a detailed discussion of several different specific blocks including: Erector Spinae Plane Block, Fascia Iliaca Compartment Block, Supraclavicular Block, Interscalene Block among others. In addition, she discusses the keys to advancing an emergency regional anesthesia program.   CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com   RESOURCES FOR PRACTICE: MDCALC for anesthetic dose calculation: https://www.mdcalc.com/calc/10205/local-anesthetic-dosing-calculator  Safe Local app for anesthetic dose calculation: https://apps.apple.com/us/app/safelocal/id1440999841  New York School of Regional Anesthesia: https://www.nysora.com/filter-topics/  Highland County Emergency Medicine Website: https://highlandultrasound.com/  ASRA - American Society of Regional Anesthesia - Checklist for treatment of LAST: https://www.asra.com/news-publications/asra-updates/blog-landing/guidelines/2020/11/01/checklist-for-treatment-of-local-anesthetic-systemic-toxicity    REFERENCES: American College of Emergency Physicians Policy Statements: Ultrasound-Guided Nerve Blocks, published April 2021. Document accessed June 20, 2024 via: https://www.acep.org/patient-care/policy-statements/ultrasound-guided-nerve-blocks American College of Emergency Physicians Policy Statements: Guideline for ultrasound transducer cleaning and disinfection, approved April 2021. Document accessed June 20, 2024 via: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.acep.org/siteassets/new-pdfs/policy-statements/guideline-for-ultrasound-transducer-cleaning-and-disinfection.pdf  Disinfection of Ultrasound Transducers Used for Percutaneous Procedures: Intersocietal Position Statement. J Ultrasound Med. 2020; online before print. https://doi.org/10.1002/jum.15653  Ramesh S, Ayyan SM, Rath DP,Sadanandan DM. Efficacy and safety of ultrasound-guidederector spinae plane block compared to sham procedure inadult patients with rib fractures presenting to the emergencydepartment: A randomized controlled trial. Acad Emerg Med.2024;31:316-325. doi:10.1111/acem.14820 New York School of Regional Anesthesia: Ultrasound-guided fascia iliaca nerve block. Accessed June 21, 2024 via: https://www.nysora.com/techniques/lower-extremity/ultrasound-guided-fascia-iliaca-block/  Downs T, Jacquet J, Disch J, Kolodychuk N, Talmage L, Krizo J, Simon EL, Meehan A, Stenberg R. Large Scale implementation of fascia iliaca compartment blocks in an emergency department. West J Emerg Med. 2023 May 3;24(3):384-389 Makkar JK, Singh NP, Bhatia N, Samra T, Singh PM. Fascia iliaca block for hip fractures in the emergency department: meta-analysis with trial sequential analysis. Am J Emerg Med. 2021 Dec:50:654-660 Rukerd MRZ, Erfaniparsa L, Movahedi M, et al. Ultrasound-guided femoral nerve block versus fascia iliaca compartment block for femoral fractures in emergency department: a randomized controlled trial. Acute Med Surg. 2024 Mar 6;11(1):e936 Beaudoin FL, Haran JP, Liebmann O. A comparison of ultrasound-guided three-in one femoral nerve block versus parenteral opioids alone for analgesia in emergency department patients with hip fractures: a randomized controlled trial. Acad Emerg Med. 2013 Jun;20(6):584-91 Reavley P, Montgomery AA, Smith JE, Binks S, Edwards J, Elder G, Benger J. Randomised trial of the fascia iliaca block versus the 3-in-1 block for femoral neck fractures in the emergency department. Emerg Med J. 2015;32:685-689 Schulte SS, Fernandez I, Van Tienderen R, Reich MS, Adler A, Nguyen MP. Impact of the fascia iliaca block on pain, opioid consumption, and ambulation for patients with hip fractures: a prospective, randomized study. J Orthop Trauma. 2020 Oct;34(10):533-538   WANT TO WORK AT MAYO? EM Physicians: https://jobs.mayoclinic.org/emergencymedicine EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs   Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs  

What's the best way to pre-oxygenate our patients prior to intubation? The evidence for this question has been mixed for some time. Dr Jarvis discusses the PREOXI Trial that directly compares preoxygenation with non-invasive ventilation compared to face mask, to see which provides the best protection against peri-intubation hypoxia. This is an important trial that sheds light on a key component of our bundle of care to make intubation safer.Citations:Gibbs KW, Semler MW, Driver BE, Seitz KP, Stempek SB, Taylor C, Resnick-Ault D, White HD, Gandotra S, Doerschug KC, et al.: Noninvasive Ventilation for Preoxygenation during Emergency Intubation. N Engl J Med. (2024)Jarvis JL, Gonzales J, Johns D, Sager L: Implementation of a Clinical Bundle to Reduce Out-of-Hospital Peri-intubation Hypoxia. Annals of Emergency Medicine. 2018;72:272–9.Groombridge C, et al: A prospective, randomised trial of pre-oxygenation strategies available in the pre-hospital environment. Anaesthesia. 2017;72:580–4.Groombridge C, et al: Assessment of Common Preoxygenation Strategies Outside of the Operating Room Environment. Acad Emerg Med. 2016;March;23(3):342–6.Baillard C, et al: Noninvasive ventilation improves preoxygenation before intubation of hypoxic patients. Am J Respir Crit Care Med. 2006;July 15;174(2):171–7.Ramkumar V, et al: Preoxygenation with 20-degree head-up tilt provides longer duration of non-hypoxic apnea than conventional preoxygenation in non-obese healthy adults. J Anesth. 2011;25:189–94.Pourmand A, et al: Pre-oxygenation: Implications in emergency airway management. American Journal of Emergency Medicine. doi: 10.1016/j.ajem.2017.06.006Solis A, Baillard C: Effectiveness of preoxygenation using the head-up position and noninvasive ventilation to reduce hypoxaemia during intubation. Ann Fr Anesth Reanim. 2008;June;27(6):490–4.April MD, Arana A, Reynolds JC, Carlson JN, Davis WT, Schauer SG, Oliver JJ, Summers SM, Long B, Walls RM, et al.: Peri-intubation cardiac arrest in the Emergency Department: A National Emergency Airway Registry (NEAR) study. Resuscitation. 2021;May;162:403–11.Trent SA, Driver BE, Prekker ME, Barnes CR, Brewer JM, Doerschug KC, Gaillard JP, Gibbs KW, Ghamande S, Hughes CG, et al.: Defining Successful Intubation on the First AttemptUsing Both Laryngoscope and Endotracheal Tube Insertions: A Secondary Analysis of Clinical Trial Data. Annals of Emergency Medicine. 2023;82(4):S0196064423002135.Pavlov I, Medrano S, Weingart S: Apneic oxygenation reduces the incidence of hypoxemia during emergency intubation: A systematic review and meta-analysis. AJEM. 2017;35(8):1184–9.

In this podcast, Dr. Chris Solie, an emergency physician, along with Jason Hicks, Fred DeMeuse, Greta Sowels (physician assistants), working for Emergency Medicine Physicians and Consultants (EMPAC) who review journals and papers around emergency medicine. *Disclosure note: None of the speakers or planners for this education activity have relevant financial relationships to disclose with any inelgible company - who's primary business is producing marketing, selling, re-selling, or distributin healthcare products used by or on patients. Enjoy the podcast. Objectives:Upon completion of this podcast, participants should be able to: Identify emergency medicine journal articles that may be potentially practice changing. Differentiate between using a HEAR score versus a HEART score when assessing patients coming into the ED with chest pain. Restate whether vaccination during pregnancy could reduce the burden of respiratory syncytial virus (RSV) - associated lower respiratory tract illness in newborns and infants. Discuss the rate of wound infection from suturing with sterile gloves, dressings, drapes, etc. versus non-sterile gloves, dressings in emergency department. Discuss the risk-benefit of using tranexamic acid (TXA) in the treatment of gastrointestional bleeds. Identify interventions designed to reduce fatigue among emergency department physicians. Determine whether a direct oral penicillin challenge is noninferior to the standard of care of penicillin skin testing followed by an oral challenge in patients with a low-risk pencillin allergy. This activity has been planned and implemented in accordance with the accreditation criteria, standards and policies of the Minnesota Medical Association (MMA). Ridgeview is accredited by the Minnesota Medical Association (MMA) to provide continuing medical education for physicians.  CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at Education@ridgeviewmedical.org. Click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker's outside interest may reflect a possible bias, either the exposition or the conclusions presented. None of Ridgeview's CME planning committee members have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.  All of the relevant financial relationships for the individuals listed above have been mitigated. RESOURCES Article 1: O'Rielly, C.M., Andruchow, J.E., McRae, A.D. et al. External validation of a low HEAR score to identify emergency department chest pain patients at very low risk of major adverse cardiac events without troponin testing. Can J Emerg Med 24, 68–74 (2022). https://doi.org/10.1007/s43678-021-00159-y Article 2: Kampmann B, Madhi SA, Munjal I, et al. Bivalent Prefusion F Vaccine in Pregnancy to Prevent RSV Illness in Infants. N Engl J Med. 2023;388(16):1451-1464. doi:10.1056/NEJMoa2216480 Article 3: Zwaans JJM, Raven W, Rosendaal AV, et al. Non-sterile gloves and dressing versus sterile gloves, dressings and drapes for suturing of traumatic wounds in the emergency department: a non-inferiority multicentre randomised controlled trial. Emerg Med J. 2022;39(9):650-654. doi:10.1136/emermed-2021-211540 Article 4: HALT-IT Trial Collaborators. Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial. Lancet. 2020;395(10241):1927-1936. doi:10.1016/S0140-6736(20)30848-5 Article 5: Fowler LA, Hirsh EL, Klinefelter Z, Sulzbach M, Britt TW. Objective assessment of sleep and fatigue risk in emergency medicine physicians. Acad Emerg Med. 2023;30(3):166-171. doi:10.1111/acem.14606 Article 6: Copaescu AM, Vogrin S, James F, et al. Efficacy of a Clinical Decision Rule to Enable Direct Oral Challenge in Patients With Low-Risk Penicillin Allergy: The PALACE Randomized Clinical Trial. JAMA Intern Med. 2023;183(9):944-952. doi:10.1001/jamainternmed.2023.2986   Thank-you for listening to the podcast. Thanks to Dr. Chris Solie, Jason Hicks, Fred DeMeuse and Greta Sowels for their expert knowledge and contribution to this podcast.

Contributor: Aaron Lessen MD Educational Pearls: Lorazepam (Ativan) is dosed at 0.1 mg/kg up to a maximum of 4 mg in status epilepticus Some ED protocols only give 2 mg initially The maximum recommended dose of levetiracetam (Keppra) is 60 mg/kg or 4.5 g In one retrospective study, only 50% of patients received the correct dose of lorazepam For levetiracetam, it was only 35% of patients Underdosing leads to complications Higher rates of intubations More likely to progress to refractory status epilepticus References 1. Cetnarowski A, Cunningham B, Mullen C, Fowler M. Evaluation of intravenous lorazepam dosing strategies and the incidence of refractory status epilepticus. Epilepsy Res. 2023;190(November 2022):107067. doi:10.1016/j.eplepsyres.2022.107067 2. Sathe AG, Tillman H, Coles LD, et al. Underdosing of Benzodiazepines in Patients With Status Epilepticus Enrolled in Established Status Epilepticus Treatment Trial. Acad Emerg Med. 2019;26(8):940-943. doi:10.1111/acem.13811 Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit  

This the first episode in our three part series on infertility, pregnancy and breastfeeding as an Emergency Physician. In this installment, we shine a light on the often unspoken struggles of infertility among physicians, specifically focusing on the emergency medicine community. Join us and expert, Dr. Melissa Parsons, as we delve into the personal experiences, professional challenges, and nuanced perspectives of emergency physicians navigating the complex journey of infertility. In part two, we'll explore what it's like to be a pregnant as an EM physician, and in our final episode of the series, we'll talk about some of the challenges surrounding breastfeeding and pumping in the ED.  Do you have questions about fertility as an EM Physician? Or want to share your own experience?  Hit us up on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Guests: Dr. Melissa Parsons, Associate Professor of Emergency Medicine and Associate Residency Program Director at University of Florida College of Medicine in Jacksonville, FL Resources: Physicians should talk about the F word: fertility. Melissa E. Parsons, MD Physician  March 3, 2019. KevinMD.com  Levy MS, Kelly AG, Mueller C, et al. Psychosocial Burdens Associated With Family Building Among Physicians and Medical Students. JAMA Intern Med. 2023 Sep 1;183(9):1018-1021. doi: 10.1001/jamainternmed.2023.2570. PMID: 37486671; PMCID: PMC10366942. Parsons M, Mannix A, Gore K, et al. The current landscape of emergency medicine resident scheduling. AEM Educ Train. 2024 Jan 16;8(1):e10926. doi: 10.1002/aet2.10926. PMID: 38235394; PMCID: PMC10790185.. Pfennig CL, Wilson CA, Britt TW, et al. A comparative analysis on fertility success among physician specialties. Acad Emerg Med. 2022 Jun;29(6):792-794. doi: 10.1111/acem.14463. Epub 2022 Feb 27. PMID: 35178827; PMCID: PMC9305146. ***** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Dr. Casey Clements spent two hours breaking down the history and influences in sepsis care over the past three decades and going through the best practices in today's emergency medicine. This is the second part of the two part series. Do you know how Sepsis is defined currently? What is the difference between SEP - 1 and surviving sepsis campaign? What is the role of steroids or vitamin C? Can you resuscitate these patients with albumin? These and so many more questions will be answered in this two part series. We review the PROCESS, PROMISE, and ARISE trials and provide pragmatic approach to your septic patients.  So join Venk like vancomycin, and Alex (aka Zosyn) and Casey "not-cidal" Clements in these amazing episodes.   CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS Intravascular volume assessment Azadian M, Win S, Abdipour A, et al. Mortality benefit from the passive leg raise maneuver in guiding resuscitation of septic shock patients: A systematic review and meta-analysis of randomized trials. J Intensive Care Med. 2022 May;37(5):611-617 Spiliotaki E, Saranteas T, Moschovaki N, et al. Inferior vena cava ultrasonography in the assessment of intravascular volume status and fluid responsiveness in the emergency department and intensive care unit: a critical analysis review. J Clin Ultrasound. 2022 Jun;50(5):733-744   Chest radiography paper referenced Poku JK, Bellamkonda-Athmaram VR, Bellolio F, Nestler DM, Stiell IG, Hess EP. Failure of prospective validation and derivation of a refined clinical decision rule for chest radiography in emergency department patients with chest pain and possible acute coronary syndrome. Acad Emerg Med. 2012 Sep;19(9):E1004-10   Albumin Caironi P, Tognoni G, Masson S, Fumagalli R, Presenti A, Romero M, Fanizza C, Caspani L, Faenza S, Grasselli G, Iapichino G, Antonelli M, Parrini V, Fiore G, Latini R, Gattinoni L, ALBIOS Study Investigators. Albumin Replacement in patients with severe sepsis or septic shock. NEJM. 2014;370(15):1412 Xu JY, Chen QH, Xie JF, Pan C, Liu SQ, Huang LW, Yang CS, Liu L, Huang YZ, Guo FM, Yang Y, Qiu HB. Comparison of the effects of albumin and cyrstalloid on mortality in adult patients with severe sepsis and septic shock: a meta-analysis of randomized clinical trials. Crit Care. 2014;18(6):702 Jiang L, Jiang S, Zhang M, Zheng Z, Ma Y. Albumin versus other fluids for fluid resuscitation in patients with sepsis: A meta-analysis. PloS One. 2014;9(12):e114666   Unbundling studies ProCESS Trial: ProCESS Investigators, Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, PIke F, Terndrup T, Wang HE, Hou PC, LoVecchio F, Filbin MR, Shapiro NI, Angus DC. A randomized trial of protocol based care for early septic shock. NEJM  2014;370(18):1683 ProMISE Trial: Mouncey PR, Osborn ™, Power GS, Harrison DA, Sadique MZ, Grieve RD, Jahan R, Harvey SE, Bell D, Bion JF, Coats TJ, Singer M, Young JD, Rowan KM, ProMISe Trial Investigators. Trial of early, goal directed resuscitation for septic shock. NEJM 2015;372(14):1301 ARISE Trial: ARISE investigators, ANZICS Clinical Trials Group, Peake SL, Delaney A, Bailey M, Bellomo R, Cameron PA, Cameron PA, Cooper DJ, Higgins AM, Holdgate A, Howe BD, WEbb SA, Williams P. Goal-directed resuscitation for patients with early septic shock. NEJM 2014;371(16):1496 Angus DC, Barnato AE, Bell D, Bellomo R, Chong CR, Coats TJ, Davies A, Delaney A, Harrison DA, Holdgate A, Howe B, Huang DT, Iwashyna T, Kellum JA, Peake SL, Pike F, Reade MC, Rowan KM, Singer M, Webb SA, Weissfeld LA, Yealy DM, Young JD. A systematic review and meta-analysis of early goal-directed therapy for septic shock: the ARISE, ProCESS, and ProMISE investigators. Intensive Care Med. 2015 SEp;41(9):1549-60 PRISM Investigators. Early Goal-Directed Therapy for Septic Shock - A Patient-Level Meta-Analysis. NEJM 2017 Lu Y, Zhang H, Teng F, Xia WJ, SUn GX, Wen AQ. Early goal-directed therapy in severe sepsis and septic shock: A meta-analysis and Trial sequential analysis of randomized controlled trials. J Intensive Care Med. 2018;33(5):296   Vitamin C Sevransky JE, et al. Effect of vitamin C, thiamine, and hydrocortisone on ventilator- and vasopressor-free days in patients with sepsis: The VICTAS randomized clinical trial. JAMA. 2021 Feb 23;325(8):742-750  

We've spoken a lot recently about intubation First Pass Success, including what the definition is. We've also discussed different papers about the impact the type of laryngoscope, video or direct, has on first pass success. There's a new paper out that directly compares video vs direct laryngoscopy. Join us to discuss the DEVICE trial.   Citations Prekker ME, Driver BE, Trent SA, et al. Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults. N Engl J Med. Published online June 16, 2023 Jarvis JL, McClure SF, Johns D. EMS Intubation Improves with King Vision Video Laryngoscopy. Prehosp Emerg Care. 2015 Ducharme S, Kramer B, Gelbart D, Colleran C, Risavi B, Carlson JN. A pilot, prospective, randomized trial of video versus direct laryngoscopy for paramedic endotracheal intubation. Resuscitation. 2017 Pourmand A, Terrebonne E, Gerber S, Shipley J, Tran QK. Efficacy of Video Laryngoscopy versus Direct Laryngoscopy in the Prehospital Setting: A Systematic Review and Meta-Analysis. Prehosp Disaster Med. 2023 Brown CA, Kaji AH, Fantegrossi A, et al. Video Laryngoscopy Compared to Augmented Direct Laryngoscopy in Adult Emergency Department Tracheal Intubations: A National Emergency Airway Registry (NEAR) Study. Acad Emerg Med. 2020 Hansel J, Rogers AM, Lewis SR, Cook TM, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adults undergoing tracheal intubation: a Cochrane systematic review and meta-analysis update. British Journal of Anaesthesia. 2022See omnystudio.com/listener for privacy information.

Dr. Helena Esmonde is a vestibular physical therapist as well as the Chief Clinical Officer and co-founder of Vestibular First. Her mission includes making essential technology for vestibular care more affordable and improving vestibular education through monthly Journal Clubs, e-newsletters, social media, and continuing education courses. Helena's number one goal is to improve care for patients with vertigo, dizziness, and imbalance by supporting the clinicians who provide that very necessary care.Episode TakeawaysDizziness triage in the EDHow to assess vestibular diagnoses in the EDWhere and how to refer your ED patients with vestibular issuesConnect with HelenaTwitterInstagramWebsiteYoutubeResourceshttps://theeddpt.com/youre-the-dizziness-detective-in-the-ed/https://youtu.be/5m-CJ88fBRwKattah JC. Update on HINTS Plus, With a Discussion of Pitfalls and Pearls. J Neurol Phys Ther. 2019 Apr;43 Suppl 2:S42-S45.Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009 Nov;40(11):3504-10.Kim CH, Jeong H, Shin JE. Incidence of idiopathic benign paroxysmal positional vertigo subtype by hospital visit type: experience of a single tertiary referral centre. J Laryngol Otol. 2023 Jan;137(1):57-60.Newman-Toker DE, Kerber KA, Hsieh YH, Pula JH, Omron R, Saber Tehrani AS, Mantokoudis G, Hanley DF, Zee DS, Kattah JC. HINTS outperforms ABCD2 to screen for stroke in acute continuous vertigo and dizziness. Acad Emerg Med. 2013 Oct;20(10):986-96.Tarnutzer AA, Berkowitz AL, Robinson KA, Hsieh YH, Newman-Toker DE. Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. CMAJ. 2011 Jun 14;183(9):E571-92.van Dam VS, Maas BDPJ, Schermer TR, van Benthem PG, Bruintjes TD. Two Symptoms Strongly Suggest Benign Paroxysmal Positional Vertigo in a Dizzy Patient. Front Neurol. 2021 Jan 14;11:625776.a

Join FlightBridgeEDs new Chief Medical Director, Mike Lauria, as we launch the FlightBridgeED MDCast. Dr. Lauria will hijack these episodes for a new perspective on current topics in critical care medicine. In this episode, Dr. Lauria looks at Eric's previously published podcast [episode 224] on ASA Overdose and gives his insight, practical application, and overall thoughts on these difficult-to-manage patients. Don't miss this episode! So much good stuff! Please like, subscribe, and leave any questions or comments. References for Acute Salicylate Intoxication Anderson RJ, Potts DE, Gabow PA, Rumack BH, Schrier RW. Unrecognized adult salicylate intoxication. Ann Intern Med. Dec 1976;85(6):745-8. doi:10.7326/0003-4819-85-6-745 Chyka PA, Erdman AR, Christianson G, et al. Salicylate poisoning: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2007;45(2):95-131. doi:10.1080/15563650600907140 Dargan PI, Wallace CI, Jones AL. An evidence-based flowchart to guide the management of acute salicylate (aspirin) overdose. Emerg Med J. May 2002;19(3):206-9. doi:10.1136/emj.19.3.206 Delaney TM, Helvey JT, Shiffermiller JF. A Case of Salicylate Toxicity Presenting with Acute Focal Neurologic Deficit in a 61-Year-Old Woman with a History of Stroke. Am J Case Rep. Feb 15 2020;21:e920016. doi:10.12659/AJCR.920016 Espírito Santo R, Vaz S, Jalles F, Boto L, Abecasis F. Salicylate Intoxication in an Infant: A Case Report. Drug Saf Case Rep. Nov 27 2017;4(1):23. doi:10.1007/s40800-017-0065-9 Goldberg MA, Barlow CF, Roth LJ. The effects of carbon dioxide on the entry and accumulation of drugs in the central nervous system. J Pharmacol Exp Ther. Mar 1961;131:308-18. Juurlink DN, Gosselin S, Kielstein JT, et al. Extracorporeal Treatment for Salicylate Poisoning: Systematic Review and Recommendations From the EXTRIP Workgroup. Ann Emerg Med. Aug 2015;66(2):165-81. doi:10.1016/j.annemergmed.2015.03.031 Kuzak N, Brubacher JR, Kennedy JR. Reversal of salicylate-induced euglycemic delirium with dextrose. Clin Toxicol (Phila). Jun-Aug 2007;45(5):526-9. doi:10.1080/15563650701365800 McCabe DJ, Lu JJ. The association of hemodialysis and survival in intubated salicylate-poisoned patients. Am J Emerg Med. Jun 2017;35(6):899-903. doi:10.1016/j.ajem.2017.04.017 Miyahara JT, Karler R. Effect of salicylate on oxidative phosphorylation and respiration of mitochondrial fragments. Biochem J. Oct 1965;97(1):194-8. doi:10.1042/bj0970194 Oliver TK, Jr., Dyer ME. The prompt treatment of salicylism with sodium bicarbonate. AMA J Dis Child. May 1960;99:553-65. doi:10.1001/archpedi.1960.02070030555001 Oualha M, Dupic L, Bastian C, Bergounioux J, Bodemer C, Lesage F. [Local salicylate transcutaneous absorption: an unrecognized risk of severe intoxication: a case report]. Arch Pediatr. Oct 2012;19(10):1089-92. Application cutanée localisée d'acide salicylique : un risque méconnu d'intoxication : à propos d'un cas. doi:10.1016/j.arcped.2012.07.012 Palmer BF, Clegg DJ. Salicylate Toxicity. N Engl J Med. Jun 25 2020;382(26):2544-2555. doi:10.1056/NEJMra2010852 Penniall R. The effects of salicylic acid on the respiratory activity of mitochondria. Biochim Biophys Acta. Nov 1958;30(2):247-51. doi:10.1016/0006-3002(58)90047-7 Shively RM, Hoffman RS, Manini AF. Acute salicylate poisoning: risk factors for severe outcome. Clin Toxicol (Phila). Mar 2017;55(3):175-180. doi:10.1080/15563650.2016.1271127 Stolbach AI, Hoffman RS, Nelson LS. Mechanical ventilation was associated with acidemia in a case series of salicylate-poisoned patients. Acad Emerg Med. Sep 2008;15(9):866-9. doi:10.1111/j.1553-2712.2008.00205.x Thurston JH, Pollock PG, Warren SK, Jones EM. Reduced brain glucose with normal plasma glucose in salicylate poisoning. J Clin Invest. Nov 1970;49(11):2139-45. doi:10.1172/JCI106431 See omnystudio.com/listener for privacy information.

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released July 18, 2017 Dr. Pouya Khankhanian describes his experience with "worst headache of life." A harbinger of head pathology, thunderclap headache should be quickly and meticulously addressed in order to prevent life-threatening neurologic disease. BrainWaves podcasts and online content are intended for medical education only and should not be used to guide medical decision-making in routine clinical practice. Any cases discussed in this episode are fictional and do not contain any patient health-identifying information. The content in this episode was vetted and approved by Roderick Spears. REFERENCESEdlow JA, Caplan LR. Avoiding pitfalls in the diagnosis of subarachnoid hemorrhage. N Engl J Med. 2000 Jan 6;342(1):29-36. doi: 10.1056/NEJM200001063420106. PMID 10620647Linn FH, Wijdicks EF, van der Graaf Y, Weerdesteyn-van Vliet FA, Bartelds AI, van Gijn J. Prospective study of sentinel headache in aneurysmal subarachnoid haemorrhage. Lancet 1994;344(8922):590-3. PMID 7914965Misra UK, Kalita J, Chandra S, Kumar B, Bansal V. Low molecular weight heparin versus unfractionated heparin in cerebral venous sinus thrombosis: a randomized controlled trial. Eur J Neurol 2012;19(7):1030-6. PMID 22416902Muehlschlegel S, Kursun O, Topcuoglu MA, Fok J, Singhal AB. Differentiating reversible cerebral vasoconstriction syndrome with subarachnoid hemorrhage from other causes of subarachnoid hemorrhage. JAMA Neurol 2013;70(10):1254-60. PMID 23939614Sames TA, Storrow AB, Finkelstein JA, Magoon MR. Sensitivity of new-generation computed tomography in subarachnoid hemorrhage. Acad Emerg Med 1996;3(1):16-20. PMID 8749962Schwedt TJ, Matharu MS, Dodick DW. Thunderclap headache. Lancet Neurol 2006;5(7):621-31. PMID 16781992van der Wee N, Rinkel GJ, Hasan D, van Gijn J. Detection of subarachnoid haemorrhage on early CT: is lumbar puncture still needed after a negative scan? J Neurol Neurosurg Psychiatry 1995;58(3):357-9. PMID 7897421Vergouwen MD, Rinkel GJ. Clinical suspicion of subarachnoid hemorrhage and negative head computed tomographic scan performed within 6 hours of headache onset--no need for lumbar puncture. Ann Emerg Med 2013;61(4):503-4. PMID 23522819Vermeulen M, Hasan D, Blijenberg BG, Hijdra A, van Gijn J. Xanthochromia after subarachnoid haemorrhage needs no revisitation. J Neurol Neurosurg Psychiatry 1989;52(7):826-8. PMID 2769274We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date. 

Dr. Ben Sandefur, Emergency Medicine attending at Mayo Clinic, joins Alex and Venk on the podcast to talk about angioedema and awake tracheal intubation. He reviews the different types of angioedema in a format designed to assist the emergency department practitioner with decision making and prognostication. This is followed by a description of how to prepare for and lead a team and patient through awake tracheal intubation using fiberoptic and video laryngoscopy techniques.   Contacts TWITTER - @AlwaysOnEM; @VenkBellamkonda INSTAGRAM – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch EMAIL - AlwaysOnEM@gmail.com References Rosenbaum S, Wilkerson RG, Winters ME, Vilke GM, Wu MYC. Clinical Practice Statement: What is the Emergency Department Management of Patients with Angioedema Secondary to an ACE-Inhibitor? J Emerg Med. 2021 Jul;61(1):105-112 [from the American Academy of Emergency Medicine] https://pubmed.ncbi.nlm.nih.gov/34006418/ Moellman JJ, Bernstein JA, et al. A consensus parameter for the evaluation and management of angioedema in the emergency department. Acad Emerg Med. 2014 Apr;21(4):469-84 [from the American College of Allergy, Asthma & Immunology (ACAAI) and the Society for Academic Emergency Medicine (SAEM)] https://pubmed.ncbi.nlm.nih.gov/24730413/ Carrillo-Martin I, Gonzalez-Estrada A, Funni SA, Sandefur BJ, Jeffery MM, Campbell RL. Angioedema - related emergency department visits in the United States: Epidemiology and time trends, 2006-2015. J Allergy Clin Immunol Pract. 2020 Jul-Aug;8(7):2442-2444. https://pubmed.ncbi.nlm.nih.gov/32302784/ Ishoo E, Shah UK, Grillone GA, Stram JR, Fuleihan NS. Predicting airway risk in angioedema: staging system based on presentation. Otolaryngol Head Neck Surg. 1999 Sep;121(3):263-8 https://pubmed.ncbi.nlm.nih.gov/10471868/ Arthur J, Caro D, Topp S, Chadwick S, Driver B, Henson M, Norse A, Spencer H, Godwin SA, Guirgis F. Clinical predictors of endotracheal intubation in patients presenting to the emergency department with angioedema. Am J Emerg Med. 2022 Oct 19;63:44-49 https://pubmed.ncbi.nlm.nih.gov/36327748/ Sandefur BJ, Liu XW, Kaji AH, Campbell RL, Driver BE, Walls RM, Carlson JN, Brown CA. Emergency Department Intubations in Patients with Angioedema: A Report from the National Emergency Airway Registry. J Emerg Med. 2021 Nov;61(5):481-488 https://pubmed.ncbi.nlm.nih.gov/34479750/ Sandefur BJ, Oliveira Silva L, Lohse CM, Goyal KA, Barbara DW, Castaneda-Guarderas A, Liu XW, Campbell RL. Clinical features and outcomes associated with angioedema in the emergency department. West J Emerg Med. 2019 Aug 6;20(5):760-769 https://pubmed.ncbi.nlm.nih.gov/31539333/ Additional Resources Wilkerson RG, Moellman JJ. Hereditary Angioedema. Emerg Med Clin North Am. 2022 Feb;40(1):99-118 https://pubmed.ncbi.nlm.nih.gov/34782094/ Wilkerson RG, Winters ME. Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema. Emerg Med Clin North Am. 2022 Feb;40(1):79-98 https://pubmed.ncbi.nlm.nih.gov/34782093/  

Contributor: Travis Barlock, MD Educational Pearls: An EKG should be obtained quickly after a syncopal event to identify possible life-threatening causes such as ischemia and arrhythmia WOBBLER is a good mnemonic for remembering additional EKG findings to look for in syncope  Wolff-Parkinson-White (WPW) Check for delta wave on QRS Obstructed AV node Any potential heart blocks Brugada syndrome Na channel blockade that can cause ST elevations in anterior leads Bifascicular block Conduction blockade in two of the three fascicles increases risk of complete heart block Left Ventricular Hypertrophy (LVH) Can be a sign of HOCM (younger patients) or aortic stenosis (older patients) Epsilon waves Positive deflections after the QRS that is seen in arrhythmogenic right ventricular dysplasia Repolarization abnormalities Prolonged/shortened QT segments References Martow E, Sandhu R. When Is Syncope Arrhythmic? Med Clin North Am. 2019;103(5):793-807. Solbiati M, Dipaola F, Villa P, et al. Predictive Accuracy of Electrocardiographic Monitoring of Patients With Syncope in the Emergency Department: The SyMoNE Multicenter Study. Acad Emerg Med. 2020;27(1):15-23.   Summarized by Mark O'Brien, MS4 | Edited by John Spartz, MD & Erik Verzemnieks, MD   In an effort to promote diversity, equity, and inclusion in Emergency Medicine, The Emergency Medical Minute is proud to present our 2nd annual Diversity and Inclusion Award. We support increasing the representation of underrepresented groups in medicine and extend this award to individuals applying to emergency medicine residencies during the 2022-2023 cycle. For information on award eligibility and the application process, visit https://emergencymedicalminute.com/edi-award/

Contributor: Lessen, Aaron MD Educational Pearls: Ketamine can be given at 0.2-0.3 mg/kg as subdissociative doses for pain control in the ED Ketamine coadministered with Haldol may reduce agitation A recent study in Iran compared subdissociative Ketamine given with 2.5 mg Haldol to 1 mg/kg Fentanyl for pain control in the ED Ketamine with Haldol had better pain control than Fentanyl at 5, 10, 15 and 30 minutes  Ketamine with Haldol less frequently required rescue medication  Ketamine with Haldol did have increased agitation at only the 10 minute mark Of note, there was not a Ketamine only group to compare  Ketamine with Haldol is a viable alternative combination for pain control    References Moradi MM, Moradi MM, Safaie A, Baratloo A, Payandemehr P. Sub dissociative dose of ketamine with haloperidol versus fentanyl on pain reduction in patients with acute pain in the emergency department; a randomized clinical trial. Am J Emerg Med. 2022;54:165-171. doi:10.1016/j.ajem.2022.02.012 Sin B, Ternas T, Motov SM. The use of subdissociative-dose ketamine for acute pain in the emergency department. Acad Emerg Med. 2015;22(3):251-257. doi:10.1111/acem.12604   Summarized by Kirsten Hughes, MS4 | Edited by John Spartz, MD & Erik Verzemnieks, MD   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.  Donate to EMM today!

Contributor: Aaron Lessen, MD Educational Pearls: Olecranon bursitis refers to inflammation in the bursa of the elbow and can be due to infection or trauma Recent study examined treating suspected septic olecranon bursitis with antibiotics versus drainage About 90% of the patients treated with antibiotic therapy for this issue did not require subsequent drainage or hospitalization for intravenous antibiotics Consider treating suspected olecranon bursitis with antibiotic therapy and good return precautions rather than defaulting to drainage References Beyde A, Thomas AL, Colbenson KM, et al. Efficacy of empiric antibiotic management of septic olecranon bursitis without bursal aspiration in emergency department patients. Acad Emerg Med. 2022;29(1):6-14. doi:10.1111/acem.14406 Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.  Donate to EMM today!

Gibbons RC et al. Ultrasound-versus landmark-guided medium-sized joint arthrocentesis: A randomized clinical trial. Acad Emerg Med 2022 Feb; 29:159. (https://doi.org/10.1111/acem.14396. opens in new tab)Use a ultrasound for arthrocentesis when possible Circ Arrhythm Electrophysiol 2022 Mar; 15:e010646. (https://doi.org/10.1161/CIRCEP.121.010646)Apple AirPods Pro and their wireless charging case, the Microsoft Surface Pen, and the Apple Pencil second generation — also have strong enough magnetic fields to affect current-generation CIEDs.https://pubmed.ncbi.nlm.nih.gov/34862940/first of all empiric therapy with clarithromycin is no longer effective for treating Helicobacter. You have two choices. The choices are thus: 14-day bismuth quadruple therapy or rifabutin triple therapy,Andreadis K, Chan E, Park M, et al. Imprecision and preferences in interpretation of verbal probabilities in health: a systematic review. J Gen Intern Med 2021;36(12):3820-3829. . The interpretation of "common" which means- accepted definition of 1% to 10%.But people thought it meant 59% (on average) --------59% is basically all the time that is great odds and would bankrupt vegas TAKE HOME!!In studies asking for preference, a majority of patients prefer numbers rather than word-based estimates of risk. Risks and Benefits of Early Rhythm Control in Patients With Acute Strokes and Atrial Fibrillation: A Multicenter, Prospective, Randomized Study (the RAFAS Trial) | Journal of the American Heart Association (ahajournals.org) The main findings were that early rhythm control led to a lower risk of stroke at 12 months (3 [1.7%] vs 6 [6.3%]; HR, 0.251; P = .034). There was no difference in risk of recurrent stroke at 3 months. 

In this episode, I talk about incorporating checklists in our daily emergency medicine practice. Why is it important? How does it help and how do you use them? I would be discussing these in this episode with some anecdotes sprayed in. You can go through the following resources if you need help in using an airway checklist in your department or can hit me up on twitter (@anksv25) or Instagram @anksv. Hope you enjoy listening. Here are the resources - 1. Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, Sexton B, Hyzy R, Welsh R, Roth G, Bander J, Kepros J, Goeschel C. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006 Dec 28;355(26):2725-32. doi: 10.1056/NEJMoa061115. Erratum in: N Engl J Med. 2007 Jun 21;356(25):2660. PMID: 17192537. 2. Smith KA, High K, Collins SP, Self WH. A preprocedural checklist improves the safety of emergency department intubation of trauma patients. Acad Emerg Med. 2015 Aug;22(8):989-92. doi: 10.1111/acem.12717. Epub 2015 Jul 20. PMID: 26194607. 3. Kerrey BT, Mittiga MR, Rinderknecht AS, Varadarajan KR, Dyas JR, Geis GL, Luria JW, Frey ME, Jablonski TE, Iyer SB. Reducing the incidence of oxyhaemoglobin desaturation during rapid sequence intubation in a paediatric emergency department. BMJ Qual Saf. 2015 Nov;24(11):709-17. doi: 10.1136/bmjqs-2014-003713. Epub 2015 Jul 16. PMID: 26183713. 4. Jaber S, Jung B, Corne P, Sebbane M, Muller L, Chanques G, Verzilli D, Jonquet O, Eledjam JJ, Lefrant JY. An intervention to decrease complications related to endotracheal intubation in the intensive care unit: a prospective, multiple-center study. Intensive Care Med. 2010 Feb;36(2):248-55. doi: 10.1007/s00134-009-1717-8. Epub 2009 Nov 17. PMID: 19921148. 5. https://emcrit.org/wp-content/uploads/2013/02/emcrit-airway-checklist-2013-02-05.pdf 6. https://das.uk.com/guidelines/icu_guidelines2017 7. https://intensiveblog.com/alfred-icu-intubation-checklist/

It's a special edition of the JournalFeed Podcast. Today, we are talking about race in EM with the authors of a recent op-ed in Annals of Emergency Medicine. We tackle some tough questions about racism and how we can be better allies as EM colleagues.Here are today's show notes from the authors Cortlyn Brown, Kimberly Brown, Italo Brown, and Rosny Daniel:Allegories on race and racism - TED TalkMapping Police ViolenceMaatouk-Bürmann B, Ringel N, Spang J, Weiss C, Möltner A, Riemann U, Langewitz W, Schultz JH, Jünger J. Improving patient-centered communication: Results of a randomized controlled trial. Patient Educ Couns. 2016 Jan;99(1):117-24. doi: 10.1016/j.pec.2015.08.012. Epub 2015 Aug 14.Langewitz WA, Edlhaimb HP, Höfner C, Koschier A, Nübling M, Leitner A. Evaluation eines zweijährigen Curriculums in Psychosozialer und Psychosomatischer Medizin--Umgang mit Emotionen und patientenzentrierter Gesprächsführung [Evaluation of a two year curriculum in psychosocial and psychosomatic medicine--handling emotions and communicating in a patient centred manner]. Psychother Psychosom Med Psychol. 2010 Nov;60(11):451-6. German. doi: 10.1055/s-0030-1251980. Epub 2010 Jun 16.Harada MY, Lara-Millán A, Chalwell LE. Policed Patients: How the Presence of Law Enforcement in the Emergency Department Impacts Medical Care. Ann Emerg Med. 2021 Dec;78(6):738-748. doi: 10.1016/j.annemergmed.2021.04.039. Epub 2021 Jul 29.Kaltiso SO, Seitz RM, Zdradzinski MJ, Moran TP, Heron S, Robertson J, Lall MD. The impact of racism on emergency health care workers. Acad Emerg Med. 2021 Sep;28(9):974-981. doi: 10.1111/acem.14347. Epub 2021 Aug 6.Washington, Harriet A. "Medical apartheid : the dark history of medical experimentation on Black Americans from Colonial times to the present." New York : Doubleday, 2006How Racism Makes us Sick - TED TalkRobert Livingston, The ConversationWhite Privilege: Unpacking the Invisible KnapsackAddressing Anti-Black Racism in Medicine

Benger JR, Kirby K, Black S, Brett SJ, Clout M, Lazaroo MJ, Nolan JP, Reeves BC, Robinson M, Scott LJ, Smartt H, South A, Stokes EA, Taylor J, Thomas M, Voss S, Wordsworth S, Rogers CA. 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 Aug 28;320(8):779-791. doi: 10.1001/jama.2018.11597. PMID: 30167701; PMCID: PMC6142999. Bernhard M, Becker TK, Gries A, Knapp J, Wenzel V. The First Shot Is Often the Best Shot: First-Pass Intubation Success in Emergency Airway Management. Anesth Analg. 2015 Nov;121(5):1389-93. doi: 10.1213/ANE.0000000000000891. PMID: 26484464. Culbreth RE, Gardenhire DS. Manual bag valve mask ventilation performance among respiratory therapists. Heart Lung. 2021 May-Jun;50(3):471-475. doi: 10.1016/j.hrtlng.2020.10.012. Epub 2020 Nov 1. PMID: 33138977; PMCID: PMC7604178. Ioannidis JP. Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials?. Philos Ethics Humanit Med. 2008;3:14. Published 2008 May 27. doi:10.1186/1747-5341-3-14 Sackles, et. al. (2013). The importance of first pass success when performing orotracheal intubation in the ED. Acad Emerg Med, 20(1). Wang HE, Schmicker RH, Daya MR, Stephens SW, Idris AH, Carlson JN, Colella MR, Herren H, Hansen M, Richmond NJ, Puyana JCJ, Aufderheide TP, Gray RE, Gray PC, Verkest M, Owens PC, Brienza AM, Sternig KJ, May SJ, Sopko GR, Weisfeldt ML, Nichol G. 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 Aug 28;320(8):769-778. doi: 10.1001/jama.2018.7044. PMID: 30167699; PMCID: PMC6583103. This podcast is hosted by ZenCast.fm

On this episode, we're lucky have a special guest from Texas Children's Hospital, pediatric sedation and pain management expert, Dr. Corrie Chumpitazi. Nitrous oxide has been in our protocols here at MCHD for some time, but probably doesn't get the recognition and appreciation that it deserves. We'll discuss NO history, dosing, indications, contraindications, and side-effects. Listen to learn why we all should be incorporating more Nitrous Oxide into our daily EMS practice. https://www.acep.org/patient-care/map/map-nitrous-oxide-tool/ REFERENCES 1. Ducassé JL et al (2013). Nitrous oxide for early analgesia in the emergency setting: a randomized, double-blind multicenter prehospital trial. Acad Emerg Med. 2013 Feb;20(2):178-84. 2. Annequin D and Carbajal R, et al; Fixed 50% Nitrous Oxide Oxygen Mixture for Painful Procedures: A French Survey. Pediatrics. 2000; 105; e47. 3. Collado V, Emmanuel N, et al; Expert Opinion: a Review of the Safety of 50% Nitrous Oxide/Oxygen in Conscious Sedation. Drug Safety. 2007, 6(5): 559-571. 4. Sanders R, Weimann J, Maze M; Biologic Effects of Nitrous Oxide. Anesthesiology. 2008, 109: 707-722 5. Gall O, Annequin D, et al; Adverse Events of Premixed Nitrous Oxide and Oxygen for Procedural Sedation in Children. Lancet. 2001; 358: 1514-15. 6. Tobias, JD, Review Article: Applications of Nitrous Oxide for Procedural Sedation in the Pediatric Population. Pediatric Emergency Care. 2013; 29: 245-265. 7. Onody P, Gil P, Hennequin M. Safety of Inhalation of a 50% Nitrous Oxide/Oxygen Premix: A Prospective Study of 35,828 Administrations. Drug Safety. 2006; 29(7):633-640. 8. American Academy of Pediatric Dentistry. (2013). Guideline on use of nitrous oxide for pediatric dental patients. Retrieved September 3, 2013, from www.aapd.org: http://www.aapd.org/media/Policies_Guidelines/G_Nitrous.pdf 9. Heinrich M, Menzel C, Hoffmann F, et al. Self-administered procedural analgesia using nitrous oxide/oxygen (50:50) in the pediatric surgery emergency room: effectiveness and limitations. Eur J Pediatr Surg. 2015;25(3):250-6. 10. 28. Pasaron R, Burnweit C, Zerpa J, et al. Nitrous oxide procedural sedation in non-fasting pediatric patients undergoing minor surgery: a 12-year experience with 1,058 patients. Pediatr Surg Int. 2015;31(2):173-80. 11. 29. Zier JL, Liu M. Safety of high-concentration nitrous oxide by nasal mask for pediatric procedural sedation: experience with 7802 cases. Pediatr Emerg Care. 2011;27(12):1107-12. 12. 30. Gamis AS, Knapp JF, Glenski JA. Nitrous oxide analgesia in a pediatric emergency department. Ann Emerg Med. 1989;18(2):177-81. 13. 31. Martin HA, Noble M, Wodo N. The Benefits of Introducing the Use of Nitrous Oxide in the Pediatric Emergency Department for Painful Procedures. J Emerg Nurs. 2018;44(4):331-5.

With the recent transition of IV acetaminophen from patent to generic, it's a good time to discuss MCHD's 2021 NAEMSP abstract describing our prehospital experience with IV tylenol for pain. If you've not looked into bringing this tool into your service, listen today to be convinced why IV Tylenol is an option worth considering across EMS. REFERENCES 1. Mahshidfar B, Rezai M, et al. Intravenous Acetaminophen vs. Ketorolac in Terms of Pain Management in Prehospital Emergency Services: A Randomized Clinical Trial. Adv J Emerg Med. 2019 May 8;3(4):e37 2.Bijur PE, Friedman BW, et al. Randomized Clinical Trial of Intravenous (IV) Acetaminophen as an Adjunct to IV Hydromorphone for Acute Severe Pain in Emergency Department Patients. Acad Emerg Med. 2020 Aug;27(8):717-724.

For paramedics, click here for CE credits.  Brought to you by Urgent Admin which is an intuitive one-touch solution that connects in-field clinicians and medical directors in real-time, this episode covers the challenge of the prehospital airway. The But Why team covers unique ways to secure the airway that include  "Ghosting the Airway" and "Romantic Hands."   Hear the But Why EMS Podcast team discuss this situation with:   Dr. Robert Stephens Emergency Medicine Resident at Washington University Click here to check it out today! Thank you for listening! Hawnwan Philip Moy MD  Gina Pellerito EMT-P John Reagan EMT-P Noah Bernhardson MD   References: 1. Sakles JC, Chiu S, Mosier J, et al. The importance of first pass success when performing orotracheal intubation in the emergency department. Acad Emerg Med 2013;20(1):71-78. 2. Sakles JC, Mosier J, Stolz U. In reply. Acad Emerg Med 2013;20(9):966. 3. Limkakeng A, Broder JS, Theiling BJ. Chicken or egg? Risks of misattribution of cause-effect relationships in studies of association. Acad Emerg Med 2013;20(9):965. 4. Kajino K, Iwami T, Kitamura T, et al. Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest. Crit Care 2011;15(5):R236. 5. Clemency BM, Roginski M, Lindstrom HA, et al. Paramedic intubation: patient position might matter. Prehosp Emerg Care 2014;18(2):239-243. 6. Murphy DL, Rea TD, McCoy AM, et al. Inclined position is associated with improved first pass success and laryngoscopic view in prehospital endotracheal intubations. Am J Emerg Med 2019;37(5):937-941. 7. Turner JS, Ellender TJ, Okonkwo ER, et al. Feasibility of upright patient positioning and intubation success rates At two academic EDs. Am J Emerg Med 2017;35(7):986-992. 8. Levitan RM, Kinkle WC, Levin WJ, et al. Laryngeal view during laryngoscopy: a randomized trial comparing cricoid pressure, backward-upward-rightward pressure, and bimanual laryngoscopy. Ann Emerg Med 2006;47(6):548-555. 9. Snider DD, Clarke D, Finucane BT. The "BURP" maneuver worsens the glottic view when applied in combination with cricoid pressure. Can J Anaesth 2005;52(1):100-104. 10. Tournadre JP, Chassard D, Berrada KR, et al. Cricoid cartilage pressure decreases lower esophageal sphincter tone. Anesthesiology 1997;86(1):7-9. 11. Chassard D, Tournadre JP, Berrada KR, et al. Cricoid pressure decreases lower oesophageal sphincter tone in anaesthetized pigs. Can J Anaesth 1996;43(4):414-417. 12. Garrard A, Campbell AE, Turley A, et al. The effect of mechanically-induced cricoid force on lower oesophageal sphincter pressure in anaesthetised patients. Anaesthesia 2004;59(5):435-439. 13. Heath KJ, Palmer M, Fletcher SJ. Fracture of the cricoid cartilage after Sellick's manoeuvre. Br J Anaesth 1996;76(6):877-878. 14. Notcutt W. Oesophageal rupture and cricoid pressure. Anaesthesia 1991;46(5):424-425. 15. Savino PB, Reichelderfer S, Mercer MP, et al. Direct Versus Video Laryngoscopy for Prehospital Intubation: A Systematic Review and Meta-analysis. Acad Emerg Med 2017;24(8):1018-1026. 16. Messa MJ, Kupas DF, Dunham DL. Comparison of bougie-assisted intubation with traditional endotracheal intubation in a simulated difficult airway. Prehosp Emerg Care 2011;15(1):30-33. 17. Driver BE, Prekker ME, Klein LR, et al. Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. JAMA 2018;319(21):2179-2189. 18. Driver B, Dodd K, Klein LR, et al. The Bougie and First-Pass Success in the Emergency Department. Ann Emerg Med 2017;70(4):473-478 e471. 19. Latimer AJ, Harrington B, Counts CR, et al. Routine Use of a Bougie Improves First-Attempt Intubation Success in the Out-of-Hospital Setting. Ann Emerg Med 2021;77(3):296-304. 20. Braude D, Richards M. Rapid Sequence Airway (RSA)--a novel approach to prehospital airway management. Prehosp Emerg Care 2007;11(2):250-252. 21. Braude D, Southard A, Bajema T, et al. Rapid sequence airway using the LMA-Supreme as a primary airway for 9 h in a multi-system trauma patient. Resuscitation 2010;81(9):1217. 22. Moss R, Porter K, Greaves I, et al. Pharmacologically assisted laryngeal mask insertion: a consensus statement. Emerg Med J 2013;30(12):1073-1075.  

Welcome to Episode 007 (cue the James Bond music please) of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 7 of “The 2 View” A Wolf in Sheep's Clothing Birnbaumer, Diane MD. A Wolf in Sheep's Clothing: Serious Causes of Common Complaints. Advanced Emergency Medicine Boot Camp. September 2019. Las Vegas. Accessed June 29, 2021. Subarachnoid Hemorrhage Carpenter CR, Hussain AM, Ward MJ, et al. Spontaneous Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis Describing the Diagnostic Accuracy of History, Physical Examination, Imaging, and Lumbar Puncture with an Exploration of Test Thresholds. Acad Emerg Med. PubMed.gov. Published September 6, 2016. Accessed June 29, 2021. https://pubmed.ncbi.nlm.nih.gov/27306497/ Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. Published 2012. Accessed June 29, 2021. https://www.ahajournals.org/doi/full/10.1161/str.0b013e3182587839 Headache. Acep.org. Published June 2019. Accessed June 29, 2021. https://www.acep.org/patient-care/clinical-policies/headache/ Hine, J MD, Marcolini, E MD. Aneurysmal Subarachnoid Hemorrhage. EM:RAP CorePendium. Emrap.org. Published September 17, 2020. Accessed June 29, 2021. https://www.emrap.org/corependium/chapter/recTI59VW0TPBpesx/Aneurysmal-Subarachnoid-Hemorrhage Kim YW, Neal D, Hoh BL. Cerebral aneurysms in pregnancy and delivery: pregnancy and delivery do not increase the risk of aneurysm rupture. Neurosurgery. PubMed.gov. Published February 2013. Accessed June 29, 2021. https://pubmed.ncbi.nlm.nih.gov/23147786/ Marcolini E, Hine J. Approach to the Diagnosis and Management of Subarachnoid Hemorrhage. West J Emerg Med. NCBI. Published February 28, 2019. Accessed June 29, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6404699/ Ogilvy, C MD, Rordorf, G MD, Singer, R MD. Aneurysmal subarachnoid hemorrhage: Clinical manifestations and diagnosis. UpToDate. Uptodate.com. Updated February 25, 2020. Accessed June 29, 2021. https://www.uptodate.com/contents/aneurysmal-subarachnoid-hemorrhage-clinical-manifestations-and-diagnosis?search=subarachnoid%20hemorrhage&source=searchresult&selectedTitle=1~150&usagetype=default&display_rank=1 Ottawa Subarachnoid Hemorrhage (SAH) Rule for Headache Evaluation. Mdcalc.com. Accessed June 29, 2021. https://www.mdcalc.com/ottawa-subarachnoid-hemorrhage-sah-rule-headache-evaluation Subarachnoid Hemorrhage, no LP. EM:RAP. Emrap.org. Published May 2020. Accessed June 29, 2021. https://www.emrap.org/episode/emrap2020may/subarachnoid Gonococcal Arthritis Klausner, J MD, MPH. Disseminated gonococcal infection. UpToDate. Uptodate.com. Updated January 7, 2021. Accessed June 29, 2021. https://www.uptodate.com/contents/disseminated-gonococcal-infection Li R, Hatcher JD. Gonococcal Arthritis. In: StatPearls. StatPearls Publishing. Published July 26, 2020. Accessed June 29, 2021. https://www.ncbi.nlm.nih.gov/books/NBK470439/ Milne, Wm. MD. SGEM#335: Sisters Are Doin' It for Themselves…Self-Obtained Vaginal Swabs for STIs. Thesgem.com. Published June 26, 2021. Accessed June 29, 2021. https://www.thesgem.com/2021/06/sgem335-all-by-myselfself-obtained-vaginal-swabs-for-stis/ Ventura, Y MD, Waseem, M MD, MS. Disseminated Gonococcal Infection: Emergency Department Evaluation and Treatment. Emdocs.net. Published May 17, 2021. Accessed June 29, 2021. http://www.emdocs.net/disseminated-gonococcal-infection-emergency-department-evaluation-and-treatment/ Epiglottitis Abdallah C. Acute epiglottitis: Trends, diagnosis and management. Saudi J Anaesth. Published July-September 2012. Accessed June 29, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498669/ Ames WA, Ward VM, Tranter RM, Street M. Adult epiglottitis: an under-recognized, life-threatening condition. Br J Anaesth. Oxford Academic. Published November 1, 2000. Accessed June 29, 2021. https://academic.oup.com/bja/article/85/5/795/273886 Dowdy RAE, Cornelius BW. Medical Management of Epiglottitis. Anesth Prog. Published July 6, 2020. Accessed June 29, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7342809/ Farkas, J. Epiglottitis. Emcrit.org. Published December 18, 2016. Accessed June 29, 2021. https://emcrit.org/ibcc/epiglottitis/ Mayo-Smith M. Fatal respiratory arrest in adult epiglottitis in the intensive care unit. Implications for airway management. Chest. PubMed.gov. Published September 1993. Accessed June 29, 2021. https://pubmed.ncbi.nlm.nih.gov/8365325/ Roberts, J MD, Roberts, M ACNP, PNP. Nasal Endoscopy for Urgent and Complex ED Cases. Lww.com. Published October 28, 2020. Accessed June 29, 2021. https://journals.lww.com/em-news/blog/theproceduralpause/pages/post.aspx?PostID=110 Wolf M, Strauss B, Kronenberg J, Leventon G. Conservative management of adult epiglottitis. Laryngoscope. PubMed.gov. Published February 1990. Accessed June 29, 2021. https://pubmed.ncbi.nlm.nih.gov/2299960/ Wellens Syndrome Wellens Syndrom EKG Sign: See full show notes here: https://bit.ly/3eSyzp0 Cadogan M, Buttner R. Wellens Syndrome. Life in the Fastlane. Litfl.com. Published June 4, 2021. Accessed June 29, 2021. https://litfl.com/wellens-syndrome-ecg-library/ Smith S. Wellens' missed. Then returns with Wellens' with dynamic T-wave inversion. Dr. Smith's ECG Blog. Blogspot.com. Published May 4, 2011. Accessed June 29, 2021. http://hqmeded-ecg.blogspot.com/2011/05/wellens-missed-then-returns-with.html?m=1 Wellens Syndrome ECG Recommended Book Resources for the Month Merck. The Merck Manual of Patient Symptoms. (Porter RS, ed.). Merck; 2008. Schaider JJ, Barkin RM, Hayden SR, et al., eds. Rosen and Barkin's 5-Minute Emergency Medicine Consult. 4th ed. Lippincott Williams and Wilkins; 2010. Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Last month we asked you a trivia question regarding the very first NP program – who was the duo that began the program and what was the first NP specialty program? The correct answer was Dr. Loretta Ford and Dr. Henry Silver. The first NP specialty program was pediatrics. We'll be sending Lindsey Harvey, MSN, FNP-BC to the November Original EM Boot Camp Gratis for providing that answer! We can't wait to see you and all of the other registrants in November in Las Vegas! Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to.

Contributor: Ricky Dhaliwal, MD Educational Pearls: Hypotension in patients requiring intubation should be resuscitated as much as possible While intubating, the negative inspiratory pressure goes away decreasing cardiac preload and worsening hypotension Phenylephrine can be given via push doses to  increase blood pressure from  alpha agonism For sedation, avoid propofol with hypotension and opt for etomidate or ketamine References April MD, Arana A, Schauer SG, et al. Ketamine Versus Etomidate and Peri-intubation Hypotension: A National Emergency Airway Registry Study. Acad Emerg Med. 2020;27(11):1106-1115. doi:10.1111/acem.14063 Panchal AR, Satyanarayan A, Bahadir JD, Hays D, Mosier J. Efficacy of Bolus-dose Phenylephrine for Peri-intubation Hypotension. J Emerg Med. 2015;49(4):488-494. doi:10.1016/j.jemermed.2015.04.033 Jaber S, Amraoui J, Lefrant JY, et al. Clinical practice and risk factors for immediate complications of endotracheal intubation in the intensive care unit: a prospective, multi-center study. Crit Care Med. 2006;34:2355–61. Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD *********************

Contributor: Jared Scott, MD Educational Pearls: Recent study evaluated vaginal self swab testing for STIs to determine if they are equally sensitive to provider-obtained swab 515 patients consented to both tests and 95% agreement was found between the two methods of obtaining samples 75% of participants who preferred this over the pelvic exam, although some patients were concerned they did not perform the self swab correctly Consider vaginal self swab with proper coaching as an option for patients References Chinnock B, Yore M, Mason J, et al. Self-obtained vaginal swabs are not inferior to provider-performed endocervical sampling for emergency department diagnosis of Neisseria gonorrhoeae and Chlamydia trachomatis [published online ahead of print, 2021 Jan 18]. Acad Emerg Med. 2021;10.1111/acem.14213. doi:10.1111/acem.14213 Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at www.emergencymedicalminute.org/cme-courses/ and create an account.  Donate to EMM today!

For paramedics, click here for CE credits! We all know the standard phrase in EMS But did you know that, in this episode, the But Why team added, "squirt mustard on the chest" to the EMS mantra?   Find out how the mustard phrase arose in this hilarious episode that covers cardiac arrest treatment history and myths with Dr. Adam Heilman Click here to check it out today! Thank you for listening! Hawnwan Philip Moy MD  Gina Pellerito EMT-P John Reagan EMT-P   Works Cited 1. American Heart Association. (n.d.). History of CPR. cpr.heart.org. https://cpr.heart.org/en/resources/history-of-cpr. 2. Bonnes JL, Brouwer MA, Navarese EP, Verhaert DV, Verheugt FW, Smeets JL, de Boer MJ. Manual Cardiopulmonary Resuscitation Versus CPR Including a Mechanical Chest Compression Device in Out-of-Hospital Cardiac Arrest: A Comprehensive Meta-analysis From Randomized and Observational Studies. Ann Emerg Med. 2016 Mar;67(3):349-360.e3. doi: 10.1016/j.annemergmed.2015.09.023. Epub 2015 Nov 19. PMID: 26607332. 3. Cheskes S, Dorian P, Feldman M, McLeod S, Scales DC, Pinto R, Turner L, Morrison LJ, Drennan IR, Verbeek PR. Double sequential external defibrillation for refractory ventricular fibrillation: The DOSE VF pilot randomized controlled trial. Resuscitation. 2020 May;150:178-184. doi: 10.1016/j.resuscitation.2020.02.010. Epub 2020 Feb 19. PMID: 32084567.https://pubmed.ncbi.nlm.nih.gov/32084567/ 4. Delorenzo A, Nehme Z, Yates J, Bernard S, Smith K. Double sequential external defibrillation for refractory ventricular fibrillation out-of-hospital cardiac arrest: A systematic review and meta-analysis. Resuscitation. 2019 Feb;135:124-129. doi: 10.1016/j.resuscitation.2018.10.025. Epub 2018 Oct 26. PMID: 30612966. 5. Fig Leaf Times Two by Kevin MacLeod is licensed under a Creative Commons Attribution 4.0 license. https://creativecommons.org/licenses/by/4.0/ Source: http://incompetech.com/music/royalty-free/index.html?isrc=USUAN1200096 Artist: http://incompetech.com/ 6.  Kette F, Ghuman J, Parr M. Calcium administration during cardiac arrest: a systematic review. Eur J Emerg Med. 2013 Apr;20(2):72-8. doi: 10.1097/MEJ.0b013e328358e336. PMID: 22990036. 7.  Landry A, Foran M, Koyfman A. Does calcium administration during cardiopulmonary resuscitation improve survival for patients in cardiac arrest? Ann Emerg Med. 2014 Aug;64(2):187-9. doi: 10.1016/j.annemergmed.2013.07.510. Epub 2013 Aug 30. PMID: 23992943. 8. Mapp JG, Hans AJ, Darrington AM, Ross EM, Ho CC, Miramontes DA, Harper SA, Wampler DA; Prehospital Research and Innovation in Military and Expeditionary Environments (PRIME) Research Group. Prehospital Double Sequential Defibrillation: A Matched Case-Control Study. Acad Emerg Med. 2019 Sep;26(9):994-1001. doi: 10.1111/acem.13672. Epub 2019 Jan 6. PMID: 30537337. 9.  Mount DB (2020).  Treatment and Prevention of Hyperkalemia in Adults. In T.W. Post Sterns RH, Forman JP (Eds.). UpToDate. Available from:  https://www-uptodate-com.beckerproxy.wustl.edu/contents/treatment-and-prevention-of-hyperkalemia-in-adults?search=hyperkalemia%20treatment§ionRank=1&usage_type=default&anchor=H462542914&source=machineLearning&selectedTitle=1~150&display_rank=1#H462542914 10. Poole K, Couper K, Smyth MA, Yeung J, Perkins GD. Mechanical CPR: Who? When? How? Crit Care. 2018 May 29;22(1):140. doi: 10.1186/s13054-018-2059-0. PMID: 29843753; PMCID: PMC5975402. 11.  Pozner CN, Link MS (2020). Supportive data for advanced cardiac life support in adults with sudden cardiac arrest. In T.W. Page RL, Walls RM, Dardas TF (Eds.).  UpToDate.  Available from:  https://www-uptodate-com.beckerproxy.wustl.edu/contents/supportive-data-for-advanced-cardiac-life-support-in-adults-with-sudden-cardiac-arrest?search=calcium%20cardiac%20arrest&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 12. Vallentin MF, Granfeldt A, Holmberg MJ, Andersen LW. Drugs during cardiopulmonary resuscitation. Curr Opin Crit Care. 2020 Jun;26(3):242-250. doi: 10.1097/MCC.0000000000000718. PMID: 32348092. 13. Velissaris D, Karamouzos V, Pierrakos C, Koniari I, Apostolopoulou C, Karanikolas M. Use of Sodium Bicarbonate in Cardiac Arrest: Current Guidelines and Literature Review. J Clin Med Res. 2016 Apr;8(4):277-83. doi: 10.14740/jocmr2456w. Epub 2016 Feb 27. PMID: 26985247; PMCID: PMC4780490.    

Contributor:  Aaron Lessen, MD Educational Pearls: Droperidol for sedation in agitated patients in the emergency department was studied compared to ziprasidone (Geodon) and lorazepam (Ativan) Double-blinded RCT showed droperidol was 65% effective to get patients to a good level of sedation in 15 minutes compared to ativan and geodon which were 25-35% effective Droperidol had less respiratory depression and prolongation of the QT compared to Ativan and Geodon References Martel ML, Driver BE, Miner JR, Biros MH, Cole JB. Randomized Double-blind Trial of Intramuscular Droperidol, Ziprasidone, and Lorazepam for Acute Undifferentiated Agitation in the Emergency Department. Acad Emerg Med. 2021 Apr;28(4):421-434. doi: 10.1111/acem.14124. Epub 2020 Oct 5. PMID: 32888340. Summarized by John Spartz, MS3 | Edited by Erik Verzemnieks, MD

Last month, Dr. Josh Elder spoke with us about UC Davis Express Care allows patients to see a doctor via virtual urgent care visits. In this episode, we explore a different side of telemedicine: teleconsults. Dr. Jim Marcin is Director of the UC Davis Center for Health and a pioneer in telemedicine. As a Pediatric Critical Care Physician, Dr. Marcin has been facilitating tele consults for physicians at rural hospitals to help provide the expertise needed for care for critically ill children. He explains the current model he and his colleagues are using, the data to support what works (and what doesn’t), and a glimpse into what he might expect in the future as telehealth becomes more widely available.  Have you tried telemedicine, either as a patient of provider? Share your experience with us via social media, @empulsepodcast, or through our website, ucdavisem.com. ***Please rate us and leave us a review on iTunes! It helps us reach more people.*** Hosts: Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis Guest: Dr. Jim Marcin, Professor of Pediatrics and Pediatric Critical Care, Vice Chair of Pediatric Clinical Research, and Director for the UC Davis Center for Health and Technology. Resources: UC Davis Center for Health and Technology CDC: About Rural Health Sauers-Ford HS, Hamline MY, Gosdin MM, Kair LR, Weinberg GM, Marcin JP, Rosenthal JL. Acceptability, Usability, and Effectiveness: A Qualitative Study Evaluating a Pediatric Telemedicine Program. Acad Emerg Med. 2019 Sep;26(9):1022-1033. doi: 10.1111/acem.13763. Epub 2019 May 2. PMID: 30974004; PMCID: PMC6732030. Marcin JP, Shaikh U, Steinhorn RH. Addressing health disparities in rural communities using telehealth. Pediatr Res. 2016 Jan;79(1-2):169-76. doi: 10.1038/pr.2015.192. Epub 2015 Oct 14. PMID: 26466080. Sauers-Ford HS, Marcin JP, Underwood MA, Kim JH, Nicolau Y, Uy C, Chen ST, Hoffman KR. The Use of Telemedicine to Address Disparities in Access to Specialist Care for Neonates. Telemed J E Health. 2019 Sep;25(9):775-780. doi: 10.1089/tmj.2018.0095. Epub 2018 Nov 3. PMID: 30394853. Rural Health Information Hub: Critical Access Hospitals *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Audio Productions for audio production services.

Contributor:  Samuel Killian, MD Educational Pearls: Anecdotally, when the computer reads a triage EKG as normal it is most often normal One study tested this theory by examining 855 computer-read EKGS (222 of which were read as normal) Two cardiologists reviewed these 222 normal EKGs and only found 13 EKGs that were slightly abnormal with nonspecific abnormalities Two EM physicians then reviewed these EKGs and only one physician on one EKG said they would change the patient’s course of care by rooming them faster The study may support eliminating physician review of normal triage EKGs as a safe practice that would decrease physician interruption References Hughes KE, Lewis SM, Katz L, Jones J. Safety of Computer Interpretation of Normal Triage Electrocardiograms. Acad Emerg Med. 2017 Jan;24(1):120-124. doi: 10.1111/acem.13067. PMID: 27519772.   Summarized by John Spartz, MS3 | Edited by Erik Verzemnieks, MD

View the full show notes on Google Docs here: http://bit.ly/3cpvlJc 2020 BLS/ACLS Guideline Changes Merchant RM, Topjian AA, Panchal AR, et al. Part 1: Executive summary: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. Published October 21, 2020. Accessed January 20, 2021. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000918 Highlights of the 2020 American Heart Association Guidelines for CPR and ECC. American Heart Association. Published 2020. Accessed January 20, 2021. https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts2020eccguidelinesenglish.pdf Edelson DP, Sasson C, Chan PS, et al. Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates with Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get with The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association. Circulation. Published April 9, 2020. Accessed January 20, 2021. https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.120.047463 Topjian A, Aziz K, Kamath-Rayne BD, et al. Interim Guidance for Basic and Advanced Life Support in Children and Neonates with Suspected or Confirmed COVID-19. Pediatrics. Published 2020. Accessed January 20, 2021. https://pediatrics.aappublications.org/content/early/2020/04/13/peds.2020-1405 Hunt EA, Jeffers J, McNamara L, et al. Improved Cardiopulmonary Resuscitation Performance with CODE ACES2: A Resuscitation Quality Bundle. Journal of the American Heart Association. Published December 7, 2018. Accessed January 20, 2021. https://www.ahajournals.org/doi/10.1161/JAHA.118.009860 Procedural Pearl of the Month - Fish Hooks Roberts M, Roberts JR. The Proceduralist. https://www.theproceduralist.org/. Accessed January 20, 2021. The Procedural Pause by James R. Roberts, MD, & Martha Roberts, ACNP, PNP. Fishing Out the Fishhook. Emergency Medicine News. Published September 1, 2020. Accessed January 20, 2021. https://journals.lww.com/em-news/blog/theproceduralpause/pages/post.aspx?PostID=108 Droperidol DeFranco, C, DO. Oldie but a Goodie: 10 Pearls of Droperidol. Acep.org. Published 2021. Accessed January 20, 2021. https://www.acep.org/how-we-serve/sections/pain-management/news/may-2020/oldie-but-a-goodie-10-pearls-of-droperidol/ Ho, J, FAAEM MD, Perkins J, FAAEM MD. Clinical Practice Statement: Safety of Droperidol Use in the Emergency Department. Aaem.org. Published September 7, 2013. Accessed January 20, 2021. https://www.aaem.org/UserFiles/file/Safety-of-Droperidol-Use-in-the-ED.pdf Cisewski, D MD. Droperidol Use in the Emergency Department – What's Old is New Again. Emdocs.net. Published August 1, 2019. Accessed January 20, 2021. http://www.emdocs.net/droperidol-use-in-the-emergency-department-whats-old-is-new-again/ Ken's Third View SGEM#315: Comfortably Numb with Topical Tetracaine for Corneal Abrasions. Thesgem.com. Published January 16, 2021. Accessed January 20, 2021. http://thesgem.com/2021/01/sgem315-comfortably-numb-with-topical-tetracaine-for-corneal-abrasions/ Shipman S, Painter K, Keuchel M, Bogie C. Short-Term Topical Tetracaine Is Highly Efficacious for the Treatment of Pain Caused by Corneal Abrasions: A Double-Blind, Randomized Clinical Trial. Ann Emerg Med. Published October 27, 2020. Accessed January 20, 2021. https://pubmed.ncbi.nlm.nih.gov/33121832/ SGEM#316: What A Difference an A.P.P. Makes? Diagnostic Testing Differences Between A.P.P.S and Physicians. Thesgem.com. Published January 23, 2021. Accessed January 24, 2021. http://thesgem.com/2021/01/sgem316-what-a-difference-an-a-p-p-makes-diagnostic-testing-differences-between-a-p-p-s-and-physicians/ Pines JM, Zocchi MS, Ritsema TS, Bedolla J, Venkat A, US Acute Care Solutions Research Group. Emergency Physician and Advanced Practice Provider Diagnostic Testing and Admission Decisions in Chest Pain and Abdominal Pain. Acad Emerg Med. Published November 21, 2020. Accessed January 20, 2021. https://pubmed.ncbi.nlm.nih.gov/33107088/ Gonorrhea Questions Answered Scully BE, Fu KP, Neu HC. Pharmacokinetics of ceftriaxone after intravenous infusion and intramuscular injection. Am J Med. Published October 19, 1984. Accessed January 20, 2021. https://pubmed.ncbi.nlm.nih.gov/6093511/ Meyers BR, Srulevitch ES, Jacobson J, Hirschman SZ. Crossover study of the pharmacokinetics of ceftriaxone administered intravenously or intramuscularly to healthy volunteers. Antimicrob Agents Chemother. Published November 1983. Accessed January 20, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC185948/ Shatsky M. Evidence for the use of intramuscular injections in outpatient practice. Am Fam Physician. Published February 15, 2009. Accessed January 20, 2021. https://pubmed.ncbi.nlm.nih.gov/19235496/ Trivia Question: Send answers to 2viewcast@gmail.com Please note that for this month, if you get the trivia question correct, you will win 20% off any CCME course you want. That's right, ANY CCME course you want. You can buy it for yourself or give it to a friend - it's your 20% off. So, download and listen to the episode for the question! Please email us your guesses at 2viewcast@gmail.com, that's the number 2, view, cast @gmail.com and tell us who you want to give a shout-out to.

View the show notes in Google Docs here: http://bit.ly/3bFS43j Gonorrhea Updates Gonorrhea Treatment and Care. Centers for Disease Control and Prevention Website. https://www.cdc.gov/std/gonorrhea/treatment.htm. Published December 14, 2020. Accessed January 11, 2021. CDC No Longer Recommends Oral Drug for Gonorrhea Treatment. Centers for Disease Control and Prevention. https://www.cdc.gov/nchhstp/newsroom/2012/gctx-guidelines-pressrelease.html. Published August 9, 2012. Accessed January 11, 2021. Recurrent UTI Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2019). American Urological Association. https://www.auanet.org/guidelines/recurrent-uti?fbclid=IwAR1TwSTQNHv8PDWLfW7WjsDan46D_9b6Qs1ptJxaXr6YFnDpBeptpW3BY. Published 2019. Accessed January 11, 2021. Combo Ibuprofen and Acetaminophen / Pain Advil® Dual Action. GSK Expert Portal. https://www.gskhealthpartner.com/en-us/pain-relief/brands/advil/products/dual-action/?utmsource=google&utmmedium=cpc&utmterm=ibuprofen+acetaminophen&utmcampaign=GS+-+Unbranded+Advil+DA+-+Alone+-+PH. Accessed January 11, 2021. FDA approves GSK's Advil Dual Action with Acetaminophen for over-the-counter use in the United States. GSK. https://www.gsk.com/en-gb/media/press-releases/fda-approves-gsk-s-advil-dual-action-with-acetaminophen-for-over-the-counter-use-in-the-united-states/. Published March 2, 2020. Accessed January 11, 2021. Tanner T, Aspley S, Munn A, Thomas T. The pharmacokinetic profile of a novel fixed-dose combination tablet of ibuprofen and paracetamol. BMC clinical pharmacology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2906415/. Published July 5, 2010. Accessed January 11, 2021. Searle S, Muse D, Paluch E, et al. Efficacy and Safety of Single and Multiple Doses of a Fixed-dose Combination of Ibuprofen and Acetaminophen in the Treatment of Postsurgical Dental Pain: Results From 2 Phase 3, Randomized, Parallel-group, Double-blind, Placebo-controlled Studies. The Clinical journal of pain. https://pubmed.ncbi.nlm.nih.gov/32271183/. Published July 2020. Accessed January 11, 2021. 1000 mg versus 600/650 mg Acetaminophen for Pain or Fever: A Review of the Clinical Efficacy. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK373467/. Published June 17, 2016. Accessed January 11, 2021. Motov S. Is There a Limit to the Analgesic Effect of Pain Medications? Medscape. https://www.medscape.com/viewarticle/574279. Published June 17, 2008. Accessed January 11, 2021. Motov, Sergey. Faculty Forum: A Practical Approach to Pain Management. YouTube. https://www.youtube.com/watch?v=lJSioPsGw3A. The Center for Medical Education. Published December 2, 2020. Accessed January 1, 2021. Wuhrman E, Cooney MF. Acute Pain: Assessment and Treatment. Medscape. https://www.medscape.com/viewarticle/735034_4. Published January 3, 2011. Accessed January 11, 2021. Social Pain Dewall CN, Macdonald G, Webster GD, et al. Acetaminophen reduces social pain: behavioral and neural evidence. Psychological science. https://pubmed.ncbi.nlm.nih.gov/20548058/. Published June 14, 2010. Accessed January 11, 2021. Mischkowski D, Crocker J, Way BM. From painkiller to empathy killer: acetaminophen (paracetamol) reduces empathy for pain. Social cognitive and affective neuroscience. https://pubmed.ncbi.nlm.nih.gov/27217114/. Published May 5, 2016. Accessed January 11, 2021. Other / Recurrent liner notes Center for Medical Education. https://courses.ccme.org/. Accessed January 11, 2021. Roberts M, Roberts JR. The Proceduralist. https://www.theproceduralist.org/. Accessed January 11, 2021. The Procedural Pause by James R. Roberts, MD, & Martha Roberts, ACNP, PNP. Emergency Medicine News. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx. Accessed January 11, 2021. The Skeptics' Guide to Emergency Medicine. sgem.ccme.org. https://sgem.ccme.org/. Accessed January 11, 2021. Trivia Question: Send answers to 2viewcast@gmail.com Please note that you must answer the 2 part question to win a copy of the EMRA Pain Guide. “What controversial drug was given a black box warning for prolonged QT and torsades in 2012 and now has been declared by WHICH organization to be an effective and safe treatment use for nausea, vomiting, headache and agitation?” Practical Pain Management in Acute Care Setting Handout Sergey Motov, MD @painfreeED • Pain is one of the most common reasons for patients to visit the emergency department and other acute care settings. Due to the extensive number of visits related to pain, clinicians and midlevel providers should be aware of the various options, both pharmacological and nonpharmacological, available to treat patients with acute pain. • As the death toll from the opioid epidemic continues to grow, the use of opioids in the acute care setting as a first-line treatment for analgesia is becoming increasingly controversial and challenging. • There is a growing body of literature that is advocating for more judicious use of opioids and well as their prescribing and for broader use of non-pharmacological and non-opioid pain management strategies. • The channels/enzymes/receptors targeted analgesia (CERTA) concept is based on our improved understanding of the neurobiological aspect of pain with a shift from a symptom-based approach to pain to a mechanistic approach. This targeted analgesic approach allows for a broader utilization of synergistic combinations of nonopioid analgesia and more refined and judicious (rescue) use of opioids. These synergistic combinations result in greater analgesia, fewer side effects, lesser sedation, and shorter LOS. (Motov et al 2016) General Principles: Management of acute pain in the acute care setting should be patient-centered and pain syndrome-specific by using multimodal approach that include non-pharmacological modalities and pharmacological ones that include non-opioid and opioid analgesics. Assessment of acute pain should be based on a need for analgesics to improve functionality, rather than patients-reported pain scores. Brief pain inventory short form BPI-SF is better than NRS/VAS as it assesses quantitative and qualitative impact of pain (Im et al 2020). ED clinicians should engage patients in shared decision-making about overall treatment goals and expectations, the natural trajectory of the specific painful condition, and analgesic options including short-term and long-term benefits and risks of adverse effects. If acute pain lasting beyond the expected duration, complications of acute pain should be ruled out and transition to non-opioid therapy and non-pharmacological therapy should be attempted. Non-Pharmacologic Therapies • Acute care providers should consider applications of heat or cold as well as specific recommendations regarding activity and exercise. • Music therapy is a useful non-pharmacologic therapy for pain reduction in acute care setting (music-assisted relaxation, therapeutic listening/musical requests, musical diversion, song writing, and therapeutic singing (Mandel 2019). • The use of alternative and complementary therapies, such as acupuncture, guided imagery, cognitive-behavioral therapy, and hypnosis have not been systemically evaluated for use in the Acute care setting including ED. (Dillan 2005, Hoffman 2007) • In general, their application may be limited for a single visit, but continued investigation in their safety and efficacy is strongly encouraged. • Practitioners may also consider utilization of osteopathic manipulation techniques, such as high velocity, low amplitude techniques, muscle energy techniques, and soft tissue techniques for patients presenting to the acute care setting with pain syndromes of skeletal, arthroidal, or myofascial origins. (Eisenhart 2003) Opioids • Acute Care providers are uniquely positioned to combat the opioid epidemic by thoughtful prescribing of parenteral and oral opioids in inpatient setting and upon discharge, and through their engagement with opioid addicted patients in acute care setting. • Acute Care providers should make every effort to utilize non-pharmacological modalities and non-opioid analgesics to alleviate pain, and to use opioid analgesics only when the benefits of opioids are felt to outweigh the risks. (not routinely) • When opioids are used for acute pain, clinicians should combine them with non-pharmacologic and non-opioid pharmacologic therapy: Yoga, exercise, cognitive behavioral therapy, complementary/alternative medical therapies (acupuncture); NSAID's, Acetaminophen, Topical Analgesics, Nerve blocks, etc. • When considering opioids for acute pain, Acute Care providers should involve patients in shared decision-making about analgesic options and opioid alternatives, risks and benefits of opioid therapies, and rational expectations about the pain trajectory and management approach. • When considering opioids for acute pain, acute care providers should counsel patients regarding serious adverse effects such as sedation and respiratory depression, pruritus and constipation, and rapid development of tolerance and hyperalgesia. • When considering administration of opioids for acute pain, acute care providers should make every effort to accesses respective state's Prescription Drug Monitoring Program (PDMP). The data obtained from PDMP's to be used to identify excessive dosages and dangerous combinations, identify and counsel patients with opioid use disorder, offer referral for addiction treatment. • PDMPs can provide clinicians with comprehensive prescribing information to improve clinical decisions around opioids. However, PDMPs vary tremendously in their accessibility and usability in the ED, which limits their effectiveness at the point of care. Problems are complicated by varying state-to-state requirements for data availability and accessibility. Several potential solutions to improving the utility of PDMPs in EDs include integrating PDMPs with electronic health records, implementing unsolicited reporting and prescription context, improving PDMP accessibility, data analytics, and expanding the scope of PDMPs. (Eldert et al, 2018) • Parenteral opioids when used in titratable fashion are effective, safe, and easily reversible analgesics that quickly relieve pain. • Acute care clinicians should consider administering these analgesics for patients in acute pain where the likelihood of analgesic benefit is judged to exceed the likelihood of harm. • Parenteral opioids must be titrated regardless of their initial dosing regimens (weight-based or fixed) until pain is optimized to acceptable level (functionality status) or side effects become intolerable. • When parenteral opioids are used, patients should be engaged in shared-decision making regarding the route of administration, as repetitive attempts of IV cannulation and intramuscular injections are associated with pain. In addition, intramuscular injections are associated with unpredictable absorption rates, and complications such as muscle necrosis, soft tissue infection and the need for dose escalation. (Von Kemp 1989, Yamanaka 1985, Johnson 1976) • Morphine sulfate provides better balance of analgesic efficacy and safety among all parenteral opioids. a. Dosing regimens and routes: b. IV: 0.05-0.1mg/kg to start, titrate q 10-20 min c. IV: 4-6 mg fixed, titrate q 10-20 min d. SQ: 4-6 mg fixed, titrate q 20 min e. Nebulized: 0.2 mg/kg or 10-20 mg fixed, repeat q 15-20 min f. PCA: prone to dosing errors g. IM: should be avoided (pain, muscle fibrosis, necrosis, increase in dosing requirements) • Hydromorphone should be avoided as a first-line opioid due to significant euphoria and severe respiratory depression requiring naloxone reversal. Due to higher lipophilicity, Hydromorphone use is associated with higher rates of euphoria and subsequent development of addiction. Should hydromorphone be administered in higher than equi-analgesic morphine milligram equivalents, close cardiopulmonary monitoring is strongly recommended. Dosing h. IV: 0.2-0.5 mg initial, titrate q10-15 min i. IM: to be avoided (pain, muscle fibrosis, necrosis, increase in dosing requirements) j. PCA: prone to dosing errors (severe CNS and respiratory depression) k. Significantly worse AE profile in comparison to Morphine l. Equianalgesic IV conversion (1 mg HM=8mg of MS) m. Overprescribed in >50% of patients n. Inappropriately large dosing in EM literature: 2 mg IVP o. Abuse potential (severely euphoric due to lipophilicity) • Fentanyl is the most potent opioid, short-acting, requires frequent titration. Dosing: p. IV: 0.25-0.5 μg/kg (WB), titrate q10 min q. IV: 25-50 μg (fixed), titrate q10 min r. Nebulization: 2-4 μg/kg, titrate q20-30 min s. IN: 1-2 μg/kg, titrate q5-10min t. Transbuccal: 100-200μg disolvable tablets u. Transmucosal: 15-20 mcg/kg Lollypops • Opioids in Renal Insufficiency/Renal Failure Patients-requires balance of ORAE with pain control by starting with lower-than-recommended doses and slowly titrate up the dose while extending the dosing interval. (Dean 2004, Wright 2011) • Opioid-induced pruritus is centrally mediated process via μ-opioid receptors as naloxone, nalbuphine reverse it, and can be caused by opioids w/o histamine release (Fentanyl). Use ultra-low-dose naloxone of 0.25 -1 mcg/kg/hr with NNT of 3.5. (Kjellberg 2001) • When intravascular access is unobtainable, acute care clinicians should consider utilization of intranasal (fentanyl), nebulized (fentanyl and morphine), or transmucosal (rapidly dissolvable fentanyl tablets) routes of analgesic administration for patients with acute painful conditions. • Breath actuated nebulizer (BAN): enclosed canister, dual mode: continuous and on-demand, less occupational exposures. a. Fentanyl: 2-4 mcg//kg for children, 4 mcg/kg for adults: titration q 10 min up to three doses via breath-actuated nebulizer (BAN): systemic bioavailability of 50-60% of IV route. (Miner 2007, Furyk 2009, Farahmand 2014) b. Morphine: 10-20 mg g10 min up to 3 doses via breath-actuated nebulizer (BAN)-Systemic bioavailability (concentration) of 30-35% of IV Route. (Fulda 2005, Bounes 2009, Grissa 2015) c. Intranasal Fentanyl: IN via MAD at 1-2 mcg/kg titration q 5 min (use highly concentrated solution of 100mcg/ml for adults and 50 mcg/ml for children)- systemic bioavailability of 90% of IV dosing. (Karisen 2013, Borland 2007, Saunders 2010, Holdgate 2010) d. IN route: shorter time to analgesia, titratable, comparable pain relief to IV route, minimal amount of side effects, similar rates of rescue analgesia, great patients and staff satisfaction. Disadvantages: requires highly concentrated solutions that not readily available in the ED, contraindicated in facial/nasal trauma. Oral Opioids • Oral opioid administration is effective for most patients in the acute care setting, however, there is no appreciable analgesic difference between commonly used opioids (oxycodone, hydrocodone and morphine sulfate immediate release (MSIR). • When oral opioids are used for acute pain, the lowest effective dose and fewest number of tablets needed should be prescribed. In most cases, less than 3 days' worth are necessary, and rarely more than 5 days' worth are needed. • If painful condition outlasts three-day supply, re-evaluation in health-care facility is beneficial. Consider expediting follow-up care if the patient's condition is expected to require more than a three-day supply of opioid analgesics. • Only Immediate release (short-acting) formulary are to be prescribed in the acute care setting and at discharge. • Clinicians should not administer or prescribe long-acting, extended-release, or sustained-release opioid formulations, which include both oral and transdermal (fentanyl) medications in the acute care setting. These formulations are not indicated for acute pain and carry a high risk of overdose, particularly in opioid-naïve patients. • Acute care providers should counsel patients about safe medication storage and disposal, as well as the consequences of failure to do this; potential for abuse and misuse by others (teens and young adults), and potential for overdose and death (children and teens). • Oxycodone is no more effective than other opioids (hydrocodone, MSIR). Oxycodone has highest potential for abuse, misuse and diversion as well as increased risks of overdose, addiction and death. Oxycodone should be avoided as a first-line oral opioid for acute pain. ( Strayer 2016) • If still prescribed, lowest dose (5mg) in combination with acetaminophen (lowest dose of 325 mg) should be considered as it associated with less abuse and diversion (in theory). Potential for acetaminophen overdose exist though with combination. • Hydrocodone is three times more prescribed than oxycodone, but three times less used for non-medical purpose. Combo with APAP (Vicodin)-Use lowest effective dose for hydrocodone and APAP (5/325). (Quinn 1997, Adams 2006) • Immediate release morphine sulfate (MSIR) administration is associated with lesser degree of euphoria and consequently, less abuse potential (Wightman 2012). ED providers should consider prescribing Morphine Sulfate Immediate Release Tablets (MSIR) (Wong 2012, Campos 2014) for acute pain due to: o Similar analgesic efficacy to Oxycodone and Hydrocodone o Less euphoria (less abuse potential) o Less street value (less diversion) o More dysphoria in large doses o Less abuse liability and likeability • Tramadol should not be used in acute care setting and at discharge due to severe risks of adverse effects, drug-drug interactions, and overdose. There is very limited data supporting better analgesic efficacy of tramadol in comparison to placebo, or better analgesia than APAP or Ibuprofen. Tramadol dose not match analgesic efficacy of traditional opioids. (Juurlink 2018, Jasinski 1993, Babalonis 2013) • Side effects are: o Seizures o Hypoglycemia o Hyponatremia o Serotonin syndrome o Abuse and addiction • Codeine and Codeine/APAP is a weak analgesic that provides no better pain relief than placebo. Codeine must not be administered to children due to: o dangers of the polymorphisms of the cytochrome P450 iso-enzyme: o ultra-rapid metabolizers: respiratory depression and death o poor metabolizers: absent or insufficient pain relief • Transmucosal fentanyl (15 and 20 mcg/kg lollypops) has an onset of analgesia in 5 to 15 minutes with a peak effect seen in 15 to 30 minutes (Arthur 2012). • Transbuccal route can be used right at the triage to provide rapid analgesia and as a bridge to intravenous analgesia in acute care setting. (Ashburn 2011). A rapidly dissolving trans-buccal fentanyl (100mcg dose) provides fast pain relief onset (median 10 min), great analgesics efficacy, minimal need for rescue medication and lack of side effects in comparison to oxycodone/acetaminophen tablet (Shear 2010) • Morphine Milligram Equivalent (MME) is a numerical standard against which most opioids can be compared, yielding a comparison of each medication's potency. MME does not give any information of medications efficacy or how well medication works, but it is used to assess comparative potency of other analgesics. • By converting the dose of an opioid to a morphine equivalent dose, a clinician can determine whether a cumulative daily dose of opioids approaches an amount associated with increased risk of overdose and to identify patients who may benefit from closer monitoring, reduction or tapering of opioids, prescribing of naloxone, and other measures to reduce risk of overdose. • Opioid-induced hyperalgesia: o opioid-induced hyperalgesia (OIH) is a rare syndrome of increasing pain, often accompanied by neuroexcitatory effects, in the setting of increasing opioid therapy. o Morphine is by far the most common opiate implicated in OIH. Hydromorphone and oxycodone, members of the same class of opiate as morphine (phenanthrenes), can also cause OIH. Fentanyl, a synthetic opioid in the class of phenylpiperidine, is less likely to precipitate OIH. Existing data suggests that OIH is caused by multiple opioid-induced changes to the central nervous system including: -Activation of N-methyl-D-aspartate (NMDA) receptors -Inhibition of the glutamate transporter system -Increased levels of the pro-nociceptive peptides within the dorsal root ganglia -Activation of descending pain facilitation from the rostral ventromedial medulla -Neuroexcitatory effects provoked by metabolites of morphine and hydromorphone • OIH can be confused with tolerance as in both cases patients report increased pain on opioids. The two conditions can be differentiated based on the patient's response to opioids. In tolerance, the patient's pain will improve with dose escalation. In OIH, pain will worsen with opioid administration. This paradoxical effect is one of the hallmarks of the syndrome. Non-opioid analgesics • Acetaminophen is indicated for management of mild to moderate pain and as a single analgesic and has modest efficacy at most. Addition of Acetaminophen to Ibuprofen does not provide better analgesia for patients with acute low back pain. The greatest limitation to the use of intravenous (IV) versus oral acetaminophen is the nearly 100-fold cost differential, which is likely not justified by any marginal improvement in pain relief. Furthermore, IV APAP provide faster onset of analgesia only after an initial dose. (Yeh 2012, Serinken 2012) • NSAIDs should be administered at their lowest effective analgesic doses both in the ED and upon discharge and should be given for the shortest appropriate treatment course. Caution is strongly advised when NSAIDs are used in patients at risk for renal insufficiency, heart failure, and gastrointestinal hemorrhage, as well as in the elderly. Strong consideration should be given to topical NSAID's in managing as variety of acute and chronic painful Musculo-skeletal syndromes. The analgesic ceiling refers to the dose of a drug beyond which any further dose increase will not result in additional analgesic efficacy. Thus, the analgesics ceiling for ibuprofen is 400 mg per dose (1200 mg/24 h) and for ketorolac is 10 mg per dose (10 mg/24 h). These doses are less than those often prescribed for control of inflammation and fever. When it comes to equipotent doses of different NSAIDs, there is no difference in analgesic efficacy. • Ketamine, at sub-dissociative doses (also known as low-dose ketamine or analgesic dose ketamine) of 0.1 to 0.4 mg/kg, provided effective analgesia as a single agent or as an adjunct to opioids (reducing the need for opioids) in the treatment of acute traumatic and nontraumatic pain in the ED. This effective analgesia, however, must be balanced against high rates of minor adverse side effects (14%–80%), though typically short-lived and not requiring intervention. In addition to IV rout, ketamine can be administered via IN,SQ, and Nebulized route. • Local anesthetics are widely used in the ED for topical, local, regional, intra-articular, and systemic anesthesia and analgesia. Local anesthetics (esters and amides) possess analgesic and anti-hyperalgesic properties by non-competitively blocking neuronal sodium channels. o Topical analgesics containing lidocaine come in patches, ointments, and creams have been used to treat pain from acute sprains, strains, and contusions as well as variety of acute inflammatory and chronic neuropathic conditions, including postherpetic neuralgia (PHN), complex regional pain syndromes (CRPS) and painful diabetic neuropathy (PDN). o UGRA used for patients with lower extremity fractures or dislocations (eg, femoral nerve block, fascia iliaca compartment block) demonstrated significant pain control, decreased need for rescue analgesia, and first-attempt procedural success. In addition, UGRA demonstrated few procedural complications, minimal need for rescue analgesia, and great patient satisfaction. o Analgesic efficacy and safety of IV lidocaine has been evaluated in patients with renal colic and acute lower back pain. Although promising, this therapy will need to be studied in larger populations with underlying cardiac disease before it can be broadly used. o knvlsd • Antidopaminergic and Neuroleptics are frequently used in acute care settings for treatment of migraine headache, chronic abdominal pain, cannabis-induced hyperemesis. • Anti-convulsant (gabapentin and pregabalin) are not recommended for management of acute pain unless pain is of neuropathic origin. Side effects, particularly when combined with opioids (potentiation of euphoria and respiratory depression), titration to effect, and poor patients' compliance are limiting factors to their use. (Peckham 2018) References: Chang HY, Daubresse M, Kruszewski SP, et al. Prevalence and treatment of pain in EDs in the United States, 2000 to 2010. Am J Emerg Med 2014;32(5):421–31. Green SM. There is oligo-evidence for oligoanalgesia. Ann Emerg Med 2012;60: 212–4. Strayer RJ, Motov SM, Nelson LS. Something for pain: Responsible opioid use in emergency medicine. Am J Emerg Med. 2017 Feb;35(2):337-341. Smith RJ, Rhodes K, Paciotti B, Kelly S,et al. Patient Perspectives of Acute Pain Management in the Era of the Opioid Epidemic. Ann Emerg Med. 2015 Sep;66(3):246-252 Meisel ZF, Smith RJ. Engaging patients around the risks of opioid misuse in the emergency department. Pain Manag. 2015 Sep;5(5):323-6. Wightman R, Perrone J. (2017). Opioids. In Strayer R, Motov S, Nelson L (Eds.), Management of Pain and Procedural Sedation in Acute Care. http://painandpsa.org/opioids/ Motov S, Nelson L, Advanced Concepts and Controversies in Emergency Department Pain Management. Anesthesiol Clin. 2016 Jun;34(2):271-85. doi: 10.1016/j.anclin.2016.01.006. Ducharme J. Non-opioid pain medications to consider for emergency department patients. Available at: http://www.acepnow.com/article/non-opioid-painmedications- consider-emergency-department-patients/. 2015. Wightman R, Perrone J, Portelli I, et al. Likeability and Abuse Liability of Commonly Prescribed Opioids. J Med Toxicol. September 2012. doi: 10.1007/s12181-012-0263-x Zacny JP, Lichtor SA. Within-subject comparison of the psychopharmacological profiles of oral oxycodone and oral morphine in non-drug-abusing volunteers. Psychopharmacology (Berl) 2008 Jan;196(1):105–16. Hoppe JA, Nelson LS, Perrone J, Weiner SG, Prescribing Opioids Safely in the Emergency Department (POSED) Study Investigators. Opioid Prescribing in a Cross Section of US Emergency Departments. Ann Emerg Med. 2015;66(3):253–259. Baehren DF, Marco CA, Droz DE, et al. A statewide prescription monitoring program affects emergency department prescribing behaviors. Ann Emerg Med. 2010; 56(1):19–23 Weiner SG, Griggs CA, Mitchell PM, et al. Clinician impression versus prescription drug monitoring program criteria in the assessment of drug-seeking behavior in the emergency department. Ann Emerg Med 2013;62(4):281–9. Greenwood-Ericksen MB, Poon SJ, Nelson LS, Weiner SG, et al. Best Practices for Prescription Drug Monitoring Programs in the Emergency Department Setting: Results of an Expert Panel. Ann Emerg Med. 2016 Jun;67(6):755-764 Patanwala AE, Keim SM, Erstad BL. Intravenous opioids for severe acute pain in the emergency department. Ann Pharmacother 2010;44(11):1800–9. Bijur PE, Kenny MK, Gallagher EJ. Intravenous morphine at 0.1 mg/kg is not effective for controlling severe acute pain in the majority of patients. Ann Emerg Med 2005; 46:362–7. Birnbaum A, Esses D, Bijur PE, et al. Randomized double-blind placebo- controlled trial of two intravenous morphine dosages (0.10 mg/kg and 0.15 mg/kg) in emergency department patients with moderate to severe acute pain. Ann Emerg Med. 2007;49(4):445–53. Patanwala AE, Edwards CJ, Stolz L, et al. Should morphine dosing be weight based for analgesia in the emergency department? J Opioid Manag 2012; 8(1):51–5. Lvovschi V, Auburn F, Bonnet P, et al. Intravenous morphine titration to treat severe pain in the ED. Am J Emerg Med 2008;26:676–82. Chang AK, Bijur PE, Napolitano A, Lupow J, et al. Two milligrams i.v. hydromorphone is efficacious for treating pain but is associated with oxygen desaturation. J Opioid Manag. 2009 Mar-Apr;5(2):75-80. Sutter ME, Wintemute GJ, Clarke SO, et al. The changing use of intravenous opioids in an emergency department. West J Emerg Med 2015;16:1079-83. Miner JR, Kletti C, Herold M, et al. Randomized clinical trial of nebulized fentanyl citrate versus i.v. fentanyl citrate in children presenting to the emergency department with acute pain. Acad Emerg Med 2007;14:895–8. Furyk JS, Grabowski WJ, Black LH. Nebulized fentanyl versus intravenous morphine in children with suspected limb fractures in the emergency department: a randomized controlled trial. Emerg Med Australas 2009;21:203–9. Borland M, Jacobs I, King B, et al. A randomized controlled trial comparing intranasal fentanyl to intravenous morphine for managing acute pain in children in the emergency department. Ann Emerg Med 2007;49:335–40 Im DD, Jambaulikar GD, Kikut A, Gale J, Weiner SG. Brief Pain Inventory-Short Form: A New Method for Assessing Pain in the Emergency Department. Pain Med. 2020 Sep 11:ppnaa269. doi: 10.1093/pm/pnaa269. Epub ahead of print. PMID: 32918473. Mandel SE, Davis BA, Secic M. Patient Satisfaction and Benefits of Music Therapy Services to Manage Stress and Pain in the Hospital Emergency Department. J Music Ther. 2019 May 10;56(2):149-173. Piatka C, Beckett RD. Propofol for Treatment of Acute Migraine in the Emergency Department: A Systematic Review. Acad Emerg Med. 2020 Feb;27(2):148-160. Tzabazis A, Kori S, Mechanic J, Miller J, Pascual C, Manering N, Carson D, Klukinov M, Spierings E, Jacobs D, Cuellar J, Frey WH 2nd, Hanson L, Angst M, Yeomans DC. Oxytocin and Migraine Headache. Headache. 2017 May;57 Suppl 2:64-75. doi: 10.1111/head.13082. PMID: 28485846. Yeh YC, Reddy P. Clinical and economic evidence for intravenous acetaminophen. Pharmacotherapy 2012;32(6):559–79. Serinken M, Eken C, Turkcuer I, et al. Intravenous paracetamol versus morphine for renal colic in the emergency department: a randomised double-blinded controlled trial. Emerg Med J 2012;29(11):902–5. Wright JM, Price SD, Watson WA. NSAID use and efficacy in the emergency department: single doses of oral ibuprofen versus intramuscular ketorolac. Ann Pharmacother 1994;28(3):309–12. Turturro MA, Paris PM, Seaberg DC. Intramuscular ketorolac versus oral ibuprofen in acute musculoskeletal pain. Ann Emerg Med 1995;26(2):117–20. Catapano MS. The analgesic efficacy of ketorolac for acute pain [review]. J Emerg Med 1996;14(1):67–75 Dillard JN, Knapp S. Complementary and alternative pain therapy in the emergency department. Emerg Med Clin North Am 2005; 23:529–549. Hoffman BM, Papas RK, Chatkoff DK, Kerns RD. Meta-analysis of psychological interventions for chronic low back pain. Health Psychol 2007;26:1–9. Eisenhart AW, Gaeta TJ, Yens DP. Osteopathic manipulative treatment in the emergency department for patients with acute ankle injuries. J Am Osteopath Assoc 2003;103:417–421.

Can we use high flow nasal cannula (HFNC/HFO/NHF) devices to manage acute severe asthma exacerbations in patients? Looking at evidence. Show Notes: https://eddyjoemd.com/high-flow-asthma/ Receive a FREE audiobook (TWO for Amazon Prime members) with your FREE 30-day trial by using my link for Audible: CLICK HERE! You will be reminded when your trial is ending, by the way.

In this episode, we review cannabinoid hyperemesis syndrome and two recent randomized controlled trials on treatments Haloperidol - Ruberto et al  (Annals of Emergency Medicine, In Press) Capsaicin - Dean et al. Acad Emerg Med 2020. Show notes (references, graphics) at FOAMcast.org Thanks for listening! Jeremy Faust and Lauren Westafer

Sometimes in medicine, we do things just because they’ve always been done that way, which is terrible reasoning. Valsalva maneuver followed by the two-syringe technique for adenosine administration has been standard practice in PSVT management for decades. Recent data suggests that both of these approaches may have better alternatives. Join Dr. Patrick and Brad Ward as they provide updates on both non-pharmacologic and pharmacologic management of PSVT. REFERENCES 1. McDowell M et al. Single-Syringe Administration of Diluted Adenosine. Acad Emerg Med 2020, Jan;1:62-63. 2. Choi SC et al. A Convenient Method of Adenosine Administration for Paroxysmal Supraventricular Tachycardia. J Korean Soc Emerg Med 2003, Aug;14(3):224-227. 3. Weberding NT, Saladino RA, Minnigh MB, et al. Adenosine administration with a stopcock technique delivers lower-than-intended drug doses. Ann Emerg Med 2018;71:220–4. 4. https://www.youtube.com/watch?v=8DIRiOA_OsA

Learn which exam maneuvers are worthwhile and which ones are worthless in your approach to shortness of breath. In our evidence based series on the physical exam, we discuss the approach to the dyspneic patient with Dr. Brian Garibaldi (Hopkins, SBM), associate professor of pulmonary and critical care medicine at Johns Hopkins, and co-president of the Society of Bedside Medicine. We discuss the physical exam’s effect on our differential diagnosis, maneuvers that are commonly taught, and some simple tests with great data that may go overlooked. Be prepared, this episode may take your breath away!   Credits Written and Produced by: Justin Berk, MD, MPH, MBA and Sam Masur, MD  Infographic: Sam Masur, MD, Beth Garbitelli Cover Art: Beth Garbitelli Hosts: Stuart Brigham, MD; Matthew Watto, MD, FACP; and Paul Williams, MD, FACP Editor:Justin Berk MD; Clair Morgan of nodderly.com Guest(s): Brian Garibaldi, MD   Sponsors:   National Internal Medicine Day Help ACP celebrate National Internal Medicine Day on October 28th. Visit https://www.acponline.org/NIMD20 to learn how you can show your internal medicine pride. Be sure to tag @ACPInternists and use the hashtags #NationalInternalMedicineDay, #IMProud, and #IMEssential.   VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. Note: A free VCU Health CloudCME account is required in order to seek credit.   Time Stamps Sponsor – National Internal Medicine Day, The American College of Physicians Sponsor – VCU Health Continuing Education 00:00 Intro, disclaimer, guest bio Sponsor – National Internal Medicine Day, The American College of Physicians 03:47 Introduction to evidence-based exam, pre-test probability, and likelihood ratios 05:29 Case from Kashlak Memorial  06:51 Dr. Garibaldi’s initial maneuvers for the dyspneic patient 11:33 Recapping the exam maneuvers 14:05 Likelihood ratios for common maneuvers 18:25 Over 6/Under 6 maneuvers 25:30 Recap of Dr. Garibaldi’s go-to maneuvers 28:19 Role of labs and diagnostic imaging 31:03 Role of point-of-care ultrasound (POCUS) 34:10 Friday at 5pm 36:31 Take home points 39:25 Outro Sponsor – VCU Health Continuing Education   Links* Stanford 25: Teaching and promoting bedside exam skills to students, residents and healthcare professionals both in person and online The 5 Minute Moment at the Society of Bedside Medicine The POCUS Atlas: Evidence Based Point of Care Ultrasound   Goal Listeners will feel confident how to optimally use the physical exam to guide clinical decision-making in patients presenting with dyspnea.   Learning objectives After listening to this episode listeners will…   Describe the effectiveness of the exam when it comes to aiding diagnosis in a patient with dyspnea Identify specific exam maneuvers that can aid clinical decision-making  Identify exam maneuvers that may not offer more information compared to imaging such as POCUS   Disclosures This episode was made with assistance from the Society of Bedside Medicine and funding from the New York Academy Medicine.  Dr Garibaldi reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.    Citation Masur S, Garibaldi BT, Watto M, Williams P, Brigham S, Berk J.  #236 Physical Exam Series: Approach to Shortness of Breath. The Curbsiders Internal Medicine Podcast. https:/www.thecurbsiders.com/episode-list. Original Air Date October 12,  2020.   References Mochizuki K et al. Importance of respiratory rate for the prediction of clinical deterioration after emergency department discharge: a single-center, case-control study. Acute Med Surg. Nov 2016. doi:10.1002/ams2.252 Sarkar M et al. Physical signs in patients with chronic obstructive pulmonary disease. Lung India. 2019. doi:10.4103/lungindia.lungindia_145_18 Fagan TJ. Letter: Nomogram for Bayes theorem. N Engl J Med. 1975;293(5):257. doi:10.1056/NEJM197507312930513 Simel, David, et al. Rational Clinical Examination, McGraw-Hill Professional Publishing, 2009. ProQuest Ebook Central  McGee, Steven. Evidence-based physical diagnosis [4th edition] Elsevier, 2018. Clinical Key Benbassat, J., Baumal, R. Narrative Review: Should Teaching of the Respiratory Physical Examination Be Restricted Only to Signs with Proven Reliability and Validity?. J GEN INTERN MED 25, 865–872 (2010). https://doi.org/10.1007/s11606-010-1327-8 Al Deeb M et al. Point-of-care ultrasonography for the diagnosis of acute cardiogenic pulmonary edema in patients presenting with acute dyspnea: a systematic review and meta-analysis. Acad Emerg Med. 2014;21(8):843-852. doi:10.1111/acem.12435 Yousefifard et al. Screening Performance Characteristic of Ultrasonography and Radiography in Detection of Pleural Effusion; a Meta-Analysis. Emerg (Tehran). 2016;4(1):1-10. Martindale et al. Diagnosing Acute Heart Failure in the Emergency Department: A Systematic Review and Meta-analysis. Acad Emerg Med. 2016;23(3):223-242. doi:10.1111/acem.12878 Caldentey et al. Prognostic value of the physical examination in patients with heart failure and atrial fibrillation: insights from the AF-CHF trial (atrial fibrillation and chronic heart failure). JACC Heart Fail 2014.. doi:10.1016/j.jchf.2013.10.004   Tags Physical exam, dyspnea, shortness of breath, auscultation, PMI, percussion, heart failure, wheeze, POCUS, COPD, JVD, hepatojugular reflux, observation, asymmetry, Brian Garibaldi, practice, pallor, lung, heart, hands.

We discuss one of the most complex problems we face – Homelessness Hosts: Kelly Doran, MD Audrey Tse, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Homelessness.mp3 Download One Comment Tags: Social Emergency Medicine Show Notes Special Thanks To: Dr. Kelly Doran, MD MHS Ronald O. Perelman Department of Emergency Medicine at NYU Langone Health, NYC Health + Hospitals/ Bellevue ___________________________ References: Doran, K.M.  Commentary: How Can Emergency Departments Help End Homelessness?  A Challenge to Social Emergency Medicine. Ann Emerg Med. 2019;74:S41-S44. Doran, K.M., Raven, M.C. Homelessness and Emergency Medicine: Where Do We Go From Here? Acad Emerg Med. 2018;25:598-600. Salhi, B.A., et al. Homelessness and Emergency Medicine: A Review of the Literature. Acad Emerg Med. 2018;25:577-93. U.S. Department of Housing and Urban Development, Annual Homeless Assessment Report to Congress. Available at: https://www.hudexchange.info/resource/5783/2018-ahar-part-1-pit-estimates-of-homelessness-in-the-us/ U.S. Interagency Council on Homelessness. Home, Together Federal Strategic Plan to Prevent and End Homelessness.

This week we discuss some of the critical issues in preparation, preoxygenation and positioning in RSI. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_54_0_Final_Cut.m4a Download Leave a Comment Tags: 7 Ps, High-flow Nasal Cannula, Intubation, Preoxygenation, RSI Show Notes Read More EM Updates: Intubation Checklist Core EM: Episode 4.0 – Perimortem C-section, Procedural Sedation and Airway Pearls Core EM: Episode 6.0 – Airway Workshops Sales JC et al. The Importance of First Pass Success When Performing Orotracheal Intubation in the Emergency Department. Acad Emerg Med 2013; 20(1): 71-8. PMID: 23574475

This week we discuss some of the critical issues in preparation, preoxygenation and positioning in RSI. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_54_0_Final_Cut.m4a Download Leave a Comment Tags: 7 Ps, High-flow Nasal Cannula, Intubation, Preoxygenation, RSI Show Notes Read More EM Updates: Intubation Checklist Core EM: Episode 4.0 – Perimortem C-section, Procedural Sedation and Airway Pearls Core EM: Episode 6.0 – Airway Workshops Sales JC et al. The Importance of First Pass Success When Performing Orotracheal Intubation in the Emergency Department. Acad Emerg Med 2013; 20(1): 71-8. PMID: 23574475

This week we review a number of controversial topics in SSTI management with a focus on the role of antibiotics in abscess management. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_45_0_Final_Cut.m4a Download Leave a Comment Tags: Abscess, Cellulitis, Controversy, I+D, Irrigation, TMP-SMX Show Notes Core EM: Predictors of failed outpatient cellulitis treatment EM Nerd: The Case of the Pragmatic Wound REBEL EM: Trimethoprim-sulfamethoxazole for uncomplicated skin abscesses EM Lyceum: Abscess, “Answers” References Peterson D et al. Predictors of Failure of Empiric Outpatient Antibiotic Therapy in Emergency Department Patients with Uncomplicated Cellulitis. Acad Emerg Med 2014; 21: 526-31. PMID: 24842503

This week we review a number of controversial topics in SSTI management with a focus on the role of antibiotics in abscess management. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_45_0_Final_Cut.m4a Download Leave a Comment Tags: Abscess, Cellulitis, Controversy, I+D, Irrigation, TMP-SMX Show Notes Core EM: Predictors of failed outpatient cellulitis treatment EM Nerd: The Case of the Pragmatic Wound REBEL EM: Trimethoprim-sulfamethoxazole for uncomplicated skin abscesses EM Lyceum: Abscess, “Answers” References Peterson D et al. Predictors of Failure of Empiric Outpatient Antibiotic Therapy in Emergency Department Patients with Uncomplicated Cellulitis. Acad Emerg Med 2014; 21: 526-31. PMID: 24842503...

This week podcast focuses on esophageal food impaction and pearls + pitfalls in the diagnosis of peds appendicitis. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_21_0_Final.m4a Download Leave a Comment Tags: Appendicitis, Food Impaction, Pediatrics Show Notes REBEL Cast: November 2015: All Vascular Access Episode Tibbling L et al. Effect of spasmolytic drugs on esophageal foreign bodies. Dysphagia 1995; 10(2): 126-7. PMID: 7600855 Samuel M. Pediatric appendicitis score. J Pediatr Surg 2002; 37(6): 877-81. PMID: 12037754 Ross MJ et al. Outcomes of children with suspected appendicitis and incompletely visualized appendix on ultrasound. Acad Emerg Med 2015; 21(5): 538-42. PMID: 24842505

This week podcast focuses on esophageal food impaction and pearls + pitfalls in the diagnosis of peds appendicitis. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_21_0_Final.m4a Download Leave a Comment Tags: Appendicitis, Food Impaction, Pediatrics Show Notes REBEL Cast: November 2015: All Vascular Access Episode Tibbling L et al. Effect of spasmolytic drugs on esophageal foreign bodies. Dysphagia 1995; 10(2): 126-7. PMID: 7600855 Samuel M. Pediatric appendicitis score. J Pediatr Surg 2002; 37(6): 877-81. PMID: 12037754 Ross MJ et al. Outcomes of children with suspected appendicitis and incompletely visualized appendix on ultrasound. Acad Emerg Med 2015; 21(5): 538-42. PMID: 24842505

This bonus podcast is from our Grand Rounds series. Here, Jeremy Faust gives a great talk on the role of Music in Medicine. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_18_1-Music_in_Medicine_feat_Jeremy_Faust_.m4a Download Leave a Comment Tags: Grand Rounds, Music Show Notes References Platz, F. and Kopiez, R., “When the first impression counts: Music performers, audience, and the evaluation of stage entrance behavior”, Musicae Scientiae 17, No. 2 (2013), pp. 167-197 Acad Emerg Med. 2012 Oct;19(10):1166-72. Epub 2012 Oct 4. Predictors of parent satisfaction in pediatric laceration repair. Lowe DA, Monuteaux MC, Ziniel S, Stack AM. Proc Natl Acad Sci U S A. 2013 Sep 3;110(36):14580-5. Epub 2013 Aug 19. Sight over sound in the judgment of music performance. Tsay CJ. Med Educ. 2013 Aug;47(8):842-50.  Music lessons: revealing medicine's learning culture through a comparison with that of music. Watling C, Driessen E, van der Vleuten CP, Vanstone M, Lingard L. The New Yorker. October 3, 2011. Personal Best. Top athletes and singers have coaches. Should you? Atul Gawande. ANZ J Surg. 2013 Jun;83(6):477-80. Epub 2013 Apr 26. Improving the impact of didactic resident training with online spaced education. Gyorki DE, Shaw T, Nicholson J, Baker C, Pitcher M, Skandarajah A, Segelov E, Mann GB. Psychol Sci Public Interest. 2013 Jan;14(1):4-58. Improving Students' Learning With Effective Learning Techniques: Promising Directions From Cognitive and Educational Psychology. Dunlosky J, Rawson KA, Marsh EJ,

This bonus podcast is from our Grand Rounds series. Here, Jeremy Faust gives a great talk on the role of Music in Medicine. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_18_1-Music_in_Medicine_feat_Jeremy_Faust_.m4a Download Leave a Comment Tags: Grand Rounds, Music Show Notes References Platz, F. and Kopiez, R., “When the first impression counts: Music performers, audience, and the evaluation of stage entrance behavior”, Musicae Scientiae 17, No. 2 (2013), pp. 167-197 Acad Emerg Med. 2012 Oct;19(10):1166-72. Epub 2012 Oct 4. Predictors of parent satisfaction in pediatric laceration repair. Lowe DA, Monuteaux MC, Ziniel S, Stack AM. Proc Natl Acad Sci U S A. 2013 Sep 3;110(36):14580-5. Epub 2013 Aug 19. Sight over sound in the judgment of music performance. Tsay CJ. Med Educ. 2013 Aug;47(8):842-50.  Music lessons: revealing medicine's learning culture through a comparison with that of music. Watling C, Driessen E, van der Vleuten CP, Vanstone M, Lingard L. The New Yorker. October 3, 2011. Personal Best. Top athletes and singers have coaches. Should you? Atul Gawande. ANZ J Surg. 2013 Jun;83(6):477-80. Epub 2013 Apr 26. Improving the impact of didactic resident training with online spaced education. Gyorki DE, Shaw T, Nicholson J, Baker C, Pitcher M, Skandarajah A, Segelov E, Mann GB. Psychol Sci Public Interest. 2013 Jan;14(1):4-58. Improving Students' Learning With Effective Learning Techniques: Promising Directions From Cognitive and Educational Psychology. Dunlosky J, Rawson KA, Marsh EJ, Nathan MJ, Willingham DT.