Podcast appearances and mentions of justin morgenstern

There are many nuances in the management of patients with pulmonary embolism in cardiac arrest, peri-arrest or simply in shock: We need to optimize oxygenation and airway management, hemodynamic support, acid/base management, thrombolysis and/or catheter-directed therapies that Anton dives into with guest experts Dr. Lauren Westafer, Dr. Bourke Tillmann and Dr. Justin Morgenstern... EM Cases is proudly FOAMEd - Please consider a donation: https://emergencymedicinecases.com/donation/

In this month's EM Quick Hits podcast: Zafar Qasim & Andrew Petrosoniak on whole blood transfusion in trauma, Justin Morgenstern on calcium pre-treatment to prevent diltiazem-induced hypotension, Kiran Rikhraj on dynamic LV outflow tract obstruction, Anand Swaminathan on resuscitative thoracotomy, Andrew Tagg on uterine casts, and Jesse McLaren on scale & proportionality in occlusion MI ECG interpretation. **Please support EM Cases to continue to be free open access by making a donation: https://emergencymedicinecases.com/donation/

How do you predict which intermediate-risk patients will suddenly deteriorate? What role do risk scores, biomarkers, imaging, and hemodynamics play in decision-making? Should these patients receive anticoagulation alone, or is thrombolysis warranted? When should you consider catheter-directed or surgical interventions? This podcast focuses us to think critically about risk stratification, early interventions and escalation in care in PE. We include an algorithm in the show notes. Not all patients fit neatly into classification boxes, making clinical judgment crucial. Join Dr. Lauren Westafer, Dr. Justin Morgenstern, Dr. Bourke Tillman and Anton as they explore the key decision points, pitfalls, and lifesaving strategies for managing intermediate-risk PE in the ED...

On this month's EM Quick Hits podcast: Stephen Freedman on pediatric bloody diarrhea, S-TEC and hemolytic uremic syndrome, Justin Morgenstern on the evidence for IM epinephrine in out of hospital cardiac arrest, Matthew McArther on recognition and ED management of dengue fever, Andrew Petrosoniak on imaging decision making in trauma in older patients, Brit Long & Michael Gotlieb on recognition and management of TTP...Please consider a donation to EM Cases to help ensure continued Free Open Access Medical Education here: https://emergencymedicinecases.com/donation/

On this month's EM Quick Hits podcast: Ross Prager on TEE in cardiac arrest, Justin Morgenstern on nebulized ketamine for analgesia in the ED, Hans Rosenberg & Krishin Yadav on standardizing cellulitis management, Mathew McArther on latest studies on subcutaneous insulin protocols in DKA, Jennifer C. Tang on documenting differential diagnoses medicolegal tips...

In this month's EM Quick Hits podcast: Andrew Petrosoniak on the role of vasopressors in the hemorrhaging trauma patient, Megan Landes on providing HIV PEP and PrEP in the ED, Justin Morgenstern & George Kovacs on the PREOXI trial and evidence for pre-oxygenation with NIPPV before intubation in RSI, Brit Long on recognition and management of blast crisis in the ED, and Leah Flanagan & Liam Loughrey on the rise of nitrous oxide toxicity...

Reference: Knack et al. Early Physician Gestalt Versus Usual Screening Tools for the Prediction of Sepsis in Critically Ill Emergency Patients. Ann Emerg Med 2024 Date: July 25, 2024 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called www.First10EM.com Case: Your hospital is running Morbidity and Mortality (M&M) […] The post SGEM#448: More than A Feeling – Gestalt vs CDT for Predicting Sepsis first appeared on The Skeptics Guide to Emergency Medicine.

In this month's EM Quick Hits podcast: Justin Morgenstern on the first RCT of high dose nitroglycerin in SCAPE, Andrew Neill on Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) indications and evidence, Brit Long on indications for CT in suspected diverticulitis, Tahara Bhate on Central Retinal Artery Occlusion (CRAO) and diagnostic error, Matthew McArthur on penicillin allergy labels, myths and penicillin challenges, and Susan Lu on how ED physician personality influences patient outcomes... The post EM Quick Hits 56 – Nitroglycerin in SCAPE, REBOA, Diverticulitis Imaging, CRAO, Penicillin Allergy, Physician Personality appeared first on Emergency Medicine Cases.

On this episode I discuss the modern scientific and practical approach to massive haemorrhage in trauma with Dr Justin Morgenstern 

Are Clinical Decision Rules (Tools) helping us make better calls in the ED? Are they making us better?  Do they lead to better outcomes for our patients? Dr Justin Morgenstern and I go over the evidence and the future of ED decision making.

In this month's EM Quick Hits podcast: Sarah Reid on an approach to Infant Vomiting, Brit Long on Orbital Cellulitis essentials, Justin Morgenstern on the PATCH trial - Prehospital TXA in Trauma, Christina Shenvi on Prevention and Treatment of Delirium, Jason Hine on Procedural Skills Decay, Aaron Billin on Altitude Sickness... The post EM Quick Hits 52 Infant Vomiting, Orbital Cellulitis, Prehospital TXA in Trauma, Prevention and Treatment of Delirium, Procedural Skills Decay, Altitude Sickness appeared first on Emergency Medicine Cases.

On this month's EM Quick Hits podcast David Carr on differential diagnosis of normal unenhanced CT renal colic, Leeor Sommer on recognition and management of perichondritis and auricular abscess, Suzanne Schuh on IV magnesium sulphate for pediatric asthma, Jess McLaren on Occlusion MI ECG interpretation requiring cath lab activation and Justin Morgenstern on update on steroids for pneumonia... The post EM Quick Hits 50 Normal Unenhanced CT Renal Colic DDx, Perichondritis, Magnesium in Pediatric Asthma, Steroids for Pneumonia, OMI Cath Lab Activation appeared first on Emergency Medicine Cases.

On todays episode we were able to talk with the Director of Player Personnel for the Appalachian League Justin Morgenstern. The Appy League is a college woodbat league and a part of the MLB/USA Baseball Prospect Development Pipeline. Morgenstern has an extensive background in scouting, most recently scouting for the Philadelphia Phillies from 2016-2022.We hear about Justin's background, how technology within the game has evolved in recent years, and a couple player stories from guys that he has scouted.2023 Opening Day for the Appalachian League is June 6th. Follow us on Twitter @BLDPod or send us an email bigleaguedreaming@gmail.com

Date: March 28, 2023 Reference: Fowler et al. Objective assessment of sleep and fatigue risk in emergency medicine physicians. AEM March 2023 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called www.First10EM.com Case: You arrive at 7am to relieve your colleague after a night shift. You find her at […] The post SGEM#399: I'm So Tired – Emergency Medicine and Fatigue first appeared on The Skeptics Guide to Emergency Medicine.

Date: February 1, 2023 Reference: Wolfrum et al. Temperature Control After In-Hospital Cardiac Arrest: A Randomized Clinical Trial. Circulation. September 2022 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called www.First10EM.com Case: You are working an overnight shift at a small rural hospital. You are tidying your things […] The post SGEM#391: Is it Time for a Cool Change (Hypothermia After In-Hospital Cardiac Arrest)? first appeared on The Skeptics Guide to Emergency Medicine.

In this EM Quick Hits podcast: Justin Morgenstern on fluids in pancreatitis, Leeor Sommer on nasal fractures, Christina Shenvi on delirium, Sheldon Cheskes and Rohit Mohindra on Dose VF, and Noor Khatib and Kari Sampsel on intimate partner violence... The post EM Quick Hits 44 Fluids in Pancreatitis, Nasal Fractures, Delirium, DOSE VF, Intimate Partner Violence appeared first on Emergency Medicine Cases.

Date: October 27th, 2022 Reference: Hayashi et al. Comparative efficacy of sedation or analgesia methods for reduction of anterior shoulder dislocation: A systematic review and network meta-analysis. AEM October 2022 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called First10EM.com   Case: A 19-year-old man presents to the emergency […]

We're all guilty of it, basing decisions on the most recent event. It's surely part of our wiring. The question is - what do we do about it? In this episode, Justin Morgenstern breaks down availability bias: what it is, how it shows up in life and medical practice, the difference between learning and bias, research showing availability bias happening in real time, and ways to turn availability bias from a bug into a feature.     Guest Bio: Justin Morgenstern is a community emergency physician with a passion for education, resuscitation, and evidence based medicine, Purveyor of the amazing First10EM blog, Justin works in the Greater Toronto Area.  On a personal note, Justin and I met years ago at a conference in the Bahamas. He was in the audience and was such an incredible contributor to a group conversation that I had him come up on stage and be a panel member. Since then, I've found that he is a rare mix of humility, genius, and kindness.   For full show notes visit our podcast page Interested in one-on-one coaching? Learn more at roborman.com To support the show - our Patreon site is https://www.patreon.com/stimuluspod   We discuss: Availability Bias and how it relates to everyday decision making.  What is availability bias; Where this shows up in clinical practice; Learning is not availability bias; Whether more testing is the right path for subtle presentations of life threatening diseases; Testing thresholds; Tips for avoiding availability bias in our practices; Real world example of availability bias; Justin's tools for addressing bias; Ways to hack the bias.

We're all guilty of it, basing decisions on the most recent event. It's surely part of our wiring. The question is - what do we do about it? In this episode, Justin Morgenstern breaks down availability bias: what it is, how it shows up in life and medical practice, the difference between learning and bias, research showing availability bias happening in real time, and ways to turn availability bias from a bug into a feature.     Guest Bio: Justin Morgenstern is a community emergency physician with a passion for education, resuscitation, and evidence based medicine, Purveyor of the amazing First10EM blog, Justin works in the Greater Toronto Area.  On a personal note, Justin and I met years ago at a conference in the Bahamas. He was in the audience and was such an incredible contributor to a group conversation that I had him come up on stage and be a panel member. Since then, I've found that he is a rare mix of humility, genius, and kindness.   For full show notes visit our podcast page Interested in one-on-one coaching? Learn more at roborman.com To support the show - our Patreon site is https://www.patreon.com/stimuluspod   We discuss: Availability Bias and how it relates to everyday decision making.  What is availability bias; Where this shows up in clinical practice; Learning is not availability bias; Whether more testing is the right path for subtle presentations of life threatening diseases; Testing thresholds; Tips for avoiding availability bias in our practices; Real world example of availability bias; Justin's tools for addressing bias; Ways to hack the bias.

In this month's EM Quick Hits podcast Justin Morgenstern & Eddy Lang discuss the problem of overdiagnosis in EM, Anand Swaminathan's approach to indications and dosing of thrombolytics for submassive (intermediate risk) pulmonary embolism, Tahara Bhate's QI Corner on a patient with unexplained shortness of breath, Brit Long on emergency treatment of the bleeding hemophilia patient... The post EM Quick Hits 39 Overdiagnosis, Lytics for Submassive PE, Pericardial Effusion, Hemophilia Treatment appeared first on Emergency Medicine Cases.

Date: May 24th, 2022 Reference: Broder et al. Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE) 2: Low-Risk, Recurrent Abdominal Pain in the Emergency Department. AEM May 2022 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called First10EM.com Case: A 33-year-old male presents to […]

In this Journal Jam podcast we dig deep into the science of FDA-approved outpatient medications for COVID with 3 critical appraisal masters: Dr. Andrew Morris, Dr. Rohit Mohindra and Dr. Justin Morgenstern. What is the evidence for the neutralizing monoclonal antibody medications like Sotrovimab? The nucleoside analogs like Remdesivir and Paxlovid? The inhaled corticosteroids like Budesonide and Ciclesonide? The SSRIs like Fluvoxamine? As you'll hear, there are many ways to interpret the data and a variety of philosophies on prescribing medications that have not had enough time to be studied adequately in a pandemic where millions of lives have been lost and we do not have much to offer patients to reduce morbidity and mortality... The post JJ 20 Outpatient Medications for COVID-19 appeared first on Emergency Medicine Cases.

Date: January 22nd, 2022 Reference: Yu et al. Inhaled budesonide for COVID-19 in people at high risk of complications in the community in the UK (PRINCIPLE): a randomised, controlled, open-label, adaptive platform trial. Lancet 2021 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called First10EM.com. Case: A 65-year-old woman […]

Date: December 13th, 2021 Reference: Lee et al. Addressing gender inequities: Creation of a multi-institutional consortium of women physicians in academic emergency medicine. AEM December 2021 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called First10EM.com Case: At the completion of her 1-month elective in your rural emergency department […]

In this months EM Quick Hits podcast: The mighty return of Carr's Cases! Sarah Reid on differentiating septic arthritis from transient synovitis in pediatric limp, Anand Swaminathan on managing tracheostomy complications in the ED, Nour Khatib on rural medicine and ethylene glycol poisoning, Justin Morgenstern on RCTs for ketamine in patients with severe agitation... The post EM Quick Hits 34 Carr's Case, Septic Arthritis vs Transient Synovitis, Managing Tracheostomies, Ethylene Glycol Poisoning, Ketamine for Agitation appeared first on Emergency Medicine Cases.

Merhaba Acil servislerimizde nadiren de olsa görebileceğimiz ve hızlı şekilde müdahale edilmesi gereken bir göz acilinden bahsetmek istiyorum. Birkaç özel durumda hızlıca müdahale edilmesi hastanın gözünü kaybetmesini engelleyebilir, bunlardan biri de orbital kompartman sendromu (OKS). Bu yazıda orbital kompartam sendromu ve  acil tıp doktorlarının yetkin olması gereken müdahalelerden biri olan lateral kantatomi işleminden bahsedeceğim. Orbital Kompartman Sendromu Künt fasial travmalar sonrasında orbital kanamalar ortaya çıkabilir. Bu kanamalar lokalizasyonuna göre preseptal ve postseptal olarak sınıflandırılır. Preseptal kanamalar genellikle iyi seyirlidir ve görme üzerine kalıcı bir hasar bırakmazlar. Postseptal kanamalar ise glob posteriorundaki potansiyel alanda giderek büyüyerek basınç artışına neden olabilir. Glob, artan basıncın etkisi ile öne doğru itilir ve göz kapakları ile sınırlanan alan içerisinde sıkışır. Göz içi basınç artmaya başlar. Acil servislerde göz içi basınç ölçümü için tonometri cihazları bulunmalı ve fasial travma hastalarında ölçüm yapılmalı ve dökümante edilmelidir. Normal göz içi basıncı 12-22mmHg arasındadır. Orbital kompartman sendromunda bu değer 30mmHg'nın üzerine çıkar. İntraorbital basıncın hızla artması ve arteryal basıncın üzerine çıkması sonucunda dolaşım bozulur veorbital sinir ve retinada iskemi gelişir. . İntraorbital basınç 40 mm Hg üzerine çıktığında lateral kantatomi ve kantoliz endikasyonu vardır. Orbital kompartman sendromu tanısı klinik olarak konur, özellikle basınç 40mmHg üzerinde ise tanıyı doğrulamak için orbital bt çekilmesi ile zaman kaybedilmemelidir. Görme kaybı, artmış göz içi basıncı, proptozis, oftalmopleji, gözün retropulsiyona direnç göstermesi ve göz kapaklarının sert ve gergin olması OKS'nun klinik bulgularıdır. OKS'den şüphelenildiğinde göz hastalıklarına konsültasyon önemlidir ancak kısa sürede kalıcı görme kaybı yaşanabileceği için müdahale acil servis hekimleri tarafından yapılmalıdır. Lateral Kantatomi ve Kantoliz Ekipman: Cilt antiseptiği, Lokal anestezik ilaç ve şırınga, düz hemostat forseps, cerrahi makas. Prosedür Hastaya işlem hakkında bilgi verilir ve onam alınır.Tercihen prosedürel sedo-analjezi önerilir.Cilt antisepsisi sağlanır.Lokal anestezik madde lateral kantus bölgesine enjekte edilir. Düz hemostat forseps ile lateral kantus 1 dakika boyunca sıkıştırılır. Bu işlem kanamayı azaltmak için önemlidir. Hemostat forsepsi ile baskı uygulanan hat üzerinden cerrahi makas ile tam kat kesilir. Kesinin uzunluğu 1-2 cm kadar olmalıdır. Kesi sonrasında serbestleşen alt göz kapağı forseps ile tutulur ve ön-aşağıa doğru retrakte edilir. Bu sayede lateral kantal ligamana ulaşılır. Bu ligamanın inferior ve superior krusları bulunur. Genellikle inferior krusun kesilmesi orbital basıncın düşmesi için yeterli olmaktadır. https://www.youtube.com/watch?v=tgQaKVGynFA&t=17s https://first10em.com/lateral-canthotomy/ Bu yazıdaki görselleri kullanmam için izin veren Asistant Professor Justin Morgenstern'e ve First10em.com'a çok teşekkür ederim. Thank you very much for letting me use those illustrations at your post, Justin Morgenstern and First10em.com.

In this EM Quick Hits: Walter Himmel on new diseases associated with immune checkpoint inhibitors, Leeor Sommer on the evolution of epiglottitis - adult epiglottitis clinical pearls, Sarah Reid on how to pick up HSP, Anand Swaminathan on an approach to management of heat stroke, Justin Morgenstern on the association between pediatric Bell's palsy and leukemia... The post EM Quick Hits 32 Checkpoint Inhibitors, Adult Epiglotitits, HSP, Heat Stroke, Bell's Palsy and Leukemia appeared first on Emergency Medicine Cases.

In this month's EM Quick Hits podcast: Justin Morgenstern on the evidence for NG tubes in SBO, Jesse MacLaren on recognition of hyperacute T-waves vs other causes of tall T-waves, Brit Long on malignant otitis externa clinical pearls, Salim Rezaie on the value of CCTA in NSTEMI, Justin Morgenstern on the value of CCTA in low-risk chest pain, Hans Rosenberg on how to use the Canadian Syncope Score and it's validation in Canada... The post EM Quick Hits 31 NG Tubes in SBO, Hyperacute T-Waves, Malignant Otitis Externa, CCTA in NSTEMI and Low-risk Chest Pain, Canadian Syncope Score appeared first on Emergency Medicine Cases.

In this month's EM Quick Hits podcast: Arun Sayal on the nuances of assessment for scaphoid fractures, Justin Morgenstern on the evidence for therapeutic hypothermia post-arrest and the TTM2 trial, Sarah Reid on HEADS-ED mental health screening tool for children, youth and young adults, Andrew Petrosoniak on pelvic trauma and pelvic binder tips and pitfalls, Michelle Klaiman on what we need to know about Kratom and Anand Swaminathan on why femoral lines are often a great central line choice... The post EM Quick Hits 30 Scaphoid Fracture, Therapeutic Hypothermia, HEADS-ED, Pelvic Trauma, Kratom, Femoral Lines appeared first on Emergency Medicine Cases.

Date: July 1st, 2021 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called First10EM.com. Reference: Dankiewicz et al: TTM2 Trial Investigators. Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest. NEJM 2021 Case: A 58-year-old man collapsed in front of his family. When paramedics arrived, they found him to be in […]

In this month's EM Quick Hits podcast: Anand Swaminathan on vasopressor failure, Brit Long and Michael Gottlieb on aspleic considerations, Sarah Reid on a bronchiolitis update and evolving patterns in the COVID era, Hans Rosenberg and Lindsay Cheskes on ICD electrical storm, Justin Morgenstern on night shift tips... The post EM Quick Hits 29 Vasopressor Failure, Asplenic Considerations, Bronchiolitis Update, ICD Electrical Storm, Night Shift Tips appeared first on Emergency Medicine Cases.

Liz Crowe interviews Justin Morgenstern about curiosity in medicine. Curiosity is the most important thing that Justin brings to medicine. Why? Because he believes that you can't be a great clinician or educator without first being curious. The future of medicine is based on asking questions – what if? In the critical care environment, when you are under pressure, your brain will often resort to the first solution that comes to mind. Being curious helps us double check our decisions. What could I be missing? What else could I be doing? We often forget to ask about the person sitting in front of us.  One or two minutes of curiosity can change an entire management plan. Curiosity makes you a better practitioner. For more head to: codachange.org/podcasts

Date: April 30th, 2021 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the excellent #FOAMed project called First10EM.com. He is also one of the SGEM Hot Off the Press Faculty. Reference: Donaldson et al. Review article: Why is there still a debate regarding the safety and efficacy of intravenous thrombolysis in the […]

In this month's EM Quick Hits podcast: Justin Morgenstern on colchicine for COVID pneumonia, Victoria Myers on sodium bicarbonate in cardiac arrest, Brit Long on troponin in chronic kidney disease, Michelle Klaiman on GHB overdose, Ian Walker on iloprost for frostbite, Sarah Reid on tips on avoiding patient and parent complaints.... The post EM Quick Hits 27 Colchicine for COVID, Bicarb in Cardiac Arrest, Troponin in CKD, GHB Withdrawal, Iloprost for Frostbite, Patient Complaints appeared first on Emergency Medicine Cases.

In this special episode, Dr. Justin Morgenstern of First10EM joins us to discuss a simplified 6-step approach to primary literature. His strategy will give you the tools to feel more comfortable with taking an active role in reading and critically evaluating the literature. Step 1: How do I find a paper to read? Step 2: Is this paper worth reading? Step 3: Read the paper Step 4: Interpret the paper (stats are less important than you think) Step 5: Ask for help Step 6: Apply the research — Thanks for listening! If you enjoy our content, consider donating to our Patreon at https://bit.ly/3n0sklh. — Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia. Email us at depthofanesthesia@gmail.com. Music by Stephen Campbell, MD. — References Justin Morgenstern, "Evidence Based Medicine is Easy", First10EM blog, January 8, 2018. Available at: https://first10em.com/ebmiseasy/.

In this month's EM Quick Hits podcast: Justin Morgenstern on which patients to consider cerebral venous thrombosis in, Maria Ivankovic on diphenhydramine alternatives, Brit Long on abdominal compartment syndrome, Sarah Reid on neonatal "constipation" - when to worry, and Anand Swaminathan on intubating the patient with metabolic acidosis... The post EM Quick Hits 25 Cerebral Venous Thrombosis, Diphenhydramine Alternatives, Abdominal Compartment Syndrome, Neonatal Constipation, Intubating Metabolic Acidosis appeared first on Emergency Medicine Cases.

Date: December 16th, 2020 Reference: Butler et al. Oseltamivir plus usual care versus usual care for influenza-like illness in primary care: an open-label, pragmatic, randomised controlled trial. The Lancet 2020 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called First10EM.com. He has a great new blog post about how […]

Is it safe to use topical local anaesthetic for the short term relief of the pain from a corneal abrasion?  Dr Rob Evison discusses the evidence.   The First10EM review by Dr Justin Morgenstern - https://first10em.com/ebm-lecture-handout-2-topical-anaesthetics-fo-corneal-abrasions/ Fraser R et al.  Topical Anaesthetic in the treatment of corneal epithelial defects:  What are the risks?  Aust J Gen Pract Vol 48 Issue 8 August 2019https://pubmed.ncbi.nlm.nih.gov/31370122/ Waldman N et al.  An Observational study to determine whether routinely sending patients home with a 24-hour supply of topical tetracaine from the emergency department for simple corneal abrasion pain is potentially safe.  Annals Emergency Medicine 2018 June;71(6):767-778 https://pubmed.ncbi.nlm.nih.gov/28483289/ Shipman S et al.  Short term topical tetracaine is highly efficacious for the treatment of pain caused by corneal abrasions: double-blind, randomised clinical trial.  Annals of Emergency Medicine 2020 Oct 27 online https://pubmed.ncbi.nlm.nih.gov/33121832/     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

In this month's EM Quick Hits podcast we have Salim Rezaie on clinical probability adjusted D-dimer for pulmonary embolism, Bourke Tillmann on ARDS for the ED Part 2, Brit Long & Michael Gottlieb on pharyngitis mimics, Justin Hensley on the many faces of barotrauma, Hans Rosenberg & Peter Johns on assessment of continuous vertigo and Justin Morgenstern & Jeannette Wolfe on gender-based differences in CPR... The post EM Quick Hits 23 – Clinical Probability Adjusted D-dimer, ARDS Part 2, Pharyngitis Mimics, Barotrauma, Vertigo, CPR Gender-Based Differences appeared first on Emergency Medicine Cases.

Date: October 21st, 2020 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician, creator of the excellent #FOAMed project called First10EM.com and a member of the #SGEMHOP team. Reference: Derkenne et al. Mobile Smartphone Technology Is Associated With Out-of-hospital Cardiac Arrest Survival Improvement: The First Year “Greater Paris Fire Brigade” Experience. AEM Oct 2020. Case: You are waiting in […]

With so much talk about COVID-19 and frequent updates to protocols and guidelines, is COVID-19 affecting the way physicians diagnose? In this podcast, two physicians describe how they misdiagnosed a patient back in April of this year. The patient presented with classic COVID-19 symptoms, but her diagnosis turned out to be something entirely different. And it took the physicians quite a lot of time to get to the correct diagnosis. Dr. Alex Kobza and Dr. Brandon Budhram are both second year internal medicine residents at McMaster University in Hamilton, Ontario and they co-wrote a practice article about the case with Dr. Naufal Mohammed. The article is published in CMAJ: www.cmaj.ca/lookup/doi/10.1503/cmaj.201426 You'll also hear from Dr. Justin Morgenstern, an emergency doctor who has spent a lot of time analyzing physician decision-making. He digs into the many factors that influence the way doctors diagnose, including cognitive bias. He discusses how the COVID-19 pandemic might be influencing physicians decision-making and diagnosis. His website is First10EM https://first10em.com/who-am-i/ ----------------------------------- This podcast is brought to you by Health Match BC, a free health professional recruitment service funded by the Government of British Columbia. Health Match BC is currently recruiting for physicians of all specialties on behalf of BC's publicly funded health employers. Visit www.healthmatchbc.org for more information and to speak with one of the recruitment consultants. ----------------------------------- This podcast episode is brought to you by Shingrix. Learn more at: www.shingrix.ca/en-ca/index.html ----------------------------------- Subscribe to CMAJ Podcasts on Apple Podcasts, iTunes, Google Play, Stitcher, Overcast, Instacast, or your favourite aggregator. You can also follow us directly on our SoundCloud page or you can visit www.cmaj.ca/page/multimedia/podcasts.

In this month's EM Quick Hits podcast, Anand Swaminathan on postpartum hemorrhage, Justin Morgenstern on phenobarbital in pediatric status epilepticus, Michelle Klaiman on managed alcohol programs, Andrew Petrosoniak on traumatic cardiac arrest, Brit Long on cholangitis pearls and pitfalls and Bourke Tillman on ED approach to ARDS... The post EM Quick Hits 22 Postpartum Hemorrhage, Phenobarbital in Status Epilepticus, Managed Alcohol Programs, Traumatic Cardiac Arrest, Cholangitis, ED Approach to ARDS appeared first on Emergency Medicine Cases.

Welcome back for another month of nerdy Nirvana with Dr Justin Morgenstern. This month on the journal club we cover TXA for GI, Dex for COVID, pinky ladies (again) and haloperidol for headaches... plus a bunch of other goodies that ust might make your job easier.

Salim Rezaie on HALT-IT trial for TXA in unstable GI bleed, Sarah Reid on pediatric DKA update in fluid management and cerebral edema, Hans Rosenberg on POCUS in shoulder dislocations via CJEM, Arun Sayal on Lisfranc injury pearls and pitfalls, Justin Morgenstern on RECOVERY Trial for Dexamethasone in COVID pneumonia, Walter Himmel on getting what you need from consultants... The post EM Quick Hits 21 TXA in GI Bleed, Pediatric DKA, POCUS for Shoulder Dislocations, Lisfranc Injuries, Dexamethasone for COVID Pneumonia, Consultation Tips appeared first on Emergency Medicine Cases.

Date: July 13th, 2020 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the excellent #FOAMed project called First10EM.com. He has a great new blog post about increasing diversity in medicine using something called the BSAP approach and an interesting Broome Doc podcast with Dr. Casey Parker called EBM 2.0.   Reference: Ebell et […]

Justin Morgenstern on imaging choices in renal colic, Hanni Stoklosa on recognition and management of human trafficking, Rohit Mohindra on management of atrial fibrillation during COVID-19, Anand Swaminathan on transvenous pacemaker placement, Rob Simard on COVID-19 lung POCUS, Brit Long on COVID-19 dermatology and Sarah Foohey & Paul Koblic on virtual simulation... The post EM Quick Hits 20 Imaging Renal Colic, Human Trafficking, Atrial Fibrillation During COVID, Transvenous Pacemaker Placement, COVID Lung POCUS, COVID Derm, Virtual Simulation appeared first on Emergency Medicine Cases.

What is the best imaging for suspected renal colic?  And do you have easy access to that imaging? Today we chat with Dr David Sorrell about a recent post by Justin Morgenstern on First10EM about imaging in suspected renal colic.  But knowing what test is best is one thing; getting access to that test is another thing altogether. https://first10em.com/imaging-for-renal-colic/   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 ScoreSquad   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 our fourth webinar and journal club reviewing recent research and featuring COVID-19 updates, hosted by the University of Manchester, Manchester Royal Infirmary and Royal College of Emergency Medicine in collaboration with St Emlyn's.   The live event tool place on Tuesday 5th May at 11.30am BST (10.30am GMT).    The panel was again be hosted by Rick Body The panel includes Prof Paul Klapper (Professor of Clinical Virology), Dr Charlie Reynard (NIHR Clinical Research Fellow), Dr Anisa Jafar (Academic Clinical Lecturer), Prof Pam Vallely (Professor of Medical Virology), Prof Simon Carley and special guest Justin Morgenstern to discuss six papers about COVID-19 infection.   There will be another COVID 19 Journal Club next week (Tuesday 12th May at 11am).   References 1. He X, Lau EHY, Wu P, et al. Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med. Published online April 15, 2020. doi:10.1038/s41591-020-0869-5   2. Bahl P, Doolan C, de Silva C, Chughtai AA, Bourouiba L, MacIntyre CR. Airborne or Droplet Precautions for Health Workers Treating Coronavirus Disease 2019? The Journal of Infectious Diseases. Published online April 16, 2020. doi:10.1093/infdis/jiaa189.   3. Wang Y, Zhang D, Du G, et al. Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. The Lancet. Published online April 2020. doi:10.1016/s0140-6736(20)31022-9   4. Rajendran K, Narayanasamy K, Rangarajan J, Rathinam J, Natarajan M, Ramachandran A. Convalescent plasma transfusion for the treatment of COVID‐19: Systematic review. J Med Virol. Published online May 2020. doi:10.1002/jmv.25961   5. Tedeschi S, Giannella M, Bartoletti M, et al. Clinical impact of renin-angiotensin system inhibitors on in-hospital mortality of patients with hypertension hospitalized for COVID-19. Clinical Infectious Diseases. Published online April 27, 2020. doi:10.1093/cid/ciaa492   6. Docherty AB, Harrison EM, Green CA, et al. Features of 16,749 hospitalised UK patients with COVID-19 using the ISARIC WHO Clinical Characterisation Protocol. Published online April 28, 2020. doi:10.1101/2020.04.23.20076042   Podcast edited from a live webinar by Izzy Carley 

Justin Morgenstern on watchful waiting for large spontaneous pneumothoraces, Michelle Klaiman on mirco-dosing buprenorphine for opiate use disorder, Arun Sayal on the practical application of CRITOE in pediatric elbow fractures, Jeff Perry on The Canadian TIA Score, Sarah Reid on updated pediatric surviving sepsis guidelines, Salim Rezaie (Best of REBELEM) on safety of vasopressor administration through peripheral IVs... The post EM Quick Hits 18 Conservative Management Pneumothorax, Microdosing Buprenorphine, Practical Use of CRITOE, Canadian TIA Score, Pediatric Surviving Sepsis Guidelines, Safety of Peripheral Vasopressors appeared first on Emergency Medicine Cases.

Drs. Sara Gray, Emily Austin, Chris Keefer, Justin Morgenstern, Sarah Reid, Chris Hicks, Peter Brindley and Andrew Cameron share their experience with the COVID-19 pandemic and offer some practical tips on human factors, pandemic airway checklist, deliberate practice airway safety course, pediatric COVID management considerations, and Sara Gray's 4 step COVID wellness program... The post EM Quick Hits 15 – COVID-19 Practical Tips, Pediatric COVID and Human Factors appeared first on Emergency Medicine Cases.

Salim Rezaie on single syringe adenosine for SVT, Sarah Reid on pertussis pearls, Elisha Targonsky on management of hyperemesis gravidarum , Joe Nemeth on the utility of hypertension as a risk factor in EM, Justin Morgenstern on tramadol myths, Reuben Strayer on ketamine only breathing intubation (KOBI)... The post EM Quick Hits 13 – One Syringe Adenosine, Pertussis Pearls, Hyperemesis Gravidarum, Tramadol, Hypertension Myths, KOBI appeared first on Emergency Medicine Cases.

What mimics cellulitis?  We ask Dr Amanda Oakley, Consultant Dermatologist, Adjunct Associate Professor at Auckland University and founder of Dermnet. https://www.dermnetnz.org/topics/cellulitis-mimics/   In case you missed our chat to Dr Justin Morgenstern on the use of IV versus PO antibiotics for cellulitis - check it out here https://rnzcuc.podbean.com/e/cme-interview-iv-versus-po-antibiotics-for-cellulitis-with-dr-justin-morgenstern/     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 ScoreSquad   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

The Journal Club is back with Justin Morgenstern and I dissecting and disputing 10 papers over an hour. Lots of Cardiology, some fractures, we answer that question: "Does saying 'QUIET' in ED make it louder?"... #FOAMed

In this EM Quick Hits podcast we have Paul Dorion on immediate cardioversion vs rate control/delayed cardioversion for atrial fibrillation, Justin Morgenstern & Justin Hensley on emergency management of snake bites, Brit Long on reliability of clinical features in the diagnosis of ovarian torsion, Michelle Klaiman on emergency management of crystal methamphetamine use disorder, Hans Rosenberg & Rob Ohle on workup of suspected aortic dissection, and Anand Swaminathan on epinephrine and magnesium sulphate in severe asthma... The post EM Quick Hits 12 AFib Early vs Delayed Cardioversion, Snake Bites, Ovarian Torsion Myths, Crystal Meth, Aortic Dissection, Severe Asthma Meds appeared first on Emergency Medicine Cases.

Show Notes for Episode Twelve of seX & whY: Sex and Gender Differences in CPR Part 3 Host: Jeannette Wolfe Guest: Dr Justin Morgenstern Here is a link to Justin Morgenstern's awesome First10EM blog site where you can find an excellent review of the two papers that we discussed today: Perman's DNR paper and Huded's Cleveland Clinic Study on gender gaps in 30 day survival after ST elevation myocardial infarctions. Here are some take home points for this podcast:  We don't know what we don't study and when we don't consider sex and gender as legitimate variables, we can inadvertently miss opportunities to improve the health of all of our patients. There appears to be lots of sex-based differences in cardiac electrophysiology females are more prone to AV nodal re-entrant arrhythmias, sick sinus syndrome, prolonged QTc and postural orthostatic tachycardia syndrome males are more prone to AV block, early repolarization, Brugada's syndrome, accessory pathway-mediated arrythmias, idiopathy ventricular arrhythmias and dangerous arrythmias associated with arrhythmogenic right ventricular cardiomyopathies In many ways, biological sex represents a much “cleaner” variable to study in that most of us have a sex specific chromosomal pairing and hormonal cocktail that allows us to be more easily placed into a binary male or female category. Biological sex differences are often detected and treated by tweaking technology- adjusting the results of a blood test or using a different type of imaging modality to account for sex based physiologically differences. Biological sex is akin to the variable of age- its importance is related to context. Although a 15 year and 50-year-old may get the same evaluation for an ankle sprain they should not get the same evaluation for chest pain. Similarly, how females and males react to any particular treatment may or may not be associated with a clinically important difference. As the science of earnestly studying males and females side by side is still so new, we are just beginning to understand where differences actually exist and in what contexts they are clinically relevant. As the influence of gender can be quite subtle and often involves many touchpoints, recognizing and fixing gender-based differences can be challenging. For example, here is how an individual's gender might influence what happens to them if they have a heart attack. Whether they live alone If and when they call an ambulance If they come in by car, how quickly they are triaged Where they are geographically placed in the department How they describe their symptoms How their symptoms are perceived by providers (which in turn may be confounded by provider gender) How quickly an EKG is done How comfortable they are with procedural consent How quickly they go to the cath lab When and what type of medications they are prescribed Who they are referred to for follow up Whether they are compliant with their new meds or appointments Whether they are referred to and participate in cardiac rehab Currently, I suspect that most of us in medicine would likely acknowledge that there are some legitimate examples out there of gender and race- based health inequities. The next step, however, requires an acknowledgement that those inequities are not just happening somewhere else, but that they have also likely creeped into our own practices. This can be difficult because it directly threatens our explicit belief that we deliver “the same” excellent care to all of our patients. Recognizing and mitigating gender disparities, especially those related to implicit bias, requires deep self-reflection along with an individual and organizational commitment to actually want things to change. Solutions include wide-spread “no-blame” educational forums and the development of technical safeguards to help reduce unintentional bias. For example, the creation of default “opt in” disease specific order sets and operational checklists. Here is a table that shows outcome data from Bosson's JAHA paper from LA County data base that we briefly mentioned on the podcast.     Men Women CPR 41% 39% shockable 35% 22% STEMI 32% 23% Cath 25% 11% TTM 40% 33% Survival/CPC 1-2 24% 16%   Other studies discussed. European study that examined sex-differences in atrial fibrillation study Danish study on cardiac arrests in people less than 35 with 2 to one ratio of men to women Korean eunuch study suggesting that a historical lineage of castrated males outlived several socioeconomically matched peers, supporting the concept of a disposable soma theory. Cleveland Clinic informational sheet on arrhythmias in women Study that suggests more women than men die or go to hospice after an intracranial hemorrhage and brings up idea of gender-based differences in “social capital” contributing to this difference EOL choices in advanced cancer patients showing gender differences in palliative care and DNR preferences

We are back!  Another journal club with Dr Justin Morgenstern.  This month we have a really diverse bunch of papers that take a look at CRASH-3, distraction techniques for kids in ED, making the patient experience better, wound closure and syncope workup (Spoiler: CTs ain't that great).

Sarah Reid on pediatric appendicitis risk calculator, Sheldon Cheskes & Mark Ramzy on double defibrillation for refractory ventricular fibrillation, Hans Rosenberg & Krishan Yadav on cellulitis clinical pearls, Anand Swaminathan on serratus anterior block, Brit Long on recognition of toxic shock syndrome, Justin Morgenstern on tranexamic acid in head injury and CRASH-3... The post EM Quick Hits 10 – TXA CRASH-3, CJEM Cellulitis, Double Defib, Serratus Anterior Block, PARC score, Toxic Shock Syndrome appeared first on Emergency Medicine Cases.

Justin Morgenstern on the lack of evidence for burn debridement, Jesse MacLaren on ECG Cases - missed ischemia and pitfalls of "normal" computer ECG interpretations, Arun Sayal on clinical diagnosis pitfalls of compartment syndrome, Sarah Reid on pediatric asthma pitfalls and myths, Andrew Petrosoniak on T-spine and L-spine fracture work-up, Michelle Klaiman & Taryn Lloyd on motivational interviewing part 2... The post EM Quick Hits 9 Burn Blister Debridement, ECG Cases, Compartment Syndrome, Pediatric Asthma, Spinal Trauma, Motivational Interviewing P2 appeared first on Emergency Medicine Cases.

Welcome back. Another instalment of the EBM Journal Club with Dr. Justin Morgenstern. Topics include NSAID dosing, moose attacks, COACT trial, snowfall impact on ED, conflicts of interest in FOAMed and a bunch of other stuff  

Anand Swaminathan on a simple approach to status epilepticus, David Juurlink on codeine and tramadol interactions: nasty drugs with nastier drug interactions, Brit Long on DOACS in patients with malignancy: which patient's with cancer can be safely prescribed DOACs? Ian Stiell on atrial fibrillation rate vs rhythm control controversy, Justin Morgenstern on peripheral vasopressors: safe or unsafe? Michelle Klaiman, Taryn Lloyd on motivational interviewing that makes a difference to patient's lives... The post EM Quick Hits 7 Approach to Status Epilepticus, Codeine Interactions, Anticoagulation in Malignancy, Atrial Fibrillation Rate vs Rhythm Control, Peripheral Vasopressors, Motivational Interviewing appeared first on Emergency Medicine Cases.

In this Episode 127 Drugs that Work and Drugs that Don't Part 2 - Antiemetics, Angioedema and Oxygen, with Justin Morgenstern and Joel Lexchin we discuss the evidence for various antiemetics like metoclopramide, prochlorperazine, promethazine, droperidol, ondansetron, inhaled isopropyl alcohol and haloperidol as well as why should not use an antiemetic routinely with morphine in the ED. We then discuss the evidence for various drugs options for a potpourri of true emergencies like angioedema and hyperkalemia, and wrap it up with a discussion on oxygen therapy... The post Ep 127 EM Drugs that Work and Drugs that Don’t Part 2 – Antiemetics, Angioedema, Oxygen appeared first on Emergency Medicine Cases.

Dr Justin Morgenstern and Damian Roland do a deep dive into the latest data around Paeds Seizure management after Eclipse and Consept trials were published.   Or maybe there is a better way?

Another instalment of the journal jam with Justin Morgenstern. This month we talk neonatal sepsis, nocebos, Pink Ladies, fever, tramadol, chin lacs and drinking strategies....

On this EM Quick Hits podcast we have Natalie May on Kawasaki disease clues to diagnosis, Justin Morgenstern on suturing dog bites: the evidence, Anand Swaminathan on BVM prior to laryngoscopy, Michelle Klaiman on anticraving medications for alcohol use disorder and special guest Howard Ovens on managing ED violence with compassionate care... The post EM Quick Hits 3 – Kawasaki Disease, Suturing Dog Bites, BVM in RSI, Anticraving Meds for Alcohol Misuse, ED Violence appeared first on Emergency Medicine Cases.

EM Quick Hits is a brand new EM Cases podcast that contains 5 minute segments chosen from 10 specific topics by 10 different experts and educators. These topics are ones that either are not taught very well in training and/or that physicians tend to be not completely comfortable with. They include toxicology, trauma, ophthalmology, orthopaedics, resuscitation, human factors, addiction and pediatric emergencies. The EM Quick Hits Team is: Emily Austin, Peter Brindley, Chris Hicks, Michelle Klaiman, Anna MacDonald, Natalie May, Justin Morgenstern, Andrew Petrosoniak, Hans Rosenberg, Arun Sayal and Anand Swaminathan... The post EM Quick Hits 1 Massive PE, Gabapentin for Alcohol Withdrawal, Dental Avulsions, Pediatric Eye Exam, Best Resuscitation Fluid appeared first on Emergency Medicine Cases.

The year is drawing to a close and we have just one more chance to learn from my very wise, ex-Canadian friend Dr Justin Morgenstern.  In this month's episode, Justin and I discuss a bunch of papers.  Topics include: Paediatric plastic poop OOHCA Airway options Weingart's suction failure Cricoid pressure is not-non-inferior to nothing a new nasal spray for SVT How much insulin is sweet? Parachutes: are they really worth the extra luggage fees?

Esta es la tercera parte de una trilogía de artículos relacionados a la publicación de estos tres estudios sobre el manejo de la vía aérea en el paciente en paro cardiaco. Si usted no ha leído las primeras dos entradas, o escuchado los episodios del ECCpodcast relacionados a esto, por favor lea u oiga estos primero ya que sientan las bases para entender el por qué estos artículos son importantes a pesar de que los resultados no sean tan alentadores. Veamos un resumen de los tres estudios antes de discutirlos en detalle: Estudio #1: Efecto de una Ventilación usando Dispositivo Bolsa Mascarilla versus Intubación Endotraqueal durante Resucitación Cardiopulmonar en el Resultado Neurológico Luego del Paro Cardiorrespiratorio Fuera del Hospital Entre pacientes con paro cardiaco fuera del hospital, el uso del dispositivo bolsa mascarilla, comparado con la intubación endotraqueal, falló e demostrar no-inferioridad o inferioridad para la sobrevivencia con función neurológica favorable a los 28 días. El estudio fue inconcluso. Estudio #2: Efecto de una Estrategia Inicial de Inserción de Tubo Laríngeo versus Intubación Endotraqueal en la Sobrevivencia a 72 horas en Adultos con Paro Cardiaco (Estudio PART) Entre adultos con paro cardiaco fuera del hospital, la estrategia de inserción inicial de un tubo laríngeo fue asociada con un incremento significativo en sobrevivencia a las 72 horas que la estrategia inicial de intubación endotraqueal. Estos hallazgos sugieren que la inserción de un tubo laríngeo puede ser considerada como una estrategia inicial de manejo de la vía aérea en el paciente en paro cardiaco fuera del hospital. Estudio #3: Efecto de la Estrategia de un Dispositivo Supraglótico versus Intubación Endotraqueal Durante el Paro Cardiaco Fuera del Hospital en Resultado Funcional (Estudio AIRWAYS-2) Entre pacientes con paro cardiaco fuera del hospital, la estrategia aleatorizada de un dispositivo supraglótico versus intubación traqueal no tuvo el resultado funcional favorable a los 30 días. Control de Daño vs. Control Definitivo En el pasado, los pacientes que tenían múltiples traumas mayores eran llevados al quirófano para corregir uno y cada uno de ellos. Estas cirugías eran muy extensas en complejidad y tiempo. Sin embargo, luego se demostró que los pacientes más complejos se beneficiaban de procedimientos más cortos donde se buscaba controlar las amenazas a la vida. Nadie está poniendo en duda la capacidad de los cirujanos de trauma en realizar las reparaciones que el paciente necesita. Lo que se demostró fue que no era el momento adecuado para hacerlas todas. Similarmente, el manejo de la vía aérea durante el paro cardiaco debe ser limitado a las intervenciones necesarias para controlar el desastre mientras se pueden corregir los otros problemas apremiantes. Luego, en una segunda tanda, se puede optar por realizar otros procedimientos más definitivos. No es una cuestión de capacidad del proveedor sino de estrategia. La reina se puede mover en cualquier dirección. Solo porque pueda no significa que siempre debe hacerlo. Estudio #1: Efecto de una Ventilación usando Dispositivo Bolsa Mascarilla versus Intubación Endotraqueal durante Resucitación Cardiopulmonar en el Resultado Neurológico Luego del Paro Cardiorrespiratorio Fuera del Hospital (Estudio CAAM) En este estudio el uso de un dispositivo avanzado para el manejo de la vía aérea no demostró ser mejor, indistintamente qué sea lo que se use. Una de las teorías detrás de esto es, como mencioné en los otros dos artículos anteriores, es que durante el paro cardiaco, hay demasiadas intervenciones críticas e importantes ocurriendo simultáneamente. Carga cognitiva durante el paro cardiaco La carga cognitiva durante el paro cardiaco es una intervención a considerar. Posiblemente el reto está en optar por la estrategia menos dañina, mientras se logra el control de la situación más rápido y efectivo posible. Dominio avanzado de destreza básica La decisión de manejar la vía aérea con un dispositivo avanzado, específicamente la intubación endotraqueal, tiene que ser guiada por el fracaso en el manejo con un dispositivo bolsa mascarilla. Aunque en este estudio no mostró diferencia en sobrevivencia con buen estado neurológico entre la ventilación con dispositivo bolsa mascarilla y la intubación endotraqueal, hubo un número muy alto de dificultades con el uso del dispositivo bolsa mascarilla. Esto sugiere que debemos buscar formas innovadoras de practicarla. Estudio #2: Efecto de una Estrategia Inicial de Inserción de Tubo Laríngeo versus Intubación Endotraqueal en la Sobrevivencia a 72 horas en Adultos con Paro Cardiaco (Estudio PART) Los proveedores que realizaron las intervenciones básicas y avanzadas en este estudio fueron paramédicos de 27 sistemas de emergencias médicas de los Estados Unidos y atendieron a 3,004 pacientes en paro cardiaco. Las tazas de éxito inicialmente con el tubo laríngeo fueron dramáticamente superiores a las del tubo endotraqueal: Tubo laríngeo: 90.3% Tubo traqueal: 51.6% En adición, hubo una gran incidencia de complicaciones con la intubación endotraqueal: 3 (o más) intentos para asegurar la vía aérea (19% vs 5%) Vía aérea inicial no exitosa (44% vs 12%) Vía aérea mal colocada o desalojamiento sin reconocer  (1.8% vs 0.7%) Ventilación inadecuada (1.8% vs 0.6%) Pneumotórax (7.0% vs 3.5%) No hubo una diferencia en eventos adversos tales como pneumonía o pneumonitis debido a aspiración. Tampoco hubo diferencias entre las lesiones orofaríngeas o edema de la vía aérea. Éxito de intubación endotraqueal en 51.6% vs 86.3% En el pasado, otros estudios han demostrado un 90% de éxito en la intubación endotraqueal fuera del hospital. Sin embargo, en este estudio solo un 51.6% tuvo éxito. Aunque los autores del estudio #2 no proveen una explicación a este número tan bajo, sí sugieren que se puede deber a que los directores médicos de estos 27 sistemas envueltos en el estudio favorecen que los proveedores no duren mucho tiempo intentando intubar un paciente y que se muevan rápido a un dispositivo supraglótico si están enfrentando dificultades. Como vamos a mencionar más adelante en la discusión del estudio AIRWAYS-2, en este estudio participaron proveedores de 27 sistemas de emergencias médicas, lo que significa que tuvo una diversidad de proveedores con diversidad de destrezas, lo que representa el mundo real. Para efectos de este estudio, queda la duda si las tazas de sobrevivencia serían mejores con la intubación endotraqueal si esta fuese hecha por proveedores con mejor destreza. Sin embargo, las intubaciones en el  estudio #1 fueron realizadas por médicos y el estudio #3 fueron realizadas por paramédicos con menor incidencia de complicaciones y la sobrevivencia no fue mayor en el grupo de las intubaciones. Intubación endotraqueal bien hecha no tiene ningún beneficio. Mal hecho, trae peores resultados cuando se compara con la inserción de un dispositivo alterno o manejo básico. Cualquiera puede aprender a hacerlo rápido. Hacerlo bien muchas veces toma tiempo. Hacerlo bien es necesario. En el siguiente estudio, las tazas de éxito durante el primer intento de intubación fueron mucho mejores, pero aún no hubo diferencia en sobrevivencia. Estudio #3: Efecto de la Estrategia de un Dispositivo Supraglótico versus Intubación Endotraqueal Durante el Paro Cardiaco Fuera del Hospital en Resultado Funcional (Estudio AIRWAYS-2) Como mencioné antes, no hubo diferencia en el retorno de circulación espontánea, o la sobrevivencia al egreso del hospital entre ambos grupos. ¿Esto me aplica a mi? Este estudio fue realizado por 1,500 paramédicos de 4 sistemas grandes de Inglaterra. Incluyó 9,896 pacientes dentro de una población de 21 millones. Fue hecho en una población metropolitana, en un sistema de alto volumen, por proveedores experimentados. No digan: "esto no me aplica porque yo intubo mejor". Este no fue un estudio doble-ciego. Los paramédicos sabían qué intervención iban a hacer porque fueron los paramédicos los que fueron aleatorizados, no los pacientes. Los paramédicos fueron instruídos y asignados a realizar una de dos intervenciones: colocar un i-gel, o un tubo endotraqueal. Sin embargo, tenían la opción de realizar una técnica alterna si entendían que era necesario o útil. Es decir, los paramédicos asignados a colocar el tubo i-gel podían decidir optar por intubar si entendían que era necesario. Vice versa, los paramédicos asignados a realizar la intubación endotraqueal podían optar por insertar un tubo supraglótico si era necesario. Esto provocó que muchos pacientes cruzaran de grupo asignado, especialmente los que estaban originalmente en el grupo de intubación. ¡Así es en la vida real! No se está comparando los dispositivos sino las estrategias Si no hay diferencia, puede optar por intubarlo. O, si el supraglótico es igual, pueden cambiar a lo "nuevo". Hay que buscar evidencia adicional que lo apoya. Hay que buscar entonces los resultados secundarios. Las tazas de éxito en ventilación inicial (primeros dos intentos de ventilación) fueron mayores en el grupo i-gel (87.4% vs. 69.4%) que los que fueron ventilados por tubo endotraqueal. Inclusive, la ventilación efectiva luego de los intentos a intubar fue de 70%. El resultado es el mismo y el i-gel fue más fácil y rápido en ser exitoso. Entonces, ¿cuál estrategia debemos usar? Ambas estrategias tienen el mismo resultado. La estrategia de usar un supraglótico es más probable de ser exitosa, es más probable que la uses, y los resultados no son peores. "Lo que haces es infinitamente más importante que cómo lo haces. La eficiencia es inútil a menos que se aplique a las cosas correctas. -Tim Ferriss Si usted decide que su estrategia de primera línea será la intubación endotraqueal, tiene que estar entrenado y al menos una vía aérea supraglótica adicional ya que hay pacientes que no van a poder ser intubables en la escena (9% según el estudio #2). Vice versa, si usted decide comenzar por una vía aérea supraglótica, tiene que tener en mente que algunos pacientes van a necesitar ser intubados (5.8% según el estudio #2). https://youtu.be/OM_um-6OydE En este otro podcast conversan con los autores del estudio y proveen la perspectiva directamente de la fuente: ¿Estudios que buscan no-inferioridad? Es importante recordar que el estudio, basado en el método científico, busca probar una hipótesis. La hipótesis se prueba o no. La hipótesis se describe con el objetivo de probar una de estas tres cosas: superioridad, equivalencia o no-inferioridad. Superioridad: Busca demostrar que una intervención es superior. Estadísticamente hablando, el hecho de que la superioridad no se pueda demostrar no significa que ambas intervenciones son equivalentes o que una es inferior. Equivalencia: Los tratamientos son comparables. No-Inferior: Buscan demostrar que el tratamiento no es inferior o peor que el control. En este artículo podrá encontrar una explicación de lo que es un estudio de no-inferioridad. https://youtu.be/ht7L-1lKBYs Conclusiones ILCOR ya ha expresado que el Advanced Life Support Task Force va a tomar estos estudios en consideración para formular una recomendación de cuál debe ser la estrategia inicial de manejo de la vía aérea dentro del contexto del paro cardiaco. La data que estamos viendo sugieren que si usted escoge la estrategia de usar una vía aérea supraglótica, el resultado de su paciente va a ser igual de bueno, o mejor, que si usted hubiese optado por colocar un tubo endotraqueal. Referencias Benger JR, Kirby K, Black S, et al. Effect of a Strategy of a Supraglottic Airway Device vs Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional OutcomeThe AIRWAYS-2 Randomized Clinical Trial. JAMA. 2018;320(8):779–791. doi:10.1001/jama.2018.11597 Jabre P, Penaloza A, Pinero D, et al. Effect of Bag-Mask Ventilation vs Endotracheal Intubation During Cardiopulmonary Resuscitation on Neurological Outcome After Out-of-Hospital Cardiorespiratory ArrestA Randomized Clinical Trial. JAMA. 2018;319(8):779–787. doi:10.1001/jama.2018.0156 Justin Morgenstern, "Airway management in cardiac arrest part 1: AIRWAYS 2 (Benger 2018)", First10EM blog, November 19, 2018. Available at: https://first10em.com/benger2018/. Justin Morgenstern, "Airway management in cardiac arrest part 2 (Jabre 2018)", First10EM blog, November 20, 2018. Available at: https://first10em.com/jabre2018/. Justin Morgenstern, "Airway management in cardiac arrest part 3: PART trial (Wang 2018)", First10EM blog, November 21, 2018. Available at: https://first10em.com/wang2018/. Lesaffre E. Superiority, Equivalence and Non-Inferiority Trials. Bull NYU Hosp Jt Dis. 2008;66(2):150-4. Wang HE, Schmicker RH, Daya MR, et al. Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac ArrestA Randomized Clinical Trial. JAMA. 2018;320(8):769–778. doi:10.1001/jama.2018.7044 https://theresusroom.co.uk/airways-2/ https://first10em.com/benger2018/

Does epinephrine improve the chances of return of spontaneous circulation at the expense of the brain? In other words, while we know that epinephrine doubles rates of ROSC in all comers in cardiac arrest, there’s never been robust evidence for long term improvements in neurologic functional outcomes. So, are we saving lives, or are we prolonging death? Find out the answer in this Journal Jam podcast with Justin Morgenstern and Rory Spiegel... The post JJ 14 Epinephrine in Cardiac Arrest appeared first on Emergency Medicine Cases.

The latest episode of the EBM journal club with Dr Justin Morgenstern  This month we cover a lot of fluids - saline, balance, FFP as well as some penile fractures and Justin explain why he is a great driver.

This episode was recorded live at Markham Stouffvile Hospital in Canada. Victoria and Jesse were generously hosted by the hospital to share some lessons learned in simulation programs. This presentation was initially developed for a symposium in Dunedin in March 2018. We decide to reprise it, but instead of a presentation - Simulcast Live. Hope you enjoy and we'd love to here some of your lessons learned and keep adding to the myths and fails. Thanks to Justin Morgenstern @First10EM for making the visit happen. We had a great time and the hospitality was amazing.

Hardcore EM: EBM - Papers of the year by Justin Morgenstern  

In this EM Cases Journal Jam podcast with Anton Helman, Justin Morgenstern, Rory Spiegel, and special guest Jacques Lee we explore the evidence for femoral nerve blocks and fascia iliaca blocks as well as discuss the practical implementation of them in your ED. We answer questions such as: Do regional nerve blocks for hip fractures effectively reduce pain? Do they decrease opioid use? Are they safe compared to standard pain management? Should the block be done prior to x-ray confirmation? and many more... The post JJ 13 Regional Nerve Blocks for Hip Fractures appeared first on Emergency Medicine Cases.

So my friend, Justin Morgenstern recently put up a post on Idarucizumab, aka Praxbind. He seemed pretty fired up on the issue, so I got him on the line to talk about it. What follows is a conversation on evidence and what to do when there is not a good amount of it. Schtuff The EM Cases Podcast that partially sparked the debate Justin Wrote an Additional Post after our Discussion On Parachutes and Such On to the Wee...

We are back!  Yes, once again I am joined by my Canadian buddy Dr Justin Morgenstern to bring you a rough guide to Justin's favourite papers of the month. #FOAMed

Lauren Westafer joins Justin Morgenstern, Rory Spiegel and Anton Helman in a deep dive discussion on the world's literature on Post Contrast Acute Kidney Injury (PCAKI) in this Journal Jam podcast. Hospitals continue to insist on time consuming, and potentially dangerous protocols for administration of fluids to patients with renal dysfunction prior to CT IV contrast despite the lack of evidence that Contrast Induced Nephropathy (CIN) even exists. Would you choose a different imaging modality if your radiologist suggested that a patient with renal dysfunction who required a CT with IV contrast should forgo the contrast risking a missed diagnosis? The post Journal Jam 11 Post Contrast Acute Kidney Injury – PCAKI appeared first on Emergency Medicine Cases.

Welcome back to the Journal Club with Dr Justin Morgenstern.  It has been 2 months since we last dusted off the papers on Justin's bedside table... but like a mythical (nerdy) Sisyphus Justin must push another load of evidence out into the ether in order to go back and start the whole process again. This episode is on steroids.  I mean it is largely about steroids, not actually "on steroids" but there is a sprinkling of other stuff and a bit of philosophical banter about machine learning at the end. So sit back, grab a beverage and tune in for another hour of evidence and education from our corners of the world.

In this two part EM Cases Journal Jam podcast Justin Morgenstern, Rory Spiegel and Anton Helman do a deep dive into the world's literature on systemic thrombolysis for ischemic stroke followed by an analysis of endovascular therapy for stroke. We elucidate the important issues related to p-values, ordinal analysis, fragility index, heterogeneity of studies, stopping trials early and conflicts of interest related to this body of evidence. While "calling a code stroke" is now considered standard for most stroke patients and tPA for stroke is considered a class 1A drug, a close look at the literature tells us that the evidence is not as strong as our stroke protocols suggest... The post Journal Jam 10 Thrombolysis & Endovascular Therapy for Stroke Part 1 appeared first on Emergency Medicine Cases.

Welcome back to the kinda monthly journal club with Dr Justin Morgenstern and I. This month we do WOMAN, CO tax, Wellen's and Sarin gas Casey

The EM Cases Team is very excited to bring you not only a new format for the Journal Jam podcast but a new member of the team, Dr. Rory Spiegel, aka @EM_Nerd an Emergency Medicine physician from The University Maryland Medical Center in Baltimore, the founder of the EM Nerd blog and the co-host of the Annals of EM podcast. The new format sees Justin Morgenstern, Teresa Chan, Rory Spiegel and Anton Helman doing deep dives into the world's literature on specific practical questions while highlighting some important evidence-based medicine concepts. The question we ask in this Journal Jam podcast: Is there a role for D-dimer testing in the workup of aortic dissection in the ED? The post Journal Jam 9 – D-dimer to Rule Out Aortic Dissection appeared first on Emergency Medicine Cases.

The first Journal club episode for 2017 with Dr Justin Morgenstern. We cover Acute heart failure, anxious chest pain, clavicle fractures and emergency zipper release amongst other topics   Enjoy the FOAM Casey  

Welcome back the the last journal club with Dr Justin Morgenstern for 2016. [Yes, it is now 2017... but that's life.]  Another batch of 10 delicious articles to satisfy your post-Christmas cravings for academic nerdiness.  There a bit of something for every taste this month. 

October 2016 Journa Club Another month of interesting reading - articles of the month journal club with Dr Justin Morgenstern.

Welcome back to the podcast for October's Articles of the Month Another month of interesting reading with Dr Justin Morgenstern.  Check out the First10EM blog for full written version.

Another month of rapid fire journal club with Dr Justin Morgenstern and myself. 15 papers in 40 minutes... with free PDFs Ready, GO! Casey

Journal Jam 7 - Amiodarone vs Lidocaine vs Placebo in Cardiac Arrest: The ALPS Trial. In our most popular EM Cases episode to date - ACLS Guidelines Cardiac Arrest Controversies, we boldly stated, that there has never been an antiarrhythmic medication that has shown any long term survival benefit in cardiac arrest. The use of medications in cardiac arrest has been one of those things that we all do, but that we know the evidence isn't great for. Yet Amiodarone is still in the newest AHA adult cardiac arrest algorithm for ventricular fibrillation or pulseless ventricular tachycarida – 300mg IV after the 3rd shock with the option to give it again at 150mg after that. Anti-arrhythmics have been shown in previous RCTs to increase the rate of return of spontaneous circulation and even increased survival to hospital admission, however none of them have been able to show a decrease in mortality or a favourable neurological outcome at hospital discharge. In other words, there has never been shown a long term survival or functional benefit - which is a bit disconcerting. But now, we have a recent large randomized, controlled trial that shines some new light on the role of anti-arrythmics in cardiac arrest - The ALPS trial: Amiodarone vs Lidocaine vs placebo in out of hospital cardiac arrest. In this Journal Jam podcast, Justin Morgenstern and Anton Helman interview two authors of the ALPS trial, Dr. Laurie Morrison a world-renowned researcher in cardiac arrest and Dr. Paul Dorian, a cardiac electrophysiologist and one of Canada's leading authorities on arrhythmias about what we should take away from the ALPS trial. It turns out, it's not so simple. We also discuss the value of dual shock therapy for shock resistant ventricular fibrillation and the future of cardiac arrest care. The post Journal Jam 7 – Amiodarone vs Lidocaine vs Placebo in Cardiac Arrest: The ALPS Trial appeared first on Emergency Medicine Cases.

Journal Jam 7 - Amiodarone vs Lidocaine vs Placebo in Cardiac Arrest: The ALPS Trial. In our most popular EM Cases episode to date - ACLS Guidelines Cardiac Arrest Controversies, we boldly stated, that there has never been an antiarrhythmic medication that has shown any long term survival benefit in cardiac arrest. The use of medications in cardiac arrest has been one of those things that we all do, but that we know the evidence isn’t great for. Yet Amiodarone is still in the newest AHA adult cardiac arrest algorithm for ventricular fibrillation or pulseless ventricular tachycarida – 300mg IV after the 3rd shock with the option to give it again at 150mg after that. Anti-arrhythmics have been shown in previous RCTs to increase the rate of return of spontaneous circulation and even increased survival to hospital admission, however none of them have been able to show a decrease in mortality or a favourable neurological outcome at hospital discharge. In other words, there has never been shown a long term survival or functional benefit - which is a bit disconcerting. But now, we have a recent large randomized, controlled trial that shines some new light on the role of anti-arrythmics in cardiac arrest - The ALPS trial: Amiodarone vs Lidocaine vs placebo in out of hospital cardiac arrest. In this Journal Jam podcast, Justin Morgenstern and Anton Helman interview two authors of the ALPS trial, Dr. Laurie Morrison a world-renowned researcher in cardiac arrest and Dr. Paul Dorian, a cardiac electrophysiologist and one of Canada's leading authorities on arrhythmias about what we should take away from the ALPS trial. It turns out, it's not so simple. We also discuss the value of dual shock therapy for shock resistant ventricular fibrillation and the future of cardiac arrest care. The post Journal Jam 7 – Amiodarone vs Lidocaine vs Placebo in Cardiac Arrest: The ALPS Trial appeared first on Emergency Medicine Cases.

This is EM Cases Journal Jam Podcast 6 - Outpatient Topical Anesthetics for Corneal Abrasions. I've been told countless times by ophthalmologists and other colleagues NEVER to prescribe topical anesthetics for corneal abrasion patients, with the reason being largely theoretical - that tetracaine and the like will inhibit re-epithelialization and therefore delay epithelial healing as well as decrease corneal sensation, resulting in corneal ulcers. With prolonged use of outpatient topical anesthetics for corneal abrasions, corneal opacification could develop leading to decreased vision. Now this might be true for the tetracaine abuser who pours the stuff in their eye for weeks on end, but when we look at the literature for toxic effects of using topical anesthetics in the short term, there is no evidence for any clinically important detrimental outcomes. Should we ignore the dogma and use tetracaine anyway? Is there evidence that the use of topical anesthetics after corneal abrasions is safe and effective for pain control without adverse effects or delayed epithelial healing? To discuss the paper "The Safety of Topical Anesthetics in the Treatment of Corneal Abrasions: A Review" by Drs. Swaminathan, Otterness, Milne and Rezaie published in the Journal of Emergency Medicine in 2015, we have EM Cases' Justin Morgenstern, a Toronto-based EM Doc, EBM enthusiast as well as the brains behind the First10EM blog and Salim Rezaie, Clinical Assistant Professor of EM and Internal Medicine at University of Texas Health Science Center at San Antonio as well as the Creator & Founder of the R.E.B.E.L. EM blog and REBELCast podcast. In this Journal Jam podcast, Dr. Morgenstern and Dr. Rezaie also discuss a simple approach to critically appraising a systematic review article, how to handle consultants who might not be aware of the literature and/or give you a hard time about your decisions and much more... The post Journal Jam 6 – Outpatient Topical Anesthetics for Corneal Abrasions appeared first on Emergency Medicine Cases.