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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/
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...
Reference: Bannelier et al. Failure rate of D-dimer testing in patients with high clinical probability of pulmonary embolism: Ancillary analysis of three European studies. AEM Feb 2025 Date: February 27, 2025 Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. She is […] The post SGEM#469: You Take My Breath Away – D-dimer for Ruling out PE in High-Risk Patients first appeared on The Skeptics Guide to Emergency Medicine.
Date: October 2, 2024 Reference: Paxton et al. Headpulse measurement can reliably identify large-vessel occlusion stroke in prehospital suspected stroke patients: Results from the EPISODE-PS-COVID study. AEM Sept 2024 Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the UMass Chan Medical School – Baystate. She is the co-founder of FOAMcast and a pulmonary […] The post SGEM#455: Harmony 5000 – Prehospital Detection of Large Vessel Occlusion Strokes first appeared on The Skeptics Guide to Emergency Medicine.
Reference: Tjan et al. Conflict in emergency medicine: A systematic review. AEM June 2024 Date: July 5, 2024 Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. She co-founded FOAMcast and is a pulmonary embolism and implementation science researcher. Dr. Westafer serves as the Social […] The post SGEM#445: Why Can't We Be Friends – Conflict in Emergency Medicine first appeared on The Skeptics Guide to Emergency Medicine.
In this episode, we review a consensus guideline from the American College of Emergency Physicians on the use of topical anesthetics in corneal abrasions. Show notes and references: FOAMcast.org Thanks for listening! Jeremy Faust and Lauren WEstafer
This episode covers emergency medicine-related recommendations from the American Heart Association's (AHA) clinical guideline on atrial fibrillation: 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation Circulation. 2023 Show notes and references: FOAMcast.org Thanks for listening! Lauren Westafer
The AABB recently published updated recommendations for blood transfusion thresholds. This podcast reviews these recommendations and a recent study, the MINT trial, in which patients with anemia and a myocardial infarction were randomized to a restrictive strategy or liberal transfusion strategy. Show notes / references: FOAMcast.org Thanks for listening! Lauren Westafer
This epsiode reviews the new clinical policy from the American College of Emergency Physicians (ACEP) on medication for acutely agitated patients needing parenteral sedation. Show notes / references: FOAMcast.org Thanks for listening! Lauren Westafer
Date: November 22, 2023 Reference: Stopyra et al. Delayed First Medical Contact to Reperfusion Time Increases Mortality in Rural EMS Patients with STEMI. AEM November 2023. Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. She is the cofounder of FOAMcast and a […] The post SGEM#421: I Think I'd Have a Heart Attack – Maybe Not in a Rural Area? first appeared on The Skeptics Guide to Emergency Medicine.
Alcohol use disorder (AUD) is commonly encountered in the ED and visits related to alcohol are estimated to be ~4% of all ED visits in the US. Despite this, most EDs offer little support and harm reduction for patients with AUD. In this podcast, we review naltrexone, the first-line medication for patients with AUD, which is starting to be initiated in US EDs by emergency clinicians. AAEM position paper References and show notes: FOAMcast.org Thanks for listening! Lauren Westafer
Date: June 16, 2023 Reference: Reed et al. Pilot Testing Fentanyl Test Strip Distribution in an Emergency Department Setting: Experiences, Lessons Learned, and Suggestions from Staff. AEM June 2023 Guest Skeptic: Dr. Lauren Westafer is an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. She is the cofounder of […] The post SGEM#407: Here We Go Test Strips for Fentanyl first appeared on The Skeptics Guide to Emergency Medicine.
In this month's episode, Assistant Editor and Amy Ho, MD, MPH, FACEP, chats with Lauren Westafer, MD, about her April column on emergency physicians stopping prescriptions for diverticulitis. Also in this episode, Alden Landry, MD, shares his thoughts about equity and equality in medicine. Read more on ACEPNow.com Revisit ACEP Nowcast podcast episodes. Catch up on all of ACEP Now in past issues.
Recommendations for the use of steroids in community-acquired pneumonia have been mixed. This episode reviews a large multicenter randomized trial in the New England Journal of Medicine by Dequin et al on hydrocortisone for severe community-acquired pneumonia. References/show notes: FOAMcast.org Thanks for listening! Lauren Westafer
Kaveh speaks with ER doctors Jeremy Faust, Ryan Marino, and Lauren Westafer about The Match - what it is and why the emergency medicine spots went so under-filled this year. Send your questions and comments to hopquestions@gmail.com.
This episode reviews guideline recommendations and literature on the management of acute, uncomplicated diverticulitis - highlighting the recommendations to only prescribe antibiotics to select patients. References/Show Notes: FOAMcast.org Thanks for listening! Lauren WEstafer
This episode reviews a shift from the "lethal triad" in trauma to the "diamond of death," exploring the role of calcium in hemostasis and critically ill patients. We review the literature that is available on hypocalcemia and trauma patients References/show notes: FOAMcast.org Thanks for listening! Lauren Westafer
This episode covers the 2022 American College of Emergency Physicians (ACEP) clinical policy on acute heart failure syndromes with a special focus on high dose nitrates References and Show Notes: FOAMcast.org Thanks for listening! Lauren Westafer
The American College of Cardiology released a new consensus statement endorsing several signs on the electrocardiogram (ECG) as "STEMI Equivalents." In this podcast, we review these signs. Show notes / graphics / references: FOAMcast.org Thanks for listening! Lauren Westafer
Date: September 28th, 2022 Reference: Hartford et al. Disparities in the emergency department management of pediatric migraine by race, ethnicity, and language preference. AEM September 2022. Guest Skeptic: Dr. Lauren Westafer is an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. She is the cofounder of FOAMcast and is a pulmonary embolism […]
Since 2010, the American Heart Association guidelines for cardiopulmonary resuscitation (CPR) have de-emphasized pulse checks - such that they recommend against routine pulse checks. Despite this recommendation, may individuals and institutions continue to perform pulse checks. This episode reviews the recommendations and the literature. References/show notes: FOAMcast.org Thanks for listening! Lauren Westafer
We review the Anorectal emergencies: WSES-AAST guidelines on complicated hemorrhoids that include some practice-changers References: FOAMcast.org Thanks for listening! Lauren Westafer
Diphenhydramine (Benadryl) and other first-generation antihistamines are commonly used, despite decades of data that there are safer and effective alternatives. In this podcast, we review the guidelines / data behind common indications. References at FOAMcast.org Thanks for listening! Lauren Westafer
Date: March 31st, 2022 Reference: Butt et al. Take-Pause: Efficacy of mindfulness-based virtual reality as an intervention in the pediatric emergency department. AEM March 2022 Guest Skeptic: Dr. Lauren Westafer is an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. She is the cofounder of FOAMcast and is a pulmonary embolism […]
In this episode we review acute urticaria and new guidelines related to the treatment of urticaria. We review additional relevant trials Palungwachira et al and Barniol et al. References/Show notes: FOAMcast.org Thanks for listening! Jeremy Faust and Lauren Westafer
In this podcast we discuss onset of action of various intramuscular agents for chemical sedation for severely agitated patients. This includes a study by Barbic et al on ketamine, the onset of action of midazolam (and association with length of stay), and is droperidol really magic? (Cole et al) Shownotes/References: FOAMcast.org Thanks for listening! Jeremy Faust and Lauren Westafer
A seminal single-center study in 2018 by Driver et al found a 98% first-pass success in patients undergoing endotracheal intubation in the Emergency Department. This multi-center randomized control trial examines bougie vs stylet in a wider array of settings Show notes/references: FOAMcast.org Thanks for listening! Lauren Westafer
The diagnostic algorithm for pulmonary embolism (PE) has evolved over the past few years to include probability or risk-adjusted D-dimer. The YEARS algorithm includes an elevated D-dimer threshold for some risk groups and has been found to be safe and reduce imaging in several studies, including in pregnant patients. Now, this multicenter trial by Freund et al evaluates use of YEARS and age-adjusted D-dimer compared with an age-adjusted approach alone. Shownotes/References: FOAMcast.org Thanks for listening! Lauren Westafer
Outpatient management of pulmonary embolism for low-risk patients has been encouraged for several years. However, little is known about pulmonary embolism diagnosed and managed exclusively in the outpatient setting. In this study, Vinson et al describe the course of patients diagnosed with PE and managed in the outpatient setting in an integrated healthcare delivery system. Shownotes/References: FOAMcast.org Thanks for listening! Lauren Westafer
Subsegmental pulmonary embolism (SSPE) is a controversial entity as they have uncertain clinical significance. As a result, the Chest Guidelines and ACEP guidelines state that a very select group of patients with isolated SSPE and no deep vein thrombosis may be managed with surveillance rather than anticoagulation. In this podcast we review SSPE and a new prospective study by Le Gal and colleagues. Show notes and references: FOAMcast.org Thanks for listening! Lauren Westafer
We review the FDA briefing document from Pfizer as well as from the CDC Advisory Council on Immunization Practices that approved the Pfizer-BioNTech COVID-19 vaccine in children ages 5-11. References and show notes: FOAMcast.org Thanks for listening! Lauren Westafer and Jeremy Faust
Date: October 20th, 2021 Reference: Talan et al. Pathway with single-dose long-acting intravenous antibiotic reduces emergency department hospitalizations of patients with skin infections. AEM October 2021 Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. She is the cofounder of FOAMcast and […]
We previously covered the management of young febrile infants in a 2017 podcast but now we have updated guidance from the AAP. In this podcast, we review the 2021 AAP Guidelines for the management of well-appearing febrile infants 8-60 days old, highlight practice-changing recommendations. Show notes/references: FOAMcast.org Thanks for listening! Lauren Westafer
In this episode, Jeremy discusses what we know about breakthrough infections in the delta variant era and what this may mean for COVID-19 vaccine boosters. Jeremy's takes can be found at Inside Medicine Show notes/references: FOAMcast.org Thanks for listening! Lauren Westafer and Jeremy Faust
In this episode, we discuss the current evidence (as of September 24, 2021) on COVID-19 vaccine boosters as well as the CDC recommendations and the details of the Advisory Council on Immunization Practices recommendations/vote. Show notes/References at FOAMcast.org Jeremy's takes can be found at Inside Medicine Thanks for listening! Lauren Westafer and Jeremy Faust
In this literature update podcast covering important papers of 2021, we cover Becattini et al on the assessment of right ventricular dysfunction in patients diagnosed with acute pulmonary embolism (PE). We review guidelines on PE risk stratification for severity and discuss this individual patient meta-analysis. Show notes/references: FOAMcast.org Thanks for listening! Lauren Westafer and Jeremy Faust
This is a quick literature update on practice-changing literature from 2021. Here we discuss Pappal et al in Annals of Emergency Medicine on awareness during paralysis in mechanically ventilated patients Show notes / References: FOAMcast.org Thanks for listening! Lauren Westafer and Jeremy Faust
This is a quick literature update of important literature in 2021 covering take home naloxone by Kilaru et al. In this episode, we discuss principles of harm reduction, including naloxone, as well as the study. Show notes, references and resources: FOAMcast.org Thanks for listening! Lauren Westafer and Jeremy Faust
This is a quick literature update of important literature in 2021 covering take-home naloxone by Kilaru et al. In this episode, we discuss principles of harm reduction, including naloxone, as well as the study. Show notes, references, and resources: FOAMcast.org Thanks for listening! Lauren Westafer and Jeremy Faust
In this episode, we review the data on the association between myocarditis and the mRNA COVID-19 vaccines. Show notes / References: FOAMcast.org Thanks for listening! Jeremy Faust and Lauren Westafer
In this quick literature update, we review a recent paper by Branch et al on early 'panscan' (head to pelvis CT scan ) in patients with return of spontaneous circulation after out of hospital cardiac arrest. Show notes/ references: FOAMcast.org Thanks for listening! Lauren Westafer and Jeremy Faust
Date: May 21st, 2021 Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. She is the cofounder of FOAMcast and a pulmonary embolism and implementation science researcher. Dr. Westafer serves as the Social Media Editor and a research methodology editor for Annals of Emergency […]
In this podcast, we review Cerebral Vein Thrombosis (CVT) including clinical presentation, diagnosis, and management. Show notes: FOAMcast.org Thanks for listening! Lauren Westafer and Jeremy Faust
In this episode we review what we know about vaccine induced thrombotic thrombocytopenia (VITT), which has been associated with the COVID-19 viral vector vaccines by AstraZeneca and Johnson & Johnson. Show notes/references: FOAMcast.org Thanks for listening! Lauren Westafer and Jeremy Faust
In this episode, we discuss ivermectin as a potential therapeutic for COVID-19 and review available randomized trials evaluating this drug. Chaccour et al E-Clinical Medicine Lopez-Medina et al. JAMA Schwartz et al (not yet published) IDSA guidelines NIH Treatment guidelines Show notes: FOAMcast.org Thanks for listening! Jeremy Faust and Lauren Westafer
In this episode, we review new registry data from the ACIP meeting on pregnant people who received an mRNA COVID-19 vaccine and discuss, in general, what we know about the COVID-19 vaccines in pregnancy. Show notes: FOAMcast.org Pregnancy Decision Aid Thanks for listening! Lauren Westafer and Jeremy Faust
We have previously covered epistaxis on FOAMcast , including the use of tranexamic acid (TXA). Now, we cover a new, large RCT, the NoPac trial by Reuben et al, on TXA for epistaxis. Show notes: FOAMcast.org Thanks for listening! Lauren Westafer and Jeremy Faust
There's been a lot of excitement over various drugs for COVID-19, including anti-inflammatory drugs. Colchicine, a medication long used for gout, fits that bill. In this podcast, we review 3 trials of colchicine including COLCORONA, GRECCO-19, and a study by Lopes et al. Show notes: FOAMcast.org Thanks for listening! Jeremy Faust and Lauren Westafer
Early studies of tocilizumab, a monoclonal antibody that binds interleukin-6 , were disappointing. However, the REMAP-CAP trial recently reported a benefit to tocilizumab in non-critically ill hospitalized patients with COVID-19. Now, from the RECOVERY trial (the trial that brought us dexamethasone), we have more good news for tocilizumab - which we cover in this podcast Show notes: FOAMcast.org Thanks for listening! Lauren Westafer and Jeremy Faust
Date: January 20th, 2021 Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. She is the cofounder of FOAMcast and a pulmonary embolism and implementation science researcher. Dr. Westafer serves as the Social Media Editor and research methodology editor for Annals of Emergency Medicine […]