EM Basic
EM Basic Essential Evidence- PECARN Head CT Rule

This episode reviews the article that most people call the PECARN head CT rule or the Kupperman head CT rule (named for the first author). This is an easy to use clinical decision rule that can help us reduce the number of head CTs that we do on children with minor head injury. We owe it to our patients to spare them excess radiation, cost, and time in the ED and this rules helps us do this. In order to use this rule effectively, you need to read this article and understand how the study was done.  This allows us to understand the strengths and weaknesses of this rule and helps us apply it in our everyday practice.

Category:general -- posted at: 4:30am EST

Psychiatric Medical Screening

In this episode, we will discuss how to perform medical screening for patients with psychiatric complaints.  While most of these workups are routine, we have to be able to catch the small percentage of patients who have a medical cause to their psychiatric complaint.  Don't think it can't happen to you- it almost happened to me twice during residency!  We'll discuss how to stay safe while evaluating psychiatric patients, how to get the entire history, how to do appropriate testing, catch the red flags, and make the appropriate disposition.

In the bonus section, a community ED doctor wrote me to tell me his thoughts on testicular pain and why we may not need an ultrasound on every patient.  As you'll hear, the answer is far from settled and not without controversy.

Category:general -- posted at: 4:30am EST

EM Basic Essential Evidence- Therapeutic Hypothermia

This episode of EM Basic Essential Evidence will review the two articles that led to the adoption of therapeutic hypothermia as a treatment for survivors of cardiac arrest. This is a simple yet highly effective therapy that improves survival and neurological outcome in survivors of cardiac arrest so it is important that we know and understand these two articles.

Category:general -- posted at: 4:30am EST

EM Basic Essential Evidence- BMJ Subarachnoid Hemorrhage

This is an article published in the last year in the British Medical Journal that looked at the sensitivity of modern CT scanners in detecting subarachnoid hemorrhage. This article made a lot of waves because it suggested that a head CT within 6 hours of headache onset is 100% sensitive for subarachnoid hemorrhage.  Some have called it a practice changer that allows us to avoid doing a lumbar puncture so its important to read it for yourself and decide if it should change your practice.

Category:general -- posted at: 4:30am EST

Non-invasive Ventilation

Non-invasive ventilation is a great technique that we can use for just about any patient who is short of breath.  We can use it to avoid intubation in our patients who are close to respiratory failure.  In this episode, we'll talk about how non-invasive ventilation works, which patients we can use it on, and how to actually make it happen.  For that last part, I'll borrow from a post by Seth Treuger at his blog mdaware.org on how to start non-invasive ventilation quickly while keeping it comfortable for the patient.

Category:general -- posted at: 9:36pm EST

EM Basic Essential Evidence- The NEXUS Study

This episode will discuss the NEXUS study.  NEXUS was a study that studied thousands of patients to validate a set of rules so that we can "clinically clear" patients with possible c-spine injury without getting an x-ray. This study has helped us avoid radiation in certain low-risk patients, saved the cost of x-rays and CT scans, and speed these patients through the ED. We'll talk a lot about the statistical side of this study and how you can apply it in your everyday practice.

Category:general -- posted at: 4:30am EST

Testicular Pain

All right- let's keep the laughter to a minimum...today's episode is talking about how to approach testicular pain in the ED.  You need to know how to approach this chief complaint because if you don't workup the patient correctly, they can lose their future fertility and possibly their testicle.  We'll review how to take a good history and do a rapid focused exam to make sure that we catch all those patients with torsion and don't delay their treatment.

Category:general -- posted at: 4:30am EST

EM Basic Essential Evidence- Admission for patients with minor head injury on coumadin- Annals of EM

In this episode, we'll talk about a recent article in Annals of Emergency Medicine that has a lot of people talking. This is a study that looked at patients on coumadin (warfarin) who had minor head injuries. The patients were admitted for 24 hours of observation and had a repeat head CT. The study looked at how many patients had bleeding on a repeat head CT and the conclusions were suprising. Should this be our new standard of care?  Maybe but maybe not.

Category:general -- posted at: 4:30am EST

Hyperkalemia

Hyperkalemia (high serum potassium) can be one of the most serious electrolyte disorders that we treat in the ED.  We'll review how to interpret hyperkalemia in light of the patient's clinical condition, how to rapidly evaluate a patient with hyperkalemia and how to quickly treat patients with severe hyperkalemia.

Category:general -- posted at: 4:30am EST

Introducing the EM Basic Apple and Android Apps

This is just a short announcement for the launch of the EM Basic App in the Apple App Store and the Android Amazon Marketplace.  Go to the blog post at embasic.org to see all the information about how to get this new app on your phone or mobile device.

Category:general -- posted at: 7:03pm EST