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

EM Basic Essential Evidence- Rivers Sepsis NEJM

Introducing EM Basic Essential Evidence- your boot camp guide to emergency medicine literature. Each episode will review an important emergency medicine article from the ground up. We'll review the study's design, basic statistics, results, and wrap it up with some analysis to help you understand the study and how to put it into your everyday practice. The goal here is to provide a guide through the emergency medicine literature so you can read and understand the "must know" studies out there.

This is also the re-launch of EM Basic to a weekly podcast format.  Every monday morning, a new episode will be uploaded to start the week. Each week will alternate between a regular review episode and an essential evidence episode. For the essential evidence episodes, I will try to split up the episodes each month- one episode on a landmark article and one episode on a newer article that is making the rounds. I have a list of articles that I will be talking about but if there are any studies out there that you think I should cover, email me at steve@embasic.org.

For this first episode, we'll talk about the famous Rivers sepsis study that started the push to early goal directed therapy for sepsis in the ED. Although I talked about this study a lot on the sepsis podcast a while back, we'll talk more in depth about the study so you can really understand it.

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

Hyponatremia

Hyponatremia (low serum sodium) is one of the most common electrolyte disorders encountered in the ED. Most of the time this electrolyte disorder requires us to do less- not more. However, if the patient is critically ill from their hyponatremia then we need to know how to quickly intervene and even be a little creative if we don't have the medications that we want. We'll review how to do the right thing for these patients, track down the cause of hyponatremia, and make the right decisions so we don't cause any harm.

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

Stroke and Transient Ischemic Attack (TIA)

In this episode, we will discuss the diagnosis and treatment of stroke and transient ischemic attack (TIA). The ED is the front line in stroke care so we need to know how to work up this chief complaint. We'll go over how to recognize the signs and symptoms of a stroke, how to get a rapid and complete history, how to screen patients for contraindications to thrombolytics, and how to catch a few stroke mimics.

Category:general -- posted at: 4:52pm EST

This episode is part 2 of the procedural sedation podcast. This episode focuses on the medications that we commonly use for procedural sedation. First, we'll review the use of oxygen during procedural sedation and then talk about basic airway maneuvers before we talk about individual medications. For each drug, the drug class, dosing, duration of action, and adverse effects will be discussed with the overall theme of patient safety.

Direct download: 23_Procedural_Sedation_Part_2-_Medications.mp3
Category:general -- posted at: 5:48pm EST

This is the first of two episodes on procedural sedation. In the ED we need to provide safe and effective procedural sedation and analgesia whenever we do painful procedures. It is our job to relieve anxiety and pain in our patients and we need to know how to do this right. This episode will focus on how to prepare for a procedural sedation. We will talk about how to make the decision as to who is an appropriate candidate for procedural sedation in the ED, the depth of sedation, and how to prepare all of our equipment so that we leave nothing to chance. This will be in preparation for the second episode where we will talk about the medications that we use in procedural sedation.

Direct download: 22_Procedural_Sedation_Part_1-_Preparation.mp3
Category:general -- posted at: 1:41pm EST

Since I refer to the neuro exam from the headache episode, I decided to take that part of the episode and make a supplement so you can easily review the "5 minute ED neuro exam." Let me know if there are any other topics that you would like me to make into a supplement like this.

Direct download: Neuro_exam_supplement.mp3
Category:general -- posted at: 1:38pm EST

We're back with a podcast on...dizziness!  While weak and dizzy is almost never the most exciting chart in the rack, we see it a lot in the ED. This is a chief complaint where we have to be on the lookout for the serious causes of dizziness among the avalanche of not-so-serious causes of dizziness. First- what does the patient mean by "I feel dizzy"? This seems like a silly question because just about everyone has felt "dizzy" before but if you get it wrong, you'll go down the completely wrong diagnostic path.

One small self-promotion- The new academic year is just about to start so if you like the podcast, please tell your colleagues, classmates, and especially the new medical students and interns.

Direct download: 21_Dizziness.mp3
Category:general -- posted at: 10:21pm EST

For the second part of trauma resuscitation, we'll discuss the various interventions that you may have to accomplish in the trauma bay. The first part is a continuation from the first episode and talks about the EFAST exam- a vital part of the secondary survey. The second part discusses the control of massive extremity hemorrhage and how to intervene on any airway, breathing, or circulation issue in the trauma bay.

Direct download: 20_Trauma_resuscitation_part_2-_interventions.mp3
Category:general -- posted at: 4:17pm EST

Being able to run an effective trauma resuscitation is a necessary skill for any emergency medicine provider. In part 1 of this 2 part series, I'll go over how to properly assess a trauma patient who arrives to the ED. We'll go over how to prepare for the patient's arrival, how to perform the primary and secondary surveys, how to make sure we get a good report from the EMS crew, and how to avoid the pitfalls during these first few crucial minutes in the care of a trauma patient.

The bonus section is a rant on why you should get your trauma patients off the backboard as soon as possible.

Direct download: Trauma_Resuscitation_Part_1-_the_evaluation.mp3
Category:general -- posted at: 10:23am EST

A week ago, I posted an airway review paper by Scott Weingart and Richard Levitan that I think is a must read. Today I decided to do a podcast reviewing the paper in order to really get it out there and talk about the major points. The best part of the paper is the description of the NO DESAT technique which virtually eliminates hypoxia during RSI and will make your next intubation a lot easier. While this podcast is a lot more advanced than the usual "basic" topics that I usually talk about, its important to know about these techniques. My 0.02- they will become the new standard of care in the near future but you can hear about them now.

Direct download: 18_Airway_update.mp3
Category:general -- posted at: 9:48pm EST

Being able to give a good ED patient presentation will not only help you get a good grade on your EM rotation, it will also make sure that nothing is missed in the patient's care.  In this episode, I'll discuss the nuts and bolts of forming and delivering a solid ED patient presentation that is complete and concise at the same time.  I'll also give a few example presentations so you can put it all together.  The show notes here are condensed down so you can carry them around with you on shift so you don't forget anything.  There is even a card sized version in the show notes for even further portability.  Feel free to take the Word format show notes and re-format them to fit your needs.

Direct download: 17_How_to_give_a_good_ED_patient_presentation.mp3
Category:general -- posted at: 11:43am EST

Shortness of breath is a chief complaint that we encounter each day in the ED.  This chief complaint encompasses a huge differential and this is a long podcast.  As always, I'll break this chief complaint down into the diagnoses that we can't miss and how to treat the underlying causes of shortness of breath for both kids and adults.

Direct download: 16_Shortness_of_Breath.mp3
Category:general -- posted at: 4:58pm EST

By popular demand, this episode will be dedicated to talking about prehospital issues. I've had several people write me and ask for my 0.02 on how EMS can better be our "eyes and ears" in the field so here's my take on this question. I'll also talk about how the ED staff can better interact with our EMS colleagues so we can both work together to deliver optimal care to our patients. Hopefully this will serve as a starting point for conversations between EMS providers and ED staff and I encourage anyone to post comments on these issues to the blog.

Direct download: 15_Prehospital_episode.mp3
Category:general -- posted at: 5:44pm EST

Syncope (or "passing out") is a chief complaint that we deal with a lot in the emergency department. While most causes of syncope are benign and need nothing more than reassurance, we need to be on the lookout for the serious causes of syncope. This episode will focus on the definition of syncope, how to get a complete history, catch the red flags, perform a targeted workup that doesn't keep the patient in the ED forever, and how to scrutinize an EKG for the deadly arrhythmias that we can't miss.

In addition, per a request from a podcast listener, there is a bonus section on how to effectively rehydrate patients in the ED. You may be surprised that there are other options besides putting an IV in everyone.

Direct download: 13_Syncope.mp3
Category:general -- posted at: 6:30pm EST

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