EM Basic
Anaphylaxis Part 2- Airway

In this episode, we'll talk about how to manage the airway in patients with anaphylaxis or any other upper airway obstruction.  These can be some of the most difficult airways to manage and we can run into trouble if we don't have a good plan ahead of time.  Some of this is a little "advanced" and "cutting edge" but it's important to have as many tools in your arsenal when dealing with these critical airways.  We'll review other options besides RSI to include awake intubation, delayed sequence intubation (DSI), and the awake cric.

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

Anaphylaxis Part 1- Diagnosis and Treatment

Anaphylaxis is a potentially deadly diagnosis that requires quick action.  In this episode, we will discuss the diagnosis and management of the entire spectrum of allergic reactions from mild cutaneous reactions to life threatening anaphylaxis.  This is the first episode in a 2 part series.  Part 2 will discuss airway management in anaphylaxis and other upper airway obstructions situations.

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

Essential Evidence #8 - The PERC Rule

Today's Essential Evidence Episode discusses the paper that derived and validated the PE Rule-out Criteria or PERC rule.  This is a clinical decision aid that we can use to reliably exclude pulmonary embolism in emergency department patients without any further testing.  We'll talk about some background on diagnosing PE in the ED, the study design, how to use the PERC rule in your everyday practice, and some clinical pearls as well.

Category:general -- posted at: 4:00am EDT

Seizures

We encounter seizure disorders frequently in the ED.  In this episode, we'll review all the important points about seizures including the confusing and difficult topic of pseudosezures.  We'll also go in depth on the ED treatment of seizures and status epilepticus.

Category:general -- posted at: 6:54pm EDT

EM Basic Essential Evidence- 7 SAEM Occult Bacteremia

We're back with a new episode of Essential Evidence.  This article is from Academic Emergency Medicine March 2009 and it talks about getting blood cultures in well appearing kids aged 3 to 36 months.  We used to get a lot of blood cultures in these well appearing kids with fever but this article was the final nail in the coffin that got us to stop doing that.  It's hard to believe that based on how we practice now but we needed this large study to show us that we are now doing the right thing.

Category:general -- posted at: 10:23pm EDT

Eye Complaints

EM Basic is back and ready for the new year.  We see various eye complaints a lot in the ED.  This episode will review common eye complaints, their treatments, and a bonus section on how to do a lateral canthotomy.

Category:general -- posted at: 12:10am EDT

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 EDT

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 EDT

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 EDT

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 EDT