EM Basic
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

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 EDT

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 EDT

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 EDT

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 EDT

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 EDT

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 EDT

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 EDT

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 EDT

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 EDT