EM Basic
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

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 EDT

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 EDT

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 EDT

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 EDT

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 EDT

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 EDT

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 EDT