The DownEast Emergency Medicine Podcast

FROM BAD TO WORSE: Avoiding peri-intubation cardiac arrest with Dr. Sam Wood

Intubation in the emergency department (ED) can be a stressful endeavor. We are often presented with patients who have complex anatomy and tenous physiology. Because of this, it can be hard to look past the critical step of securing the airway. Rapid sequence intubation (RSI) and positive pressure ventilation can dismantle patients’ physiology and contribute to an almost 4% rate of post intubation cardiac arrest (PICA). Is there anything we can do to predict or prevent this? In this podcast, Sam Wood gives us an overview of the literature to help us answer these questions.

 

Check out our Down East EM blog for show notes, references and a whole lot more amazing content.

 

Author: Dr. Sam Wood MD

Peer Review: Dr. Jason Hine MD and Dr. Jeff Holmes MD

Sugar Is Bad For Kids- Pediatric DKA with Dr. George Willis

The management of diabetic ketoacidosis (DKA) in children is full of difficult questions- how much insulin should I give? Who is at risk for cerebral edema? What treatments, if any, increase the risk for this dreaded complication? Which fluid is ideal? How much of this fluid should I give? We sat down with ED physician and endocrine aficionado Dr. George Willis to answer these questions.

 

Click here for show notes

 

Authors: Dr. Jason Hine and Dr. George Willis

Peer Review: Dr. Mike Burla and Dr. Jeff Holmes

Not Just Drunk- wernicke's encephalopathy in the ED

The diagnosis of Wernicker's encephalopathy is a elusive beast. The classic triad of altered mental status, ataxia, and ophthalmoplegia is, of course, anything but classic in terms of presentation. To make matters worse, the most at-risk population, the chronic alcohol misuser, often have these signs and symptoms for alternative reasons. In this podcast we discuss diagnosing Wernicke's in the alcoholic.

 

Check out our post on the Down East EM blog for shownotes, references, and more.

 

Author: Jason Hine MD

Peer Review: Jeff Holmes MD

Boarding in the ED- what it does to patients & how to fix it

Boarding is a problem across most Emergency Departments in the United States, and likely the world. This adversely affects patients and staff. In this post we review the data on the detriments of boarding in the ED, how it impacts patients, and some ideas on how to fix it.

 

Check out our post on the Down East EM blog for shownotes, references, and more.

 

Authors: Pat Sanders MD and Jason Hine MD

Peer Review: Jeff Holmes MD and Michael Burla MD

 

 

Does the FOAM rise to the top?- Critiquing quality of FOAM publications

In this vodcast we review the prolific use of FOAM (free open access medical education) by learners, the need to assess FOAM quality, and a structured way to do so. 

 

Check out our post on the Down East EM blog for shownotes, references, and more.

 

Author: Jason Hine MD

 

COVID CODE BLUE!!- Logistics of running codes in the COVID era

In this vodcast we review the logistics of running a CODE BLUE (cardiac arrest) in a COVID patient, or any other patient under isolation care. Please note PAPR use is throughout this video, but PAPR can be replaced with proper eye protection and N95s.

 

Check out our post on the Down East EM blog for shownotes, references, and more.

 

Author: Jeff Holmes MD

COVID-19 and Personal Protective Equipment -What the Front Line Provider Needs to Know to Stay Safe

The personal protective equipment (PPE) for COVID-19 has been the center of attention in the medical world and laypress, in part because of the short supply and in part because of the importance of healthcare personnel safety. In this vodcast we review the different levels of PPE and what you need to know to safely protect yourself.

 

Check out our post on the Down East EM blog for shownotes, references, and more.

 

 

Author: Jason Hine MD

Peer Review: Christina Dematteo, DO and Jeff Holmes MD

Uterine bleeding in the ED

Uterine bleeding is a common presentation to the Emergency Department and rarely these patients are SICK. When they come in sick, it's not the time to be googling the ACOG recs on managing uterine bleeding. Here we review the proper management of the pregnant, post-partum, and non-pregnant patient with uterine bleeding.

 

Check out our post on the Down East EM blog for shownotes, references, and more.

 

When listening to this post, please consider the following questions (and follow us on twitter for spaced retrieval of this material @downeastem):

 

1. What tools do we have at our disposal to treat uterine bleeding in the non-pregnant patient?
2. What is your overall approach to uterine bleeding in the hemodynamically unstable patient? What are your first two interventions?
3. What is the number one cause of postpartum hemorrhage? What are the standard preventative interventions?
4. What other agents do we have at our disposal? Are there any procedures?

 

Authors: Jason Hine MD

Peer Review: Jeff Holmes MD Rebecca Bloch MD

Tranexamic Acid Beyond Trauma

Tranexamic acid (TXA) is a synthetic lysine derivative that binds with the lysine site on plasminogen, inhibits fibrinolysis and stabilizes clot. While it has been around since the 1960’s, its popularity for major trauma has gained a lot of steam in recent years. This has also resulted in creative emergency providers finding novel uses for it at the bedside. In this podcast, Dr. Tim Fallon discusses some of the more novel bedside uses of TXA including epistaxis, hemoptysis, post tonsillectomy bleeding, and dental trauma.

Click Here for the Show Notes on Downeastem.org

References

1. Zahad, R. A new and rapid method for espistaxis treatmetn using injectable form of tranexamic acid topically: a randomized controlled trial. AJEM. 31 (2013)1389-1392.[Pubmed]

2. Wand, O. Inhaled Tranexamic Acid for Hemoptysis Treatment. Chest. 2018; 154(6):1379-1384.[Pubmed]

3. Schwarz, W. Nebulized tranexamic Acid Use for Pediatric Secondary Post-Tonsillectomy Hemorrhage. Annals of Emerg Med. in Press. [Pdf]

4. Dietrich, S. Trick of the Trade: Topical Tranexamic Acid Paste for Hemostasis. ALiEM. https://www.aliem.com/category/clinical/tricks-of-the-trade/

5. Mason, J. Epistaxis TXA Pack. EMRAP HD. May 2018

6. Rezaie, S. TXA for Everyone: Inhaled TXA for Hemoptysis. RebelEM.

7. Rezaie, S. Topical Tranexamic Acid for Epistaxis or Oral Bleeds. RebelEM

You passed out, Eh?- the Canadian Syncope Risk Score and its use in the ED

Syncope is an incredibly common presentation to the Emergency Department with a broad differential diagnosis from the benign (vasovagal) to the lethal (arrhythmia). Because of this, the care and disposition of these patients can be challenging. In this podcast we sat down with Dr. Mike Burla to talk through the details of a new(er) decision aid- the Canadian Syncope Risk Score.

 

The paper we discuss can be found HERE

Thiruganasambandamoorthy V et al. Duration of Electrocardiographic Monitoring of Emergency Department Patients With Syncope. Circulation. 2019 Mar 12;139(11):1396-1406.

 

 

Check out our post on the Down East EM blog for shownotes, references, and more.

 

When listening to this post, please consider the following questions (and follow us on twitter for spaced retrieval of this material @downeastem):

1. How long did the CSRS study investigators observe patients for major arrhythmic outcomes after presentation to the ED? 

2. Approximately what percentage of the study cohort was classified as low risk by the CSRS?

3. What proportion of serious arrhythmic outcomes occurred within 6 hours of ED arrival, regardless of CSRS score? 

4. According to the study authors, what is the recommended time for observation of a low risk patient by CSRS? How about for Medium and High Risk Patients? 

5. Based on the study results, what risk stratification category are the recommendations most applicable to? What is the recommendation for electrocardiographic monitoring of this group? 

 

Authors: Mike Burla MD and Jason Hine MD

Peer Review: Lauren Wendell MD