Intro: ACEP Headache Policy

ACEP gives guidance on evaluating patients with possible subarachnoid hemorrhage, but sometimes there's no avoiding the hedge.

Amplified Pain Syndromes

Does your patients pain, or at least reaction to it, seem out of proportion to the underlying issue? An amplified pain syndrome may be at play.

Lit Matters 1: Who Elopes?

LWBS is a well known phenomenon in the ED waiting room, but there is little data on who leaves and when. Until now. 

An Evidence Based Approach to Small Bowel Obstruction

Brit Long separates the wheat from the chaff when it comes to diagnosing and managing small bowel obstructions. 

Lit Matters 2: Is That a Variceal Bleed?

Can a clinical decision tool tell us which GI bleed patients don't have varices?

Amal Mattu's Lessons Learned as an Expert Witness

Amal Mattu is many things, including an expert and being an expert witness. He sits down with Mizuho Morrison to lay out the pearls he's gleaned over the past decade and a half of case review.

Lit Matters 3: Adjusting Dimer Based on Probability of Disease

We are finding that a one size fits all d-dimer strategy isn't always the best way to go. First it was adjustment based on age, now we see if dimer thresholds can be shifted based on pretest probability.

Rojo Mojo: Non Sedated Shoulder Reduction

Rojo Grande is back with his clinical approach to dislocated shoulders.

How to Achieve Flow State

What is a flow state? When you feel it, you know it. An almost effortless ease of action. To define it, you could say it's a feeling of being in control without making any conscious effort to do so, or being completely immersed in an activity with energized focus. In this episode, performance coach Jason Brooks, PhD breaks down the steps to achieving flow and how to get it back when it slips away.

Intro: Cold vs Warm Hemorrhagic Shock

Scott Weingart addresses two listener questions on using pressors (and vasodilators!) in hemorrhagic shock.

T and L-Spine Fractures in the Trauma Bay

Trauma team leader Andrew Petrosoniak gives his approach to patients with potential thoraco-lumbar trauma. 

Lit Matters 1: Validation of the Canadian Syncope Risk Score

EEM: Badness Afoot in the Prostate

From Essentials of Emergency Medicine 2019, Tarlan Hedayati presents a case of prostatitis gone awry. 

Lit Matters 2: HINTS Exam

Acute Flaccid Myelitis

Rob and Jason dissect a case of weakness in a 9 year old.

Lit Matters 3: Acute Aortic Syndromes and CXR

Do You Need to Get a CXR on STEMI Patients Before the Cath Lab?

ED intensivist Sam Wood breaks down the math for reconsidering routine chest x-rays in STEMI patients. 

Race and Medicine - An Introduction

 In recent weeks, many of our medical organizations have released official statements declaring racism to be a public health crisis. In this introduction to Hippo Education’s new Race and Medicine audio series, Dr. Jay-Sheree Allen sits down with Primary Care RAP host Dr. Neda Frayha for a candid conversation exploring the definition and types of racism, the historical and present-day manifestations of racism in medicine, and potential strategies we all can incorporate into our daily practices to go beyond the hashtag and become true allies.   

Facing Death in the Time of COVID-19 with Dr. BJ Miller

How are you coping with all of the death around us these days? In this Hippo Education update, Primary Care RAP host Dr. Neda Frayha interviews Dr. BJ Miller, a hospice and palliative care specialist at the University of California, San Francisco whose TED talk on what really matters at the end of life has been viewed over 10 million times. Along with Shoshana Berger, Dr. Miller is the co-author of the book, A Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death and founder of the Center for Dying and Living. In this conversation, he helps us come to terms with our own mortality and provide better support to our patients at the end of life. 

The Day I Almost Killed a Patient

They say that the best doctors are the ones who make the most mistakes in training. 

COVID Antibodies and Immunity

Dr. Mizuho Morrison & Dr.Jenny Beck Esmay both having had covid themselves, briefly discuss the clinical course and what presence of IgM vs. IgG signifies. They discuss what we currently know about antibody testing (national availability, reliability, sensitivity) as well as convalescent plasma transfusion (CPT) and criteria for donation vs. recipient.

What ECMO Does (and doesn't) Do

Scott Weingart breaks down which patients will (and will not) benefit from ECMO. 

Lit Matters 1: Naproxen vs Colchicine for Acute Gout

Is there a clear winner for treating gout flares? 

Slaying ED Flow Like a Boss

Keeping ED flow moving is a master skill that is under-taught. 

Lit Matters 2: TXA for Traumatic Brain Injury

The CRASH-3 study looks at TXA in the treatment of traumatic brain injury. 

Death By Disimpaction

A unexpected turn of events with fecal disimpaction. 

Lit Matters 3: Can We Lower the MAP Target in the Elderly?

Finding the ideal MAP is harder that it seems. 

Delirium in the Elderly

Geriatric EM specialist Christina Shenvi breaks down her approach to the delirious elderly patient. 

*UPDATED*The Saga Continues with Remdesivir and Hydroxychloroquine

*Editor's note: As of June 4, 2020, The Lancet article by Mehra MR et al has been retracted. (https://www.thelancet.com/lancet/article/s0140673620313246) n this Hippo Education short, Dr.Salim Rezaie from REBEL EM and Lit Matters critically appraises two papers published on Friday May 22nd, 2020.  He discusses what the evidence shows for both remdesivir & hydroxychloroquine/chloroquine as effective treatment or prophylaxis for COVID-19.

COVID CARDIOLOGY

COVID-19 causes STEMI’s, arrhythmias and myocarditis?!? Emergency medicine and cardiology guru Amal Mattu, MD chats with Mizuho Morrison, DO on the cardiovascular effects of COVID-19. They discuss: the known pathophysiology of how viral infections affect the heart; Review the new consensus statement from the Society of Cardiovascular Angiography and interventions (SCAI), American College of Cardiology (ACC), and the American College of Emergency Physicians (ACEP) on how to manage STEMIs; and lastly discuss how cardiac arrest management differs in this COVID era.   

Indirect Impact of COVID-19 on Children

Children seem to be less affected than adults by the direct effects of COVID-19 infection, but the pandemic has brought forth other health risks to the pediatric population. Sol Behar interviews Oakland, CA based primary care pediatricians Celine Sparrow and Katie D’Harlingue about the indirect  impact of COVID-19 on children. Topics covered include home school and academic achievement, mental health issues, and nutrition/food insecurity. 

Failed IUP: Then What?

Ben Shepherd, double trained in OB/Gyn and EM breaks down a rational approach to managing patients with failed IUP.

Lit Matters 1: What Happens to Ureteral Colic Patients After Discharge?

Most patients with renal colic have a low risk of needing urologic procedures and many don’t follow up.

EEM: Flashes and Floaters

From Essentials of Emergency Medicine 2019, ophthalmologist Will Flannery (AKA Dr. Glaucomflecken) gives his approach to evaluating emergency dept. patients with flashes and floaters. 

Lit Matters 2: TPA for Stroke Mimics

What happens to stroke mimics that get TPA?

Alternatives to Opioids (ALTO)

We're now in an era of hyper-awareness to the detrimental effects of opioids. But more than saying, "These meds are a problem," how do we apply that awareness to clinical practice and still provide analgesia. Don Stader, champion of the Colorado Alternatives to Opioids (ALTO) project, gives his clinical approach.

Lit Matters 3: Single Syringe Adenosine

Is it better to use a single syringe when giving adenosine for SVT?

Bits and Pieces

Your questions (and answers) on: dilating eyes in the ED, the hidden cost of crossmatchnig blood, hyper K, and what to do when administrators weaponize performance metrics. 

The Boiling Point of Stress

None of us are immune from stress, especially now. This is a critical moment for us to look out not only for our own mental health but that of our colleagues. In this episode, Dr. Melissa Shepard sits down with Primary Care RAP host Dr. Neda Frayha for some real talk on the mental health challenges facing health care workers in the COVID-19 pandemic, and some concrete, tangible tools to help us get through this period. Spoiler alert: it’s more than yoga.

COVID-19: Fundamentals of Critical Care

A critical care crash course with Mizuho Morrison and Scott Weingart.

Talking to Fear

Non-CME: This episode is not accredited for CME.  Jason Brooks, PhD is a performance coach who works with physicians, athletes, and the military, helping them develop the cognitive skills not only to operate at the highest level, but to thrive no matter what the task. During the COVID-19 pandemic, Jason has been working with frontline clinicians, helping and guiding them through the cognitive and emotional aspects of what’s happening. This episode will give us strategies to mentally prepare for each day. It will show us how to find an anchor to ground us so that rather than feeling like we’re constantly running defense, we are actually on offense.

COVID-19: Dimers, Clots and DIC

Hematologist Tom Deloughery gives a primer on COVID-19 cytokine storm, d-dimer, DIC that leans toward thrombus, why some clots break through heparin, utility of low molecular weight heparin, and using TPA for ARDS (don’t get too excited on that one quite yet).

COVID-19: Weingart Q & A on Airway, Vents, Tubes, Lungs, ECMO, and CPAP

ED-intensivist Scott Weingart has developed several protocols for airway management in COVID-19 patients, but each of those answers brings up more questions. In this episode: ‘Happy Hypoxemia’, the 4 types of COVID patients, Covid L vs H, is there a role for ECMO in severe disease, why intubation should be a last resort, the importance of patient positioning, and much more.

COVID-19: Code Blue

In this episode we speak with Chris Hicks, a Canadian emergency physician and trauma team leader who is a master of teaching the cognitive skills of resuscitation.  Chris shares several protocols from his hospital regarding code blue and intubation in the era of COVID-19 including: the pre-brief process, communication during a code in PPE, preparing for a code (when you have time), what to do when there’s a surprise arrest and the team isn’t in PPE, how to effectively use an airway checklist, and how to find your anchor when you’re stressed.

COVID-19: Fluids, Prone Position, and Your Emails

In today’s update: New York experience with fluid restriction in COVID ARDS, prone positioning for non-intubated hypoxic patients, resetting the intubation threshold, and using ABGs. Your questions for Reuben Strayer and Patrick Reinfried. For all the previous COVID podcasts plus a bunch of other super useful stuff, here is our depository of resources.

Big Changes Inside the 'Cast'

This month we introduce our new literature review ‘LitMatters’ with practicologists Salim Rezaie and Matt DeLaney. Trauma team leader Andrew Petrosoniak is back and this time it’s all about eval and tx of blunt cerebrovascular trauma. Ryan Radecki makes us question fecal blood testing. We dig deep on Kawasaki disease, dialysis emergencies, and why you should love your bougie even more.

Blunt Cerebrovascular Injury

Trauma team leader Andrew Petrosoniak gives a streamlined approach to evaluating patients for blunt cerebrovascular injury.

Lit Matters: Second Line Seizure Medications

Is there a best second line agent for status epilepticus?

EEM: Dialysis patients in the ED

From the Essentials of EM studio sessions, Jeremy Branzetti gives a structured approach to evaluating dialysis patients. 

Lit Matters: Peripheral Pressors are your Frenemy

Peripheral pressors were once persona non grata in the resus room, but that has changed over the past few years as mounting evidence has purported their safety. But are they as safe as we've been led to believe?

The Dirty Truth about Fecal Occult Blood Testing

Ryan Radecki from EM Lit of Note throws shade on fecal occult blood testing. Should guaiac cards be relegated to the emergency department waste bin? 

Lit Matters: Roc vs Sux. Clash of the Titans?

A prehospital study comparing Roc and Sux for first pass intubation success.

Kawasaki Disease Update

Kawasaki Disease can be hard to catch for so many reasons- findings may appear at staggered times, it can present atypically, and there's no gold standard test to clinch the diagnosis. To help mitigate some of the confusion, we review the recent Kawasaki guideline update and dissect some of the disease's nuance that might burn us in the ED.

Vive la Bougie!

The winning and runner up 1 minute podcasts from our recent Essentials of Emergency Medicine fellowship contest.

COVID-19: Triage Tent Logistics

Triage and treatment tents have become ubiquitous in the current pandemic, improving throughput and keeping infectious but relatively well patients outside of the hospital. In this episode, emergency physician Josh Bucher, assistant professor at the Robert Wood Johnson Medical School, breaks down how his team has set up and uses their tent.

COVID-19: Inside New York City

In this episode I speak with Dr. Reuben Strayer, emergency physician at Maimonides Medical Center in Brooklyn, NY. The news is rife with reports of New York’s escalating COVID-19 cases and there are lessons we can learn from how they are responding. Discussion includes: Managing a Massive Surge (which is only going to get worse), Ventilator Allocation Planning, Hot/Warm/Cold zones, High Flow Nasal Cannula O2 for Preox, Use (or non use) of Non-Invasive Ventilation, Variations in COVID Presentation, COVID and Cardiac Arrest, In Harm’s Way When PPE Runs Out.

COVID: Lessons Learned and First Hand Account From Kirkland, WA.

Kirkland, Washington was the first U.S. city with reports of a large-scale COVID-19 outbreak. In this special edition of ERcast, Dr. Patrick Reinfried, an emergency physician practicing at Kirkland’s Evergreen Hospital, gives a first hand account of what happened in his community, how his hospital has responded, and lessons learned. In this episode: difficult decisions that might not have been made before the outbreak, testing, what factors go into deciding admission vs. discharge, how to limit exposure to COVID patients and save PPE,  re-ordering the emergency department with an area dedicated to fever and respiratory illness, patient flow, utility of BiPAP vs intubation, lab ordering, X-rays, and psychological impact.

COVID-19: Troponin, Abx, Chloroquine, X-rays, Rationing Tests, Public Health

In this episode I speak with Dr. Rick Pescatore, Chief Physician for Preparedness for the state of Delaware and a front-line emergency physician.  While the general topic is the COVID-19 pandemic, specific issues discussed include:  triage decisions, X-rays, troponin, what to do when there’s limited testing ability, antibiotics, chloroquine, viable strategies for managing homeless populations, and more.  Let’s go.

How to Save PPE and Reduce Exposure, HIPAA Relaxes

In today's episode, emergency physicians Amy Cho and Jason Adler break down novel ways to limit use of PPE while at the same time minimizing contact with potentially infected patients. We also talk about how government regulations have obstructed our ability to provide intelligent care but now those regulations are starting to relax, a few seconds on washing your gloves,  how do you respond when a COVID patient is coding (more of a question than an answer in this conversation), and what are the next steps in leadership that can make an impact.

Bonus Short - COVID-19 Update

In this Hippo Education Short, Infectious Diseases specialist Dr. Devang Patel and our own Dr. Neda Frayha discuss the latest, clinician-focused updates on the COVID-19 coronavirus outbreak.

Troponinemia in Renal Disease

From afar, this would seem like utter esoterica but from close up, in the heat of the ED, it’s anything but. Elevated troponin in renal disease is the gift of frustration that keeps on giving.  Brit Long breaks down the evidence, areas of uncertainty, and structure of a rational approach to managing patients with high trop and bad beans. 

EEM: The X-Ray Paradox

From Essentials of Emergency Medicine 2019, emergency orthopedics specialist Arun Sayal tells us why X-rays aren't always to be trusted and how they should be considered a management tool rather than a diagnostic one. 

N of 1: Stoicism with a Capital S

Philosopher in residence Dan Mccollum gives a primer on Stoic philosophy and its application to emergency medicine. 

Salicylate Toxicity and Elimination

Toxicologist Heath Jolliff gives a look inside the toxicologist's brain in the management of aspirin toxicity. 

Can You can Discharge a Hypoxic Bronchiolitic?

A few years ago, discharging hypoxic bronchiolitics on homie O2 would have sounded like madness. Today, however, that's not the case. Pediatric emergency physician Jason Woods explains how it's done at his hospital as well as pro-tips on bronchiolitis management, 

Bits and Pieces

Your emails, comments, and an acappella ode to pediatric hip pain. New evidence supporting a 1000 d-dimer cutoff for low risk PE patients, Ran Ran demystifies electrolytes, Matt Delaney tackles skin tears and Nate Kuppermann on vomiting after head injury. 

It’s Critical Care Time!

Coding and billing specialist Jason Adler says that most of us misunderstand 'critical care time'. He's here to set the record straight and help us on our path to becoming documentation blackbelts.

New IDSA Pneumonia Guidelines

Clay Smith is back to break down the high (and possibly low) points of the new pneumonia guidelines.

N of 1 - The Art of Breathing

We've been breathing since our first moments of life, but does that mean we are truly experts? In this episode of the N of 1, therapist and breathwork expert Ryan Cheney walks us through how we can make breath work for us, not just with us.

EEM: Is There a Role for Plain Films in Trauma?

Back in the day (way back) plain films were all we could get in the trauma patient. In the age of CT, ultrasound, and other advanced imaging, is it time to put plain films to rest? From Essentials of EM 2017, Kenji Inaba gives his perspective. 

Mechanical Falls Aren’t Just Mechanical

Geriatric EM specialist Christina Shenvi breaks down the nuance of something that might seem simple but is anything but; the geriatric patient who falls and hits their head. In this episode, why the term 'mechanical fall' should not be the final diagnosis when an elderly patient trips and falls, when to get a CT head and neck in even minor trauma, utility (or lack thereof) in doing repeat head CTs on anticoagulated pts with minor head trauma, and so much more...

Bonus Short - Novel Coronavirus

In this Hippo Education Short, Infectious Diseases specialist Dr. Devang Patel sits down with our own Dr. Neda Frayha to discuss what we know so far about the new 2019-n-CoV coronavirus outbreak and what front-line clinicians can do if we suspect a patient of ours might have this viral illness.

ERcast turns 10. Failure, Growth, Choices, and Karate

In this 10th anniversary special, GFOP Josh Russell, MD interviews Rob and digs deep into...failing at work, finding the right job (and being honest about the wrong one), Top Gun, origins of ERcast, why rectal foreign bodies was the subject of episode one, advice for young doctors, how failing a black belt test was a pivotal moment, guiding principles, and memento mori. This pod contains absolutely no clinical medical education. There is no CME credit for this episode.

Bits and Pieces

Our bi-montly session where YOU take the helm with… bloody pee, baby coughs, salty blood, Sam Ashoo's beef with blood pressure, and the power of silence. "

BRUE Works

A few years ago, ALTEs (Apparent Life Threatening Events) got reworked, renamed, and rebranded as BRUE. But did changing the name actually impact patient care? Clay Smith from Journal Feed is back to break down some recent literature answering just that question. 

N of 1 -- The World’s Most Efficient ED?

Once a patient is placed in an ED room and bed, it can feel like time slows down. Unless they're dying, most systems don't have a rush order on getting things done. Florida emergency physician Michael White says things don't have to be that way. He has re-worked his ED's flow so that discharge length of stay is less than 80 minutes, patients are happier, and docs more satisfied.

EEM 2019: Non-pregnant Vaginal Bleeding

From Essentials of Emergency Medicine 2019, Ob/Gyn Megan Jones gives her simple approach to evaluating and treating ED patients with abnormal uterine bleeding. 

Cardiac Transplant Patients in the ED

We should never trust the transplanted heart. Loss of innervation, no chest pain with MI's, infection, rejection, and vasculitis are just a few of the problems we can run up against. In this episode, ED intensivist Sam Wood gives us the tools for a rational approach to evaluation and treatment the next time one of these patients visits your ED.