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.