Total Em - Tools Of The Trade And Academic Learning In Emergency Medicine

Although point of care ultrasound (POCUS) is a valuable tool, there are times that a formal radiology performed ultrasound is needed.  We continue our October POCUS month marathon with a discussion on this topic and how we can improve success for our radiology colleagues.  Mainly, we want patient's to have a properly sized bladder that will allow for the best imaging on transabdominal pelvic ultrasound.

Continuing in our month long discussion of point of care ultrasound (POCUS), we move to talking about patient understanding and satisfaction.  This is all in conjunction with Practical POCUS which will be having courses at the end of this year.  ​We have previously heard that the use of bedside ultrasound has helped with patient satisfaction, but a recent paper investigated the benefits with improving patient understanding.

The month of October is often associated with Halloween and people think "hocus pocus" but this time we are promoting point of care ultrasound (POCUS) with a month-long discussion of subjects regarding bedside ultrasound.  This is all in conjunction with Practical POCUS which will be having courses at the end of this year.  Our first topic, ultrasound for the diagnosis of urolithiasis.

Recently, Dr. Jeff Jarvis was published in the Annals of Emergency Medicine for a paper regarding a clinical bundle he developed to reduce complications during intubation.  Specifically, his paper was to help reduce hypoxia in out-of-hospital intubation attempts.  However, the pearls can be used by anyone managing the airway of a patient.

What happens when you have someone who is anticoagulated fall and have minor head trauma?  They are talking to you, they appear neurologically intact, and they feel like they can go home.  Do you let them or do you still encourage a CT scan of their head?  There is a recent paper that may change your practice.

Firefighters are exposed to a number of dangers on a daily basis.  With this being the anniversary of 9/11, we want to dedicate this blog and podcast to all the victims from that day.  Most of us are already very familiar with issues that arise with firefighters such as PTSD and the impact on the body from long hours, overtime, and physical stress.  Unfortunately, we often forget about the other needs and special scenarios that firefighters come across and will cover some of the key aspects in this blog and podcast.

At the request of listeners, we are covering some essential clinical topics such as deep neck infections including peritonsilar abscess (also known as "quinsy").  These are life-threatening conditions that require early recognition and intervention.  Since peritonsilar infections are not of deep visceral spaces, this is technically separate but given their high incidence and at times coexistence with other deep neck infections they are often combined such as in discussion.

I​​ntraosseous (IO) devices are traditionally used in the initial stages of resuscitation when peripheral intravenous (IV) access is not readily obtainable.  This can happen for a variety of reasons such as edema, burns, obesity, or IV drug abuse among others.  Although ultrasound can be used to obtain peripheral or central venous access, the most rapid route is the IO.  The device has been used both in adults and children with great success.  It can safely facilitate the delivery of fluids, medications, and blood.  There are very few contraindications and it is rare to have a complication.

It has been 100 podcasts since the last time Jim DuCanto talked about his SALAD (Suction Assisted Laryngoscopy Airway Decontamination) technique.  Podcasts #8 and #9 were so long ago we wanted to have Jim back on to celebrate his achievements and talk more about the future of SALAD and other related projects.

Every year, we see drownings.  In some cases people survive, but unfortunately sometimes they do not.  However, there is confusion in both the medical community and the public regarding what is considered to be a drowning event.  Dogma and myths are everywhere and one of the most common is "dry drowning"  which is why we brought Michelle Perkins on to discuss this important issue.

We see changes in potassium levels all of the time in patients.  However, what works and what does not?  What is the evidence behind the management?  Are there special pearls?  These questions and much more are addressed in this podcast with Michelle Perkins.

Patients often come in complaining of a possible spider bite, but is this actually the cause of their symptoms?  In this blog and podcast, we talk specifically about brown recluse bites, differentiating them from other causes, treatment, and other pearls.

Epinephrine (adrenaline) has been a hallmark of cardiac arrest management as an attempt to obtain a return of spontaneous circulation (ROSC).  However, the evidence for epinephrine in out-of-hospital cardiac arrest (OHCA) as well as in the hospital (IHCA) has been conflicting.  We review the largest trial to date just recently published in the New England Journal of Medicine (NEJM).

Does it actually matter how you dress when you go to work?  The BMJ recently published an open access article covering this exact issue.  Although in many ways limited, this study offered some key insights regarding how our dress attire in different settings could potentially impact patient perceptions.

Too often we find ourselves fighting trolls and people both on social media and sometimes in real life.  Most of the time though, we are not able to engage in any form of real debate and discussion.  In this blog and podcast, we talk about how to meaningfully discuss and properly debate in any situation, especially on social media.

Excited delirium has been covered quite a bit, but like other hot topics it is always changing with new evidence.  Here are some of the key pearls and pitfalls to managing this high risk population.

The last 100 podcasts has been a major milestone.  Now that we are in the triple digits, it is worth reviewing some of the highlights from the first 100 episodes.  Also, we have a major announcement to share!

When you hear five of anything in regards to emergency medicine, you have to think of Ken Milne who is an evidence based medicine (EBM) guru in the field of emergency medicine (EM).  He hosts The Skeptics Guide to Emergency Medicine (The SGEM) and is a major advocate in cutting down the knowledge translation (KT) window down from over 10 years to less than one year.  In true celebratory fashion for the 100th podcast, Ken came on to discuss being a skeptic by reviewing five examples of when EM got ahead of the evidence.

The first time you see it, there can be any number of emotions.  On some patients, it looks like their chest is being caved in by a machine.  On other patients, it feels like a smooth and controlled aspect of an otherwise difficult resuscitation.  There are many opinions and stories about mechanical cardiopulmonary resuscitation (mCPR), but the evidence may surprise you and lead to the question: does it work?

​Mobile Stroke Units (MSUs) are ambulances that are designed to improve the time of delivery of stroke care to patients.  This sounds like an excellent idea at the surface, but is the cost and approach practical?