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

Everyone talks about airway all the time, and I was at first reluctant to give this talk.  However, I believe it is time to talk about this important subject in a slightly different way.  The last time we talked about airway management in regards to intubation was with Kris Maday (from the PAINE Podcast) in Podcast #18 where we went over the basics (a great review to listen to first if needed).  There we talked mostly about rapid sequence intubation (RSI).  Although commonly used, this is not for every patient.  Today, we talk about RTI, which is what we need in most patients.

No matter what aspect of emergency medicine you work in (EMS, fast track, main ED, rural, remote, urban, suburban, or whatever else), you need to be a resuscitationist in my book.  This is entirely my opinion, but I believe it is important one worth your time in both reading and listening. ​Envision a busy night shift.  It is three in the morning and somehow you still have a waiting room full of people waiting to be seen in your small ED that is hours away by ground to tertiary care.  Scattered thunderstorms and overwhelmed emergency services have made it difficult to transfer out patients.  You would swear it was a full moon, but when you were outside just to get a quick breath of fresh air from all the chaos you look up and it is not.  Suddenly, you hear sirens in the distance and EMS reports are all coming in at once...

Tranexamic acid (TXA) is an old drug, but one that we in emergency medicine have found love for once again.  In preparation for an upcoming talk at a conference, I realized I had not yet made a post regarding TXA.  This is a quick summary of TXA and links to a lot of great #FOAMed resources out there you can also check out regarding the same.  I have also included one bit that I have recently found very successful but with little evidence currently.  Listen to the podcast for more!

After Podcast #44 regarding how to incorporate change, our friend Patrick Bafuma reached out to provide his thoughts on how to make change happen in your department.  He has championed the process and has pearls that are well worth the listen.

We are having a special episode to add to what we did with Salim Rezaie on REBEL Cast recently as a guest.  While we were there, we talked a lot about the TOAST trial and reviewed our own clinical use of dexamethasone.  It is definitely worth your time to visit his page and listen to that podcast.  However, we wanted to add our own little supplement to the #FOAMed world by adding a detailed analysis of the paper in true BEEM fashion.  Please check all of this out for a more thorough understanding of the topic.

We have talked about abscess management before both here (Podcast #13) and on the Skeptics' Guide to Emergency Medicine (Podcasts #156 and #164).   Even though we have talked about using antibiotics before, there has been debate on its use in smaller abscesses.  Today, we cover how antibiotics are still beneficial even for the small ones given the most recent evidence out there.  Listen to podcast and read this blog for all the details as we cover different points in each.

We are joined by Tyler Christifulli, a well experienced critical care paramedic and host of the Lifestar Podcast, to discuss a proposed ventilation strategy.  It is worth listening to his original podcast first to get a complete picture.  I would also recommend listening to Scott Weingart's Dominating the Vent lectures on his EmCrit website if you are not very familiar with ventilator management in general.  A warning in advance, there is some cursing in the podcast.

Happy Fourth of July!  Today we are joined by Evidence Based Medicine (EBM) rock star Ken Milne who is known for the Skeptics' Guide to Emergency Medicine (SGEM) blog and podcast.  He has been a major mentor to the TOTAL EM project and to celebrate our 50th podcast he agreed to join us for a detailed discussion on FOAMed and EBM.  Both SGEM and TOTAL EM are part of the Free and Open Access to Medical Education (FOAMed) movement.

Kevin Burns is back from our last podcast for another discussion, this time specifically on Point of Care Ultrasound (POCUS) and prehospital care.  He is assisting with some new research and we review how POCUS could be beneficial in the EMS.

Keving Burns is one of those PAs who is on the cutting edge of prehospital care.  He is the co-director of the Yale New Haven Hospital (YNHH) Emergency Medicine PA Residency program.  One of his favorite aspects of emergency medicine is prehospital care and we wanted to talk to him about some of the plans for the future of PAs in emergency medicine.

Clay Smith of EM Topics joins us today for a first-ever crossover post.  His amazingly well-done blog with daily posts on clinically important papers is a must to subscribe.  In today's post, we cover a review he is also publishing today regarding ramping in intubations.  In this RCT, there is no benefit in the primary outcome (lowest oxygen saturation) when comparing ramping versus sniffing position.  However, there is a lot more to the paper as discussed in this podcast.

Brian Lin is back for the second part of our conversation with him from the 2017 SEMPA 360 conference, but this time we are talking about two subjects with a lot of dogma: the Golden Period for wound closure and dog bite closure.  This brief review is designed to remind you of some of the key components in order to better care for your patients.

Brian Lin is an impressive physician with expert knowledge in wound management and care.  It was well worth the visit to talk to him in person about some of the more intricate parts of wound management.  At SEMPA 360 this year he gave so many pearls that there is no doubt he was a treasure to the conference.  If you could not make it this year or want a reminder of some of the key points, check out the notes and listen to the podcast.

​Medicine is slow to change, and using #FOAMed can be a challenge at times if you feel stuck and unable to speed up the process.  Today, we talk about some tips that could help you better move things along in your department and among colleagues.

​We have two previous guests today that are returning to talk about a familiar topic: sepsis.  There has been a lot of coverage recently but we want to cover it from a different angle by getting back to basics while including some of the key updates from recent literature and guidelines.  This recording was originally made for the Emergency Quality Network (E-QUAL) which is part of the American College of Emergency Physicians (ACEP).  It was our pleasure to work with ACEP to provide this content and we hope you enjoy it, as well.

Today we are covering a study on a medication not commonly used in the United States or most of the world: Shenfu.  It is not discussed much but does have implications as a potential cure for sepsis and has been used in China for the last two decades.  Given the recent discussions about cures for sepsis based on other studies, it seemed appropriate to talk about something with a growing body of evidence that most of the world may be ignoring without a good reason.

We have all been there before.  The consult that just does not go to plan.  Most of us first experience it as students and it can drive us mad.  Recently, while at the Podcasting Course in Lexington, Kentucky a fun and brief podcast was made covering the subject.  This was a group project and hopefully this will remind us to cover more content on "soft skills" such as consults and daily interactions.  Mainly, the things not covered in any sort of medical texts at least on a regular basis.

Major Jonathan Monti, PA-C is our first SEMPA 360 posting from the recent 2017 conference.  We were able to talk to a variety of people at the conference thanks to the staff there and we truly appreciate their help.  For the first time ever, SEMPA had what they call the "EMPA of the Year" award and this went to the very deserving Major Monti.  We had the exclusive chance to interview him immediately after the award and his thoughts are included here.

Rob Orman is back again for another fun week where we continue his "grab bag" interview.  I need to make a quick warning that there is some language in this podcast so if you are easily offended please be warned now.  However, language is very brief and minimal at best.  This interview was done in a lot of fun and we hope you find it entertaining, too.

We just came back from SEMPA 360 and it was a blast!  But today, we have a two part interview with Rob Orman.  The first half, today's discussion, is all about patient satisfaction.  Next week, we will further our "grab bag" discussion with some other interesting questions that others wanted to hear from Rob about, but all I can say is you do not want to miss the pearls from the interview so make sure to listen to both!