The patient's blood pressure is 190/80 but they feel fine...how do we treat these patients in the ED? Labs? EKG? BP meds? Admission???...but they are here for an ankle sprain! Asymptomatic hypertension is a challenging complaint to deal with in the ED because of so many conflicting opinions and worries but it doesn't have to be difficult. In this episode, we'll discuss a systematic and rational way to evaluate patients with asymptomatic HTN, do limited and targeting testing, and get them the rig...
Feb 17, 2014
This episode is part 2 of the PE podcast where we will discuss risk stratification and treatment of PE. It's important that we accurately quanitfy the amount of clot burden that the patient has to order the right treatment and admit them (or maybe even discharge them) to the right location. We'll talk about how to classify massive, sub-massive, and "non-massive" PEs and how to treat them. We'll also briefly talk about emergning evidence for the expanding role of thrombolytics and outpatient trea...
Feb 03, 2014
This episode has been a long time in the making- presenting Pulmonary Embolism, part 1. PE is a deadly diagnose that we frequently have to consider in the ED. The presentations can be very varied but we need to know how to work up this disease while avoid unnecessary testing and harm to our patients. In part 1, we will discuss risk factors for PE, symptoms that should make you suspicious for PE, and how to order the correct labs and imaging to diagnose this serious condition.
Jan 28, 2014
The last podcast on COPD led to some great discussion online about the use of oxygen in patients with COPD. To address this, Drs. Tim Peck and Colby Redfield are back with a quick summary to clarify how to best use oxygen in patients with COPD. There's also another cameo by the one and only Dr. Peter Rosen on how to suceede in emergency medicine.
Jan 08, 2014
EM Basic is back with another episode of the EM Basic Project. In today's episode Drs. Tim Peck and Colby Redfield review the chief complaint of shortness of breath with a focus on COPD. Even though we did an episode on shortness of breath a while back, it's always great to get a new perspective on this chief complaint. Today's episode also features a very special guest cameo by the name of Dr. Peter Rosen. He pretty much started EM as a speciality and you may have seen his name on a textbook or...
Dec 09, 2013
This is the premiere of the first contribution to the EM Basic Project. Dr. Brian Cohn from Washington University in Saint Louis, Missouri is on the podcast today talking about mono-articular arthritis. He reviews the common physical exam findings, the appropriate lab work and medications, how to avoid common pitfalls in this diagnosis, some evidence based medicine pearls and even some relevant medical trivia. Dr. Cohn is one of the authors of the EMJ club podcast which reviews common EM topics ...
Sep 16, 2013
This episode is something unlike anything I have ever done with EM Basic. I had a case recently of a super sick patient who required a big resuscitation. Fortunately, the patient did great and was gracious enough to give me her permission to share her case so that others can learn. In this episode, we'll go over what happened with this patient step by step and I'll review some valuable teaching points on how to get things done in the resuscitation bay and how to think about treating critically i...
Aug 07, 2013
This is an announcement instead of an episode. Introducing the EM Basic Project. If you are a senior resident or attending in emergency medicine- this is your chance to contribute to the podcast. I will be accepting quality submissions for the podcast with help every step of the way. I'm also looking for a webmaster to help spruce up the blog page. In addition- if you have an idea for a blog or a podcast or don't even know where to start, email me and I can help. Take a listen to hear all the de...
Jul 26, 2013
In this episode, we'll talk about how to manage the airway in patients with anaphylaxis or any other upper airway obstruction. These can be some of the most difficult airways to manage and we can run into trouble if we don't have a good plan ahead of time. Some of this is a little "advanced" and "cutting edge" but it's important to have as many tools in your arsenal when dealing with these critical airways. We'll review other options besides RSI to include awake intubation, delayed sequence intu...
Jul 22, 2013
Anaphylaxis is a potentially deadly diagnosis that requires quick action. In this episode, we will discuss the diagnosis and management of the entire spectrum of allergic reactions from mild cutaneous reactions to life threatening anaphylaxis. This is the first episode in a 2 part series. Part 2 will discuss airway management in anaphylaxis and other upper airway obstructions situations.
Jul 15, 2013
Today's Essential Evidence Episode discusses the paper that derived and validated the PE Rule-out Criteria or PERC rule. This is a clinical decision aid that we can use to reliably exclude pulmonary embolism in emergency department patients without any further testing. We'll talk about some background on diagnosing PE in the ED, the study design, how to use the PERC rule in your everyday practice, and some clinical pearls as well.
May 20, 2013
We encounter seizure disorders frequently in the ED. In this episode, we'll review all the important points about seizures including the confusing and difficult topic of pseudosezures. We'll also go in depth on the ED treatment of seizures and status epilepticus.
Apr 29, 2013
We're back with a new episode of Essential Evidence. This article is from Academic Emergency Medicine March 2009 and it talks about getting blood cultures in well appearing kids aged 3 to 36 months. We used to get a lot of blood cultures in these well appearing kids with fever but this article was the final nail in the coffin that got us to stop doing that. It's hard to believe that based on how we practice now but we needed this large study to show us that we are now doing the right thing....
Feb 26, 2013
EM Basic is back and ready for the new year. We see various eye complaints a lot in the ED. This episode will review common eye complaints, their treatments, and a bonus section on how to do a lateral canthotomy.
Jan 23, 2013
This episode reviews the article that most people call the PECARN head CT rule or the Kupperman head CT rule (named for the first author). This is an easy to use clinical decision rule that can help us reduce the number of head CTs that we do on children with minor head injury. We owe it to our patients to spare them excess radiation, cost, and time in the ED and this rules helps us do this. In order to use this rule effectively, you need to read this article and understand how the study was don...
Oct 29, 2012
In this episode, we will discuss how to perform medical screening for patients with psychiatric complaints. While most of these workups are routine, we have to be able to catch the small percentage of patients who have a medical cause to their psychiatric complaint. Don't think it can't happen to you- it almost happened to me twice during residency! We'll discuss how to stay safe while evaluating psychiatric patients, how to get the entire history, how to do appropriate testing, catch the red fl...
Oct 22, 2012
This episode of EM Basic Essential Evidence will review the two articles that led to the adoption of therapeutic hypothermia as a treatment for survivors of cardiac arrest. This is a simple yet highly effective therapy that improves survival and neurological outcome in survivors of cardiac arrest so it is important that we know and understand these two articles.
Oct 15, 2012
This is an article published in the last year in the British Medical Journal that looked at the sensitivity of modern CT scanners in detecting subarachnoid hemorrhage. This article made a lot of waves because it suggested that a head CT within 6 hours of headache onset is 100% sensitive for subarachnoid hemorrhage. Some have called it a practice changer that allows us to avoid doing a lumbar puncture so its important to read it for yourself and decide if it should change your practice.
Oct 01, 2012
Non-invasive ventilation is a great technique that we can use for just about any patient who is short of breath. We can use it to avoid intubation in our patients who are close to respiratory failure. In this episode, we'll talk about how non-invasive ventilation works, which patients we can use it on, and how to actually make it happen. For that last part, I'll borrow from a post by Seth Treuger at his blog mdaware.org on how to start non-invasive ventilation quickly while keeping it comfortabl...
Sep 25, 2012
This episode will discuss the NEXUS study. NEXUS was a study that studied thousands of patients to validate a set of rules so that we can "clinically clear" patients with possible c-spine injury without getting an x-ray. This study has helped us avoid radiation in certain low-risk patients, saved the cost of x-rays and CT scans, and speed these patients through the ED. We'll talk a lot about the statistical side of this study and how you can apply it in your everyday practice.
Sep 17, 2012
All right- let's keep the laughter to a minimum...today's episode is talking about how to approach testicular pain in the ED. You need to know how to approach this chief complaint because if you don't workup the patient correctly, they can lose their future fertility and possibly their testicle. We'll review how to take a good history and do a rapid focused exam to make sure that we catch all those patients with torsion and don't delay their treatment.
Sep 10, 2012
In this episode, we'll talk about a recent article in Annals of Emergency Medicine that has a lot of people talking. This is a study that looked at patients on coumadin (warfarin) who had minor head injuries. The patients were admitted for 24 hours of observation and had a repeat head CT. The study looked at how many patients had bleeding on a repeat head CT and the conclusions were suprising. Should this be our new standard of care? Maybe but maybe not.
Sep 03, 2012
Hyperkalemia (high serum potassium) can be one of the most serious electrolyte disorders that we treat in the ED. We'll review how to interpret hyperkalemia in light of the patient's clinical condition, how to rapidly evaluate a patient with hyperkalemia and how to quickly treat patients with severe hyperkalemia.
Aug 27, 2012
This is just a short announcement for the launch of the EM Basic App in the Apple App Store and the Android Amazon Marketplace. Go to the blog post at embasic.org to see all the information about how to get this new app on your phone or mobile device.
Aug 20, 2012
Introducing EM Basic Essential Evidence- your boot camp guide to emergency medicine literature. Each episode will review an important emergency medicine article from the ground up. We'll review the study's design, basic statistics, results, and wrap it up with some analysis to help you understand the study and how to put it into your everyday practice. The goal here is to provide a guide through the emergency medicine literature so you can read and understand the "must know" studies out there.Th...
Aug 20, 2012
Hyponatremia (low serum sodium) is one of the most common electrolyte disorders encountered in the ED. Most of the time this electrolyte disorder requires us to do less- not more. However, if the patient is critically ill from their hyponatremia then we need to know how to quickly intervene and even be a little creative if we don't have the medications that we want. We'll review how to do the right thing for these patients, track down the cause of hyponatremia, and make the right decisions so we...
Aug 13, 2012
In this episode, we will discuss the diagnosis and treatment of stroke and transient ischemic attack (TIA). The ED is the front line in stroke care so we need to know how to work up this chief complaint. We'll go over how to recognize the signs and symptoms of a stroke, how to get a rapid and complete history, how to screen patients for contraindications to thrombolytics, and how to catch a few stroke mimics.
Jul 27, 2012
This episode is part 2 of the procedural sedation podcast. This episode focuses on the medications that we commonly use for procedural sedation. First, we'll review the use of oxygen during procedural sedation and then talk about basic airway maneuvers before we talk about individual medications. For each drug, the drug class, dosing, duration of action, and adverse effects will be discussed with the overall theme of patient safety.
Jul 07, 2012•33 min
This is the first of two episodes on procedural sedation. In the ED we need to provide safe and effective procedural sedation and analgesia whenever we do painful procedures. It is our job to relieve anxiety and pain in our patients and we need to know how to do this right. This episode will focus on how to prepare for a procedural sedation. We will talk about how to make the decision as to who is an appropriate candidate for procedural sedation in the ED, the depth of sedation, and how to prepa...
Jul 01, 2012•24 min
Since I refer to the neuro exam from the headache episode, I decided to take that part of the episode and make a supplement so you can easily review the "5 minute ED neuro exam." Let me know if there are any other topics that you would like me to make into a supplement like this.
Jun 19, 2012•9 min
