In part 1 of the cardiac arrest series, we review some key recommendations and clinical pearls from the 2020 adult BLS and ACLS guidelines. References: Panchal AR, Bartos JA, Cabanas JG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation . 2020; 142: S366-S468 Edelson DP, Sasson C, Chan PS, et al. Interim Guidance for Basic and Advanced Life Support in Adults, Children, ...
Dec 03, 2020•10 min•Season 1Ep. 34
What is dual/double defibrillation? How does it work? Does it improve patient outcomes? Find out this week! References: Miraglia D, Miguel LA, Alonso W. Double defibrillation for refractory in- and out-of-hospital cardiac arrest: a systematic review and meta-analysis. J Emerg Med . 2020; 59 (4): 531-541 Panchal AR, Bartos JA, Cabanas JG, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular ...
Nov 26, 2020•6 min•Season 1Ep. 33
What happens when/ if etomidate goes on shortage? Are methohexital or ketamine viable options for RSI in the ER? Find out this week. References: Farrell NM, Killius K, Kue R, et al. A comparison of etomidate, ketamine, and methohexital in emergency department rapid sequence intubation. J Emerg Med . 2020; 59(4): 508-514 Disclaimer: The information contained within the ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informational/ educational purposes only, is ...
Nov 19, 2020•8 min•Season 1Ep. 32
In this episode, we discuss the pros and cons of the main antiplatelet agents used in the setting of ACS. Who comes out on top? References: Norgard NB, DiNicolantonio JJ. Clopidogrel, prasugrel, or ticagrelor? A practical guide to use of antiplatelet agents in patients with acute coronary syndromes. Postgrad Med . 2013; 125(4): 91-102 Thachil J. Antiplatelet therapy- a summary for the general physicians. Clin Med. 2016; 16(2): 152-160 Disclaimer: The information contained within the ER-Rx podcas...
Nov 12, 2020•7 min•Season 1Ep. 31
The rate of IV magnesium administration depends on the particular indication, dose, and patient-specific factors. Tune in for more details. References: Kaye P, O’Sullivan I. The role of magnesium in the emergency department. Emerg Med J. 2002; 19: 288-291 Grissinger M. Avoiding patient harm from a magnesium bolus dose. P & T . 2014; 39(2): 81-82 Preventing magnesium toxicity in obstetrics. ISMP. Updated October 5, 2005. Accessed November 2 2020. https://www.ismp.org/resources/preventing-magn...
Nov 05, 2020•7 min•Season 1Ep. 30
Days away from Halloween, we discuss a few common ER superstitions. Are they actually legit? Or do you belive the data? Your call. References: Brookfield CR, Phillips PPJ, Shorten RJ. Q fever- the superstition of avoiding the word “quiet” as a coping mechanism: randomized controlled non-inferiority trial. BMJ . 2019; 367: 16446 Lamb JN, Howard AJ, Marciniak J. Does the word ‘quiet’ really make things busier? RCS Bull. 2017; 99: 133-136 Exadaktylos AK, Sclabas G, Siegenthaler A, et al. Friday the...
Oct 29, 2020•8 min•Season 1Ep. 29
Bradycardic? Hypotensive? Keep the agent discussed in this week's episode in mind when reviewing your patient's medication list. References: Rains J, Kesterson J. Ocular timolol as the causative agent for symptomatic bradycardia in an 89-year-old female. Am J Emerg Med . 2020; Article in Press Abbas SA, Hamadani SM, Ahmad U, et al . Ophthalmic timolol and hospitalization for symptomatic bradycardia and syncope: a case series. Cureus . 2020; 12(3): e7270 Wang Z, Denys I, Chen F, et al. Complete a...
Oct 22, 2020•5 min•Season 1Ep. 28
In Part 2 of this "Mini Grand Rounds" series, we discuss important side effects of ATII including thrombosis, especially in the setting of COVID. References: Celi A, Cianchetti S, Dell’Omo G, Pedrinelli R. Angiotensin II, tissue factor and the thrombotic paradox of hypertension. Expert Review Cardiovasc Therapy. 2010. 8 (12) Senchenkova EY, Russell J, Almeida-Paula LD, et al . Angiotensin II-mediated microvascular thrombosis. Hypertension . 2010; 56 (6): 1089-1095 Zhang P, Zhu L, Cai J, et al. A...
Oct 15, 2020•10 min•Season 1Ep. 27
In Part 1 of this "Mini Grand Rounds" series, we discuss Angiotensin II use for vasodilatory shock, reviewing the ATHOS-3 trial and real-world experiences. References: Khanna A, English SW, Wang XS, et al. Angiotensin II for the treatment of vasodilatory shock. NEJM . 2017; 377: 419-430 Farina N, Bixby A, Alaniz C. Angiotensin II brings more questions than answers. P T . 2019; 43 (11): 685- 687 Disclaimer: The information contained within the ER-Rx podcast episodes, errxpodcast.com, and the @err...
Oct 08, 2020•9 min•Season 1Ep. 26
Should we be giving procainamide to patients with atrial fibrillation/ flutter? We discuss two clinical trials that may give us some answers. References: Stiell IG, Clement CM, Symington C, et al . Emergency department use of intravenous procainamide for patients with acute atrial fibrillation or flutter. Acad Emerg Med . 2007; 14: 1158-1164 Stiell IG, Sivilotti MLA, Taljaard M, et al. Electrical versus pharmacological cardioversion for emergency department patients with acute atrial fibrillatio...
Oct 01, 2020•7 min•Season 1Ep. 25
This week we discuss methemoglobinemia with Dr. KC Lee, a clinical pharmacist who recently completed her clinical toxicology/ emergency medicine fellowship. * Note: Although rare, there has been a slight increase in hydroxychloroquine-associated methemoglobinemia in the setting of COVID References: Price DP, Howland MA. Methemoglobin inducers and methylene blue. Goldfrank’s Toxicologic Emergencies 9th edition: 1698-1710. McGraw-Hill; New York: 2011 Methemoglobin. Hennepin Regional Poison Center ...
Sep 24, 2020•18 min•Season 1Ep. 24
Should we be using ammonia levels to diagnose, determine the severity, or monitor the resolution of hepatic encephalopathy? References: Ninan J, Feldman L. Ammonia levels and hepatic encephalopathy in patients with known chronic liver disease. J Hosp Med . 2017 (8): 659-661 Gundling F, Zelihic E, Seidl H, et al. How to diagnose hepatic encephalopathy in the emergency department. Ann Hepatol . 2013; 12(1): 108-114 Ong JP, Aggarwal A, Krieger D, et al . Correlation between ammonia levels and the s...
Sep 17, 2020•5 min•Season 1Ep. 23
Is giving your patient a one-time dose of IV antibiotics prior to discharge helpful? Or are you doing more harm than good? Tune in this week to find out! References: Mueller K, McCammon C, Skrupky L, Fuller BM. Vancomycin use in patients discharged from the emergency department: a retrospective observational cohort study. J Emerg Med . 2015; 49 (1): 50-57 Disclaimer: The information contained within the ER-Rx podcast episodes, errxpodcast.com, and the @errxpodcast Instagram page is for informati...
Sep 09, 2020•7 min•Season 1Ep. 22
This week we review a meta-analysis that looked at the use of esmolol in patients in refractory VF/pVT arrest. Will this change your practice? References: Miraglia D, Miguel LA, Alonso W. Esmolol in the management of pre-hospital refractory ventricular fibrillation: a systematic review and meta-analysis. Am J Emerg Med . 2020; 38: 1921-1934 Driver BE, Debaty G, Plummer DW, et al . Use of esmolol after failure of standard cardiopulmonary resuscitation to treat patients with refractory ventricular...
Sep 01, 2020•6 min•Season 1Ep. 21
In this Mini Grand Rounds episode, we discuss cyanide toxicology and management, including antidotes. References: Holstege CP, Isom GE, Kirk MA. Cyanide and hydrogen sulfide. Goldfrank’s Toxicologic Emergencies 9th edition: 1678-1688. McGraw-Hill; New York: 2011 Cyanide. Hennepin Regional Poison Center Treatment Guidelines. Minnesota Poison Control System. Accessed 11/20/2017 Lawson-Smith P, Jansen EC, Hyldegaard O. Cyanide intoxication as part of smoke inhalation- a review on diagnosis and trea...
Aug 25, 2020•10 min•Season 1Ep. 20
Stop the steroid bomb! If you are giving 125 mg IV methylprednisolone (Solu-Medrol) to your asthma or COPD exacerbation patients, that may be too much. References: Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease 2020 report. https://goldcopd.org (Accessed on August 14, 2020) Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention. www.ginasthma.o...
Aug 18, 2020•4 min•Season 1Ep. 19
Tune in as we discuss ventilator-associated tracheobronchitis and what the guidelines say we should do about this little-known entity! References: Nseir S, Favory R, Jozefowicz E, et al. Antimicrobial treatment for ventilator-associated tracheobronchitis: a randomized, controlled, multicenter study. Crit Care. 2008: 12; R6 2 Koulenti D, Arvaniti K, Judd, M, et al. Ventilator-associated tracheobronchitis: to treat or not to treat? Antibiotics. 2020: 9 (2): 51 Metlay JP , Waterer GW, Long AC, et a...
Aug 11, 2020•5 min•Season 1Ep. 18
In case you missed it, last week Dr. Nick Tsipis from the Emergency Medical Minute discussed a few rapid-fire ER topics with our host, Adis Keric. Check out the full episode here or on the Emergency Medical Minute podcast! *Correction to figures quoted on anticoagulation reversal pricing. High-dose Andexxa regimen maxes out around $60,000 and Kcentra maxes out at $6,000. So there is still a massive price difference, but not as high as quoted in the audio. References: Metlay JP , Waterer GW, Long...
Aug 04, 2020•19 min•Season 1Ep. 17
This week, we review the "HALT-IT" trial. Will you routinely give your patients TXA (tranexamic acid) in the setting of GI bleeds after reading this study? References: Roberts I, Shakur-Still H, Afolabi A, et al. Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial. Lancet . 2020; 395: 1927-36 Shakur H, Roberts I, Fawole B, et al . ...
Jul 28, 2020•7 min•Season 1Ep. 16
Today, we discuss what it means to have a "sulfa" allergy. Are things such as furosemide and tamsulosin really contraindicated in these patients? Tune In! References: Smith WB. ‘Sulfur allergy’ label is misleading. Aust Prescr . 2008; 31: 8-10 Ponka D. Approach to managing patients with sulfa allergy. Can Fam Physician . 2006; 52(11): 1434-1438 Strom BL, Schinnar R, Apter AJ, et al. Absence of cross-reactivity between sulfonamide antibiotics and sulfonamide nonantibiotics. NEJM . 2003; 349: 1628...
Jul 21, 2020•4 min•Season 1Ep. 15
What does a negative or positive antibody test mean? Should it change our behavior? Do we have to view the results in the setting of where we are located? Tune in this week! References: Interim guidelines for COVID-19 antibody testing. CDC. May 23, 2020. Accessed July 7, 2020. Abbott ARCHITECT SARS-CoV-2 IgG Instructions for Use. H14806R01. April 2020 Bryan A, Pepper G, Wener MH, et al . Performance characteristics of the Abbott Architect SARS-CoV-2 IgG assay and seroprevalence testing in Idaho....
Jul 14, 2020•7 min•Season 1Ep. 14
In Part 2 of 2 of our "Mini Grand Rounds" series, we discuss the use of thrombolytics in the setting of cardiac arrest and wrap it up with our final recommendations. References: Lederer W, Lichtenberger C, Pechlaner C, et al. Recombinant tissue plasminogen activator during cardiopulmonary resuscitation in 108 patients with out‐of‐hospital cardiac arrest. Resuscitation 2001; 50(1): 71-76 Abu-Laban RB, Christenson JM, Innes GD, et al. Tissue plasminogen activator in cardiac arrest with pulseless e...
Jul 07, 2020•10 min•Season 1Ep. 13
In Part 1 of 2 of our "Mini Grand Rounds" series, we discuss the use of thrombolytics in the setting of submassive and massive pulmonary embolism. Tune in as we review studies and guidelines that discuss these agents in these settings, as well as appropriate dosing and administration of alteplase. References: Konstantinides S, Geibel A, Heusel G, et al. Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. NEJM. 2002; 347(15): 1143-1150 Sharifi M, Bay...
Jun 30, 2020•10 min•Season 1Ep. 12
What is the most important agent for anaphylaxis? What other treatments are only considered as adjuncts? How should I give these agents? Find out this week as we review updated anaphylaxis treatment guidelines published in April 2020! References: Shaker MS, Wallace DV, Golden DBK, et al . Anaphylaxis- a 2020 practice parameter update, systematic review, and grading of recommendations, assessment, development, and evaluation (GRADE) analysis . J Allergy Clin Immunol 2020; 146 (4): 1082-1123 Discl...
Jun 23, 2020•10 min•Season 1Ep. 11
Join us for a quick review on a recently-published study describing the association between alteplase door-to-needle times and long-term patient outcomes in the setting of ischemic stroke. Please subscribe to our Podcast ("ER-Rx") and leave us a review! References: Man S, Xian Y, Holmes DN, et al. Association between thrombolytic door-to-needle time and 1-year mortality and readmission in patients with acute ischemic stroke. JAMA ; 2020: 323(21): 2170-2184 Gilbert BW, Huffman J. Effect on door-t...
Jun 16, 2020•7 min•Season 1Ep. 10
This week, we discuss a strange and rare pseudomonas phenotype. Find out why these strains are resistant to carbapenems but usually not other antibiotics and the significance of these strains. Search "ER-Rx" on Apple Podcasts, Google Podcast, and YouTube. Also, check out our Instagram page: errxpodcast ! References: Gajdacas M. Carbapenem-resistant but cephalosporin-susceptible pseudomonas aeruginosa in urinary tract infections: opportunity for colistin sparing. Antibiotics . 2020; 9(4): 153. Li...
Jun 09, 2020•8 min•Season 1Ep. 9
In this week's episode, we discuss a recently-published meta-analysis and summarize a couple of guidelines that discuss the management of esophageal foreign bodies/ food boluses. Find us on Apple Podcasts (iTunes), Google Podcasts, Spotify, and YouTube! References: Long B, Gottlieg M. Is glucagon effective for relieving acute esophageal foreign bodies and food impactions? Ann Emerg Med . 2020; 75(2): 299- 301 Peksa GD, DeMott JM, Slocum GW, et al. Glucagon for relief of acute esophageal foreign ...
Jun 02, 2020•6 min•Season 1Ep. 8
Do we have any data on topical agent use to control nosebleeds? How about prophylactic antibiotics for patients with nasal packing in place? Find out on this week's episode. Follow us on YouTube, Instagram, and Google Podcasts! References: Tunkel DE, Anne S, Payne SC, et al. Clinical practice guideline: nosebleed (epistaxis). Am J Otolaryngol . 2020; 162(IS): S1-S38. Whitworth K, Johnson J, Wisniewski S, et al. Comparative effectiveness of topically administered tranexamic acid versus topical ox...
May 26, 2020•7 min•Season 1Ep. 7
In this episode, we discuss the use of prophylactic corticosteroids for patients at high risk of reintubation. Please leave us a comment for your chance to win a medically-related prize! References: Kuriyama A, et al. Prophylactic corticosteroids for prevention of postextubation stridor and reintubation in adults: a systematic review and meta analysis. CHEST . 2017; 151(5): 1002-1010 Girard TD, et al. An official American Thoracic Society/ American College of Chest Physicians clinical practice g...
May 20, 2020•7 min•Season 1Ep. 6
In this episode, we look into the pharmacological treatment of Ogilvie's Syndrome using subcutaneous neostigmine. Please remember to subscribe to our podcast and leave us feedback! References: Lopez Valle RG, Godoy FL. Neostigmine for acute colonic pseudo-obstruction: a meta-analysis. Annals of Medicine and Surgery . 2014; 3: 60-64 Bernardi MP, et al . Acute and chronic pseudo-obstruction: a current update. ANZ J Surg. 2015; 85: 709-714 Vogel JD, et al. Clinical practice guidelines for colon vol...
May 15, 2020•10 min•Season 1Ep. 5
