Foamcast - Emergency Medicine Core Content

This episode is slightly different.  We review some of our favoite pearls from the last year including our favorite mnemonics and memory aids (and some that we think bombed). Thanks, y'all, for listening, providing feedback, and continuing to inspire us to look through FOAM and Rosenalli to enhance our emergency medicine education.   -Jeremy Faust and Lauren Westafer

We review thisa post from Dr. Charles Bruen of Resus Review on Malignant Hyperthermia and dantrolene. Then, we delve into core content pearls on polypharmacy -  serotonin syndrome, neuroleptic malignant syndrome, and extrapyramidal side effects.  We do this using Tintinalli and Rosen's as guides.  As always, visit foamcast.org for show notes and the generously donated Rosh Review questions. Thanks y'all! -Jeremy Faust and Lauren Westafer

We review this post from the amazing Maryland Critical Care Project on N-acetylcysteine for Inhalational Burn Injury Then, we delve into core content pearls on  burns including nomenclature, fluid resuscitation, burn center referral criteria, and more.  We do this using Tintinalli and Rosen's as guides.  As always, visit foamcast.org for show notes and the generously donated Rosh Review questions. Thanks y'all! -Jeremy Faust and Lauren Westafer

We review use of longboards and cervical collars for spinal immobilization using the  new ACEP statement and posts by ScanCrit (Curse of the Cervical Collar, Cervical Collar RIP,  Cervical Collars Slashed From Guidelines), a post by Dr. Minh Le Cong from PHARM, and this Medest118 post (in addition to new policy statement from ACEP)  Then, we delve into core content pearls on differentiating spinal shock from neurogenic shock, the incomplete cord syndromes such as anterior cord syndrome, central cord syndrome, and Brown Sequard syndrome, as well as a quick and dirty review of key spinal reflexes.  We do this using Tintinalli, and Rosen's as a guide.  As always, visit foamcast.org for show notes and the generously donated Rosh Review questions. Thanks y'all! -Jeremy Faust and Lauren Westafer

In this mini FOAMcast, we introduce a new segment - statistics.   We cover inter-rater reliability,\ or, the kappa coefficient, using the PECARN head trauma decision aid as a tool. As always, visit foamcast.org for show notes and the generously donated Rosh Review questions. Thanks y'all! -Jeremy Faust and Lauren Westafer

We review the post by Bryan Hayes, PharmD, FAACT on Academic Life in Emergency Medicine,  Sulfamethoxazole-Trimethoprim for Skin and Soft Tissue Infections: 1 or 2 Tablets BID?  Then, we delve into core content pearls on cellulitis and abscesses, necrotizing skin infections, and Erythema Multiforme/Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis using the IDSA guidelines, Tintinalli, and Rosen's as a guide.  As always, visit foamcast.org for show notes and the generously donated Rosh Review questions. Thanks y'all! -Jeremy Faust and Lauren Westafer

This week we review the Taming the SRU podcast, "Ketamine Cagematch" (iTunes) in which Drs. Minh Le Cong and Chris Zammit banter about the use of ketamine in patients with traumatic brain injury (TBI).  Then, we delve into core content pearls on concussion/mild TBI including diagnosis, treatment, and complications using Tintinalli 254 but to be honest, Rosenalli is lacking on this topic so we've turned to the ACEP clinical policy, AAN guidelines, Ontario Pediatric Guidelines, and the  AAP guidelines on the topic. As always, visit foamcast.org for show notes and the generously donated Rosh Review questions. Thanks y'all! -Jeremy Faust and Lauren Westafer

This week we're covering Dr. Jacob Avila's post on ultrasound for small bowel obstruction (SBO)  located at Ultrasound of the week.  He has an accompanying video on 5minSono. The Bread and Butter We cover key points on SBO and Acute Mesenteric Ischemia from Rosenalli, that’s Tintinalli (7e) Chapter 86; Rosen’s (8e) Chapter 92.  But, don’t just take our word for it.  Go enrich your fundamental understanding yourself. As always, visit foamcast.org for show notes and the generously donated Rosh Review questions. Thanks y'all! -Jeremy Faust and Lauren Westafer

As detailed in this FOAMcastini, ACEP just released a draft of an updated clinical policy on tPA for acute ischemic stroke.  This came in the wake of years of controversy over the aggressive position taken in the 2012 clinical policy. While FOAMcast is not an interview style podcast, we felt compelled to get some perspective on Emergency Physicians a little more experienced than ourselves.  Here we interview: Dr. Ryan Radecki (@emlitofnote), Assistant Professor, University of Texas - Houston See his response to the policy on his blog here Dr. David Newman (#draftnewman), Associate Professor of Emergency Medicine, Mount Sinai Hospital Dr. Anand Swaminathan (@EMSwami), Assistant Professor of Emergency Medicine, NYU Dr. Ken Milne (@thesgem), Chief of Staff at South Huron Hospital

On Jan 12, 2015, ACEP released the draft of the new clinical policy on tPA in acute ischemic stroke. This was an update of the  ACEP tPA Clinical Policy 2012, which has been entrenched in controversy since it was published.   In this episode we dicuss the major differences between the two policies.  Then, have your say. Comment on the draft here. 

We review the FOAM resource, Don’t Forget the Bubbles, "Knee X-ray Interpretation" by Dr. Tessa Davis.  We use a systematic approach to assessing chest x-rays, so why not knee x-rays? Then, we delve into a core content review using Rosenalli as a base, covering knee dislocations and septic arthritis.  Key Texts:Tintinalli (7e) Chapters 271, 281; Rosen’s (8e) Chapters 57, 136 As always, visit foamcast.org for show notes and the generously donated Rosh Review questions. Thanks y'all! -Jeremy Faust and Lauren Westafer

This week we review Dr. Josh Farkas's PulmCrit blog posts, Renal microvascular hemodynamics in sepsis: a new paradigm and Renoresuscitation: Sepsis resuscitation designed to avoid long-term complications in which he posits that renal protection in sepsis may prove beneficial for patients.   Then, we delve into core content pearls on acute kidney injury using Rosenalli (Rosen's Emergency Medicine and Tintinalli's Emergency Medicine: A Comprehensive Review Guide) as a guide.   As always, visit foamcast.org for show notes and the generously donated Rosh Review questions. Thanks y'all! -Jeremy Faust and Lauren Westafer

This week we review Dr. Rory Spiegel's EMNerd blog post, A Case of Identity Part Two, on dual antiplatelet therapy for ACS and MI.  Dual antiplatelet therapy, often aspirin + P2Y12 inhibitors, although commonly used, do not affect mortality and have questionable benefit but are associated with risks of bleeding. Then, we delve into core content pearls on anticoagulation including aspirin, ibuprofen, and novel oral anticoagulants using Rosenalli  (Rosen's Emergency Medicine and Tintinalli's Emergency Medicine: A Comprehensive Review Guide) and Goldrank (10th ed) Chapter 60 and EMPractice October 2013 as a guide.   As always, visit foamcast.org for show notes and the generously donated Rosh Review questions. Thanks y'all! -Jeremy Faust and Lauren Westafer

This week we review the Tox Talk podcast, Episode 23, Mushrooms. Key pearls  Clitocybe, Inocybe - contain muscarine which stimulates muscarinic receptors (acetylcholine/parasympathetic), causing a cholinergic toxidrome.  Memory aid: these mushrooms end in -yBE, akin to the "killer B's" that make cholinergic toxicity deadly - bradycardia, bronchorrhea, bronchospasm. Gyromitra - (false morel) Memory aid: gyromitra named because they look like the gyri of the brain and, conveniently, make the brain seize through depletion of GABA.  Amanita phalloides - the mushroom equivalent of acetaminophen toxicity. Then, we delve into core content pearls on accidental hypothermia using Rosenalli (Rosen's Emergency Medicine and Tintinalli's Emergency Medicine: A Comprehensive Review Guide).   As always, visit foamcast.org for show notes and the generously donated Rosh Review questions. Thanks y'all! -Jeremy Faust and Lauren Westafer

This week we review Dr.Ken Milne's podcast, the Skeptics Guide to Emergency Medicine new feature - Hot off the Press. It's all about geriatric falls, y'all. Then, we delve into core content pearls on the geriatrics using Rosenalli (Rosen's Emergency Medicine and Tintinalli's Emergency Medicine: A Comprehensive Review Guide).  We review polypharmacy, abdominal pain, and other key pearls. As always, visit foamcast.org for show notes and the generously donated Rosh Review questions. Thanks y'all! -Jeremy Faust and Lauren Westafer

FOAMcast will be back shortly with regular core content-cutting edge mash ups; however, we wanted to take a moment to focus on a conference that inadvertently created FOAMcast...and is coming to Chicago in June 2015.  SMACC - Chicago (#smaccUS) June 23-26, 2015. Registration begins Nov 5, 2014 There are too many core content lectures to choose from and they're available on iTunes. Our favorites are listed on FOAMcast.org and here we review: Dr. Haney Mallemat - The Art and Science of Fluid Responsiveness Dr. Scott Weingart - Sepsis in New York: Our First 15,000 Patients Dr. Cliff Reid - Resuscitation Dogmalysis Dr. Rob Mac Sweeney - ARDS: An Evidence Based Update Timing, Tribes, and STEMIs  

FOAMcast is bringing you pearls from conferences we attend and, first up, the American College of Emergency Physicians annual meeting, ACEP14.   Today's Pearls: ACEP is revisiting the TPA policy - Dr. David Newman, Dr. Edward Sloan, and Dr. Seaberg Evidence based approach to Intracerebral Hemorrhage by Dr. Jon Edlow Drs. Jerome Hoffman and Richard Bukata delivered key literature pearls. For updates, follow #ACEP14   Thanks for listening, y'all! Jeremy Faust and Lauren Westafer

FOAMcast is bringing you pearls from conferences we attend and, first up, the American College of Emergency Physicians annual meeting, ACEP14.   Today's Pearls: HIV patients are at risk for ACS and thrombotic complications Resuscitation pearls from Weingart:  Don't trust "normal" vital signs, ACLS is not for emergency physicians, REBOA and ECMO are coming Palliative care in the Emergendy Department - important and often not well done ACEP has 5 more "Chosing Wisely" Pearls For updates, follow #ACEP14   Thanks for listening, y'all! Jeremy Faust and Lauren Westafer

FOAMcast is bringing you pearls from conferences we attend and, first up, the American College of Emergency Physicians annual meeting, ACEP14.   Today's Pearls: Emergency Physicians are like economists (We're more probalisticians than diagnosticians). Cardiology pearls from Dr. Slovis - TTM to 36 Celsius post-arrest should be standard. Many people probably could benefit from caths after arrest, we're not sure exactly who at this point. Patients returning from West Africa with fever probably have a regular virus, maybe malaria, but probably not ebola. There's really not much use for glucagon in calcium channel blocker toxicity. Think supportive care, insulin-dextrose. ETCO2 - it doesn't equal PaCO2 and it depends on cardiac output and alveolar ventilation   For updates, follow #ACEP14   Thanks for listening, y'all! Jeremy Faust and Lauren Westafer

FOAMcast is bringing you pearls from conferences we attend and, first up, the American College of Emergency Physicians annual meeting, ACEP14.  However, Jeremy and I both worked overnights so we got into town a little late.  Our friends and ACEP luminaries, Drs. Justin Hensley, Howie Mell, and Todd Slesinger. For updates, follow #ACEP14   Thanks for listening, y'all! Jeremy Faust and Lauren Westafer