Foamcast - Emergency Medicine Core Content

We review myths and reality in the management of patients with Sickle Cell Disease (SCD)  Are these patients typically opioid seeking? (No) If the patient appears comfortable I should withhold proper analgesia. (No). Should IV fluids be a routine part of the cocktail for vaso-occlusive pain episodes? (No) We also review common emergencies in sickle cell disease that include Infections Acute chest syndrome Anemia (Aplastic crisis, splenic sequestration) Ischemia Strokes Avascular necrosis Renal, pulmonary, splenic infarctions Vaso-occlusive pain episodes Thanks for listening! Lauren Westafer and Jeremy Faust

We are at #SMACC in Sydney, Australia, thanks to the Rosh Review, delivering updates from the conference to your earbuds. Advocacy in Emergency Medicine - Esther Choo and Hugh Montgomery Mechanical CPR vs Manual CPR - Ken Milne vs Salim Rezaie Super sick massive GI bleeds and balloon tamponade - Sara Gray Thanks for listening! Jeremy Faust and Lauren Westafer

 We are at SMACC in Sydney, Australia, thanks to the Rosh Review, delivering updates from the conference to your earbuds. Today we cover resuscitation pearls. Bougie vs Standard Stylet in emergency department (ED) rapid sequence intubation (RSI) - Brian Driver vs Rich Levitan Rocuronium vs Succinylcholine Debate - Billy Mallon and Reuben Strayer The Crashing Asthmatic - Haney Mallemat Thanks for listening! Lauren Westafer and Jeremy Faust

We are at #smacc in Australia thanks to the Rosh Review! The opening session this morning was amazing and we can't do it justice on the podcast. Gill Hicks (@MadForPeace), a victim in the July 7, 2005 bombing attack on a London train spoke on how impactful everyone in the healthcare delivery system can be (from medics to detectives to nurses to physical therapists to physicians). Dr. Dara Kass delivered a powerful talk on vulnerability, responsibility, and lack of knowledge even in a super health care literate individual.....what it means to be a provider and a patient (and a mom and a medical home for the family and a wife) in her story of donating part of her liver to her son. David Carr on anti-NMDA receptor encephalitis  Anti-NMDA receptor encephalitis is the most common cause of encephalitis in young people (

We co-hosted (with John Vassiliadis) the SMACC EM Updates half-day conference. We had amazing speakers. Salim Rezaie spoke on TXA for Everything, Ken Milne spoke on hot papers from 2018, and we learned about when ultrasound may be helpful in pediatric lumbar punctures. In addition, Jeremy spoke on what is usual care in sepsis and Lauren spoke on pulmonary embolism: the next generation. In this short podcast we highlight some of our other talks. Aidan Baron (@Aidan_Baron) on Prehospital Updates in Cardiac Arrest This talk focused on focusing on things that are most likely to make a difference in OHCA (bystander CPR and defibrillation) rather than on fun interventions like intubation and adrenaline (epinephrine). Aidan suggests that the future debates and questions in OHCA will be largely philosophical - what outcomes do we care about: neuro intact survival or ROSC or survival?  Jabre P, Penaloza A, Pinero D, et al. Effect of bag-mask ventilation vs endotracheal intubation during cardiopulmonary resuscitation

We have previously podcasted on tachyarrythmias (Episode 34 Tachyarrhythmias), but in this episode, we focus specifically on the treatment of supraventricular tachycardia  (SVT),  specifically paroxysmal SVT. We discuss the treatment options of adenosine and calcium channel blockers, weighing in with the evidence, the guidelines, and some opinion. Thanks for listening! Lauren Westafer and Jeremy Faust   Thanks to Figure 1 for supporting this episode. We do not make money off of this podcast, this support is just for operational costs associated with the podcast.

The US Food and Drug Administration (FDA) recently released another warning for fluoroquinolones, this time regarding aortic dissection and aneurysm.  We review the evidence behind this warning, including the following studies: Lee CC  Risk of Aortic Dissection and Aortic Aneurysm in Patients Taking Oral Fluoroquinolone. JAMA Intern Med. 2015;175(11):1839-47. Lee CC Oral Fluoroquinolone and the Risk of Aortic Dissection. J Am Coll Cardiol. 2018;72(12):1369-1378. Pasternak B Fluoroquinolone use and risk of aortic aneurysm and dissection: nationwide cohort study. BMJ. 2018;360:k678. We then review the ACEP clinical policy on aortic dissection covering risk scores, d-dimers, and management of aortic dissection Thanks for listening! Jeremy Faust and Lauren Westafer

We cover the clinical policy from the American College of Emergency Physicians - Clinical Policy: Critical Issues in the Evaluation and Management of Emergency Department Patients With Suspected Non–ST-Elevation Acute Coronary Syndromes In adult patients without evidence of ST-elevation acute coronary syndrome, can initial risk stratification be used to predict a low rate of 30-day major adverse cardiac events? Use HEART score ≤3  In adult patients with suspected acute non–ST-elevation acute coronary syndromes, can troponin testing within 3 hours of emergency department presentation be used to predict a low rate of 30-day major adverse cardiac events? Negative conventional troponins at 0,3 hrs in low risk patients High sensitivity troponin: undetectable initial troponin, no need for another. Negative initial troponin, repeat at 2 hours In adult patients with suspected acute non–ST-elevation acute coronary syndromes in whom acute myocardial infarction has been excluded, does further diagnostic testing (eg,

We discuss Medicated Assisted Treatment (MAT) for opioid use disorder (OUD) including buprenorphine initiated from the emergency department. This show was sponsored by Figure 1, a free open access application for providers using images and cases Thanks for listening! Jeremy Faust and Lauren Westafer References: Berg ML, Idrees U, Ding R, Nesbit SA, Liang HK, and McCarthy ML. Evaluation of the use of buprenorphine for opioid withdrawal in an emergency department. Drug Alcohol Depend. 2007;86(2-3):239-44. doi:10.1016/j.drugalcdep.2006.06.014. Mattick RP, Breen C, Kimber J, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2014;(2):CD00220 Pierce M, Bird SM, Hickman M, Marsden J, Dunn G, Jones A, and Millar T. Impact of treatment for opioid dependence on fatal drug-related poisoning: a national cohort study in England. Addiction. 2016;111(2):298-308. doi:10.1111/add.13193. Clark RE, Samnaliev M, Baxter JD, and Leung GY. The evidence do

 The Free Open Access Medical Education (FOAM) world is often obsessed with magnesium. In this show we address the use of magnesium for various applications. Magnesium for Acute Atrial Fibrillation with Rapid Ventricular Response (RVR) Bouida et al. LOw dose MAGnesium sulfate versus HIgh dose in the early management of rapid atrial fibrillation: randomised controlled double blind study. Acad Emerg Med. 2018 Jul 19. Ho KM, Sheridan DJ, Paterson T. Use of intravenous magnesium to treat acute onset atrial fibrillation: a meta-analysis. Heart. 2007;93(11):1433-40. Davey MJ, Teubner D. A randomized controlled trial of magnesium sulfate, in addition to usual care, for rate control in atrial fibrillation. Ann Emerg Med. 2005;45(4):347-53. Magnesium for Migraine Corbo J, Esses D, Bijur PE, Iannaccone R, Gallagher EJ. Randomized clinical trial of intravenous magnesium sulfate as an adjunctive medication for emergency department treatment of migraine headache. Ann Emerg Med. 2001;38(6):621–7. Bigal ME, Bordini CA, T

In this episode we highlight key articles in Emergency Medicine that came out, thus far, in 2018. D'souza et al. Effects of prophylactic anticholinergic medications to decrease extrapyramidal side effects in patients taking acute antiemetic drugs: a systematic review and meta-analysis Emerg Med J. 2018;35(5):325-331. Driver et al. Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. JAMA. 2018;319(21):2179-2189. Atkinson PR, Milne J, Diegelmann L, et al. Does Point-of-Care Ultrasonography Improve Clinical Outcomes in Emergency Department Patients With Undifferentiated Hypotension? An International Randomized Controlled Trial From the SHoC-ED Investigators. Ann Emerg Med. 2018; In press. Perkins GD et al. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. N Engl J Med 2018; 379:711-721 Meltzer et al. Effect of Tamsulosin on Passage of Symptomatic Uretera

We bring you pearls from the American College of Emergency Physicians (ACEP) 2018 Scientific Assembly in San Diego, CA. In this episode we highlight: Myths in diagnostic imaging Torsion ultrasound is insensitive CTPA for PE is not perfect. There are false positives AND false negatives Myths in pediatrics Response to antipyretics does NOT make viral infection more likely Juice in kids with gastroenteritis is a great way to rehydrate them Kids don't have to wait 24 hours on antibiotics for strep throat before returning to school, if they got 50 mg/kg amoxicillin prior to 5pm the night before, they're fine Thanks for listening! Jeremy Faust and Lauren Westafer

We bring you pearls from the American College of Emergency Physicians (ACEP) 2018 Scientific Assembly in San Diego, CA. In this episode we highlight: Problems with CYA (Cover your a$$) medicine such as admissions Problems with lactate, procalcitonin, and other biomarkers Thanks for listening! Jeremy Faust and Lauren Westafer

We bring you pearls from the American College of Emergency Physicians (ACEP) 2018 Scientific Assembly in San Diego, CA. In this episode we highlight: Severe pediatric brain injury, tips for management and preventing badness Aortic dissection diagnostics Chest tube pearls Thanks for listening! Jeremy Faust and Lauren Westafer

We cover a JAMA Clinical Reviews podcast on lyme disease, including some myth-busters. *Doxycycline can be used, safely, in kids < 8 years old *Testing for lyme is a mess because : (1) we test patients with ultra low probability of disease (2) we test patients who shouldn't be tested (i.e. have erythema migrans) (3) the tests are a pain to interpret *Lyme disease is spreading further south and west in the US, into Canada, and it's also increasingly found in Europe. We then delve into core content for Rosen's, Tintinalli, and the IDSA 2006 guidelines. Thanks for listening! Jeremy Faust and Lauren Westafer FOAMcast.org    

We review the American Urological Association guidelines on penile fracture and priapism. We supplement this with core content from Tintinalli and Rosen's Emergency Medicine.

We review one of the editors top picks from Annals of Emergency Medicine, which are free for 6 months from issue release.  The article covered in this podcast is Waldman et al, is a study of tetracaine in corneal abrasions. We also review commonly encountered corneal emergencies: Corneal abrasions Corneal ulcers and herpes keratoconjunctivitis. Thanks for listening! Jeremy Faust and Lauren Westafer

Show notes at FOAMcast.org We cover the 2017 IDSA/SHEA guidelines on clostridium difficile (c diff). We then review core content on c diff including risk stratification and treatment using Rosen's and Tintinalli as guides. Thanks for listening! Jeremy Faust and Lauren Westafer

Workup for pulmonary embolism (PE) is common (perhaps too common) in the United States. The American College of Emergency Physicians has released a clinical policy on pulmonary embolism. We cover this policy as well as core content on PE risk stratification and "rule out" Thanks for listening, Jeremy Faust and Lauren Westafer

We cover the emergency department care of lactating patients including Medications during breastfeeding - who should "pump and dump"? (spoiler: very few people, check LactMed or InfantRisk) Mastitis & Breast Abscesses Emergency Department Support Thanks for listening! Jeremy Faust and Lauren Westafer