Foamcast - Emergency Medicine Core Content

Show notes at FOAMcast.org We have a special April 1st show - the Faust-Westafer Central Theorem of Emergency Medicine. Listen for details Thanks for listening! Jeremy Faust and Lauren Westafer

We review select articles from 2017 that are important or that got people talking including: Sadeghirad B et al. Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials. BMJ. 2017;358:j3887. Barniol et al.Levocetirizine and Prednisone Are Not Superior to Levocetirizine Alone for the Treatment of Acute Urticaria: A Randomized Double-Blind Clinical Trial. Ann Emerg Med. 2018;71(1):125-131.e1 Wilson SS, Kwiatkowski GM, Millis SR, Purakal JD, Mahajan AP, Levy PD. Use of nitroglycerin by bolus prevents intensive care unit admission in patients with acute hypertensive heart failure. Am J Emerg Med. 2017;35(1):126-131. Hu et al  Variability in Interpretation of Cardiac Standstill Among Physician Sonographers. Ann Emerg Med. 2017 Sep 1. S0196-0644(17)31376-8 Clattenburg et al Point-of-care ultrasound use in patients with cardiac arrest is associated prolonged cardiopulmonary resuscitation pauses: A prospective cohort study. Resuscitation. 2018;122:65-68. Hinson JS et al.

We tackle some free open access medical education from the CDC on the flu vaccine, including: Recommendations that individuals with any severity of egg allergy (including anaphylaxis) receive the flu vaccine. The only modification that needs to occur is patients with a history of true anaphylaxis to eggs should be given the flu shot in a setting where they can be monitored by a healthcare professional if needed (i.e. a doctor's office). It is very unlikely that the flu vaccine causes Guillan-Barre Syndrome (GBS). If there is any increase as a result of the flu shot, it is 1-2 in 1,000,000. We then dive into CDC recommendations on oseltamivir as well as contradictory data from the most recent Cochrane review. Thanks for listening! Jeremy Faust and Lauren Westafer

Over at the Pulmcrit blog, Dr. Josh Farkas has proposed the use of phenobarbital monotherapy for the treatment of ethanol withdrawal and we cover this protocol. We then dive into core content alcohol withdrawal using Rosen’s Emergency Medicine (9th ed) Chapter 142 , Tintinalli’s Emergency Medicine (8th ed) Chapter 292, and Goldfrank's Toxicologic Emergencies (10th ed) Chapter 81  as guides. Thanks for listening, Lauren Westafer and Jeremy Faust

We discuss ultrasound diagnosis of pneumoperitoneum using a podcast from 5MinSono. Then we delve into core content on gastritis, PUD, and helicobacter pylori using Rosen's Ch 78 and Tintinalli's Ch 79 as guides. Thank for listening! Jeremy Faust and Lauren Westafer

We cover Free Open Access Medical Education (FOAM) on mass casualty incidents, an unfortunate reality in the current United States climate (and elsewhere).  There is a must read (truly, emergency providers really should read this) in EP Monthly by Dr.Kevin Menes, “How One Las Vegas ED Saved Hundreds of Lives After the Worst Mass Shooting in U.S. History”. He details his process in running the Emergency Department that evening. We cover pearls from other great resources include a post on the St. Emlyn's blog, "Mass Casualty Incidents: Lessons from the AAST" and a free EBMedicine article on ballistic injuries Core Content: Chapter 192 Rosen's, Chapter 5 Tintinalli - Mass Casualty Incident Triage Thanks for listening! Jeremy Faust and Lauren Westafer

We bring you pearls from the American College of Emergency Physicians (ACEP) 2017 Scientific Assembly. We cover in-flight emergencies, need for contrast enhanced CT scans, bronchiolitis and sucrose for infants Thanks for listening! Jeremy Faust and Lauren Westafer

We bring you pearls from the American College of Emergency Physicians (ACEP) 2017 Scientific Assembly. Pearls on H. Pylori from: It's Alimentary - Poo-Pourri of Conditions From the Mouth to Rectum - Dr. Adebayo, Dr. Batra, Dr. Bavokek Emerging Infections: Zika and Its Friends - Dr. Joan Noelker High Yield Toxicology - Dr Erickson, Dr Traub, Dr. Perrone  

We cover top pearl from the American College of Emergency Physicians (ACEP) Scientific Assembly 2017. Dr. Michael Winters - Critical Care Updates Dr. Tim Horeczko - Pediatric Pitfalls Thanks for listening! Jeremy Faust and Lauren Westafer

We cover some high yield, important, or frequently discussed recent articles. Antibiotics and abscesses - Daum et al FAST in hemodynamically stable patients -  Holmes et al Haloperidol in gastroparesis - Roldan et al and Ramirez et al Ignoring PERC - Buchanan et al Steroids in non-asthma/COPD lower respiratory tract infections - Hay et al Gender pay gap persists in academic EM (and it's not due to hours, rank, or roles) - Madsen et al

We review this blog post by Bryan Hayes, an ED pharmacist (@PharmERToxGuy), on the use of physostigmine in anticholinergic toxicity. We then review anticholinergic toxidrome using Rosen's, Tintinalli's, and Goldfrank's as a guide. Thanks for listening! Lauren Westafer and Jeremy Faust

We review gastroparesis treatment with haloperidol including a recent study by Ramirez and colleagues. This study had significant methodologic limitations but provides some interesting insight into a practice that many providers have adopted - using haloperidol for gastroparesis. A tiny RCT by Roldan and colleagues also looked at this practice and found promising results, although the study was very small.  Haloperidol has also been used in cannabinoid hyperemesis but literature on this is limited to case reports/series. We also cover core content on biliary pathology using Tintinalli and Rosen's as guides. Thanks for listening! Jeremy Faust and Lauren Westafer

We review recent discussions on the accuracy of cuff blood pressures including a meta-analysis Picone et al published in the Journal of the American College of Cardiology discussing the accuracy of cuff blood pressures. We cover core content on hypertensive emergencies and asymptomatic markedly elevated blood pressure using the ACEP clinical policy on hypertension, Rosen's (9th ed) Chapter 74 "Hypertension," and Tintinalli (8th ed),  Chapter  57 “Systemic Hypertension” Chapter 59 “Aortic Dissection and Related Aortic Syndromes” as guides Show notes on FOAMcast.org Thanks for listening! Jeremy Faust and Lauren WEstafer

We cover Free Open Access Medical Education on opioids. The Poison Review podcast reviews papers on the opioid epidemic, including a paper by Rudd et al demonstrating an increase in opioid-related deaths over the past five years as well as the following paper by Shah and colleagues. The Dantastic Mr. Tox and Howard, a new podcast on the scene, also covers multiple topics on opioids, including common misconceptions of tramadol. Then we cover core content on opioid overdose and withdrawal using Rosen's Emergency Medicine (9th ed) Chapter 156 and Tintinalli's Emergency Medicine (8th ed), Chapter 186 as a guide.   Thanks for listening! Jeremy Faust and Lauren Westafer

We are in Berlin for #dasSMACC and have lots of pearls to share from the speakers at this amazing conference.  Talks will be released for free on the SMACC podcast over the next year, but this podcast holds some pearls that we thought couldn't wait. We cover... One of the major themes of #dasSMACC has been - we are more overconfident in our knowledge, skills, ability, and good behavior than we actually demonstrate. We cover the Dunning-Kruger effect and how to help combat the notion that "this happens to other people, not me."  Drs. Jacob Avila and Ben Smith on Airway Ultrasound Dr. James Rippey on Point of Care Ultrasound Incidental Findings Dr. Jack Iwashyna on Critical Care Prognosis Thanks for listening! Jeremy Faust and Lauren Westafer

We are in Berlin for #dasSMACC and have lots of pearls to share from the speakers at this amazing conference.  Talks will be released for free on the SMACC podcast over the next year, but this podcast holds some pearls that we thought couldn't wait. We cover... Dr. Leanne Harnett on Pulmonary Embolism with Right Heart Thrombus (PE with RHT) Dr. Michele Domico on Pediatric Cardiology Emergencies Dr. Haney Mallemat (@CriticalCareNow) on Transesophageal Echocardiography (TEE) during Cardiac Arrest   Thanks for listening! Jeremy Faust and Lauren Westafer

We deliver pearls from the first day of #dasSMACC in Berlin. We cover talks by Dr. Brian Burns on trauma, Dr. David Carr on endocarditis, Dr. Paul Young on statistics, and Dr. Jess Mason on sickle cell vaso-occlusive crisis. Check out foamcast.org for show notes and pictographic summaries. Thanks for listening and for the Rosh Review for sending us! Jeremy Faust and Lauren Westafer

We interrupt our normal core content for this update: Texting amongst medical professionals is ubiquitous; however, given patient privacy laws, many wonder, what is permissible? We discuss a recent article in JAMA by Brian Drolet on this very topic as well as some basic professionalism pearls. Show notes at FOAMcast.org Thanks for listening, Lauren Westafer and Jeremy Faust

We cover FOAM on the WOMAN trial of tranexamic acid (TXA) in post-partum hemorrhage including BroomeDocs, EMlitofnote, and The Bottom Line Then we delve into core content on non-pregnant vaginal bleeding using Rosen's and Tintinalli's as a guide. Show notes are available at FOAMcast.org Thanks for listening! Lauren Westafer & Jeremy Faust

We cover Free Open Access Medical Education (FOAM) from a recent Emergency Medicine Cases podcast and First10inEM blog post by Dr. Justin Morganstern regarding urinary tract infections (UTIs).   This podcast and blog tackle common issues in UTI diagnosis and treatment, including the following points: UTI is a clinical diagnosis, a dirty urine does not mean the patient has a UTI Urinalyses are more complicated to interpret than we probably understand Then we cover core content from Rosen’s Emergency Medicine (8th ed), Chapter 99; Tintialli's Emergency Medicine (8th ed), Chapter 91; IDSA Guidelines for Treatment and Asymptomatic Bacteriuria Thanks for listening! Jeremy Faust and Lauren Westafer