EMplify - October 2021Announcements: The EB Medicine app is live and available for free in the Apple Store. Coming to Google Play soon. It is in Beta and your feedback is welcome. ,Also, this month use code SB25 and get a $25 Starbucks gift card when you subscribe at ebmedicine.net Emergency Dept. Management of Cervical Spine Injuries Authors: Geoffrey Jara-Alamonte, MDChandni Pawar, MDEpidemiologyAnatomy (Figure 2 +3)Spinal Cord Injury Injury (Table1)PrimarySecondaryDifferential DiagnosisPrehospital Care - selective immobilizationED evaluationsHistoryPhysical Exam (Table 6)ImagingVascular Injury - Modified Denver Criteria (table 9)TreatmentSpecial PopulationsPediatrics

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Episode 62 - Cervical Spine Injuries- An Interview with Dr. Jara-Alamonte

EMplify - September 2021 Announcements: Be on the lookout for an announcement regarding the new EB Medicine app, coming to an App Store near you this month !! Also, this month use code SB25 and get a $25 Starbucks gift card when you subscribe at ebmedicine.net ! Abnormal Uterine Bleeding in the Emergency Department Authors: Tazeen Abbas, MD Abbas Husain, MD, FACEP Physiology review Terminology Differentiating Causes: PALM-COEIN Structural: Polyp, Adenomyosis, Leiomyoma, Malignancy/Hyperplasia Non-structural: Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not otherwise specified Other causes: thyroid disease, hyperprolactinemia, stress, weight loss and anorexia, heavy exercise Age Based Differential 12-18 Immaturity of the hypothalamic-pituitary- ovarian axis Sexually transmitted infections Coagulopathies, and bleeding disorders (von Willibrand disease) 19-39 polyps fibroids malignancy PCOS Age 40 and older endometrial atrophy malignancy History Physical Exam Diagnostic Studies Treatment Unstable Stable Special Cases DOACs Prepubescent girls genital injuries  

Episode 61 - Abnormal Uterine Bleeding

EMplify - August 2021 Announcements: Be on the lookout for an announcement regarding the new EB Medicine app, coming to an App Store near you this month !! August 2021 Pediatric Emergency Medicine Practice Less Lethal Law Enforcement Weapons Authors: Jessica Osterman, MD , Cara Buchanan, MD What kinds of less-lethal weapons are law enforcement using? Pepper spray Conducted Electrical Weapons (CEWs) K-9s Beanbag guns Rubber bullets Stingballs Differential Diagnosis Prehospital Care Trauma Informed Care Conductive Electrical Weapons - Taser Chemical Irritants- Pepper Spray, Tear Gas K9 Injuries Kinetic Impact Projectiles- Rubber Bullets, Beanbags, Sting Balls/Grenades Sounds: Police Siren https://freesound.org/people/MultiMax2121/sounds/156869/ Ambulance https://freesound.org/people/sofialomba/sounds/469413/ Angry Man https://freesound.org/people/ebcrosby/sounds/334439/ Taser https://freesound.org/people/The_Chemical_Workshop/sounds/403252/ Taser https://freesound.org/people/Greub/sounds/402636 Coughs https://freesound.org/people/freesound/sounds/25301/ Dog Bark https://freesound.org/people/ivolipa/sounds/337101/ Grenade https://freesound.org/people/superfreq/sounds/268101/

Episode 60 - Less Lethal Law Enforcement Weapons

EMplify - July 2021 Announcements: Be on the lookout for an announcement regarding the new EB Medicine app, coming to an App Store near you this month !! HIV- An Interview With Dr. Daniel Egan See the EB Medicine Article @ https://www.ebmedicine.net/topics/infectious-disease/HIV Why HIV?  2018 , 1,2 million people living with HIV, almost 40k new infections People living with HIV visit the ED 3 x per year on average HIV infected patients accounted for 6 in 1000 ED visits in 2017 New Transmission of HIV, Figure 1 What does acute infection look like ? What about chronic infection ?The chronic phase can last 10 years or more and be asymptomatic. Are people with HIV more likely to develop: CAD, COPD, DVT and why? What if they are on medication for HIV? Screening in the ED, everyone? Do they have to have symptoms or risks? What does universal screening mean? What does risk based screening mean? What are the risk factors? What if I see someone on PrEP who is in the ED for an unrelated complaint? History Ask about cd4 and viral load and last test Ask about he of opportunistic infections Ask about medication side effects What else? Exam Labs - rapid testing, 4th gen, viral load and cd4, etc Imaging Treatment Table 1 Highly effective and reduces transmission Medication side effects (we don’t have to dwell on each Med and side effect and just reference the charts) hep B virus deactivation System Based Disease Heart Failure and CAD PCP (role of LDH) TB COPD Renal Disease - stones , radiolucent Neurologic- CVA, cryptococcal meningitis, toxo, progressive multi focal leukoencephalopathy, HAND GI - diarrhea causes, c diff, hep C Heme- cytopenia Endocrine - metabolic syndrome Musculoskeletal Psychiatric table 3 Derm Special Circumstances PEP PrEP  

Episode 59 - HIV - An Interview With Dr. Daniel Egan

EMplify - June 2021 Announcements: The Clinical Decision Making in the Emergency Department conference is June 23-27 live and virtual. More information here: https://clinicaldecisionmaking.com Be on the lookout for an announcement regarding the new EB Medicine app, coming to an App Store near you this summer !! Syncope- An Interview With Dr. James Morris See the EB Medicine Article @ https://www.ebmedicine.net/topics/cardiovascular/syncope Why syncope? Prevalence, hospitalizations, etc. Etiology: figure 1 is fantastic. Physiologic basis of syncope Neurally mediated Orthostatic - are we still doing orthostatic vitals in the ED? Cardiac Differentiating syncope from seizure Features that point to seizure Urinary incontinence Number of jerks Age? Prehospital care is all about details What did bystanders see? What do paramedics see? Any trauma? Any neuro deficits ? Glucose ECG ED  History - table 4 History of similar Prodrome Associated symptoms (chest pain, neuro symptoms, etc) Falls Pre-syncope ? ED exam Vitals, vitals, vitals Orthostatic vitals ? Carotid sinus massage, why this? Do we do in the ED? ECG Brugada, blocks, VT, ST changes, etc Labs BNP, delta bnp ? Trop Lactic acid Pregnancy test CBC lutes Bun/Cr Echo - any role in the ED? CT Head PE- get this on everyone ? Is it high prevalence? Risk stratification tools- the bad and the worse Table 7, amazing Controversies Admitting the elderly Orthostatic vitals (we discussed already) Disposition 

Episode 58 - Syncope - An Interview With Dr. James Morris

EMplify - May 2021 Announcements: The Clinical Decision Making in the Emergency Department conference is June 23-27 live and virtual. More information here: https://clinicaldecisionmaking.com Be on the lookout for an announcement regarding the new EB Medicine app, coming to an App Store near you this summer !! Atrial Fibrillation : An Approach To Diagnosis And Management In The Emergency Department - An Interview with Dr Brian Millman Epidemiology Causes Prehospital treatment - careful with causes of the A Fib. ED Evaluation History - beware the causes Physical ECG Labs Imaging Echocardiography Treatment Rate control Calcium channel blockers Beta blockers Esmolol Magnesium Rhythm control Amiodarone Procainamide Cardioversion Watch and Wait Anticoagulation Disoposition  

Episode 57 - Atrial Fibrillation : An Approach To Diagnosis And Management In The Emergency Department

EMplify - April 2021 Announcements Traumatic Hemorrhage in the ED- with Dr Scott Weingart - April 13th, 8pm EST Free ! Register now: https://www.crowdcast.io/e/traumatic-hemorrhagic/register Pandemic Preparedness publication is coming soon. Mt Sinai COVID-19 Treatment Protocols have been updated and are available for free here: https://www.ebmedicine.net/topics/COVID-19/Protocols The Clinical Decision Making in the Emergency Department conference is June 23-27 live and virtual. More information here: https://clinicaldecisionmaking.com   Management of Suspected Rabies Exposure in the Emergency Department - An Interview with Dr. Bess Storch Epidemiology: Fatality rate of over 99% Half of cases occur in children 95% of cases are in resource limited countries, 35% in India 99% caused by infected dogs (worldwide) In the US, cases are predominantly bat variant Why this topic? "In a recent survey of licensed physicians, less than half could identify rabies transmission routes, the correct PEP schedule, and the correct anatomic administration sites." Pathophysiology: What causes it? The RNA virus Lyssavirus How is it transmitted? How does it reach the brain? ED Evaluation: What does it look like clinically? 5 stages- incubation, prodrome, acute neurologic phase, coma death Why doesn’t everyone just get vaccinated? What patient medical history is important ? Steroids, chloroquine What animals are high risk? What about pets and quarantine? What about rodents ? Is there any role for labs or imaging ? What is the treatment regimen for those who are unvaccinated? And vaccinated? What about people who are immunosuppressed? Children? Pregnant? Recently traveled?  

Episode 56 - Management of Suspected Rabies Exposure in the Emergency Department

EMplify - March 2021 Management of Acute Urinary Retention in the Emergency Department An algorithmic approach to urinary retention. Relieve the obstruction  Foley Cudet cather Silicone catheter Suprapubic catheter Determine the cause -  Structural Medications / Toxicologic Neurologic Infectious Alpha blockers Antibiotics Slow vs rapid bladder decompression Admit or discharge Phimosis and Paraphimosis Announcements: New Airway Course Available: Current Topics in Airway Management: Mechanical Ventilation, Supraglottic Airway Devices, and Intubating Patients With COVID-19 Upcoming Live Course: Dr. Scott Weingart - Traumatic Hemorrhage - April 13th., 8-9pm, EST Look for the "Key Points And Pearls From 2020" coming to your inbox or mailbox next month ! 

Episode 55 -Management of Acute Urinary Retention in the Emergency Department

EMplify - February 2021 Community Acquired Pneumonia - An Interview with Dr. Matthew DeLaney, FACEP 1. Pneumonia and nomenclature : healthcare associated vs hospital associated2. COVID-19 and antibiotics3. Bacteriology - Strep is only 10-15% of hospitalized pneumonia, Viral pneumonia is about 20% (pre covid)4. Conditions that predispose to pneumonia chronic lung disease (chronic obstructive pulmonary disease, bronchiectasis) smoking older age immuno-compromise proton-pump inhibitors, H2 blockers, and antipsychotic agents 5. Is there a historical or exam item most likely to be indicative of pneumonia?6. How good is a CXR?7. When should I consider a CT if the CXR is normal?8. Procalcitonin9. Blood cultures, sputum cultures, urine antigens- are these helpful?10. CURB-65 vs PSI11. Antibiotics- table 3 major and minor, history of prior infection, and doxy for everyone !12. Duration - 5 days works13. A walk through the pathway

Episode 54 - Community-Acquired Pneumonia in the Emergency Department - Interview with Matthew DeLaney, MD

EMplify January 2021 Evaluation and Management of ST-Segment Elevation Myocardial Infarction in the Emergency Department Authors Marshall Frank, DO, MPH, FACEP Carson Sanders, BS, NRP, CCEMT-P Bryan P. Berry, MD, BCEM, FACEP   Topics Epidemiology Pathophysiology Prehospital care Emergency Dept Evaluation History Physical Imaging Labs Electrocardiogram aVR Posterior Leads LBBB Serial ECGs Reciprocal Changes Pericarditis vs STEMI Treatment Oxygen Opioids Antiplatelet Agents Nitroglycerin Beta Blockers Reperfusion PCI Thrombolytics Dysrhythmias Anticoagulants Transfers Special Circumstances Gender Age Cocaine Have questions or comments on the podcast? Write us at emplify@ebmedicine.net .

Episode 53- Evaluation and Management of ST-Segment Elevation Myocardial Infarction in the Emergency Department

EMplify December 2020 Rhabdomyolysis: Evidence- Based Management in the Emergency Department Authors: Gi Xiang Lee, MD David Duong MD, MS, FACEP Topics:   Evidence Review Biology & Pathophysiology Differential Diagnosis Pre-hospital care Emergency Department Evaluation History Physical Examination Labs Treatment Special Populations Disposition   Have questions or comments on the podcast? Write us at emplify@ebmedicine.net . Don’t forget about the $50 Amazon card with any order over $300 through 12/31/20. Use code AMAZON20

Episode 52 - Rhabdomyolysis: Evidence- Based Management in the Emergency Department

EMplify November 2020 An Evidence-Based Approach to Nonoperative Management of Traumatic Hemorrhagic Shock in the Emergency Department Authors: Christopher Pitotti, MD, FACEP Jason David, MD Topics: The Lethal Triad Prehospital Care Tourniquets - Placement and Pitfalls Stop The Bleed Hemostatic Dressings TXA Temperature Management ED Assessment Shock Recognition Predictors of Massive Transfusion Imaging Ultrasound - eFAST CT Labs Viscoelastic Clot Testing Treatment REBOA- Resuscitative Endovascular Balloon Occlusion of the Aorta CPR Resuscitative Thoracotomy Airway - Intubation Breathing Circulation Massive Transfusion Crystalloid Blood Products Special Populaations   Have questions or comments on the podcast? Write us at emplify@ebmedicine.net .

Episode 51 - Nonoperative Management of Traumatic Hemorrhagic Shock in the Emergency Department

EMplify October 2020 Management of Deep Vein Thrombosis in the Emergency Department   Authors: Shane R. Sergent, DO, FAAEM, FACOEP, FAWM, RDMS Michael Galuska, MD, FACEP, FAAEM John Ashurst, DO, MSc, FACEP, FACOEP   Topics: Epidemiology Causes: • Unprovoked • Provoked Risk Factors Testing • D-dimer • Ultrasound Anticoagulation • Heparins • DOACs • Warfarin • Other Special Populations • Malignancy • Pregnancy • Elderly • Distal Calf DVT Have questions or comments on the podcast? Write us at emplify@ebmedicine.net . 

Episode 50 - Management of Deep Vein Thrombosis in the Emergency Department

Emergency Care for Transgender and Gender-Diverse Children and Adolescents - An Interview With Dr. Hannah Janeway and Dr. Clinton Coil   This issue of Pediatric Emergency Medicine Practice is available at no cost here: https://www.ebmedicine.net/topics/ethics/trasnsgender-gender-diverse-children Topics: What is the difference between gender and sexual orientation? What are some of the terms we may encounter (current or retired)? How does a lack of knowledge / competency regarding care for transgender and gender diverse (TGD) youth create barriers to effective care? Or negatively affect the quality of care these patients receive? What is the best way to approach a transgender patient in the ER? There are a number of ways transgender patient may alter their appearance. Why are these methods relevant (complications) and how do I ask about them? Tucking Packing Binding What medical gender-affirming therapies are currently available? And what complications can they cause? Pubertal suppression Feminizing or masculinizing hormones Contraception Is gender-affirming surgery used in this population ? What types (chest, genital) ? STI’s and Pregnancy are still considerations, correct? What are some of the problems that transgender youth have an increased risk of? Substance abuse Suicide Self harm Anxiety Depression Eating disorders Physicians and sexual violence Family rejection Homelessness Food insecurity Poverty What are some helpful resources if I want to learn more? UCSF Center for Excellence for Transgender Health (https://prevention.ucsf.edu/transhealth) PFLAG (https://pflag.org/)   Learn more about EBMedicine and subscribe to Emergency Medicine Practice or Pediatric Emergency Medicine Practice here: https://www.ebmedicine.net/  

Episode 49 - Emergency Care for Transgender and Gender-Diverse Children and Adolescents - An Interview With Dr. Hannah Janeway and Dr. Clinton Coil

EMplify September 2020 – Infective Endocarditis Topics: Definition and new classification methods. Changes in at-risk patients in the U.S. History and Examination Imaging Chest Xray Trans-throacic Echocardiography (TTE) Trans-esophagel Echocardiography (TEE) CT Angiography MRI Bacteriology Antibiotics Summary Write us at emplify@ebmedicine.net

Episode 48 - Infective Endocarditis

Get quick-hit summaries of hot topics in emergency medicine. EMplify summarizes evidence-based reviews in a monthly podcast. Highlights of the latest research published in EB Medicine’s peer-reviewed journals educate and arm you for life in the ED.

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