There are a variety of anorectal emergencies that present to the emergency department.  Recently, there were updated guidelines made by the World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST).  In this post, we review some of the updated guidelines including for anorectal abscess, perineal necrotizing fasciitis (Fournier's gangrene), bleeding anorectal varices, complicated rectal prolapse (irreducible or strangulated), and retained anorectal foreign bodies.

We are back to providing our ATLS content and we are picking up where we left off.  Our last ATLS podcast was on spine and spinal cord trauma.  Somewhat similar in nature is musculoskeletal trauma.  This is a very common form of trauma.  However, delayed recognition and  treatment can result in life-threatening hemorrhage or limb loss.

Cluster headaches are often considered one of the most painful human experiences.  They are short (lasting usually 15-180 minutes), frequent (up to 8 a day), unilateral headaches behind or around the eye often with ipsilateral autonomic symptoms and restlessness.  While migraines and tension headaches are seen frequently in the emergency department, cluster headaches are much less frequently seen and often are harder to identify as a result.  There are certain points to remember with patients that are experiencing cluster headaches and we list 10 of them here.

The use of tranexamic acid (TXA) has expanded with growing evidence in its use for a variety of clinical situations.  However, not all evidence is created equal and not all applications show benefit.  In this blog and podcast we discuss the various uses of TXA and the surrounding evidence.

For decades, there has been a major name debate regarding the appropriate title for PAs.  However, on May 24, 2021 the American Academy of PAs (AAPA) House of Delegates (HOD) came to a vote.  Over 100 possible titles were considered, but ultimately the winning vote was for "physician associate" which has led to a significant amount of discussion.  What is the history behind this decision and why now?  What has been the response?  We discuss this and more in this new blog and podcast.

There are countless guides and references that can be used in emergency medicine.  However, some books prove to be better resources than others and it is vital to identify them.  In this post, we review one of the books you should seriously consider having if you work in emergency medicine.

Last year, the American Heart Association (AHA) provided updates to their basic life support (BLS), advanced cardiac life support (ACLS), and pediatric advanced life support (PALS) programs.  Mike Sharma is helping again by reviewing some of the key updates and changes to guidelines.  We also provide some additional feedback and information to consider with these new guidelines.

March is Women's History Month and we wanted to celebrate some of the accomplishments of women in medicine.  While there are countless women that could be mentioned, we wanted to focus on a few that have been seen as pioneers in medicine.

Recently there was commentary in a forum that suggested the Pulmonary Embolism Rule-Out Criteria (PERC Rule) was essentially useless for detecting a pulmonary embolism (PE).  It started with an anecdote, which is a logical fallacy (post hoc ergo propter hoc) and went wild from there.  This led to the realization that many still do not understand how to use the Wells' Criteria for Pulmonary Embolism (referred to from here simply as the Wells' Criteria) and the PERC Rule.

Injuries to the spine can occur both in blunt and penetrating trauma.  They can also be with or without neurological deficits.  For this reason, they should be considered in all patients with multiple injuries.  In this podcast, Chip Lange and Mike Sharma review the pearls and pitfalls of this disease process.

We are able to provide a sneak peak at some updated content with Practical POCUS.  Over the last few months, Practical POCUS has been working to improve its content with the plan to help further promote point of care ultrasound (POCUS) to a broader audience.  One audience in particular is with EMS.  This 10 minute video is an excerpt from the updated course worth 24 hours of CME.  Make sure  to check out PracticalPOCUS.com to learn more.

A little while back, we asked for help on getting out more content.  David Wright and Kate Randolph answered that call and provided a special podcast on osteogenesis imperfecta.  We hope you enjoy this unique podcast and encourage you to reach out if you want to contribute, as well.

Neonatal sepsis can be subtle, especially early on.  It can rapidly progress to multisystem organ failure, meningitis, and death.  Given the real dangers of neonatal sepsis, we will focus on 10 key points to remember when evaluating for this lurking terror.

Elevated intracranial pressure (ICP) was just discussed in our last podcast on head injuries.  However, we briefly mentioned how there is a certain amount of controversy on this subject.  This separate podcast is to act as a supplement to the Chapter 6 ATLS podcast on head trauma that was just covered.  We find this particularly important given how long our ATLS podcasts run in general.

The newest Advanced Trauma Life Support (ATLS) blog and podcast is here!  This time we talk about head trauma.  Get the key pearls and pitfalls as provided by Chip Lange and Mike Sharma.

We received quite a bit of feedback with the last podcast and requests to discuss specifically the variants and their potential impacts on the current COVID-19 vaccines.  It is worth noting that at the time of this publication there is still limited data but we discuss the key concepts and takeaways with the current knowledge we have on the topic.

There have already been many podcasts discussing COVID-19 vaccines, so what makes this one different and worth listening to now?  This podcast is more about some of the key highlights and frequent questions asked to help listeners get the right resources and information.

We are back at it again with our newest ATLS podcast.  This time we are focusing on the abdomen and pelvis which can be host to a wide range of severe pathology.  Given its many intricacies, we focused most on the highlights from ATLS Chapter 5 including the key "red text" that it emphasizes. 

Recently, the Centers for Disease Control (CDC) released updated guidelines for treating gonococcal infections.  Given the increase in antibiotic resistance, this provides an important change in the recommended management for not only gonorrhea but also chlamydia. 

2020 was a very different year and now it is time to start into 2021.  As always this time of year we want to provide everyone with an update and our plans.  This is especially true given how the last couple of months have been particularly challenging with COVID-19.

It has been a while (a month) since we last posted.  We apologize, but wanted to explain why and remind you that we are still here and ready to help.  Take a listen to the podcast to understand more.

We are finally back with another ATLS podcast.  Mike Sharma and Chip Lange together discuss the complex but important subject of thoracic trauma.  They break it down this time by addressing key aspects that come up during the primary and secondary assessments.  This topic also broaches how to manage the traumatic circulatory arrest patient without a pulse.

We have mentioned in previous podcasts that if you have questions or special requests to send them our way.  Another one of our listeners did just this after listening to part of our ATLS series.  This has been a very popular series and we are so glad you enjoy it so much.  The discussions that have been built off of this as a result has led to even more great podcasts.

With the recent release of the Butterfly iQ+, we wanted to provide everyone with comparison images and review some of the changes the new device and the original Butterfly iQ.  We will continue to work on comparing images and review cases with the new Butterfly iQ+ with Practical POCUS.

For the first time ever, we delayed our normal podcast release to coincide with a very special reveal by Butterfly Network: the new and improved version of their device called the Butterfly iQ+.  Practical POCUS was able to get their hands on the brand new device so that you can see what it looks like.  There are videos to help compare the two devices and the unboxing of the Butterfly iQ+.  Stay tuned for updates as videos come out demonstrating the improvements when comparing the original to the new device.

In resuscitation situations, such as trauma and sepsis, it is important to appropriately replace the patient's lost volume and be able to give medications in a quick and successful manner.  However, what is the best way to accomplish this and why?

Sam Ireland from FOAMfrat invited me on to their podcast to talk more about PAs in EMS.  This was a fantastic conversational piece that is well worth listening to in order to learn more about what it means to have PAs in EMS and the potential future of such as role.

There are many people who are still uncertain how point of care ultrasound (POCUS) can benefit them in their practice.  This podcast will give you five examples of how POCUS can significantly change your patient care (in a very positive way) and  what you can start doing to to improve your patient care by using POCUS.

On our last blog and podcast, part of the ATLS series, we covered shock.  In that last post, it was briefly mentioned how vasopressin could be used in hemorrhagic shock.  We want to build on that discussion today with a more detailed review on using vasopressin (and other vasopressors) in such a situation.

Shock, especially in trauma, is an absolute killer.  Defined as an abnormality of the circulatory system that results in inadequate organ perfusion and tissue oxygenation, shock must be recognized and treated accordingly.  Here to help us with this discussion is Mike Sharma.

Scaphoid fractures are often missed but important fractures due to their potential complications including non-union, post-traumatic osteoarthritis, and potential for avascular necrosis (AVN).  These complications can even lead to lawsuits which further emphasizes the need to identify and properly treat these fractures whenever possible.

Airway management is a commonly discussed topic in emergency medicine and there are some challenges that are unique with trauma.  Mike Sharma co-hosts again with our ATLS podcast series on this topic.  Take the time to listen both to better prepare for your ATLS course but also to better manage your future trauma patients.

To some, this may feel like spaced repetition.  However, the discussion with tramadol today is a common and recurring issue.  We will highlight the problems with tramadol and why it may be better to think of it as "tramadont" moving forward.

With the blast that occurred in Beirut earlier, this is a good time to do a rapid review on blast injuries.  This can be a rather complex topic but we will focus on conventional explosives.

Summer is often a time that people visit the beach for vacation.  While this may be different with the current COVID-19 pandemic, it is still worth learning how to manage one common injury at the beach: jellyfish stings.

It is time to dive into some core Advanced Trauma Life Support (ATLS) content.  Mike Sharma is back to co-host the podcast and help us cover the first chapter of ATLS which discusses the initial assessment and management of trauma patients.

This is probably one of the most niche blog and podcast that has been done for a while, but it is a special one given the work that has been put into this particular topic.  This has been a long term goal that has finally made some real progress recently.

Since the early stages of the COVID-19 pandemic, the use of masks has been discussed.  As this pandemic continues, there has been a great deal of debate on this issue.  This post is meant to help address some of the more common myths surrounding masks for COVID-19.

This is a project that has been in the works for a long time.  We have finally been able to coordinate and introduce a new podcast series covering ATLS.  This is only the beginning.

Surprisingly, we are back already to talk about dexamethasone.  Our last podcast, #204, covered the press release from the RECOVERY (Randomised Evaluation of COVid-19 thERapY) trial and their mentioning of results regarding dexamethasone.  Now, the study is available in a pre-print form.  It is important that this has not yet been peer-reviewed and is still preliminary, but we now have some real information that we can review!

By now you may have heard of a potential breakthrough in COVID-19 treatment: dexamethasone.  The steroid is well known and has been widely used.  It is inexpensive and readily available making it a great choice if it proves to be successful.  However, do we really have the evidence yet to support its use?

Law enforcement has used tear gas and pepper spray to help with crowd control.  Many of those exposed will require some form of treatment.  This post is meant to help provide some guidance in regards to the treatment of such injuries.

Given recent events and a longstanding concern for certain restraint positions causing positional asphyxia, we took the time to dive into this subject more by discussing how and why this occurs along with the surrounding evidence.

We have made it!  Another milestone to celebrate.  200 podcasts down and (hopefully) many more to come.  The format continues to change, but we hope to provide many great discussions and continue to educate as much as possible.  The goal moving forward is to continue to provide high quality content.

We celebrate another anniversary with this podcast.  This podcast marks the 200th one!  With every 50th podcast, we invite back Ken Milne from The SGEM.  When trying to decide what to discuss this time, Ken suggested we discuss the Peltzman Effect.  If you are not familiar, no problem!  Ken breaks it down for us and how it is applied to medicine, including the current COVID-19 pandemic.

We had an excellent opportunity that we had to turn into a video podcast.  The roundtable discussion is with Weill Cornell Medicine in New York City staff: a physician (Dr. McCarty), a PA (Matt), and a RN (Christina).  They cover their ED's response and how each of them took on new roles to better manage patients in this challenging time.  Their tips and tricks are worth listening to, especially if you have not yet seen a surge of patients.

Adrian Banning is back as our guest host this week.  Once again, she did a stellar job and performed a very interesting interview with David Allen.  As demonstrated on his Instagram account, he has become internationally renowned for his work as a tattoo artist.  He focuses most of his work on mastectomy scar coverage.  He has been published on JAMA and has been a speaker for medical conferences.   The unique skills and experiences have contributed to the discussion of this podcast.

Adrian Banning is acting as the host this week (and did a fantastic job!).  She interviewed Katherine (Katie) Thompson from IPV Educators regarding domestic violence surrounding the changes with COVID-19 and how we can still help these patients.  

If you have been to a healthcare facility recently or work in a hospital, chances are you have been screened as soon as you got to that location.  Sometimes, you are even screened prior to arrival.  The same strategies are being proposed to help us return to our "normal" lives.  While this may seem like a beneficial strategy, there is a significant problem with these screening protocols.

We are in a point of time where information is incredibly easy to access.  We also have the convenience to be able to rapidly share information.  We are also in a crisis from a pandemic.  We as a whole are in a dangerous situation where misinformation, rumors, and bias can play a major part in hurting ourselves, our loved ones, and the world as a whole.

We are back to talk more about POCUS with COVID-19.  This post covers the clinical course when using lung ultrasound, Q&A from someone who experienced it first hand, and how to disinfect your pocket ultrasound device.  We are joined in this discussion by Dr. Yale Tung Chen.

We are in the middle of the COVID-19 pandemic, and there are still many unanswered questions.  As mentioned in our previous post, we will not discuss in detail specific treatments yet as new data is constantly coming out and it is all very limited.  However, one question that comes up frequently is the use of ibuprofen and if it is safe with COVID-19.

As we continue our discussion regarding COVID-19, we wanted to cover the point of care ultrasound (POCUS) findings that you should know.  Much discussion surrounds this topic including some debates about if and how it should be used.  We tackle when, why, and how to use POCUS for COVID-19 as well as what to look for in this video podcast ("vodcast").  In this vodcast we are joined by SPOCUS President, Fritz Fuller

Infectious disease can become intertwined with illicit drug use for a variety of reasons.  HIV, hepatitis, and endocarditis are some of the common examples where drug use can lead someone to need help from an infectious disease specialist.  However, Patrick Bafuma interviewed Dr. Michael Silverman regarding some interesting research he did regarding how certain drugs were increasing the risk of serious infections.

With our last podcast discussing some of the key facts of COVID-19, it is worth discussing another important component: resource utilization.  One of the scarier projections with a large outbreak is how resources can be used to their maximum capacity very quickly.  We break down how COVID-19 is one example that can have disastrous consequences.

Coronavirus Disease 2019 (COVID-19) has been a very popular topic over the last few months.  However, there has been a great deal of misinformation and new information that has changed what we previously thought about this disease.  While we discuss this topic, it is worth noting that this may continue to change further and that this post was last updated on 3/3/2020.

Blunt trauma in the pediatric patient is fairly common.  Blunt trauma to the abdomen though is less common and provides some unique challenges.  The patient's developmental stage, limitations in verbal and language skills, lack of prehospital information, and the potential for an unreliable exam creates a situation that can create additional stress for both the family and those taking care of the patient.  We will break down a recent EB Medicine article and cover some of the key aspects that will help you provide better care to these patients.

Patients present with headaches frequently, but they do not all need imaging.  However, the question becomes who does need the imaging?  The American College of Radiology updated their guidelines from the ones previously made in 2014 and we provide a rapid review in this post.

One of the most commonly feared diagnoses to miss in medicine is the ruptured aortic aneurysm or aortic dissection.  Despite classic teachings, the presentation of most patients is not textbook.  While there are many studies trying to find ways to help with the evaluation, they have been limited in success.  However, what if you add ultrasound?  We discuss some new evidence in this post.

Patrick Bafuma is back for the second part of his EM ID interview with Dr. Valerie Vaughn.  She is internal medicine trained and a hospitalist with a special interest in infectious disease.  Go back to Podcast #182 to hear her discussion with nudges as it comes back to play in this post.

Tibial plateau fractures can be easily missed, especially to the untrained eye.  Missing these important fractures can have devastating outcomes.  In this post we will talk about how to identify and manage these fractures.

Point of care ultrasound (POCUS) can range in complexity from very basic exams to those that are expert level in nature.  While some basic wall motion abnormalities are taught in many introductory classes, the concept of regional wall motion abnormalities (RWMA) for myocardial infarctions (MIs) can be a little more complicated and as a result is often not taught to novice learners of POCUS.  Some have questioned the validity of the results, as well.  In this post, we will cover some highlights including recent evidence that may further support the potential role of RWMA in MIs.

Patrick Bafuma is back to provide another EM ID special, this time with Dr. Valerie Vaughn.  She is internal medicine trained and a hospitalist with a special interest in infectious disease.  The concept of asymptomatic bacteriuria has been discussed before with with Podcast #158, but this time Dr. Vaughn introduces the idea of nudges and how it can help use reduce our antibiotic use.

Both rashes and fevers are very common complaints in the emergency department.  However, the challenge becomes very real distinguishing the serious to the more benign.  Fortunately, EB Medicine has once again come to help make this challenging topic a little easier to understand.  We review some of the highlights from their article in this post.

Another year is in the books.  We appreciate you reading the blog and listening to the podcast.  This post is devoted to wrapping up the year.

Happy Holidays and if you are listening to this when it is published, Merry Christmas.  Last year for Podcast #127, on Christmas Day we reviewed the importance of family, friends, and colleagues.  This year we wanted to discuss the importance of kindness.

We love EB Medicine specials and we hope you do, too!  This time we are talking about a subject that many forget about: pediatric stroke.  While it is far less common than what we see in the adult population, it carries a high morbidity and mortality rate.  In November, EB Medicine went into detail about this particular topic and we think it was a fantastic review.  Let's get started!

Examining the gallbladder on ultrasound is not a particularly difficult skill.  However, the rest of the biliary exam on point of care ultrasound (POCUS) can be both challenging and time consuming.  Sometimes, the common bile duct (CBD) is not able to be positively identified.  This has led to questioning the importance of this particular component of the exam.  We will review some of the recent evidence in this post.

We have Patrick Bafuma back interviewing Dr. Nico Cortes-Penfeld from the University of Nebraska Medical Center.  He specializes in orthopedic infectious diseases.  Nico and Patrick are covering septic arthritis in this conversation.

EM ID is back again with Patrick Bafuma interviewing Dr. Nico Cortes-Penfeld from the University of Nebraska Medical Center.  He specializes in orthopedic infectious diseases.  Patrick interview Nico for two discussions, with the first being clindamycin.  Join back for the next discussion on septic arthritis.

It is time for another EB Medicine special.  The febrile young infant can be one of the scarier patients for a variety of reasons.  They are so young they are unable to communicate, they have very real and serious pathogens that can have deadly consequences, and the family as well as other individuals taking care of the patient can be nervous or scared creating increased stress.  In this post, we cover EB Medicine's recent article on this topic to better improve your practice.

If you have not figured it out yet, point of care ultrasound (POCUS) is not going away anytime soon.  It is a powerful tool in the hands of clinicians across the world.  With its growing utilization, there are still many that are hesitant to implement it into their daily practice.  In this podcast, we talk about how to encourage others to start using POCUS.

Katherine (Katie) Thompson from IPV Educators is discussing more pediatric abuse pearls.  Our focus this time is on the very sensitive subject regarding examination in pediatric sexual abuse.  Katie walks us through how we can interview and perform a preliminary exam before a complete exam by a forensic examiner.

Katherine (Katie) Thompson from IPV Educators is back to discuss some more pearls in regards to abuse and neglect.  This time, we talk about dogma regarding the history and physical exam components specifically for pediatric abuse and neglect.  We pay particular attention to the incorrect dogma that can impact our management.

Anaphylaxis is a life-threatening condition that requires early recognition and appropriate treatment for the best outcomes.    In pediatric cases, this can be more challenging for a variety of reasons including the barriers to obtaining a history and physical, knowing the appropriate dosing of medications, and the general stress of managing sick pediatric patients.  We discuss how to manage such patients in this EB Medicine special.

Patrick Bafuma handed over the reigns for this month's EM ID series to Dr. Gita Pensa with Brown University.  She  interviewed Dr. Colleen Kelly who is a gastroenterologist and also teaches at Brown.  In this podcast they talk about two very common GI complaints where antibiotics play a role: upper GI bleeding and C. diff infections.

We talk about point of care ultrasound (POCUS) frequently, but a common favorite topic is the use of ocular ultrasound.  This application can provide a vast amount of information quickly and easily.  As an added bonus, our main paper discussed in this post used PAs.  The week this is being originally posted is National PA Week.

Back by popular demand we have enough podcast to cover 10 important pearls about a particular topic and this one comes from a recently published BMJ article covering Clostridioides difficile (formerly known as Clostridium difficile).

Patrick Bafuma continues his series of EM ID interviews this time with Dr. Solberg from Bismark, North Dakota and has her own website.  Peripherally inserted central catheter (PICC) lines are commonly used for both inpatient and outpatient care.  These patients can come to us for a variety of potential complications.  We will discuss some of the key ones in this post.

We return with our second podcast featuring EB Medicine content.  Our  partnership with them allows us to access their content and share it with you through the power of #FOAMed and this time we are tackling an all too common emergency: appendicitis.  Specifically, we discuss the pediatric population given their most recent evidence-based review article on the same.

Tofu can be used as a food product, but it has uses in medicine.  In particular for the discussion today is its role in point of care ultrasound (POCUS) training.  We discuss ways to use this inexpensive product to better improve your education.

We are completing the second installment of a new series with the help of Katherine Thompson from IPV Educators.  The discussion continues on human trafficking but this time we talk about how we can help.

We are starting a new series with the help of Katherine Thompson from IPV Educators.  It was born out of a passion for advocating for survivors of interpersonal violence.  We are glad to learn from Katherine  and the first discussion is regarding human trafficking.

As point of care ultrasound (POCUS) continues to expand in roles, the diagnosis of appendicitis using POCUS is one application with growing evidence.  This is especially true for the pediatric population.  In this blog and podcast learn how to diagnose appendicitis by POCUS and some of the most recent evidence.

In emergency medicine, we are generally very good about evaluating chest pain.  We also are familiar with procedures including coronary artery bypass grafts (CABG).  However, in patients with recent CABG, there are some key reminders we need with this patient population.

Both Patrick Bafuma and Dr. Sandra Gompf who specializes in infectious disease (Gompf's ID Pearls) are back this time to discuss some unique cases regarding antibiotic stewardship in the emergency department.

For this round of EM ID, Patrick Bafuma interviews Dr. Sandra Gompf who specializes in infectious disease and has Gompf's ID Pearls.  They focus primarily on delirium, indwelling Foley catheters, and callbacks.

We have started partnering with EB Medicine to provide you with some great content.  For our first post, we will cover the use of point of care ultrasound (POCUS) for the pediatric trauma patient.

This is not a podcast covering clinical content.  Instead, the focus will be about being a podcast guest and recording your own podcasts.  For that reason, it may not apply for you right now but if you are ever thinking about doing either, come back here.  Speaking of, we are always looking for guests and if you are interested please contact us.

This is a special sort of "bonus" podcast where we discuss with David Fifer a topic that was brought up entirely for fun: the nocebo effect.  Take a listen as we provide some real life examples of this phenomenon in action.

To celebrate the Fourth of July, David Fifer joined us to talk about heat exhaustion, heat stroke, and the dogma around these conditions.  This topic is one that is frequently misunderstood and David helps us understand the key pearls and pitfalls with heat stress emergencies.

Patrick O'Malley is an emergency medicine physician that invented the IRIG-8 device.  He decided to create a device that he feels is better than what was previously on the market in regards to wound irrigation.  Learn how he developed the device and how he has incorporated it into his practice.

Point of care ultrasound (POCUS) is becoming more widely used in a variety of musculoskeletal applications and this includes infectious pathology such as flexor tenosynovitis.  In this blog and podcast, we talk about a recent paper regarding the diagnostic utility of this condition.

Joining Patrick Bafuma again is Dr. John Perkins from Carilion Clinic in Virginia this time to discuss antibiotic stewardship in pediatric patients.

Ken Milne is back to discuss statistical significance to celebrate our 150th podcast.  With the different pearls and pitfalls regarding statistical significance, Ken came back on to try and help us navigate through the process and allow us to better understand what this term actually means.

Patrick Bafuma is back with another interview this time with Dr. John Perkins from Carilion Clinic in Virginia to talk about the post-infectious period as a cardiovascular risk factor.

We just finished helping at AAPA 2019 in Denver, Colorado.  It was a fun time with over 500 learners being taught by excellent faculty.  In this post we talk about the benefits of workshop style courses as well as full courses such as the upcoming Critical Access 2019.

With the recent surge of measles cases, it is important to understand the facts with measles.  In this post we cover a recent paper that reminds us some of the key details.

Quite often, people ask what other podcasts we would recommend.  These are the top 10 podcasts that always have us coming back for more.

In the later half of 2018, the American College of Emergency Physicians (ACEP) published their guidelines with non-ST-elevation myocardial infarction (NSTEMI) patients.  These guidelines were beneficial to support some current practices based on current evidence.  In this post, we review the guidelines and some of the supporting evidence.

A relatively recent article, the SHoC-ED trial, can sound like the need for ultrasonography in hypotension is not necessarily beneficial.  In this podcast the trial, along with its strengths and limitations, will be reviewed.

Patrick Bafuma is back to interview Janelle Bludorn for this installment of the EM ID podcast series.  This time they talk about testing for two of the most common sexually transmitted infections (STIs), Gonorrhea and Chlamydia (GC/C).   

Andrew Fisher is not your typical medical student.  In addition to his EMS background, he was a PA in the military.  Now, he is in his third year of medical school and has a passion for education.  This is especially true when it comes to blood products.

Furosemide (frusemide) is a commonly used loop diuretic.  Also known by the commercial name, Lasix, it is well established drug but is prone to some common myths.  To help kill the dogma, we review a recently published paper discussing 10 myths regarding this frequently used medication.

Sometimes, especially during a long shift, we want to ask our patients why they thought they needed to come see us suddenly for a complaint that does not seem emergent.  It can be challenging to remember that our patients seek our help for a variety of reasons.

Recently, our own Chip Lange was on The Skeptic's Guide to Emergency Medicine (The SGEM) for Podcast #249 covering ultrasound to confirm endotracheal tube placement.  This had previously been discussed in detail on our own Podcast #118 along with the technique.  However, after some discussions on social media it was decided to expand on this discussion further regarding the ways to confirm beyond ultrasound.

Thanks to the talents of Patrick Bafuma (who also has the EM in Focus blog), we have a new series on the podcast called Emergency Medicine Infectious Disease (EM ID).  The first podcast is with Lauren Westafer who also is part of the FOAMcast podcast and a FemInEM Speaker.  These two brilliant minds got together to record a podcast on spinal epidural abscess (SEA).

A while back, Podcast #70, we talked about how to perform a neurological exam.  We also spoke on FOAMfrat.  Since that time, at WEMSA we built on the subject and discussed the exam as well as its caveats.  At that time, there was not a name.  Now, we have the Brief Repeatable Assessment In Neurology (BRAIN) exam.

Sam Ireland is back to talk again about ventilatory failure.  Last time, he talked about the less severe impending ventilatory failure but this time he runs us through acute ventilatory failure.  If you have not already checked it out, look at our last post for details on impending ventilatory failure.

We have a two part special with Sam Ireland from FOAMfrat.  He is a critical care paramedic in Wisconsin and a brilliant mind including with ventilation.  Sam agreed to come on to talk both about impending and acute ventilatory failure.  Stay tuned next week for the second part of his talk.

This podcast is to discuss two important subjects with ultrasound.  The first is a quick review of the Butterfly iQ (more detailed review to come) and the second discusses some of the key benefits of POCUS in EMS and other settings where having a larger machine is not feasible.

This one is sure to generate some controversy, especially by my fellow #FOAMed colleagues but it is a conversation we need to have in all earnest.  We must seriously consider if double sequential defibrillation (DSD) is as good a plan as we may have originally thought.

Radial head subluxation, commonly referred to as nursemaid's elbow, is a common condition.  In this post we talk about how to diagnose and manage this condition in a timely and effective manner.

We are wrapping up our interview with guests Janelle Bludorn and Laura Blesse-Hampton as part of a collaborative series with the Society of Point of Care Ultrasound (SPOCUS) and Practical POCUS with this portion discussing the logistics of integrating ultrasound into a program.

It is time for the second part of our collaborative series with the Society of Point of Care Ultrasound (SPOCUS) and Practical POCUS.  We are again joined by our guests Janelle Bludorn and Laura Blesse-Hampton.  This time we discuss how to integrate ultrasound into an educational program. 

In collaboration with the Society of Point of Care Ultrasound (SPOCUS) and Practical POCUS, we are striving to help those who are wanting to improve their training programs.  We bring faculty that have experience of introducing ultrasound to the classroom.  These pearls are beneficial to all levels of education and not just for PA programs.

Under the Gregorian calendar, today is the first day of 2019.  Many are making resolutions and there are ways to add this can implemented into your role in medicine.  This is a New Year so take on something new and grow.

The original post is on Christmas Day 2018 but the principle remains true no matter the time of year.  In medicine, burnout is a commonly faced problem.  The Holidays and time away from family makes this even more difficult.

Sometimes in medicine we find things we were not necessarily looking for when we perform a test.  We call these incidental findings.  While many of these are benign they can potentially be problematic as they can change the workup of a patient including their disposition and management.

The department is busy and you want to keep the flow running smoothly.  It is easy to cut corners when it comes to imaging.  After all, a radiologist will be reviewing those images.  If you are lucky, those images will be read within minutes of them being taken.  Why then, should you review those images that you ordered?

This post is in direct response to a question that was asked recently.  There is a surprising amount of dogma around the subject of strep testing, but one major piece is that children under three years of age should not be tested for strep because of its reported rarity.  However, there have been multiple studies that disagree with this claim, and we took a mini deep-dive on the subject.

Acute bronchiolitis is another condition that will start showing more this time of year.  In some parts of the country, it is already being diagnosed.  It is important to know the current recommendations for this common and potentially dangerous condition.

Lawrence Berdan is a paramedic who has personally experienced the importance of recognizing and acutely managing pediatric neurological emergencies.  This post discusses some of the emergencies we may see in this uniquely challenging population.

It is that time of year.  It is cold and croup is in the air.  There is a spectrum of patients that present ranging from the mild to the life threatening.  We discuss how to manage these patients.

Now that our month of point of care ultrasound (POCUS) is over, it is time to talk about other clinically relevant topics.  Michelle Perkins is back again this time to help us cover tickborne illnesses in the United States.

We wrap up our month of discussing point of care ultrasound (POCUS) papers by having our guest Michelle Perkins.  Over the last couple of years a flurry of evidence has come out regarding abscess management.  Now, POCUS is taking center stage in a recent paper.  Here to help us discuss it is one of our favorite guests, Michelle Perkins.

There are many ways to confirm successful intubation.  Some are better than others, but they all have limitations.  One newer approach is the use of point of care ultrasound (POCUS) to provide real-time confirmation of tube placement.  We will talk about how to do this exam and its evidence in this blog and podcast.

Although point of care ultrasound (POCUS) is a valuable tool, there are times that a formal radiology performed ultrasound is needed.  We continue our October POCUS month marathon with a discussion on this topic and how we can improve success for our radiology colleagues.  Mainly, we want patient's to have a properly sized bladder that will allow for the best imaging on transabdominal pelvic ultrasound.

Continuing in our month long discussion of point of care ultrasound (POCUS), we move to talking about patient understanding and satisfaction.  This is all in conjunction with Practical POCUS which will be having courses at the end of this year.  ​We have previously heard that the use of bedside ultrasound has helped with patient satisfaction, but a recent paper investigated the benefits with improving patient understanding.

The month of October is often associated with Halloween and people think "hocus pocus" but this time we are promoting point of care ultrasound (POCUS) with a month-long discussion of subjects regarding bedside ultrasound.  This is all in conjunction with Practical POCUS which will be having courses at the end of this year.  Our first topic, ultrasound for the diagnosis of urolithiasis.

Recently, Dr. Jeff Jarvis was published in the Annals of Emergency Medicine for a paper regarding a clinical bundle he developed to reduce complications during intubation.  Specifically, his paper was to help reduce hypoxia in out-of-hospital intubation attempts.  However, the pearls can be used by anyone managing the airway of a patient.

What happens when you have someone who is anticoagulated fall and have minor head trauma?  They are talking to you, they appear neurologically intact, and they feel like they can go home.  Do you let them or do you still encourage a CT scan of their head?  There is a recent paper that may change your practice.

Firefighters are exposed to a number of dangers on a daily basis.  With this being the anniversary of 9/11, we want to dedicate this blog and podcast to all the victims from that day.  Most of us are already very familiar with issues that arise with firefighters such as PTSD and the impact on the body from long hours, overtime, and physical stress.  Unfortunately, we often forget about the other needs and special scenarios that firefighters come across and will cover some of the key aspects in this blog and podcast.

At the request of listeners, we are covering some essential clinical topics such as deep neck infections including peritonsilar abscess (also known as "quinsy").  These are life-threatening conditions that require early recognition and intervention.  Since peritonsilar infections are not of deep visceral spaces, this is technically separate but given their high incidence and at times coexistence with other deep neck infections they are often combined such as in discussion.

I​​ntraosseous (IO) devices are traditionally used in the initial stages of resuscitation when peripheral intravenous (IV) access is not readily obtainable.  This can happen for a variety of reasons such as edema, burns, obesity, or IV drug abuse among others.  Although ultrasound can be used to obtain peripheral or central venous access, the most rapid route is the IO.  The device has been used both in adults and children with great success.  It can safely facilitate the delivery of fluids, medications, and blood.  There are very few contraindications and it is rare to have a complication.

It has been 100 podcasts since the last time Jim DuCanto talked about his SALAD (Suction Assisted Laryngoscopy Airway Decontamination) technique.  Podcasts #8 and #9 were so long ago we wanted to have Jim back on to celebrate his achievements and talk more about the future of SALAD and other related projects.

Every year, we see drownings.  In some cases people survive, but unfortunately sometimes they do not.  However, there is confusion in both the medical community and the public regarding what is considered to be a drowning event.  Dogma and myths are everywhere and one of the most common is "dry drowning"  which is why we brought Michelle Perkins on to discuss this important issue.

We see changes in potassium levels all of the time in patients.  However, what works and what does not?  What is the evidence behind the management?  Are there special pearls?  These questions and much more are addressed in this podcast with Michelle Perkins.

Patients often come in complaining of a possible spider bite, but is this actually the cause of their symptoms?  In this blog and podcast, we talk specifically about brown recluse bites, differentiating them from other causes, treatment, and other pearls.

Epinephrine (adrenaline) has been a hallmark of cardiac arrest management as an attempt to obtain a return of spontaneous circulation (ROSC).  However, the evidence for epinephrine in out-of-hospital cardiac arrest (OHCA) as well as in the hospital (IHCA) has been conflicting.  We review the largest trial to date just recently published in the New England Journal of Medicine (NEJM).

Does it actually matter how you dress when you go to work?  The BMJ recently published an open access article covering this exact issue.  Although in many ways limited, this study offered some key insights regarding how our dress attire in different settings could potentially impact patient perceptions.

Too often we find ourselves fighting trolls and people both on social media and sometimes in real life.  Most of the time though, we are not able to engage in any form of real debate and discussion.  In this blog and podcast, we talk about how to meaningfully discuss and properly debate in any situation, especially on social media.

Excited delirium has been covered quite a bit, but like other hot topics it is always changing with new evidence.  Here are some of the key pearls and pitfalls to managing this high risk population.

The last 100 podcasts has been a major milestone.  Now that we are in the triple digits, it is worth reviewing some of the highlights from the first 100 episodes.  Also, we have a major announcement to share!

When you hear five of anything in regards to emergency medicine, you have to think of Ken Milne who is an evidence based medicine (EBM) guru in the field of emergency medicine (EM).  He hosts The Skeptics Guide to Emergency Medicine (The SGEM) and is a major advocate in cutting down the knowledge translation (KT) window down from over 10 years to less than one year.  In true celebratory fashion for the 100th podcast, Ken came on to discuss being a skeptic by reviewing five examples of when EM got ahead of the evidence.

The first time you see it, there can be any number of emotions.  On some patients, it looks like their chest is being caved in by a machine.  On other patients, it feels like a smooth and controlled aspect of an otherwise difficult resuscitation.  There are many opinions and stories about mechanical cardiopulmonary resuscitation (mCPR), but the evidence may surprise you and lead to the question: does it work?

​Mobile Stroke Units (MSUs) are ambulances that are designed to improve the time of delivery of stroke care to patients.  This sounds like an excellent idea at the surface, but is the cost and approach practical?

​Recently, the Surviving Sepsis Campaign (SSC) launched their 2018 update.  Although sepsis bundles have been brought up in the past, they are now pushing the limits by introducing a revised “hour-1 bundle” with the initiating time starting in triage.  Initially, this may not seem like a big deal, but there are significant implications.

Patients die.  It is a reality we all must face.  But what happens after you call the code?  This is when you may meet a death investigator such as Darren Dake.  He hosts the popular Coroner Talk website which has a weekly podcast.  After being invited to come onto his show, we wanted to share the conversation on our site to both help promote his work and to discuss some of the key points we can do to help facilitate a death investigation.

Fritz Fuller has been gone for a while but joins us for a discussion of lung ultrasound with its application specifically for pneumothorax.  This is probably something you have learned or at least heard of before, but rarely does an introductory course get into the details we are going to discuss in this post.

Our friendly evidence based medicine (EBM) PA guru, Adrian Banning, joins us again to talk about being a lifelong learner.  It is a "hot topic" for PAs and other medical providers, but what does it actually mean and how do we become a lifelong learner?  To help us with these questions and more, Adrian joins us for a detailed discussion.

Did you know that many of the aircraft that are being used in helicopter emergency medical services (HEMS) in the United States are not using advanced safety features that could help save the lives of crews and patients in an accident?  We are joined today by Karen Mahany who has taken it upon herself to make a real change when it comes to safety in HEMS.

​It is so tempting to want to share stories of the things we see, especially in emergency medicine.  Maybe we just want to tell the world about something strange, or maybe we are being more innocent and want feedback or to answer questions.  However, patient confidentiality is a major issue and in the United States specifically we run into the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

​It is so tempting to want to share stories of the things we see, especially in emergency medicine.  Maybe we just want to tell the world about something strange, or maybe we are being more innocent and want feedback or to answer questions.  However, patient confidentiality is a major issue and in the United States specifically we run into the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Our guest, Eric Steffel, is a paramedic that reached out wanting to discuss active exhalation.  It goes by many other names including "external chest compressions" or "lateral chest compressions" as some sources have indicated.  We decided not to use the term "compression" though because this can quickly lead to someone thinking this is a chest compression similar to what is performed in cardiopulmonary resuscitation (CPR).  Eric prefers "active exhalation" and (understanding its potential limitations) is what we use for this podcast to define this procedure.

​There is also some source of news out there that is contributing to misinformation.  As we have talked about before, misinformation is a daily presence but usually we can quickly fact check a source.  Most of these are from sources where the credibility is already questionable.  However, what happens when a major media source misrepresents information in a way that is potentially damaging to medicine and the patients we care for?

We have Tyler Christifulli from FOAMfrat back on to discuss two acronyms (we each developed one) for post-intubation agitation and sedation.  We also talk about the utility of acronyms in general.  As a fair warning, there is some explicit language in the podcast itself.  However, this is not only a great post but is entertaining and sure to help you better understand the topic.

Building off of our last post with Harrison Reed talking about communication, we are moving to a very similar and related topic this time talking about cognitive stop points with paramedic Tyler Christifulli.  He also has his own blog and podcast called FOAMfrat and one we have actually featured on our website.  Our next post will also have Tyler back discussing acronyms and how they tie in with these cognitive stop points so make sure to check that, as well.

Critical care PA Harrison Reed joins us to discuss communication in critical care resuscitation by breaking it down into phases along with talking about the pearls and pitfalls when it comes to these challenging situations.

​Fever can be scary.  It brings in many parents and even adults no matter the time of day.  However, there is a lot of misinformation regarding fevers which brings about this important discussion.  Using available evidence, we are going to talk about fevers and some of the main myths versus the actual evidence.  As always, with topics like these, it is worth remembering that this does not replace clinical judgment and is meant to be informational.  Any time there is concern, it should be appropriately evaluated and managed.

​Every time we transfer the care of a patient, we are performing in many ways a high risk maneuver.  It is so second nature to many that we do not think about the risks.  However, according to the Joint Commission up to 80% of serious preventable medical errors are attributed to poorly communicated handoffs.  It begs the question, how do we better transition the care of patients within the emergency department (ED).

We are medical professionals and we want to help our family and friends as much as we help our patients.  However, there is a real challenge to balance how you help a family member or friend when they have medical questions or concerns.  After all, most likely you are not their primary care provider (PCP).

​Most of us are having issues with using opiates in general given problems with misuse and abuse.  However, more recently we are experiencing significant shortages.  We discuss some key articles in recent literature (almost exclusively 2017) to help discuss alternatives to using opiates in pain control.

​We are no stranger to controversial subjects here at TOTAL EM, but one that already has a significant division in emergency medicine is the use of pelvic exams.  Most people fall into one of two camps: to do one, or not to do one in the event of vaginal bleeding.  The big factor in more recent medical history has been with the availability of ultrasound to supplement or fully replace the pelvic exam.  Michelle Perkins, who has co-authored some of our most well visited posts, joins us in this discussion.

​​Night shift can be rewarding and some of us choose to do it all the time.  There is little to no administration, the crew tends to be more relaxed (but obviously place variant), the cases can be a bit more interesting, the patients are very different from the daytime (both good and bad), and it can there are the small things that is hard to list but you can truly appreciate with time (watching meteor showers and shopping while the rest of the world is asleep) are only a few of the bonuses.  However, it also has its challenges and it is hard to get into the routine.  We discuss some tips from friends, other media, and research in this review.

​What do you do when the dead are awake?  It is confusing terminology, but patients may develop consciousness and be alert during cardiac arrest while receiving chest compressions.  In the literature, this is often reported as cardiopulmonary resuscitation induced consciousness (CPR-IC)  The phenomenon is overall rare but reports are increasing with time.  In this blog and podcast we talk about how to manage such patients.

Most of us working any length of time in emergency medicine are either familiar with or perform the (extended) Focused Assessment of Sonography in Trauma (eFAST).  Some keep with the original FAST exam which does not include the lungs, and we will talk more about why you want to include the lungs in a separate podcast.  However, after having just returned from 2018 AASPA Conference where we taught participants about many clinically important exams, there were some details of the eFAST that simply could not be covered simply due to time.  This podcast is devoted to providing some quick tips to improve your exam no matter your practice level.

Back in April 2017 we went to SEMPA 360 and we have been saving some pearls just for a reminder of what SEMPA can offer when it comes to a conference.  The long wait is over and to help support our SEMPA friends we have an interview of some quick pearls from expert Robert Dachs.

Dental pain is a common complaint in emergency medicine.  Often, it is seen as a non-emergent complaint and there is truth to that issue.  However, dental pain can be life threatening and has some key points we will discuss in this podcast.  The first step is to remember 3-2-1.

​2017 has been an intriguing year.  For the blog and podcast specifically, there have been many accomplishments.  Goals have been obtained faster than planned and we still are striving for even more success.  Today, we are talking about something that is not in medicine much but we see it elsewhere such as the military and firefighting: the after action review (AAR).  However, a traditional AAR can sometimes be difficult to perform at it takes a long time.  In critical events there is an abbreviated version known as the "hot offload" which is being promoted by some such as Ashley Liebig.  However, it is worth noting there are some key differences.

Working in emergency medicine is always a challenge, but when you work solo it can make you feel like a lone wolf.  In reality, there is always help somewhere.  New grad and EMPA Aaron Inouye is in a relatively unique scenario.  Not only does he work in the challenging environment of a single-coverage EM provider, he does so as a new graduate.  Listen to this interview no matter your career as you may find some fascinating pearls you were not expecting.

We are joined by a specialist in child abuse and neglect, Tom Balga, who is a fellow EMPA.  Child abuse and neglect is not a fun subject, but it is very important as we can truly change lives.  In this blog and podcast we cover some of the essentials that can be easily carried over to your next shift.

We hear plenty on the news about the opioid crisis, but we are hearing more and more about exposure to these opiates potentially harming first responders and even those in the emergency department.  It begs the question, how much is enough in regards to personal protective equipment (PPE)?

Risk management expert Kevin Klauer joins us today with some rapid fire documentation pearls.  We had a similar discussion focused on the MDM when we had Mike Weinstock on back in September.  Hopefully, we will have both experts (and others) back again in the future but this was a great talk focusing on some key pearls that we can all bring on the next shift.

​Practice makes permanent and only perfect practice makes perfect.  There have been recent conversations on "deliberate practice" which has hit FOAMed with Scott Weingart's interview of Anders Ericsson and subsequent posts.  This post is not going to delve in that topic, but rather how we should be teaching and training when it comes to procedures.

​There have been recent requests for further discussion of the neurological exam.  Specifically, how to do a brief neurological exam in the emergency department, how to perform a HINTS exam, and documenting the exams performed. 

We need to talk about something: misinformation.  Unfortunately, the world is full of it and we cannot seem to stop ourselves. The Internet was one of the greatest inventions brought forth to the modern world to allow for the rapid sharing of scientific information. We have bastardized it in time to now spread hate and grossly incorrect information. What was once a way to spread knowledge is now attacking science and what we have learned.

When we started last month's celebration of PAs for October, we discussed breaking bad news.  We were then going to expand on that discussion with reference to end of life discussions.  However, through some very unfortunate audio issues, we lost the original content in a way that made it so we could not present the original conversation.  However, Melodie Kolmetz was gracious enough to record it again on her own and we are presenting this for our newest post.

Technically, this is the last post for PA Month here on the podcast.  Fear not!  There will be more PAs on podcasts coming up.  However, we wanted to finish our discussion with Fred Wu since people may find this portion on contracts helpful in the immediate future.

Emergency Medicine PA Fred Wu is joining us to talk about starting and advancing a career in emergency medicine.  In this two-part series, Fred is reviewing the many aspects of emergency medicine careers from finding a position that will work well for you to signing a contract.

​We continue our month of celebrating PAs with a new podcast on a topic not well covered: triaging and assessment of the total joint arthroplasty (replacement) patient.  To help us, we have a special guest who is an orthopedic surgery PA named Amy Jean.

Our guest today (the first for PA month here on TOTAL EM) is Adrian Banning.  She is an Evidence Based Medicine (EBM) guru and is also on the JAAPA Podcast with a previous guest, Kris Maday.  Today though she is here to talk to us about breaking bad news.  Something most of us are experienced with but one thing few of us do well.  We combine EBM and "soft skills" to better care for our patients and families in this very difficult time.

PA Week is October 6-12 this year.  As PAs, we have a lot to be proud of in the 50 years of our existence but with our many advances, there still more we can do.  This month, we are hosting PAs for our podcasts.  However, to kick off the month, we are going to talk about the challenges that lay ahead.  It is worth noting though that much of it is now possible thanks to those who came before us.

Some of us do it well, some of us do not do it at all, but we all could use improvement.  The medical decision making (MDM) portion of the chart is one area we all can work on.  It is quite possibly the single most important portion of the chart for multiple reasons including acting as a "hard stop" in decision making, explaining course of care and management, reviewing highlights of the visit, and even potentially helping in a legal situation.  Today, we have Mike Weinstock joining us on this very important podcast.

We need to get better taking care of out patients.  One of the easiest ways to get better is to work both sides of the emergency medicine realm.  The main divide rests in the prehospital environment versus the emergency department.  We can still see this in the rural versus urban environment.  Our experiences in different realms can make us much better providers.

Today is a brief podcast about leaving the ivory tower.  As a PA or physician, we have to train at such a place but with time we will leave.  Not all nurses, paramedics, or others in such settings will ever see the "ivory tower" and may have their education only in rural environments or at least not at a tertiary care center.  The challenge for us becomes not only getting the medical knowledge, but also how to spread it.

​Today’s podcast is a little brief but covers and important topic: blood draws and patient’s rights.  This comes up due to a recent incident in Salt Lake City at University Hospital when a detective of the Salt Lake City Police Department arrested Alex Wubbels, a nurse there, when the officer attempted to collect blood for testing from an unconscious patient.

“Everyone has a plan until they get punched in the mouth.” – Mike Tyson Mental preparedness is not taught to us in emergency medicine or in healthcare generally, but it is something we are all doing to a degree.  However, we need to improve our abilities and expand on them to do our jobs better.  There are many approaches and everyone has their own style, but we will go over some approaches today to help improve your shifts and hopefully lead to you being a better clinician.​

Everyone talks about airway all the time, and I was at first reluctant to give this talk.  However, I believe it is time to talk about this important subject in a slightly different way.  The last time we talked about airway management in regards to intubation was with Kris Maday (from the PAINE Podcast) in Podcast #18 where we went over the basics (a great review to listen to first if needed).  There we talked mostly about rapid sequence intubation (RSI).  Although commonly used, this is not for every patient.  Today, we talk about RTI, which is what we need in most patients.

No matter what aspect of emergency medicine you work in (EMS, fast track, main ED, rural, remote, urban, suburban, or whatever else), you need to be a resuscitationist in my book.  This is entirely my opinion, but I believe it is important one worth your time in both reading and listening. ​Envision a busy night shift.  It is three in the morning and somehow you still have a waiting room full of people waiting to be seen in your small ED that is hours away by ground to tertiary care.  Scattered thunderstorms and overwhelmed emergency services have made it difficult to transfer out patients.  You would swear it was a full moon, but when you were outside just to get a quick breath of fresh air from all the chaos you look up and it is not.  Suddenly, you hear sirens in the distance and EMS reports are all coming in at once...

Tranexamic acid (TXA) is an old drug, but one that we in emergency medicine have found love for once again.  In preparation for an upcoming talk at a conference, I realized I had not yet made a post regarding TXA.  This is a quick summary of TXA and links to a lot of great #FOAMed resources out there you can also check out regarding the same.  I have also included one bit that I have recently found very successful but with little evidence currently.  Listen to the podcast for more!

After Podcast #44 regarding how to incorporate change, our friend Patrick Bafuma reached out to provide his thoughts on how to make change happen in your department.  He has championed the process and has pearls that are well worth the listen.

We are having a special episode to add to what we did with Salim Rezaie on REBEL Cast recently as a guest.  While we were there, we talked a lot about the TOAST trial and reviewed our own clinical use of dexamethasone.  It is definitely worth your time to visit his page and listen to that podcast.  However, we wanted to add our own little supplement to the #FOAMed world by adding a detailed analysis of the paper in true BEEM fashion.  Please check all of this out for a more thorough understanding of the topic.

We have talked about abscess management before both here (Podcast #13) and on the Skeptics' Guide to Emergency Medicine (Podcasts #156 and #164).   Even though we have talked about using antibiotics before, there has been debate on its use in smaller abscesses.  Today, we cover how antibiotics are still beneficial even for the small ones given the most recent evidence out there.  Listen to podcast and read this blog for all the details as we cover different points in each.

We are joined by Tyler Christifulli, a well experienced critical care paramedic and host of the Lifestar Podcast, to discuss a proposed ventilation strategy.  It is worth listening to his original podcast first to get a complete picture.  I would also recommend listening to Scott Weingart's Dominating the Vent lectures on his EmCrit website if you are not very familiar with ventilator management in general.  A warning in advance, there is some cursing in the podcast.

Happy Fourth of July!  Today we are joined by Evidence Based Medicine (EBM) rock star Ken Milne who is known for the Skeptics' Guide to Emergency Medicine (SGEM) blog and podcast.  He has been a major mentor to the TOTAL EM project and to celebrate our 50th podcast he agreed to join us for a detailed discussion on FOAMed and EBM.  Both SGEM and TOTAL EM are part of the Free and Open Access to Medical Education (FOAMed) movement.

Kevin Burns is back from our last podcast for another discussion, this time specifically on Point of Care Ultrasound (POCUS) and prehospital care.  He is assisting with some new research and we review how POCUS could be beneficial in the EMS.

Keving Burns is one of those PAs who is on the cutting edge of prehospital care.  He is the co-director of the Yale New Haven Hospital (YNHH) Emergency Medicine PA Residency program.  One of his favorite aspects of emergency medicine is prehospital care and we wanted to talk to him about some of the plans for the future of PAs in emergency medicine.

Clay Smith of EM Topics joins us today for a first-ever crossover post.  His amazingly well-done blog with daily posts on clinically important papers is a must to subscribe.  In today's post, we cover a review he is also publishing today regarding ramping in intubations.  In this RCT, there is no benefit in the primary outcome (lowest oxygen saturation) when comparing ramping versus sniffing position.  However, there is a lot more to the paper as discussed in this podcast.

Brian Lin is back for the second part of our conversation with him from the 2017 SEMPA 360 conference, but this time we are talking about two subjects with a lot of dogma: the Golden Period for wound closure and dog bite closure.  This brief review is designed to remind you of some of the key components in order to better care for your patients.

Brian Lin is an impressive physician with expert knowledge in wound management and care.  It was well worth the visit to talk to him in person about some of the more intricate parts of wound management.  At SEMPA 360 this year he gave so many pearls that there is no doubt he was a treasure to the conference.  If you could not make it this year or want a reminder of some of the key points, check out the notes and listen to the podcast.

​Medicine is slow to change, and using #FOAMed can be a challenge at times if you feel stuck and unable to speed up the process.  Today, we talk about some tips that could help you better move things along in your department and among colleagues.

​We have two previous guests today that are returning to talk about a familiar topic: sepsis.  There has been a lot of coverage recently but we want to cover it from a different angle by getting back to basics while including some of the key updates from recent literature and guidelines.  This recording was originally made for the Emergency Quality Network (E-QUAL) which is part of the American College of Emergency Physicians (ACEP).  It was our pleasure to work with ACEP to provide this content and we hope you enjoy it, as well.

Today we are covering a study on a medication not commonly used in the United States or most of the world: Shenfu.  It is not discussed much but does have implications as a potential cure for sepsis and has been used in China for the last two decades.  Given the recent discussions about cures for sepsis based on other studies, it seemed appropriate to talk about something with a growing body of evidence that most of the world may be ignoring without a good reason.

We have all been there before.  The consult that just does not go to plan.  Most of us first experience it as students and it can drive us mad.  Recently, while at the Podcasting Course in Lexington, Kentucky a fun and brief podcast was made covering the subject.  This was a group project and hopefully this will remind us to cover more content on "soft skills" such as consults and daily interactions.  Mainly, the things not covered in any sort of medical texts at least on a regular basis.

Major Jonathan Monti, PA-C is our first SEMPA 360 posting from the recent 2017 conference.  We were able to talk to a variety of people at the conference thanks to the staff there and we truly appreciate their help.  For the first time ever, SEMPA had what they call the "EMPA of the Year" award and this went to the very deserving Major Monti.  We had the exclusive chance to interview him immediately after the award and his thoughts are included here.

Rob Orman is back again for another fun week where we continue his "grab bag" interview.  I need to make a quick warning that there is some language in this podcast so if you are easily offended please be warned now.  However, language is very brief and minimal at best.  This interview was done in a lot of fun and we hope you find it entertaining, too.

We just came back from SEMPA 360 and it was a blast!  But today, we have a two part interview with Rob Orman.  The first half, today's discussion, is all about patient satisfaction.  Next week, we will further our "grab bag" discussion with some other interesting questions that others wanted to hear from Rob about, but all I can say is you do not want to miss the pearls from the interview so make sure to listen to both!

Acutely decompensated CHF can be a highly dangerous condition and one that needs immediate management.  Previous Resuscitation Leadership Academy (RLA) student Michelle Perkins comes on for her debut to discuss management of this condition.

This week's podcast is all about hypertension. Like a previous podcast, #13 on abscess management, this podcast is in response to a recent Skeptic's Guide to Emergency Medicine (SGEM) post that TOTAL EM was featured on. We want to add to that discussion by expanding on clinically important hypertension in the emergency department. This primer will most likely only be the start to future discussions on deeper reviews about hypertension that we need to be concerned about in emergencies.

We are back for our first ever trio podcast!  We have two previous PA guests, Patrick Bafuma and Frank Norman, to discuss a new paper regarding dyspnea and POCUS.  At this time, the paper has not received much publicity but we agreed it was important to cover.  Like our last podcast, this one is a bit longer but it is well worth your time so please look over the blog and listen to the podcast.  A quick apology though as to the audio quality, especially in the second half.  Due to a technical issue, it could not be refined to the same extent but it is still worth the listen.

Kris Maday is back for another podcast which is also available at the PAINE Podcast this time to discuss complications of chemotherapy.  We review some of the most common conditions that also possess a risk to be life threatening for those fighting cancer.  Since chemotherapy is designed to kill rogue cancer cells (some by sniper, some by nuke), there is bound to be collateral damage.  The detailed show notes provided are in large part from Kris Maday's review of the literature.

Reading the title you may be concerned that this interview is broken up into multiple parts but fear not for this is a new series we are starting!  Greg Schmor, a critical care paramedic in Canada is our first guest in a series of podcasts that we plan to have on Rural Mass Casualty Incidents (MCIs).  In any system, MCIs are a challenge but there are unique difficulties that are seen in the rural/remote environment or at least are exacerbated by such an environment.  This series can be of benefit for anyone who may become involved in MCIs but we focus especially on those in the rural and remote settings.

It may feel like we have been talking about a lot on imaging recently, but in emergency medicine, we do a lot of imaging!  More specifically, CTs are a cornerstone in the emergency department and contrast is frequently used.  However, there have been concerns about the use of contrast in higher risk populations which we have also discussed before.  In patients at higher risk, is prophylactic hydration beneficial?  We discuss that on today's podcast with a new randomized control trial.

We have Frank Norman back on the podcast to talk a little more about the Society of Physician Assistants in Clinical Ultrasound (SPACUS) but also to discuss integrating an ultrasound program into an already busy PA school curriculum or getting it into the work place.  Especially in rural or remote settings, this can be a significant challenge, but we cover it in today's podcast.

Frank Norman joins the podcast today to discuss the Society of Physician Assistants in Clinical Ultrasound (SPACUS) and point of care ultrasound (POCUS) competency.  The conversation also includes teasing out competency versus certification.  Listening to this podcast is great not only for those who are new to ultrasound but also for those with experience and looking to help out others interested in POCUS.

With Physician Assistants (PAs) starting to celebrate 50 years of the profession, there is still debate as to the quality of care provided by PAs. There have been studies on the topic, but very little in the field of emergency medicine and the paper we discuss today helps address this issue. Today with our guest Patrick Bafuma we tackle that very question along with a discussion of PAs in emergency medicine in general.

Contrast has been hotly debated in the radiology and emergency medicine world.  Many of these contrast medications have demonstrated safety and efficacy.  However, a deep dive has been sorely needed on this subject and with recent relevant papers over the last year this felt like the right time.  Joined by Dr. Paul Schunk, we explore the mysteries and evidence that exists for contrast safety in CTs for acute kidney injury and contrast induced nephropathy.

Soft collars are being supported more with a growing body of literature.  There is growing support for the change from semi-rigid (hard) collars to soft collars by a number of organizations, especially prehospital, in nations such as Australia.  After our initial primer podcast on this subject, we review some of the finer points to this debate on this podcast.  Details on the pros and cons are mentioned more extensively in the podcast itself so take a listen.

How have you taken ACLS?  Most of us will have taken a course in person but what if you are not able to do the course in person before your license expires?  Do you take an online course and if so which one?  In this podcast we review one option, HeartCode ACLS, and discuss the pros/cons of the course.  As always, there is nothing to disclose as any of the courses and organizations mentioned do not have any financial ties with this author.

To some, the rightful place for a rigid cervical collar is in a trash bin, but is it really that easy?  Parts of Australia seem to think so and have made a hard push in that direction.  To prepare us for the debate, this podcast is devoted to an introduction of the issue.  A primer if you will.  Minh Le Cong helps explain more in the podcast.

Dexamethasone is commonly used in the treatment of asthma exacerbations both in adults and children. It is growing popularity with new research that supports its role over traditional alternatives such as prednisone. One key difference is its longer lasting effect. However, this new paper demonstrates some potential limitations as discussed in this review.

Although a lot good and bad has happened around the world in 2016, this year marked the first year for TOTAL EM.  This project has been beneficial for many and continues to get very positive feedback.  The message continues though and this podcast talks about the past year along with the future of this podcast.

Fritz Fuller, PA-C is back for another great podcast this time for our inaugural Rural Rants which features a discussion on night shift as well as early adopters.  With Rural Rants we talk about the unconventional or at least approach it in a way that many do not want to talk about in your traditional academic setting.  Not only do we rant though, but we come up with ways to improve and develop solutions.

We have had many recent firsts on the podcast, and this is the first of two new concepts coming up with a new regular guest, Fritz Fuller.  Fritz is a PA practicing in emergency medicine.  He plans on coming on regularly for such discussions as these "Tales from the Holler" as well as "Rural Rants" which will be our next type of new podcast.  Until next week, enjoy this first episode of "Tales from the Holler."

Rule out criteria can be our biggest friends or our worst enemies depending on how we use them.  They are not perfect, but can save us from a lot of over-testing.  In this blog and podcast, we talk about the good and the bad along with how to use rule out criteria appropriately.

Anaphylaxis is a life-threatening condition.  It needs to be identified quickly and treated appropriately to save a patient's life.  Today marks our first ever "Patient and Provider" podcast.  This means that although the podcast itself is still meant to provide more of the basics, the blog will also be helping educate patients in the relevant condition.  Check both the blog and the podcast for all the details.

Sometimes we have to go back to the basics.  Airway management has its many advanced methods but with all the great FOAMed out there, very little of it covers the basic approach.  We wish to remedy this with guest Kris Maday, PA-C.  He is another PA with a podcast.  His is called the PAINE Podcast and can be easily found.

When a patient needs to be given to EMS for transfer to another facility, it is important to have a solid hand-off.  The last podcast was about the EMS to ED hand-off process and it was the most popular podcast to date.  With paramedic Geoff Horning the discussion continues with his thoughts about how EMS and ED can work together to make an even better transfer of care.  

When EMS brings a patient to the ED, there are many factors that can make that hand-off either good or bad.  It seems like no matter how hard each side tries, the message does not always carry over.  A lot of it comes down to not addressing the basics of EMS hand-offs to the emergency department.  Today, we will be covering how to make that hand-off better with our paramedic friend, Geoff Horning.

There was a lot of coverage for the original Vortex Approach and the revised version has also caught some attention. Others like Minh Le Cong have covered it and the British Journal of Anesthesia has the paper available for free (at this time). It is definitely worth going to the Vortex Approach website as well for details, especially regarding training.

The Vortex Approach is another game changer in airway management.  This podcast features Dr. Nicholas Chrimes reviewing this technique to manage the airway.  He also ties in some Star Trek in there (listen to the podcast to know who his favorite character is).

If you have worked in emergency medicine for any length of time, you have seen an abscess.  No, it's not a spider bite, it's almost always an abscess.  With abscess management, there are a number of approaches.  We are going to review a relatively evidence based approach to treating these pus filled pockets of joy.  Grab your eye protection and masks as this can get messy.

This is not your usual podcast.  To be fair, what has been the usual podcast with us?  We have gone over certain papers and a few interviews, but this is a young podcast.  It was important to give everyone an update on what is currently going on, and that is exactly what this podcast is all about.

We are back for the second half of our conversation with Jeff Jarvis.  If you missed the first half, go back and listen to Podcast #10 as it will make more sense.  We discussed his EMS system that only uses video laryngoscopy (VL) with intubation.  This is huge and unique with this group.  However, it was a process to find what was best for him and where he acts as a medical director. In this part of the conversation, we talk about the benefits of VL and how he chose the King Vision.  He also reviews some of the protocols in place for their management of intubations in some unique settings including getting the tall device into the mouth during certain situations such as during cardiac arrest and  patients with a soiled airway.

You read that right!  Dr. Jeff Jarvis is a medical director who only uses video laryngoscopy (VL) for the EMS agencies he acts as a medical director.  Not only that, but in his own practice in emergency medicine, he uses a VL system.   What is so great with VL that they ditched traditional direct laryngoscopy?  Well for that, you will need to listen to the show.  However, there are some key points discussed that we wanted to include in our show notes for our readers.

Have you heard of Jim DuCanto?  If not, then you missed our last podcast.  You can listen to either of them in any order, but since you are here, go ahead and listen to this one first.  However, we highly recommend that you go to Podcast #8 after that to see what our guest has been up to recently.  If you manage airways take a listen as it has some interesting findings.   In this podcast, Jim DuCanto tells us more about himself and answers questions from Twitter.  Go to totalem.org to read some of the highlights and to listen to the podcast.  Remember, we are now also on iTunes Podcasts for your listening pleasure.

You may not have heard of Jim DuCanto specifically, but you have probably heard about his SALAD (Suction Assisted Laryngoscopy Airway Decontamination technique. Click on the links that we have here if you have not heard of him or his technique including this one from Life in the Fast Lane. Don't worry, we will wait right here... Are you back now?  Does it make sense?  We will talk about it more soon.  However, we had a very unique conversation about something you most likely have not heard of yet.  On August 28, 2016 he completed an experiment regarding supraglottic airways.  The next day we interviewed him with this podcast being all about the experiment.  Go to totalem.org for some of the key points from our talk.  

After our talk with Minh Le Cong from the PHARM podcast, we decided it was appropriate to discuss the POKER Trial.  No, it is not about cards, but rather about if propofol mixed with ketamine is better than propofol alone. In addition to this podcast, there have been a few other blogs such as St. Emlyn's and REBEL EM that reviewed this study. At this time, we believe that this is the only podcast to create an audio discussion in detail on the subject (we may have missed someone and we apologize). For that reason, we wanted to make sure there was a way you could listen to a detailed analysis of this study soon as it is still a relatively recent publication.

The image above is the chemical structure of ketamine, and that is exactly what we are talking about today.  This is the second half of our conversation with Minh Le Cong who is best known for his involvement on Twitter with the FOAMED world and his PHARM podcast.  If you did not listen to the first half, please go back to Podcast #5 to listen to that portion.  Otherwise, get ready for the second half of this excellent conversation.    

Minh Le Cong is known worldwide especially on Twitter and his PHARM website.  On August 16, 2016 he agreed to get on Skype and discuss ketamine in detail with me.  Although we lost some of the original audio due to a mistake on my end, we still recorded approximately one hour's worth of audio.  Due to the length, we are breaking up the discussion into two separate podcasts.  The second one will come out next week.  So sit back, relax, and enjoy the conversation.  

Yes, that oh so common complaint that brings patients into the ER.   With acute back pain, everyone seems to have their own cocktail for treatment, but what has been shown to work?  In this reviewed of a trial in JAMA published October 20, 2015 we review a randomized control trial that looked into just this issue.

You have waited long enough!  It is time for some real information and that has come in the form of a paper I find very important.  The REACT-2 study was published online with The Lancet on June 28, 2016.  I started looking at it right away but did not get the chance to actually post about the topic until now.  Listen to the podcast, read the blog, but do not forget to read the original paper, too!

I realized in my last podcast that I really did not mention much about myself.  This second podcast includes details about myself and my background.  There is still much to tell but hopefully this will give you enough information for us to get started.  

It has finally happened!  We have our very first podcast up and running.  It is short and to the point with only some quick information as to the TOTAL EM project in podcast form.  Click below to learn more about what is mentioned in the podcast and to listen to the podcast itself.