Welcome to Episode 33 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 33 of “The 2 View” – Walking Boots, Jones Fracture: A Review, and a Few Procedures: Penile Foreign Body Removal and Keloid Removal. Walking Boots Infraorbital Nerve Block Courtesy of Jessica Mason MD. Dropbox. Accessed January 24, 2024. https://www.dropbox.com/scl/fi/r6ite1ior1wdcg63jcect/Infraorbital-Nerve-Block-Courtesy-of-Jessica-Mason-MD.mp4?rlkey=o5aiz60qmcvpqlnz2z62q8vkz&dl=0 Jones Fracture: A Review Jones J, Datir A. Jones fracture. In: Radiopaedia.org. Radiopaedia.org; 2008. Revised October 20, 2023. Accessed January 24, 2024. https://radiopaedia.org/articles/jones-fracture-1?lang=us Metzl JA, Bowers MW, Anderson RB. Fifth Metatarsal Jones Fractures: Diagnosis and Treatment. J Am Acad Orthop Surg. Published February 15, 2022. Accessed January 24, 2024. https://journals.lww.com/jaaos/Fulltext/2022/02150/FifthMetatarsalJonesFracturesDiagnosisand.6.aspx Michigan Foot Doctors. 5th Metatarsal Jones Fracture [Recovery, Treatment & Surgery]. YouTube. Published April 22, 2020. Accessed January 24, 2024. https://www.youtube.com/watch?v=8f0ECP1FtCc A Few Procedures: Penile Foreign Body Removal and Keloid Removal Memariani H, Memariani M, Moravvej H, Shahidi-Dadras M. Emerging and Novel Therapies for Keloids: A compendious review. Sultan Qaboos Univ Med J. NIH: National Library of Medicine, National Center for Biotechnology Information. Published February 2021. Accessed January 24, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7968901/ Roberts JR. Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care, 7th Edition; 2018. Accessed January 24, 2024. https://www.us.elsevierhealth.com/roberts-and-hedges-clinical-procedures-in-emergency-medicine-and-acute-care-9780323354783.html Roberts JR, Roberts M. The Curse of the Keloid. Emergency Medicine News. Published February 28, 2018. Accessed January 24, 2024. https://journals.lww.com/em-news/blog/theproceduralpause/pages/post.aspx?PostID=79 The Proceduralist. Foreign body in the shaft of the penis removal using dorsal nerve block. YouTube. Published January 11, 2024. Accessed January 24, 2024. https://www.youtube.com/watch?v=71PesnLDl-0 The Proceduralist. Keloid. YouTube. Published February 9, 2018. Accessed January 24, 2024. https://www.youtube.com/watch?v=wRBstgCULBc Weech D, Ameer MA, Ashurst JV. Anatomy, Abdomen and Pelvis, Penis Dorsal Nerve. StatPearls Publishing. NIH: National Library of Medicine, National Center for Biotechnology Information. Updated August 8, 2023. Accessed January 24, 2024. https://www.ncbi.nlm.nih.gov/books/NBK525966/ Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Welcome to Episode 32 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 32 of “The 2 View” – EMTALA, provider-in-triage positions, head injuries, appendicitis EMTALA / Head Injuries / Provider In Triage Latner A. Man Escorted Out of Hospital Without Being Seen: Is This an EMTALA Violation? Clinicaladvisor.com. Published April 11, 2023. Accessed January 21, 2024. https://www.clinicaladvisor.com/home/my-practice/legal-advisor/man-escorted-out-of-hospital-emtala-violation/ Centers for Medicare and Medicaid Services. Emergency Medical Treatment & Labor Act (EMTALA). Cms.gov. Accessed January 21, 2024. https://www.cms.gov/medicare/regulations-guidance/legislation/emergency-medical-treatment-labor-act MDCalc. Canadian CT Head Injury/Trauma Rule. Mdcalc.com. Accessed January 21, 2024. https://www.mdcalc.com/calc/608/canadian-ct-head-injury-trauma-rule Appendicitis Latner A. PA and NP Fail to Diagnose Appendicitis. Clinicaladvisor.com. Published December 6, 2023. Accessed January 21, 2024. https://www.clinicaladvisor.com/home/my-practice/legal-advisor/pa-np-fail-appendicitis/ Roberts M, Sharma M. 29 - Toxoplasmosis, the OPAL trial, medical marijuana, appendicitis, and colchicine. The 2 View: EM PA & NP Podcast. Published November 20, 2023. Published October 13, 2023. Accessed January 21, 2024. https://2view.fireside.fm/29 Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Questions: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Dengue CDC. Clinical assessment. Centers for Disease Control and Prevention. Cdc.gov. https://www.cdc.gov/dengue/training/cme/ccm/page73112.html CDC. Dengue. Centers for Disease Control and Prevention. Published August 15, 2023. https://www.cdc.gov/dengue/index.html Rigby J. First Pill for Dengue Shows Promise in Human Challenge Trial. Medscape: Emergency Medicine. Published October 23, 2023. https://www.medscape.com/s/viewarticle/997558?ecd=wnlscitech231101MSCPEDIT_etid6007373&uac=255848DR&impID=6007373 Schnirring L. California confirms 2nd local dengue case. Center for infectious disease research and policy. University of Minnesota. Umn.edu. Published November 2, 2023. https://www.cidrap.umn.edu/dengue/california-confirms-2nd-local-dengue-case Penis Pain Lizza E. Peyronie Disease. Medscape.com. Published August 17, 2023. https://emedicine.medscape.com/article/456574-overview Malloy M, Sinert R. Dysuria and Discharge After a New Sexual Partner. Medscape. Published November 20, 2023. https://reference.medscape.com/viewarticle/847159 Promethazine 2018-2019 Targeted Medication Safety Best Practices for Hospitals. Ismp.org. https://www.ismp.org/sites/default/files/attachments/2019-01/TMSBP-for-Hospitalsv2.pdf Drug Shortage Detail: Promethazine Injection. Ashp.org. Updated November 21, 2023. https://www.ashp.org/drug-shortages/current-shortages/drug-shortage-detail.aspx?id=872 Fass O. Antiemetics and QT prolongation. Clinicalcorrelations.org. Published January 15, 2021. https://www.clinicalcorrelations.org/2021/01/15/antiemetics-and-qt-prolongation/ Ozempic Korte C. Ozempic side effects could lead to hospitalization — and doctors warn that long-term impacts remain unknown. CBS News. Published June 10, 2023. https://www.cbsnews.com/news/ozempic-side-effects-weight-loss-drugs-wegovy-mounjaro-doctors-warn/ Krishnan L, Dhatariya K, Gerontitis D. No clinical harm from a massive exenatide overdose – a short report. Clin Toxicol (Phila). Clinical Toxicology. Published December 11, 2012. https://www.tandfonline.com/doi/pdf/10.3109/15563650.2012.752495 MedWatch: The FDA Safety Information and Adverse Event Reporting Program. FDA: U.S. Food and Drug Administration. Published September 15, 2022. https://www.fda.gov/medwatch Nakanishi R, Hirose T, Tamura Y, et.al. Attempted suicide with liraglutide overdose did not induce hypoglycemia. Diabetes Research and Clinical Practice. Diabetesresearchclinicalpractice.com. Published November 12, 2012. https://www.diabetesresearchclinicalpractice.com/article/S0168-8227(12)00384-1/fulltext Ozempic® (semaglutide) injection for Type 2 Diabetes. Ozempic.com. https://www.ozempic.com/ Hearing Loss Ahmed OH, Gallant SC, Ruiz R, Wang B, Shapiro WH, Voigt EP. Validity of the Hum Test, a Simple and Reliable Alternative to the Weber Test. Ann Otol Rhinol Laryngol. NIH: National Library of Medicine: National Center for Biotechnology Information. Published June 2018. https://pubmed.ncbi.nlm.nih.gov/29776326/#:~:text=Results%3A%20When%20examining%20the%20ability,respectively%2C%20with%20low%20pitched%20humming. Clinical Practice Guideline: Sudden Hearing Loss (Update). American Academy of Otolaryngology – Head and Neck Surgery. Entnet.org. https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/sudden-hearing-loss-update/ Hearing loss in adults: assessment and management. National Guideline Centre (UK). Immediate, Urgent and Routine Referral. National Institute for Health and Care Excellence; 2018. NIH: National Library of Medicine: National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK536553/#:~:text=If%20the%20hearing%20loss%20developed,service%20or%20an%20emergency%20department. Mroz M. Do you know the three main types of hearing loss? Healthy Hearing. Published April 17, 2014. https://www.healthyhearing.com/help/hearing-loss/types Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. thesgem.com. http://www.thesgem.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Welcome to Episode 30 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 30 of “The 2 View” – oral phenylephrine, visual diagnosis plans, and NSVT. Oral Phenylephrine Myers Z. FDA panel: Many oral allergy meds don’t work. WTTV CBS4Indy. Published October 15, 2023. Accessed October 17, 2023. https://cbs4indy.com/news/fda-panel-many-oral-allergy-meds-dont-work/ Neurosyphilis Review Hamill MM, Ghanem KG, Tuddenham S. State of the art review: neurosyphilis. Clin Infect Dis. Published August 18, 2023. Accessed November 1, 2023. doi: 10.1093/cid/ciad437 Visual Diagnosis - Behcet’s Disease Behcet’s Disease. Vasculitis Foundation. Published July 18, 2012. Accessed October 17, 2023. https://www.vasculitisfoundation.org/education/behcets-disease/ ACEP Clinical Policy on Ischemic Stroke Clinical Policies – Acute Ischemic Stroke. ACEP. Published May 2023. Accessed November 2, 2023. https://www.acep.org/patient-care/clinical-policies/acute-ischemic-stroke The VAN Assessment to Identify Large Vessel Occlusion Strokes. Core EM. Published May 17, 2018. Accessed November 2, 2023. https://coreem.net/journal-reviews/the-van-assessment/ Los Angeles Motor Scale (LAMS). MDCalc. Accessed November 2, 2023. https://www.mdcalc.com/calc/3959/los-angeles-motor-scale-lams Rapid Arterial oCclusion Evaluation (RACE) Scale for Stroke. MDCalc. Accessed November 2, 2023. https://www.mdcalc.com/calc/3941/rapid-arterial-occlusion-evaluation-race-scale-stroke NSVT: Non-Sustained Ventricular Tachycardia Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. Published August 1, 2018. Accessed October 17, 2023. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000549 Farzam K, Tivakaran VS. QT Prolonging Drugs. StatPearls Publishing; 2023. Accessed October 17, 2023. https://www.ncbi.nlm.nih.gov/books/NBK534864/ Foth C, Gangwani MK, Ahmed I, Alvey H. Ventricular Tachycardia. StatPearls Publishing; 2023. Accessed October 17, 2023. https://www.ncbi.nlm.nih.gov/books/NBK532954/ Ep 1 Lady G and Courage Under Fire. Burnt. Published January 27, 2021. Accessed November 2, 2023. https://podcasts.apple.com/us/podcast/ep-1-lady-g-and-courage-under-fire/id1551194920?i=1000506903956 Glaucomflecken. Will and Kristin’s Cardiac Arrest Story with Paramedic Lieutenant Aaron Gregg. Published August 22, 2023. Accessed October 17, 2023. https://www.youtube.com/watch?v=CQtYoKPNsrM Laslett DB, Cooper JM, Greenberg RM, et al. Electrolyte Abnormalities in Patients Presenting With Ventricular Arrhythmia (from the LYTE-VT Study). Am J Cardiol. PubMed. NIH: National Library of Medicine: National Center for Biotechnology Information. Published August 15, 2020. Accessed October 17, 2023. https://pubmed.ncbi.nlm.nih.gov/32565090/ Nonsustained ventricular tachycardias. Bmj.com. BMJ Best Practice. Accessed October 25, 2023. https://bestpractice.bmj.com/topics/en-us/831 PVCs and Nonsustained VT: When to Worry? How to Treat? - Penn Physician VideoLink.; 2015. Published January 7, 2015. Accessed October 17, 2023. https://videolink.pennmedicine.org/videos/pvcs-and-nonsustained-vt-when-to-worry-how-to-treat TualatinValleyFire. Dr. Will Flanary - Cardiac Arrest Survivor. Published February 16, 2021. Accessed October 17, 2023. https://www.youtube.com/watch?v=wu9uAwnSrJU Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Show Notes for Episode 29 of “The 2 View” – Toxoplasmosis, the OPAL trial, medical marijuana, appendicitis, and colchicine. CDC - Toxoplasmosis CDC – Parasites – Toxoplasmosis (Toxoplasma infection). Cdc.gov. Published June 9, 2023. Accessed September 26, 2023. https://www.cdc.gov/parasites/toxoplasmosis/index.html OPAL RCT for Opioids in Back Pain Jones C, O’Day R, Koes B, et. al. Opioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomised placebo-controlled trial. The Lancet. Thelancet.com. Published July 22, 2023. Accessed September 26, 2023. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00404-X/fulltext Sikina M, Kiel J. Re-evaluating Red Flags for Back Pain. Acep.org. Sports Med. Published August 17, 2022. Accessed September 26, 2023. https://www.acep.org/sportsmedicine/newsroom/newsroom-articles/august2022/re-evaluating-red-flags-for-back-pain Medical Marijuana Brooks M. Is Medical Cannabis the Answer to the Opioid Crisis? Medscape Emergency Medicine. Published October 3, 2022. Accessed September 26, 2023. https://www.medscape.com/viewarticle/981767?ecd=wnlinfocu4broadbroadpersoexpansion-editorial_20230603&uac=106964SV&impID=5490911 Novak S. Physicians Aren’t Asking Enough Questions About Cannabis Use. Medscape Emergency Medicine. Published August 29, 2023. Accessed September 26, 2023. https://www.medscape.com/viewarticle/995954?ecd=WNLtrdalrtpos1230904etid5820671&uac=106964SV&impID=5820671 Appendicitis Appendicitis. Acep.org. Accessed September 26, 2023. https://www.acep.org/patient-care/clinical-policies/appendicitis Dora-Laskey A. Acute pain control. EM. Accessed September 26, 2023. https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m3-curriculum/group-acute-pain-control/acute-pain-control Hidayat AI, Purnawan I, Mulyaningrat W, et al. Effect of Combining Dhikr and Prayer Therapy on Pain and Vital Signs in Appendectomy Patients: A Quasi-Experimental Study. NIH: National Library of Medicine. J Holist Nurs. Accessed September 26, 2023. https://pubmed.ncbi.nlm.nih.gov/37277995/ Smink D, Soybel D. Management of acute appendicitis in adults. UpToDate. Uptodate.com. Updated February 15, 2023. Accessed September 26, 2023. https://www.uptodate.com/contents/management-of-acute-appendicitis-in-adults Colchicine Chiabrando JG, Bonaventura A, Vecchié A, et al. Management of Acute and Recurrent Pericarditis: JACC State-of-the-Art Review. J Am Coll Cardiol. ScienceDirect. Published January 2020. Accessed September 26, 2023. https://www.sciencedirect.com/science/article/pii/S0735109719384840?via%3Dihub Gout clinical practice guidelines. American College of Rheumatology. Rheumatology.org. Accessed September 26, 2023. https://rheumatology.org/gout-guideline Telmesani A, Moss E, Chetrit M. The Use of Colchicine in Pericardial Diseases. American College of Cardiology. Published December 5, 2019. Accessed September 26, 2023. https://www.acc.org/Latest-in-Cardiology/Articles/2019/12/04/08/22/The-Use-of-Colchicine-in-Pericardial-Diseases Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Show Notes for Episode 28 of “The 2 View” – Live from Vegas, Fungal Meningitis Outbreak, NPs Sue for "Doctor" Title, Guest Chip Lange. When Medical Tourism Goes Wrong CDC. Fungal Meningitis Outbreak Social Media Toolkit. Centers for Disease Control and Prevention. Published July 18, 2023. Accessed July 25, 2023. https://www.cdc.gov/fungal/infections/HAI-fungal-meningitis-toolkit.html Evaluating and Treating Patients for Fungal Meningitis. For both symptomatic and asymptomatic patients: perform lumbar puncture (LP) to evaluate CSF for fungal meningitis* Abnormal LP results Normal initial LP results Counsel patient to monitor for symptoms for 30 days following initial LP Consider scheduling repeat LP two weeks after initial LP Normal repeat LP results. Funguseducationhub.org. Accessed July 25, 2023. https://funguseducationhub.org/wp-content/uploads/2023/06/FM-algorithm_edited.pdf Fungal Meningitis Outbreak Associated with Procedures Performed under Epidural Anesthesia in Matamoros, Mexico. Cdc.gov. Published August 11, 2023. Accessed July 25, 2023. https://www.cdc.gov/hai/outbreaks/meningitis-epidural-anesthesia.html PA Title Change / Nurse Practitioners Sue California to use the Title “Doctor.” Taylor M. Nurse practitioners sue California over restricted use of “doctor.” Beckershospitalreview.com. Published July 18, 2023. Accessed July 25, 2023. https://www.beckershospitalreview.com/hospital-physician-relationships/nurse-practitioners-sue-california-over-restricted-use-of-doctor.html Title Change Rationale. Aapa.org. Accessed July 25, 2023. https://www.aapa.org/title-change/general-faqs/ Malaria Contracted in the US Bendix A, Alexander B. New malaria case in Florida brings national total to 8, the first U.S. acquired cases in 20 years. NBC News. Published July 18, 2023. Accessed July 25, 2023. https://www.nbcnews.com/health/health-news/new-malaria-case-florida-brings-national-total-8-first-us-cases-20-yea-rcna94899 Locally Acquired Malaria Cases Identified in the United States. Health Alert Network (HAN) - 00494. Cdc.gov. Published June 26, 2023. Accessed July 25, 2023. https://emergency.cdc.gov/han/2023/han00494.asp Meat allergy. ACAAI Public Website. Published October 30, 2020. Accessed July 25, 2023. https://acaai.org/allergies/allergic-conditions/food/meat/ Reliability of Fingerstick Glucometers Media H. Picking cherries leads to a case of pseudohyperglycemia. Clinical Advisor. Published December 12, 2016. Accessed July 25, 2023. https://www.clinicaladvisor.com/home/case-files/picking-cherries-leads-to-a-case-of-pseudohyperglycemia/ Olansky L, Kennedy L. Finger-stick Glucose Monitoring. Diabetes Care. Published April 2010. Accessed July 25, 2023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2845057/ Special Guest Chip Lange, PA-C, and His Story of Going into Myasthenia Crisis About us. PRACTICAL POCUS. Accessed July 25, 2023. https://www.practicalpocus.com/aboutus.html Cautionary Drugs. Drugs to avoid or use with caution in MG. Myasthenia.org. Accessed July 25, 2023. https://myasthenia.org/Portals/0/Cautionary%20Drugs.pdf Colton, K. Myasthenia Gravis. EM:RAP CorePendium. EM:RAP CorePendium. Updated December 2, 2022. Accessed July 25, 2023. https://www.emrap.org/corependium/chapter/recrDWsB2k1uYPL9U Libsyn, iTunes. Medical professionals. TOTAL EM. Accessed July 25, 2023. https://www.totalem.org/emergency-professionals Something Sweet Woodall AJ, McCrohan CR. Excitatory actions of propofol and ketamine in the snail Lymnaea stagnalis. Comp Biochem Physiol C. ScienceDirect. Comparative Biochemistry and Physiology Part C: Pharmacology, Toxicology and Endocrinology. Volume 127, Issue 3. Pages 297-305. Published December 2000. Accessed July 25, 2023. https://www.sciencedirect.com/science/article/abs/pii/S0742841300001559?via%3Dihub Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Show Notes for Episode 27 of “The 2 View” – Brain abscesses, torsion, and delirium. Brain Abscesses Accorsi EK, Hall M, Hersh AL, Shah SS, Schrag SJ, Cohen AL. Notes from the Field: Update on Pediatric Intracranial Infections - 19 States and the District of Columbia, January 2016-March 2023. MMWR Morb Mortal Wkly Rep. CDC, Centers for Disease Control and Prevention. https://www.cdc.gov/mmwr/volumes/72/wr/mm7222a5.htm Brook I. Clinical Case. Brain Abscess Clinical Presentation. Medscape.com. https://reference.medscape.com/article/212946-clinical Goodman B. Doctors watching for more cases after mysterious cluster of brain infections strikes kids in southern Nevada. CNN. CNN Health. https://www.cnn.com/2023/04/28/health/brain-abscess-cluster-nevada/index.html The Center for Medical Education. 23 - Dear Doctor, Skin Closures, and Wound Management. 2 View: Emergency Medicine PAs & NPs. https://2view.fireside.fm/23 What’s “ordinary negligence”? //Missed brain abscess//Special offer. Mad Mimi. Medical Malpractice Insights: Learning from Lawsuits. https://madmimi.com/s/3fc5711 Testicular Torsion Lukosiute-Urboniene A, Nekrosius D, Dekeryte I, Kilda A, Malcius D. Clinical risk factors for testicular torsion and a warning against falsely reassuring ultrasound scans: a 10-year single-centre experience. Emerg Med J. BMJ Journals. https://emj.bmj.com/content/40/2/134.info Mellick LB, Watters BC. The Torsed Testicle Traction Technique and 2 Case Reports. Pediatr Emerg Care. https://journals.lww.com/pec-online/Citation/2023/05000/TheTorsedTesticleTractionTechniqueand2_Case.14.aspx Sessions AE, Rabinowitz R, Hulbert WC, Goldstein MM, Mevorach RA. Testicular torsion: direction, degree, duration and disinformation. J Urol. PubMed. NIH: National Library of Medicine. National Center for Biotechnology Information. https://pubmed.ncbi.nlm.nih.gov/12544339/ Ovarian Torsion Long B, Koyfman A, Gottlieb M. Dispelling 5 Ovarian Torsion Myths. ACEP Now. https://www.acepnow.com/article/dispelling-5-ovarian-torsion-myths/ Ovarian Torsion. Acep.org. ACEP Emergency Ultrasound Section. https://www.acep.org/emultrasound/newsroom/sept2020/ovarian-torsion Spinelli C, Piscioneri J, Strambi S. Adnexal Torsion in Adolescents: Update and review of the literature. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/08/adnexal-torsion-in-adolescents Swenson DW, Lourenco AP, Beaudoin FL, Grand DJ, Killelea AG, McGregor AJ. Ovarian torsion: Case-control study comparing the sensitivity and specificity of ultrasonography and computed tomography for diagnosis in the emergency department. European Journal of Radiology. ScienceDirect. https://edus.ucsf.edu/sites/edus.ucsf.edu/files/wysiwyg/1-s2.0-S0720048X14000023-main.pdf Delirium ACEP’s Position on Hyperactive Delirium. American College of Emergency Physicians. https://www.acep.org/news/acep-newsroom-articles/aceps-position-on-hyperactive-delirium Hatten BW, Bonney C, Dunne RB, et al. ACEP Task Force Report on Hyperactive Delirium with Severe Agitation in Emergency Settings, Approved by the ACEP Board of Directors, June 23, 202. American College of Emergency Physicians. https://www.acep.org/siteassets/new-pdfs/education/acep-task-force-report-on-hyperactive-delirium-final.pdf Hayes BD, O’Brien M. Should Diphenhydramine be included in an Acute Agitation Regimen? AliEM: Academic Life in Emergency Meedicine. https://www.aliem.com/diphenhydramine-acute-agitation-regimen/ Psychiatric Patient. American College of Emergency Physicians. https://www.acep.org/patient-care/clinical-policies/Psychiatric-Patient Reuben. Emergency Department Agitated Patient Treatment Map. Emergency Medicine Updates. https://emupdates.com/danger/ Veraart JKE, Smith-Apeldoorn SY, Bakker IM, et al. Pharmacodynamic Interactions Between Ketamine and Psychiatric Medications Used in the Treatment of Depression: A Systematic Review. Int J Neuropsychopharmacol. Oxford Academic. https://academic.oup.com/ijnp/article/24/10/808/6309481?login=false Prescription Drug Monitoring Programs D’Souza RS, Lang M, Eldrige JS. Prescription Drug Monitoring Program. StatPearls Publishing. NIH: National Library of Medicine. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK532299/ Something Sweet Brito C. Bobi, the world’s oldest dog, turns 31 years old. CBS News. https://www.cbsnews.com/news/bobi-the-worlds-oldest-dog-turns-31-years-old/ Recurring Sources Center for Medical Education. http://ccme.org The Proceduralist. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com

Welcome to Episode 26 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 26 of “The 2 View” – Save time charting & code accurately, dementia, PE in pregnancy, and the PCN shortage. PCN Shortage Ault, A. FDA Drug Shortages. Current and Resolved Drug Shortages and Discontinuations Reported to FDA. FDA issues new rule on drug shortages. Community Oncology, 9(1), 34. U.S. Food & Drug. Published April 26, 2023. Accessed May 9, 2023. https://doi.org/10.1016/j.cmonc.2011.12.003 Bendix, A. Shortage of penicillin limits access to the go-to drug for syphilis. NBC News. Published April 27, 2023. Accessed May 9, 2023. https://www.nbcnews.com/health/health-news/shortage-penicillin-limits-access-go-drug-syphilis-rcna81777 Global shortages of penicillin. Shortages of benzathine penicillin. Global Sexually Transmitted Infections Programme. World Health Organization. Who.int. Accessed May 9, 2023. https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/stis/treatment/shortages-of-penicillin Dementia Alzheimer’s Disease Fact Sheet. Alzheimer’s Disease and Related Dementias: Basics of Alzheimer’s Disease and Dementia. National Institute on Aging. Accessed May 9, 2023. https://www.nia.nih.gov/health/alzheimers-disease-fact-sheet Home. Alzheimer’s Disease and Dementia. Alzheimer’s Association. Accessed May 9, 2023. https://www.alz.org/ Silbert, L, Erten-Lyons, D. Memory Loss, Confusion in a 51-Year-Old Fired From Her Job. Medscape. Published March 2, 2023. Accessed May 9, 2023. https://reference.medscape.com/viewarticle/850363 PE in Pregnancy Negaard M. YEARS Algorithm for pulmonary embolism (PE). MDCalc. Accessed May 9, 2023. https://www.mdcalc.com/calc/4067/years-algorithm-for-pulmonary-embolism-pe Stals MAM, Moumneh T, Ainle FN, et al. Noninvasive diagnostic work-up for suspected acute pulmonary embolism during pregnancy: a systematic review and meta-analysis of individual patient data. J Thromb Haemost. 2023;21(3):606-615. NIH: National Library of Medicine: National Center for Biotechnology Information. PubMed. Published December 22, 2022. Accessed May 9, 2023. https://pubmed.ncbi.nlm.nih.gov/36696189/ Thromboembolism in Pregnancy. ACOG: The American College of Obstetricians and Gynecologists. Acog.org. Practice Bulletin, Number 196. Published July 2018. Accessed May 9, 2023. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2018/07/thromboembolism-in-pregnancy Charting & Coding 2023 Emergency Department Evaluation and Management Guidelines. ACEP: American College of Emergency Physicians. Acep.org. Last Updated: October 2022. Accessed May 9, 2023. https://www.acep.org/administration/reimbursement/reimbursement-faqs/2023-ed-em-guidelines-faqs American Medical Association. 2023 Emergency Medicine Coding Guide. MDCalc. Accessed May 9, 2023. https://www.mdcalc.com/calc/10454/2023-emergency-medicine-coding-guide CPT Evaluation and Management (E/M) Code and Guideline Changes. AMA: American Medical Association. Ama-assn.org. Accessed May 9, 2023. https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf ICD-10-CM Coding for Social Determinants of Health. AHA: American Hospital Association – Advancing Health in America. Aha.org. Published January 2022. Accessed May 9, 2023. https://www.aha.org/system/files/2018-04/value-initiative-icd-10-code-social-determinants-of-health.pdf Level of MDM (based on 2 of 3 elements of MDM) number and complexity of problems addressed. ACEP: American College of Emergency Physicians – Advancing Emergency Care. ERCODER. Acep.org. Accessed May 9, 2023. https://www.acep.org/siteassets/sites/acep/media/reimbursement/acep---2023-ed-mdm-grid.pdf Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Welcome to Episode 25 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 25 of “The 2 View” Pediatric Nurse Practitioners Are Not Okay Della Volpe K. We Are Not Ok, Say Pediatric NPs. Clinical Advisor. Published March 17, 2023. Accessed March 27, 2023. https://www.clinicaladvisor.com/home/meeting-coverage/napnap-2023/pediatric-nps-not-ok/?utmsource=newsletter&utmmedium=email&utmcampaign=NWLTRCADCONFNAPNAPMODERNA032023RM&hmEmail=1f%2FJfEV7hN5vJr6vg%2FQRqK0NA6IXtyO3&sha256email=092493d8223fdfa40d9e995176d13e5fc5b5211674db9deb440c025fd462c80c&hmSubId=&NID=1639413404&elqTrackId=31abe541d69a4ca587368d18c07e2aeb&elq=24134fa5abd64addafddd14ad54e8f8d&elqaid=13088&elqat=1&elqCampaignId=10964&fbclid=IwAR2YZErTgA9ET7Yzib3bPYuhD68VDtGAayIfQ2bu398LBTX6xEmLjZX3EY Sarjoo A. Pediatricians: We Can’t Bear the Burden of Teen Angst. Medscape. Published March 13, 2023. Accessed March 27, 2023. https://www.medscape.com/viewarticle/989552 New TASER Bleetman A, Hepper AE, Sheridan RD. The use of TASER devices in UK policing: an update for clinicians following the recent introduction of the TASER 7. BMJ Journals. Emerg Med J. Published 2023. Accessed March 27, 2023. https://emj.bmj.com/content/40/2/147.long Taser Injuries. Emergency Central. Unboundmedicine.com. Accessed March 27, 2023. https://emergency.unboundmedicine.com/emergency/view/5-MinuteEmergencyConsult/307682/all/Taser_Injuries Vilke G, Chan T, Bozeman WP, Childers R. Emergency Department Evaluation After Conducted Energy Weapon Use: Review of the Literature for the Clinician. NIH National Library of Medicine: National Center for Biotechnology Information. PubMed. J Emerg Med. Published September 26, 2019. Accessed March 27, 2023. https://pubmed.ncbi.nlm.nih.gov/31500994/ Hyperacute T-Waves Dr. Smith’s ECG blog. Blogspot.com. Published March 2023. Accessed March 27, 2023. http://hqmeded-ecg.blogspot.com/search/label/hyperacute%20T-waves Koechlin L, Strebel I, Zimmermann T, et al. Hyperacute T Wave in the Early Diagnosis of Acute Myocardial Infarction. Ann Emerg Med. PubMed. NIH: National Library of Medicine. National Center for Biotechnology Information. Published online February 9, 2023. Accessed March 27, 2023. https://pubmed.ncbi.nlm.nih.gov/36774205/ Writing Committee, Kontos MC, de Lemos JA, et al. 2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. Published November 2022. Accessed March 27, 2023. https://www.jacc.org/doi/10.1016/j.jacc.2022.08.750 DEA Updates – Segment with Dr. Rick Bukata Criteria for Furnishing Number Utilization by Nurse Practitioners. State of California, DCA (Department of Consumer Affairs). Board of Registered Nursing. Rn.ca.gov. Accessed March 27, 2023. https://www.rn.ca.gov/pdfs/regulations/npr-i-16.pdf DEA Announces Proposed Rules for Permanent Telemedicine Flexibilities. Drug Enforcement Administration (DEA). Published February 24, 2023. Accessed March 27, 2023. https://www.dea.gov/press-releases/2023/02/24/dea-announces-proposed-rules-permanent-telemedicine-flexibilities Mid-Level Practitioners Authorization by State. US Department of Justice. Drug Enforcement Administration. Diversion Control Division. Usdoj.gov. Accessed March 27, 2023. https://www.deadiversion.usdoj.gov/drugreg/practioners/ Removal of DATA Waiver (X-Waiver) Requirement. SAMHSA. Substance Abuse and Mental Health Services Administration. Samhsa.gov. Last Updated January 25, 2023. Accessed March 27, 2023. https://www.samhsa.gov/medications-substance-use-disorders/removal-data-waiver-requirement Statutory Changes in Pharmacy Law. Pharmacy.ca.gov. Published December 9, 2022. Accessed March 27, 2023. https://www.pharmacy.ca.gov/lawsregs/newlaws.pdf Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Welcome to the 2 View - Episode 24 Welcome to Episode 24 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 24 of “The 2 View” – New street drug xylazine/"tranq," app for EM coding changes, FPL injuries, hemorrhoids. Molnupiravir Butler CC, Hobbs FDR, Gbinigie OA, et al. Molnupiravir plus usual care versus usual care alone as early treatment for adults with COVID-19 at increased risk of adverse outcomes (PANORAMIC): an open-label, platform-adaptive randomised controlled trial. Lancet. PubMed. NIH: National Library of Medicine, National Center for Biotechnology Information. Published January 28, 2023. Accessed February 21, 2023. https://pubmed.ncbi.nlm.nih.gov/36566761/ Molnupiravir. COVID-19 Treatment Guidelines. NIH. Last Updated: September 26, 2022. Accessed February 21, 2023. https://www.covid19treatmentguidelines.nih.gov/therapies/antivirals-including-antibody-products/molnupiravir/ Easy Emergency Medicine Coding Calculator American Medical Association. 2023 Emergency Medicine Coding Guide. MDCalc. Accessed February 21, 2023. https://www.mdcalc.com/calc/10454/2023-emergency-medicine-coding-guide CPT Evaluation and Management (E/M) Code and Guideline Changes. Ama-assn.org. AMA: American Medical Association. Accessed February 21, 2023. https://www.ama-assn.org/system/files/2023-e-m-descriptors-guidelines.pdf Graham. 2023 Emergency Medicine Level of Service/Billing Guidelines Overview. Published December 31, 2022. Accessed February 21, 2023. https://www.youtube.com/watch?v=WuV8O3SuXJI The Center for Medical Education. Documentation Changes that Can Help Your Practice. Published August 16, 2022. Accessed February 21, 2023. https://www.youtube.com/watch?v=gHLBjzQt4vo Xylazine DEA Joint Intelligence Report. The Growing Threat of Xylazine and its Mixture with Illicit Drugs. U.S. Department of Justice Drug Enforcement Administration. Dea.gov. Published October 2022. Accessed February 21, 2023. https://www.dea.gov/sites/default/files/2022-12/The%20Growing%20Threat%20of%20Xylazine%20and%20its%20Mixture%20with%20Illic it%20Drugs.pdf FDA warns about the risk of xylazine exposure in humans. Fda.gov. FDA. Published November 8, 2022. Accessed February 21, 2023. https://www.fda.gov/media/162981/download Hoffman J. Tranq dope: Animal Sedative Mixed with Fentanyl Brings Fresh Horror to U.S. Drug Zones. The New York Times. Published January 7, 2023. Accessed February 21, 2023. https://www.nytimes.com/2023/01/07/health/fentanyl-xylazine-drug.html. National Institute on Drug Abuse. Xylazine. National Institute on Drug Abuse: Advancing Addiction Science. Published April 21, 2022. Accessed February 21, 2023. https://nida.nih.gov/research-topics/xylazine Overdose C on O. Toxicity of Xylazine and How It Impacts People Who Use Drugs by Dr. Joseph D’Orazio. Published June 15, 2022. Accessed February 21, 2023. https://www.youtube.com/watch?v=Rqpf0jIuyCo Flexor Pollicis Longus and Other Thumb Injuries Gault D. A review of repaired flexor tendons. J Hand Surg Br. ScienceDirect. Published October 1987. Accessed February 21, 2023. https://www.sciencedirect.com/science/article/abs/pii/0266768187901811 Urbaniak JR. Repair of the flexor pollicis longus. Hand Clin. Europe PMC. Published February 1, 1985. Accessed February 21, 2023. https://europepmc.org/article/med/3912396 Hemorrhoids Procedure Review: Thrombosed Hemorrhoids. EM:RAP. EM:RAP.ORG. Published April 2018. Accessed February 21, 2023. https://www.emrap.org/episode/emrapliveapril/procedurereview Zuber TJ. Hemorrhoidectomy for Thrombosed External Hemorrhoids. Am Fam Physician. AAFP. Published 2002. Accessed February 21, 2023. https://www.aafp.org/pubs/afp/issues/2002/0415/p1629.html Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Welcome to Episode 23 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Links To Our Live Courses Original EM Boot Camp Course: https://courses.ccme.org/course/embootcamp Advanced EM Boot Camp Course: https://courses.ccme.org/course/advancedbootcamp Emergency Medicine & Acute Care Series Course: https://courses.ccme.org/course/ema Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Welcome to Episode 22 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Links To Our Live Courses Original EM Boot Camp Course: https://courses.ccme.org/course/embootcamp Advanced EM Boot Camp Course: https://courses.ccme.org/course/advancedbootcamp Emergency Medicine & Acute Care Series Course: https://courses.ccme.org/course/ema Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Welcome to Episode 21 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Links To Our Live Courses Advanced EM Boot Camp Course: https://courses.ccme.org/course/advancedbootcamp Original EM Boot Camp Course: https://courses.ccme.org/course/embootcamp Emergency Medicine & Acute Care Series Course: https://courses.ccme.org/course/ema Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Dr. James R. Roberts, MD, FACMT, FACEP, FAAEM, CMRO, accomplished physician, professor, leader in Emergency Medicine, previous Chairman at Mercy Catholic Medical Center Emergency Department in Philadelphia, Pennsylvania, and Vice Chairman of the Department of Emergency Medicine at Drexel University College of Medicine, beloved father, brother, friend, and husband, passed away Friday, July 22nd, 2022, in Folsom, California. He was 76. Jim was born February 9th, 1946, in Forty Fort, Pennsylvania, son of Jane and George Roberts. He is survived by his children, Martha and Matthew Roberts, his grandchildren Eleanor Cronin and Liam Roberts, his brother George Roberts, his sister Mary Peterlin, nieces, nephews, family-in-law, and his partner Lydia Forte Roberts, to whom he was married for over 40 years. Jim graduated from Lafayette College, and studied medicine at Thomas Jefferson University. He completed his internship at Highland General Hospital in Oakland, California, with residencies at The Medical College of Pennsylvania, and was a McNeil Scholar at Bellevue Hospital in New York City. Jim was a trailblazer in the field of Emergency Medicine, and was one of the first board-certified Emergency Medicine physicians in the world. He taught thousands of students via ED residency programs he built and led. He was a board-certified Toxicologist and worked with Philadelphia Poison Control Center for several decades. Jim was a medical expert witness and published a robust library of work. He was broadly recognized for his clinical practice, research, writing, and teaching. Jim was Chairman of the editorial board for Emergency Medicine News magazine (Wolters Kluwer) for almost 40 years. Jim's widely-read textbook, "Clinical Procedures in Emergency Medicine and Acute Care" (Elsevier) had seven editions. Jim loved the outdoors, especially boating, fishing, and exploring his favorite waters off the Florida Keys. A memorial for Jim will be held this Fall, 2022. In lieu of flowers, please send donations to Project Home (https://www.projecthome.org/).

Welcome to Episode 19 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 19 of “The 2 View” – All things EM Boot Camp Course Links To Our Live Courses Advanced EM Boot Camp Course: https://courses.ccme.org/course/advancedbootcamp Original EM Boot Camp Course: https://courses.ccme.org/course/embootcamp Emergency Medicine & Acute Care Series Course: https://courses.ccme.org/course/ema Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Welcome to Episode 18 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 18 of “The 2 View” – Acute Infectious Conjunctivitis, Post-Traumatic Patients in the ER: Treatment of the Sexual Assault Survivor, Cops in the ED, and a Very Special Interview. Acute Infectious Conjunctivitis Review & Meta-Analysis Fox SM. Conjunctivitis and Conjunctivitis-Otitis Syndrome. Pediatric EM Morsels. Published February 17, 2012. Accessed June 23, 2022. https://pedemmorsels.com/conjunctivitis-and-conjunctivitis-otitis-syndrome/ Johnson D, Liu D, Simel D. Does This Patient with Acute Infectious Conjunctivitis Have a Bacterial Infection?: The Rational Clinical Examination Systematic Review. The Rational Clinical Examination. JAMA Network. Published June 14, 2022. Accessed June 23, 2022. https://jamanetwork.com/journals/jama/article-abstract/2793248 Prescription prices, coupons & pharmacy information. GoodRx. Accessed June 23, 2022. http://www.goodrx.com Sheikh A, Hurwitz B, van Schayck CP, McLean S, Nurmatov U. Antibiotics versus placebo for acute bacterial conjunctivitis. Cochrane Database Syst Rev. Cochrane Library. Published September 12, 2012. Accessed June 23, 2022. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001211.pub3/full Post-Traumatic Patients in the ER: Treatment of the Sexual Assault Survivor Post-Exposure Prophylaxis (PEP). Cdc.gov. Centers for Disease Control and Prevention. Published March 28, 2022. Accessed June 23, 2022. https://www.cdc.gov/hiv/risk/pep/index.html Preventing New HIV infections. Cdc.gov. Centers for Disease Control and Prevention. Published March 29, 2022. Accessed June 23, 2022. https://www.cdc.gov/hiv/guidelines/preventing.html Sexual Assault and Abuse and STIs – Adolescents and Adults – STI Treatment Guidelines. Sexually Transmitted Infections Treatment Guidelines, 2021. Cdc.gov. Centers for Disease Control and Prevention. Published July 14, 2021. Accessed June 23, 2022. https://www.cdc.gov/std/treatment-guidelines/sexual-assault-adults.htm Alcohol and Drug Testing of the Patient in Police Custody Supreme Court Ruling Provides Clarity on Law Enforcement-Requested Blood Draws. Reliasmedia.com. Published January 1, 2020. Accessed June 23, 2022. https://www.reliasmedia.com/articles/145471-supreme-court-ruling-provides-clarity-on-law-enforcement-requested-blood-draws Tessier W, Keegan W. Mandatory Blood Testing: When can police compel a health provider to draw a patient’s blood to determine blood levels of alcohol or other intoxicants? Mo Med. PMC PubMed Central. NIH: National Library of Medicine, National Center for Biotechnology Information. Published Jul-Aug 2019. Accessed June 23, 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699816/ Risk Management Monthly featuring W. Richard Bukata MD, Greg Henry MD, and Rachel Lindor MD, JD The Center for Medical Education. Physician Separation Agreements, Lawsuit from Starting IV line, and More | Risk Management Monthly. Published June 7, 2022. Accessed June 23, 2022. https://www.youtube.com/watch?v=6D24mJ5aJ_Y&list=PLlgl86ABpNQweXlLL8sNT19oixAoaTS46 Jim Roberts MD in Emergency Medicine News Roberts J. Looking Back on a Career in Emergency Medicine. InFocus. Emergency Medicine News. Lww.com. Published June 2022. Accessed June 23, 2022. https://journals.lww.com/em-news/fulltext/2022/06000/infocus_lookingbackonacareerin_emergency.8.aspx Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Welcome to Episode 17 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 17 of “The 2 View” – Monkeypox, A Typical NP/PA Day in the ER: Tips from the Heart, Timesavers, and Anaphylaxis. Monkeypox Lewis D. How PAs Can Avoid Malpractice: Go Back to Practice Basics. Medscape. Published May 23, 2022. Accessed May 30, 2022. https://www.medscape.com/viewarticle/974472 Monkeypox in Multiple Countries - Alert - Level 2, Practice Enhanced Precautions - Travel Health Notices. Centers for Disease Control and Prevention. Travelers’ Health. Cdc.gov. Accessed May 30, 2022. https://wwwnc.cdc.gov/travel/notices/alert/monkeypox Monkeypox: public health advice for gay, bisexual and other men who have sex with men. World Health Organization. Who.int. Published May 25, 2022. Accessed May 30, 2022. https://www.who.int/news/item/25-05-2022-monkeypox--public-health-advice-for-gay--bisexual-and-other-men-who-have-sex-with-men Monkeypox Virus Infection in the United States and Other Non-endemic Countries – 2022. Centers for Disease Control and Prevention. HAN archive - 00466. Cdc.gov. Published May 20, 2022. Accessed May 30, 2022. https://emergency.cdc.gov/han/2022/han00466.asp Morgenstern J. Monkeypox. First10EM. Published May 19, 2022. Accessed May 30, 2022. https://first10em.com/monkeypox/ Rezaie S. Monkeypox…the basics. REBEL EM - Emergency Medicine Blog. Published May 26, 2022. Accessed May 30, 2022. https://rebelem.com/monkeypoxthe-basics/ Top Three Timesavers Heckerling PS, Tape TG, Wigton RS, et al. Clinical prediction rule for pulmonary infiltrates. Ann Intern Med. NIH National Library of Medicine: National Center for Biotechnology Information. PubMed.gov. Published November 1, 1990. Accessed May 30, 2022. https://pubmed.ncbi.nlm.nih.gov/2221647/ Mellick L. Ten Ways to Reduce a Dislocated Shoulder. Published August 13, 2015. Accessed May 30, 2022. https://www.youtube.com/watch?v=HtOnreM7heg Mellick L. The Davos Method of Shoulder Dislocation Reduction. Published May 2, 2016. Accessed May 30, 2022. https://www.youtube.com/watch?v=u2MsnjVNoPM UofSC Athletic Training. Spaso Technique for Glenohumeral Joint Reduction. Published October 11, 2020. Accessed May 30, 2022. https://www.youtube.com/watch?v=ei5Z62Whs1I Anaphylaxis? Roberts M, Sharma M. The 2 View. The Center for Medical Education. 14 - Urticaria, Foreign Bodies, and a Special Interview. 2 View: Emergency Medicine PAs & NPs. Published February 27, 2022. Accessed May 30, 2022. https://2view.fireside.fm/14 Tang AW. A Practical Guide to Anaphylaxis. Am Fam Physician. Published October 1, 2003. Accessed May 30, 2022. https://www.aafp.org/pubs/afp/issues/2003/1001/p1325.html Something Sweet Shoutouts to: Dr. Brendon Carmondy, who is the Assistant Director of the Emergency Department at Suburban Hospital in Maryland, and his entire team. Sierra Campus of the Hospitals of Providence in El Paso, TX, especially Dr. Madhu Achalla. Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Welcome to Episode 16 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 16 of “The 2 View” – SAH: revisited, pediatric hepatitis outbreak, medical errors, and AHA/ACC heart failure guidelines. SAH - Revisited Headache. American College of Emergency Physicians. Acep.org. Published June 2019. Accessed April 27, 2022. https://www.acep.org/patient-care/clinical-policies/headache/ Ibrahim YA, Mironov O, Deif A, Mangla R, Almast J. Idiopathic Intracranial Hypertension: Diagnostic Accuracy of the Transverse Dural Venous Sinus Attenuation on CT scans. Neuroradiol J. PubMed Central. National Library of Medicine: National Center for Biotechnology Information. Published December 2014. Accessed April 27, 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4291803/ Spadaro A, Scott KR, Koyfman A, Long B. Reversible cerebral vasoconstriction syndrome: A narrative review for emergency clinicians. Am J Emerg Med. PubMed.gov. National Library of Medicine: National Center for Biotechnology Information. Published October 4, 2021. Accessed April 27, 2022. https://pubmed.ncbi.nlm.nih.gov/34879501/ Pediatric Hepatitis Outbreak Jetelina K. Severe hepatitis outbreak among children. Your Local Epidemiologist. Published April 26, 2022. Accessed April 27, 2022. https://yourlocalepidemiologist.substack.com/p/severe-hepatitis-outbreak-among-children Multi-Country – Acute, severe hepatitis of unknown origin in children. Who.int. Published April 23, 2022. Accessed April 27, 2022. https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON376 Recommendations for Adenovirus Testing and Reporting of Children with Acute Hepatitis of Unknown Etiology. HAN archive - 00462. Cdc.gov. Published April 21, 2022. Accessed April 27, 2022. https://emergency.cdc.gov/han/2022/han00462.asp Medical Errors Dihydroergotamine (DHE) for Migraine Treatment. American Migraine Foundation. Published January 28, 2021. Accessed April 27, 2022. https://americanmigrainefoundation.org/resource-library/dhe-for-migraine/ Kelman B. Former nurse found guilty in accidental injection death of 75-year-old patient. NPR. Published March 25, 2022. Accessed April 27, 2022. https://www.npr.org/sections/health-shots/2022/03/25/1088902487/former-nurse-found-guilty-in-accidental-injection-death-of-75-year-old-patient. Khan A. Medical Errors in the Emergency Department. SAJEM Editorial. Researchgate.net. Accessed April 27, 2022. https://www.researchgate.net/profile/Abdus-Khan/publication/336838935MedicalErrorsintheEmergencyDepartment/links/5dbae7df4585151435d6e97f/Medical-Errors-in-the-Emergency-Department.pdf Pasquini S. Healthcare Experience Required for PA School: The Ultimate Guide. The Physician Assistant Life. Published February 2, 2015. Accessed April 27, 2022. https://www.thepalife.com/hce-paschool/ AHA/ACC Heart Failure Guidelines Emergency Heart Failure Mortality Risk Grade (EHMRG). MDCalc. Accessed April 27, 2022. https://www.mdcalc.com/emergency-heart-failure-mortality-risk-grade-ehmrg Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. Published April 1, 2022. Accessed April 27, 2022. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063 Ottawa Heart Failure Risk Scale (OHFRS). MDCalc. Accessed April 27, 2022. https://www.mdcalc.com/ottawa-heart-failure-risk-scale-ohfrs Rider I. Evidence Based Disposition in Heart Failure – Who needs to be admitted and who can be discharged? emDOCs.net - Emergency Medicine Education. Published October 5, 2020. Accessed April 27, 2022. http://www.emdocs.net/evidence-based-disposition-in-heart-failure-who-needs-to-be-admitted-and-who-can-be-discharged/ SGEM#170: Don’t Go Breaking My Heart – Ottawa Heart Failure Risk Scale. The Skeptics Guide to Emergency Medicine. Published March 5, 2017. Accessed April 27, 2022. https://thesgem.com/2017/03/sgem170-dont-go-breaking-my-heart-ottawa-heart-failure-risk-scale/ Thibodeau J, Turer A, Gualano S, et al. Characterization of a Novel Symptom of Advanced Heart Failure: Bendopnea. ScienceDirect. Sciencedirect.com. Presented November 3, 2012. Accessed April 27, 2022. https://www.sciencedirect.com/science/article/pii/S2213177913004125?via%3Dihub Something Sweet O’Connell A, Greco S, Zhan T, et al. Analyzing the effect of interview time and day on emergency medicine residency interview scores. BMC Med Educ. Published April 26, 2022. Accessed April 27, 2022. https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-022-03388-6 Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Welcome to Episode 15 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 15 of “The 2 View” – Guidelines for the evaluation and diagnosis of chest pain, non-traumatic shoulder pain in the ER, thoughts on recertification, and mushrooms & psychedelics. 2021 AHA/ACC/etc. Guideline for the Evaluation and Diagnosis of Chest Pain Chest Pain Choice. care that fits. Published May 19, 2021. Accessed March 29, 2022. https://carethatfits.org/chest-pain-choice/ Grauer K. ECG Blog #292 — Why Did the Patient Die? Blogspot.com. Published March 21, 2022. Accessed March 29, 2022. https://ecg-interpretation.blogspot.com/2022/03/ecg-blog-292-why-did-patient-die.html Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. Published October 28, 2021. Accessed March 29, 2022. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001029 Non-Traumatic Shoulder Pain in the ER Appropriate Use Criteria Program. CMS.gov. Last Modified December 1, 2021. Accessed March 29, 2022. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Appropriate-Use-Criteria-Program Center For Medicare & Medicaid Implement New Rules for Shoulder Pain Diagnosis. Sonosite.com. Published January 22, 2020. Accessed March 29, 2022. https://www.sonosite.com/blog/center-medicare-medicaid-implement-new-rules-shoulder-pain-diagnosis Elaassar MMN, Emadeldin A, Zidan DZ, Sakr HM, Abdelazim H. Chronic non-traumatic shoulder pain: evaluation with ultrasonography and conventional mr imaging. QJM. Oxford Academic. Published May 19, 2020. Accessed March 29, 2022. https://academic.oup.com/qjmed/article/113/Supplement_1/hcaa068.013/5829209?login=true Mitchell C, Adebajo A, Hay E, Carr A. Shoulder pain: diagnosis and management in primary care. BMJ. National Library of Medicine: National Center for Biotechnology Information. Published November 12, 2005. Accessed March 29, 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1283277/ Parker, et al. Musculoskeletal imaging: Medicare use, costs, and potential for cost substitution. Journal of American College of Radiology. 2008: 182:188. PANRE-LA Option for PA Recertification - What Do We Think about Recertification? Admin M. Home. Aaenp-natl.org. AAENP. Accessed March 29, 2022. https://www.aaenp-natl.org/ American Association of Nurse Practitioners. AANP. American Association of Nurse Practitioners. Published September 4, 2019. Accessed March 29, 2022. https://www.aanp.org/ American Nurses Credentialing Center. ANA. Accessed March 29, 2022. https://www.nursingworld.org/ancc/ Homepage. PNCB. Accessed March 29, 2022. https://www.pncb.org/ Maintain Certification. NCCPA. Published September 15, 2020. Accessed March 29, 2022. https://www.nccpa.net/maintain-certification/#panre-la-faqs NCCPA Announces Permanent Alternative to PANRE, PANRE-LA. NCCPA. Published December 1, 2021. Accessed March 29, 2022. https://www.nccpa.net/news/panre-la/ Mushrooms and Psychedelics Approach to Altered Mental Status. Default. CDEM. Accessed March 29, 2022. https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-approach-to/approach-to-altered-mental-status Garcia J, Costa VM, Carvalho A, et al. Amanita phalloides poisoning: Mechanisms of toxicity and treatment. Food Chem Toxicol. NIH. Published September 12, 2015. Accessed March 29, 2022. https://pubmed.ncbi.nlm.nih.gov/26375431/ Lowe H, Toyang N, Steele B, et al. The Therapeutic Potential of Psilocybin. Molecules. NIH. Published May 2021. Accessed March 29, 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8156539/ Something Sweet COVID-19 Therapeutics Locator. Arcgis.com. ASPR. Accessed March 29, 2022. https://covid-19-therapeutics-locator-dhhs.hub.arcgis.com/ Prevention of SARS-CoV-2 Infection. NIH: COVID-19 Treatment Guidelines. Last Updated March 24, 2022. Accessed March 29, 2022. https://www.covid19treatmentguidelines.nih.gov/overview/prevention-of-sars-cov-2/ Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Welcome to Episode 14 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 14 of “The 2 View” – Urticaria, Foreign Bodies, and a Special Interview Urticaria Bernstein JA, Lang DM, Khan DA, et al. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol. Published 2014. Accessed February 11, 2022. https://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Practice%20and%20Parameters/Urticaria-2014.pdf Radecki RP, MS. Does New IV Urticaria Medication Offer Benefits Over Current Treatments? ACEP Now. Published June 15, 2021. Accessed February 11, 2022. https://www.acepnow.com/article/does-new-iv-urticaria-medication-offer-benefits-over-current-treatments/ Safety of use of high dose antihistamines in difficult-to-control chronic urticaria patients. J Am Acad Dermatol. Published May 1, 2015. Accessed February 11, 2022. https://www.jaad.org/article/S0190-9622(15)00371-0/fulltext Sarti L, Barni S, Giovannini M, Liccioli G, Novembre E, Mori F. Efficacy and tolerability of the updosing of second-generation non-sedating H1 antihistamines in children with chronic spontaneous urticaria. Pediatr Allergy Immunol. Wiley Online Library. Published August 3, 2020. Accessed February 11, 2022. https://onlinelibrary.wiley.com/doi/10.1111/pai.13325 Schaefer P. Acute and Chronic Urticaria: Evaluation and Treatment. Am Fam Physician. Published June 2017. Accessed February 11, 2022. https://www.aafp.org/afp/2017/0601/p717.html Winters M. Clinical Practice Guideline: Initial Evaluation and Management of Patients Presenting with Acute Urticaria or Angioedema. AAEM - American Academy of Emergency Medicine. Published July 10, 2006. Accessed February 11, 2022. https://www.aaem.org/resources/statements/position/clinical-practice-guideline-initial-evaluation-and-management-of-patients-presenting-with-acute-urticaria-or-angioedema Foreign Bodies & Toxic Shock Syndrome Cone LA, Woodard DR, Byrd RG, Schulz K, Kopp SM, Schlievert PM. A recalcitrant, erythematous, desquamating disorder associated with toxin-producing staphylococci in patients with AIDS. J Infect Dis. NIH. PubMed.gov. Published April 1992. Accessed February 11, 2022. https://pubmed.ncbi.nlm.nih.gov/1552193/ Contou D, Colin G, Travert B, et al. Menstrual Toxic Shock Syndrome: A French Nationwide Multicenter Retrospective Study. Clin Infect Dis. Oxford Academic. Published January 15, 2022. Accessed February 11, 2022. https://academic.oup.com/cid/article-abstract/74/2/246/6255963 Parsonnet J, Hansmann MA, Delaney ML, et al. Prevalence of Toxic Shock Syndrome Toxin 1-Producing Staphylococcus aureus and the Presence of Antibodies to This Superantigen in Menstruating Women. J Clin Microbiol. NCBI. Published September 2005. Accessed February 11, 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1234102/ Shands KN, Schmid GP, Dan BB, et al. Toxic-Shock Syndrome in Menstruating Women: Association with Tampon Use and Staphylococcus aureus and Clinical Features in 52 cases. N Engl J Med. Published December 18, 1980. Accessed February 11, 2022. https://www.nejm.org/doi/full/10.1056/nejm198012183032502?casa_token=GVNPVVA8uB4AAAAA:LQTf1B8PlxwffYbLmuOeWnteCLdkKtwEydZDKn2lYW-NoNe8953D58cgSMnWVnwbN136BWtd23zr Streptococcal Toxic Shock Syndrome: All You Need to Know. Cdc.gov. Published November 23, 2021. Accessed February 11, 2022. https://www.cdc.gov/groupastrep/diseases-public/streptococcal-toxic-shock-syndrome.html Toxic Shock Syndrome (Other Than Streptococcal) (TSS) 2011 case definition. Cdc.gov. Reviewed April 16, 2021. Accessed February 11, 2022. https://ndc.services.cdc.gov/case-definitions/toxic-shock-syndrome-2011/ Foreign Bodies Continued - Management Coskun A, Erkan N, Yakan S, Yıldirim M, Cengiz F. Management of rectal foreign bodies. World J Emerg Surg. Published March 13, 2013. Accessed February 11, 2022. https://wjes.biomedcentral.com/articles/10.1186/1749-7922-8-11 O’Malley G, O’Malley R. Body Packing and Body Stuffing. Merck Manuals Professional Edition. Reviewed/Revised May 2020. Accessed February 11, 2022. https://www.merckmanuals.com/professional/special-subjects/recreational-drugs-and-intoxicants/body-packing-and-body-stuffing Guest Interview: Kenny Walks Across America Facebook. Facebook.com. Accessed February 11, 2022. https://www.facebook.com/KennywalksacrossAmerica Kenny Walks Across America. Kenny Walks Across America. Accessed February 11, 2022. http://www.kennywalksacrossamerica.com Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Welcome to Episode 13 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 13 of “The 2 View” – Nystagmus, SCAD, Sotromivab, Paxlovid, Molnupivarvir, and more. Nystagmus Mehar A. CanadiEM Frontline Primer - Vertigo workup. CanadiEM. Published April 25, 2020. Accessed January 11, 2022. https://canadiem.org/canadiem-frontline-primer-vertigo/ Nystagmus. NeurologyNeeds.com. Accessed January 11, 2022. https://www.neurologyneeds.com/neurological-examination-tips-tricks/nystagmus/ Nystagmus. The Proceduralist. Published January 10, 2022. Accessed January 11, 2022. https://www.youtube.com/watch?v=fW3sVsNgJ2k Talmud JD, Coffey R, Edemekong PF. Dix Hallpike Maneuver. NCBI. StatPearls Publishing. Last Update December 19, 2021. Accessed January 11, 2022. https://www.ncbi.nlm.nih.gov/books/NBK459307/ SCAD Beardsell L. Preventing mid-life spontaneity becoming a crisis - SCAD as a serious cause of chest pain. St Emlyn’s. St.Emlyn’s Emergency Medicine. Published May 29, 2021. Accessed January 11, 2022. https://www.stemlynsblog.org/scad/ Durrani M. Spontaneous Coronary Artery Dissection (SCAD). REBEL EM - Emergency Medicine Blog. Published October 19, 2020. Accessed January 11, 2022. https://rebelem.com/spontaneous-coronary-artery-dissection-scad/ Hayes SN, Tweet MS, Adlam D, et al. Spontaneous Coronary Artery Dissection: JACC State-of-the-Art Review. J Am Coll Cardiol. Published August 2020. Accessed January 11, 2022. https://www.jacc.org/doi/abs/10.1016/j.jacc.2020.05.084 Johnson AK, Tweet MS, Rouleau SG, Sadosty AT, Raukar NP. 243 Spontaneous Coronary Artery Dissection in the Emergency Department: The Elusive Dissection. Ann Emerg Med. Published October 1, 2020. Accesseed January 11, 2022. https://www.annemergmed.com/article/S0196-0644(20)31003-9/fulltext#relatedArticles Kim ESH. Spontaneous Coronary-Artery Dissection. N Engl J Med. Published December 10, 2020. Accessed January 11, 2022. https://www.nejm.org/doi/full/10.1056/NEJMra2001524 Sotromivab, Paxlovid and Molnupivarvir Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the Treatment of Covid-19 - Final Report. N Engl J Med. Published November 5, 2020. Accessed January 11, 2022. https://www.nejm.org/doi/full/10.1056/nejmoa2007764 Jayk Bernal A, Gomes da Silva MM, Musungaie DB, et al. Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients. N Engl J Med. Published online December 16, 2021. Accessed January 11, 2022. https://www.nejm.org/doi/full/10.1056/NEJMoa2116044 PAXLOVIDTM (nirmatrelvir tablets; ritonavir tablets): Now Authorized for Emergency Use. For Patients. Pfizer. Covid19oralrx-patient.com. Accessed January 11, 2022. https://www.covid19oralrx-patient.com/ Sotrovimab. Sotrovimab.com. GSK. Accessed January 11, 2022. https://www.sotrovimab.com/ Guest Interview: JIM ROBERTS - IVERMECTIN Bryant A, Lawrie T, Dowswell T, et al. Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines. American Journal of Therapeutics. Lww.com. Published July/August 2021. Accessed January 11, 2022. https://journals.lww.com/americantherapeutics/fulltext/2021/08000/ivermectinforpreventionandtreatment_of.7.aspx Em-news.com. Accessed January 11, 2022. http://www.em-news.com Kory P MD, Meduri GU MD, Iglesias J, et al. Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19. Published online 2020. Updated January 16, 2021. Accessed January 11, 2022. https://covid19criticalcare.com/wp-content/uploads/2020/11/FLCCC-Ivermectin-in-the-prophylaxis-and-treatment-of-COVID-19.pdf Mike & Martha’s Something Sweet: Safest Countries in the World in 2021 Safest Countries in the World 2021. Worldpopulationreview.com. Accessed January 11, 2022. https://worldpopulationreview.com/country-rankings/safest-countries-in-the-world Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in – this month we are giving away 20% off of our July Bootcamp Course and lunch with the faculty! Win and join us in Vegas this summer – come and share your ER experiences with us over a good meal.

Welcome to Episode 12 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show links below: Ondansetron in Children: https://journalfeed.org/article-a-day/2021/isolated-vomiting-is-it-just-a-virus https://journalfeed.org/article-a-day/2021/does-ondansetron-impact-meaningful-outcome-in-preschoolers https://journalfeed.org/article-a-day/2020/maybe-ondansetron-rx-does-reduce-bouncebacks-in-ki Auricular Hematomas & Auricular Block: Martha’s Video https://youtu.be/jND3_4SdQvU Martha’s Blog https://www.theproceduralist.org/thecases/auricular-blocks-and-hematomas Auricular Hematoma’s https://www.ncbi.nlm.nih.gov/books/NBK531499/ Jess Mason’s video on auricular blocks https://www.youtube.com/watch?v=6ZiB_9eNpcA Auricular Hematoma Drainage https://www.youtube.com/watch?v=mXjQu26BlIg Langer’s Lines https://dermnetnz.org/topics/skin-tension-lines Bolsters https://www.aliem.com/trick-of-trade-splinting-ear/ Latest Guidelines of Zoster / Shingles: CDC https://www.cdc.gov/shingles/index.html Merck Manual https://www.merckmanuals.com/professional/infectious-diseases/herpesviruses/herpes-zoster Facial Dermatomes https://www.ebmconsult.com/articles/anatomy-dermatomes-face AAFP - Shingles https://www.aafp.org/afp/2000/0415/p2437.html Gabapentin https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0217335 The Usual Links: CCME www.ccme.org SGEM: www.thesgem.com The Proceduralist: www.theproceduralist.org Old Procedural Pause videos: https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx

Welcome to Episode 11 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 11 of “The 2 View” – LIVE at the November 2021 EM Boot Camp Course CA Regulations for NP RX Authority / Prescribing for Friends & Family AB 2789 Bulletin: New Prescribing Laws Take Effect January 1, 2022. State of California, Department of Consumer Affairs. Dca.ca.gov. Accessed November 16, 2021. https://www.dca.ca.gov/licensees/ab2789_bulletin.pdf Mid-Level Practitioners Authorization by State. U.S. Department of Justice. Drug Enforcement Administration. Diversion Control Division. Usdoj.gov. Accessed November 16, 2021. https://www.deadiversion.usdoj.gov/drugreg/practioners/ Treatment of Family, Friends, Colleagues, and Self. American College of Emergency Physicians. Acep.org. Published April 2020. Accessed November 16, 2021. https://www.acep.org/patient-care/policy-statements/treatment-of-family-friends-colleagues-and-self/ New Boot Camp Lecturer Chip Lange, PA (Practical Pocus / Total EM) About Us. PRACTICAL POCUS. Practicalpocus.com. Accessed November 16, 2021. https://www.practicalpocus.com/about-us.html About Us and Disclaimer: The Information Behind Us. TOTAL EM. Totalem.org. Accessed November 16, 2021. https://www.totalem.org/about-us-and-disclaimer.html Chip with TOTAL EM. Twitter. Twitter.com. Accessed November 16, 2021. https://twitter.com/thetotalem New Boot Camp Lecturer Jessie Werner, MD (UCSF / EM:RAP) EMRA*Cast Host: Jessie Werner, MD. EMRA. Emra.org. Published October 9, 2020. Accessed November 16, 2021. https://www.emra.org/about-emra/publications/emra-cast/emra-cast-hosts/jessie-werner/ Jessie Werner MD. Twitter. Twitter.com. Accessed November 16, 2021. https://twitter.com/jesswernermd Meet Jessie Werner, MD. EM Resident. Emra.org. Published February 26, 2020. Accessed November 16, 2021. https://www.emra.org/emresident/article/spotlight-werner/ Risk Management Monthly with Dr. Rick Bukata Risk Management Monthly: Emergency Medicine. The Center for Medical Education. Ccme.org. Accessed November 16, 2021. https://www.ccme.org/riskmgmt/ Mike & Martha’s Something Sweet: Seglentis (Celebrex + Tramadol) Brooks M. FDA Approves Combo Pill for Severe, Acute Pain. Medscape. Medscape.com. Published October 19, 2021. Accessed November 16, 2021. https://www.medscape.com/viewarticle/961177 Cunha J. Seglentis. RxList. Rxlist.com. Updated November 2, 2021. Accessed November 16, 2021. https://www.rxlist.com/seglentis-drug.htm Morgenstern J. Don’t Prescribe Tramadol. First10EM: When minutes matter… First10em.com. Published May 13, 2019 – Updated July 14, 2021. Accessed November 16, 2021. https://first10em.com/tramadol/ Motov S and Genes N. The Painful Reality Behind America’s Surge in Tramadol Prescriptions. Emergency Physicians Monthly. Epmonthly.com. Published December 12, 2017. Accessed November 16, 2021. http://epmonthly.com/article/painful-reality-behind-americas-surge-tramadol-prescriptions/ Rezaie S. Tramadol or Tramadont. REBELEM. Rebelem.com. Published April 8, 2019. Accessed November 16, 2021. https://rebelem.com/tramadol-or-tramadont/ Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. For those of you who tuned in live, we hope you enjoyed it and we can’t wait to do this again for the 2022 Original EM Boot Camp LIVE Courses!

Welcome to Episode 10 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 10 of “The 2 View” – Skipping a Beat, Strep Throat, Hyperthyroidism and TSH, and More… Skipping a Beat: Zio Patch and Loop Recorders Barrett PM, Komatireddy R, Haaser S, et al. Comparison of 24-hour Holter monitoring with 14-day novel adhesive patch electrocardiographic monitoring. Am J Med. PubMed.gov. Published January 2014. Accessed October 6, 2021. https://pubmed.ncbi.nlm.nih.gov/24384108/ Burke J, Haigney MCP, Borne R, Krantz MJ. Smartwatch detection of ventricular tachycardia: Case series. HeartRhythm Case Rep. NCBI. Published October 2020. Accessed October 6, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7573479/ Elsinger F, Smithuis R, Spijkerboer A. Cardiovascular devices on Chest X-Ray. Radiology Assistant. Radiologyassistant.nl. Published December 1, 2018. Accessed October 6, 2021. https://radiologyassistant.nl/cardiovascular/devices/cardiovascular-devices Elsinger F, Smithuis R, Spijkerboer A. Cardiovascular devices on Chest X-Ray. Radiology Assistant. Radiologyassistant.nl. Published December 1, 2018. Accessed October 6, 2021. https://radiologyassistant.nl/cardiovascular/devices/cardiovascular-devices#loop-recorders iRhythm Technologies, Inc. Why Zio. Irhythmtech.com. Accessed October 6, 2021. https://www.irhythmtech.com/patients/why-zio Loop Recorder Implantation. Johns Hopkins Medicine. Hopkinsmedicine.org. Accessed October 6, 2021. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/loop-recorder-implantation Yenikomshian M, Jarvis J, Patton C, et al. Cardiac arrhythmia detection outcomes among patients monitored with the Zio patch system: a systematic literature review. Curr Med Res Opin. Taylor & Francis Online. Published May 28, 2019. Accessed October 6, 2021. https://www.tandfonline.com/doi/full/10.1080/03007995.2019.1610370 Hyperthyroidism and TSH Collection Tubes and Description. Additive B, Color/Volume U. COLLECTION TUBES AND DESCRIPTION. NYU Langone Medical Center. Testmenu.com. Accessed October 6, 2021. https://www.testmenu.com/nyumc/TestDirectory/SiteFile?fileName=sidebar%5Ccollection%20tubes%20and%20descriptions.pdf Graves’ disease. Mayo Clinic. Mayoclinic.org. Accessed October 6, 2021. https://www.mayoclinic.org/diseases-conditions/graves-disease/symptoms-causes/syc-20356240 Plasma Separation: Why Do You Need It? How Do You Achieve It? DCN Dx. Dcndx.com. Published July 17, 2019. Accessed October 6, 2021. https://dcndx.com/plasma-separation-why-you-need-it/ What are Normal Thyroid Hormone Levels? UCLA Health. Uclahealth.org. Accessed October 6, 2021. https://www.uclahealth.org/endocrine-center/normal-thyroid-hormone-levels Mike & Martha’s Something Sweet Home - National APP week. Nationalappweek.com. Published July 9, 2021. Accessed October 6, 2021. http://www.nationalappweek.com Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Last month we asked you a trivia question regarding food and the manufacturing of war weaponry. It was another 2-part question and we asked: During what war were Americans urged to save this food fat so that it could be used to manufacture bombs? The answer was: World War II and bacon. Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. We hope to see you at the November Original EM Boot Camp LIVE in Las Vegas!

Welcome to Episode 9 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 9 of “The 2 View” – STI Treatment Guidelines, Muscle Relaxers, Patient Satisfaction Scores, Lidocaine, and More… 2021 Updated CDC STI Treatment Guidelines Pocket Guide: Sexually Transmitted Infections. Summary of CDC Treatment Guidelines – 2021. Cdc.gov. Accessed September 7, 2021. https://www.cdc.gov/std/treatment-guidelines/pocket-guide.pdf Sexually Transmitted Infections Treatment Guidelines, 2021. CDC. Provider Resources. Cdc.gov. Published August 5, 2021. Accessed September 7, 2021. https://www.cdc.gov/std/treatment-guidelines/provider-resources.htm SGEM#335: Sisters Are Doin’ It for Themselves…Self-Obtained Vaginal Swabs for STIs. The Skeptics’ Guide to EM. Thesgem.com. Published June 26, 2021. Accessed September 7, 2021. https://www.thesgem.com/2021/06/sgem335-sisters-are-doin-it-for-themselves/ The Center for Medical Education. The 2 View: Episode 1. Fireside.fm. Published January 11, 2021. Accessed September 7, 2021. https://2view.fireside.fm/1 Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. CDC. Published July 23, 2021. Accessed September 7, 2021. https://www.cdc.gov/mmwr/volumes/70/rr/rr7004a1.htm Muscle Relaxers Cashin AG, Folly T, Bagg MK, et al. Efficacy, acceptability, and safety of muscle relaxants for adults with non-specific low back pain: systematic review and meta-analysis. BMJ. PubMed.gov. Published July 7, 2021. Accessed September 7, 2021. https://pubmed.ncbi.nlm.nih.gov/34233900/ Chou R, Peterson K, Helfand M. Comparative efficacy and safety of skeletal muscle relaxants for spasticity and musculoskeletal conditions: a systematic review. J Pain Symptom Manage. PubMed.gov. Published August 2004. Accessed September 7, 2021. https://pubmed.ncbi.nlm.nih.gov/15276195/ Gerardo Sison P. Robaxin vs. Flexeril: Differences, similarities, and which is better for you. Singlecare.com. Published April 28, 2020. Accessed September 7, 2021. https://www.singlecare.com/blog/robaxin-vs-flexeril/ Gordon, S. Muscle Relaxants for Back Pain Are Soaring: Are They Safe? Webmd.com. Published July 1, 2020. Accessed September 7, 2021. https://www.webmd.com/back-pain/news/20200701/muscle-relaxants-for-back-pain-are-soaring-are-they-safe Motov, S. Faculty Forum: A Practical Approach to Pain Management. YouTube. https://www.youtube.com/watch?v=lJSioPsGw3A. The Center for Medical Education. Published December 2, 2020. Accessed September 7, 2021. van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-specific low back pain. Cochrane Database Syst Rev. PubMed.gov. Published 2003. Accessed September 7, 2021. https://pubmed.ncbi.nlm.nih.gov/12804507/ Patient Satisfaction Scores Belanger T, Axene E, Martens K. numbERs: How to Improve Patient Satisfaction Scores (Without Really Trying). Emergency Medicine News: The Most Trusted News Source in Emergency Medicine. Lww.com. Published July 2021. Accessed September 7, 2021. https://journals.lww.com/em-news/Fulltext/2021/07000/numbERs_HowtoImprovePatient_Satisfaction.22.aspx Lidocaine El-Boghdadly K, Pawa A, Chin KJ. Local anesthetic systemic toxicity: current perspectives. Local Reg Anesth. PMC: US National Library of Medicine National Institutes of Health. Published August 8, 2018. Accessed September 7, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6087022/ Van Meter M. How is a 1% lidocaine concentration for oral nerve block calculated? Medscape.com. Updated January 17, 2019. Accessed September 7, 2021. https://www.medscape.com/answers/82850-105919/how-is-a-1-lidocaine-concentration-for-oral-nerve-block-calculated Mike & Martha’s Something Sweet Emanuel G. Does Your Kid’s Classroom Need An Air Purifier? Here’s How You Can Make One Yourself. NPR. Published August 26, 2021. Accessed September 7, 2021. https://www.npr.org/sections/back-to-school-live-updates/2021/08/26/1031018250/does-your-kids-classroom-need-an-air-purifier-heres-how-you-can-make-one-yoursel. Mahoney S. Summerville woman receives national “Magic Maker” award from Disney. WCIV. Published August 26, 2021. Accessed September 7, 2021. https://abcnews4.com/news/local/summerville-woman-receives-national-magic-maker-award-from-disney Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Last month we asked you a trivia question in conjunction with our pediatric-themed episode. It was another 2-part question and we asked: What year did the TV show Sesame Street first air in the United States and what color was Oscar the Grouch’s fur? The answer was: 1969 and orange. Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to.

Welcome to Episode 8 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 8 of “The 2 View” – A Pediatric Special Bronchiolitis Chapman S. Bronchiolitis: evidence for practice? Evidentlycochrane.net. Published February 15, 2018. Accessed August 6, 2021. https://www.evidentlycochrane.net/bronchiolitis-evidence-practice/ Kirolos, A, Manti, S, Blacow, R, et.al. A Systematic Review of Clinical Practice Guidelines for the Diagnosis and Management of Bronchiolitis. Oxford Academic: The Journal of Infectious Diseases. Published November 1, 2020. Accessed August 6, 2021. https://academic.oup.com/jid/article/222/Supplement_7/S672/5549996?login=true R. Abaya, MD; K. Crescenzo, RN; E. Delgado, MD; et.al. Emergency Department Clinical Pathway for Evaluation/Treatment of Children with Bronchiolitis. The Children’s Hospital of Philadelphia. Bronchiolitis Clinical Pathway — Emergency Department. Chop.edu. Published September 2005. Accessed August 6, 2021. https://www.chop.edu/clinical-pathway/bronchiolitis-emergent-evaluation-clinical-pathway Image on Following Page --> https://bit.ly/2VSKInN Rose, E, MD. Pediatric Fever and Infections. EM:RAP CorePendium. Emrap.org. Published July 6, 2021. Accessed August 6, 2021. https://www.emrap.org/corependium/chapter/recWjNx3zLXggj7co/Pediatric-Fever-and-Infections Schroeder AR MD, Marlow JA MD, Bonafide CP MD, MSCE. Improving Value in Bronchiolitis Care. JAMA Network Open. Published 2021. Accessed August 6, 2021. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2776436 Kawasaki’s Kubota M, Usami I, Yamakawa M, Tomita Y, Haruta T. Kawasaki Disease With Lymphadenopathy And Fever As Sole Initial Manifestations. EMA September 2008. Emrap.org. Published September 2008. Accessed August 6, 2021. https://www.emrap.org/episode/ema-2008-9/abstract26 Mizuta M, Shimizu M, Inoue N, et al. Serum ferritin levels as a useful diagnostic marker for the distinction of systemic juvenile idiopathic arthritis and Kawasaki disease. Mod Rheumatol. PubMed.gov. Published July 19, 2016. Accessed August 6, 2021. https://pubmed.ncbi.nlm.nih.gov/27433933/ Saguil A MD, MPH, Fargo MV MD, MPH, Grogan SP MD, MBA. Diagnosis and Management of Kawasaki Disease. Am Family Physician. Published March 15, 2015. Accessed August 6, 2021. https://www.aafp.org/afp/2015/0315/p365.html Son MBF, Newburger JW. Kawasaki Disease. Pediatrics in Review: An Official Journal of the American Academy of Pediatrics. Published February 2018. Accessed August 6, 2021. https://pedsinreview.aappublications.org/content/39/2/78 Whitney, D MD; Dorland, K BSN; Beus, J MD; et.al. Emergency Department and Inpatient Clinical Pathway for Evaluation/Treatment of Children with Kawasaki Disease or Incomplete Kawasaki Disease. The Children’s Hospital of Philadelphia. Kawasaki Disease or Incomplete Kawasaki Disease clinical pathway — Emergency Department and Inpatient. Chop.edu. Published January 2018. Accessed August 6, 2021. https://www.chop.edu/clinical-pathway/kawasaki-disease-incomplete-kawasaki-disease-clinical-pathway *Image on Following Page* --> https://bit.ly/2VSKInN Pediatric Fever Kaufman J, Fitzpatrick P, Tosif S, et al. Faster clean catch urine collection (Quick-Wee method) from infants: randomised controlled trial. BMJ. Published 2017. Accessed August 6, 2021. https://www.bmj.com/content/357/bmj.j1341 Pantell RH, Roberts KB, Adams WG, et al. Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 days old. Pediatrics: Official Journal of the American Academy of Pediatrics. Published August 2021. Accessed August 6, 2021. https://pediatrics.aappublications.org/content/148/2/e2021052228 Figure 1: https://bit.ly/2VSKInN Figure 2: https://bit.ly/2VSKInN Figure 3: https://bit.ly/2VSKInN Tran A, Fortier C, Giovannini-Chami L, et al. Evaluation of the Bladder Stimulation Technique to Collect Midstream Urine in Infants in a Pediatric Emergency Department. PLoS One. Published March 31, 2016. Accessed August 6, 2021. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0152598 COVID in Kids CDC. Information for Pediatric Healthcare Providers. Cdc.gov. Published July 14, 2021. Accessed August 6, 2021. https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html Chiotos, K MD, Davis, D MD, Kerman, C MD, et.al. Clinical Pathway for Evaluation and Treatment of Patients with Active COVID-19 Infection. The Children’s Hospital of Philadelphia. Acute COVID-19, clinical pathway — all settings. Chop.edu. Published June 2020. Accessed August 6, 2021. https://www.chop.edu/clinical-pathway/covid-disease-clinical-pathway Image on Following Page --> https://bit.ly/2VSKInN Coronavirus outbreak and kids. Harvard.edu. Published August 2, 2021. Accessed August 6, 2021. https://www.health.harvard.edu/diseases-and-conditions/coronavirus-outbreak-and-kids Dong Y, Mo X, Hu Y, et al. Epidemiology of COVID-19 Among Children in China. Pediatrics: Official Journal of the American Academy of Pediatrics. Published June 2020. Accessed August 6, 2021. https://pediatrics.aappublications.org/content/145/6/e20200702 Ives-Tallman, C MD, Guest, B DO. Novel Coronavirus 2019 (COVID-19). EM:RAP CorePendium. Emrap.org. Published July 30, 2021. Accessed August 6, 2021. https://www.emrap.org/corependium/chapter/rec906m1mD6SRH9np/Novel-Coronavirus-2019-COVID-19 Ouldali N MD, Pouletty M MD, Mariani P MD, et al. Emergence of Kawasaki disease related to SARS-CoV-2 infection in an epicentre of the French COVID-19 epidemic: a time-series analysis. Lancet Child & Adolescent Health. Published July 2, 2020. Accessed August 6, 2021. https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30175-9/fulltext Parcha V, Booker KS, Kalra R, et al. A retrospective cohort study of 12,306 pediatric COVID-19 patients in the United States. Sci Rep. PubMed.gov. Published May 13, 2021. Accessed August 6, 2021. https://pubmed.ncbi.nlm.nih.gov/33986390/ Mike & Martha’s Something Sweet Abbasi B, Kimiagar M, Sadeghniiat K, et.al. The effect of magnesium supplementation on primary insomnia in elderly: A double-blind placebo-controlled clinical trial. J Res Med Sci. PubMed.gov. Published December 2012. Accessed August 6, 2021. https://pubmed.ncbi.nlm.nih.gov/23853635/ Gottlieb, M MD, Riddell, J MD, Cooney, R MD, et.al. Maximizing the Morning Commute: A Randomized Trial Assessing the Effect of Driving on Podcast Knowledge Acquisition and Retention. Annals of Emergency Medicine: An International Journal. Annemergmed.com. Published April 28, 2021. Accessed August 6, 2021. https://www.annemergmed.com/article/S0196-0644(21)00162-1/fulltext Guerrera MP MD, Volpe SL PhD, Mao JJ MD. Therapeutic Uses of Magnesium. American Family Physician. Published July 15, 2009. Accessed August 6, 2021. https://www.aafp.org/afp/2009/0715/p157.html Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Last month we asked you a trivia question regarding Wellens syndrome. It was a 2-part question and we asked: Who is Wellens syndrome named after and in what year did he co-author the paper that describes what we now know as Wellens syndrome? The answer was: Cardiologist Dr. Henrich Wellens described, with his co-authors, what we now know as Wellens syndrome in 1982 in the American Heart Journal. The winner this month is Mike Sprosty, PA. Mike actually came to our live Original Emergency Medicine Boot Camp in July! It was great to meet him. Maybe he’ll use the prize to check out another one of Center for Medical Education courses, or he’ll give it to a friend. Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to.

Welcome to Episode 007 (cue the James Bond music please) of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 7 of “The 2 View” A Wolf in Sheep’s Clothing Birnbaumer, Diane MD. A Wolf in Sheep’s Clothing: Serious Causes of Common Complaints. Advanced Emergency Medicine Boot Camp. September 2019. Las Vegas. Accessed June 29, 2021. Subarachnoid Hemorrhage Carpenter CR, Hussain AM, Ward MJ, et al. Spontaneous Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis Describing the Diagnostic Accuracy of History, Physical Examination, Imaging, and Lumbar Puncture with an Exploration of Test Thresholds. Acad Emerg Med. PubMed.gov. Published September 6, 2016. Accessed June 29, 2021. https://pubmed.ncbi.nlm.nih.gov/27306497/ Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. Published 2012. Accessed June 29, 2021. https://www.ahajournals.org/doi/full/10.1161/str.0b013e3182587839 Headache. Acep.org. Published June 2019. Accessed June 29, 2021. https://www.acep.org/patient-care/clinical-policies/headache/ Hine, J MD, Marcolini, E MD. Aneurysmal Subarachnoid Hemorrhage. EM:RAP CorePendium. Emrap.org. Published September 17, 2020. Accessed June 29, 2021. https://www.emrap.org/corependium/chapter/recTI59VW0TPBpesx/Aneurysmal-Subarachnoid-Hemorrhage Kim YW, Neal D, Hoh BL. Cerebral aneurysms in pregnancy and delivery: pregnancy and delivery do not increase the risk of aneurysm rupture. Neurosurgery. PubMed.gov. Published February 2013. Accessed June 29, 2021. https://pubmed.ncbi.nlm.nih.gov/23147786/ Marcolini E, Hine J. Approach to the Diagnosis and Management of Subarachnoid Hemorrhage. West J Emerg Med. NCBI. Published February 28, 2019. Accessed June 29, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6404699/ Ogilvy, C MD, Rordorf, G MD, Singer, R MD. Aneurysmal subarachnoid hemorrhage: Clinical manifestations and diagnosis. UpToDate. Uptodate.com. Updated February 25, 2020. Accessed June 29, 2021. https://www.uptodate.com/contents/aneurysmal-subarachnoid-hemorrhage-clinical-manifestations-and-diagnosis?search=subarachnoid%20hemorrhage&source=searchresult&selectedTitle=1~150&usagetype=default&display_rank=1 Ottawa Subarachnoid Hemorrhage (SAH) Rule for Headache Evaluation. Mdcalc.com. Accessed June 29, 2021. https://www.mdcalc.com/ottawa-subarachnoid-hemorrhage-sah-rule-headache-evaluation Subarachnoid Hemorrhage, no LP. EM:RAP. Emrap.org. Published May 2020. Accessed June 29, 2021. https://www.emrap.org/episode/emrap2020may/subarachnoid Gonococcal Arthritis Klausner, J MD, MPH. Disseminated gonococcal infection. UpToDate. Uptodate.com. Updated January 7, 2021. Accessed June 29, 2021. https://www.uptodate.com/contents/disseminated-gonococcal-infection Li R, Hatcher JD. Gonococcal Arthritis. In: StatPearls. StatPearls Publishing. Published July 26, 2020. Accessed June 29, 2021. https://www.ncbi.nlm.nih.gov/books/NBK470439/ Milne, Wm. MD. SGEM#335: Sisters Are Doin’ It for Themselves…Self-Obtained Vaginal Swabs for STIs. Thesgem.com. Published June 26, 2021. Accessed June 29, 2021. https://www.thesgem.com/2021/06/sgem335-all-by-myselfself-obtained-vaginal-swabs-for-stis/ Ventura, Y MD, Waseem, M MD, MS. Disseminated Gonococcal Infection: Emergency Department Evaluation and Treatment. Emdocs.net. Published May 17, 2021. Accessed June 29, 2021. http://www.emdocs.net/disseminated-gonococcal-infection-emergency-department-evaluation-and-treatment/ Epiglottitis Abdallah C. Acute epiglottitis: Trends, diagnosis and management. Saudi J Anaesth. Published July-September 2012. Accessed June 29, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498669/ Ames WA, Ward VM, Tranter RM, Street M. Adult epiglottitis: an under-recognized, life-threatening condition. Br J Anaesth. Oxford Academic. Published November 1, 2000. Accessed June 29, 2021. https://academic.oup.com/bja/article/85/5/795/273886 Dowdy RAE, Cornelius BW. Medical Management of Epiglottitis. Anesth Prog. Published July 6, 2020. Accessed June 29, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7342809/ Farkas, J. Epiglottitis. Emcrit.org. Published December 18, 2016. Accessed June 29, 2021. https://emcrit.org/ibcc/epiglottitis/ Mayo-Smith M. Fatal respiratory arrest in adult epiglottitis in the intensive care unit. Implications for airway management. Chest. PubMed.gov. Published September 1993. Accessed June 29, 2021. https://pubmed.ncbi.nlm.nih.gov/8365325/ Roberts, J MD, Roberts, M ACNP, PNP. Nasal Endoscopy for Urgent and Complex ED Cases. Lww.com. Published October 28, 2020. Accessed June 29, 2021. https://journals.lww.com/em-news/blog/theproceduralpause/pages/post.aspx?PostID=110 Wolf M, Strauss B, Kronenberg J, Leventon G. Conservative management of adult epiglottitis. Laryngoscope. PubMed.gov. Published February 1990. Accessed June 29, 2021. https://pubmed.ncbi.nlm.nih.gov/2299960/ Wellens Syndrome Wellens Syndrom EKG Sign: See full show notes here: https://bit.ly/3eSyzp0 Cadogan M, Buttner R. Wellens Syndrome. Life in the Fastlane. Litfl.com. Published June 4, 2021. Accessed June 29, 2021. https://litfl.com/wellens-syndrome-ecg-library/ Smith S. Wellens’ missed. Then returns with Wellens’ with dynamic T-wave inversion. Dr. Smith’s ECG Blog. Blogspot.com. Published May 4, 2011. Accessed June 29, 2021. http://hqmeded-ecg.blogspot.com/2011/05/wellens-missed-then-returns-with.html?m=1 Wellens Syndrome ECG Recommended Book Resources for the Month Merck. The Merck Manual of Patient Symptoms. (Porter RS, ed.). Merck; 2008. Schaider JJ, Barkin RM, Hayden SR, et al., eds. Rosen and Barkin’s 5-Minute Emergency Medicine Consult. 4th ed. Lippincott Williams and Wilkins; 2010. Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Last month we asked you a trivia question regarding the very first NP program – who was the duo that began the program and what was the first NP specialty program? The correct answer was Dr. Loretta Ford and Dr. Henry Silver. The first NP specialty program was pediatrics. We’ll be sending Lindsey Harvey, MSN, FNP-BC to the November Original EM Boot Camp Gratis for providing that answer! We can’t wait to see you and all of the other registrants in November in Las Vegas! Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to.

Welcome to Episode 6 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 6 of “The 2 View” Lyme Disease Arumugam S, Nayak S, Williams T, et al. A Multiplexed Serologic Test for Diagnosis of Lyme Disease for Point-of-Care Use. J Clin Microbiol. Published November 22, 2019. Accessed June 1, 2021. https://journals.asm.org/doi/full/10.1128/JCM.01142-19 Gastroparesis Camilleri, M. MD. Gastroparesis: Etiology, Clinical Manifestations, and Diagnosis. Uptodate.com. Updated September 30, 2020. Accessed June 1, 2021. https://www.uptodate.com/contents/gastroparesis-etiology-clinical-manifestations-and-diagnosis?search=gastroparesis&sectionRank=1&usagetype=default&anchor=H859989&source=machineLearning&selectedTitle=2~150&displayrank=2 Center for Drug Evaluation, Research. How to Request Domperidone for Expanded Access Use. Fda.gov. Published February 2, 2021. Accessed June 1, 2021. https://www.fda.gov/drugs/investigational-new-drug-ind-application/how-request-domperidone-expanded-access-use Gastroparesis. American College of Gastroenterology. Updated December 2012. Accessed June 1, 2021. https://gi.org/topics/gastroparesis/ Gastroparesis - NORD (national organization for rare disorders). Rarediseases.org. Published February 11, 2015. Accessed June 1, 2021. https://rarediseases.org/rare-diseases/gastroparesis/ Spiked Helmet EKG Sign: See full show notes here: https://bit.ly/3xaCoga Career Advancements: Side Gigs & Moving Up in the Workforce Passive Income. The List of Physician Side Hustles. Passiveincomemd.com. Published February 4, 2020. Accessed June 1, 2021. https://passiveincomemd.com/list-physician-side-hustles/ Shemmassian. 14 Physician Side Gigs to Accelerate Your Income — Shemmassian Academic Consulting. Shemmassianconsulting.com. Published March 26, 2020. Accessed June 1, 2021. https://www.shemmassianconsulting.com/blog/physician-side-gigs Sitar, D. 11 Side Gigs You Can Do Entirely from Home. Thepennyhoarder.com. Published July 7, 2020. Accessed June 1, 2021. https://www.thepennyhoarder.com/make-money/side-gigs/work-from-home-coronavirus/ Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Last month we asked you a trivia question regarding needlestick safety and prevention – who was the President of the United States that signed the Needlestick Safety and Prevention Act into law and who was the Massachusetts nurse whose advocacy for sharps injury safety helped the act pass and who later became president of the American Nurses Association? The correct answer was President Bill Clinton and Karen Daley, PhD, MPH, RN, FAAN. Please note that for this month, if you get the trivia question correct, you will win your course registration to one of our LIVE EM Boot Camp Courses, available in July and November of this year! It’s a great course so be sure to download and listen to the episode for the question! Please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to.

Welcome to Episode 5 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Full show notes for Episode 5 of “The 2 View” can also be found here: https://docs.google.com/document/d/1zcY2AKac2_5xxSwwubIgkypWkRI-uRit9zuIvqDpPLY/edit?usp=sharing Needle Sticks Needlestick Helpline: If you have questions about appropriate medical treatment for occupational exposures, assistance is available from the Clinicians’ Post Exposure Prophylaxis (PEP) Line at 1-888-448-4911. National Clinician Consultation Center. Ucsf.edu. Accessed April 22, 2021. https://nccc.ucsf.edu/ Moayedi, Siamak MD, Torres, Mercedes MD. HIV Post-Exposure Prophylaxis. EM:RAP CorePendium. Emrap.org. Updated October 5, 2020. Accessed April 22, 2021. https://www.emrap.org/corependium/chapter/rech6mbrZTyKtAIqw/HIV-Post-Exposure-Prophylaxis Roberts, Martha ACNP, CEN. Viewpoint: A Needle Stick and a Life Lesson. Emergency Medicine News. Lww.com. Updated December 2015. Accessed April 22, 2021. https://journals.lww.com/em-news/Fulltext/2015/12000/Viewpoint_ANeedleStickandaLife_Lesson.19.aspx Announcement: Updated Guidelines for Antiretroviral Postexposure Prophylaxis after Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV — United States, 2016. Morbidity and Mortality Weekly Report (MMWR). Cdc.gov. Updated May 6, 2016. Accessed April 22, 2021. https://www.cdc.gov/mmwr/volumes/65/wr/mm6517a5.htm U.S. Public Health Service. Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis. MMWR Recomm Rep. 2001;50(RR-11):1-52. Cdc.gov. Updated June 29, 2001. Accessed April 22, 2021. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm Dominguez KL, Smith DK, Thomas V, et al. Updated guidelines for antiretroviral postexposure prophylaxis after sexual, injection drug use, or other nonoccupational exposure to HIV—United States, 2016. Cdc.gov. Updated May 23, 2018. Accessed April 22, 2021. https://stacks.cdc.gov/view/cdc/38856 Schillie S, Vellozzi C, Reingold A, et al. Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2018;67(1):1-31. Cdc.gov. Updated January 12, 2018. Accessed April 22, 2021. https://www.cdc.gov/mmwr/volumes/67/rr/rr6701a1.htm CDC - Bloodborne Infectious Diseases: HIV/AIDS, Hepatitis B, Hepatitis C - Emergency Needlestick Information - NIOSH Workplace Safety and Health Topic. Cdc.gov. Published November 21, 2018. Accessed April 22, 2021. https://www.cdc.gov/niosh/topics/bbp/emergnedl.html Hepatitis C Questions and Answers for Health Professionals. Cdc.gov. Published April 9, 2021. Accessed April 22, 2021. https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm Hepatitis B Foundation: Understanding Your Hepatitis B Test Results. Hepb.org. Accessed April 22, 2021. https://www.hepb.org/prevention-and-diagnosis/diagnosis/understanding-your-test-results/ Procedures: The Top Ten in EM Right Now Roberts M, Roberts JR. The Proceduralist. Accessed April 22, 2021. https://www.theproceduralist.org/ The Proceduralist. Youtube.com. Accessed April 22, 2021. https://www.youtube.com/channel/UCQtZPVvIl2tCJdNrslXcCww Back Pain Featuring W. Richard Bukata, M.D. Motov, Sergey. Faculty Forum: A Practical Approach to Pain Management. YouTube. https://www.youtube.com/watch?v=lJSioPsGw3A. The Center for Medical Education. Published December 2, 2020. Accessed April 22, 2021. @painfreeED LaFollette R. Back to Basics: Treatment of Acute Low Back Pain in the ED — Taming the SRU. Emergency Medicine Tamed. Tamingthesru.com. Published August 31, 2020. Accessed April 22, 2021. https://www.tamingthesru.com/blog/diagnostics/back-pain Della-Giustina D. Evaluation and treatment of acute back pain in the emergency department. Emerg Med Clin North Am. 2015;33(2):311-326. Published May 2015. Accessed April 22, 2021. https://pubmed.ncbi.nlm.nih.gov/25892724/ Edlow JA. Managing Nontraumatic Acute Back Pain. Ann Emerg Med. 2015;66(2):148-153. 2015. Accessed April 22, 2021. https://www.annemergmed.com/article/S0196-0644(14)01509-1/pdf Recurring Sources Center for Medical Education. Ccme.org. Accessed April 22, 2021. http://ccme.org The Skeptics Guide to Emergency Medicine. Thesgem.com. Accessed April 22, 2021. http://www.thesgem.com The Proceduralist. Theproceduralist.org. Accessed April 22, 2021. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. Accessed April 22, 2021. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx *Here are just a few links we mentioned in the podcast. This is a small taste of the 100's of videos and blogs we have on procedures. Be sure to check out the FULL library of videos and blogs on the blog site, The Procedural Pause. For new blogs and more, you can check out our new site, The Proceduralist! Procedure: Slit Lamp Exam - https://journals.lww.com/em-news/blog/theproceduralpause/pages/post.aspx?PostID=89 Procedure: Cerumen Impaction - https://journals.lww.com/em-news/blog/theproceduralpause/pages/post.aspx?PostID=109 Procedures: Ear Wicks - https://journals.lww.com/em-news/blog/theproceduralpause/pages/post.aspx?PostID=105 Procedure: Ankle relocations and splinting - https://journals.lww.com/em-news/blog/theproceduralpause/pages/post.aspx?PostID=90 Procedure: Some lower leg splinting - https://journals.lww.com/em-news/blog/theproceduralpause/pages/post.aspx?PostID=73 Procedure: Tonometry - https://journals.lww.com/em-news/blog/theproceduralpause/pages/post.aspx?PostID=86 Procedure: TXA / Epistaxis - https://www.youtube.com/watch?v=vx0nPnkJK44 Procedure: Lumbar Puncture (Part I in a series) - https://journals.lww.com/em-news/blog/theproceduralpause/pages/post.aspx?PostID=20 Procedure: Central Line Tie Down - https://www.youtube.com/watch?v=JyDjU3O_bNA Trivia Question: Send answers to 2viewcast@gmail.com Last month we asked you a trivia question regarding sickle cell disease – we know why it’s called sickle cell disease, but who were the two people who discovered why the red blood cells become a sickled shape? Desi Spellings, FNP-C from Memphis, Tennessee gave us the correct answer of E. Vernon Hahn and Elizabeth Gillespie. Be sure to cash in your prize – you can email meghan@ccme.org to get your course at 20% off. Please note that for this month, if you get the trivia question correct, you will win 20% off any CCME course you want. That’s right, ANY CCME course you want, including live courses. You can buy it for yourself or give it to a friend - it’s your 20% off. So, download and listen to the episode for the question! Please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to.

Welcome to Episode 4 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Full show Notes for Episode 4 of “The 2 View” can be found here: https://docs.google.com/document/d/1Awc9VPm2igzhKwNoDO07eq269bZTgrPtfSCJVVCvu6U/edit?usp=sharing Sickle Cell Brandow AM, Carroll CP, Creary S, et al. American Society of Hematology 2020 guidelines for sickle cell disease: management of acute and chronic pain. Blood Adv. 2020;4(12):2656-2701. Accessed April 5, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7322963/ Della-Moretta S, Delatore L, Purcell M, et al. The Effect of Use of Individualized Pain Plans in Sickle Cell Patients Presenting to the Emergency Department. Ann Emerg Med. Published September 2020. Accessed March 17, 2021. https://www.sciencedirect.com/science/article/pii/S019606442030648X Table from Cisewski D. ED Management of Sickle Cell Vaso-occlusive Crises: Myths, Facts, and A Novel Approach to Acute Pain Management. emDocs. Updated April 15, 2019. Accessed April 5, 2021. https://www.emdocs.net/ed-management-of-sickle-cell-vaso-occlusive-crises-myths-facts-and-a-novel-approach-to-acute-pain-management/ A Practical Approach to Pain Management in the Acute Care Setting with Dr. Sergey Motov, MD / EM Boot Camp Faculty Forum #2. Updated December 2, 2020. Accessed April 5, 2021. https://youtu.be/lJSioPsGw3A Sickle Cell Disease. CorePendium. EM:RAP.org, 2020. Updated December 7, 2020. Accessed April 5, 2021. https://www.emrap.org/corependium/chapter/recZWicqx0K20uwsz/Sickle-Cell-Disease Procedure IM Shots Roberts M, Roberts JR. Intramuscular Injections: 101 — The Proceduralist. The Proceduralist. Accessed March 17, 2021. https://www.theproceduralist.org/thecases/intramusclar-injections-101 You Call the Shots – Vaccine Administration: Intramuscular (IM) Injection Adults 19 years of age and older. Cdc.gov. Published November 16, 2020. Accessed March 17, 2021. https://www.cdc.gov/vaccines/hcp/admin/downloads/IM-Injection-adult.pdf Documentation Henry, Greg, MD. What You Must Know to Avoid Being Sued. Original Emergency Medicine Boot Camp. December 2019. Las Vegas. Accessed March 17, 2021. Risk Management Monthly. The Center for Medical Education. Accessed March 17, 2021. https://www.ccme.org/riskmgmt/ Weinstock MB; Longstreth R; Henry GL. Bouncebacks! Emergency Department Cases: ED Returns. 2nd ed. Anadem; 2018. First Time Seizures Epilepsy. American Association of Neurological Surgeons. Accessed March 17, 2021. https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Epilepsy Types of Seizures. Johns Hopkins Medicine. Accessed March 17, 2021. https://www.hopkinsmedicine.org/health/conditions-and-diseases/epilepsy/types-of-seizures Billet, M MD, Khouja, D MBBS. Seizures in Adults. EM:RAP CorePendium. Emrap.org. Updated September 15, 2020. Accessed March 17, 2021. https://www.emrap.org/corependium/chapter/recLTpXKGatE7jq2r/Seizures-in-Adults Pohlmann-Eden B, Beghi E, Camfield C, Camfield P. The first seizure and its management in adults and children. BMJ. Published February 11, 2006. Accessed March 17, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1363913/ Adamolekun, B MD. Seizure Disorders. Merck Manuals. Content last modified July 2020. Accessed March 17, 2021. https://www.merckmanuals.com/professional/neurologic-disorders/seizure-disorders/seizure-disorders Neurology. American Academy of Neurology. Accessed March 17, 2021. https://n.neurology.org/ Ho K, Lawn N, Bynevelt M, Lee J, Dunne J. Neuroimaging of first-ever seizure: Contribution of MRI if CT is normal. Neurol Clin Pract. Published October 2013. Accessed March 17, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5765827/ First Time Seizure. Emrap.org. Published August 2017. Accessed March 17, 2021. https://www.emrap.org/episode/c3seizures/seizuresfirst Trivia Question: Send answers to 2viewcast@gmail.com Please note that for this month, if you get the trivia question correct, you will win 20% off any CCME course you want. That’s right, ANY CCME course you want, including live courses. You can buy it for yourself or give it to a friend - it’s your 20% off. So, download and listen to the episode for the question! Please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to.

Welcome to episode 3 of The 2 View, the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 3 of The 2 View Pancreatitis Mederos MA, Reber HA, Girgis MD. Acute Pancreatitis: A Review. JAMA. Published January 26, 2021. Accessed February 3, 2021. https://jamanetwork.com/journals/jama/article-abstract/2775452 Besinger, B, Stehman, C. Pancreatitis and Cholecystitis. McGraw-Hill Medical. Accessed February 3, 2021. https://accessmedicine.mhmedical.com/content.aspx?bookid=2353&sectionid=189593288 Singh VK, Wu BU, Bollen TL, et al. Early Systemic Inflammatory Response Syndrome is Associated with Severe Acute Pancreatitis. Clin Gastroenterol Hepatol. Published 2009. Accessed February 3, 2021. https://www.cghjournal.org/article/S1542-3565(09)00774-5/pdf#:~:text=Second%2C%20patients%20with%203%20or,care%2C%20and%2013%25%20died. Mofidi R, Duff MD, Wigmore SJ, Madhavan KK, Garden OJ, Parks RW. Association between early systemic inflammatory response, severity of multiorgan dysfunction and death in acute pancreatitis. Br J Surg. Published June 2006. Accessed February 3, 2021. https://pubmed.ncbi.nlm.nih.gov/16671062/ Murali, N. Pancreatic Disease. EM:RAP CorePendium. Emrap.org. Updated January 13, 2021. Accessed February 3, 2021. https://www.emrap.org/corependium/chapter/recNUBEcCXS86j9qX/Pancreatic-Disease Cast Cutter Roberts M, Roberts JR. The Proceduralist. https://www.theproceduralist.org/. Accessed February 3, 2021. Frosch, D, Knott, P. Cast Cutter. ScienceDirect. Published 2007. Accessed February 3, 2021. https://www.sciencedirect.com/topics/nursing-and-health-professions/cast-cutter Questions Local Reactions, Systemic Reactions, Adverse Events, and Serious Adverse Events: Pfizer-BioNTech COVID-19 Vaccine. Cdc.gov. Published January 14, 2021. Accessed February 3, 2021. https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/reactogenicity.html Local Reactions, Systemic Reactions, Adverse Events, and Serious Adverse Events: Moderna COVID-19 Vaccine. Cdc.gov. Published December 22, 2020. Accessed February 3, 2021. https://www.cdc.gov/vaccines/covid-19/info-by-product/moderna/reactogenicity.html Information on COVID-19 treatment, prevention and research. Nih.gov. Accessed February 3, 2021. https://www.covid19treatmentguidelines.nih.gov/ Targett C, Harris T. Towards evidence-based emergency medicine: Best BETs from the Manchester Royal Infirmary. BET 3: Can metronomes improve CPR quality? Emerg Med J. Published 2014. Accessed February 3, 2021. https://emj.bmj.com/content/31/3/251 Headaches/Migraine Volpi-Abadie J, Kaye AM, Kaye AD. Serotonin Syndrome. Ochsner J. Published Winter 2013. Accessed February 3, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865832/ Roberts, J. InFocus: The Best Three Treatments for Migraine. Emergency Medicine News. Published January 2018. Accessed February 3, 2021. https://journals.lww.com/em-news/Fulltext/2018/01000/InFocus_TheBestThreeTreatmentsforMigraine.8.aspx Roberts, J. InFocus: The Miserable, Misunderstood Migraine. Emergency Medicine News. Published December 2017. Accessed February 3, 2021. https://journals.lww.com/em-news/Fulltext/2017/12000/InFocus_TheMiserable,MisunderstoodMigraine.8.aspx Your resource for headache info. Americanheadachesociety.org. Published May 17, 2016. Accessed February 3, 2021. https://americanheadachesociety.org/

View the full show notes on Google Docs here: http://bit.ly/3cpvlJc 2020 BLS/ACLS Guideline Changes Merchant RM, Topjian AA, Panchal AR, et al. Part 1: Executive summary: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. Published October 21, 2020. Accessed January 20, 2021. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000918 Highlights of the 2020 American Heart Association Guidelines for CPR and ECC. American Heart Association. Published 2020. Accessed January 20, 2021. https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts2020eccguidelinesenglish.pdf Edelson DP, Sasson C, Chan PS, et al. Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates with Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get with The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association. Circulation. Published April 9, 2020. Accessed January 20, 2021. https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.120.047463 Topjian A, Aziz K, Kamath-Rayne BD, et al. Interim Guidance for Basic and Advanced Life Support in Children and Neonates with Suspected or Confirmed COVID-19. Pediatrics. Published 2020. Accessed January 20, 2021. https://pediatrics.aappublications.org/content/early/2020/04/13/peds.2020-1405 Hunt EA, Jeffers J, McNamara L, et al. Improved Cardiopulmonary Resuscitation Performance with CODE ACES2: A Resuscitation Quality Bundle. Journal of the American Heart Association. Published December 7, 2018. Accessed January 20, 2021. https://www.ahajournals.org/doi/10.1161/JAHA.118.009860 Procedural Pearl of the Month - Fish Hooks Roberts M, Roberts JR. The Proceduralist. https://www.theproceduralist.org/. Accessed January 20, 2021. The Procedural Pause by James R. Roberts, MD, & Martha Roberts, ACNP, PNP. Fishing Out the Fishhook. Emergency Medicine News. Published September 1, 2020. Accessed January 20, 2021. https://journals.lww.com/em-news/blog/theproceduralpause/pages/post.aspx?PostID=108 Droperidol DeFranco, C, DO. Oldie but a Goodie: 10 Pearls of Droperidol. Acep.org. Published 2021. Accessed January 20, 2021. https://www.acep.org/how-we-serve/sections/pain-management/news/may-2020/oldie-but-a-goodie-10-pearls-of-droperidol/ Ho, J, FAAEM MD, Perkins J, FAAEM MD. Clinical Practice Statement: Safety of Droperidol Use in the Emergency Department. Aaem.org. Published September 7, 2013. Accessed January 20, 2021. https://www.aaem.org/UserFiles/file/Safety-of-Droperidol-Use-in-the-ED.pdf Cisewski, D MD. Droperidol Use in the Emergency Department – What’s Old is New Again. Emdocs.net. Published August 1, 2019. Accessed January 20, 2021. http://www.emdocs.net/droperidol-use-in-the-emergency-department-whats-old-is-new-again/ Ken’s Third View SGEM#315: Comfortably Numb with Topical Tetracaine for Corneal Abrasions. Thesgem.com. Published January 16, 2021. Accessed January 20, 2021. http://thesgem.com/2021/01/sgem315-comfortably-numb-with-topical-tetracaine-for-corneal-abrasions/ Shipman S, Painter K, Keuchel M, Bogie C. Short-Term Topical Tetracaine Is Highly Efficacious for the Treatment of Pain Caused by Corneal Abrasions: A Double-Blind, Randomized Clinical Trial. Ann Emerg Med. Published October 27, 2020. Accessed January 20, 2021. https://pubmed.ncbi.nlm.nih.gov/33121832/ SGEM#316: What A Difference an A.P.P. Makes? Diagnostic Testing Differences Between A.P.P.S and Physicians. Thesgem.com. Published January 23, 2021. Accessed January 24, 2021. http://thesgem.com/2021/01/sgem316-what-a-difference-an-a-p-p-makes-diagnostic-testing-differences-between-a-p-p-s-and-physicians/ Pines JM, Zocchi MS, Ritsema TS, Bedolla J, Venkat A, US Acute Care Solutions Research Group. Emergency Physician and Advanced Practice Provider Diagnostic Testing and Admission Decisions in Chest Pain and Abdominal Pain. Acad Emerg Med. Published November 21, 2020. Accessed January 20, 2021. https://pubmed.ncbi.nlm.nih.gov/33107088/ Gonorrhea Questions Answered Scully BE, Fu KP, Neu HC. Pharmacokinetics of ceftriaxone after intravenous infusion and intramuscular injection. Am J Med. Published October 19, 1984. Accessed January 20, 2021. https://pubmed.ncbi.nlm.nih.gov/6093511/ Meyers BR, Srulevitch ES, Jacobson J, Hirschman SZ. Crossover study of the pharmacokinetics of ceftriaxone administered intravenously or intramuscularly to healthy volunteers. Antimicrob Agents Chemother. Published November 1983. Accessed January 20, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC185948/ Shatsky M. Evidence for the use of intramuscular injections in outpatient practice. Am Fam Physician. Published February 15, 2009. Accessed January 20, 2021. https://pubmed.ncbi.nlm.nih.gov/19235496/ Trivia Question: Send answers to 2viewcast@gmail.com Please note that for this month, if you get the trivia question correct, you will win 20% off any CCME course you want. That’s right, ANY CCME course you want. You can buy it for yourself or give it to a friend - it’s your 20% off. So, download and listen to the episode for the question! Please email us your guesses at 2viewcast@gmail.com, that’s the number 2, view, cast @gmail.com and tell us who you want to give a shout-out to.

View the show notes in Google Docs here: http://bit.ly/3bFS43j Gonorrhea Updates Gonorrhea Treatment and Care. Centers for Disease Control and Prevention Website. https://www.cdc.gov/std/gonorrhea/treatment.htm. Published December 14, 2020. Accessed January 11, 2021. CDC No Longer Recommends Oral Drug for Gonorrhea Treatment. Centers for Disease Control and Prevention. https://www.cdc.gov/nchhstp/newsroom/2012/gctx-guidelines-pressrelease.html. Published August 9, 2012. Accessed January 11, 2021. Recurrent UTI Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2019). American Urological Association. https://www.auanet.org/guidelines/recurrent-uti?fbclid=IwAR1TwSTQNHv8PDWLfW7WjsDan46D_9b6Qs1ptJxaXr6YFnDpBeptpW3BY. Published 2019. Accessed January 11, 2021. Combo Ibuprofen and Acetaminophen / Pain Advil® Dual Action. GSK Expert Portal. https://www.gskhealthpartner.com/en-us/pain-relief/brands/advil/products/dual-action/?utmsource=google&utmmedium=cpc&utmterm=ibuprofen+acetaminophen&utmcampaign=GS+-+Unbranded+Advil+DA+-+Alone+-+PH. Accessed January 11, 2021. FDA approves GSK's Advil Dual Action with Acetaminophen for over-the-counter use in the United States. GSK. https://www.gsk.com/en-gb/media/press-releases/fda-approves-gsk-s-advil-dual-action-with-acetaminophen-for-over-the-counter-use-in-the-united-states/. Published March 2, 2020. Accessed January 11, 2021. Tanner T, Aspley S, Munn A, Thomas T. The pharmacokinetic profile of a novel fixed-dose combination tablet of ibuprofen and paracetamol. BMC clinical pharmacology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2906415/. Published July 5, 2010. Accessed January 11, 2021. Searle S, Muse D, Paluch E, et al. Efficacy and Safety of Single and Multiple Doses of a Fixed-dose Combination of Ibuprofen and Acetaminophen in the Treatment of Postsurgical Dental Pain: Results From 2 Phase 3, Randomized, Parallel-group, Double-blind, Placebo-controlled Studies. The Clinical journal of pain. https://pubmed.ncbi.nlm.nih.gov/32271183/. Published July 2020. Accessed January 11, 2021. 1000 mg versus 600/650 mg Acetaminophen for Pain or Fever: A Review of the Clinical Efficacy. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK373467/. Published June 17, 2016. Accessed January 11, 2021. Motov S. Is There a Limit to the Analgesic Effect of Pain Medications? Medscape. https://www.medscape.com/viewarticle/574279. Published June 17, 2008. Accessed January 11, 2021. Motov, Sergey. Faculty Forum: A Practical Approach to Pain Management. YouTube. https://www.youtube.com/watch?v=lJSioPsGw3A. The Center for Medical Education. Published December 2, 2020. Accessed January 1, 2021. Wuhrman E, Cooney MF. Acute Pain: Assessment and Treatment. Medscape. https://www.medscape.com/viewarticle/735034_4. Published January 3, 2011. Accessed January 11, 2021. Social Pain Dewall CN, Macdonald G, Webster GD, et al. Acetaminophen reduces social pain: behavioral and neural evidence. Psychological science. https://pubmed.ncbi.nlm.nih.gov/20548058/. Published June 14, 2010. Accessed January 11, 2021. Mischkowski D, Crocker J, Way BM. From painkiller to empathy killer: acetaminophen (paracetamol) reduces empathy for pain. Social cognitive and affective neuroscience. https://pubmed.ncbi.nlm.nih.gov/27217114/. Published May 5, 2016. Accessed January 11, 2021. Other / Recurrent liner notes Center for Medical Education. https://courses.ccme.org/. Accessed January 11, 2021. Roberts M, Roberts JR. The Proceduralist. https://www.theproceduralist.org/. Accessed January 11, 2021. The Procedural Pause by James R. Roberts, MD, & Martha Roberts, ACNP, PNP. Emergency Medicine News. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx. Accessed January 11, 2021. The Skeptics' Guide to Emergency Medicine. sgem.ccme.org. https://sgem.ccme.org/. Accessed January 11, 2021. Trivia Question: Send answers to 2viewcast@gmail.com Please note that you must answer the 2 part question to win a copy of the EMRA Pain Guide. “What controversial drug was given a black box warning for prolonged QT and torsades in 2012 and now has been declared by WHICH organization to be an effective and safe treatment use for nausea, vomiting, headache and agitation?” Practical Pain Management in Acute Care Setting Handout Sergey Motov, MD @painfreeED • Pain is one of the most common reasons for patients to visit the emergency department and other acute care settings. Due to the extensive number of visits related to pain, clinicians and midlevel providers should be aware of the various options, both pharmacological and nonpharmacological, available to treat patients with acute pain. • As the death toll from the opioid epidemic continues to grow, the use of opioids in the acute care setting as a first-line treatment for analgesia is becoming increasingly controversial and challenging. • There is a growing body of literature that is advocating for more judicious use of opioids and well as their prescribing and for broader use of non-pharmacological and non-opioid pain management strategies. • The channels/enzymes/receptors targeted analgesia (CERTA) concept is based on our improved understanding of the neurobiological aspect of pain with a shift from a symptom-based approach to pain to a mechanistic approach. This targeted analgesic approach allows for a broader utilization of synergistic combinations of nonopioid analgesia and more refined and judicious (rescue) use of opioids. These synergistic combinations result in greater analgesia, fewer side effects, lesser sedation, and shorter LOS. (Motov et al 2016) General Principles: Management of acute pain in the acute care setting should be patient-centered and pain syndrome-specific by using multimodal approach that include non-pharmacological modalities and pharmacological ones that include non-opioid and opioid analgesics. Assessment of acute pain should be based on a need for analgesics to improve functionality, rather than patients-reported pain scores. Brief pain inventory short form BPI-SF is better than NRS/VAS as it assesses quantitative and qualitative impact of pain (Im et al 2020). ED clinicians should engage patients in shared decision-making about overall treatment goals and expectations, the natural trajectory of the specific painful condition, and analgesic options including short-term and long-term benefits and risks of adverse effects. If acute pain lasting beyond the expected duration, complications of acute pain should be ruled out and transition to non-opioid therapy and non-pharmacological therapy should be attempted. Non-Pharmacologic Therapies • Acute care providers should consider applications of heat or cold as well as specific recommendations regarding activity and exercise. • Music therapy is a useful non-pharmacologic therapy for pain reduction in acute care setting (music-assisted relaxation, therapeutic listening/musical requests, musical diversion, song writing, and therapeutic singing (Mandel 2019). • The use of alternative and complementary therapies, such as acupuncture, guided imagery, cognitive-behavioral therapy, and hypnosis have not been systemically evaluated for use in the Acute care setting including ED. (Dillan 2005, Hoffman 2007) • In general, their application may be limited for a single visit, but continued investigation in their safety and efficacy is strongly encouraged. • Practitioners may also consider utilization of osteopathic manipulation techniques, such as high velocity, low amplitude techniques, muscle energy techniques, and soft tissue techniques for patients presenting to the acute care setting with pain syndromes of skeletal, arthroidal, or myofascial origins. (Eisenhart 2003) Opioids • Acute Care providers are uniquely positioned to combat the opioid epidemic by thoughtful prescribing of parenteral and oral opioids in inpatient setting and upon discharge, and through their engagement with opioid addicted patients in acute care setting. • Acute Care providers should make every effort to utilize non-pharmacological modalities and non-opioid analgesics to alleviate pain, and to use opioid analgesics only when the benefits of opioids are felt to outweigh the risks. (not routinely) • When opioids are used for acute pain, clinicians should combine them with non-pharmacologic and non-opioid pharmacologic therapy: Yoga, exercise, cognitive behavioral therapy, complementary/alternative medical therapies (acupuncture); NSAID’s, Acetaminophen, Topical Analgesics, Nerve blocks, etc. • When considering opioids for acute pain, Acute Care providers should involve patients in shared decision-making about analgesic options and opioid alternatives, risks and benefits of opioid therapies, and rational expectations about the pain trajectory and management approach. • When considering opioids for acute pain, acute care providers should counsel patients regarding serious adverse effects such as sedation and respiratory depression, pruritus and constipation, and rapid development of tolerance and hyperalgesia. • When considering administration of opioids for acute pain, acute care providers should make every effort to accesses respective state’s Prescription Drug Monitoring Program (PDMP). The data obtained from PDMP’s to be used to identify excessive dosages and dangerous combinations, identify and counsel patients with opioid use disorder, offer referral for addiction treatment. • PDMPs can provide clinicians with comprehensive prescribing information to improve clinical decisions around opioids. However, PDMPs vary tremendously in their accessibility and usability in the ED, which limits their effectiveness at the point of care. Problems are complicated by varying state-to-state requirements for data availability and accessibility. Several potential solutions to improving the utility of PDMPs in EDs include integrating PDMPs with electronic health records, implementing unsolicited reporting and prescription context, improving PDMP accessibility, data analytics, and expanding the scope of PDMPs. (Eldert et al, 2018) • Parenteral opioids when used in titratable fashion are effective, safe, and easily reversible analgesics that quickly relieve pain. • Acute care clinicians should consider administering these analgesics for patients in acute pain where the likelihood of analgesic benefit is judged to exceed the likelihood of harm. • Parenteral opioids must be titrated regardless of their initial dosing regimens (weight-based or fixed) until pain is optimized to acceptable level (functionality status) or side effects become intolerable. • When parenteral opioids are used, patients should be engaged in shared-decision making regarding the route of administration, as repetitive attempts of IV cannulation and intramuscular injections are associated with pain. In addition, intramuscular injections are associated with unpredictable absorption rates, and complications such as muscle necrosis, soft tissue infection and the need for dose escalation. (Von Kemp 1989, Yamanaka 1985, Johnson 1976) • Morphine sulfate provides better balance of analgesic efficacy and safety among all parenteral opioids. a. Dosing regimens and routes: b. IV: 0.05-0.1mg/kg to start, titrate q 10-20 min c. IV: 4-6 mg fixed, titrate q 10-20 min d. SQ: 4-6 mg fixed, titrate q 20 min e. Nebulized: 0.2 mg/kg or 10-20 mg fixed, repeat q 15-20 min f. PCA: prone to dosing errors g. IM: should be avoided (pain, muscle fibrosis, necrosis, increase in dosing requirements) • Hydromorphone should be avoided as a first-line opioid due to significant euphoria and severe respiratory depression requiring naloxone reversal. Due to higher lipophilicity, Hydromorphone use is associated with higher rates of euphoria and subsequent development of addiction. Should hydromorphone be administered in higher than equi-analgesic morphine milligram equivalents, close cardiopulmonary monitoring is strongly recommended. Dosing h. IV: 0.2-0.5 mg initial, titrate q10-15 min i. IM: to be avoided (pain, muscle fibrosis, necrosis, increase in dosing requirements) j. PCA: prone to dosing errors (severe CNS and respiratory depression) k. Significantly worse AE profile in comparison to Morphine l. Equianalgesic IV conversion (1 mg HM=8mg of MS) m. Overprescribed in >50% of patients n. Inappropriately large dosing in EM literature: 2 mg IVP o. Abuse potential (severely euphoric due to lipophilicity) • Fentanyl is the most potent opioid, short-acting, requires frequent titration. Dosing: p. IV: 0.25-0.5 μg/kg (WB), titrate q10 min q. IV: 25-50 μg (fixed), titrate q10 min r. Nebulization: 2-4 μg/kg, titrate q20-30 min s. IN: 1-2 μg/kg, titrate q5-10min t. Transbuccal: 100-200μg disolvable tablets u. Transmucosal: 15-20 mcg/kg Lollypops • Opioids in Renal Insufficiency/Renal Failure Patients-requires balance of ORAE with pain control by starting with lower-than-recommended doses and slowly titrate up the dose while extending the dosing interval. (Dean 2004, Wright 2011) • Opioid-induced pruritus is centrally mediated process via μ-opioid receptors as naloxone, nalbuphine reverse it, and can be caused by opioids w/o histamine release (Fentanyl). Use ultra-low-dose naloxone of 0.25 -1 mcg/kg/hr with NNT of 3.5. (Kjellberg 2001) • When intravascular access is unobtainable, acute care clinicians should consider utilization of intranasal (fentanyl), nebulized (fentanyl and morphine), or transmucosal (rapidly dissolvable fentanyl tablets) routes of analgesic administration for patients with acute painful conditions. • Breath actuated nebulizer (BAN): enclosed canister, dual mode: continuous and on-demand, less occupational exposures. a. Fentanyl: 2-4 mcg//kg for children, 4 mcg/kg for adults: titration q 10 min up to three doses via breath-actuated nebulizer (BAN): systemic bioavailability of 50-60% of IV route. (Miner 2007, Furyk 2009, Farahmand 2014) b. Morphine: 10-20 mg g10 min up to 3 doses via breath-actuated nebulizer (BAN)-Systemic bioavailability (concentration) of 30-35% of IV Route. (Fulda 2005, Bounes 2009, Grissa 2015) c. Intranasal Fentanyl: IN via MAD at 1-2 mcg/kg titration q 5 min (use highly concentrated solution of 100mcg/ml for adults and 50 mcg/ml for children)- systemic bioavailability of 90% of IV dosing. (Karisen 2013, Borland 2007, Saunders 2010, Holdgate 2010) d. IN route: shorter time to analgesia, titratable, comparable pain relief to IV route, minimal amount of side effects, similar rates of rescue analgesia, great patients and staff satisfaction. Disadvantages: requires highly concentrated solutions that not readily available in the ED, contraindicated in facial/nasal trauma. Oral Opioids • Oral opioid administration is effective for most patients in the acute care setting, however, there is no appreciable analgesic difference between commonly used opioids (oxycodone, hydrocodone and morphine sulfate immediate release (MSIR). • When oral opioids are used for acute pain, the lowest effective dose and fewest number of tablets needed should be prescribed. In most cases, less than 3 days’ worth are necessary, and rarely more than 5 days’ worth are needed. • If painful condition outlasts three-day supply, re-evaluation in health-care facility is beneficial. Consider expediting follow-up care if the patient’s condition is expected to require more than a three-day supply of opioid analgesics. • Only Immediate release (short-acting) formulary are to be prescribed in the acute care setting and at discharge. • Clinicians should not administer or prescribe long-acting, extended-release, or sustained-release opioid formulations, which include both oral and transdermal (fentanyl) medications in the acute care setting. These formulations are not indicated for acute pain and carry a high risk of overdose, particularly in opioid-naïve patients. • Acute care providers should counsel patients about safe medication storage and disposal, as well as the consequences of failure to do this; potential for abuse and misuse by others (teens and young adults), and potential for overdose and death (children and teens). • Oxycodone is no more effective than other opioids (hydrocodone, MSIR). Oxycodone has highest potential for abuse, misuse and diversion as well as increased risks of overdose, addiction and death. Oxycodone should be avoided as a first-line oral opioid for acute pain. ( Strayer 2016) • If still prescribed, lowest dose (5mg) in combination with acetaminophen (lowest dose of 325 mg) should be considered as it associated with less abuse and diversion (in theory). Potential for acetaminophen overdose exist though with combination. • Hydrocodone is three times more prescribed than oxycodone, but three times less used for non-medical purpose. Combo with APAP (Vicodin)-Use lowest effective dose for hydrocodone and APAP (5/325). (Quinn 1997, Adams 2006) • Immediate release morphine sulfate (MSIR) administration is associated with lesser degree of euphoria and consequently, less abuse potential (Wightman 2012). ED providers should consider prescribing Morphine Sulfate Immediate Release Tablets (MSIR) (Wong 2012, Campos 2014) for acute pain due to: o Similar analgesic efficacy to Oxycodone and Hydrocodone o Less euphoria (less abuse potential) o Less street value (less diversion) o More dysphoria in large doses o Less abuse liability and likeability • Tramadol should not be used in acute care setting and at discharge due to severe risks of adverse effects, drug-drug interactions, and overdose. There is very limited data supporting better analgesic efficacy of tramadol in comparison to placebo, or better analgesia than APAP or Ibuprofen. Tramadol dose not match analgesic efficacy of traditional opioids. (Juurlink 2018, Jasinski 1993, Babalonis 2013) • Side effects are: o Seizures o Hypoglycemia o Hyponatremia o Serotonin syndrome o Abuse and addiction • Codeine and Codeine/APAP is a weak analgesic that provides no better pain relief than placebo. Codeine must not be administered to children due to: o dangers of the polymorphisms of the cytochrome P450 iso-enzyme: o ultra-rapid metabolizers: respiratory depression and death o poor metabolizers: absent or insufficient pain relief • Transmucosal fentanyl (15 and 20 mcg/kg lollypops) has an onset of analgesia in 5 to 15 minutes with a peak effect seen in 15 to 30 minutes (Arthur 2012). • Transbuccal route can be used right at the triage to provide rapid analgesia and as a bridge to intravenous analgesia in acute care setting. (Ashburn 2011). A rapidly dissolving trans-buccal fentanyl (100mcg dose) provides fast pain relief onset (median 10 min), great analgesics efficacy, minimal need for rescue medication and lack of side effects in comparison to oxycodone/acetaminophen tablet (Shear 2010) • Morphine Milligram Equivalent (MME) is a numerical standard against which most opioids can be compared, yielding a comparison of each medication’s potency. MME does not give any information of medications efficacy or how well medication works, but it is used to assess comparative potency of other analgesics. • By converting the dose of an opioid to a morphine equivalent dose, a clinician can determine whether a cumulative daily dose of opioids approaches an amount associated with increased risk of overdose and to identify patients who may benefit from closer monitoring, reduction or tapering of opioids, prescribing of naloxone, and other measures to reduce risk of overdose. • Opioid-induced hyperalgesia: o opioid-induced hyperalgesia (OIH) is a rare syndrome of increasing pain, often accompanied by neuroexcitatory effects, in the setting of increasing opioid therapy. o Morphine is by far the most common opiate implicated in OIH. Hydromorphone and oxycodone, members of the same class of opiate as morphine (phenanthrenes), can also cause OIH. Fentanyl, a synthetic opioid in the class of phenylpiperidine, is less likely to precipitate OIH. Existing data suggests that OIH is caused by multiple opioid-induced changes to the central nervous system including: -Activation of N-methyl-D-aspartate (NMDA) receptors -Inhibition of the glutamate transporter system -Increased levels of the pro-nociceptive peptides within the dorsal root ganglia -Activation of descending pain facilitation from the rostral ventromedial medulla -Neuroexcitatory effects provoked by metabolites of morphine and hydromorphone • OIH can be confused with tolerance as in both cases patients report increased pain on opioids. The two conditions can be differentiated based on the patient’s response to opioids. In tolerance, the patient’s pain will improve with dose escalation. In OIH, pain will worsen with opioid administration. This paradoxical effect is one of the hallmarks of the syndrome. Non-opioid analgesics • Acetaminophen is indicated for management of mild to moderate pain and as a single analgesic and has modest efficacy at most. Addition of Acetaminophen to Ibuprofen does not provide better analgesia for patients with acute low back pain. The greatest limitation to the use of intravenous (IV) versus oral acetaminophen is the nearly 100-fold cost differential, which is likely not justified by any marginal improvement in pain relief. Furthermore, IV APAP provide faster onset of analgesia only after an initial dose. (Yeh 2012, Serinken 2012) • NSAIDs should be administered at their lowest effective analgesic doses both in the ED and upon discharge and should be given for the shortest appropriate treatment course. Caution is strongly advised when NSAIDs are used in patients at risk for renal insufficiency, heart failure, and gastrointestinal hemorrhage, as well as in the elderly. Strong consideration should be given to topical NSAID’s in managing as variety of acute and chronic painful Musculo-skeletal syndromes. The analgesic ceiling refers to the dose of a drug beyond which any further dose increase will not result in additional analgesic efficacy. Thus, the analgesics ceiling for ibuprofen is 400 mg per dose (1200 mg/24 h) and for ketorolac is 10 mg per dose (10 mg/24 h). These doses are less than those often prescribed for control of inflammation and fever. When it comes to equipotent doses of different NSAIDs, there is no difference in analgesic efficacy. • Ketamine, at sub-dissociative doses (also known as low-dose ketamine or analgesic dose ketamine) of 0.1 to 0.4 mg/kg, provided effective analgesia as a single agent or as an adjunct to opioids (reducing the need for opioids) in the treatment of acute traumatic and nontraumatic pain in the ED. This effective analgesia, however, must be balanced against high rates of minor adverse side effects (14%–80%), though typically short-lived and not requiring intervention. In addition to IV rout, ketamine can be administered via IN,SQ, and Nebulized route. • Local anesthetics are widely used in the ED for topical, local, regional, intra-articular, and systemic anesthesia and analgesia. Local anesthetics (esters and amides) possess analgesic and anti-hyperalgesic properties by non-competitively blocking neuronal sodium channels. o Topical analgesics containing lidocaine come in patches, ointments, and creams have been used to treat pain from acute sprains, strains, and contusions as well as variety of acute inflammatory and chronic neuropathic conditions, including postherpetic neuralgia (PHN), complex regional pain syndromes (CRPS) and painful diabetic neuropathy (PDN). o UGRA used for patients with lower extremity fractures or dislocations (eg, femoral nerve block, fascia iliaca compartment block) demonstrated significant pain control, decreased need for rescue analgesia, and first-attempt procedural success. In addition, UGRA demonstrated few procedural complications, minimal need for rescue analgesia, and great patient satisfaction. o Analgesic efficacy and safety of IV lidocaine has been evaluated in patients with renal colic and acute lower back pain. Although promising, this therapy will need to be studied in larger populations with underlying cardiac disease before it can be broadly used. o knvlsd • Antidopaminergic and Neuroleptics are frequently used in acute care settings for treatment of migraine headache, chronic abdominal pain, cannabis-induced hyperemesis. • Anti-convulsant (gabapentin and pregabalin) are not recommended for management of acute pain unless pain is of neuropathic origin. Side effects, particularly when combined with opioids (potentiation of euphoria and respiratory depression), titration to effect, and poor patients’ compliance are limiting factors to their use. (Peckham 2018) References: Chang HY, Daubresse M, Kruszewski SP, et al. 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