FOAMcast - Emergency Medicine Core Content

 The Free Open Access Medical Education (FOAM) world is often obsessed with magnesium. In this show we address the use of magnesium for various applications.

Magnesium for Acute Atrial Fibrillation with Rapid Ventricular Response (RVR)

  1. Bouida et al. LOw dose MAGnesium sulfate versus HIgh dose in the early management of rapid atrial fibrillation: randomised controlled double blind study. Acad Emerg Med. 2018 Jul 19.
  2. Ho KM, Sheridan DJ, Paterson T. Use of intravenous magnesium to treat acute onset atrial fibrillation: a meta-analysis. Heart. 2007;93(11):1433-40.
  3. Davey MJ, Teubner D. A randomized controlled trial of magnesium sulfate, in addition to usual care, for rate control in atrial fibrillation. Ann Emerg Med. 2005;45(4):347-53.

Magnesium for Migraine

  1. Corbo J, Esses D, Bijur PE, Iannaccone R, Gallagher EJ. Randomized clinical trial of intravenous magnesium sulfate as an adjunctive medication for emergency department treatment of migraine headache. Ann Emerg Med. 2001;38(6):621–7.
  2. Bigal ME, Bordini CA, Tepper SJ, Speciali JG. Intravenous magnesium sulphate in the acute treatment of migraine without aura and migraine with aura. A randomized, double-blind, placebo-controlled study. Cephalalgia. 2002;22(5):345-53.
  3. 1Cete Y, Dora B, Ertan C, Ozdemir C, Oktay C. A randomized prospective placebo-controlled study of intravenous magnesium sulphate vs. metoclopramide in the management of acute migraine attacks in the Emergency Department. Cephalalgia. 2005;25(3):199–204.
  4. Shahrami A, Assarzadegan F, Hatamabadi HR, Asgarzadeh M, Sarehbandi B, Asgarzadeh S. Comparison of therapeutic effects of magnesium sulfate vs. dexamethasone/metoclopramide on alleviating acute migraine headache. J Emerg Med. 2015;48(1):69–76.
  5. Orr SL, Friedman BW, Christie S, Minen MT, Bamford C, Kelley NE, et al. Management of Adults with Acute Migraine in the Emergency Department: The American Headache Society Evidence Assessment of Parenteral Pharmacotherapies. Headache. 2016;56(6):911–40.

Magnesium for Acute Asthma Exacerbation

Griffiths B, Kew KM. Intravenous magnesium sulfate for treating children with acute asthma in the emergency department. Cochrane Database Syst Rev. 2016;4:CD011050.
Kew KM, Kirtchuk L, Michell CI. Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department. Cochrane Database Syst Rev. 2014;(5):CD010909.

 

Thanks for listening!

Jeremy Faust and Lauren Westafer

Direct download: magFIX.mp3
Category:general -- posted at: 8:24am EST

In this episode we highlight key articles in Emergency Medicine that came out, thus far, in 2018.

D'souza et al. Effects of prophylactic anticholinergic medications to decrease extrapyramidal side effects in patients taking acute antiemetic drugs: a systematic review and meta-analysis Emerg Med J. 2018;35(5):325-331.

Driver et al. Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. JAMA. 2018;319(21):2179-2189.

Atkinson PR, Milne J, Diegelmann L, et al. Does Point-of-Care Ultrasonography Improve Clinical Outcomes in Emergency Department Patients With Undifferentiated Hypotension? An International Randomized Controlled Trial From the SHoC-ED Investigators. Ann Emerg Med. 2018; In press.

Perkins GD et al. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. N Engl J Med 2018; 379:711-721

Meltzer et al. Effect of Tamsulosin on Passage of Symptomatic Ureteral Stones: A Randomized Clinical Trial. JAMA Intern Med. 2018 Aug 1;178(8):1051-1057

Kabrhel et al Multicenter Evaluation of the YEARS Criteria in Emergency Department Patients Evaluated for Pulmonary Embolism. Acad Emerg Med. 2018;25(9):987-994

 

Thanks for listening!
Jeremy Faust and Lauren Westafer

Direct download: FOAMCast_2018_literature_review.mp3
Category:general -- posted at: 11:30am EST

We bring you pearls from the American College of Emergency Physicians (ACEP) 2018 Scientific Assembly in San Diego, CA.

In this episode we highlight:

  • Myths in diagnostic imaging
    • Torsion ultrasound is insensitive
    • CTPA for PE is not perfect. There are false positives AND false negatives
  • Myths in pediatrics
    • Response to antipyretics does NOT make viral infection more likely
    • Juice in kids with gastroenteritis is a great way to rehydrate them
    • Kids don't have to wait 24 hours on antibiotics for strep throat before returning to school, if they got 50 mg/kg amoxicillin prior to 5pm the night before, they're fine

Thanks for listening!
Jeremy Faust and Lauren Westafer

Direct download: FOAMCast_ACEP18_San_Diego_Day_3_.mp3
Category:general -- posted at: 5:14pm EST

We bring you pearls from the American College of Emergency Physicians (ACEP) 2018 Scientific Assembly in San Diego, CA.

In this episode we highlight:

  • Problems with CYA (Cover your a$$) medicine such as admissions
  • Problems with lactate, procalcitonin, and other biomarkers

Thanks for listening!
Jeremy Faust and Lauren Westafer

Direct download: FOAMCast_ACEP18_San_Diego_Day_2_.mp3
Category:general -- posted at: 8:07pm EST

We bring you pearls from the American College of Emergency Physicians (ACEP) 2018 Scientific Assembly in San Diego, CA.

In this episode we highlight:

  • Severe pediatric brain injury, tips for management and preventing badness
  • Aortic dissection diagnostics
  • Chest tube pearls

Thanks for listening!
Jeremy Faust and Lauren Westafer

Direct download: FOAMCast_Pediatrics_Head_Trauma_from_ACEP18_San_Diego_Day_1_.mp3
Category:general -- posted at: 6:15pm EST

We cover a JAMA Clinical Reviews podcast on lyme disease, including some myth-busters.

*Doxycycline can be used, safely, in kids < 8 years old

*Testing for lyme is a mess because : (1) we test patients with ultra low probability of disease (2) we test patients who shouldn't be tested (i.e. have erythema migrans) (3) the tests are a pain to interpret

*Lyme disease is spreading further south and west in the US, into Canada, and it's also increasingly found in Europe.

We then delve into core content for Rosen's, Tintinalli, and the IDSA 2006 guidelines.

Thanks for listening!
Jeremy Faust and Lauren Westafer

FOAMcast.org

 

 

Direct download: FOAMCast_Lyme_v2.mp3
Category:general -- posted at: 9:27am EST

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

Direct download: FOAMcast_Penile_Fracture_and_Priapism__.mp3
Category:general -- posted at: 3:31pm EST

We review one of the editors top picks from Annals of Emergency Medicine, which are free for 6 months from issue release.  The article covered in this podcast is Waldman et al, is a study of tetracaine in corneal abrasions.

We also review commonly encountered corneal emergencies:

Corneal abrasions

Corneal ulcers

and herpes keratoconjunctivitis.

Thanks for listening!
Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_Annals_Corneal_Abrasion__v2.mp3
Category:general -- posted at: 8:24am EST

Show notes at FOAMcast.org

We cover the 2017 IDSA/SHEA guidelines on clostridium difficile (c diff).

We then review core content on c diff including risk stratification and treatment using Rosen's and Tintinalli as guides.

Thanks for listening!
Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_C_diff.mp3
Category:general -- posted at: 2:32am EST

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

Thanks for listening,
Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_ACEP_policy_on_VTE_and_PE.mp3
Category:general -- posted at: 10:02am EST

We cover the emergency department care of lactating patients including

Medications during breastfeeding - who should "pump and dump"? (spoiler: very few people, check LactMed or InfantRisk)

Mastitis & Breast Abscesses

Emergency Department Support

Thanks for listening!
Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_lactation_.mp3
Category:general -- posted at: 9:30pm EST

Show notes at FOAMcast.org

We have a special April 1st show - the Faust-Westafer Central Theorem of Emergency Medicine. Listen for details

Thanks for listening!
Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_Faust_Westafer_Central_Theorem_of_Emergency_Medicine_.mp3
Category:general -- posted at: 12:00am EST

We review select articles from 2017 that are important or that got people talking including:

Sadeghirad B et al. Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials. BMJ. 2017;358:j3887.

Barniol et al.Levocetirizine and Prednisone Are Not Superior to Levocetirizine Alone for the Treatment of Acute Urticaria: A Randomized Double-Blind Clinical Trial. Ann Emerg Med. 2018;71(1):125-131.e1

Wilson SS, Kwiatkowski GM, Millis SR, Purakal JD, Mahajan AP, Levy PD. Use of nitroglycerin by bolus prevents intensive care unit admission in patients with acute hypertensive heart failure. Am J Emerg Med. 2017;35(1):126-131.

Hu et al  Variability in Interpretation of Cardiac Standstill Among Physician Sonographers. Ann Emerg Med. 2017 Sep 1. S0196-0644(17)31376-8

Clattenburg et al Point-of-care ultrasound use in patients with cardiac arrest is associated prolonged cardiopulmonary resuscitation pauses: A prospective cohort study. Resuscitation. 2018;122:65-68.

Hinson JS et al. Risk of Acute Kidney Injury After Intravenous Contrast Media Administration. Ann Emerg Med. 2017

Healey CD et al. Asymptomatic cervical spine fractures: Current guidelines can fail older patients. J Trauma Acute Care Surg. 2017;83(1):119-125.

Crowell et al. Accuracy of Computed Tomography Imaging Criteria in the Diagnosis of Adult Open Globe Injuries by Neuroradiology and Ophthalmology. Acad Emerg Med. 2017;24(9):1072-1079.

Talan et al. Subgroup Analysis of Antibiotic Treatment for Skin Abscesses. Ann Emerg Med. 2018;71(1):21-30.

 

Direct download: FOAMcast_2017_lit_review.mp3
Category:general -- posted at: 6:36pm EST

We tackle some free open access medical education from the CDC on the flu vaccine, including:

  • Recommendations that individuals with any severity of egg allergy (including anaphylaxis) receive the flu vaccine. The only modification that needs to occur is patients with a history of true anaphylaxis to eggs should be given the flu shot in a setting where they can be monitored by a healthcare professional if needed (i.e. a doctor's office).
  • It is very unlikely that the flu vaccine causes Guillan-Barre Syndrome (GBS). If there is any increase as a result of the flu shot, it is 1-2 in 1,000,000.

We then dive into CDC recommendations on oseltamivir as well as contradictory data from the most recent Cochrane review.

Thanks for listening!

Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_influenza_2nd_bounce.mp3
Category:general -- posted at: 3:58am EST

Over at the Pulmcrit blog, Dr. Josh Farkas has proposed the use of phenobarbital monotherapy for the treatment of ethanol withdrawal and we cover this protocol.

We then dive into core content alcohol withdrawal using Rosen’s Emergency Medicine (9th ed) Chapter 142 , Tintinalli’s Emergency Medicine (8th ed) Chapter 292, and Goldfrank's Toxicologic Emergencies (10th ed) Chapter 81  as guides.

Thanks for listening,

Lauren Westafer and Jeremy Faust

Direct download: FOAMcast_Alcohol_withdrawal_.mp3
Category:general -- posted at: 8:28am EST

We discuss ultrasound diagnosis of pneumoperitoneum using a podcast from 5MinSono.

Then we delve into core content on gastritis, PUD, and helicobacter pylori using Rosen's Ch 78 and Tintinalli's Ch 79 as guides.

Thank for listening!
Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_pneumoperitoneum_.mp3
Category:general -- posted at: 9:21am EST

We cover Free Open Access Medical Education (FOAM) on mass casualty incidents, an unfortunate reality in the current United States climate (and elsewhere).  There is a must read (truly, emergency providers really should read this) in EP Monthly by Dr.Kevin Menes, “How One Las Vegas ED Saved Hundreds of Lives After the Worst Mass Shooting in U.S. History”. He details his process in running the Emergency Department that evening.

We cover pearls from other great resources include a post on the St. Emlyn's blog, "Mass Casualty Incidents: Lessons from the AAST" and a free EBMedicine article on ballistic injuries

Core Content: Chapter 192 Rosen's, Chapter 5 Tintinalli - Mass Casualty Incident Triage

Thanks for listening!
Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_MCIs_.mp3
Category:general -- posted at: 1:56am EST

We bring you pearls from the American College of Emergency Physicians (ACEP) 2017 Scientific Assembly.

We cover in-flight emergencies, need for contrast enhanced CT scans, bronchiolitis and sucrose for infants

Thanks for listening!
Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_ACEP_17_day_3_.mp3
Category:general -- posted at: 1:48pm EST

We bring you pearls from the American College of Emergency Physicians (ACEP) 2017 Scientific Assembly.

Pearls on H. Pylori from: It's Alimentary - Poo-Pourri of Conditions From the Mouth to Rectum - Dr. Adebayo, Dr. Batra, Dr. Bavokek

Emerging Infections: Zika and Its Friends - Dr. Joan Noelker

High Yield Toxicology - Dr Erickson, Dr Traub, Dr. Perrone

 

Direct download: FOAMcast_ACEP_17_day_2.mp3
Category:general -- posted at: 6:02pm EST

We cover top pearl from the American College of Emergency Physicians (ACEP) Scientific Assembly 2017.

Dr. Michael Winters - Critical Care Updates

Dr. Tim Horeczko - Pediatric Pitfalls

Thanks for listening!
Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_ACEP_17_day_1.mp3
Category:general -- posted at: 10:37pm EST

We cover some high yield, important, or frequently discussed recent articles.

Antibiotics and abscesses - Daum et al

FAST in hemodynamically stable patients -  Holmes et al

Haloperidol in gastroparesis - Roldan et al and Ramirez et al

Ignoring PERC - Buchanan et al

Steroids in non-asthma/COPD lower respiratory tract infections - Hay et al

Gender pay gap persists in academic EM (and it's not due to hours, rank, or roles) - Madsen et al

Direct download: FOAMcast_Lit_review_fall_2017_.mp3
Category:general -- posted at: 4:45pm EST

We review this blog post by Bryan Hayes, an ED pharmacist (@PharmERToxGuy), on the use of physostigmine in anticholinergic toxicity.

We then review anticholinergic toxidrome using Rosen's, Tintinalli's, and Goldfrank's as a guide.


Thanks for listening!

Lauren Westafer and Jeremy Faust

Direct download: FOAMcast_anticholinergics_and_physostigmine.mp3
Category:general -- posted at: 3:24pm EST

We review gastroparesis treatment with haloperidol including a recent study by Ramirez and colleagues. This study had significant methodologic limitations but provides some interesting insight into a practice that many providers have adopted - using haloperidol for gastroparesis. A tiny RCT by Roldan and colleagues also looked at this practice and found promising results, although the study was very small.  Haloperidol has also been used in cannabinoid hyperemesis but literature on this is limited to case reports/series.

We also cover core content on biliary pathology using Tintinalli and Rosen's as guides.

Thanks for listening!
Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_gastroparesis_and_cholecystitis.mp3
Category:general -- posted at: 8:52pm EST

We review recent discussions on the accuracy of cuff blood pressures including a meta-analysis Picone et al published in the Journal of the American College of Cardiology discussing the accuracy of cuff blood pressures.

We cover core content on hypertensive emergencies and asymptomatic markedly elevated blood pressure using the ACEP clinical policy on hypertension, Rosen's (9th ed) Chapter 74 "Hypertension," and Tintinalli (8th ed),  Chapter  57 “Systemic Hypertension” Chapter 59 “Aortic Dissection and Related Aortic Syndromes” as guides

Show notes on FOAMcast.org

Thanks for listening!
Jeremy Faust and Lauren WEstafer

Direct download: FOAMcast_Hypertension.mp3
Category:general -- posted at: 5:57am EST

We cover Free Open Access Medical Education on opioids.

  • The Poison Review podcast reviews papers on the opioid epidemic, including a paper by Rudd et al demonstrating an increase in opioid-related deaths over the past five years as well as the following paper by Shah and colleagues.
  • The Dantastic Mr. Tox and Howard, a new podcast on the scene, also covers multiple topics on opioids, including common misconceptions of tramadol.

Then we cover core content on opioid overdose and withdrawal using Rosen's Emergency Medicine (9th ed) Chapter 156 and Tintinalli's Emergency Medicine (8th ed), Chapter 186 as a guide.

 

Thanks for listening!
Jeremy Faust and Lauren Westafer

Direct download: foamcast_opioids__.mp3
Category:general -- posted at: 12:12pm EST

We are in Berlin for #dasSMACC and have lots of pearls to share from the speakers at this amazing conference.  Talks will be released for free on the SMACC podcast over the next year, but this podcast holds some pearls that we thought couldn't wait.

We cover...

One of the major themes of #dasSMACC has been - we are more overconfident in our knowledge, skills, ability, and good behavior than we actually demonstrate. We cover the Dunning-Kruger effect and how to help combat the notion that "this happens to other people, not me." 

Drs. Jacob Avila and Ben Smith on Airway Ultrasound

Dr. James Rippey on Point of Care Ultrasound Incidental Findings

Dr. Jack Iwashyna on Critical Care Prognosis

Thanks for listening!

Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_DasSMACC_Day_3._Ultrasound_incidentalomas_ICU_prognostics_.mp3
Category:general -- posted at: 1:42pm EST

We are in Berlin for #dasSMACC and have lots of pearls to share from the speakers at this amazing conference.  Talks will be released for free on the SMACC podcast over the next year, but this podcast holds some pearls that we thought couldn't wait.

We cover...

Dr. Leanne Harnett on Pulmonary Embolism with Right Heart Thrombus (PE with RHT)

Dr. Michele Domico on Pediatric Cardiology Emergencies

Dr. Haney Mallemat (@CriticalCareNow) on Transesophageal Echocardiography (TEE) during Cardiac Arrest

 

Thanks for listening!

Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_DasSMACC_Day_2._TEE_in_codes_PE_with_RH_thrombus_SCAPE.mp3
Category:general -- posted at: 1:11pm EST

We deliver pearls from the first day of #dasSMACC in Berlin.

We cover talks by Dr. Brian Burns on trauma, Dr. David Carr on endocarditis, Dr. Paul Young on statistics, and Dr. Jess Mason on sickle cell vaso-occlusive crisis.

Check out foamcast.org for show notes and pictographic summaries.

Thanks for listening and for the Rosh Review for sending us!

Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_DasSMACC_Day_1._Endocarditis.mp3
Category:general -- posted at: 2:14pm EST

We interrupt our normal core content for this update:

Texting amongst medical professionals is ubiquitous; however, given patient privacy laws, many wonder, what is permissible?

We discuss a recent article in JAMA by Brian Drolet on this very topic as well as some basic professionalism pearls.

Show notes at FOAMcast.org

Thanks for listening,

Lauren Westafer and Jeremy Faust

Direct download: FOAMcast_texting_and_patient_privacy_VERSION_2.mp3
Category:general -- posted at: 8:56am EST

We cover FOAM on the WOMAN trial of tranexamic acid (TXA) in post-partum hemorrhage including BroomeDocsEMlitofnote, and The Bottom Line

Then we delve into core content on non-pregnant vaginal bleeding using Rosen's and Tintinalli's as a guide.

Show notes are available at FOAMcast.org

Thanks for listening!
Lauren Westafer & Jeremy Faust

Direct download: Foamcast_WOMAN_and_dysfunctinoal_uterine_bleeding.mp3
Category:general -- posted at: 5:24pm EST

We cover Free Open Access Medical Education (FOAM) from a recent Emergency Medicine Cases podcast and First10inEM blog post by Dr. Justin Morganstern regarding urinary tract infections (UTIs).   This podcast and blog tackle common issues in UTI diagnosis and treatment, including the following points:

  • UTI is a clinical diagnosis, a dirty urine does not mean the patient has a UTI
  • Urinalyses are more complicated to interpret than we probably understand

Then we cover core content from Rosen’s Emergency Medicine (8th ed), Chapter 99; Tintialli's Emergency Medicine (8th ed), Chapter 91; IDSA Guidelines for Treatment and Asymptomatic Bacteriuria

Thanks for listening!

Jeremy Faust and Lauren Westafer

Direct download: Foamcast_episode_68_UTI_.mp3
Category:general -- posted at: 11:42am EST

 A recent study in Academic Emergency Medicine by Hughes and colleagues, looks at the potential clinical relevance of having emergency physicians sign ECGs read "normal" by the computer software.  FOAM reviews of this article can be found here:

Then we review ischemia on ECGs, including STEMIs as well as a dive into ischemic T waves

Check out FOAMcast.org for more show notes and images.

Thanks for listening!

Lauren Westafer and Jeremy Faust

Direct download: FOAMcast_STEMI_and_its_mimics.mp3
Category:general -- posted at: 9:08am EST

We cover an episode of The Skeptic's Guide to Emergency Medicine that covers a validation study of the Step by Step approach to pediatric fever.  This approach to infants with a fever <3 months old is alluring as it does not necessitate a lumbar puncture.  This algorithm had a better sensitivity and negative predictive value than the Rochester criteria.   The approach did miss some infants with a serious bacterial infection and these tended to be those between 21 and 28 days old and those with fever onset <2 hours prior to arrival. 

We cover Chapter 116 in Tintinalli's Emergency Medicine (8th ed) and Rosen's on pediatric fever.

Visit FOAMcast.org for more information and thanks for listening!

-Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_Step_by_Step_and_pediatric_fevers.mp3
Category:general -- posted at: 8:40am EST

We cover a post from the fantastic St. Emlyn's team which breaks down a recently published article in Annals of Emergency Medicine comparing diazepam with placebo in patients with acute low back pain.  We recommend you read the full text of the article by Friedman et al.

We delve into core content on red flags in back pain and spinal epidural abscess using Rosen's Emergency Medicine and Tintinalli's Emergency Medicine Chapter 279 as a guide.

visit FOAMcast.org for show notes and more information.

Thanks for listening!
Lauren Westafer and Jeremy Faust

Direct download: FOAMcast_benzos_for_back_pain_.mp3
Category:general -- posted at: 3:02pm EST

 

We cover Free Open Access Medical Education (FOAM) on Contrast-Induced Nephropathy (CIN).  Recent interes

The American College of Radiology (ACR) Manual on Contrast Induced Nephropathy

This Emergency Medicine Literature of Note post covers the AMACING  trial, which looks at intravenous fluid administration (0.9% NaCl) versus usual care in patients "at risk" for CIN undergoing contrast-enhanced CT scan.   The study found a difference of -0.1% (95% CI -2.25 to 2.06), which was below the non-inferiority margin. Prior literature shows similar results, with no clear-cut efficacy from prevention strategies for CIN.

This post by Dr. Joel Topf (nephrologist @kidneyboy) on the Precious Bodily Fluids blog discusses a nephrologist's take on CIN.

EM topics post on fluids in CIN.

Core Content

We then delve into core content on genitourinary trauma using Rosen’s Chapter 47 and Tintinalli’s Chapter265 as a guide.

Thanks for listening!
Jeremy Faust and Lauren Westafer

Direct download: Episode_65.mp3
Category:general -- posted at: 8:19pm EST

Ultrasound is gaining popularity in assisting lumbar punctures (LPs). We review this technique as well as Free Open Access Medical Education (FOAM) from the following sites:  5 Min SonoSinai EM, and PEM pearls from ALiEM.

We then delve into core content on meningitis, encephalitis, and antiNMDA receptor encephalitis using Rosen's Chapter 109 and Tintinalli's Chapters 117 and 174 as a guide.

Thanks for listening!

Jeremy Faust and Lauren Westafer

 

Direct download: FOAMcast_lumbar_punctures_.mp3
Category:general -- posted at: 5:14pm EST

We cover FOAM on transvenous pacing from Ultrasound Podcast, Dr. Jason Nomura, and Dr. Al Sachetti

 

 

Then, we delve into basics on bradycardias using Rosen's Emergency Medicine and Tintinalli's as a guide.


Thanks for listening!
Jeremy Faust and Lauren Westafer

Direct download: Foamcast_transvenous_pacers_and_bradycardia.mp3
Category:general -- posted at: 5:02pm EST

The Surviving Sepsis Campaign Guidelines were updated, reflecting some changes carried forward from Sepsis 3.0 that was released in 2016.

In this podcast we go over some of the updates, many of the recommendations that stayed the same.

As a bonus we cover a new study on validation of qSOFA.

Show notes at FOAMcast.org


Thanks for listening!

Jeremy Faust and Lauren Westafer

Direct download: Foamcast_2017_sepsis_update.mp3
Category:general -- posted at: 3:06pm EST

A lot of good literature came out in 2016 so we wanted to mention a couple of our favorite articles of the year.

Sepsis 3.0

Singer M, Deutschman CS, Seymour CW, et al: The Sepsis Definitions Task Force The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).

The quick SOFA score (qSOFA) also came out in hopes it "provides simple bedside criteria to identify adult patients with suspected infection who are likely to have poor outcomes."  It is not part of the sepsis definition 

Back Up Head Elevated Intubation

Khandelwal et al. Head-elevated Patient Positioning Decreases Complications of Emergent Tracheal Intubation in the Ward and Intensive Care Unit. Anesthesia and Analgesia. Apr 2016.

Ketorolac Dose

Motov, S, Yasavolian, M, Likourezos, A, et al. Comparison of Intravenous Ketorolac at Three Single-Dose Regimens for Treating Acute Pain in the Emergency Department. .Ann Emerg Med. 2016 Dec 16.

Out of Hospital Cardiac Arrest Prognostication

Jabre et al. Early Identification of Patients With Out-of-Hospital Cardiac Arrest With No Chance of Survival and Consideration for Organ Donation.   Intern Med. 2016 Dec 6;165(11):770-778

 

Thanks for listening!

Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_2016_roundup.mp3
Category:general -- posted at: 8:35pm EST

We review a trick of the trade from Academic Life in Emergency medicine for temporomandibular joint (TMJ)  dislocation, the extra-oral reduction as well as other methods of TMJ reduction.

We delve into core content on dental injuries including fractures, avulsion, luxations, pulpitis and more using Rosen’s Emergency Medicine (8th edition) Chapter 70 "Oral Emergencies" and Tintinalli’s Emergency Medicine (8th edition) Chapter 245 "Oral and Dental Emergencies" as a guide.

Thanks for listening!
Jeremy Faust and Lauren Westafer

Direct download: Foamcast_TMJ_and_dental_.mp3
Category:general -- posted at: 4:09pm EST

We review a podcast from Dr. Tim Horeczko's Pediatric Emergency Playbook on elbow injuries including identifying normal ossification centers (CRITOE), radial head subluxation, and supracondylar fractures.

Then, we delve into core content on other elbow adjacent injuries including elbow dislocations, humerus fractures, and olecranon bursitis using Rosen’s Emergency Medicine (8th edition) Chapter  and Tintinalli’s Emergency Medicine (8th edition) Chapter  as a guide.

Thanks for listening!
Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_nursemaids_and_humerus.mp3
Category:general -- posted at: 6:54am EST

We review a talk by Dr. Sara Gray from SMACC (Social Media and Critical Care) conference in June 2016, Resuscitative hysterotomy, which is the new name for perimortem c-section [1]. In this talk she challenges the "4 minute" rule: if resuscitative efforts following maternal circulatory arrest are unsuccessful, cesarean delivery should be commenced at 4 minutes and completed by 5 minutes to optimize fetal outcome. 

Then we delve into core content on pregnancy emergencies using Rosen’s Emergency Medicine (8th edition) Chapter 98and Tintinalli’s Emergency Medicine (8th edition) Chapter 178 as a guide, discussing nausea and vomiting, hyperemesis gravidarum, bacteriuria, and vaginal bleeding in the first trimester.

Thanks for listening!
Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_Resuscitative_Hysterotomy.mp3
Category:general -- posted at: 12:00am EST

The PESIT study in the New England Journal of Medicine stirred up controversy in the FOAM world earlier in October 2016.  In this episode we cover the following posts on this article on pulmonary embolism in syncope:

Then, We delve into core content on syncope usingRosen's Emergency Medicine (8th edition) and Tintinalli's Emergency Medicine (8th edition) Chapter 52

 

Thanks for listening!

-Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_syncope_and_PE_v2.mp3
Category:general -- posted at: 5:31pm EST

We are bringing y'all pearls from ACEP 2016 in Las Vegas.

Today we cover Bell's Palsy (are you sure it's not a stroke?), burn dogma, and some hot abstracts of the year.

Thanks for listening!

Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_ACEP_16_Day_3.mp3
Category:general -- posted at: 9:00pm EST

We are at ACEP 2016 summarizing the hottest pearls

Today we cover placebos in the ED for back pain, nausea, and upper respiratory tract infections as well as atrial fibrillation management controversies and vaccine side effects.

Thanks for listening!

Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_Vaccine_side_effects_and_Placebos_ACEP_16_Day_2_.mp3
Category:general -- posted at: 8:28am EST

We bring you highlights from ACEP2016 in Las Vegas.


Today we focus on the care of the transgender patient and some pearls on caring appropriately for our diverse patients.

We also cover active shooters and lawsuit pearls

 

Thanks for listening!
Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_ACEP16_Transgender.mp3
Category:general -- posted at: 6:27am EST

We cover an incredible ophthalmology resource, OphthoBook.com, by Dr. Tim Roots.  This resource has a free book and excellent free video lectures.  Specifically, we detail a hilarious video on eye exam tricks, especially targeting individuals who "can't see."

We previously reviewed eye trauma in this podcast. In this episode, we review ophthalmology basics using Tintinalli’s Emergency Medicine (8e), Chapter 241

Visit FOAMcast.org for more and Rosh Review questions. Thanks for listening! 

Jeremy Faust + Lauren Westafer

Direct download: nks..mp3
Category:general -- posted at: 5:30pm EST

The Free Open Access Medical Education (FOAM) 

We cover a post from Dr. Josh Farkas on PULMcrit on lithium toxicity. The key message from the post is: a single serum lithium level doesn't necessitate dialysis, despite a recommendation from the EXTRIP working group  to initiate dialysis in patients with a lithium level > 5 mEq/L [1].  Dr. Farkas advocates for aggressive management in asymptomatic patients with chronic lithium toxicity and patients without impaired renal function.

Core Content

We review rhabdomyolysis using Rosen's Emergency Medicine (8e)  Chapter 160 and Tintinalli's Emergency Medicine (8e), Chapter 181.

 

Show notes at FOAMcast.org

Thanks for listening!

Jeremy Faust & Lauren Westafer

Direct download: foamcast_57_lithium_and_rhabdo.mp3
Category:general -- posted at: 3:33pm EST

We review a FOAM post by Dr. Matthew MacPartlin on Rollcage Medic on flying after a pneumothorax.

Then we delve into a core content review of altitude sickness, high altitude pulmonary edema, high altitude cerebral edema, and altitude related problems using Tintinalli and Rosen's Emergency Medicine as a guide.

Thanks for listening!
-Jeremy Faust & Lauren Westafer

Direct download: foamcast_56_Aviation_and_Altitudes_.mp3
Category:general -- posted at: 3:35am EST

We cover several excellent post on rashes, including:

Next, we dive into core content on platelet problems including problems caused by drugs, immune thrombocytopenic purpura (ITP/idiopathic thrombocytopenic purpura) and thrombotic thrombocytopenic purpura (TTP) using Tintinalli Chapter 233 (8th ed) and Rosen's Chapter 122 (7th ed) as a guide.

 

Thanks for listening!

Jeremy Faust and Lauren Westafer

Direct download: Foamcast_55_Purpura_Show_.mp3
Category:general -- posted at: 6:12am EST

We cover ultrasound guided pericardiocentesis using the posts from EMin5, CoreEM, and the Ultrasound Podcast.

Then, we delve into core content on the pericardium using Rosen’s (8th ed) Chapter 82 and Tintinalli (8th ed) Chapter 55 covering pericardial effusions, pericarditis, and myocarditis.

 

Thanks for listening!

Jeremy Faust & Lauren Westafer

Direct download: foamcast_54_pericardiocentesis.mp3
Category:general -- posted at: 7:28am EST

We cover a post by Dr. Rory Spiegel, EMNerd: The Case of Differing Perspectives, on the results of the ATACH-2 trial on blood pressure control in intracranial hemorrhage (ICH). This study sought to determine the safety and efficacy of the

Population: adults (>18 y/o) with ICH on CT scan, GCS ≥ 5 and <4.5 hours since symptom onset (changed mid-study)

Intervention: Reduce and maintain the hourly minimum systolic blood pressure in the range of 110 to 139 mm Hg throughout the period of 24 hours after randomization ("intensive treatment"). Preferred agents for blood pressure control in order of preference were 1. nicardipine 2. labetalol (diltiazem or urapidil if not available)

  • Mean minimum in hours 0-2: 128.9±16 mm Hg

Control: Reduce and maintain the hourly minimum systolic blood pressure in the range of 140 to 179 mm Hg throughout the period of 24 hours after randomization.

  • Mean minimum in hours 0-2: 141.1±14.8 mm Hg

Outcome: The primary outcome was the proportion of patients who had moderately severe or severe disability (modified Rankin scale score (mRS) 4-5) or those who had died (mRS 6; hereafter referred to as “death or disability”) at 3 months.

  • death or disability: Intensive treatment = 186 participants (38.7%) vs Standard treatment = 181 (37.7%)

We also discuss the history of blood pressure control in ICH and the pendulum swing on this in recent years, using an episode of the Skeptic's Guide to Emergency Medicine, Episode 73. This episode covers the Interact-2 trial.

Core Content

We delve into core content on ICH using Rosen’s (8th ed) Chapter  and Chapter in Tintinalli (8th ed).

We also discuss the PATCH trial with regard to ICH management in patients on antiplatelet agents, discussing a REBELEM post on this trial.

 

 

Direct download: FOAMcast_53_ICH.mp3
Category:general -- posted at: 8:06am EST

Just in time for the new interns, we answer the most common question asked of us - our favorite resources to use on shift.

Free Open Access Medical Education (FOAM) exists in forms that are suitable for self-study or function as resources and those that are easy to use resources to consult on shift, Just In Time (JIT) Resources. We review our favorite FOAM JIT resources.

Direct download: FOAMcastini_July_1_Just_in_time_FOAM.mp3
Category:general -- posted at: 11:35am EST

We cover a Scancrit post on the Back Up Head Elevated (BUHE) intubation position.  This post details a multicenter retrospective observational study by Khandelwal et al in Anesthesia & Analgesia.  Intubating with the head elevated (ear to sternal notch) and the back of the bed up reduces complications.

We delve into core content on the esophagus using Rosen’s (8th ed) Chapter 71 and Chapter 77 in Tintinalli (8th ed). We discuss dysphagia, food impaction, and esophagitis.


Thanks for listening!

JEremy Faust and Lauren WEstafer

Direct download: Foamcast_52_Back_up_head_elevated_intubation_-_6-25-16_5.17_PM.mp3
Category:general -- posted at: 8:56am EST

ITUNES OR LISTEN HERE

We cover pearls from smaccDUB (Social Media and Critical Care Conference in Dublin, Ireland), Day 3. We are here thanks to the Rosh Review.

Dr. Scott Weingart - "Post-Intubation Sedation"

  • Analgesia first. Try a hydromorphone 1mg push while you're waiting for the fentanyl drip. The endotracheal tube is uncomfortable.
  • Minimize sedation. There's this principle: eCASH: early Comfort using Analgesia, minimal Sedatives and maximal Humane care [1]. 
  • Sedation: go for dexmedetomidine if you have it (but it's expensive) or propofol. This is supported by the Society of Critical Care Medicine (SCCM) Pain, Agitation, and Delirium guidelines [2].
  • Be careful with rocuronium.  The long duration of rocuronium means that you can't assess for pain or discomfort so you must be responsible and get these

Dr. David Carr - "The Aorta Will #!&?% You Up"

Screen Shot 2016-06-16 at 6.57.56 PM

Dr. Kathleen Thomas - "Oh Sh**! They’re bombing the hospital!"

We should not need a website entitled STOPBOMBINGHOSPITALS.ORG but, unfortunately, over the past 4 years, 400 hospitals have been bombed. This passionate, wrenching talk is a "must see" and "must listen" when the free talks are released on the SMACC podcast over the course of the next year.

ive use in the emergency department. Emergency medicine journal : EMJ. 30(11):893-5. 2013. [pubmed]

  1. Imamura H, Sekiguchi Y, Iwashita T et al. Painless Acute Aortic Dissection. Circ J. 75(1):59-66. 2011. [article]
  2. Diercks DB, et al. Clinical policy: critical issues in the evaluation and management of adult patients with suspected acute nontraumatic thoracic aortic dissection. Ann Emerg Med. 2015 Jan;65(1):32-42.e12. PMID: 25529153.
  3. Hagan PG, Nienaber CA, Isselbacher EM. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. JAMA. 283(7):897-903. 2000. [pubmed]
Direct download: Foamcastini_smaccdub_day_3_aorta_and_pain.mp3
Category:general -- posted at: 2:01pm EST

#smaccDUB day 2

Dr. Reuben Strayer - “Disruption, Danger, and Droperidol: Emergency Management of the Agitated Patient."  

Dr. Strayer presented a brilliant talk on dealing with the quintessential Emergency Medicine patient - the undifferentiated acutely agitated patient. These patients are high risk and require emergent stabilization and resuscitation.

Dr. Haney Mallemat - "The PEA Paradox"

The typical way we think about PEA, the "H's and T's," is overly complicated. Further, we are horrendous at pulse palpation (see this for more), and so what we think is PEA may not actually be PEA.  Dr. Mallemat proposed QRS duration as one way to think about PEA, although this has limitations.

Dr. Michele Dominico - "How Usual Resuscitative Maneuvers Can Kill Paediatric Cardiac Patients"

Interventions we jump to in sick patients - oxygenation, ventilation, vasopressors - these can kill pediatric patients with cardiac pathology. She gave examples of some high yield pearls in these already terrifying patients.

EM Literature update by Drs. Ashley Shreves and Ryan Radecki

Interesting and Ridiculous Research Pearls from Drs. Ashley Shreves and Ryan Radecki

  • Perception of dyspnea and pulmonary function tests change with stress - and rollercoaster rides.  Rietveld S, van Beest I. Rollercoaster asthma: when positive emotional stress interferes with dyspnea perception. Behaviour research and therapy. 45(5):977-87. 2007. [pubmed]
  • Cured pork for epistaxis? Possibly. Researchers will try everything, especially if it involves bacon. Humphreys I, Saraiya S, Belenky W, Dworkin J. Nasal packing with strips of cured pork as treatment for uncontrollable epistaxis in a patient with Glanzmann thrombasthenia. The Annals of otology, rhinology, and laryngology. 120(11):732-6. 2011. [pubmed]
Direct download: FOAMcastini_smacc_dub_day_2_undiff.mp3
Category:general -- posted at: 2:23pm EST

We are at SMACC in Dublin - thanks to the Rosh Review, an excellent board review question bank. Here are some of our favorite pearls.

Do We Make Saves?

Dr. Mervyn Singer "Is Survival Predetermined in the Critically  Ill?"

  • Many critical care studies are negative, but in some cases this may be because critically ill patients don't have a uniform prognosis.
  • Dr. Singer argues that some people may be "destined to die" and some may be "destined to live."  So, it's not really us "saving the patient", it's just the math playing out. Interventions may be harmful or futile in one group but beneficial in the other.  For example, Dr. Singer references the CORTICUS trial of steroids in septic shock. This was a negative trial.  Dr. Singer asserts that some evidence (of not great quality), purports that the sickest patients could benefit from steroids, while this same intervention could be deleterious in the healthier ones.
  • Problem: many of the studies that go back and re-analyze these groups looking at the sickest or least sick patients? They perform subgroup analyses, a form of data dredging that must be taken with a huge grain of salt.

Favorite Pearls

Dr. Suzanne Mason - "Acute Care of the Elderly"

  • Hospital admission may not benefit geriatric patients - interdisciplinary interventions involving nurses, consultants, pharmacists, physical therapy may be best.
  • If there is a single, free intervention that providers can do it's assessing for polypharmacy. Polypharmacy in the elderly is a huge problem.  Check the patient's medication list and beware adding new medications that may not be absolutely necessary.

Dr. Victoria Brazil - "So You Think You're a Resuscitationist?"

  • The Dunning-Kruger effect is real in medicine and this is why we MUST have and provide feedback.  A review of the Dunning-Kruger effect can be found here.  Essentially, people tend to overestimate what they know (i.e. overly confident in their knowledge). The exception?  Masters tend to underestimate their knowledge.
    • Our perception of reality is very skewed so, again, feedback is crucial. For example, Cemalovic and colleagues found that intubators underestimated the time they took to intubate: they estimated 23.5 seconds on average vs the 45.5 seconds intubation actually took. Additionally, they thought 13% of their patients desaturated during intubation but 23% actually desaturated.

 

Direct download: FOAMcastini_SmaccDub_Saves_day_1_-_6_14_16_7.56_PM.mp3
Category:general -- posted at: 3:05pm EST

We cover this short video from EMRAP on lateral canthotomies.  This is one of those rare procedures that is vision saving; hence, it is worthy of frequent review.

Then, we delve into core content on orbital fractures, hyphemas, and ocular burns using Tintinalli and Rosen's Emergency Medicine as a guide.

Show notes and references at foamcast.org

Thanks for listening!

Jeremy Faust and Lauren Westafer

Direct download: foamcast_51.mp3
Category:general -- posted at: 6:59am EST

We review the FOAM video by Dr. Anna Pickens of EMin5.com on "Special Seizures" including hyponatremia, isoniazid toxcitiy, alcohol withdrawal, and eclampsia.


Then we review core content on seizures using Rosen's Emergency Medicine and Tintinalli's Emergency Medicine: A Comprehensive Review.


Thanks for listening!

Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_50_Seizures_v2.mp3
Category:neurology -- posted at: 11:51pm EST

ALTE is out and BRUE is in.

We review the American Academy of Pediatrics guideline on Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants 

Direct download: FOAMcast_49_BRUE.mp3
Category:general -- posted at: 5:58am EST

We cover a post by Dr. Seth Trueger (@MDaware) on false positives in the urine drug screen and review limitations of this test. 

Then we review some toxicology, including toxicity associated with cocaine and PCP using Rosen's Emergency Medicine (8e) and Tintinalli's (8e) as a guide.


Thanks for listening!

Lauren Westafer and Jeremy Faust

Direct download: FOAMcast_48_The_U_tox_v2.mp3
Category:general -- posted at: 6:36pm EST

In this episode we cover a post from Dr. Smith's ECG blog investigating ways to read ischemia on a ventricular paced ECG:  A Patient with Ischemic symptoms and a Biventricular Pacemaker.

Then we delve into core content on the Sgarbossa/modified Sgarbossa criteria as well as pacers and implantable defibrillators and their complications.

Thanks for listening!

Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_47_pacers_.mp3
Category:general -- posted at: 9:01am EST

We cover a podcast from HEFT EMcast  demonstrating that needle decompression at the 2nd intercostal space at the midclavicular line (2ICS MCL) is likely to fail.  They review a systematic review and meta-analysis by Laan et al in 2015 that suggests the fifth intercostal space at the anterior axillary line (5ICS AAL) is less likely to fail.

Then we delve into core content on pneumothoraces and empyemas using Tintinalli and Rosen's Emergency Medicine as a guide.

Thanks for listening,

Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_46_Needle_decompression_-_3-19-16_4.28_PM.mp3
Category:general -- posted at: 10:43pm EST

We cover a post from Life in the Fast Lane Research and Reviews (LITFL R&R) #121  featuring a section on the new American Gastroenterology Association (AGA) guidelines on diverticulitis. The game changer?  Antibiotics aren't a requirement in select patients with uncomplicated acute diverticulitis.

Then we delve into core content on diverticulosis, diverticulitis, and clostridium difficile using Rosen's Emergency Medicine (8e) and Tintinalli: A Comprehensive Review (7e).

Show notes at FOAMcast.org

Thanks for listening!

Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_45_Diverticulitis_export.mp3
Category:gastroenterology -- posted at: 7:18am EST

We bring you breaking news on the updated sepsis definition from the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine.

SIRS and Severe Sepsis?   Out.

qSOFA (HAT - Hypotension, AMS, Tachypnea)?  In.

Septic Shock?  Sepsis + Vasopressors needed to maintain MAP >65 mmHg + Lactate >2 mmol/L (*after adequate fluids)

 

 

Direct download: FOAMcast_44_SEPSIS_DEFINITIONS.mp3
Category:general -- posted at: 6:22pm EST

We cover the Skeptic's Guide to Emergency Medicine Episode 144, "That Smell of Isopropyl Alcohol for Nausea in the Emergency Department." This podcast reviews an article by Beadle et al, an RCT on the use of inhalational isopropyl alcohol for nausea.

Then we delve into core content on vertigo using Rosen’s Medicine (8e) and Tintinalli’s Emergency Medicine: A Comprehensive Study Guide  (7e) on all things toxic alcohols

 

Thanks for listening!
Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_43_toxic_alcohols.mp3
Category:general -- posted at: 9:59am EST

We cover an EMcrit episode on Semantics of End of Life Discussions with Dr. Ashley Shreves as well as pearls from another favorite episode with her, Episode 93 - Critical Care Palliation.  We can't do these episodes justice summarizing them so listen to them.

Key Pearls on moving away from "DNAR" and moving towards "AND" - Allow Natural Death, how to have the conversation, and with whom to have the end of life discussion.

Then we delve into core content on vertigo using Rosen’s Medicine (8e) electronic chapter, "End of Life,"  and Tintinalli’s Emergency Medicine: A Comprehensive Study Guide  (7e) Chapter 297 “Death and Dying.”

Thanks for listening!
Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_42_Palliative_Care.mp3
Category:general -- posted at: 12:38am EST

We cover two bits of FOAM,Emergency Medicine Literature of Note - Dr. Ryan Radecki - on the use of meclizine for vertigo and EMcrit - Dr. Scott Weingart on the HiNTs exam.

Then we delve into some of the problems with the HiNTs exam including it can only be performed on patients with continuous vertigo and that external validity is a major issue with HiNTs.

Then, we delve into core content on vertigo using Rosen’s Medicine (8e) Chapter 19,  and Tintinalli’s Emergency Medicine: A Comprehensive Study Guide  (7e) Chapter 164 “Vertigo and Dizziness."

Thanks for listening!

Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_41_HiNTs_and_Vertigo.mp3
Category:emergency medicine, neurology -- posted at: 6:00am EST

In this special episode we review some of the top items of 2015*

David Newman:

  • Opioids for back pain - falling out of favor.
  • Risk stratifying (and testing) low risk chest pain.

Haney Mallemat:

Michelle Lin

  • Merging of FOAM with traditional journals 
  • Merging of FOAM resources into conglomerates
  • More medical education FOAM (ex: ICEnet, EMin5)

Rob Orman

Thanks for listening!

Jeremy Faust and Lauren Westafer

*Chosen by people smarter than we are.

(nb: Lauren initially wrote "smarter than us," but I fixed it. You're welcome, universe. -JF)

Direct download: FOAMcast_42_Best_new_pearls_and_biggest_trends_of_2015.mp3
Category:general -- posted at: 12:19pm EST

In this episode we cover The Skeptic's Guide to Emergency Medicine Episode on Regional Anesthesia for hip and femoral neck fractures.

Then we delve into core content on Rosen's and Tintinalli (Rosenalli) on core content pearls on compartment syndrome.


Thanks for listening!

Jeremy and Lauren

Direct download: FOAMcast_40_Femoral_Nerve_Blocks_and_Compartment_Syndrome.mp3
Category:general -- posted at: 2:33pm EST

We cover Dr. Rory Spiegel's blog EMNERD, covering an article in Chest 2015 by Pivetta et al, discussing the ways lung ultrasound (US) may be far more helpful than the brain natriuretic peptide (BNP) in determining heart failure in the dyspneic patient. 

Then we delve into likelihood ratios and show notes can be found at FOAMCAST.org

Bottom Line, LR of 1 is useless. It doesn't change the likelihood of using the disease.

+ LR >5 is good, + LR of 10 means that a test is useful and, if positive, patient most likely had the disease

- LR 0.2 is ok but a - LR of 0.1 is much more helpful.

Using a Fagan nomogran, one can understand how various likelihood ratios (and tests with their known LRs) may affect the post-test probability (i.e. the likelihood the patient has the disease). The utility of tests also depends on the pretest probability.

 

Direct download: FOAMcast_39_Likelihood_Ratios_.mp3
Category:general -- posted at: 10:01am EST

The FOAM realm has teamed with interest in a randomized trial in the ICU by Semler et al, the FELLOW trial. This week we cover some aspects of this trial, such as statistical power, highlighted in some of the following Free Open Access Medical Education (FOAM) posts

 

Then, we delve into core content on epistaxis and sinusitis using Rosenalli (Tintinalli (7e) Chapter 239, “Epistaxis, Nasal Fractures, and Rhinosinusitis.” Rosen’s  (8e) Chapter 75, “Upper Respiratory Infection.", "Otolaryngology") as a guide.

Thanks for listening,

Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_38_FELLOW_and_ent.mp3
Category:general -- posted at: 11:52am EST

We cover a trick of the trade from Dr. Brian Lin, posted on the Academic Life in Emergency Medicine (ALiEM site) on hemostasis in finger tip avulsions. Dr. Lin also has his own excellent FOAM site on all things laceration - LacerationRepair.com.

We also cover FOAM on dogma of wound care from Dr. Ken Milne's The Skeptic's Guide to Emergency Medicine, Episode #63

 

Then we cover laceration and wound care core content pearls using Rosenalli (Rosen's Emergency Medicine and Tintinalli's Emergency Medicine Review).

Direct download: FOAMcast_37_Lacerations.mp3
Category:general -- posted at: 3:05pm EST

This miniature FOAMcast episode brings you pearls the American College of Emergency Physicians annual meeting, ACEP15 in Boston.

We summarize some popular highlights from Day 3 including foodborne illness, wound management, and tips for giving presentations.

Direct download: FOAMcastini_acep15_day_3.mp3
Category:general -- posted at: 5:31pm EST

This miniature FOAMcast episode brings you pearls the American College of Emergency Physicians annual meeting, ACEP15 in Boston.

We summarize some popular highlights from Day 2 including ECMO, trauma myths, and renal colic.

Direct download: FOAMcastini_acep15_day_2.mp3
Category:general -- posted at: 5:36pm EST

This miniature FOAMcast episode brings you pearls the American College of Emergency Physicians annual meeting, ACEP15 in Boston.

We summarize some popular highlights from Day 1 including Jerry Hoffman and Rick Bukata's literature review and a talk from Dr. Jeff Kline on pulmonary embolism.

Direct download: FOAMcastini_acep15_day_1.mp3
Category:general -- posted at: 6:14pm EST

We cover an episode of the Ultrasound Podcast, in which Drs. Matt Dawson, Mike Mallin, and Jacob Avila demonstrate how to diagnose rib and sternal fractures with bedside ultrasound.

 

Then we cover core content pearls using Rosen's, Tintinalli, and the EAST guidelines on rib fractures, sternal fractures, and blunt cardiac injury.

Visit foamcast.org for references as well as generously donated Rosh Review questions.

Thanks y'all!

-Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_rib_fx.mp3
Category:general -- posted at: 11:17am EST

In this tiny episode we do something a little different.

Dr. Paul Young (@dogICUma) and colleagues published two papers in JAMA and NEJM, SPLIT and HEAT, respectively.  

SPLIT is an RCT looking at balanced crystalloid vs 0.9% NaCl and AKI, an ever popular topic in FOAM.

HEAT is an RCT of acetaminophen in ICU patients.

 

We'll be back with regular episodes, soon.

 

-Jeremy Faust and Lauren Westafer

Direct download: FOAMcastini_SPLIT_and_HEAT.mp3
Category:general -- posted at: 7:13am EST

In this episode, we cover the New York Times article, "What Comes After The Heimlich Maneuver" and Dr. Seth Trueger's take on this article, "Bad Idea Jeans." The take home message - cricothyrotomies should be done by experts and we should probably traine ourselves for these a little better.

Then, we cover core content pearls on tracheostomy emergencies and a quick summary of infections in or near the trachea.  Visit foamcast.org for more as well as generously donated Rosh Review questions.

Thanks y'all!

-Jeremy Faust and Lauren Westafer

Direct download: FOAMcastini_Layperson_Cric_V3.mp3
Category:respiratory -- posted at: 7:38pm EST

This tiny episode covers a blog entry from BrownCoatNation.com (University of Illinois, Chicago), who has a new series entitled “Inconceivable.” The idea is to expose medical terminology that we tend to use incorrectly. The first installment is focused on the misuse of the term "left shift," and it's the focus of this FOAMcastini.

'Left shift" refers to the presence of banded (immature) neutrophils in the blood. It does not refer to an elevated white blood cell count with a high percentage of neutrophils. An elevated white blood cell count with an abnormally high percentage of neutrophils should be called "neutrophillic leukocytosis." Only the presence of immature neutrophils in the periphery (including bands) can accurately be called a "left shift." 

We will be back shortly with regular episodes, once their schedules coincide.

Thanks for listening!

 
Direct download: FOAMcastini_left_shift.mp3
Category:general -- posted at: 7:29am EST

In this episode, we cover the St. Emlyn's team's post on the REVERT trial, which added a new spin to the traditional (and traditionally ineffective) Valsalva maneuver for stable supraventricular tachycardia (SVT). In this post, Dr. Rick Body goes through the trial covering not only the results and also drops pearls on methodology.

Then, we cover core content pearls on supraventricular tachycardia and ventricular tachycardia. Visit foamcast.org for more as well as generously donated Rosh Review questions.

Thanks y'all!

-Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_34._SVT_and_Vtach_take_2.mp3
Category:cardiology -- posted at: 6:54am EST

This week we cover Dr. Ryan Radecki's post on Gestational Age Adjusted D-Dimer covering an article by Murphy et al. 

Then we review the differential diagnosis and workup of hemoptysis using Rosen's Emergency Medicine and Tintinalli as a guide.

We have Rosh Review questions and more available on our website, FOAMcast.org.


Thanks y'all!

-Jeremy Faust and Lauren Westafer

 

Direct download: FOAMcast_33._Pulmonary_Embolisms_in_Pregnancy.mp3
Category:respiratory -- posted at: 5:32pm EST

This week we cover Dr. Rory Spiegel's post on initial non-operative management of acute appendicitis in his blog post on EMnerd reviewing a paper by Salminen et al.

Then we review appendicitis and some other right lower quadrant abdominal pearls using Rosen's Emergency Medicine and Tintinalli as a guide.

We have Rosh Review questions and more available on our website, FOAMcast.org.


Thanks y'all!

-Jeremy Faust and Lauren Westafer

 

Direct download: FOAMcast_32._Acute_Appendicitis..mp3
Category:general -- posted at: 3:46pm EST

This week we cover posts from the Wessex ICS site, The Bottom Line, which is an excellent source for breakdown of recent and important trials. We cover their post on a systematic review of peripheral pressor complications (Loubani et al) and then we delve into a recent prospective trial by Cardenas-Garcia and colleagues that came up at SMACC.

Then we review peripheral vasopressors using Tintinalli and Rosen's Emergency Medicine as a guide. 

We have Rosh Review questions and more available on our website, FOAMcast.org.


Thanks y'all!

-Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_31._Pressors.mp3
Category:general -- posted at: 9:39am EST

ACEP released an updated clinical policy on the use of tPA for acute ischemic stroke in June 2015.  We reviewed this on a prior episode. While we are not an interview based show, we had to seize the opportunity to talk with those with more experience. 

In this episode, Jeremy interviews Dr. Jerry Hoffman, a notorious tPA critic.

We shall return to regular core content soon.

-Jeremy Faust and Lauren Westafer

Direct download: FOAMcastini_Jerry_Hoffman.mp3
Category:general -- posted at: 8:45pm EST

ACEP published the clinical policy on the use of tPA for acute ischemic stroke in June.  We covered the draft in January in a FOAMcastini.  Given some significant changes, we wanted to update y'all to ensure we deliver accurate information.

We review the changes and then tap our tPA brain trust, Drs. Anand Swaminathan, Ken Milne, Ryan Radecki, and David Newman for expert opinion.

Direct download: FOAMcastini_ACEP_tPA_update.mp3
Category:emergency medicine, neurology -- posted at: 5:29pm EST

FOAMcast is bringing you pearls from conferences we attend including SMACC.  (and next June 13-16, we'll bring you pearls from smaccDUB in Dublin, Ireland)

Today we discuss some pearls on shift work, analgesia (even without drugs), the perils of the Glasgow Coma Scale and more!

Direct download: FOAMcastini_SMACC_day_3.mp3
Category:general -- posted at: 8:41pm EST

FOAMcast is bringing you pearls from conferences we attend including SMACC.  (and next June 13-16, we'll bring you pearls from smaccDUB in Dublin, Ireland)

Today we discuss some pearls on pediatric fluids, impact apnea, evidence based medicine, and death.

 

Direct download: FOAMcastini_SMACC_day_2.mp3
Category:general -- posted at: 8:14pm EST

FOAMcast is bringing you pearls from conferences we attend including SMACC.  

The overarching theme to Day 1 at SMACC?  Use your team-to check you and for feedback.  Dr. Cliff Reid reminded us to follow up our patients and outcomes and learn from it all, without letting our egos get in the way.   Dr. Simon Carley (St. Emlyn's) gave a powerful talk on learning from mistakes later in the day; you will definitely want to listen to these when they come out.

We cover trauma pearls from Dr. Scott Weingart, pain pearls from Dr. Reuben Strayer, tox pearls form Dr. David Juurlin, and a bunch of sepsis goodness. 

Direct download: FOAMcastini_SMACC_day_1.1.mp3
Category:general -- posted at: 10:14pm EST

We review this post from Dr. Scott Weingart's EMCrit podcast on Thyroid Storm.

Then, we delve into core even more content pearls on the thyroid including differentiating different hyperthyroid states and mxyedema coma.  We do this using Tintinalli and Rosen's as guides. 

As always, visit foamcast.org for show notes and the generously donated Rosh Review questions.

Thanks y'all!

-Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_30_Thyroid.mp3
Category:general -- posted at: 7:29pm EST

We review this  post from Dr. Anton Helman of Emergency Medicine Cases on Pediatric DKA

Then, we delve into core content pearls on hyperglycemia including Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State.  We do this using Tintinalli and Rosen's as guides. 

As always, visit foamcast.org for show notes and the generously donated Rosh Review questions.

Thanks y'all!

-Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_29._DKA_and_HHS.mp3
Category:general -- posted at: 7:30pm EST

This episode is slightly different.  We review some of our favoite pearls from the last year including our favorite mnemonics and memory aids (and some that we think bombed).

Thanks, y'all, for listening, providing feedback, and continuing to inspire us to look through FOAM and Rosenalli to enhance our emergency medicine education.

 

-Jeremy Faust and Lauren Westafer

Direct download: FOAMCastini_One_year.mp3
Category:general -- posted at: 10:06am EST

We review thisa post from Dr. Charles Bruen of Resus Review on Malignant Hyperthermia and dantrolene.

Then, we delve into core content pearls on polypharmacy -  serotonin syndrome, neuroleptic malignant syndrome, and extrapyramidal side effects.  We do this using Tintinalli and Rosen's as guides. 

As always, visit foamcast.org for show notes and the generously donated Rosh Review questions.

Thanks y'all!

-Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_Episode_28_NMS_MH_and_Serotonin_Syndrome_edited.mp3
Category:general -- posted at: 7:10pm EST

We review this post from the amazing Maryland Critical Care Project on N-acetylcysteine for Inhalational Burn Injury

Then, we delve into core content pearls on  burns including nomenclature, fluid resuscitation, burn center referral criteria, and more.  We do this using Tintinalli and Rosen's as guides. 

As always, visit foamcast.org for show notes and the generously donated Rosh Review questions.

Thanks y'all!

-Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_Episode_27_Burns.mp3
Category:general -- posted at: 1:38pm EST

We review use of longboards and cervical collars for spinal immobilization using the  new ACEP statement and posts by ScanCrit (Curse of the Cervical Collar, Cervical Collar RIP,  Cervical Collars Slashed From Guidelines), a post by Dr. Minh Le Cong from PHARM, and this Medest118 post (in addition to new policy statement from ACEP) 

Then, we delve into core content pearls on differentiating spinal shock from neurogenic shock, the incomplete cord syndromes such as anterior cord syndrome, central cord syndrome, and Brown Sequard syndrome, as well as a quick and dirty review of key spinal reflexes.  We do this using Tintinalli, and Rosen's as a guide. 

As always, visit foamcast.org for show notes and the generously donated Rosh Review questions.

Thanks y'all!

-Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_26_Spine.mp3
Category:general -- posted at: 9:11pm EST

In this mini FOAMcast, we introduce a new segment - statistics.  

We cover inter-rater reliability,\ or, the kappa coefficient, using the PECARN head trauma decision aid as a tool.

As always, visit foamcast.org for show notes and the generously donated Rosh Review questions.

Thanks y'all!

-Jeremy Faust and Lauren Westafer

Direct download: FOAMcastini_Kappa.mp3
Category:statistics -- posted at: 7:33am EST

We review the post by Bryan Hayes, PharmD, FAACT on Academic Life in Emergency Medicine,  Sulfamethoxazole-Trimethoprim for Skin and Soft Tissue Infections: 1 or 2 Tablets BID? 

Then, we delve into core content pearls on cellulitis and abscesses, necrotizing skin infections, and Erythema Multiforme/Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis using the IDSA guidelines, Tintinalli, and Rosen's as a guide. 

As always, visit foamcast.org for show notes and the generously donated Rosh Review questions.

Thanks y'all!

-Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_25._MRSA_cellulitis_and_skin_FIXED.mp3
Category:general -- posted at: 11:12pm EST

This week we review the Taming the SRU podcast, "Ketamine Cagematch" (iTunes) in which Drs. Minh Le Cong and Chris Zammit banter about the use of ketamine in patients with traumatic brain injury (TBI). 

Then, we delve into core content pearls on concussion/mild TBI including diagnosis, treatment, and complications using Tintinalli 254 but to be honest, Rosenalli is lacking on this topic so we've turned to the ACEP clinical policyAAN guidelinesOntario Pediatric Guidelines, and the  AAP guidelines on the topic.

As always, visit foamcast.org for show notes and the generously donated Rosh Review questions.

Thanks y'all!

-Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_24._Ketamine_and_Concussions.mp3
Category:neurology -- posted at: 10:55pm EST

This week we're covering Dr. Jacob Avila's post on ultrasound for small bowel obstruction (SBO)  located at Ultrasound of the week.  He has an accompanying video on 5minSono.

Screen Shot 2015-01-25 at 10.20.44 AM

The Bread and Butter

We cover key points on SBO and Acute Mesenteric Ischemia from Rosenalli, that’s Tintinalli (7e) Chapter 86; Rosen’s (8e) Chapter 92.  But, don’t just take our word for it.  Go enrich your fundamental understanding yourself.

As always, visit foamcast.org for show notes and the generously donated Rosh Review questions.

Thanks y'all!

-Jeremy Faust and Lauren Westafer

Direct download: FOAMcast_SBO.mp3
Category:general -- posted at: 9:45pm EST

As detailed in this FOAMcastini, ACEP just released a draft of an updated clinical policy on tPA for acute ischemic stroke.  This came in the wake of years of controversy over the aggressive position taken in the 2012 clinical policy.

While FOAMcast is not an interview style podcast, we felt compelled to get some perspective on Emergency Physicians a little more experienced than ourselves.  Here we interview:

Dr. Ryan Radecki (@emlitofnote), Assistant Professor, University of Texas - Houston

  • See his response to the policy on his blog here

Dr. David Newman (#draftnewman), Associate Professor of Emergency Medicine, Mount Sinai Hospital

Dr. Anand Swaminathan (@EMSwami), Assistant Professor of Emergency Medicine, NYU

Dr. Ken Milne (@thesgem), Chief of Staff at South Huron Hospital

Direct download: FOAMcastini_ACEP_tPA_interviews.mp3
Category:neurology -- posted at: 11:21pm EST