FOAMcast - Emergency Medicine Core Content

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

On Jan 12, 2015, ACEP released the draft of the new clinical policy on tPA in acute ischemic stroke. This was an update of the  ACEP tPA Clinical Policy 2012, which has been entrenched in controversy since it was published.  

In this episode we dicuss the major differences between the two policies.  Then, have your say. Comment on the draft here

Direct download: FOAMcastini_ACEP_tPA_.mp3
Category:neurology -- posted at: 1:12pm EST

We review the FOAM resource, Don’t Forget the Bubbles, "Knee X-ray Interpretation" by Dr. Tessa Davis.  We use a systematic approach to assessing chest x-rays, so why not knee x-rays?

Then, we delve into a core content review using Rosenalli as a base, covering knee dislocations and septic arthritis.  Key Texts:Tintinalli (7e) Chapters 271, 281; Rosen’s (8e) Chapters 57, 136

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_22._Knee_FOAM.mp3
Category:ortho -- posted at: 6:33am EST

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