FOAMcast - Emergency Medicine Core Content (general)

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 EDT

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 EDT

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 EDT

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 EDT

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 EDT

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 EDT

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 EDT

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 EDT

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 EDT

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 EDT