Outpatient management of pulmonary embolism for low-risk patients has been encouraged for several years. However, little is known about pulmonary embolism diagnosed and managed exclusively in the outpatient setting. In this study, Vinson et al describe the course of patients diagnosed with PE and managed in the outpatient setting in an integrated healthcare delivery system.

Shownotes/References: FOAMcast.org

Thanks for listening!
Lauren Westafer

The diagnostic algorithm for pulmonary embolism (PE) has evolved over the past few years to include probability or risk-adjusted D-dimer. The YEARS algorithm includes an elevated D-dimer threshold for some risk groups and has been found to be safe and reduce imaging in several studies, including in pregnant patients. Now, this multicenter trial by Freund et al evaluates use of YEARS and age-adjusted D-dimer compared with an age-adjusted approach alone.

Shownotes/References: FOAMcast.org

Thanks for listening!
Lauren Westafer

A seminal single-center study in 2018 by Driver et al found a 98% first-pass success in patients undergoing endotracheal intubation in the Emergency Department. This multi-center randomized control trial examines bougie vs stylet in a wider array of settings

Show notes/references: FOAMcast.org

Thanks for listening!
Lauren Westafer

Subsegmental pulmonary embolism (SSPE) is a controversial entity as they have uncertain clinical significance. As a result, the Chest Guidelines  and ACEP guidelines state that a very select group of patients with isolated SSPE and no deep vein thrombosis may be managed with surveillance rather than anticoagulation. In this podcast we review SSPE and a new prospective study by Le Gal and colleagues.

Show notes and references: FOAMcast.org

Thanks for listening!

Lauren Westafer

We review the FDA briefing document from Pfizer   as well as from the CDC Advisory Council on Immunization Practices that approved the Pfizer-BioNTech COVID-19 vaccine in children ages 5-11.

References and show notes: FOAMcast.org

Thanks for listening!
Lauren Westafer and Jeremy Faust

We previously covered the management of young febrile infants in a 2017 podcast  but now we have updated guidance from the AAP. In this podcast, we review the 2021 AAP Guidelines for the management of well-appearing febrile infants 8-60 days old, highlight practice-changing recommendations.

Show notes/references: FOAMcast.org

Thanks for listening!
Lauren Westafer

In this episode, Jeremy discusses what we know about breakthrough infections in the delta variant era and what this may mean for COVID-19 vaccine boosters.

In this episode, we discuss the current evidence (as of September 24, 2021) on COVID-19 vaccine boosters as well as the CDC recommendations and the details of the Advisory Council on Immunization Practices recommendations/vote.

Show notes/References at FOAMcast.org

Jeremy's takes can be found at Inside Medicine

Thanks for listening!
Lauren Westafer and Jeremy Faust

In this literature update podcast covering important papers of 2021, we cover Becattini et al on the assessment of right ventricular dysfunction in patients diagnosed with acute pulmonary embolism (PE). We review guidelines on PE risk stratification for severity and discuss this individual patient meta-analysis.

Show notes/references: FOAMcast.org

Thanks for listening!
Lauren Westafer and Jeremy Faust

This is a quick literature update on practice-changing literature from 2021. Here we discuss Pappal et al in Annals of Emergency Medicine on awareness during paralysis in mechanically ventilated patients

Show notes / References: FOAMcast.org

Thanks for listening!
Lauren Westafer and Jeremy Faust

This is a quick literature update of important literature in 2021 covering take-home naloxone by Kilaru et al. In this episode, we discuss principles of harm reduction, including naloxone, as well as the study. 

Show notes, references, and resources: FOAMcast.org

Thanks for listening!

Lauren Westafer and Jeremy Faust

We review new clinical policy guidelines from SAEM on patients with recurrent (2 ED evaluations in 12 months) low risk (e.g. HEART score <4) chest pain.

Show notes and references: FOAMcast.org

Thanks for listening!
Jeremy Faust and Lauren Westafer

In this episode, we review the data on the association between myocarditis and the mRNA COVID-19 vaccines.

Show notes / References: FOAMcast.org

Thanks for listening!

Jeremy Faust and Lauren Westafer

In this quick literature update, we review a recent paper by Branch et al on early 'panscan' (head to pelvis CT scan ) in patients with return of spontaneous circulation after out of hospital cardiac arrest. 

Show notes/ references: FOAMcast.org

Thanks for listening!
Lauren Westafer and Jeremy Faust

In this episode we review what we know about vaccine induced thrombotic thrombocytopenia (VITT), which has been associated with the COVID-19 viral vector vaccines by AstraZeneca and Johnson & Johnson.

Show notes/references: FOAMcast.org

Thanks for listening!
Lauren Westafer and Jeremy Faust

In this podcast, we review Cerebral Vein Thrombosis (CVT) including clinical presentation, diagnosis, and management.

Show notes: FOAMcast.org

Thanks for listening!
Lauren Westafer and Jeremy Faust

In this episode, we discuss ivermectin as a potential therapeutic for COVID-19 and review available randomized trials evaluating this drug.

• Chaccour et al E-Clinical Medicine
• Lopez-Medina et al. JAMA
• Schwartz et al (not yet published)
• IDSA guidelines
• NIH Treatment guidelines

Show notes: FOAMcast.org

Thanks for listening!
Jeremy Faust and Lauren Westafer

In this episode, we review new registry data from the ACIP meeting on pregnant people who received an mRNA COVID-19 vaccine and discuss, in general, what we know about the COVID-19 vaccines in pregnancy. 

Show notes: FOAMcast.org

Pregnancy Decision Aid

Thanks for listening!
Lauren Westafer and Jeremy Faust

In this episode, we review the FDA briefing document on the Janssen (Johnson & Johnson) viral vector COVID-19 vaccine.

Show notes: FOAMcast.org

Thanks for listening!
Lauren Westafer & Jeremy Faust

We have previously covered epistaxis on FOAMcast , including the use of tranexamic acid (TXA). Now, we cover a new, large RCT, the NoPac trial by Reuben et al, on TXA for epistaxis.

Show notes: FOAMcast.org

Thanks for listening!
Lauren Westafer and Jeremy Faust

There's been a lot of excitement over various drugs for COVID-19, including anti-inflammatory drugs. Colchicine, a medication long used for gout, fits that bill. In this podcast, we review 3 trials of colchicine including COLCORONA, GRECCO-19, and a study by Lopes et al. 

Show notes: FOAMcast.org

Thanks for listening!

Jeremy Faust and Lauren Westafer

Early studies of tocilizumab, a monoclonal antibody that binds interleukin-6 , were disappointing. However, the REMAP-CAP trial recently reported a benefit to tocilizumab in non-critically ill hospitalized patients with COVID-19. Now, from the RECOVERY trial (the trial that brought us dexamethasone), we have more good news for tocilizumab - which we cover in this podcast

Show notes: FOAMcast.org

Thanks for listening!
Lauren Westafer and Jeremy Faust

As vaccinations role out, the news of SARS-CoV-2 variants with mutations to the spike protein have dominated news cycles. One unanswered question has been - do the current vaccines protect against these variants?

We tackle this issue and look at a new paper [pre-print] by Wu et al. 

Prior randomized trials of convalescent plasma in COVID-19 have had disappointing results. However, these trials included patients with severe illness who were many days (if not weeks) into the course of their illness. To date, it was hypothesized, but unknown, that the benefit would be in patients very early in the course of their illness. We cover an RCT by Libster et al in NEJM on convalescent plasma in older patients with mild COVID-19.

Show notes/references: FOAMcast.org

Thanks for listening!

Lauren Westafer and Jeremy Faust

In this quick literature update we review the new recommendations from the CDC for the treatment of gonococcal infections which include:

• Higher dose ceftriaxone (500 mg IM) or 1 gm IM if ≥150 kg patient
• No routine azithromycin
• Preference for doxycycline for co-treatment of presumed chlamydial infection

Show notes and references: FOAMcast.org

Thanks for listening!
Lauren Westafer and Jeremy Faust

For years studies have questioned whether pulse oximeters perform as well in non-White patients as in White patients. This is particularly important now as disposition decisions in patients with COVID-19 are often made based on pulse oximetry readings.

We discussed an article by Sjoding et al in NEJM 

Show notes at FOAMcast.org

Thanks for listening!
Lauren Westafer and Jeremy Faust

Despite multiple Phase II/III vaccine trials of >30,000 participants, pregnant patients or those who are lactating have been largely excluded. In this podcast, we cover what we know (and what we don't know thus far).

The Pfizer BNT162b2 trial data submitted for FDA Emergency Use Authorization does include information on a minuscule number of patients who were immunized and became pregnant.

The Society for Maternal and Fetal Medicine has released statements on vaccines in SARS-CoV-2.

In the United Kingdom, Public Health England has released guidance for their population on vaccination in pregnancy and breastfeeding which are rooted in the lack of data.

Shownotes: FOAMcast.org

Thanks for listening!
Jeremy Faust and Lauren Westafer

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

Vaccines for SARS-CoV-2 have been in development for only a few months, but several have published early results from Phase III efficacy trials in press releases. In this episode, we review these vaccines and what we know about them, and what we know about  them

Show notes (references/graphics): FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

In this episode, we review cannabinoid hyperemesis syndrome and two recent randomized controlled trials on treatments

• Haloperidol - Ruberto et al  (Annals of Emergency Medicine, In Press)
• Capsaicin - Dean et al. Acad Emerg Med 2020.

Show notes (references, graphics) at FOAMcast.org

Thanks for listening!

Jeremy Faust and Lauren Westafer

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

Monoclonal antibodies have received significant attention over the past month and we previously podcasted on antibodies that target SARS-CoV-2. In this episode, we review several recent studies on a different "mab", tocilizumab,  which targets inflammation mediated by interleukin-6 that is overly ramped up. 

We review:

Stone et al  ( RCT)

Hermine et al (RCT)

Salvarani et al. (RCT)

STOP-COVID (observational)

Show notes (references/graphics): FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

Monoclonal antibodies have received significant attention over the past couple of weeks. In this episode, we review what we know, as of October 9, 2020, about monoclonal antibodies as a therapy for COVID-19. 

Show notes (references/graphics): FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

We review a retrospective evaluation of COVID-19 infections in employees after a protocol that increased the use of high flow nasal cannula (Westafer et al)

Show notes (references/graphics): FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

We spoonfeed you a new article on risk stratification of pulmonary embolism (with critical appraisal pearls!)

In this episode, we review a new trial by Barnes et al on antacids versus antacids with lidocaine for epigastric pain and dyspepsia

Show notes and references at FOAMcast.org

Thanks for listening,

Lauren Westafer and Jeremy Faust

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

We review a new meta-analysis from the WHO REACT group of steroids in critically ill patients with COVID-19 and 3 new randomized trials of steroids in COVID-19 published in JAMA on September 2:

• REMAP-CAP COVID-19 
• CoDEX
• CAPE Covid

Show notes (references/graphics): FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

We review the evidence, to date, on convalescent plasma for the treatment of COVID-19. This includes 3 randomized trials, as well the US experience with >35,000 patients treated with convalescent plasma, a noncontrolled study by Joyner et al [pre-print].

Show notes (references/graphics): FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

We review Spinner et al in JAMA 2020, an open label trial of remdesivir 5 days vs remdesivir 10 days vs 'standard of care' for the treatment of #COVID19

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

 We review the Ascorbic Acid, Corticosteroids, and Thiamine in Septic Shock (ACTS) Trial by Moskowitz et al in JAMA

Show notes: FOAMcast.org

Thanks for listening!
Jeremy Faust and Lauren Westafer

We review the AAAAI 2020 anaphylaxis guideline (Shaker et al)

A lightening review of anaphylaxis, follow by a discussion of biphasic reaction and the role of steroids and antihistamines

Thanks for listening,

Jeremy Faust and Lauren Westsafer

Introducing a new series of quick, spoonfed literature updates, 1 article at a time

In this episode we review a new trial by Warren et al on antacids versus antacids with lidocaine for epigastric pain and dyspepsia

Show notes and references at FOAMcast.org

Thanks for listening,

Lauren Westafer and Jeremy Faust

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

We review the RECOVERY trial results on hydroxychloroquine for COVID-19 [pre-print by Hornby et al]

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

We review the RECOVERY trial results on dexamethasone for COVID-19 [pre-print by Hornby et al]

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

We explore effects of sterilization and re-use on N95s and KN95s efficiency and fit

Sterilization of N95s and KN95s with Hydrogen Peroxide and Chlorine Dioxide (Cai et al)

Extended use/reuse of N95 and fit test failure (Degesys et al) 

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded June 19, 2020

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

In this episode we discuss data on when SARS-CoV-2 began being detected in US communities  (Jorden et al)

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded June 9, 2020

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

In this episode we discuss some of the mental health ramifications of COVID-19 and the lockdowns:

US ED visits for mental health (Smalley et al)

Mental health of children during lockdown Xie et al

Psychological distress in US adults (McGinty et al)

Mood and violence in Chinese interns (Li et al)

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded June 9, 2020

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

In an update to the Convalsecent plasma episode we now cover the first RCT on the topic, Li et al

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded June 4, 2020

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

This episode reviews a study published by Mehra et al in the Lancet with concerning methods and data anomalies, leading to the possibility and likelihood of falsified data. This came to light after an open letter by Watson et al  detailing major issues. The Lancet issued a correction, which did not address many of the major issues and resulted in significant changes to Table S3 in the supplement. Concerningly, this group also authored the NEJM study on ACE-I/ARBs in COVID-19. 

Note: This is an evolving story

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded June 1, 2020

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

This episode reviews a study published by Goldman et al dissecting a study on remdesivir - 5 day vs 10 day course.

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded May 30, 2020

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

This episode reviews a study published by Wang et al that received incredible press coverage for touting benefits of mask wearing in one's own home....if it started prior to symptoms. This study is problematic, and we discuss why.

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded May 29, 2020

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

This episode reviews the NIAID trial, ACTT-1, on remdesivir vs placebo (Beigel et al)

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded May 23, 2020

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

This episode reviews an article by Groß et al that demonstrates SARS-CoV-2 RNA can be found in breastmilk

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded May 22, 2020

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19. *Our understanding of COVID-19 is rapidly developing and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

This episode reviews an article by Peyrony et al examining the performance of symptoms, physical exam findings, and ultrasound on the probability of COVID-19.

We also go into a bit of an interlude on likelihood ratios

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded May 22, 2020

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

This episode is a literature potpourri 

• Outcomes in pregnancy (Knight et al - pre-print).
• Are EMS calls for strokes and STEMIs down during the pandemic? Holmes et al
• More pediatric hyperinflammatory /Kawasaki-esque cases from Italy Verdoni et al
• More Kawasaki Disease in Paris. (Toubiana et al)
• Aerosol boxes for intubation (Begley et al)
• Genomic sequencing reveals healthcare associated clusters (Meredith et al)

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded May 15, 2020

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

This episode discusses

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

This episode discusses Pediatric Multisystem Inflammatory Syndrome Temporally Associated with COVID-19 , including the study published in the Lancet by Riphagen et al

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded May 6, 2020

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded May 9, 2020

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

This episode discusses convalescent plasma, specifically a recent systematic review by Rajendran et al

• Shen et al
• Zhang et al
• Ye et al
• Ahn et al
• Duan et al
• Biegel et al (influenza A RCT)

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded May 6, 2020

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

This episode discusses antibody testing including

• IDSA Antibody Testing Primer
• Crook et al [MedRxIv pre-print]
• FIND.org compilation and external assessment of tests
• Zhao et al 

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded May 2, 2020

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

This episode discusses an article by Baldi et al on excess mortality and Out of Hospital Cardiac Arrest

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded 4.29.20

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

This episode discusses cutaneous manifestations of COVID-19 including "COVID toes"

• Recalcati
• Manalo
• Duong et al
• Nieto
• Piccolo et al
• Alrantham  et al
• Kolivras et al

And the more serious lesions

• Zhang et al
• Zhang et al

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded 4.28.20

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

This episode discusses autopsy findings

• Carsana et al
• Barton et al
• Dolhnikoff et al

and VTE

• Llitjos
• Klok
• Tavazzi
• Grillet
• Obi (H1N1)

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded 4.26.20

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

This episode discusses an article by Caputo et al.   on self proning and oxygenation in COVID-19

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded 4.23.20

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

In this episode, Dr. Rory Spiegel (@EMNerd_) and I discuss the "switch" from early intubation to aggressive non-invasive modalities and our respiratory protocols including what we know about the evidence behind...

• Early intubation recommendations
• High flow nasal cannula in COVID-19
• Self/awake proning

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded 4.17.20

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

In this episode, we discuss thrombosis and COVID-19, specifically:

• Journal of the American College of Cardiology recommendations for COVID-19 (prophylaxis, anticoagulation, myocardial infarction)
• Bangalore et al in NEJM on ST elevation in COVID-19

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded 4.18.20

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

In this episode, we discuss special populations including

• Homeless individuals - Baggett et al 
• Racial disparities - African-Americans / Blacks disproportionately contracting SARS-CoV-2 and dying Yancy CW
• Healthcare workers with COVID-19 Heinzerling et al (CDC) and MMWR and Ng et al

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded 4.17.20

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

In this episode, we discuss testing issues

• Asymptomatic obstetric patients in NYC (Sutton et al. )
• Effects of narrow screening criteria (Wee et al)

And hydroxychloroquine updates

• More data without a comparator from the Raoult group (only published as abstract and table)
• Retrospective study with propensity matching (Mahévas et al)

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded 4.14.20

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

In this episode, we discuss outcomes from NYU

• Petrilli et al [pre-print]

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded 4.12.20

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

In this episode, Dr. Rory Spiegel (@EMNerd_) and I discuss risk stratification tools in COVID-19

• Zhou et al.
• Gong et al 

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded 4.10.20

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

In this episode, we discuss the NEJM article by Grien et al on the compassionate use of remdesivir in COVID-19 

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded 4.10.20

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

In this episode, we are joined by Dr. Rory Spiegel (EMNerd) and discuss what we are seeing in COVID-19 and various theories.

• Atypical ARDS picture

• HAPE: Solaimanzadeh

• Hemoglobinopathy-type of picture: Liu et al

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

*Recorded 4.5.20

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check back for updates/fact check what you hear*

In this episode, we are joined by Dr. Rory Spiegel (EMNerd) and discuss the ROX index predicting failure of HFNC and any applicability to COVID-19

• Derivation: Roca O, Messika J, Caralt B, et al. Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: The utility of the ROX index. J Crit Care. 2016;35:200-5.

• Roca O, Caralt B, Messika J, et al. An Index Combining Respiratory Rate and Oxygenation to Predict Outcome of Nasal High-Flow Therapy. Am J Respir Crit Care Med. 2019;199(11):1368-1376.

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

Recorded 4.5.20

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check us*

In this episode, we discuss emerging evidence for high flow nasal cannula 

• Wang et al. Ann Intensive Care. 2020 10(37)

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

Recorded 4.3.20

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check us*

In this episode, we discuss the theory (there is no great evidence) of hypercoagulability in severe COVID-19

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

Recorded 4.2.20

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check us*

In this episode, we cover

• The Brescia-COVID Respiratory Severity Scale (BCRSS) / Algorithm 
• ICU outcomes in Washington State - Bhatraju et al.

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

Recorded 3.31.20

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check us*

Recorded 3.30.20

In this episode, we cover

• Awake proning: Sun et al and Ding et al
• Hydroxychloroquine/Azithromycine update: Gautret et al.
• Neonatal update: Zeng et al.

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check us*

Recorded 3.28.20

In this episode, we cover

• Air samples from hallways and rooms contain SARS-CoV-2 [Santarpia et al - Pre-print]
• Convalescent plasma for the treatment of COVID-19 [Shen et al - JAMA]

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check us*

Recorded 3.27.20

In this episode, we cover

• Vertical transmission in pregnancy
• High flow nasal cannula with a mask

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check us*

Recorded 3.25.20

In this episode, we cover

• Incubation period
• Disease timeline
• Viral shedding
• Re-infection

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check us*

Recorded 3.23.20

In this episode, we cover

• Anosmia / dysgeusia
• Gastrointestinal symptoms
• Policy updates

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check us*

In this episode, we cover

• Transmission of SARS-CoV-2 (including stability on surfaces / aerosols)
• Cloth masks - do they work?
• UV light decontamination

Recorded 3.22.20

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check us*

In this episode, we cover

• High flow nasal cannula in COVID-19
• Cytokine storm
• Asymptomatic transmission and Ro of Sars-CoV2

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks. So, check us*

In this episode, we cover the Society of Critical Care Medicine, Surviving Sepsis Guidelines for COVID-19

Show notes: FOAMcast.org

Thanks for listening,
Lauren Westafer and Jeremy Faust

We interrupt our normal FOAMcast episodes to bring you updates from COVID-19, as literature develops. *Things change frequently and this may be out of date in days/weeks.

In this episode we review:

• guidance for pregnant and breastfeeding patients and healthcare workers
• experimental treatments that are all the craze: remdesivir, chloroquine, hydroxychloroquine, lopinavir-ritonavir

Show notes: FOAMcast.org

Thanks for listening!
Lauren Westafer and Jeremy Faust

We are going to try to bring you updates regarding COVID-19 on a regular basis. These podcasts will likely be out of date in a few days, so check back for updates.

This episode features:

• Co-infections (extended respiratory panel positive and positive for Sars-CoV-20
• Epidemiology of pediatric infections
• Ibuprofen and ACE-inhibitor use

Recorded 3.18.20

Thanks for listening,

Lauren Westafer and Jeremy Faust

We review the evaluation and management of Community-Acquired Pneumonia (CAP) as well as the Infectious Disease Society of America (IDSA) / American Thoracic Society (ATS) 2019 guidelines for CAP.

Shownotes and references at FOAMcast.org

Thanks for listening!
Jeremy Faust and Lauren Westafer

We cover some top articles of 2019, including the following: 

Roc vs Sux:  Guihard B et al. Effect of rocuronium vs succinylcholine on endotracheal intubation success rate among patients undergoing out-of-hospital rapid sequence intubation: A randomized clinical trial. JAMA 2019 Dec 17; 322:2303. (https://doi.org/10.1001/jama.2019.18254)

Targeted Temperature Management after Cardiac Arrest: Lascarrou JB, Merdji H, Le gouge A, et al. Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm. N Engl J Med. 2019.

Pulmonary Embolism - a new D-dimer cut off Kearon C, De wit K, Parpia S, et al. Diagnosis of Pulmonary Embolism with d-Dimer Adjusted to Clinical Probability. N Engl J Med. 2019;381(22):2125-2134.

Pulmonary Embolism in Pregnancy: Van der pol LM, Tromeur C, Bistervels IM, et al. Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism. N Engl J Med. 2019;380(12):1139-1149.

TXA in head injury The CRASH-3 Trial Collaborators. Effects of Tranexamic Acid on Death, Disability, Vascular Occlusive Events and Other Morbidities in Patients with Acute Traumatic Brain Injury (CRASH-3): A Randomised, Placebo-Controlled Trial. Lancet 2019

The VITAMINS trial by Fujii et al has been published in JAMA and provides insight into the performance of the "metabolic cocktail" (Vitamin C + thiamine + hydrocortisone) in ICU patients with septic shock. We review this trial in the context of prior literature.

Show notes and references at FOAMcast.org

Thanks for listening!
Jeremy Faust and Lauren Westafer

We review the American College of Emergency Physicians (ACEP) clinical policy on headache from June 2019, most of which revolves around the diagnosis of subarachnoid hemorrhage. 

Show notes and references at FOAMcast.org

Thanks for listening!
Jeremy Faust and Lauren Westafer

We are at ACEP 2019 in Denver and do a deep dive on a topic introduced by Bryan Hayes (@PharmERToxGuy) in a talk on black boxed medications used in the ED.

We review the data underlying the FDA warning for olanzapine and benzodiazepines.

Thanks for listening!
Jeremy Faust and Lauren Westafer

In this episode covering the American College of Emergency Physicians (ACEP) 2019, we cover common black box warnings including

• fluoroquinolones
• midazolam
• droperidol
• NSAIDs
• and more

Thanks for listening!

Jeremy Faust and Lauren Westafer

We are at ACEP 2019 in Denver and cover pearls from interesting lectures. Today, that included concussion and VP shunts.

Vaping associated lung injury (VALI) has become a frequent topic in the news in the United States (US). In this episode we review the epidemiology, presumed pathophysiology, and new recommendations from the Centers for Disease Control (CDC) in the US.

Thanks for listening!
Jeremy Faust and Lauren Westafer

FOAMcast.org

References:

1. Morbidity and Mortality Weekly Report (MMWR). 2019; 68(40)
2. Layden JE, Ghinai I, Pray I, et al. Pulmonary Illness Related to E-Cigarette Use in Illinois and Wisconsin - Preliminary Report. N Engl J Med. 2019; Sept 6.
3. Maddock SD, Cirulis MM, Callahan SJ, et al. Pulmonary Lipid-Laden Macrophages and Vaping. N Engl J Med. 2019;381:1488-1489.

In this episode we briefly review hyperkalemia and the principles of emergent treatment. Then we explore, in-depth, the role of insulin and dextrose including the incidence of hypoglycemia and pearls to reduce this side effect.

Pearls:

• 10-20% of patients treated with insulin/dextrose for hyperkalemia get hypoglycemic
• Consider giving 5 units insulin instead of 10 units
• Check the glucose for hours (dextrose lasts <1 hr, insulin lasts ≥2 hours)
• Beware of insulin in patients with renal insufficiency or with near normal starting glucose.

Thanks for listening!
Lauren

We discuss the US Food & Drug Administration's black box warning for droperidol and the evidence behind this warning.

We then discuss the use of butyrophenones such as droperidol and haloperidol for the treatment of agitation, headaches, nausea and vomiting, and gastroparesis/cannabinoid hyperemesis.

Thanks for listening!
Jeremy Faust and Lauren Westafer 

We discuss the coagulation test thromboelastography (TEG) / Rotational Thromboelastometry (ROTEM), reviewing the evidence behind the use of the tests as well as the clinical implications.

Show notes and graphics FOAMcast.org

Thanks for listening!
Jeremy Faust and Lauren Westafer

In this episode, we discuss important and "hot" articles thus far in 2019. These articles include:

• Testing for pulmonary embolism in pregnant patients

  • Van der pol LM, Tromeur C, Bistervels IM, et al. Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism. N Engl J Med. 2019;380(12):1139-1149.

    Langlois E, Cusson-dufour C, Moumneh T, et al. Could the YEARS algorithm be used to exclude pulmonary embolism during pregnancy? Data from the CT-PE-pregnancy study. J Thromb Haemost. 2019; In Press

• Asymptomatic bacteriuria guidelines from the Infectious Disease Society of America (IDSA)
  • Nicolle LE, Gupta K, Bradley SF, et al. Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2019.
• Dosing of benzodiazepines in seizures
  • Sathe AG, Tillman C, Coles LD, et al. Underdosing of benzodiazepines in patients with status epilepticus enrolled in Established Status Epilepticus Treatment Trial. Acad Emerg Med. 2019 Jun 4.
• Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in trauma patients
  • Joseph B et al. Nationwide analysis of resuscitative endovascular balloon occlusion of the aorta in civilian trauma. JAMA Surg 2019. Mar 20.
• Mortality following opioid overdose
  • Weiner SG, Baker O, Bernson D, Schuur JD. One-Year Mortality of Patients After Emergency Department Treatment for Nonfatal Opioid Overdose. Ann Emerg Med. 2019; In Press

Thanks for listening!

Jeremy Faust and Lauren Westafer

We review the entity formally known as pseudoseizures and psychogenic non-epileptic seizures (PNES), now referred to as psychogenic non-epileptic attacks (PNEA). 

We discuss the history of PNEA as well as relevant literature on the diagnosis and treatment of this entity.

Thanks for listening!
Jeremy Faust and Lauren Westafer

We review myths and reality in the management of patients with Sickle Cell Disease (SCD) 

• Are these patients typically opioid seeking? (No)
• If the patient appears comfortable I should withhold proper analgesia. (No).
• Should IV fluids be a routine part of the cocktail for vaso-occlusive pain episodes? (No)

We also review common emergencies in sickle cell disease that include

• Infections
• Acute chest syndrome
• Anemia (Aplastic crisis, splenic sequestration)
• Ischemia
  • Strokes
  • Avascular necrosis
  • Renal, pulmonary, splenic infarctions
• Vaso-occlusive pain episodes

Thanks for listening!
Lauren Westafer and Jeremy Faust

We are at #SMACC in Sydney, Australia, thanks to the Rosh Review, delivering updates from the conference to your earbuds.

Advocacy in Emergency Medicine - Esther Choo and Hugh Montgomery

Mechanical CPR vs Manual CPR - Ken Milne vs Salim Rezaie

Super sick massive GI bleeds and balloon tamponade - Sara Gray

Thanks for listening!
Jeremy Faust and Lauren Westafer

 We are at SMACC in Sydney, Australia, thanks to the Rosh Review, delivering updates from the conference to your earbuds. Today we cover resuscitation pearls.

Bougie vs Standard Stylet in emergency department (ED) rapid sequence intubation (RSI) - Brian Driver vs Rich Levitan

Rocuronium vs Succinylcholine Debate - Billy Mallon and Reuben Strayer

The Crashing Asthmatic - Haney Mallemat

Thanks for listening!

Lauren Westafer and Jeremy Faust

We are at #smacc in Australia thanks to the Rosh Review!

The opening session this morning was amazing and we can't do it justice on the podcast. Gill Hicks (@MadForPeace), a victim in the July 7, 2005 bombing attack on a London train spoke on how impactful everyone in the healthcare delivery system can be (from medics to detectives to nurses to physical therapists to physicians). Dr. Dara Kass delivered a powerful talk on vulnerability, responsibility, and lack of knowledge even in a super health care literate individual.....what it means to be a provider and a patient (and a mom and a medical home for the family and a wife) in her story of donating part of her liver to her son.

David Carr on anti-NMDA receptor encephalitis

 Anti-NMDA receptor encephalitis is the most common cause of encephalitis in young people (<30 years old), with an average age of ~20. We review the presentation, diagnosis, and treatment of this disease

Thanks for listening!
Jeremy Faust and Lauren Westafer

We co-hosted (with John Vassiliadis) the SMACC EM Updates half-day conference. We had amazing speakers. Salim Rezaie spoke on TXA for Everything, Ken Milne spoke on hot papers from 2018, and we learned about when ultrasound may be helpful in pediatric lumbar punctures. In addition, Jeremy spoke on what is usual care in sepsis and Lauren spoke on pulmonary embolism: the next generation. In this short podcast we highlight some of our other talks.

Aidan Baron (@Aidan_Baron) on Prehospital Updates in Cardiac Arrest

This talk focused on focusing on things that are most likely to make a difference in OHCA (bystander CPR and defibrillation) rather than on fun interventions like intubation and adrenaline (epinephrine). Aidan suggests that the future debates and questions in OHCA will be largely philosophical - what outcomes do we care about: neuro intact survival or ROSC or survival? 

1. Jabre P, Penaloza A, Pinero D, et al. Effect of bag-mask ventilation vs endotracheal intubation during cardiopulmonary resuscitation on neurological outcome after out-of-hospital cardiorespiratory arrest a randomized clinical trial. JAMA -2018;319(8):779–87.
2. Benger JR, Kirby K, Black S, et al. Effect of a Strategy of a Supraglottic Airway Device vs Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome: The AIRWAYS-2 Randomized Clinical Trial. JAMA. 2018;320(8):779-791.
3. Wang HE, Schmicker RH, Daya MR, et al. Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA. 2018;320(8):769-778

Barbra Backus on the future of the HEART score

Modified Heart Score (redefining the T or troponin based on newer assays) results in a NPV of 99.8% and classifies 48% of patients as low-risk.

Clinically Relevant Adverse Cardiac Events (CRACE) is way less common than major adverse cardiac events (MACE). HEART score of ≤3 ? CRACE is 0.05%

Hot Literature in 2019

1. Lemkes JS, Janssens GN, van der Hoeven NW, et al. Coronary Angiography after Cardiac Arrest without ST-Segment Elevation. N Engl J Med. 2019;NEJMoa1816897
2. Pluymaekers NAHA, Dudink EAMP, Luermans JGLM, et al. Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation. N Engl J Med .2019;NEJMoa1900353.

We have previously podcasted on tachyarrythmias (Episode 34 Tachyarrhythmias), but in this episode, we focus specifically on the treatment of supraventricular tachycardia  (SVT),  specifically paroxysmal SVT.

We discuss the treatment options of adenosine and calcium channel blockers, weighing in with the evidence, the guidelines, and some opinion.

Thanks for listening!
Lauren Westafer and Jeremy Faust

Thanks to Figure 1 for supporting this episode. We do not make money off of this podcast, this support is just for operational costs associated with the podcast.