EMplify Emergency Medicine Podcast

Dr. Susan Kirelik, a concussion specialist and emergency medicine physician, discusses the key points of concussion diagnosis and management from the perspective of the emergency medicine clinician.

The use of direct oral anticoagulants – the direct thrombin inhibitor and the anti-factor Xa inhibitors – has increased greatly since 2010, when the first agent was approved by the FDA. Though DOACs are popular with patients because they don’t require the lab monitoring and dietary changes of warfarin, these patients can present new challenges to emergency clinicians.

Bariatric surgery has shown evidence of being a means of achieving sustainable weight loss, along with improvement in the comorbidities associated with obesity, such as hypertension, diabetes, and dyslipidemia. Though relatively safe, these patients do frequently present to the ED with complications, and proper management depends on emergency clinicians’ swift recognition and treatment.

Patients with abdominal pain are common in the ED, but you need a strategy for quickly identifying patients who are at high risk for life-threatening causes of pain, and you need to order testing and consultation that improves the accuracy of your clinical assessment.

Though there is growing evidence that shows that ED patients present with high rates of depression and suicidal ideation, there are some novel strategies that emergency clinicians can use to quickly identify patients most at risk: What are the DSM-5 symptoms for major depressive disorder (MDD)?

Sexually transmitted disease can cause severe outcomes for patients, their partners, and their unborn babies, and swift and accurate diagnosis and treatment is essential to reduce morbidity and minimize the potential public health risks.

When a patient arrives in the ED following blunt force trauma to the anterior chest wall, how can you tell whether they have a life-threatening cardiac injury that requires urgent operative management or just some soreness and can be discharged?

Though patients often present to the ED seeking relief from headaches that cause significant pain and suffering, 90% of them can be considered “benign.” It is essential to identify the 10% of headache patients who are in danger of having a life-threatening disorder presenting with a sudden and severe headache to ensure that they are treated quickly and effectively.

When a first-trimester-pregnant patient presents to the ED, emergency clinicians must consider the life and health of both the mother and the fetus in diagnosis and management. Abdominal pain, bleeding, urinary tract infection, and nausea and vomiting are common conditions in the differential for pregnant patients – as well as for patients who don’t yet know they’re pregnant.

Patients presenting to the ED with “influenza-like illness” (cough, sore throat, fever) are typical in the fall and winter. How can you tell whether a patient might have influenza and infect others with a potentially dangerous strain? Are the guidelines the same in the spring and summer?

A patient presenting to the ED after an electric shock is a potential multisystem trauma patient. All body systems can be affected by electrical injury: musculoskeletal, cardiac, vascular, respiratory, and neurologic. History and physical examination will be the best indicators of the extent of injury.

For patients in the ED who are suspected of having sepsis, swift, effective management is vital to improving outcomes. This issue reviews the latest evidence on the diagnosis and treatment of sepsis and septic shock: how do the definitions of sepsis affect treatment decisions – and CMS quality measurements?

Venomous native North American snake families include the pit vipers (copperheads, water moccasins/cottonmouths, and rattlesnakes) and coral snakes. Pit viper venom is coagulopathic, and coral snake venom is neurotoxic – so what are the differences in ED management between the 2 types of envenomations?

As the use of cannabinoids increases, so have ED presentations of patients with acute intoxication and cannabinoid hyperemesis syndrome. This issue reviews the latest evidence on recognizing and managing patients with emergent conditions related to cannabinoid use, including an overview of the pathophysiology of cannabinoids.

Up to three quarters of patients with terminal cancer experience dyspnea, and many patients near the end of life will present to the ED seeking help. For emergency clinicians, the goals of care for patients with terminal illness are very different. This issue reviews what emergency clinicians must know to safely, effectively, and sensitively manage the distressing symptoms of breathlessness.

Fractures, dislocations, and overuse syndromes all produce shoulder pain, but a systematic approach to evaluation and treatment will ensure that your diagnosis and treatment plan locates the source of the pain and reduces the chances that the patient will have life-long disability or life-threatening sequelae.

This issue reviews management of patients with suspected Middle East respiratory syndrome, chikungunya virus infection, and Zika virus infection. To safeguard the health of the public – and hospital staff – it is essential for emergency clinicians to know the current status of worldwide infectious disease outbreaks

Jaundice is a manifestation of elevated serum bilirubin, and can have many causes, some of which can be life-threatening. This issue will help the emergency clinician narrow down the differential diagnosis to determine a cause and allow for swift disposition

When treating patients who have suffered injury in a fire, managing their airway is as critical as treating their burns. Following on the February 2018 issue on Thermal Burns, this issue reviews strategies for diagnosing and treating inhalation injuries in fire-exposed patients.

Thermal burn injuries are a significant cause of morbidity and mortality worldwide. In addition to treatment of the burns, emergency clinicians must assess for inhalation injury, exposure to toxic gases, and related traumatic injuries. Priorities for emergency resuscitation include stabilization of airway and breathing, intravenous fluid administration, pain control, and local wound care.

Whether a patient with cancer presents to the ED with cancer-treatment side effects or complications of the disease itself, timely diagnostic workup and evidence-based management strategies can make the difference in their quality of life. This issue reviews management recommendations for 3 ED presentations of oncologic patients: metastatic spinal cord compression, tumor lysis syndrome, and neutropenic fever.

Dislocations of the hip, knee, or ankle are painful presentations in the trauma ED that must be managed quickly to avoid morbidity, disability, and even possible amputation. This issue presents an evidence-based approach to: Quickly assess the dislocation based on the mechanism of injury, manage fractures often associated with dislocations, quickly and safely diagnose and treat dangerous knee dislocations, and order diagnostic studies to determine the exact nature of the dislocation: x-rays or CT?

Managing acute flares of chronic inflammatory bowel disease (IBD) in the ED can be challenging. This issue will help you: Differentiate the routine flare from a complication, learn the extraintestinal manifestations of undiagnosed IBD to help spot the disease early, determine whether the signs and symptoms indicate an infectious etiology, and communicate effectively with gastroenterologists and assist in long-term management

As more and more patients present to the ED with symptoms that suggest an acute exacerbation of COPD –worsening dyspnea, cough and sputum production – emergency clinicians can improve patient comfort and possibly mitigate morbidity and mortality with the right testing and treatment interventions

Adrenal disorders can be life-threatening if they are unrecognized. In this issue, you will learn to distinguish primary and secondary adrenal insufficiency from many similar presentations, order laboratory tests in the ED that will assist emergent management, administer the optimal corticosteroid in the correct dose to quickly manage the cortisol deficit, and recognize and treat adrenal insufficiency in patients with critical illnesses

For trauma patients in the ED, life- and limb-threatening injuries take priority, but renal and genitourinary injury can have long-term consequences for patients, including chronic kidney disease, erectile dysfunction, incontinence, and other serious problems. This issue offers a review of the literature regarding treatment of renal and GU injuries, from diagnosis to management to disposition.

A missed diagnosis of acute coronary syndromes can be life threatening, but what about patients who appear to be at low risk of ACS? What are the best ways to make sure those at risk are flagged without ordering unnecessary testing? In this issue, you will learn to Manage the special diagnostic challenges with women, the young, the old, and those with previously treated CAD

This article makes management of most dental emergencies easier by providing recommendations for replanting avulsed teeth, the use of imaging to identify suspected deep neck infections (especially in high-risk immunocompromised or diabetic patients), appropriate use of antibiotics, and familiarity with orofacial nerve blocks to deliver safe and effective pain relief.

Acute decompensated heart failure is a common emergency department presentation with significant associated morbidity and mortality. This issue reviews recent literature regarding appropriate management of emergency department presentations of acute decompensated heart failure, with special attention to newer medication options.

Patients with maxillofacial trauma require a careful evaluation due to the anatomical proximity of the maxillofacial region to the head and neck. Facial injuries can range from soft-tissue lacerations and nondisplaced nasal fractures to severe, complex fractures, eye injuries, and possible brain injury.

Sedative-hypnotic drugs include gamma-Aminobutyric acid (GABA)ergic agents such as benzodiazepines, barbiturates, gamma-Hydroxybutyric acid [GHB], gamma-Butyrolactone [GBL], baclofen, and ethanol. Benzodiazepines, phenobarbital, propofol, and other GABA agonists or analogues can effectively control symptoms of withdrawal from GABAergic agents.

This systematic review analyzes the basic life support factors that improve survival outcome, including chest compression technique and rapid defibrillation of shockable rhythms. For patients who are successfully resuscitated, comprehensive postresuscitation care is essential. Management of cardiac arrest in circumstances such as pregnancy, pulmonary embolism, opioid overdose and other toxicologic causes, hypothermia, and coronary ischemia are also reviewed.