EM Free Monthly Emergency Medicine Practice Podcast EMplify | EB Medicine
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EMplify Emergency Medicine Podcast

Get quick-hit summaries of hot topics in emergency medicine. EMplify summarizes evidence-based reviews in a monthly podcast. It highlights the latest research published in EB Medicine's peer-reviewed journals in order to educate and arm you for life in the ED.

Most recent episodes

Episode 50
In this episode of EMplify, Dr. Sam Ashoo reviews the evidence as presented in the October 2020 issue of Emergency Medicine Practice. Deep vein thrombosis (DVT) can present a diagnostic dilemma due to the overlapping of symptoms with other diseases, and ED management of patients with DVT has changed markedly over the last 10 years.
Table 1. Likelihood Ratios of Clinical Features Ruling In Deep Vein Thrombosis
 
 
Episode 49
In this episode of EMplify, Dr. Sam Ashoo interviews Dr. Hannah Janeway and Dr. Clinton Coil, of the David Geffen School of Medicine at UCLA, the authors of the September 2020 issue of Pediatric Emergency Medicine Practice, "Emergency Care for Transgender and Gender-Diverse Children and Adolescents." In this in-depth conversation, they explore the topics covered in the issue, including barriers to care, potential medical complications associated with gender-affirming therapies and appearance-altering practices, and the risks faced by this patient population.
Table 1. Terminology and Definitions Relating to Gender Identity and Expression
 
Episode 48
Infective Endocarditis September 1, 2020
Recognition of infective endocarditis in the ED can be a challenge, with varied and sometimes subtle complaints, and there is a lack of definitive testing available in the acute care setting. Learn when to suspect the disease, how recognize the risk factors for its development, and how to provide stabilization and treatment
Table 1. Risk Factors for Infective Endocarditis
 
Episode 47
Racism In Medicine with Dr. Maurice Selby August 12, 2020
In this episode of EMplify, Dr. Sam Ashoo interviews Dr. Maurice Selby, Assistant Professor of Emergency Medicine at the Emory University School of Medicine; Dr. Selby is also the host of the Health in Harlem radio show and podcast. Dr. Ashoo and Dr. Selby discuss racism in medicine, both historically and currently, and how it impacts patients and clinicians.
 
Episode 46
In this episode of EMplify, Dr. Sam Ashoo interviews Dr. Ryan Pedigo of Harbor-UCLA Medical Center, the author of the July 2020 issue of Emergency Medicine Practice, "Ventilator Management of Adult Patients in the Emergency Department." In this finale of their two-part conversation, Dr. Pedigo and Dr. Ashoo discuss the nuances of ventilation management for patients with ARDS (especially in those with COVID-19), as well as metabolic derangements such as DKA.
Table 3. Examples of Initial Ventilator Settings for Obstructive Physiology (Asthma/COPD), Volume Assist-Control Mode
 
Episode 45
In this episode of EMplify, Dr. Sam Ashoo interviews Dr. Ryan Pedigo of Harbor-UCLA Medical Center, the author of the July 2020 issue of Emergency Medicine Practice, "Ventilator Management of Adult Patients in the Emergency Department." In Part 1 of their two-part conversation, Dr. Pedigo and Dr. Ashoo discuss modes of ventilation, tidal volumes, and ventilator settings for patients with COPD and asthma.
Table 3. Examples of Initial Ventilator Settings for Obstructive Physiology (Asthma/COPD), Volume Assist-Control Mode
 
Episode 44
In this episode of EMplify, Dr. Sam Ashoo interviews Dr. Ilene Claudius and Dr. Mohsen Saidinejad about Multi-system Inflammatory Syndrome in Children (MIS-C) with COVID-19.
Dr. Ilene Claudius and Dr. Mohsen Saidinejad
 
Episode 43
In this episode of EMplify, Dr. Sam Ashoo interviews Dr. Harry Wingate and Dr. Ken Gramyk about Rural Emergency Medicine during the COVID-19 pandemic.
 
Episode 42
In this episode of EMplify, Dr. Sam Ashoo interviews Dr. Ashley Shreves about her experience as an emergency clinician and palliative medicine clinician in New Orleans during the COVID-19 pandemic.
Dr. Sam Ashoo interviews Dr. Ashley Shreves
 
Episode 41
In this episode of EMplify, Dr. Sam Ashoo interviews Dr. Eric Legome about "Emergency Department COVID Management Protocols: One Institution’s Experience and Lessons Learned."
Dr. Sam Ashoo interviews Dr. Eric Legome
 
Episode 40
In this episode of EMplify, Dr. Sam Ashoo interviews Dr. Colby Redfield, about Triage Tent Implementation, Telemedicine, PPE and EMS.
Dr. Sam Ashoo interviews Dr. Colby Redfield
 
Episode 39
In this episode of EMplify, Dr. Sam Ashoo interviews Dr. Joe Habboush, MD, CEO of MDCalc about new COVID-19 tools and his New York City experience.
Dr. Sam Ashoo interviews Dr. Joe Habboush
 
Episode 38
In this episode of EMplify, Dr. Sam Ashoo interviews Dr. Andrea Duca, an attending physician in the Emergency Department of Papa Giovanni XXIII Hospital in Bergamo, Italy.
Table 2. Clinical Features and Epidemiological Risks of COVID-19
 
Episode 37
This overview analyzes the best information from the early research and offers valuable links to the most reliable and trustworthy resources to stay up-to-date.
Table 2. Clinical Features and Epidemiological Risks of COVID-19
 
Episode 36
Acute gastroenteritis is a common complaint in the ED, and we know that in 79% of the cases, a causative organism is never found. Neither patients nor emergency clinicians want unnecessary testing or antibiotics
Table 3. Exposure/Patient Factors Associated With Bacterial Causes Likely to be Found on Stool Culture and Shiga Toxin Testing
 
Episode 35
Hyperglycemic emergencies – diabetic ketoacidosis (DKA) and the hyperosmolar hyperglycemic state (HHS) – are common presentations in the ED that require swift, specialized management strategies.
Table 8. Recommended Potassium Replacement in the First Hours of Diabetic Ketoacidosis
 
Episode 34
Chest pain is a common presentation to the emergency department, and survival outcomes depend on prompt, accurate risk assessment, diagnosis, and initiation of care. This issue reviews the current guidelines and latest evidence regarding the most effective strategies in emergency management of NSTEMI.
Table 4. Sgarbossa Criteria
 
Episode 33
Differentiating bronchiolitis from asthma and reactive airway disease in young children can be challenging, and a rapidly changing clinical presentation can confound accurate assessment of the severity of the illness.
Table 1. Differential Diagnosis for Wheezing in Infancy
 
Episode 32
Next time you’re onboard an airplane and hear, “Is there a medical professional on board?” should you raise your hand? What are your risks, responsibilities, and protections as a medical volunteer? This podcast reviews what you need to know before you fly.
Table 2. FAA-Mandated Supplies Contained in the Emergency Medical Kit
 
EXTRA Supplement 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.
Table 7. Proper Sleep Hygiene Techniques
 
Episode 31
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.
Figure 1. Clotting Factor Cascade and Site of Action of Oral Anticoagulant Agents
 
Episode 30
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.
Figure 3. Roux-en-Y Gastric Bypass
 
Episode 29
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.
Table 6. Alvarado Score
 
Episode 28
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)?
Table 2. Risk Factors for Major Depression
 
Episode 27
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.
Table 1. Sexually Transmitted Diseases Differential
 
Episode 26
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?
Table 1. Eastern Association for the Surgery of Trauma – Levels of Recommendation
 
Episode 25
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.
Table 2. Historical and Physical Examination Findings Associated with Subarachnoid Hemorrhage
 
Episode 24
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.
Figure 1. Sites of Ectopic Pregnancy Implantation
 
Episode 23
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?
Table 4. Most Frequent Clinical Symptoms of Seasonal Influenza, by Age Group
 
Episode 22
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.
Table 1. Physical Effects at Selected Currents
 
Episode 21
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?
Table 5. Historical and Physical Examination Findings Concerning for Sepsis
 
Episode 20
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?
Figure 3. Elapidae (Coral Snake) Distribution in North America
 
Episode 19
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.
Table 4. Differential Diagnosis for Suspected Cannabis Intoxication
 
Episode 18
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.
Table 3. Prognostic Signs in the Dyspneic Patient at the End of Life
 
Episode 17
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.
Figure 15. Traction-Countertraction Technique
 
Episode 16
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
Table 2. Travel Risk Exposures and Associated Infections
 
Episode 15
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
Table 11. Stages of Hepatic Encephalopathy
 
Episode 14
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.
Figure 1. Soot and Bronchial Casts From Smoke Inhalation
 
Episode 13
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.
Figure 6. Accidental Versus Intentional Scald
 
Episode 12
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.
Table 1. Components of the Multinational Association of Supportive Care in Cancer (MASCC) Risk Index
 
Episode 11
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?
Figure 2. Anatomy of the Knee
 
Episode 10
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
Table 2. Differential Diagnosis of an Inflammatory Bowel Disease Flare
 
Episode 9
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
Figure 4. End-Tidal Capnography Tracings
 
Episode 8
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
Figure 1. Hypothalamic-Pituitary-Adrenal Axis and Feedback Loops
 
Episode 7
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.
Table 1. Potential Sequelae of Renal and Genitourinary Injuries
 
Episode 6
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
Table 2. Electrocardiographic Classification and Likelihood of 30-day Major Adverse Cardiac Event
 
Episode 5
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.
Figure 4. Luxation of Teeth
 
Episode 4
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.
Figure 1. Diastolic and Systolic Heart Failure
 
Episode 3
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.
Figure 10. Fractures Of The Right Parasymphysis And The Left Mandibular Ramus
 
Episode 2
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.
Table 2_ Differential Diagnosis For Sympathomimetic Toxidrome
 
Episode 1
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.
Table 1. The Hs And Ts In Pulseless Electrical Activity
 

Meet the Host

Sam Ashoo, MD, FACEP

Dr. Ashoo is a practicing emergency physician, board-certified in emergency medicine and clinical informatics. Join him as he takes you through the October 2019 issue of Pediatric Emergency Medicine Practice: Acute Bronchiolitis: Assessment and Management in the Emergency Department (Pharmacology CME).

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