Core EM | Core Emergency Medicine
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Core EM | Core Emergency Medicine
6M ago
We revisit the topic of Hyperkelamia to update our prior episode from 2015 (pre-Lokelma)
Hosts:
Brian Gilberti, MD
Jonathan Kobles, MD
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Hyperkalemia.mp3
Download Leave a Comment Tags: Renal Colic
Show Notes
Introduction
Background
Physiology:
Normal range and the significance of deviations (>5.5 mEq/L)
Epidemiology:
Prevalence of hyperkalemia in the ER
ESRD missed HD → ECG, monitor
Causes / Risk Factors
Causes
Kidney Dysfunction, Medications, Cellular Destruction, Endocrine Causes, Pseudohyperkalemia ..read more
Core EM | Core Emergency Medicine
6M ago
Diagnostic accuracy of the physical examination in emergency department patients with acute vertigo or dizziness: A systematic review and meta-analysis for GRACE-3 Academic Emergency Medicine, 2023
Background
GRACE Background
The GRACE guidelines – “Guidelines for Reasonable and Appropriate Care in the Emergency Department” – are a Society for Academic Emergency Medicine (SAEM) program designed to “reduce wasteful testing, provide explicit criteria to reduce foreseeable risk, and define sensible and prudent medical care”. The GRACE-1 guidelines were about chest pain, and the GRACE-2 guidelin ..read more
Core EM | Core Emergency Medicine
7M ago
We go over the essential and complex topic of vasopressors in the ED.
Hosts:
Brian Gilberti, MD
Catherine Jamin, MD
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Vasopressors.mp3
Download Leave a Comment Tags: Critical Care
Show Notes
Introduction
Host: Brian Gilberti, MD
Guest: Catherine Jamin, MD
Associate professor of Emergency Medicine at NYU Langone Health
Vice Chair of Operations
Triple-boarded in Emergency Medicine, Internal Medicine, and Critical Care Medicine
Topic: Vasopressors: Essential agents for supporting critically ill patients in the ED
What Are Vasopr ..read more
Core EM | Core Emergency Medicine
7M ago
The Case
A 41-year-old male presents to the ED with constant palpitations for one day. The patient's medical history is notable for a congenital bicuspid aortic valve, four months post aortic valve replacement with a post-surgical ejection fraction of 30%. The following ECG is obtained:
EKG
Show Details
EKG Characteristics
Rate
Fast
Rhythm
Wide complex tachycardia
Intervals
Wide complex QRS (146 ms)
Axis
Left axis deviation
ST Segments
Non-specific
Additional Features
Right bundle branch block morphology
Diagnosis
Idiopathic Fascicular Ventricular Tachycardia
Questions
What i ..read more
Core EM | Core Emergency Medicine
7M ago
Written by: Sadakat Chowdhury MD
Edited by: Mak Sarich MD, Jay Lin MD, Jonathan Kobles MD
Background:
Ultrasound (US) guided nerve blocks offer an applicable option for achieving analgesia in the emergency department. As an alternative to parenteral or oral analgesia, nerve blocks have the potential for improved pain control, decreased risk of harm (hypoventilation, compromised airway or perfusion, potential for addiction), and decreased length of hospital stay.1 2 3 4 This article will focus on three lower extremity (LE) nerve blocks commonly used for acute lower extremity pain in the ED ..read more
Core EM | Core Emergency Medicine
10M ago
Written by:
Samantha Kerester, MD
Naillid Felipe, MD
Edited by:
Gregg Chesney, MD
Jonathan Kobles, MD
Background:
Thrombotic thrombocytopenic purpura (TTP) is a hematologic disorder caused by platelet aggregation and thrombus formation in the microvasculature, resulting in severe thrombocytopenia, hemolytic anemia, and multi-organ ischemia.
Annual incidence of approximately 2-4 cases/million/year (Kappler, 2017), with 90% of cases occurring in adulthood. (Joly, 2017)
Risk factors include:
Female, 2:1 female to male predominance (Terrell, 2010)
Black race  ..read more
Core EM | Core Emergency Medicine
1y ago
Written By: Kaitlynn Tracy, MD
Edited By: Sean Schnarr, MD and Gregg Chesney, MD
Definition/Background:
Burns are classified as being major, moderate, or minor in severity. The American Burn Association classifies a burn as “minor” if it meets the following criteria:2
Partial thickness < 15% BSA in a patient between the ages of 10-50
Partial thickness < 10% BSA in a patient younger than 10 or older than 50
Full thickness < 2% BSA
In general, a “minor” burn should also be without any following characteristics:2
No signs of associated inhalation injury
Not from a chem ..read more
Core EM | Core Emergency Medicine
1y ago
Background: The immediate post intubation period in the ED is a critical time for continued patient stabilization. While physical adjuncts like securing the tube, in line suctioning, and head positioning are part of general post intubation management, a better understanding of analgesics and sedatives have offered newer approaches and improved outcomes down the line during the patient’s hospital stay. The reality of ever increasing ED volumes and longer boarding times to the ICU makes it imperative for emergency physicians to learn how to manage these critical patients.
Earl ..read more
Core EM | Core Emergency Medicine
2y ago
BACKGROUND:
Necrotizing soft tissue infections are a rare but potentially lethal condition that can quickly lead to severe morbidity and mortality if not identified by clinical history and physical exam. It is a rapidly progressing infection that moves along fascial planes, often evading the immune system. This is a tricky diagnosis that can often be inconspicuous, so clinical gestalt is key. The definitive treatment of a necrotizing soft tissue infection is surgical debridement and removal of the necrotic tissue. Studies have shown that early surgical intervention is associated with reduced ..read more
Core EM | Core Emergency Medicine
2y ago
A quick primer on hypocalcemia in the ED.
Hosts:
Joseph Offenbacher, MD
Audrey Bree Tse, MD
https://media.blubrry.com/coreem/content.blubrry.com/coreem/hypocalcemia.mp3
Download Leave a Comment Tags: calcium, Critical Care, Endocrine
Show Notes
Swami’s CoreEM Post
Hypocalcemia Repletion:
IV calcium supplementation with 100-300 mg Ca2+ raises serum Ca2+ by 0.5 – 1.5 mEq
For acute but mild symptomatic hypocalcemia: 200-1000mg calcium chloride IV or 1-2g IV calcium gluconate over 2 hours
For severe hypocalcemia: 1g calcium chloride IV or 1-2g IV calcium gluconate IV over 10 minutes ..read more