Episode 189: Hyperkalemia 2.0
Core EM | Core Emergency Medicine
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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
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Classic EM: GRACE – 3 Guidelines
Core EM | Core Emergency Medicine
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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
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Episode 188: Vasopressors
Core EM | Core Emergency Medicine
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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
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Wide Complex Tachycardia
Core EM | Core Emergency Medicine
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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
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Ultrasound Guided Lower Extremity Nerve Blocks
Core EM | Core Emergency Medicine
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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
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Thrombotic Thrombocytopenic Purpura (TTP)
Core EM | Core Emergency Medicine
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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
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ED Management of Minor Thermal Burns
Core EM | Core Emergency Medicine
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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
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Post-Intubation Sedation and Analgesia
Core EM | Core Emergency Medicine
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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
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Ultrasound Diagnosis of Necrotizing Soft Tissue Infections
Core EM | Core Emergency Medicine
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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
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Podcast 186.0: Hypocalcemia
Core EM | Core Emergency Medicine
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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
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