ERCAST
By Rob Orman, MD
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Podcast Description
A short, focused discussion of emergency medicine topics with perspectives from emergency physicians as well as other specialties. Here's the problem: When I listen to a 45 minute lecture that goes through about 15 different studies and has 50 slides, I come out feeling like a genius. An hour later, I have forgotten 95% of it. Here's the solution: ercast. We cover a single issue and try to tease out all the relevant elements without overstuffing your frontal cortex. It's for physicians and anyone interested in a bare bones look at emergency care.
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The Constipation Manifesto | There are many paths to laxation, below are my management strategies. Patient is on narcotics and you want to prevent constipation 1. Polyethylene glycol (PEG) 17g/1 glass per day. Up to 3 doses daily if needed 2. PEG + fecal inotrope/stimulant. Senna first choice 3. Docusate + Senna Docusate alone is probably not sufficient to prevent constipation in a patient on narcotics. The problem with narcotics is that they slow gut motility. Docusate works by breaking down fats, making stool soft/slick and also works as a weak osmotic laxative. This creates a soft stool that is still sitting in the colon. It's like a fast car propped up on cinderblocks. If docusate is used in combination with a stimulant like senna, laxation improves significantly. Warning: Bulking agents are often recommended as constipation prophylaxis for patients on narcotics. This may expand the diameter of the colonic lumen without moving anything though. Patient is on narcotics and is now constipated Step 1. Manually disimpact if needed and place an enema in the ED. Step 2. 2mg PO naloxone before ED discharge Step 3. Disimpaction dose of PEG (1.5g/kg/day or easy dosing 4 glasses per day). Take for 6 days or until soft stool passes, whichever comes first Step 4. Maintenance PEG. (0.3-0.8g/kg/day or easy dosing 1 glass per day). Take for 2 weeks and slowly taper Need a soft stool because of a sore anus (fissure, hemorrhoids, abscess, etc) Choice 1. Bulking agent like methylcellulose or psyllium. Must drink at least 1.5 liters of water per day, or the stool will become a colon shaped piece of concrete. Choice 2. Docusate Constipated kids older than 1 1. I will often place a saline enema while the patient is in the ED. 2. Another option in the ED, especially for younger kids who may not be able to hold in an enema, is a glycerin suppository. Glycerin softens stool and makes the passageway slick, but more importantly, acts as a stimulant and increases intestinal propulsion. See The Suppository Conundrum for details on how to place an suppository. 3. Outpatient treatment: PEG disimpaction dose (1.5g/kg/day) for 6 days or until soft stool passes, followed by a maintenance dose of 0.3-0.8g/kg/day for two weeks followed by a slow taper 4. Lactulose also a laxative option 5. Stress a diet with lots of fiber and water 6. Don’t hold it in Kids should defecate when the urge strikes. Waiting may make the urge pass with the result being a harder, drier, more impacted stool. Then, like an overdue baby, it won’t want to leave its happy home. Kids will keep playing rather than going to the bathroom, and some have angst with pooping so they hold it in. We need to talk to our patients/parents about this. What about mineral oil? Mineral oil makes the stool slick and soft so it passes easier. In the studies and reviews I’ve read, the recurrent theme is that it shouldn’t be given in infants or long term use because of complications like aspiration, lipoid pneumonia and foreign body reaction in gut. The toxicity is increased if it’s given along with docusate. The risk/reward analysis does not favor mineral oil. Bottom line: there are better a | 2/2/12 | Free | View In iTunes |
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Decision Tools: PERC, NEXUS and CURB-65 | Is NEXUS dead? Are we admitting too many patients with pneumonia? How useful is the PERC rule? It's all about decision rules on this episode of ERcast. Ryan Radecki from EM LIterature of Note joins us for a review of four papers: 1. Hospital admission decision for patients with community-acquired pneumonia: variability among physicians in an emergency department 2. Diagnostic Accuracy of Pulmonary Embolism Rule-Out Criteria: A Systematic Review and Meta-analysis. 3. National Emergency X-Radiography Utilization Study criteria is inadequate to rule out fracture after significant blunt trauma compared with computed tomography. 4. Are Steroids Effective for Treating Bell's Palsy? Scott Weingart from emcrit.org gives his 2 cents worth on how we should be using the PERC rule. The question is, "How do we decide if a patient has a low pretest probability so that we can select the proper patients in whom to apply PERC?" Scott recommends using the Well's score to decide if the patient is low risk. This gives you validated method of establishing a pretest probability rather than guessing. Although guessing/gestalt works pretty well too. Here is a link to Scott's algorithm. NEXUS Criteria 1. No posterior midline neck tenderness 2. No evidence of intoxication 3. Oriented to person, place, time, and event 4. No focal neurological deficit 5. No painful distracting injury Canadian C-Spine Rules PERC Rule Age < 50 years Pulse < 100 bpm SaO2 > 94% No unilateral leg swelling No hemoptysis No recent trauma or surgery No prior PE or DVT No hormone use MD Calc Wells Score Calculation Engine Bonus Section: Shoulder Dislocation The Cunningham Technique for shoulder reduction is all the rage. Check out the ERcast tutorial on how it's done. Even though this method can get some dislocated shoulders in like a hot knife through butter, remember that all shoulder dislocations are not the same, nor will all patients be relaxed enough to make it work. I think every emergency provider should be proficient with several reduction techniques. Here are my top 6 1. Cunningham technique 2. Scapular manipulation 3. Milch/Modified Milch 4. Kocher method 5. Spaso Technique 6. Traction/counter traction with my elbow hooked inside the patients AC fossa while their arm is bent. The best way to keep up on hot topics in emergency medicine: R and R in the Fastlane | 1/19/12 | Free | View In iTunes |
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CleanPediatric fever | One of the most important factors driving the medical workup on a well appearing, febrile infant is the prevalence of serious bacterial infection (SBI) . This number changes depending on age and immunization status (pneumococcus vaccine having the most impact in North America.) The higher the likelihood of disease, the more aggressive the workup and treatment. Prevalence of serious bacterial infection/meningitis by age 0-14 days (pre-vaccine) 1/10 14-28 days 1/20 28-60 days (pre-vaccine) 1/100 28-60 days (post-vaccine) 1/1,000 60-90 days 1/1,000-1/10,000 >90 days 1/>10,000 How do we make sense of these numbers and apply them to our evaluation of febrile infants? In this podcast, an interview with Dr. Andy Sloas of the PEM ED podcast goes through the method and madness of figuring out what to do when and why we do it at all. The above statistics and age related fever workups later in the blog post are adapted from Dr. Sloas' algorithm on fever without a source. Pediatric Fever Trivia Many parents will bring their febrile infant to the emergency department because the fever is not responding to antipyretics. Does response to antipyretics make SBI less likely? No. This has been extensively studied and no relationship has been found between response to antipyretics and severity of illness or presence of bacteremia. Yamamoto LT, Wigder HN, Fligner DJ, et al. Relationship of bacteremia to antipyretic therapy in febrile children. Pediatr Emerg Care. 1987;3:223-227. Should a chest X-ray be ordered on a febrile child < 3 months of age without respiratory symptoms? The data to date would suggest no. The likelihood of finding an infiltrate on CXR is extremely low in the absence of ANY of the following exam findings: tachypnea > 50 bpm cough nasal flaring stridor grunting wheezing ronchi rales hypoxia coryza (runny nose) If you see even one of these criteria in a febrile infant or neonate, it's a mandatory CXR, although I still find runny nose a bit of a hard sell indicating a lower respiratory tract infection. Caveat: a child >3 months with a WBC >20,000 should get a CXR to evaluate for occult pneumonia (even if asymptomatic) ACEP Policy on Pediatric Fever PDF Bachur R,Perry H,Harper MB.Occult pneumonias: empiric chest radiographs in febrile children with leukocytosis. Ann Emerg | 12/26/11 | Free | View In iTunes |
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CleanMark Crislip on Vaccines and Why You Should Get a Flu Shot | As interview with podcast and blogging grandmaster Mark Crislip, MD on vaccinology and influenza. Mark's website CDC Flu Site CDC info for clinicians on antiviral medications and influenza testing Check out ZdoggMD's video 'Immunize'. Honorable mention winner of the 2011 Disposable Film Festival. http://youtu.be/-vQOM91C7us And last, but certainly not least, Mark Crislip's A Budget of Dumb Asses I wonder if you are one of those Dumb Asses who do not get the flu shot each year? Yes. Dumb Ass. Big D, big A. You may be allergic to the vaccine, you may have had Guillain Barre, in which case I will cut you some slack. But if you don't have those conditions and you work in health care and you don't get a vaccine for one of the following reasons, you are a dumb ass. 1. The vaccine gives me the flu. Dumb Ass. It is a killed vaccine. It cannot give you the influenza. It is impossible to get flu from the influenza vaccine. 2. <em style="color: inherit; font- | 12/1/11 | Free | View In iTunes |
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RLQ pain in pregnancy. Bonus track: the return of Zdoggmd | The list of potential badness in the pregnant patient with right lower quadrant pain is long and distinguished, but it often comes down to a simple question, "Does this patient have appendicitis?" The subtext of this question is, "Is this patient going to need a CT scan?" Nobody likes ordering am abdominal CT on a pregnant patient because, no matter how low the statistical risk of damage to the fetus, there is still potential harm from ionizing radiation. As you will see below, the risk of immediate maternal and fetal harm is far greater than the long term risk of ionizing radiation exposure. Interview with Ingrid Lim MD at ACEP 2011 Risk of mortality with appendicitis in pregnancy: In a pregnant patient with unperforated appendicitis, fetal loss is 3-5%. With perforation, fetal loss skyrockets: -30% in trimesters 1 and 2 -70% in trimester 3 Maternal mortality is 1% without perforation and 4% with perforation Diagnosis: Step 1: Ultrasound- more sensitive in the 1st vs. 3rd trimester. Even though it may be inconclusive as far as appendicitis, ultrasound can give valuable information about the fetus, uterus, ovaries, kidneys and gallbladder. If ultrasound doesn't give the answer.... Step 2: MRI without contrast DO NOT USE GADOLINIUM:CONTRAINDICATED IN PREGNANCY If no MRI available... Step 3: CT with or without contrast depends on your local radiologist. Contrast (IV or PO) is considered safe in pregnancy. Research has shown that contrast does not harm fetal thyroid RADIATION PRIMER for CT Appy protocol Fetal background radiation exposure during 9 months of pregnancy 0.1 rad (1mGy) Teratogenesis threshold: 5 rad (50mGy) <p style="color: #444 | 11/17/11 | Free | View In iTunes |
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CleanHyphema | Hyphema: blood in the anterior chamber of the eye. It may appear as a reddish tinge, or it may appear as a small pool of blood at the bottom of the iris or in the cornea. <div style="color: #444444; font-family: Georgia, 'Bitstream Charter', serif; li | 10/31/11 | Free | View In iTunes |
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CleanDo we still need to do a spinal tap with a negative CT in worst headache of life? | It's deeply rooted medical dogma that spinal tap needs to follow a negative CT when evaluating patients for subarachnoid hemorrhage. New literature has come out to challenge that idea. We talk with Scott Weingart of emcrit.org and Ryan Radecki of Emergency Medicine Literature of Note about a 2011 BMJ paper that looks at the sensitivity of computed tomography when performed within 6 hours of headache onset. Keeping with the neurology theme, what's the story with awake blunt trauma patients with a negative cervical spine CT who still have neck pain. Do they need an MRI? Also... Broome Docs in Western Australia Justin Arambasick gets published in EP monthly Zdoggmd has been busy | 9/28/11 | Free | View In iTunes |
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CleanSuicide risk assessment in the emergency department: a how to guide | -- | 9/7/11 | Free | View In iTunes |
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CleanThe propofol assassins. US vs CT for appy. Defensive documentation. ERcast RANT-OFF | ERCAST Rant-Off 2011 It's open mike time for whatever get's your goat (in medicine, that is). Featured rants... Cliff Reid of resus.me: The Propofol Assassins Dave Peaslee: "Do you know what medicines you're on, sir?" Andy Neill of emergencymedicineireland: Are we thinking about PE the right way? Mike and Matt from the emergency ultrasound podcast: US vs CT for appendicitis Resident Jim: How I feel about attendings who do a full H&P before I get in the room Dan Gromis: Can you really be allergic to iodine? I think not! Gerry O'Malley: Why do we teach residents defensive documentation? Steve Ayers: When can you really say someone has HTN? Mike Jasumback: Wants an emergency medicine forum. Email him at EMforum@live.com Haven't subscribed to ercast in itunes yet? Here's how. | 8/3/11 | Free | View In iTunes |
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CleanThe Truth About Distal Radial Fractures | How important is it to get a perfect reduction of a distal radius fracture in the ED? Is it even worthwhile? Pro -Pain is improved when a severely displaced fracture is reduced and immobilized. -The ED has sedation capabilities that the orthopedist's office does not. If we can get good anatomic alignment in the ED and save a trip to the OR, we've benefitted the patient -You are treating the patient for their presenting complaint Con -A significant portion of reduced fractures will fall out of reduction -They are a huge time and resource sink. Time to reach NPO status keeps a bed occupied. The sedation and splinting involve multiple staff members. A nurse is taken away from other ED patients for as long as the patient needs close monitoring -Many of these patients may not actually benefit from reduction. Do you like to reduce Colles fractures? If so, have at it. They're one of my favorite procedures and I rarely pass up the chance. But there is no fault in splinting and referring to the orthopedist as long as the skin and neurovascular exam are intact. You just need to explain to the patient/family why you're not fixing a deformed wrist. Written Summary: Justin Arambasick MD Akron General Medical Center Consult with Hans Moller, MD Does a mild to moderate (< 35˚) nonarticular fracture of the distal radius have to be reduced? Not necessarily. Many countries in Europe do no perform surgery or reduction on these, and a variety of low powered studies have not shown fun | 7/8/11 | Free | View In iTunes |
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ExplicitHypertension Rocks! Zdoggmd returns to ercast to discuss the ins and outs of HTN | HTN should be straightforward, so why is it confusing? Part of the problem is terminology. Shane and Pitts got it right in 2003 when they made sense of classifying different hypertensive scenarios. What in the world do accelerated, malignant, urgent and malignant HTN mean? I have no idea either. Here's the Shane and Pitts BP breakdown.... Severely elevated blood pressure can be thought of in three ways: Hypertensive emergency: end organ damage because of severely increased blood pressure. In this scenario, BP should be lowered in the next 1 to 2 hours. Hypertensive urgency: severely elevated blood pressure in patients at high risk for acute end organ damage but without evidence of new injury. This includes a history of prior end organ disease like CHF, unstable angina, renal failure, CVA, etc. Do these patients need to be admitted or have immediate BP reduction in the ED? Your decision will be physician comfort level based rather than evidence based, because there's no evidence so say what's the right thing to do. However, you should have increased vigilance. If the patient is discharged, set up a plan for BP reduction and follow-up in a day or two. Everyone else is in the third group: Uncontrolled Severe HTN. The most important management piece here is good follow up. You may end up starting these patients on antihypertensives in the ED, or maybe they’ll be referred for a BP recheck in a week because this was a first reading of high BP or they had an acute painful condition that confounded to the picture. In the old system, where everyone with really high blood pressure but without end organ dysfunction was classified as an urgency, it was hard to organize treatment and disposition. With this grouping: emergency, urgency and uncontrolled severe HTN, I find it easier to organize my treamtent and disposition. And now for some sho | 6/7/11 | Free | View In iTunes |
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What would Hippocrates do? | Interview with emergency medicine luminary Dr. David Newman of.... SMART EM The NNT website Hippocrates Shadow | 5/18/11 | Free | View In iTunes |
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CleanFlutter, Fib, and the mystery of ablation | Comments, Rants, Australian accent? Ercast google voice line 503-208-5680 Consult with electrophysiologist Randy Jones MD Is there a limit to the number of cardioversions a patient can have in a year? -No limit -if a patient comes into the ED for frequent cardioversion, treatment strategy needs to be changed. - ablation, increased dose of medication or new medication -Goal is have the patient be able to tolerate the condition. No matter the treatment, it should be considered a chronic condition like hypertension. It can be managend and controlled, but it is a lifelong companion What is the clinical difference between a-fib and a- flutter? -If it looks like a mix of fib and flutter, it’s probably just a-fib. Delete the term fib-flutter from your EKG lexicon. -Classic/ typical flutter –EKG down going saw tooth pattern in II, III and AVF & up going in V1. An electric circuit going around the tricuspid valve counter-clockwise. - Interrupting the circuit will terminate the rhythm. That’s why it doesn’t take so muchenergy to cardiovert. It’s a defined track. If any point of the track is interrupted, the dysrhythmia ends. Compare to a-fib, which involves a larger area of atrium and thus takes more energy to convert Why you should be nervous about sending an atrial flutter patient home -Be aware if you slow the atrial rate you may raise the ventricular rate, by allowing the av node to conduct 1:1 -A concern in sending someone home with a flutter is that the rate may become very variable (i.e. while lying down they may be in a 4:1 conduction though while standing may go to 2:1. -Ablation is an effective tx for a –flutter -Recurrence rate almost 100% without ablation Treatment of Atrial Fibrillation (outside of rate control) Short or infrequent flares of a-fib Cardioversion -Electricity -Chemical: Procainamide: 1 gm in 250cc D5w over 1 hour-discussed in previous episode-52% conversion Pill in a Pocket -American guidelines of tx of atrial fibrillation August 2006, endorsed the pill in pocket approach. -Dosage is 200 mg of flecainide or 450 mg of propafenone (for people weighing 70 kg (155 lbs) or less) or 300 mg of flecainide or 600 mg of propafenone for people weighing more than 70 kg. First time should be done in the a monitored setting Ablation -Candidates: younger, normal sized atrium, not in long term/chronic afib -Desire to discontinue use of warfarin not a reason for ablation. Ablation does not decrease stroke risk. Pts will still need anticoagulation. Desired outcome from ablation is to improve symptoms and quality of life -Warfarin treatment after an ablation procedure -typically 2-3 months, though this can be looked at individually *IF a patient is high risk for thromboembolic event, will place pt on warfarin indefinitely, even if in NSR How do you decide if a patient needs anticoagulation? In the United States <img class="alignnone size-medium wp-image-311" title="CHADS2 score" src="http://ercastblog.files.wordpress.com/ | 4/26/11 | Free | View In iTunes |
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ExplicitThe Problem with Salt: How low is too low? | Hyponatremia is all the rage these days, but the question in my mind is: When is a sodium level too low to send someone home? We are joined by some of emergency medicine's greatest minds in our search for the answer. Scott Weingart from EMCrit Mel Herbert of EMRAP, CME Download and Captain Cortex Allen Roberts of Grunt Doc fame Chris Nickson from Life in the Fast Lane Rob Rogers, the man behind EMRAP Educators Edition Elise Lovell Ken Bizovi and.... Zdogg, MD Zdogg, MD | 3/29/11 | Free | View In iTunes |
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CleanA Fib Unleashed! | Curbside consult with electrophysiologist Randy Jones MD about the fine points of atrial fibrillation managment. -Proper pad placement. -The difference between a-fib and a-flutter. -How much energy to use. -What to do when that nice sinus rhythm after cardioversion turns back into a-fib. -What's the deal with mixing calcium channel and beta blockers? -The best agents for acute rate control. -Do we need to worry about ventricular dysrhythmias after cardioversion? -Procainamide for cardioversion of acute a-fib H | 3/13/11 | Free | View In iTunes |
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Pediatric Syncope | It's usually nothing serious, but sometimes it can be a harbinger of sudden death. Ercast interviews Ray Moreno, MD about a rational approach to the pediatric patient who presents following a syncopal event. Here are a few of the links mentioned in the episode. Pediatric Syncope Review Article Rob's Suicide Risk Assessment Mnemonic PV Card Loop Abscess Surgical Technique Video | 2/23/11 | Free | View In iTunes |
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Perianal Abscess | We talk with colorectal surgeon Megan Cavanaugh about the ins and outs of managing perianal abscesses in the ED. Two listener emails. One asking a question about induced hypothermia. For more info on induced hypothmermia, click here Rob becomes a Fellow of the Utopoian College Of Emergency Medicine. F.UCEM. Complements of Life in the Fast Lane Product review on Bionix lighted ear curettes. See the post just below this one for more info. Ercast celebrates its first birthday. | 1/28/11 | Free | View In iTunes |
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ExplicitAcademia versus the privates. Where to now? | We take an in depth look at what it's like to work in academia and the private community hospital. The medicine is the same but the day to day of your job is quite different. Scott Weingart from emcrit and Rob Rogers from emrap educators podcast join ercast for the session. Also, ten axioms to get a good start on your life as a community ED doc. | 1/4/11 | Free | View In iTunes |
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V Tach Storm | What do you do when you get to the end of the ventricular tachycardia algorithm your patient is still in V-Tach. You are now off the map of ACLS and in the middle of a V Tach Storm. We go step by step through a case of incessant ventricular tachycardia with pearls, pitfalls and things to think about when the fecus is hitting the fan. | 12/9/10 | Free | View In iTunes |
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Do cardiac risk factors matter? | It's beaten into our heads that we need to ask, document and consider cardiac risk factors in the acute chest pain patient. And we do. Diligently. But do risk factors for chronic coronary artery disease play a role in helping to predict whether or not the emergency department patient presenting with chest pain has an acute coronary syndrome? Logic says they should but the data says otherwise. Studies referenced in this episode Resuscitation 2008 Annals of Emergency Medicine 2007 | 11/24/10 | Free | View In iTunes |
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Loop Abscess Q and A | Your emails about the loop abscess technique. A new way to put in a Nasograstic Tube Read if you dare. Bob the anal fissure. Have a comment, rant, profanity laden manifesto? Give the ercast vocemail a call! 503-208-5680 | 11/14/10 | Free | View In iTunes |
| 22 | VideoLoop abscess drainage video | If you are an EM:RAP listener, this is the video I talked about in the November episode on abscess managment. It goes through the steps of a new technique for draining a cutaneous abscess as described in this article. I am a huge fan of this procedure and use it on most abscesses that I would have otherwise packed. Why I like it: there is no packing to change, the incisions stay open because of the drain and the incisions themselves are much smaller than we historically use. The original video has footage of the loop drainage being done on an actual abscess but that is currently under review for HIPPA compliance and all that goodness. When the dust settles, I'll re-post with the original movie. | 11/4/10 | Free | View In iTunes |
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8 Ortho questions | ercast is back in action! Keep a lookout for the upcoming video of the loop abscess technique in the next week or so. But for today.... What Colles' fractures should go to the OR? Does an IO line create an open fracture? These questions and many more with our orthopedic curbside consultant Dr. Adam Barmada. | 10/27/10 | Free | View In iTunes |
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CleanCompetence vs Decision Making Capacity | Legal expert Rich Orman joins ercast for a discussion about the distinction between competence and medical decision making capacity. Also -A dog bites my brother's s*****m -ercast and EMRAP -listener email on induced hypothermia and MRSA | 9/22/10 | Free | View In iTunes |
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CleanMRSA and Abscess Part 1 | Dr. Greg Moran, the ultimate Jedi Master of emergency medicine infectious disease, talks with ercast about MRSA, abscesses, decolonization therapy, cellulitis and much, much more. Does a simple cutaneous abscess need antibiotics? Why is MRSA such a nasty bug? How should we be treating cellulitis in the MRSA era? Do most abscesses need a wound culture? Is decolonization therapy worth it for emergency department patients? | 9/16/10 | Free | View In iTunes |
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Induced Hypothermia | Everything you need to know about the how and why to induce hypothermia in post cardiac arrest patients. We interview Dr. Scott Weingart and take a deep look into his soul to discover the platinum nugget of critical care emergency medicine. Also... -The ercast hotline is open. Give us a call at 503-208-5680 and tell us what you have to say -Another reason that c-diff sucks -Your emails And not much more | 8/6/10 | Free | View In iTunes |
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ExplicitC Diff is never a good thing | Do you have a habit of taking a z-pack 3 days into your viral URI? Do you work in a hospital or health care setting? Do you have a colon? If you answered yes to any of these three questions, this episode is for you. We break down c-diff into the nuts and bolts that you need to know, as well as a few things you probably don't need to know but will never forget after you listen. | 7/12/10 | Free | View In iTunes |
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Climbing Everest | Terry OConnor talks with ercast about climbing Mt Everest and being an expedition physicianAn experience with delayed sequence intubationRob is interviewed on The Skeptical Review websiteA letter from Dr. Ken Walker about the international emergency medicine and the Partners for International Development | 6/11/10 | Free | View In iTunes |
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The Toxic Neonate | An interview with Dr. Tim Horeczko about how to recognize and manage the crashing neonate. Topics include:-The pediatric assessment triangle-Managing hypoglycemia in a pediatric resuscitation-IV fluid management-Cyanotic Heart Disease-Inborn errors of metabolism-An appearance by Borat | 5/26/10 | Free | View In iTunes |
| 30 | CleanVideovidcast review of airwaycam loupes | We review airwaycam.com's 2x loupes. I've been seeing ads for these in the throwaway journals for the past few months and for $150 they seemed too good to be true. Tune in and see what we found. | 5/13/10 | Free | View In iTunes |
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Awake Intubation | An interview with ED Critical Care 7th degree black belt Scott Weingart, MD. | 5/3/10 | Free | View In iTunes |
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CleanSuicide Risk | Suicide risk assessment in the emergency department. An interview with Jeff Young, MD. Here's the link to the 'famous awake intubation video' that will be one of the topics on the next episode http://blog.emcrit.org/misc/awake-intub-video/ | 4/16/10 | Free | View In iTunes |
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CleanPediatric Elbow Injuries | -- | 3/29/10 | Free | View In iTunes |
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CleanThe Death Tell | How do we deliver the news of death? It ain't easy, but it can be done well. Stuart Swadron from EMRAP joins us for a discussion. | 3/8/10 | Free | View In iTunes |
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ExplicitPriapism and Hematuria | Why is a 12 hour erection a bad thing? How should we manage the patient with bloody urine? A curbside consult with urologist Brian Shaffer, MD. Your emails An unusual southern accent and much more... Urology Primer Priapism a rare condition that causes a persistent, and often painful, penile erection. Priapism is drug induced, injury related, or caused by disease, not sexual desire. As in a normal erection, the p***s fills with blood and becomes erect. However, unlike a normal erection that dissipates after sexual activity ends, the persistent erection caused by priapism is maintained because the blood in the penile shaft does not drain. The shaft remains hard, while the tip of the p***s is soft. If it is not relieved promptly, priapism can lead to permanent scarring of the p***s and inability to have a normal erection. Clot retention blood clots in the bladder prevent urine emptying Coude Catheter a semi-rigid catheter that has a curve or bend at the tip. The curved tip allows it to navigate over the curvature of the prostate or any other urethral obstruction it may encounter. A Coude catheter is specifically designed for this purpose. Coude catheters are available in size 8 French to size 26 French. De Novo The Latin expression de novo literally means something akin to "from the beginning" or "anew" Interstitial cystitis also called painful bladder syndrome — is a chronic condition characterized by a combination of uncomfortable bladder pressure, bladder pain and sometimes pain in your pelvis, which can range from mild burning or discomfort to severe pain. Cystoscopy the use of a scope (cystoscope) to examine the bladder. This is done either to look at the bladder for abnormalities or to help with surgery being performed on the inside of the urinary tract (transurethral surgery). CT Urogram A urogram is a radiograph, or X-ray image, of the urinary tract. TURP transurethral resection of the prostate Foley catheter a thin, sterile tube inserted into the bladder to drain urine. Because it can be left in place in the bladder for a period of time, it is also called an indwelling catheter. It is held in place with a balloon at the end, which is filled with sterile water to hold it in place. The urine drains into a bag and can then be taken from an outlet device to be drained | 2/23/10 | Free | View In iTunes |
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CleanBrain Attack--Controversies in acute stroke management | Treating acute stroke beyond the 3 hour window. A discussion of the history of thrombolytics in acute stroke, current literature and an interview with Providence Stroke Center director Dr. Ted Lowenkopf. | 2/10/10 | Free | View In iTunes |
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Episode 2--Pediatric Limp | How do you workup a child with limp? Decisions rules for distinguishing between toxic synovitis and septic hip. A curbside consult with pediatric orthopedic surgeon Adam Barmada Listener email and much more | 2/3/10 | Free | View In iTunes |
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ExplicitRectal Foreign Bodies | Welcome to episode 1! Rectal foreign bodies. | 1/23/10 | Free | View In iTunes |
| Total: 38 Episodes |
Customer Reviews
A fascinating and entertaining look inside the emergency department
Dr. Rob Orman, M.D. takes listeners into the Emergency Department in an entertaining look at emergency medicine. Geared toward the medical professional, but accessable for everybody, if you are interested in medicine this is the pocast for you. Also, I really like Dr. Orman's style--kind of like a medical version of This American Life.
Fabulous First Episode!
Dr. Rob Orman has a great podcast side manner! Fabulous first show and look forward to hearing more from you and your associates. Even if you have no medical knowledge, this podcast really pulls the listener in and gets them involved with the subject matter.
Bravo Dr. Rob and thanks!
Nick Charles, California
Great Podcast!
Dr. Rob is engaging and entertaining. Although I'm not currently in the medical field (I'm working toward a career as a Physician Assistant), Dr. Rob's conversational style make these heavy medical topics easily digestible. My only suggestion is to work on the audio editing a little, as the audio volumes tend to go up and down throughout the podcast. Other than that, it's spectacular. Great job!!!
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