192 episodes

Core EM is dedicated to bringing Emergency Providers all things core content Emergency Medicine. In the true spirit of Emergency Medicine our content is available to anyone, anywhere, anytime.

Core EM - Emergency Medicine Podcast Core EM

    • Health & Fitness
    • 4.7 • 13 Ratings

Core EM is dedicated to bringing Emergency Providers all things core content Emergency Medicine. In the true spirit of Emergency Medicine our content is available to anyone, anywhere, anytime.

    Podcast 186.0: Hypocalcemia

    Podcast 186.0: Hypocalcemia

    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







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    4 Comments











    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 repeated q 60 min until symptoms resolve



    References:



    * Cooper MS, Gittoes NJ. Diagnosis and management of hypocalcaemia. BMJ 2008; 336:1298.

    * ​​Desai TK, Carlson RW, Geheb MA. Prevalence and clinical implications of hypocalcemia in acutely ill patients in a medical intensive care setting. Am J Med 1988; 84:209.

    * Goltzman, D. Diagnostic approach to hypocalcemia. UpToDate. UpToDate; Jul 17, 2020. Accessed April 29, 2022. https://www.uptodate.com/contents/plantar-fasciitis

    * Kelly A, Levine MA. Hypocalcemia in the critically ill patient. J Intensive Care Med 2013; 28:166.

    * Pfenning CL, Slovis CM: Electrolyte Disorders; in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. St. Louis, Mosby, Inc., 2014, (Ch) 125: p 1636-53.

    * Swaminathan, A. (2016, January 27). Hypocalcemia. CoreEM. Retrieved April 29, 2022, from https://coreem.net/core/hypocalcemia/

    * Vantour L, Goltzman D. Regulation of calcium homeostasis. In: rimer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, 9th ed, Bilezikian JP (Ed), Wiley-Blackwell, Hoboken, NJ 2018. p.163.







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    • 9 min
    Podcast 185.0: Anticoagulation Reversal

    Podcast 185.0: Anticoagulation Reversal

    How and when to reverse anticoagulation in the bleeding EM patient.

    Hosts:

    Joe Offenbacher, MD

    Audrey Bree Tse, MD







    https://media.blubrry.com/coreem/content.blubrry.com/coreem/AC_reversal.mp3







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    3 Comments











    Tags: Anticoagulation, Critical Care, Resuscitation











    Show Notes

    Coagulation Cascade:



     

    Algorithm for Anticoagulated Bleeding Patient in the ED:

     



     

    Indications for Anticoagulation Reversal:



     

    References: 



    Baugh CW, Levine M, Cornutt D, et al. Anticoagulant Reversal Strategies in the Emergency Department Setting: Recommendations of a Multidisciplinary Expert Panel. Ann Emerg Med. 2020;76(4):470-485. doi:10.1016/j.annemergmed.2019.09.001

    Eikelboom JW, Quinlan DJ, van Ryn J, Weitz JI. Idarucizumab: The Antidote for Reversal of Dabigatran. Circulation. 2015 Dec 22;132(25):2412-22. doi: 10.1161/CIRCULATIONAHA.115.019628. PMID: 26700008.

    Fariborz Farsad B, Golpira R, Najafi H, et al. Comparison between Prothrombin Complex Concentrate (PCC) and Fresh Frozen Plasma (FFP) for the Urgent Reversal of Warfarin in Patients with Mechanical Heart Valves in a Tertiary Care Cardiac Center. Iran J Pharm Res. 2015;14(3):877-885.

    Fariborz Farsad B, Golpira R, Najafi H, et al. Comparison between Prothrombin Complex Concentrate (PCC) and Fresh Frozen Plasma (FFP) for the Urgent Reversal of Warfarin in Patients with Mechanical Heart Valves in a Tertiary Care Cardiac Center. Iran J Pharm Res. 2015;14(3):877-885.

    Palta S, Saroa R, Palta A. Overview of the coagulation system. Indian J Anaesth. 2014;58(5):515-523. doi:10.4103/0019-5049.144643

    Siegal DM, Curnutte JT, Connolly SJ, Lu G, Conley PB, Wiens BL, Mathur VS, Castillo J, Bronson MD, Leeds JM, Mar FA, Gold A, Crowther MA. Andexanet Alfa for the Reversal of Factor Xa Inhibitor Activity. N Engl J Med. 2015 Dec 17;373(25):2413-24. doi: 10.1056/NEJMoa1510991. Epub 2015 Nov 11. PMID: 26559317.







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    • 21 min
    Episode 184.0 Ludwig’s Angina

    Episode 184.0 Ludwig’s Angina

    A primer on this airway/ ID/ ENT emergency.

    Hosts: Joe Offenbacher MD, A Bree Tse, MD







    https://media.blubrry.com/coreem/content.blubrry.com/coreem/ludwigs_2.mp3







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    2 Comments











    Tags: Airway, ENT, Infectious Diseases











    Show Notes







    References:



    Botha A, Jacobs F, Postma C. Retrospective analysis of etiology and comorbid diseases associated with Ludwig’s Angina. Ann Maxillofac Surg 2015; 5:168.

    Boscolo-Rizzo P, Da Mosto MC. Submandibular space infection: a potentially lethal infection. Int J Infect Dis 2009; 13:327.

    Brook I. Microbiology and principles of antimicrobial therapy for head and neck infections. Infect Dis Clin North Am. 2007 Jun;21(2):355-91, vi. doi: 10.1016/j.idc.2007.03.014. PMID: 17561074.

    Chong W, Hijazi M, Abdalrazig M, Patil N. Respect the Floor of the Mouth. J Emerg Med. 2020 Jul;59(1):e27-e29. doi: 10.1016/j.jemermed.2020.04.015. Epub 2020 May 19. PMID: 32439254.

    http://www.emdocs.net/ludwigs-angina-2/

    Mohamad I, Narayanan MS. “Double Tongue” Appearance in Ludwig’s Angina. N Engl J Med 2019; 381:163.

    Saifeldeen K, Evans R. Ludwig’s angina. Emerg Med J. 2004 Mar;21(2):242-3. doi: 10.1136/emj.2003.012336. PMID: 14988363; PMCID: PMC1726306.

    Wolfe MM, Davis JW, Parks SN. Is surgical airway necessary for airway management in deep neck infections and Ludwig angina? J Crit Care. 2011 Feb;26(1):11-4. doi: 10.1016/j.jcrc.2010.02.016. PMID: 20537506.







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    • 9 min
    Pneumothorax

    Pneumothorax

    A quick overview of pneumothorax for the EM physician: the what, why, diagnosis, and treatment.

    Hosts:

    Joe Offenbacher, MD

    Audrey Tse, MD







    https://media.blubrry.com/coreem/content.blubrry.com/coreem/Pneumothorax_CoreEM_podcast.mp3







    Download





    One Comment











    Tags: #pneumothorax #FOAMed











    Show Notes

    Shownotes:

    CoreEM Pulmonary Ultrasound Post







    References:

    Bense L, Lewander R, Eklund G, et al. Nonsmoking, non-alpha 1-antitrypsin deficiency-induced emphysema in nonsmokers with healed spontaneous pneumothorax, identified by computed tomography of the lungs. Chest 1993; 103:433.

    Bense L, Wiman LG, Hedenstierna G. Onset of symptoms in spontaneous pneumothorax: correlations to physical activity. Eur J Respir Dis 1987; 71:181.

    Brown SGA, Ball EL, Perrin K, Asha SE, Braithwaite I, Egerton-Warburton D, Jones PG, Keijzers G, Kinnear FB, Kwan BCH, Lam KV, Lee YCG, Nowitz M, Read CA, Simpson G, Smith JA, Summers QA, Weatherall M, Beasley R; PSP Investigators. Conservative versus Interventional Treatment for Spontaneous Pneumothorax. N Engl J Med. 2020 Jan 30;382(5):405-415. doi: 10.1056/NEJMoa1910775. PMID: 31995686.

    Chardoli M, Hasan-Ghaliaee T, Akbari H, Rahimi-Movaghar V. Accuracy of chest radiography versus chest computed tomography in hemodynamically stable patients with blunt chest trauma. Chin J Traumatol 2013; 16:351.

    Chan KK, Joo DA, McRae AD, et al. Chest ultrasonography versus supine chest radiography for diagnosis of pneumothorax in trauma patients in the emergency department. Cochrane Database Syst Rev 2020; 7:CD013031.

    Ebrahimi A, Yousefifard M, Mohammad Kazemi H, et al. Diagnostic Accuracy of Chest Ultrasonography versus Chest Radiography for Identification of Pneumothorax: A Systematic Review and Meta-Analysis. Tanaffos 2014; 13:29.

    Gobbel Jr WG, Rhea Jr WG, Nelson IA, Daniel RA. Spontaneous pneumothorax. J Thorac Cardiovasc Surg 1963; 46:331.

    Lesur O, Delorme N, Fromaget JM, et al. Computed tomography in the etiologic assessment of idiopathic spontaneous pneumothorax. Chest 1990; 98:341.

    Lichtenstein DA, Mezière G, Lascols N, et al. Ultrasound diagnosis of occult pneumothorax. Crit Care Med 2005; 33:1231.

    Melton LJ 3rd, Hepper NG, Offord KP. Influence of height on the risk of spontaneous pneumothorax. Mayo Clin Proc 1981; 56:678.

    Ohata M, Suzuki H. Pathogenesis of spontaneous pneumothorax. With special reference to the ultrastructure of emphysematous bullae. Chest 1980; 77:771.

    Sahn SA, Heffner JE. Spontaneous pneumothorax. N Engl J Med 2000; 342:868.

     





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    • 13 min
    Episode 182.0 – Wellens

    Episode 182.0 – Wellens

    An interesting back story on this must-not-miss EKG finding in the ED!

    Hosts:

    Joseph Offenbacher, MD

    Audrey Bree Tse, MD







    https://media.blubrry.com/coreem/content.blubrry.com/coreem/CoreEM_Wellens.mp3







    Download





    One Comment











    Tags: #FOAMed, #wellens, Cardiology, EKG, STEMI











    Show Notes

    Hosts: Joe Offenbacher MD, Audrey Bree Tse MD

    EKG Findings in de Zwaan C, Bär FW, Wellens HJ. Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. Am Heart J. 1982 Apr;103(4 Pt 2):730-6. doi: 10.1016/0002-8703(82)90480-x. PMID: 6121481.



    Table 1 in de Zwaan C, Bär FW, Wellens HJ. Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. Am Heart J. 1982 Apr;103(4 Pt 2):730-6. doi: 10.1016/0002-8703(82)90480-x. PMID: 6121481.



    REFERENCES:

    de Zwaan C, Bär FW, Wellens HJ. Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. Am Heart J. 1982 Apr;103(4 Pt 2):730-6. doi: 10.1016/0002-8703(82)90480-x. PMID: 6121481.

    Lee, M., & Chen, C. (2015). Myocardial Bridging: An Up-to-Date Review. Journal of Invasive Cardiology, 27(11), 521–528.

     https://lifeinthefastlane.com/ecg-library/wellens-syndrome/

    Lin AN, Lin S, Gokhroo R, Misra D. Cocaine-induced pseudo-Wellens’ syndrome: a Wellens’ phenocopy. BMJ Case Rep. 2017 Dec 14;2017:bcr2017222835. doi: 10.1136/bcr-2017-222835. PMID: 29246935; PMCID: PMC5753703.

    Rhinehardt, J., Brady, W. J., Perron, A. D., & Mattu, A. (2002). Electrocardiographic manifestations of Wellens’ syndrome. The American Journal of Emergency Medicine, 20(7), 638–643. https://doi.org/10.1053/ajem.2002.34800

    Tandy, TK; Bottomy DP; Lewis JG (March 1999). “Wellens’ syndrome”. Annals of Emergency Medicine. 33 (3): 347–351. PMID 10036351. doi:10.1016/S0196-0644(99)70373-2. (via Wikipedia)





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    • 8 min
    Subarachnoid Hemorrhage

    Subarachnoid Hemorrhage

    We discuss EM presentation, diagnosis, and management of subarachnoid hemorrhage.

    Hosts:

    Mark Iscoe, MD

    Brian Gilberti, MD

    Bree Tse, MD







    https://media.blubrry.com/coreem/content.blubrry.com/coreem/SAH.mp3







    Download





    One Comment











    Tags: Critical Care, Neurology, Subarachnoid Hemorrhage











    Show Notes

    Non-contrast head CT showing SAH (Case courtesy of Dr. David Cuete, Radiopaedia.org, rID: 22770)



     

    Hunt-Hess grade and mortality (from Lantigua et al. 2015.)







    Hunt-Hess grade

    Mortality (%)





    1. Mild Headache

    3.5





    2. Severe headache or cranial nerve deficit

    3.2





    3. Confusion, lethargy, or lateralized weakness

    9.4





    4. Stupor

    23.6





    5. Coma

    70.5







     

    Ottawa Subarachnoid Hemorrhage Rule, and appropriate population for rule application (from Perry et al. 2017)

    Apply to patients who are:



    * Alert

    ≥ 15 years old

    Have new, severe, atraumatic headache that reached maximum intensity within 1 hour of osnet



    Do not apply to patients who have:



    New neurologic deficits

    Previous diagnosis of intracranial aneurysm, SAH, or brain tumor

    History of similar headaches (≥ 3 episodes over ≥ 6 months)



    SAH cannot be ruled out if the patient meets any of the following criteria:



    * Age ≥ 40

    Symptom of neck pain or stiffness

    Witnessed loss of consciousness

    Onset during exertion

    “Thunderclap headache” (defined as instantly peaking pain)

    Limited neck flexion on examination (defined as inability to touch chin to chest or raise head 3 cm off the bed if supine)





     

    ___________________________

    Special Thanks To:



    * Dr. Mark Iscoe, MD (Ronald O. Perelman Department of Emergency Medicine at NYU Langone Health, NYC Health + Hospitals/ Bellevue)



    ___________________________

    References:

    Bellolio MF, Hess EP, Gilani WI, et al. External validation of the Ottawa subarachnoid hemorrhage clinical decision rule in patients with acute headache. Am J Emerg Med. 2015;33(2):244-9.

    Carstairs SD, Tanen DA, Duncan TD, et al. Computed tomographic angiography for the evaluation of aneurysmal subarachnoid hemorrhage. Acad Emerg Med. 2006;13(5):486-492.

    Connolly ES, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke. 2012;43(6):1711-1737.

    Czuczman AD, Thomas LE, Boulanger AB, et al. Interpreting red blood cells in lumbar puncture: distinguishing true subarachnoid hemorrhage from traumatic tap. Acad Emerg Med. 2013;20(3):247-256.

    Dugas C,

    • 19 min

Customer Reviews

4.7 out of 5
13 Ratings

13 Ratings

DrDan2410 ,

Core content doesnt get any better

A brilliant and concise look at truly essential EM topics. Essential listening for all EM Docs.

Jakethemedic ,

The Swami strikes again

An excellent series of podcasts, done by The Swami, whom most people interested in EM Foamed will at least have heard of.

Good coverage of most topics, well structured and interesting podcasts.

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