Take a deeper dive into our peer-reviewed emergency medicine content with the EMplify podcast. Join host Dr. Sam Ashoo for educational, conversational reviews of current evidence guaranteed to help you make your best clinical decisions. Each high-yield episode gives you practical, time-tested guidance from practicing emergency medicine clinicians and subject-matter experts. Listen and learn!
Conversation - Meningococcal Meningitis
In this episode of EMplify: Conversation, Sam Ashoo, MD and TR Eckler, MD discuss meningococcal meningitis and the recent outbreak in Florida.Topics discussed include:* Which vaccines are currently approved by the FDA and recommended by the CDC.* The difference between the MEN ACWY vaccine and the meningococcal B vaccine.* What the current recommendations are for those exposed.* Challenges for healthcare providers treating patients who have been exposed or have symptoms.Further reading:Hogan AN, Brockman II CR, Santa Maria A. Emergency department management of adults with infectious meningitis and encephalitis. Emerg Med Pract. 2022 Apr;24(4):1-24. Epub 2022 Apr 2. PMID: 35315604.CDC Meningococcal Disease (https://www.cdc.gov/meningococcal/index.html) and Vaccination (https://www.cdc.gov/meningococcal/about/prevention.html). As always, we value your feedback. Please take our listener survey (https://www.surveymonkey.com/r/ZQRWQFW).See the episode page (https://foamed.ebmedicine.net/podcast/conversation-meningococcal-meningitis/)for more details.
Conversation - High Sensitivity Troponin
In this episode of EMplify: Conversation, Sam Ashoo, MD and TR Eckler, MD discuss high sensitivity troponin testing and clinical pathways.Topics discussed include: * Which troponin assay are you currently using and what are its limits of detection? * Do delta troponin results only count if they increase? * If the test result is indeterminate, then what? repeat in 1 hr (European standard), repeat in 3 hours (depending on chest pain onset), or just admit if the HEAR(T) score is high? * What does one negative troponin on presentation mean? No death in 30 days to 1 year but still missed MI?* And more... References* Anand A, et al; HiSTORIC Investigators†. High-Sensitivity Cardiac Troponin on Presentation to Rule Out Myocardial Infarction: A Stepped-Wedge Cluster Randomized Controlled Trial. Circulation. 2021 Jun 8;143(23):2214-2224. doi: 10.1161/CIRCULATIONAHA.120.052380. Epub 2021 Mar 23. PMID: 33752439; PMCID: PMC8177493.* Chapman AR, et al. Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome. JAMA. 2017 Nov 21;318(19):1913-1924. doi: 10.1001/jama.2017.17488. Erratum in: JAMA. 2018 Mar 20;319(11):1168. Soerensen NA [corrected to Sorensen NA]. PMID: 29127948; PMCID: PMC5710293.* Chenevier-Gobeaux C, et al. Multi-centre evaluation of recent troponin assays for the diagnosis of NSTEMI. Pract Lab Med. 2018 Feb 26;11:23-32. doi: 10.1016/j.plabm.2018.02.003. PMID: 30014015; PMCID: PMC6045566.* Chiang CH, Chiang CH, Lee GH, Qian F, Chen SC, Lee CC. Time to Implement the European Society of Cardiology 0/1-Hour Algorithm. Ann Emerg Med. 2020 Nov;76(5):690-692. doi: 10.1016/j.annemergmed.2020.05.038. PMID: 33097132; PMCID: PMC7575504.* McCarthy CP, Januzzi JL Jr. Increasingly Sensitive Troponin Assays: Is Perfect the Enemy of Good? J Am Heart Assoc. 2020 Dec;9(23):e019678. doi: 10.1161/JAHA.120.019678. Epub 2020 Nov 26. PMID: 33238785; PMCID: PMC7763764.* Neumann JT, et al. Application of High-Sensitivity Troponin in Suspected Myocardial Infarction. N Engl J Med. 2019 Jun 27;380(26):2529-2540. doi: 10.1056/NEJMoa1803377. PMID: 31242362.* Miller J, Cook B, Singh-Kucukarslan G, Tang A, Danagoulian S, Heath G, Khalifa Z, Levy P, Mahler SA, Mills N, McCord J. RACE-IT - Rapid Acute Coronary Syndrome Exclusion using the Beckman Coulter Access high-sensitivity cardiac troponin I: A stepped-wedge cluster randomized trial. Contemp Clin Trials Commun. 2021 Apr 23;22:100773. doi: 10.1016/j.conctc.2021.100773. PMID: 34013092; PMCID: PMC8114080.
Conversation – Cognitive Reframing
In this episode of EMplify: Conversation, Sam Ashoo, MD and Rob Orman, MD discuss cognitive reframing.What is cognitive reframing you ask? It is a tool for dealing with a particularly difficult event. In our case, we discuss the “near miss” medical case and how it impacted a physician. Then we discuss how the use of cognitive reframing can help improve our perception of these “near miss” events in medicine. We also discuss what this tool can do for our longevity in medicine, regardless of our career choices. So take a listen. You may be surprised how this tool can be used in all aspects of your life.Rob Orman refers to a videos he created for a client for the post-shift power-down. You can find it and other helpful videos on his YouTube (https://www.youtube.com/channel/UC8odOxdiKXuRonJK0lHYdzQ) channel.Also, if you would like to learn more about Dr Rob Orman’s coaching services, visit his home page (https://roborman.com/) .As always, we value your feedback. Please take our listener survey (https://www.surveymonkey.com/r/ZQRWQFW).See the episode page (https://foamed.ebmedicine.net/podcast/conversation-cognitive-reframing/)for more details.
Procedural Sedation & Analgesia
In this episode, Sam Ashoo, MD interviews Prayag Mehta, MD and Joshua Kern, MD – two of the authors of the June, 2022 EMP article on Procedural Sedation and Analgesia in the Emergency Department (https://www.ebmedicine.net/topics/emergency-procedures/emergency-medicine-procedural-sedation). Listen to the discussion to hear more about the emergency medicine approach to sedation in adults and pediatrics !Procedural Sedation and Analgesia in the Emergency DepartmentEMplify – June 2022Episode Outline:1.Procedural sedation and analgesia (PSA): terminology2.Levels of sedation* Minimal* Moderate* Deep* General anesthesia3.Prehospital care4.ED care: patient assessment* ASA class system* Complications* Equipment needed (Table 1)* Larson maneuver (Figure 2)5.Procedural technique* Current ACEP and AAP recommendations* Data for 1- or 2-physician sedation6.Preprocedural fasting* Do we even need to consider this in PSA?7.Capnography8.Oxygen supplementation9.Preprocedural opioids10.Preprocedural sedatives11.Anticholinergics12.Antiemetics13.Treatment (Table 2)* Fentanyl* Remifentanil* Midazolam* Nitrous oxide* Propofol* Ketamine* Ketofol* Etomidate14.Reversal agents* Naloxone* Flumazenil15.Special populations* Pediatrics* Pregnancy* Geriatrics16.Cutting edge* Dexmedetomidine
Conversation – Ukraine with Dr. JP McBryde
The war in Ukraine has now been ongoing for 100 days. In today’s episode of EMplify: Conversations we hear from Dr. J.P. McBryde about his experience as an emergency physician volunteering in Ukraine.You can read more about Med Global and their efforts in Ukraine, on their home page:https://medglobal.org/ukraine/ (https://medglobal.org/ukraine/)We would love to have your feedback. Please take the listener survey:https://www.surveymonkey.com/r/ZQRWQFW (https://www.surveymonkey.com/r/ZQRWQFW)Thanks for being a listener.
Epidemiology* Caused by double stranded DNA virus, genus orthopoxvirus, closely related to smallpox and cowpox.* Discovered in 1958 in monkeys with first human case recorded in 1970 in the Democratic Republic of Congo. (CDC (https://www.cdc.gov/poxvirus/monkeypox/index.html)) * It is a zoonotic disease , meaning it is transmitted from animal to humans, with primary reservoir (https://www.who.int/health-topics/monkeypox#tab=tab_1)in squirrels, Gambian poached rats, dormice, different species of monkeys and others. * First reported in the U.S. in 2003. Cases were related to pet prairie dogs that had been housed with monkeypox virus infected African rodents, imported from Ghana (WHO (https://www.who.int/emergencies/disease-outbreak-news/item/monkeypox---the-united-states-of-america))* There are 2 clades (having evolved from same ancestral line) of the disease. The current outbreak is from the West African lineage. (WHO (https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON385))West African – milder disease, 1-3% fatalityCongo Basin – severe disease, 10% fatality * Due to the similarity in the viruses, immunization against smallpox has been found to prevent infection with monkeypox. The WHO (https://www.who.int/emergencies/disease-outbreak-news/item/monkeypox---the-united-states-of-america) believes that increasing frequency of worldwide infection may be related to waning immunity against smallpox, since that disease was eradicated in 1980 and the vaccine is no longer popularly used. Transmission* Animal to human – contact with sick or dead animals, ingesting poorly cooked meat of infected animals.* Human to human -” Human-to-human transmission is thought to occur primarily through large respiratory droplets. Respiratory droplets generally cannot travel more than a few feet, so prolonged face-to-face contact is required. Other human-to-human methods of transmission include direct contact with body fluids or lesion material, and indirect contact with lesion material, such as through contaminated clothing or linens.” (CDC (https://www.cdc.gov/poxvirus/monkeypox/transmission.html))Symptoms* Initial 1-3 days – fever, lymphadenopathy, back pain, headache, myalgias, fatigue* 2-4 weeks of rash progression: macules -> papules -> vesicles -> pustules -> scabs* The pox rash starts on the face and spreads to the rest of the body.Testing* Detection is by PCR testing, ideally of body fluid contained in the pox blisters.* Test kits are available through local U.S. Health Departments and the CDC. All suspected cases should be reported to local authorities.Treatment* Treatment includes vaccinating anyone who has been exposed with the smallpox vaccine (ring vaccination). The general population is no longer routinely vaccinated due to side-effects of the smallpox vaccine.* No current recommendation exists for antiviral therapy or smallpox immunoglobulin therapy. * See CDC (https://www.cdc.gov/poxvirus/monkeypox/clinicians/treatment.html) recommendations Prevention* The JYNNEOS vaccine was FDA (https://www.fda.gov/media/131802/download) approved in 2019 for adults > 18 against both smallpox and monkeypox. It is a 2 dose non-replicating attenuated virus that does not produce a lesion, and therefore can not cause transmission to others. The
This podcast is great review for us long-standing lovers of emergency medicine ❤️ Thank you for sharing your wisdom ! 🙏🏻
Great summaries of the evidence in emergency medicine. Enjoying listening every month!
Good content a bit dry
The content is great but I wish they presented it in a more interesting way. It sounds like someone reading off PowerPoint slides.