EMplify by EB Medicine Sam Ashoo, MD

This is the second episode of Conversation, an EMplify podcast series. Episodes are shorter, more conversational, and cover a single topic relevant to practice in Emergency Medicine.



This episode is a conversation between Dr. T.R. Eckler and Dr. Sam Ashoo about airway management and how it has changed in their practice over the last decade. This podcast makes reference to the EB Medicine course - Current Topics in Airway Management: Mechanical Ventilation, Supraglottic Airway Devices, and Intubating Patients With COVID-19, which can be found here:



https://www.ebmedicine.net/airway-training



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In this episode, Sam Ashoo, MD interviews Kyle Howarth, MD and Joby Thoppil, MD, PhD - two of the authors of the May, 2022 EMP article on Cellulitis and Skin and Soft Tissue Infections. Listen to the discussion to hear more about the emergency department management of cellulitis and necrotizing skin infections.

Episode 69 – Emergency Department Management of Cellulitis and Other Skin and Soft-Tissue Infections (https://www.ebmedicine.net/topics/infectious-disease/emergency-medicine-skin)

EMplify – May 2022

Episode Outline:

1. Why cellulitis/skin infections?

2. Terminology

Erysipelas vs cellulitis vs fasciitis
Purulent cellulitis

3. Most common pathogens

4. Special situations

5. Necrotizing infection classification system – is this helpful in the ED, and if so, why?

6. Differential – unilateral vs bilateral presentation

7. Prehospital care

8. ED evaluation

History – what should we be asking?
Examination: SSTI vs NSTI

9. Diagnostics

POCUS: “cobblestoning” and fluid collection
Xray: subcutaneous gas
CT: when is this helpful?

10. Labs

Blood cultures – if given the option, are they helpful? 
Wound cultures – any role for these?  
Routine labs (CBC, BMP, etc) – are they helpful? 
LRINEC score – what is it and should we be using it? 

11. Treatment  

NSTI antibiotics 
 Abscesses 

12. Special populations 

IV drug users 
Diabetic patients 
Immunocompromised patients 

13. Wound irrigation and loop drainage 

14. Disposition 

The first episode of Conversation, an EMplify podcast series. Episodes are shorter, more conversational, and cover a single topic relevant to practice in Emergency Medicine.

This episode is a conversation between Dr. T.R. Eckler and Dr. Sam Ashoo about the recently passed federal Dr. Lorna Breen Legislation and its significance on the field of Emergency Medicine.

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More on the Dr. Lorna Breen Legislation here.

Episode 68 -- Emergency Department Management of Adults With Infectious Meningitis and Encephalitis – An Interview with Dr. Andrew Hogan

EMplify -- April 2022

Interview with the Author: Andrew N. Hogan, MD

1.Meningitis vs encephalitis

Why this topic?
What do the words mean? What's the difference?

2.Bacterial meningitis

How common is it in the US? Is it more common in third world countries?
Mortality rate in the US
Causes – if Neisseria and H influenzae improved post vaccination, why not S pneumoniae disease ? (Table 1)

3.Viral meningitis

How common is it in the US?
What are the common causes? (Table 2)

4.Viral encephalitis

Same prognosis as viral meningitis?
Same organisms as viral meningitis? (Table 2)
Does COVID-19 cause this illness?

5.Fungal infections

Who gets these?
60% die? 1 million cases a year, 600K deaths?

6.Prehospital care:

What does EMS need to know?
How do they protect themselves from being exposed?
How can they help us make the diagnosis?
EMS is giving antibiotics in some areas?
PEP

7.ED evaluation: History

8.ED evaluation: Physical exam

9.Diagnostics: CSF

What's large volume? Is it safe?
Cell counts on tubes 1+4, all the time or only if traumatic and obviously bloody?
Is opening pressure helpful?
CSF lactate level – can this be run in a normal lactic acid analyzer?
PCR/NAAT testing

10.Serum labs

What is helpful?
Serum PCR
Serum cryptococcal antigen

11.Imaging 

Is CT imaging before LP still necessary? Can we be selective?
Is MRI helpful in the ED, or is there a role in encephalitis?

12.Treatment

Antibiotics
Steroids: Who gets them? When? Are there downsides of giving them?

13.Special populations

Autoimmune disease
Lacking childhood vaccines
Healthcare associated infections

14.Cutting edge

15.Disposition

Episode 67 – Managing Postpartum Complications in the Emergency Department – An Interview with Dr. Nicole Yuzuk, Dr. Joseph Bove, and Dr. Riddhi DesaiEMplify – March 2022Interview with the Authors: Nicole Yuzuk, DO, Joseph Bove, DO, and Riddhi Desai, DOEpisode Outline:1.Why is this an important topic in EM? 2.Hemorrhage etiologies and definition3.Headache etiologies, both common and the more dangerous (ICH)4.Fever and infectionMastitisEndometritis5.Preeclampsia/eclampsia Definition, diagnosis, risk factors (Table 1)6.HELLP syndromeDefinition, diagnosis (Table 2)7.Peripartum cardiomyopathyTime of onset, how to make the diagnosis, risks (Table 3)8.Prehospital careIV fluidsTXAAMS evaluationChest painFever/hypotension 9.ED evaluation History (what kind of things should we remember to ask?) Physical exam (what should we be paying attention to?) 10.Diagnostic studiesHemorrhage (exam, vitals, labs, US)Headache (labs, imaging – what type?)Fever and infection (labs, imaging – US or CT, antibiotics)Cardiopulmonary complaints (labs, imaging, ECG)11.TreatmentHemorrhage Headache (CVT)Infection (mastitis, endometritis, wound Infection)Preeclampsia, eclampsia, HELLP, seizuresCardiomyopathy12.What about breastfeeding mothers? 13.Controversies and cutting edgeEndovascular therapyThromboelastography

Episode 66 – Acute Asthma Exacerbations – An Interview with Dr. Steven Hochman and Dr. Brandon SomwaruEMplify – February 2022Emergency Department Management of Acute Asthma ExacerbationsInterview with the authors: Steven M. Hochman, MD, and Brandon Somwaru, DO Episode Outline:EpidemiologyRisk factors for death from asthma (Table 1)Triggers for asthma attacksVariants of asthma (Table 2)Differential diagnosis (Table 3)Can PE be a trigger for an acute asthma attack? Prehospital careED care: history (what should we ask?)ED care: physical exam (what are we looking for?)Classifying mild/moderate/severe asthma Lab studiesPOCUS (Table 5 and Figure 3)Peak expiratory flowETCO2 capnography and capnometryChest x-rayTreatment (Table 6)MedicationsOxygenSABA vs LABAWhat about MDIs?Continuous nebs?AnticholinergicsSteroids (IV, oral, inhaled; prednisone vs dexamethasone)Magnesium sulfateEpinephrineTerbutalineKetamineNIPPVIntubation pearls and pitfalls (Table 8)Special populationsPediatrics PregnancyCOVID-19 Controversies and cutting edgeBiologicsFractional exhaled nitric oxideHeliox High flow nasal cannulaDelayed sequence intubationECMODisposition