Salicylate Overdose

Today’s episode is another installment for the EM Basic Project by Dr. Andrea Sarchi. Salicylate overdose is a toxidrome that we have to be on the lookout for in the ED. While some cases are obvious because the patient or EMS can tell us what they took, some cases are subtle and require vigilance to make the diagnosis. In this episode we’ll review the important history and physical points, how to order the right tests, manage the toxicity, and properly disposition the patient.

Salicylate Overdose Podcast

Salicylate Overdose Show Notes (Word Format)

Salicylate Overdose Show Notes (PDF)

Another pitch for the EM Basic Project. I am now opening up submissions from 4th year medical students, EM interns, and EM junior residents. The only requirement is that you work with an attending at your institution to develop your script or podcast. If you want information- check out the EM Basic Project Submission Guidelines.

Sunday July 27th, 2014 will be the 3rd anniversary of the podcast. I will be releasing a special episode sometime during that week in a brand new format. Stay tuned!

Acetaminophen overdose

Today’s episode talks about the diagnosis and management of Acetaminophen overdose.  This is another addition to the EM Basic Project written by Dr. Andrea Sarchi.

We encounter acetaminophen overdose frequently in the ED and we need to be on the look out for this because patients can be completely asymptomatic.  If we don’t catch it, acetaminophen overdose can result in liver failure requiring transplant or even death unless we interevene early.  This episode will review how to properly workup a patient with a known or suspected acetaminophen overdose, what tests to order, and how to decide who needs antidote therapy.

Acetaminophen overdose podcast

Acetaminophen Overdose Show Notes (Word Format)

Acetaminophen Overdose Show Notes (PDF)

Mentioned in the podcast:

FOAMcast- a new project by Drs. Lauren Westafer and Jeremy Faust to review the core content behind current FOAMed blog posts and podcasts.  Available on iTunes

Rumack-Matthew Nomogram (to determine when to use NAC)

Rumack_Matthew_nomogram_with_treatment_(study)_line

NAC Protocol:

72-hour PO protocol – loading dose 140 mg/kg PO, then 70 mg/kg PO every 4 hrs for 17 total doses

21-hour IV protocol – loading dose 150 mg/kg over 1 hr, then 4-hr infusion of 12.5mg/kg/hr, then 16-hr infusion at 6.25 mg/kg/hr

 

Documentation

In today’s episode we are going to talk about documentation in the ED.  It is very important that we are complete but concise in our documentation in order to provide an accurate record for the patient’s ED patient to protect them and ourselves from problems down the road.  Good documentation is good patient care so we need to know how to do this efficiently.  We will review each part of the chart starting with the triage note and ending how to give good discharge instructions.  We’ll also review some tips and tricks of the trade regarding abbreviations that will make your charting faster, how to document interactions with our consultants, and even what to do when you have to document a difficult situation with a consultant.

Documentation podcast

Documentation episode (Word Format)

Documentation episode (PDF)

Asymptomatic Hypertension

The patient’s blood pressure is 190/80 but they feel fine…how do we treat these patients in the ED?  Labs?  EKG? BP meds?  Admission???…but they are here for an ankle sprain!  Asymptomatic hypertension is a challenging complaint to deal with in the ED because of so many conflicting opinions and worries but it doesn’t have to be difficult.  In this episode, we’ll discuss a systematic and rational way to evaluate patients with asymptomatic HTN, do limited and targeting testing, and get them the right followup while calming the patient’s fears and avoiding harm.

Asymptomatic Hypertension Podcast

Asymptomatic HTN (Word Format)

Asymptomatic HTN (PDF)

Philosoraptor wants to know

asymptomatic HTN philo

Links from the podcast:

ACEP Clinical Policy on Asymptomatic HTN in the ED

HTN doesn’t cause headaches- editorial with relevant studies

Short Coats in EM by Dr. Lauren Westafer on Asymptomatic HTN

Home blood pressure monitors cause cancer?  Not really but Dr. Reuben Strayer has some great ideas on asymptomatic HTN as well

The highest recorded blood pressure I could find was…

PE Part 2 Show Notes Posted

Here are the show notes for PE Part 2- Risk Stratification and Treatment

PE Part 2 Show Notes (Word Format)

PE Part 2 Show Notes (PDF)