October 2012 Posts

EM Basic Essential Evidence- PECARN Head CT Rule

This episode reviews the article that most people call the PECARN head CT rule or the Kuppermann head CT rule (named for the first author). This is an easy to use clinical decision rule that can help us reduce the number of head CTs that we do on children with minor head injury. We owe it to our patients to spare them excess radiation, cost, and time in the ED and this rules helps us do this. In order to use this rule effectively, you need to read this article and understand how the study was done.  This allows us to understand the strengths and weaknesses of this rule and helps us apply it in our everyday practice.

EM Basic Essential Evidence- PECARN Head CT rule

PECARN Head CT Rule (Abstract on the Lancet website- paid access)

PECARN Head CT Rule (Free full text direct download from PECARN website)

Psychiatric Medical Screening

In this episode, we will discuss how to perform medical screening for patients with psychiatric complaints.  While most of these workups are routine, we have to be able to catch the small percentage of patients who have a medical cause to their psychiatric complaint.  Don’t think it can’t happen to you- it almost happened to me twice during residency!  We’ll discuss how to stay safe while evaluating psychiatric patients, how to get the entire history, how to do appropriate testing, catch the red flags, and make the appropriate disposition.

In the bonus section, a community ED doctor wrote me to tell me his thoughts on testicular pain and why we may not need an ultrasound on every patient.  As you’ll hear, the answer is far from settled and not without controversy.

During the podcast, I mention the ERcast episode on Suicide Risk Assessment.  If you are stuck having to discharge low-risk suicidal ideation patients from your ED, Rob Orman gives you an excellent primer on how to do it safely and effectively

ERcast suicide risk assessment page

Psychiatric Medical Screening Podcast

Psychiatric Medical Screening (Word Format)

Psychiatric Medical Screening (PDF)

iTunes feed fixed

Hey everybody,
Today I discovered an issue with the iTunes feed that may have resulted in iTunes subscribers missing out on episodes since late July and/or only downloading the PDFs of the show notes instead of the audio files.  I think I have it fixed- it may only affect you if you use the desktop version of iTunes because I didn’t have any issues with it on my iPhone.  So if you subscribe through iTunes- you may want to refresh your feed and you may have to unsubscribe then re-subscribe to get the episodes you missed.

Here are the affected episodes:

Essential Evidence- Therapeutic Hypothermia

Essential Evidence- BMJ Subarachnoid Hemorrhage

Essential Evidence- The NEXUS Study


Essential Evidence- NEJM Rivers Sepsis


Stroke and Transient Ischemic Attach (TIA)


Sorry for the mix-up- I hope the episodes download correctly from now on.  Let me know if you find any other issues


EM Basic Essential Evidence- Therapeutic Hypothermia

This episode of EM Basic Essential Evidence will review the two articles that led to the adoption of therapeutic hypothermia as a treatment for survivors of cardiac arrest. This is a simple yet highly effective therapy that improves survival and neurological outcome in survivors of cardiac arrest so it is important that we know and understand these two articles.

EM Basic Essential Evidence- Therapeutic hypothermia

NEJM Therapeutic Hypothermia (Free full text website link to NEJM issue)

NEJM Therapeutic Hypothermia articles (Free full text direct download)

EM Basic Essential Evidence- BMJ Subarachnoid Hemorrhage Study

This is an article published in the last year in the British Medical Journal that looked at the sensitivity of modern CT scanners in detecting subarachnoid hemorrhage. This article made a lot of waves because it suggested that a head CT within 6 hours of headache onset is 100% sensitive for subarachnoid hemorrhage.  Some have called it a practice changer that allows us to avoid doing a lumbar puncture so its important to read it for yourself and decide if it should change your practice.

BMJ Subarachnoid Hemorrhage Study (free full text website link)

BMJ Subarachnoid Hemorrhage Study (free full text PDF direct download)

BMJ Subarachnoid Hemorrhage podcast