Uncategorized Posts

EM Basic is returning in 2017

Hey everybody,

This is just a quick note to say that EM Basic will be back and better than ever in the New Year.  As of January 2017, it will be almost a year since I have published an episode and that is going to change just after the New Year.  With the help of some collaborators, I have been able to record a number of episodes in advance so I can release episodes on a more regular basis.

I have a plan to publish two episodes per month for the rest of 2017 and I have already recorded ahead a number of episodes to make that happen.  They are all set to publish in the next few months.  That’s why those of you who have an email subscription to the website accidentally got an email today with February’s topics- whoops!

A big thank you to all the contributors who have been patient in seeing their work published on the podcast.  Since this is mostly a one-person operation, my time has been limited with my transition out of the military and into my new job.  This is all on me and I appreciate everyone’s patience.

Stay tuned for another announcement on how providers of all levels and training can get involved in helping to make EM Basic an even better resource.

The first episodes right after the New Year will publish on Monday January 2nd with a two part review on Opioids in the ED, followed by hypothermia, then a three part screencast to review orthopedic injuries just before the inservice exam.

Until next time- Stay Classy,

Steve

The undifferentiated sick infant by Dr. Tim Horeczko

EM Basic is back with a re-broadcast from the awesome podcast Pediatric Emergency Playbook by Dr. Tim Horeczko.  Tim is a double boarded in EM and Peds EM and works at Harbor-UCLA hospital.  This was the first episode he published at the beginning of September and it is pure gold.  Tim goes beyond the febrile neonate and talks about how to consider all possible causes for a sick infant- not just anchoring on sepsis the whole time!  Tim presents a rational and systematic approach on how to deal with these young sick patients that get our anxiety and our adrenaline levels through the roof.

The undifferentiated sick infant by Dr. Tim Horeczko podcast

The Undifferentiated Sick Infant by Dr. Tim Horeczko Show Notes (Word Format)

The Undifferentiated Sick Infant by Dr. Tim Horeczko (PDF)

PEM Playbook Website

PEM Playbook on iTunes

Check out our bandwidth sponsor, EB Medicine.  Residents can get free access and attendings can get a great discount on their CME products

EB Medicine EM Basic page

 

Heme Onc Part 2- Hematology Emergencies

This is part 2 of the Heme Onc Emergencies series.  This episode will talk about common hematology emergencies that we see in the ED.  Sickle cell disease will be its own episode but this episode will talk about the approach to anemia in the ED, as well as the approach to hemophilias, ITP and TTP.  While you will see lots of anemic patients in the ED, the other diseases are rare but we have to be on the look out for them and know what to do.

Heme Onc Part 2- Hematology Emergencies

Heme Onc Part 2 Show Notes (Word Format)

Heme Onc Part 2 Show Notes (PDF)

Check out the EM Basic page on EB Medicine for free access for residents and discounts for attendings.  The September issue of Pediatric EM Practice discusses Hemophilia and von Willebrand disease in kids.

Factor Replacement Formula

Factor 8- (Target factor activity level – Baseline factor activity level) / (2 x pt weight in kilograms)

Factor 9- (Target factor activity level – Baseline factor activity level) / (pt weight in kilograms)

Heme Onc Part 1- Oncology Emergencies

This is the first of a two part series on Heme-Onc Emergencies.  In this episode, we’ll discuss oncology emergencies to include neutropenic fever, tumor lysis syndrome, malignant spinal cord compression and malignant pericardial effusion.  Neutropenic fever is a common chief complaint for patients on chemotherapy so we have to be especially good at this chief complaint.

Heme Onc Part 1- Oncology Emergencies

Heme Onc Part 1 Show Notes (Word Format)

Heme Onc Part 1 Show Notes (PDF)

 

Check out EB Medicine’s EM Basic page for free access for residents and discounts for attendings.  Check out their new Adult and Pediatric Trauma Kits

Update (10/10/2015)- Someone brought to my attention that some sources have different definitions for neutropenia.  Here’s what I found:

Rosen’s/Tintinalli’s- ANC <1000, Severe neutropenia ANC <500

Uptodate: ANC <1,500, Severe Neutropenia ANC <500

IDSA: Neutropenia starts at ANC <500, “Profound” neutropenia ANC <100

Bottom line: Any ANC in the neighborhood of 1,000 to 1,500 is concerning and needs consultation and follow-up with the patient’s oncologist.  Also remember that an ANC that is expected to drop below <500 in the next 1-2 days is also concerning (remember that the WBC nadir is usually 5-10 days after last chemo dose).

Also- I forgot to add in the ANC calculation that bands are added to neutrophils (sometimes called “Segs” on a CBC with differential).  I fixed it in the show notes.

Here’s the formula:

Absolute Neutrophil Count= (percentage of neutrophils + percentage of bands) x Total WBCs

Example: WBC 1,000, Segs 70%, Bands 5%- (0.7 +0.05) x 1,000 = (0.75) x 1,000 = ANC 750

Measles

Today’s episode is another installment of the EM Basic Project.  Dr. Sheyna Gifford and Dr. Chrisanna Mink will talk about measles.  This is a disease that we thought we had stamped out long ago with vaccination but the rise of the anti-vaccine movement has caused several small outbreaks so we need to be ready and on the lookout.  They will discuss how to recgonize measles, how to order the right testing and treatment, how to properly disposition these patients and the importance of getting your public health colleagues involved.

Measles with Drs. Sheyna Gifford and Chrisanna Mink

 

Check out our bandwidth sponsor EB Medicine for free access for residents and discounts for attendings.