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

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EB Medicine EM Basic page

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)

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

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.

Today marks the 4th anniversary of the EM Basic podcast.  To celebrate this occasion, we are going to do a screencast on aortic dissection.  This is a very challenging disease to diagnose because patients have lots of different presentations that can make it difficult to diagnose.  We’ll talk about the common presentations of dissection, the not-so-common presentations, how to order the right imaging, how to treat these patients in the ED, and how to get them to the right level of care.

Aortic Dissection Screencast

Aortic Dissection Screencast Audio File

Aortic Dissection Show Notes (Word Format)

Aortic Dissection Show Notes (PDF)

IRAD study link (Free full text)

IRAD study PDF (Free full text)

Check out our bandwidth sponsor EB Medicine.  Residents can get free access to all of their resources and attending can get a discount on some of their great products at the EB Medicine EM Basic page.  They just released the EB Medicine app that allows access to their entire collection without on your mobile device without WiFi.