EM Basic

Essential Evidence #8 – The PERC rule

EM Basic — Mon, 20 May 2013 10:00:13 +0000

Today’s Essential Evidence Episode discusses the paper that derived and validated the PE Rule-out Criteria or PERC rule. This is a clinical decision aid that we can use to reliably exclude pulmonary embolism in emergency department patients without any further testing. We’ll talk about some background on diagnosing PE in the ED, the study design, how to use the PERC rule in your everyday practice, and some clinical pearls as well.

Essential Evidence #8- The PERC Rule

The PERC study- free full text

Links to studies mentioned in the podcast

ACEP Clinical Policy on PE diagnosis in the ED

Kahbrel, et al- accuracy of PE diagnosis in different years of training

Other podcasts on PE (not an exhaustive list!)

Jeff Kine (1st author on PERC) on PE in pregnancy from ERcast

Jeff Kline- D-dimer cut-offs from ERcast

EmCrit on PE workup

Jeff Kline on EmCrit- fibrinolysis in PE

Seizures

EM Basic — Mon, 29 Apr 2013 23:04:07 +0000

We encounter seizure disorders frequently in the ED. In this episode, we’ll review all the important points about seizures including the confusing and difficult topic of pseudosezures. We’ll also go in depth on the ED treatment of seizures and status epilepticus.

Seizures podcast

Seizures podcast show notes (Word Format)

Seizures podcast show notes (PDF)

Links mentioned in the podcast

Rapid oral loading of Phenytoin (dilantin) from Academic Life in Emergency Medicine

Status epilepticus algorithm pocket guide (pediatric but it works for adults too)

How to write a medical blog/podcast disclaimer

EM Basic — Tue, 19 Mar 2013 02:41:18 +0000

Hey everybody,

Inspired by Brent Thoma at boringem.org (@boringEM)- I’ve decided to write a post on how you can construct a disclaimer for your medical blog or podcast. This can be an important part of your site and can provide some limited protection against legal issues. So instead of FOAM, consider this FOAD- Free and Open Access Disclaimer. Feel free to copy and paste any sections of my disclaimer if you want.

First- a disclaimer on the disclaimer. This is not legal advice. I had a practicing US attorney review my disclaimer and he thought it was on solid ground legally. This being said- no disclaimer can be 100% protective against all legal actions and there is always a way around any type of disclaimer. I also can’t attest to how this disclaimer would play outside of the US legal system. However, any lawyer would agree that having a disclaimer is always a good idea.

For this post- I will review each section of my disclaimer with the thought process behind it followed by the actual text of my own disclaimer for the blog/podcast.

To get started- the first step is to make sure that your disclaimer is easily visible on your front page. I list mine under the “About and Disclaimers” on the front page.

The next tip is to separate any disclaimers into sections. My first one is the PODCAST and BLOG disclaimer. This is mostly a free flowing description of what I am presenting. In my case- “I am simply presenting my views on how to workup common ED complaints that will be as evidence based as possible.” You should also mention not to use this blog/podcast as medical advice to treat yourself or others. It’s also a good idea to spell out that you don’t accept money from drug or device companies to maintain impartiality.

PODCAST and BLOG disclaimer: While I make every effort to broadcast correct information, I am still learning. I will double check all my facts but realize that medicine is a constantly changing science and art. One doctor may have a different way of doing things from another. I am simply presenting my views on how to workup common ED complaints that will be as evidence based as possible. I welcome any comments, suggestions, or correction of errors. I take no money from drug or device companies. By listening to this podcast or reading this blog, you agree not to use this podcast or blog as medical advice to treat any medical condition in either yourself or others, including but not limited to patients that you are treating. Consult your own physician for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast or blog. Under no circumstances shall Stephen Carroll, EM Basic LLC, any guests or contributors to the podcast or blog, or any employees, associates, or affiliates of EM Basic LLC be responsible for damages arising from use of the podcast or blog.

Legal Disclaimer- I put this in after a rather interesting situation. A person from a law office contacted me regarding one of my podcasts. According to them, an expert witness quoted my podcast as a basis for expert witness testimony. At first, I was flattered that my podcast would be used for expert witness testimony but I was also horrified to think that there was an “expert” witness quoting a blog and podcast titled EM BASIC whose tag line was “Your boot camp guide to Emergency Medicine.” This section addresses that specific concern.

ADDITIONAL LEGAL DISCLAIMER: This blog or podcast should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast or blog.

Employer/General Disclaimer: You probably aren’t blogging/podcasting to represent your employer and you should spell that out to make sure people understand that and you protect your current employment. Of course, it’s also a good idea to talk to your employer about your blogging/podcasting ahead of time as well. I take this one step further by including a verbal disclaimer in each of my podcasts but that is probably overkill.

General DISCLAIMER: This blog and podcast are my own opinions and do not represent the views or opinions of the Department of Defense, the US army, the SAUSHEC EM residency, or the Fort Hood post command.

Privacy notice: Privacy of online and medical information is very important to your users so it’s important to spell out that out. You should let your readers/listeners know that what you post is HIPPA complaint for those in the United States. Privacy of email addresses is also important.

Privacy notice: This website, blog, and podcast are all HIPPA compliant. While you may give your email address to subscribe to the website posts or to post information on the website/blog, I will never share your email address or contact information with any third parties without your explicit permission.

Advertising policy: If you accept any advertising money, spell it out here. If you don’t it’s also important to state that you don’t accept any advertising money. This will help you maintain credibility and impartiality.

Advertising policy: At the present time, the EM Basic blog, website, and podcast does not accept any advertising money. If this changes, this will be spelled out directly via a post to the blog/website and the podcast.

Copyright information: In the spirit of Free and Open Access Medical Education (#FOAMed) you want to make your content freely and readily available but no one should steal your content either. Make sure to spell out that your materials are copyrighted by yourself or any LLC/corporation that you have set up for your blog/podcast. If you want people to freely distribute your material, just state that your name (or your website/podcast/corporation name) needs to be included on the materials.

Copyright and distribution info: The contents of the EM Basic Blog, EM Basic Podcast, and the EM Basic show notes are all copyrighted, EM Basic LLC. All blog posts, podcasts, and show notes that are distributed to the public for free can be re-distributed via hard copy or electronic copy for free ONLY if “EM Basic” is included as the acknowledged author within the actual media that is re-distributed.

Want another example of a disclaimer? Check out the disclaimer page for the EMCrit podcast.

I hope this helps you with development of your own website’s disclaimer. Please comment or send feedback to steve@embasic.org.

-Steve

Essential Evidence #7- SAEM Occult Bacteremia

EM Basic — Tue, 26 Feb 2013 03:34:35 +0000

We’re back with a new episode of Essential Evidence. This article is from Academic Emergency Medicine March 2009 and it talks about getting blood cultures in well appearing kids aged 3 to 36 months. We used to get a lot of blood cultures in these well appearing kids with fever but this article was the final nail in the coffin that got us to stop doing that. It’s hard to believe that based on how we practice now but we needed this large study to show us that we are now doing the right thing.

One announcement- I will be going to the SMACC conference- Social Media and Critical Care- in 2 weeks in Australia. If you see me at the conference, please say hi and let me know what you think about the podcast.

Essential Evidence #7- Occult Bacteremia

SAEM Occult Bacteremia- Free full text link

SAEM Occult Bacteremia- Direct Download (PDF)

Eye Complaints Show notes and links

EM Basic — Sat, 26 Jan 2013 19:41:49 +0000

Here are the show notes for Eye Complaints and links on the best You tube videos that I could find to supplement the podcast

Eye Complaints (Word Format)

Eye Complaints (PDF)

Links:

Slit lamp exam- 24 minutes but excellent and great videos of actual exams- worth watching the whole thing

https://www.youtube.com/watch?v=w9wMJ6job_0

Fundoscopic exam- kinda cheesy but effective

https://www.youtube.com/watch?v=wPzCA9k8GRQ

Pan-opthalmoscope- https://www.youtube.com/watch?v=a9rhPWqV_ac

Ocular ultrasound- from the ultrasound podcast

http://www.ultrasoundpodcast.com/2012/04/episode-26-ocular-ultrasound-with-chris-fox/

Lateral Canthotomy on a cadaver

http://www.youtube.com/watch?v=cAYBGW3c95M

Eye Complaints

EM Basic — Wed, 23 Jan 2013 05:18:28 +0000

EM Basic is back and ready for the new year. We see various eye complaints a lot in the ED. This episode will review common eye complaints, their treatments, and a bonus section on how to do a lateral canthotomy. It’s a long episode but there is lots to cover. I will get the show notes posted as soon as possible.

Eye Complaints Episode

Eye Complaints (Word Format)

Eye Complaints (PDF)

Links:

Slit lamp exam- 24 minutes but excellent and great videos of actual exams- worth watching the whole thing

https://www.youtube.com/watch?v=w9wMJ6job_0

Fundoscopic exam- kinda cheesy but effective

https://www.youtube.com/watch?v=wPzCA9k8GRQ

Pan-opthalmoscope- https://www.youtube.com/watch?v=a9rhPWqV_ac

Ocular ultrasound- from the ultrasound podcast

http://www.ultrasoundpodcast.com/2012/04/episode-26-ocular-ultrasound-with-chris-fox/

Lateral Canthotomy on a cadaver

http://www.youtube.com/watch?v=cAYBGW3c95M

If you didn’t see it before- here is more info on a new project I am involved in:

I completed some video podcasts for emergencyboardreview.com. This is an awesome project run by Jon Schonert (emchatter.com) and Bob Stuntz (ER Res website and podcast). The goal here is to create the web’s first and only 100% free EM inservice/board review website. They have created several videos as well as recruited other EM bloggers to do the same and it is an amazing resource for med students, residents, or anyone studying for an EM exam.

Since I did an ortho review lecture for my own residency’s inservice exam review, that was my contribution. You can find the vodcasts for free at emergencyboardreview.com and on iTunes as well.

I’ve got the Bronchitis!

EM Basic — Wed, 16 Jan 2013 01:20:59 +0000

Ain’t no body got time for that! (Sorry, couldn’t resist…if you don’t know that reference check this out)

Hey everybody

Sorry but still no new episode. I’m almost ready to record the long awaited episode on eye complaints but now I’ve got some viral junk that has messed with my voice so that’s a no go. So stay tuned for that episode- I promise it’s coming!

In the mean time- this past weekend I completed some video podcasts for emergencyboardreview.com. This is an awesome project run by Jon Schonert (emchatter.com) and Bob Stuntz (ER Res website and podcast). The goal here is to create the web’s first and only 100% free EM inservice/board review website. They have created several videos as well as recruited other EM bloggers to do the same and it is an amazing resource for med students, residents, or anyone studying for an EM exam.

Since I did an ortho review lecture for my own residency’s inservice exam review, that was my contribution. You can find the vodcasts for free at emergencyboardreview.com and on iTunes as well.

I have some other projects in the works that will be announced in the coming months so stay tuned. EM Basic is still alive and well- just ramping up for the new year.

Stay classy,

Steve

Sorry for the hiatus

EM Basic — Tue, 18 Dec 2012 17:15:48 +0000

Just to let everyone know that EM Basic is still up and running- just on an extended hiatus. I’ve had some projects come up recently that haven’t given me enough time to get an episode out- stay tuned for more info on those.

I’ve gotten some great feedback on the weekly episodes but I was only able to put that volume together because I had a lot of time between residency and starting my new job. In the future I’ll be shooting for one topic episode a month and one Essential Evidence episode.

Still planning on doing the next episode on eye complaints. I may be able to get it done before the end of the year but it will probably be ready shortly after the new year.

Once again- sorry for the delay but stay tuned for some great new episodes and projects

-Steve

EM Basic Essential Evidence- PECARN Head CT Rule

EM Basic — Mon, 29 Oct 2012 08:30:45 +0000

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

EM Basic — Mon, 22 Oct 2012 08:30:15 +0000

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)