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)

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

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)

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

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…

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)

This episode is part 2 of the PE podcast where we will discuss risk stratification and treatment of PE.  It’s important that we accurately quantify the amount of clot burden that the patient has to order the right treatment and admit them (or maybe even discharge them) to the right location.  We’ll talk about how to classify massive, sub-massive, and “non-massive” PEs and how to treat them. We’ll also briefly talk about emerging evidence for the expanding role of thrombolytics and outpatient treatment of PE.

PE Podcast Part 2

PE Part 2 Show Notes (Word Format)

PE Part 2 Show Notes (PDF)

Links mentioned during the podcast:

Cardiac ultrasound for diagnosing right heart strain/PE– from the Ultrasound Podcast (starts the PE section at 34:10)

TPA dose during cardiac arrest– from Brian Hayes at Academic Life in EM

Thrombolytics for submissive PE– from Dr. Salim Rezaie at Academic Life in EM

Outpatient management of PE– from the Skeptics Guide to Emergency Medicine (SGEM)