TOTAL EM - Tools Of the Trade and Academic Learning in Emergency Medicine
245 episodes - English - Latest episode: almost 2 years ago - ★★★★★ - 71 ratingsWe are a FOAMED project devoted to providing TOTAL care everywhere. This is done by sharing the Tools Of the Trade and Academic Learning in Emergency Medicine (TOTAL EM). We believe in education for emergency medicine professionals and the public.
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Episodes
Podcast #144 - Should Your RUSH to the Ultrasound in Hypotension?
April 23, 2019 17:00 - 20 minutes - 19 MBA relatively recent article, the SHoC-ED trial, can sound like the need for ultrasonography in hypotension is not necessarily beneficial. In this podcast the trial, along with its strengths and limitations, will be reviewed.
Podcast #143 - EM ID: Testing for Gonorrhea and Chlamydia with Janelle Bludorn
April 16, 2019 17:00 - 22 minutes - 20.9 MBPatrick Bafuma is back to interview Janelle Bludorn for this installment of the EM ID podcast series. This time they talk about testing for two of the most common sexually transmitted infections (STIs), Gonorrhea and Chlamydia (GC/C).
Podcast #142 - Whole Blood, Tricks with Blood Products, and Stop the Bleed
April 09, 2019 17:00 - 30 minutes - 27.6 MBAndrew Fisher is not your typical medical student. In addition to his EMS background, he was a PA in the military. Now, he is in his third year of medical school and has a passion for education. This is especially true when it comes to blood products.
Podcast #141 - Furosemide (Frusemide) Mythbusting
April 02, 2019 17:00 - 10 minutes - 9.98 MBFurosemide (frusemide) is a commonly used loop diuretic. Also known by the commercial name, Lasix, it is well established drug but is prone to some common myths. To help kill the dogma, we review a recently published paper discussing 10 myths regarding this frequently used medication.
Podcast #140 - Six Common Reasons Patients Come to the ED
March 26, 2019 17:00 - 13 minutes - 12.5 MBSometimes, especially during a long shift, we want to ask our patients why they thought they needed to come see us suddenly for a complaint that does not seem emergent. It can be challenging to remember that our patients seek our help for a variety of reasons.
Podcast #139 - Methods to Confirm Airway Placement
March 19, 2019 17:00 - 15 minutes - 13.8 MBRecently, our own Chip Lange was on The Skeptic's Guide to Emergency Medicine (The SGEM) for Podcast #249 covering ultrasound to confirm endotracheal tube placement. This had previously been discussed in detail on our own Podcast #118 along with the technique. However, after some discussions on social media it was decided to expand on this discussion further regarding the ways to confirm beyond ultrasound.
Podcast # 138 - EM ID: Diagnosing Spinal Epidural Abscess (SEA) with Lauren Westafer
March 12, 2019 17:00 - 29 minutes - 26.6 MBThanks to the talents of Patrick Bafuma (who also has the EM in Focus blog), we have a new series on the podcast called Emergency Medicine Infectious Disease (EM ID). The first podcast is with Lauren Westafer who also is part of the FOAMcast podcast and a FemInEM Speaker. These two brilliant minds got together to record a podcast on spinal epidural abscess (SEA).
Podcast #137 - The BRAIN Exam
March 05, 2019 18:00 - 13 minutes - 12.7 MBA while back, Podcast #70, we talked about how to perform a neurological exam. We also spoke on FOAMfrat. Since that time, at WEMSA we built on the subject and discussed the exam as well as its caveats. At that time, there was not a name. Now, we have the Brief Repeatable Assessment In Neurology (BRAIN) exam.
Podcast #136 - Acute Ventilatory Failure
February 26, 2019 18:00 - 23 minutes - 21.4 MBSam Ireland is back to talk again about ventilatory failure. Last time, he talked about the less severe impending ventilatory failure but this time he runs us through acute ventilatory failure. If you have not already checked it out, look at our last post for details on impending ventilatory failure.
Podcast #135 - Impending Ventilatory Failure
February 19, 2019 18:00 - 20 minutes - 18.9 MBWe have a two part special with Sam Ireland from FOAMfrat. He is a critical care paramedic in Wisconsin and a brilliant mind including with ventilation. Sam agreed to come on to talk both about impending and acute ventilatory failure. Stay tuned next week for the second part of his talk.
Podcast #134 - Quick Butterfly iQ Review and the Benefits of POCUS in EMS
February 12, 2019 18:00 - 24 minutes - 22.8 MBThis podcast is to discuss two important subjects with ultrasound. The first is a quick review of the Butterfly iQ (more detailed review to come) and the second discusses some of the key benefits of POCUS in EMS and other settings where having a larger machine is not feasible.
Podcast #133 - Is Double Sequential Defibrillation a Good Thing?
February 05, 2019 18:00 - 17 minutes - 16.1 MBThis one is sure to generate some controversy, especially by my fellow #FOAMed colleagues but it is a conversation we need to have in all earnest. We must seriously consider if double sequential defibrillation (DSD) is as good a plan as we may have originally thought.
Podcast #132 - Nursemaid's Elbow
January 29, 2019 18:00 - 15 minutes - 14 MBRadial head subluxation, commonly referred to as nursemaid's elbow, is a common condition. In this post we talk about how to diagnose and manage this condition in a timely and effective manner.
Podcast #131 - SPOCUS Series: Logistics to Integrating Ultrasound into a Program
January 22, 2019 18:00 - 19 minutes - 17.5 MBWe are wrapping up our interview with guests Janelle Bludorn and Laura Blesse-Hampton as part of a collaborative series with the Society of Point of Care Ultrasound (SPOCUS) and Practical POCUS with this portion discussing the logistics of integrating ultrasound into a program.
Podcast #130 - SPOCUS Series: How to Integrate Ultrasound into a Program
January 15, 2019 18:00 - 13 minutes - 12.3 MBIt is time for the second part of our collaborative series with the Society of Point of Care Ultrasound (SPOCUS) and Practical POCUS. We are again joined by our guests Janelle Bludorn and Laura Blesse-Hampton. This time we discuss how to integrate ultrasound into an educational program.
Podcast #129 - SPOCUS Series: Why to Integrate Ultrasound into a Program
January 08, 2019 18:00 - 12 minutes - 11.8 MBIn collaboration with the Society of Point of Care Ultrasound (SPOCUS) and Practical POCUS, we are striving to help those who are wanting to improve their training programs. We bring faculty that have experience of introducing ultrasound to the classroom. These pearls are beneficial to all levels of education and not just for PA programs.
Podcast #128 - New Year and a New Start
January 01, 2019 18:00 - 9 minutes - 8.95 MBUnder the Gregorian calendar, today is the first day of 2019. Many are making resolutions and there are ways to add this can implemented into your role in medicine. This is a New Year so take on something new and grow.
Podcast #127 - The Importance of Family, Friends, and Colleagues
December 25, 2018 18:00 - 14 minutes - 13 MBThe original post is on Christmas Day 2018 but the principle remains true no matter the time of year. In medicine, burnout is a commonly faced problem. The Holidays and time away from family makes this even more difficult.
Podcast #126 - Incidental Findings
December 18, 2018 18:00 - 10 minutes - 9.76 MBSometimes in medicine we find things we were not necessarily looking for when we perform a test. We call these incidental findings. While many of these are benign they can potentially be problematic as they can change the workup of a patient including their disposition and management.
Podcast #125 - Check All Images
December 11, 2018 18:00 - 12 minutes - 11.6 MBThe department is busy and you want to keep the flow running smoothly. It is easy to cut corners when it comes to imaging. After all, a radiologist will be reviewing those images. If you are lucky, those images will be read within minutes of them being taken. Why then, should you review those images that you ordered?
Podcast #124 - How are we Supposed to Test Strep in Young Patients?
December 04, 2018 18:00 - 13 minutes - 12.3 MBThis post is in direct response to a question that was asked recently. There is a surprising amount of dogma around the subject of strep testing, but one major piece is that children under three years of age should not be tested for strep because of its reported rarity. However, there have been multiple studies that disagree with this claim, and we took a mini deep-dive on the subject.
Podcast #123 - The ABCs of Bronchiolitis
November 27, 2018 18:00 - 10 minutes - 9.5 MBAcute bronchiolitis is another condition that will start showing more this time of year. In some parts of the country, it is already being diagnosed. It is important to know the current recommendations for this common and potentially dangerous condition.
Podcast #122 - Pediatric Neurological Emergencies with Lawrence Berdan
November 20, 2018 18:00 - 34 minutes - 31.9 MBLawrence Berdan is a paramedic who has personally experienced the importance of recognizing and acutely managing pediatric neurological emergencies. This post discusses some of the emergencies we may see in this uniquely challenging population.
Podcast #121 - Acute Management of Croup
November 13, 2018 18:00 - 18 minutes - 16.5 MBIt is that time of year. It is cold and croup is in the air. There is a spectrum of patients that present ranging from the mild to the life threatening. We discuss how to manage these patients.
Podcast #120 - Tickborne Illnesses with Michelle Perkins
November 06, 2018 18:00 - 42 minutes - 38.8 MBNow that our month of point of care ultrasound (POCUS) is over, it is time to talk about other clinically relevant topics. Michelle Perkins is back again this time to help us cover tickborne illnesses in the United States.
Podcast #119 - POCUS Improves Abscess Management
October 30, 2018 17:00 - 17 minutes - 15.6 MBWe wrap up our month of discussing point of care ultrasound (POCUS) papers by having our guest Michelle Perkins. Over the last couple of years a flurry of evidence has come out regarding abscess management. Now, POCUS is taking center stage in a recent paper. Here to help us discuss it is one of our favorite guests, Michelle Perkins.
Podcast #118 - Confirming Intubation with Ultrasound
October 23, 2018 17:00 - 11 minutes - 10.8 MBThere are many ways to confirm successful intubation. Some are better than others, but they all have limitations. One newer approach is the use of point of care ultrasound (POCUS) to provide real-time confirmation of tube placement. We will talk about how to do this exam and its evidence in this blog and podcast.
Podcast #117 - Check the Bladder Before the Radiology Performed Ultrasound
October 16, 2018 17:00 - 14 minutes - 13.3 MBAlthough point of care ultrasound (POCUS) is a valuable tool, there are times that a formal radiology performed ultrasound is needed. We continue our October POCUS month marathon with a discussion on this topic and how we can improve success for our radiology colleagues. Mainly, we want patient's to have a properly sized bladder that will allow for the best imaging on transabdominal pelvic ultrasound.
Podcast #116 - POCUS Improves Patient Understanding and Satisfaction
October 09, 2018 17:00 - 11 minutes - 10.2 MBContinuing in our month long discussion of point of care ultrasound (POCUS), we move to talking about patient understanding and satisfaction. This is all in conjunction with Practical POCUS which will be having courses at the end of this year. We have previously heard that the use of bedside ultrasound has helped with patient satisfaction, but a recent paper investigated the benefits with improving patient understanding.
Podcast #115 - To POCUS or Not to POCUS Renal Colic and Flank Pain
October 02, 2018 17:00 - 15 minutes - 14.4 MBThe month of October is often associated with Halloween and people think "hocus pocus" but this time we are promoting point of care ultrasound (POCUS) with a month-long discussion of subjects regarding bedside ultrasound. This is all in conjunction with Practical POCUS which will be having courses at the end of this year. Our first topic, ultrasound for the diagnosis of urolithiasis.
Podcast #114 - An Airway Bundle to Improve Intubation with Jeff Jarvis
September 25, 2018 17:00 - 44 minutes - 41 MBRecently, Dr. Jeff Jarvis was published in the Annals of Emergency Medicine for a paper regarding a clinical bundle he developed to reduce complications during intubation. Specifically, his paper was to help reduce hypoxia in out-of-hospital intubation attempts. However, the pearls can be used by anyone managing the airway of a patient.
Podcast #113 - Gotta Scan 'Em All: Intracranial Bleeding Risk in Anticoagulation
September 18, 2018 17:00 - 10 minutes - 9.35 MBWhat happens when you have someone who is anticoagulated fall and have minor head trauma? They are talking to you, they appear neurologically intact, and they feel like they can go home. Do you let them or do you still encourage a CT scan of their head? There is a recent paper that may change your practice.
Podcast #112- Eating Smoke: Inhalation Injuries
September 11, 2018 17:00 - 15 minutes - 14.4 MBFirefighters are exposed to a number of dangers on a daily basis. With this being the anniversary of 9/11, we want to dedicate this blog and podcast to all the victims from that day. Most of us are already very familiar with issues that arise with firefighters such as PTSD and the impact on the body from long hours, overtime, and physical stress. Unfortunately, we often forget about the other needs and special scenarios that firefighters come across and will cover some of the key aspects ...
Podcast #111 - Peritonsilar and Deep Neck Infections
September 04, 2018 17:00 - 14 minutes - 12.9 MBAt the request of listeners, we are covering some essential clinical topics such as deep neck infections including peritonsilar abscess (also known as "quinsy"). These are life-threatening conditions that require early recognition and intervention. Since peritonsilar infections are not of deep visceral spaces, this is technically separate but given their high incidence and at times coexistence with other deep neck infections they are often combined such as in discussion.
Podcast #110 - IO Devices and Lab Values
August 28, 2018 17:00 - 17 minutes - 15.6 MBIntraosseous (IO) devices are traditionally used in the initial stages of resuscitation when peripheral intravenous (IV) access is not readily obtainable. This can happen for a variety of reasons such as edema, burns, obesity, or IV drug abuse among others. Although ultrasound can be used to obtain peripheral or central venous access, the most rapid route is the IO. The device has been used both in adults and children with great success. It can safely facilitate the delivery of fluids,...
Podcast #109 - Tips to Manage the Contaminated Airway with Jim DuCanto
August 21, 2018 17:00 - 52 minutes - 48 MBIt has been 100 podcasts since the last time Jim DuCanto talked about his SALAD (Suction Assisted Laryngoscopy Airway Decontamination) technique. Podcasts #8 and #9 were so long ago we wanted to have Jim back on to celebrate his achievements and talk more about the future of SALAD and other related projects.
Podcast #108 - Dogmalysis of Dry Drowning
August 14, 2018 17:00 - 16 minutes - 14.7 MBEvery year, we see drownings. In some cases people survive, but unfortunately sometimes they do not. However, there is confusion in both the medical community and the public regarding what is considered to be a drowning event. Dogma and myths are everywhere and one of the most common is "dry drowning" which is why we brought Michelle Perkins on to discuss this important issue.
Podcast #107 - Emergent Management of Hyperkalemia
August 07, 2018 17:00 - 22 minutes - 20.6 MBWe see changes in potassium levels all of the time in patients. However, what works and what does not? What is the evidence behind the management? Are there special pearls? These questions and much more are addressed in this podcast with Michelle Perkins.
Podcast #106 - Brown Recluses: This IS the Spider You Were Looking For
July 31, 2018 17:00 - 16 minutes - 15.4 MBPatients often come in complaining of a possible spider bite, but is this actually the cause of their symptoms? In this blog and podcast, we talk specifically about brown recluse bites, differentiating them from other causes, treatment, and other pearls.
Podcast #105 - PARAMEDIC2: It's Time to Call the Code on Epinephrine (Adrenaline)
July 24, 2018 17:00 - 35 minutes - 32.6 MBEpinephrine (adrenaline) has been a hallmark of cardiac arrest management as an attempt to obtain a return of spontaneous circulation (ROSC). However, the evidence for epinephrine in out-of-hospital cardiac arrest (OHCA) as well as in the hospital (IHCA) has been conflicting. We review the largest trial to date just recently published in the New England Journal of Medicine (NEJM).
Podcast #104 - Does How You Dress Matter?
July 17, 2018 17:00 - 19 minutes - 17.7 MBDoes it actually matter how you dress when you go to work? The BMJ recently published an open access article covering this exact issue. Although in many ways limited, this study offered some key insights regarding how our dress attire in different settings could potentially impact patient perceptions.
Podcast #103 - Stop Fighting! Start Discussing the Right Way!
July 10, 2018 17:00 - 16 minutes - 15.4 MBToo often we find ourselves fighting trolls and people both on social media and sometimes in real life. Most of the time though, we are not able to engage in any form of real debate and discussion. In this blog and podcast, we talk about how to meaningfully discuss and properly debate in any situation, especially on social media.
Podcast #102 - Pearls for Excited Delirium
July 03, 2018 17:00 - 18 minutes - 17.2 MBExcited delirium has been covered quite a bit, but like other hot topics it is always changing with new evidence. Here are some of the key pearls and pitfalls to managing this high risk population.
Podcast #101 - The Last 100 Podcasts and a BIG Announcement
June 26, 2018 17:00 - 12 minutes - 11 MBThe last 100 podcasts has been a major milestone. Now that we are in the triple digits, it is worth reviewing some of the highlights from the first 100 episodes. Also, we have a major announcement to share!
Podcast #100 - Five Examples of When EM Got Ahead of the Evidence with Ken Milne
June 19, 2018 17:00 - 47 minutes - 43.9 MBWhen you hear five of anything in regards to emergency medicine, you have to think of Ken Milne who is an evidence based medicine (EBM) guru in the field of emergency medicine (EM). He hosts The Skeptics Guide to Emergency Medicine (The SGEM) and is a major advocate in cutting down the knowledge translation (KT) window down from over 10 years to less than one year. In true celebratory fashion for the 100th podcast, Ken came on to discuss being a skeptic by reviewing five examples of when E...
Podcast #99 - Does Mechanical CPR Work?
June 12, 2018 17:00 - 13 minutes - 12.3 MBThe first time you see it, there can be any number of emotions. On some patients, it looks like their chest is being caved in by a machine. On other patients, it feels like a smooth and controlled aspect of an otherwise difficult resuscitation. There are many opinions and stories about mechanical cardiopulmonary resuscitation (mCPR), but the evidence may surprise you and lead to the question: does it work?
Podcast #98 - The Practicality of Mobile Stroke Units (Ambulances)
June 05, 2018 17:00 - 20 minutes - 18.4 MBMobile Stroke Units (MSUs) are ambulances that are designed to improve the time of delivery of stroke care to patients. This sounds like an excellent idea at the surface, but is the cost and approach practical?
Podcast #97 - One Hour Sepsis Bundles and 2018 SSC Update Madness
May 29, 2018 17:00 - 15 minutes - 14.1 MBRecently, the Surviving Sepsis Campaign (SSC) launched their 2018 update. Although sepsis bundles have been brought up in the past, they are now pushing the limits by introducing a revised “hour-1 bundle” with the initiating time starting in triage. Initially, this may not seem like a big deal, but there are significant implications.
Podcast #96 - Your Part in a Death Investigation with Darren Dake
May 22, 2018 17:00 - 59 minutes - 54.6 MBPatients die. It is a reality we all must face. But what happens after you call the code? This is when you may meet a death investigator such as Darren Dake. He hosts the popular Coroner Talk website which has a weekly podcast. After being invited to come onto his show, we wanted to share the conversation on our site to both help promote his work and to discuss some of the key points we can do to help facilitate a death investigation.
Podcast #95 - Lung Ultrasound for Pneumothorax with Fritz Fuller
May 15, 2018 17:00 - 30 minutes - 28.3 MBFritz Fuller has been gone for a while but joins us for a discussion of lung ultrasound with its application specifically for pneumothorax. This is probably something you have learned or at least heard of before, but rarely does an introductory course get into the details we are going to discuss in this post.