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.
Homepage Apple Podcasts Google Podcasts Overcast Castro Pocket Casts RSS feed
Episodes
Podcast #94 - Lifelong Learning with Adrian Banning
May 08, 2018 17:00 - 35 minutes - 32.7 MBOur friendly evidence based medicine (EBM) PA guru, Adrian Banning, joins us again to talk about being a lifelong learner. It is a "hot topic" for PAs and other medical providers, but what does it actually mean and how do we become a lifelong learner? To help us with these questions and more, Adrian joins us for a detailed discussion.
Podcast #93 - Aircraft Safety in HEMS with Karen Mahany
May 01, 2018 17:00 - 24 minutes - 22.6 MBDid you know that many of the aircraft that are being used in helicopter emergency medical services (HEMS) in the United States are not using advanced safety features that could help save the lives of crews and patients in an accident? We are joined today by Karen Mahany who has taken it upon herself to make a real change when it comes to safety in HEMS.
Podcast #92 - HIPAA Compliance and Patient Privacy on Social Media
April 24, 2018 17:00It is so tempting to want to share stories of the things we see, especially in emergency medicine. Maybe we just want to tell the world about something strange, or maybe we are being more innocent and want feedback or to answer questions. However, patient confidentiality is a major issue and in the United States specifically we run into the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Podcast #92 - HIPAA Compliance and Patient Privacy on Social Media
April 24, 2018 17:00It is so tempting to want to share stories of the things we see, especially in emergency medicine. Maybe we just want to tell the world about something strange, or maybe we are being more innocent and want feedback or to answer questions. However, patient confidentiality is a major issue and in the United States specifically we run into the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Podcast #91 - Active Exhalation (External Chest Compression) for Air Trapping
April 17, 2018 17:00 - 25 minutes - 23.2 MBOur guest, Eric Steffel, is a paramedic that reached out wanting to discuss active exhalation. It goes by many other names including "external chest compressions" or "lateral chest compressions" as some sources have indicated. We decided not to use the term "compression" though because this can quickly lead to someone thinking this is a chest compression similar to what is performed in cardiopulmonary resuscitation (CPR). Eric prefers "active exhalation" and (understanding its potential l...
Podcast #90 - Indefinite Evidence and Biased Reporting
April 10, 2018 17:00 - 22 minutes - 20.9 MBThere is also some source of news out there that is contributing to misinformation. As we have talked about before, misinformation is a daily presence but usually we can quickly fact check a source. Most of these are from sources where the credibility is already questionable. However, what happens when a major media source misrepresents information in a way that is potentially damaging to medicine and the patients we care for?
Podcast #89 - The Intubated and Agitated Acronym Debate with Tyler Christifulli
April 03, 2018 17:00 - 17 minutes - 16.3 MBWe have Tyler Christifulli from FOAMfrat back on to discuss two acronyms (we each developed one) for post-intubation agitation and sedation. We also talk about the utility of acronyms in general. As a fair warning, there is some explicit language in the podcast itself. However, this is not only a great post but is entertaining and sure to help you better understand the topic.
Podcast #88 - Cognitive Stop Points with Tyler Christifulli
March 27, 2018 17:00 - 28 minutes - 26.1 MBBuilding off of our last post with Harrison Reed talking about communication, we are moving to a very similar and related topic this time talking about cognitive stop points with paramedic Tyler Christifulli. He also has his own blog and podcast called FOAMfrat and one we have actually featured on our website. Our next post will also have Tyler back discussing acronyms and how they tie in with these cognitive stop points so make sure to check that, as well.
Podcast #87 - Communication in Critical Care Resuscitation with Harrison Reed
March 20, 2018 17:00 - 51 minutes - 47.4 MBCritical care PA Harrison Reed joins us to discuss communication in critical care resuscitation by breaking it down into phases along with talking about the pearls and pitfalls when it comes to these challenging situations.
Podcast #86 - Fever Phobia and Myths with Michelle Perkins
March 13, 2018 17:00 - 37 minutes - 34 MBFever can be scary. It brings in many parents and even adults no matter the time of day. However, there is a lot of misinformation regarding fevers which brings about this important discussion. Using available evidence, we are going to talk about fevers and some of the main myths versus the actual evidence. As always, with topics like these, it is worth remembering that this does not replace clinical judgment and is meant to be informational. Any time there is concern, it should be app...
Podcast #85 - Transitioning Patient Care Within The ED
March 06, 2018 18:00 - 9 minutes - 8.24 MBEvery time we transfer the care of a patient, we are performing in many ways a high risk maneuver. It is so second nature to many that we do not think about the risks. However, according to the Joint Commission up to 80% of serious preventable medical errors are attributed to poorly communicated handoffs. It begs the question, how do we better transition the care of patients within the emergency department (ED).
Podcast #84 - We Are Family (Not Your PCP)
February 27, 2018 18:00 - 8 minutes - 8.04 MBWe are medical professionals and we want to help our family and friends as much as we help our patients. However, there is a real challenge to balance how you help a family member or friend when they have medical questions or concerns. After all, most likely you are not their primary care provider (PCP).
Podcast #83 - Recent Literature Updates on Opiate Alternatives
February 20, 2018 18:00 - 18 minutes - 16.8 MBMost of us are having issues with using opiates in general given problems with misuse and abuse. However, more recently we are experiencing significant shortages. We discuss some key articles in recent literature (almost exclusively 2017) to help discuss alternatives to using opiates in pain control.
Podcast #82 - Can Ultrasound Replace Pelvic Exams in Vaginal Bleeding?
February 13, 2018 18:00 - 46 minutes - 42.5 MBWe are no stranger to controversial subjects here at TOTAL EM, but one that already has a significant division in emergency medicine is the use of pelvic exams. Most people fall into one of two camps: to do one, or not to do one in the event of vaginal bleeding. The big factor in more recent medical history has been with the availability of ultrasound to supplement or fully replace the pelvic exam. Michelle Perkins, who has co-authored some of our most well visited posts, joins us in thi...
Podcast #81 - Conquer the Night Shift
February 06, 2018 18:00 - 14 minutes - 13.7 MBNight shift can be rewarding and some of us choose to do it all the time. There is little to no administration, the crew tends to be more relaxed (but obviously place variant), the cases can be a bit more interesting, the patients are very different from the daytime (both good and bad), and it can there are the small things that is hard to list but you can truly appreciate with time (watching meteor showers and shopping while the rest of the world is asleep) are only a few of the bonuses....
Podcast #80 - "Awake and Dead" or CPR-IC
January 30, 2018 18:00 - 13 minutes - 12.3 MBWhat do you do when the dead are awake? It is confusing terminology, but patients may develop consciousness and be alert during cardiac arrest while receiving chest compressions. In the literature, this is often reported as cardiopulmonary resuscitation induced consciousness (CPR-IC) The phenomenon is overall rare but reports are increasing with time. In this blog and podcast we talk about how to manage such patients.
Podcast #79 - Quick Tips to Improve the eFAST Exam
January 23, 2018 18:00 - 12 minutes - 11.3 MBMost of us working any length of time in emergency medicine are either familiar with or perform the (extended) Focused Assessment of Sonography in Trauma (eFAST). Some keep with the original FAST exam which does not include the lungs, and we will talk more about why you want to include the lungs in a separate podcast. However, after having just returned from 2018 AASPA Conference where we taught participants about many clinically important exams, there were some details of the eFAST that s...
Podcast #78 - Skin and Soft Tissue Infection Pearls with Robert Dachs
January 16, 2018 18:00 - 5 minutes - 5.16 MBBack in April 2017 we went to SEMPA 360 and we have been saving some pearls just for a reminder of what SEMPA can offer when it comes to a conference. The long wait is over and to help support our SEMPA friends we have an interview of some quick pearls from expert Robert Dachs.
Podcast #77 - The 3-2-1 of Dental Pain
January 09, 2018 18:00 - 10 minutes - 9.84 MBDental pain is a common complaint in emergency medicine. Often, it is seen as a non-emergent complaint and there is truth to that issue. However, dental pain can be life threatening and has some key points we will discuss in this podcast. The first step is to remember 3-2-1.
Podcast #76 - After Action Review and 2017 Recap
January 02, 2018 18:00 - 9 minutes - 8.72 MB2017 has been an intriguing year. For the blog and podcast specifically, there have been many accomplishments. Goals have been obtained faster than planned and we still are striving for even more success. Today, we are talking about something that is not in medicine much but we see it elsewhere such as the military and firefighting: the after action review (AAR). However, a traditional AAR can sometimes be difficult to perform at it takes a long time. In critical events there is an abb...
Podcast #75 - Single Coverage ED with EMPA Aaron Inouye
December 26, 2017 18:00 - 24 minutes - 22 MBWorking in emergency medicine is always a challenge, but when you work solo it can make you feel like a lone wolf. In reality, there is always help somewhere. New grad and EMPA Aaron Inouye is in a relatively unique scenario. Not only does he work in the challenging environment of a single-coverage EM provider, he does so as a new graduate. Listen to this interview no matter your career as you may find some fascinating pearls you were not expecting.
Podcast #74 - Abuse and Neglect with Tom Balga
December 19, 2017 18:00 - 28 minutes - 26.5 MBWe are joined by a specialist in child abuse and neglect, Tom Balga, who is a fellow EMPA. Child abuse and neglect is not a fun subject, but it is very important as we can truly change lives. In this blog and podcast we cover some of the essentials that can be easily carried over to your next shift.
Podcast #73 - PPE in Opiate Overdoses
December 12, 2017 18:00 - 16 minutes - 15.1 MBWe hear plenty on the news about the opioid crisis, but we are hearing more and more about exposure to these opiates potentially harming first responders and even those in the emergency department. It begs the question, how much is enough in regards to personal protective equipment (PPE)?
Podcast #72 - Rapid Fire Documentation Pearls with Kevin Klauer
December 05, 2017 18:00 - 17 minutes - 16.2 MBRisk management expert Kevin Klauer joins us today with some rapid fire documentation pearls. We had a similar discussion focused on the MDM when we had Mike Weinstock on back in September. Hopefully, we will have both experts (and others) back again in the future but this was a great talk focusing on some key pearls that we can all bring on the next shift.
Podcast #71 - Practice Makes Permanent: Developing Safe Training
November 28, 2017 18:00 - 17 minutes - 16.1 MBPractice makes permanent and only perfect practice makes perfect. There have been recent conversations on "deliberate practice" which has hit FOAMed with Scott Weingart's interview of Anders Ericsson and subsequent posts. This post is not going to delve in that topic, but rather how we should be teaching and training when it comes to procedures.
Podcast #70 - Neurological Exam Including HINTS and Documentation
November 21, 2017 18:00 - 11 minutes - 10.3 MBThere have been recent requests for further discussion of the neurological exam. Specifically, how to do a brief neurological exam in the emergency department, how to perform a HINTS exam, and documenting the exams performed.
Podcast #69 - Misinformation
November 14, 2017 18:00 - 8 minutes - 8.09 MBWe need to talk about something: misinformation. Unfortunately, the world is full of it and we cannot seem to stop ourselves. The Internet was one of the greatest inventions brought forth to the modern world to allow for the rapid sharing of scientific information. We have bastardized it in time to now spread hate and grossly incorrect information. What was once a way to spread knowledge is now attacking science and what we have learned.
Podcast #68 - End of Life Discussions with Melodie Kolmetz
November 07, 2017 18:00 - 23 minutes - 21.5 MBWhen we started last month's celebration of PAs for October, we discussed breaking bad news. We were then going to expand on that discussion with reference to end of life discussions. However, through some very unfortunate audio issues, we lost the original content in a way that made it so we could not present the original conversation. However, Melodie Kolmetz was gracious enough to record it again on her own and we are presenting this for our newest post.
Podcast #67 - Contracts and Negotiations with Fred Wu
October 31, 2017 17:00 - 28 minutes - 25.8 MBTechnically, this is the last post for PA Month here on the podcast. Fear not! There will be more PAs on podcasts coming up. However, we wanted to finish our discussion with Fred Wu since people may find this portion on contracts helpful in the immediate future.
Podcast #66 - Success in Your Emergency Medicine Career with Fred Wu
October 24, 2017 17:00 - 25 minutes - 23.7 MBEmergency Medicine PA Fred Wu is joining us to talk about starting and advancing a career in emergency medicine. In this two-part series, Fred is reviewing the many aspects of emergency medicine careers from finding a position that will work well for you to signing a contract.
Podcast #65 - Triage and Assessment of Joint Replacement Patients with Amy Jean
October 17, 2017 17:00 - 30 minutes - 27.8 MBWe continue our month of celebrating PAs with a new podcast on a topic not well covered: triaging and assessment of the total joint arthroplasty (replacement) patient. To help us, we have a special guest who is an orthopedic surgery PA named Amy Jean.
Podcast #64 - Breaking Bad News Using EBM with Adrian Banning
October 10, 2017 17:00 - 51 minutes - 47.1 MBOur guest today (the first for PA month here on TOTAL EM) is Adrian Banning. She is an Evidence Based Medicine (EBM) guru and is also on the JAAPA Podcast with a previous guest, Kris Maday. Today though she is here to talk to us about breaking bad news. Something most of us are experienced with but one thing few of us do well. We combine EBM and "soft skills" to better care for our patients and families in this very difficult time.
Podcast #63 - The Long Road Ahead
October 03, 2017 17:00 - 11 minutes - 10.3 MBPA Week is October 6-12 this year. As PAs, we have a lot to be proud of in the 50 years of our existence but with our many advances, there still more we can do. This month, we are hosting PAs for our podcasts. However, to kick off the month, we are going to talk about the challenges that lay ahead. It is worth noting though that much of it is now possible thanks to those who came before us.
Podcast #62 - Improve Your MDM with Mike Weinstock
September 26, 2017 17:00 - 37 minutes - 34.4 MBSome of us do it well, some of us do not do it at all, but we all could use improvement. The medical decision making (MDM) portion of the chart is one area we all can work on. It is quite possibly the single most important portion of the chart for multiple reasons including acting as a "hard stop" in decision making, explaining course of care and management, reviewing highlights of the visit, and even potentially helping in a legal situation. Today, we have Mike Weinstock joining us on th...
Podcast #61 - Work Both Sides to Be on the Same Side
September 19, 2017 17:00 - 10 minutes - 10 MBWe need to get better taking care of out patients. One of the easiest ways to get better is to work both sides of the emergency medicine realm. The main divide rests in the prehospital environment versus the emergency department. We can still see this in the rural versus urban environment. Our experiences in different realms can make us much better providers.
Podcast #60 - Leaving the Ivory Tower
September 12, 2017 17:00 - 14 minutes - 13.1 MBToday is a brief podcast about leaving the ivory tower. As a PA or physician, we have to train at such a place but with time we will leave. Not all nurses, paramedics, or others in such settings will ever see the "ivory tower" and may have their education only in rural environments or at least not at a tertiary care center. The challenge for us becomes not only getting the medical knowledge, but also how to spread it.
Podcast #59 - Blood Draws, Patient's Rights, and Hospital Policies
September 05, 2017 17:00 - 19 minutes - 17.7 MBToday’s podcast is a little brief but covers and important topic: blood draws and patient’s rights. This comes up due to a recent incident in Salt Lake City at University Hospital when a detective of the Salt Lake City Police Department arrested Alex Wubbels, a nurse there, when the officer attempted to collect blood for testing from an unconscious patient.
Podcast #58 - Mental Preparation for Stressful Events
August 29, 2017 17:00 - 24 minutes - 22.7 MB“Everyone has a plan until they get punched in the mouth.” – Mike Tyson Mental preparedness is not taught to us in emergency medicine or in healthcare generally, but it is something we are all doing to a degree. However, we need to improve our abilities and expand on them to do our jobs better. There are many approaches and everyone has their own style, but we will go over some approaches today to help improve your shifts and hopefully lead to you being a better clinician.
Podcast #57 - Resuscitate Then Intubate (RTI) Approach Saves Lives
August 22, 2017 17:00 - 38 minutes - 35.6 MBEveryone talks about airway all the time, and I was at first reluctant to give this talk. However, I believe it is time to talk about this important subject in a slightly different way. The last time we talked about airway management in regards to intubation was with Kris Maday (from the PAINE Podcast) in Podcast #18 where we went over the basics (a great review to listen to first if needed). There we talked mostly about rapid sequence intubation (RSI). Although commonly used, this is no...
Podcast #56 - Why We All Should Be Resuscitationists and How to Get There
August 15, 2017 17:00 - 16 minutes - 15.2 MBNo matter what aspect of emergency medicine you work in (EMS, fast track, main ED, rural, remote, urban, suburban, or whatever else), you need to be a resuscitationist in my book. This is entirely my opinion, but I believe it is important one worth your time in both reading and listening. Envision a busy night shift. It is three in the morning and somehow you still have a waiting room full of people waiting to be seen in your small ED that is hours away by ground to tertiary care. Sca...
Podcast #55 - So Much Blood! Tranexamic Acid (TXA) in Emergency Medicine
August 08, 2017 17:00 - 17 minutes - 16.3 MBTranexamic acid (TXA) is an old drug, but one that we in emergency medicine have found love for once again. In preparation for an upcoming talk at a conference, I realized I had not yet made a post regarding TXA. This is a quick summary of TXA and links to a lot of great #FOAMed resources out there you can also check out regarding the same. I have also included one bit that I have recently found very successful but with little evidence currently. Listen to the podcast for more!
Podcast #54 - Making Change Happen with Patrick Bafuma
August 01, 2017 17:00 - 30 minutes - 27.7 MBAfter Podcast #44 regarding how to incorporate change, our friend Patrick Bafuma reached out to provide his thoughts on how to make change happen in your department. He has championed the process and has pearls that are well worth the listen.
Podcast #53 - Oral Dexamethasone for Sore Throats: A Bonus to a REBEL Cast Post
July 25, 2017 17:00 - 10 minutes - 9.25 MBWe are having a special episode to add to what we did with Salim Rezaie on REBEL Cast recently as a guest. While we were there, we talked a lot about the TOAST trial and reviewed our own clinical use of dexamethasone. It is definitely worth your time to visit his page and listen to that podcast. However, we wanted to add our own little supplement to the #FOAMed world by adding a detailed analysis of the paper in true BEEM fashion. Please check all of this out for a more thorough understa...
Podcast #52 - Big or Small, Abscesses Improve with Antibiotics
July 18, 2017 17:00 - 11 minutes - 10.9 MBWe have talked about abscess management before both here (Podcast #13) and on the Skeptics' Guide to Emergency Medicine (Podcasts #156 and #164). Even though we have talked about using antibiotics before, there has been debate on its use in smaller abscesses. Today, we cover how antibiotics are still beneficial even for the small ones given the most recent evidence out there. Listen to podcast and read this blog for all the details as we cover different points in each.
Podcast #51 - A Proposed Hybrid Ventilation Strategy with Tyler Christifulli
July 11, 2017 17:00 - 23 minutes - 21 MBWe are joined by Tyler Christifulli, a well experienced critical care paramedic and host of the Lifestar Podcast, to discuss a proposed ventilation strategy. It is worth listening to his original podcast first to get a complete picture. I would also recommend listening to Scott Weingart's Dominating the Vent lectures on his EmCrit website if you are not very familiar with ventilator management in general. A warning in advance, there is some cursing in the podcast.
Podcast #50 - Interpreting FOAMed and EBM with Ken Milne
July 04, 2017 17:00 - 35 minutes - 32 MBHappy Fourth of July! Today we are joined by Evidence Based Medicine (EBM) rock star Ken Milne who is known for the Skeptics' Guide to Emergency Medicine (SGEM) blog and podcast. He has been a major mentor to the TOTAL EM project and to celebrate our 50th podcast he agreed to join us for a detailed discussion on FOAMed and EBM. Both SGEM and TOTAL EM are part of the Free and Open Access to Medical Education (FOAMed) movement.
Podcast #49 - Upcoming POCUS Research with Kevin Burns
June 27, 2017 17:00 - 12 minutes - 11.6 MBKevin Burns is back from our last podcast for another discussion, this time specifically on Point of Care Ultrasound (POCUS) and prehospital care. He is assisting with some new research and we review how POCUS could be beneficial in the EMS.
Podcast #48 - Prehospital PAs with Kevin Burns
June 20, 2017 17:00 - 27 minutes - 25.2 MBKeving Burns is one of those PAs who is on the cutting edge of prehospital care. He is the co-director of the Yale New Haven Hospital (YNHH) Emergency Medicine PA Residency program. One of his favorite aspects of emergency medicine is prehospital care and we wanted to talk to him about some of the plans for the future of PAs in emergency medicine.
Podcast #47 - Do You Ramp? A New Ramping Paper with Clay Smith
June 13, 2017 17:00 - 19 minutes - 18.1 MBClay Smith of EM Topics joins us today for a first-ever crossover post. His amazingly well-done blog with daily posts on clinically important papers is a must to subscribe. In today's post, we cover a review he is also publishing today regarding ramping in intubations. In this RCT, there is no benefit in the primary outcome (lowest oxygen saturation) when comparing ramping versus sniffing position. However, there is a lot more to the paper as discussed in this podcast.
Podcast #46 - The Golden Period of Wound Closure and Closing Dog Bites with Brian Lin
June 06, 2017 17:00 - 9 minutes - 8.26 MBBrian Lin is back for the second part of our conversation with him from the 2017 SEMPA 360 conference, but this time we are talking about two subjects with a lot of dogma: the Golden Period for wound closure and dog bite closure. This brief review is designed to remind you of some of the key components in order to better care for your patients.