EMplify by EB Medicine

EMplify December 2020Rhabdomyolysis: Evidence- Based Management in the Emergency Department Authors: Gi Xiang Lee, MDDavid Duong MD, MS, FACEPTopics: Evidence ReviewBiology & PathophysiologyDifferential DiagnosisPre-hospital careEmergency Department EvaluationHistoryPhysical ExaminationLabsTreatmentSpecial PopulationsDisposition Have questions or comments on the podcast? Write us at [email protected] .Don’t forget about the $50 Amazon card with any order over $300 through 12/31/20. Use code AMAZON20

EMplify November 2020An Evidence-Based Approach to Nonoperative Management of Traumatic Hemorrhagic Shock in the Emergency Department Authors: Christopher Pitotti, MD, FACEPJason David, MD Topics:The Lethal Triad Prehospital Care Tourniquets - Placement and PitfallsStop The BleedHemostatic DressingsTXATemperature ManagementED AssessmentShock RecognitionPredictors of Massive TransfusionImagingUltrasound - eFASTCTLabsViscoelastic Clot TestingTreatmentREBOA- Resuscitative Endovascular Balloon Occlusion of the AortaCPRResuscitative ThoracotomyAirway - IntubationBreathingCirculationMassive TransfusionCrystalloidBlood ProductsSpecial Populaations Have questions or comments on the podcast? Write us at [email protected] .

EMplify October 2020 Management of Deep Vein Thrombosis in the Emergency Department Authors: Shane R. Sergent, DO, FAAEM, FACOEP, FAWM, RDMS Michael Galuska, MD, FACEP, FAAEM John Ashurst, DO, MSc, FACEP, FACOEP Topics: Epidemiology Causes: • Unprovoked • Provoked Risk Factors Testing • D-dimer • Ultrasound Anticoagulation • Heparins • DOACs • Warfarin • Other Special Populations • Malignancy • Pregnancy • Elderly • Distal Calf DVT Have questions or comments on the podcast? Write us at [email protected] .

Emergency Care for Transgender and Gender-Diverse Children and Adolescents - An Interview With Dr. Hannah Janeway and Dr. Clinton Coil This issue of Pediatric Emergency Medicine Practice is available at no cost here: https://www.ebmedicine.net/topics/ethics/trasnsgender-gender-diverse-children Topics: What is the difference between gender and sexual orientation? What are some of the terms we may encounter (current or retired)? How does a lack of knowledge / competency regarding care for transgender and gender diverse (TGD) youth create barriers to effective care? Or negatively affect the quality of care these patients receive? What is the best way to approach a transgender patient in the ER? There are a number of ways transgender patient may alter their appearance. Why are these methods relevant (complications) and how do I ask about them? Tucking Packing Binding What medical gender-affirming therapies are currently available? And what complications can they cause? Pubertal suppression Feminizing or masculinizing hormones Contraception Is gender-affirming surgery used in this population ? What types (chest, genital) ? STI’s and Pregnancy are still considerations, correct? What are some of the problems that transgender youth have an increased risk of? Substance abuse Suicide Self harm Anxiety Depression Eating disorders Physicians and sexual violence Family rejection Homelessness Food insecurity Poverty What are some helpful resources if I want to learn more? UCSF Center for Excellence for Transgender Health (https://prevention.ucsf.edu/transhealth) PFLAG (https://pflag.org/) Learn more about EBMedicine and subscribe to Emergency Medicine Practice or Pediatric Emergency Medicine Practice here: https://www.ebmedicine.net/

EMplify September 2020 – Infective Endocarditis Topics: Definition and new classification methods. Changes in at-risk patients in the U.S. History and Examination Imaging Chest Xray Trans-throacic Echocardiography (TTE) Trans-esophagel Echocardiography (TEE) CT Angiography MRI Bacteriology Antibiotics Summary Write us at [email protected]

EMplify August 2020 – Racism In Medicine with Dr. Maurice Selby, Assistant Professor, Emergency Medicine, Emory School of Medicine Host- Health In Harlem radio show (WHCR 90.3 FM)and podcast Topics: History of racism in medicine Niggerology Experimentation on Women Pain thresholds, endurance to harsh environments, food and water Institutional Review Boards (IRBs) and their role in racism Non-compliant patients Believing your patient Poor outcomes in medicine due to racial bias Bereaving families Racism among physicians and providers Micro agressions What it’s like to experience racism as a physician. Next steps. Leave us a voicemail at 678-336-8466, ext 128 Write us at [email protected]

EMplify July 2020 – Ventilator Management Of Adult Patients with Dr. Ryan Pedigo, Part 2 Topics: ARDS COVD-19 Lung Compliance Prone Positioning Metabolic Derangements DKA Capnography and Waveform Analysis Leave us a voicemail at 678-336-8466, ext 128 Write us at [email protected]

EMplify July 2020 – Ventilator Management Of Adult Patients with Dr. Ryan Pedigo, Part 1 Topics: Ventilator Modes Volume Assist vs Pressure Support Tidal Volumes Tidal Volume Measurement Tables Inspiratory / Expiratory Ration FiO2: How much oxygen do we need? COPD Patients Permissive Hypercapnia Volume vs Respiratory Rate Adjustments Asthma Patients Respiratory Rate Adjustments Leave us a voicemail at 678-336-8466, ext 128 Write us at [email protected]

EMplify June 2020 Multi-system Inflammatory Syndrome in Children (MIS-C) with COVID-19: An Interview with Dr. Ilene Claudius and Dr. Mohsen Saidinejad. What is it and when did we discover it as an entity? Have either of you treated anyone with the disease? Discussion of different cohorts of patients with MIS-C. Definition of MIS-C. Shock: cardiogenic and distributive shock presentations. Fever, is 4 days required? Discussion of where in the COVID-19 illness MIS-C occurs. Is clinical shock a requirement? Screening criteria (labs) and the Children’s Hospital Of Philadelphia pathway. What is available as treatment? A discussion of IVIG Steroids Cytokine blockers Remdesivir Why IVIG? Complications of the disease. Why are there more cases in New York? How has MIS-C changed your practice of testing children? Is there utility in testing for COVID-19 infection or antibodies in these cases? Resources:EB Medicine Novel 2019 Coronavirus SARS-CoV-2 (COVID-19): An Updated Overview for Emergency Clinicians EB Medicine COVID-19: The Impact on Pediatric Emergency Care Children’s Hospital of Philadelphia Clinical Pathway for MIS-C. Have questions or comments on the podcast? Leave us a voicemail at 678-336-8466, ext 128 or write us at [email protected] .

EMplify June 2020 Rural Emergency Medicine and COVID-19: An Interview with Dr. Harry Wingate and Dr. Ken Gramyk. The rural experience in Georgia and Idaho. Covering both the ED and inpatient areas. Transfers. Schedule and ED operation changes. Practicing in a resource limited environment. Volume changes during the pandemic. Employee furloughs and staffing changes. EMS availability and transfers. Telemedicine. Have questions or comments on the podcast? Leave us a voicemail at 678-336-8466, ext 128 or write us at [email protected] .

You may be accustomed to hearing me speak about COVID-19. Yes, the crisis appears to be improving, and yes much remains unknown and still to be told. But today, even in the midst of pandemic, there is another, different crisis gripping our country. Racism. It did not begin this week, this year, or this century. It did not catch us by surprise. But it certainly is a crisis of pandemic proportion. And we cannot sit in silence. People of color in our communities have been deemed unequal, unworthy of justice, unworthy of life itself. I would love to say that the practice of medicine puts us above racism. But that would be a lie. I would love to say that the Hippocratic oath makes us behave differently, see the world differently, and treat people of color justly. But that too, would be a lie. Today Black Americans are suffering, and that pain is boiling over, becoming a torrent of injustice that we can no longer ignore. And our response cannot be silence. I don’t know the solution, but I am listening and learning. I don’t know a way to relieve the pain, as a fellow human or as a physician, but I will sit and be present. I don’t know the depth of the suffering, but I lament the loss of George Floyd, Breonna Taylor, Ahmaud Arbery, and countless others. Martin Luther King Jr. said: “The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy.” So today, I want to be clear. We, at EB Medicine, stand with our brothers and sisters of color. -------------------------------------- Leave us a voicemail at 678-336-8466, ext 128 Write us at [email protected]

EMplify May 2020 – The New Orleans Experience and Palliative Care : An Interview with Dr. Ashley Shreves EBMedicine Live Webinars: Thursday, June 4th - Life-threatening Headaches + current considerations due to COVID-19 Wednesday, June 17th – A New Timing-and-Triggers Approach to Diagnosing Causes of Acute Dizziness Click the link to register: https://www.crowdcast.io/e/20200606/register Leave us a voicemail at 678-336-8466, ext 128 Write us at [email protected]

EMplify May 2020- Mt Sinai COVID-19 Protocols - Dr. Legome Contact us: [email protected] 1-678-336-8466, ext. 128 Emergency Department COVID Management Protocols: One Institution’s Experience and Lessons Learned Laboratory Testing and Imaging Disposition/admission Criteria Cardiac Arrest Protocol Medication Treatment Guidelines Anticoagulation Protocol Intubation Protocol Nonaerosolized Asthma Protocol Acute Dyspnea/Palliative Care Treatment Death Management Talking Points COVID-19 Smart Phrases / Discharge Plan for Likely COVID-19 Patients Guidelines for Prone Positioning of Nonintubated Patients Critical Care for ED COVID-19 Patients

EMplify April 2020 – Colby Redfield, MD Contact us: [email protected] 1-678-336-8466, ext. 128 COVID-19 Topics: 1.Triage Tent Implementation (02:35) 2.Telemedicine – In the tent, in the department, and in follow up. (08:45) 3. PPE (16:30) Reusing N95s Using elastomeric full and half face respirators CDC, FDA, Osha 4. EMS (22:44) Crew Safety Criteria for transport Viral filters Handoff to the ED Helpful Links: 1. Novel 2019 Coronavirus SARS-CoV-2 (COVID-19): An Updated Overview for Emergency Clinicians https://www.ebmedicine.net/topics/infectious-disease/COVID-19 2. Reusable Facemasks and COVID-19 https://adminem.com/reusable-facemasks-and-covid-19/ 3. University of Florida Halyard H600 masks https://anest.ufl.edu/clinical-divisions/mask-alternative/ https://ufhealth.org/news/2020/uf-health-anesthesiology-team-devises-respirator-mask-made-existing-hospital-materials

Interview with Joe Habboushe, MD, CEO of MDCalc about new COVID-19 tools and his New York City experience. MDCalc's new COVID-19 resource center: https://www.mdcalc.com/covid-19 EBMedicine's COVID-19 article with recent updates: https://www.ebmedicine.net/topics/infectious-disease/COVID-19 Time Stamps: 00:00- Discussion of new tools for COVID-19: calculators, risk factors and odds ratios, labs, etc. 40:02- Discussion of the New York City COVID-19 crisis.

COVID-19 Update 03-18-2020 - An interview with Andrea Duca, MD, Emergency Physician in Bergamo, Italy Time Stamps: 01:29 Dr. Andrea Duca introduction. 02:05 What were your shifts like at the start of the epidemic? 04:50 Were you testing patients for CoOVID-19 initially? 05:08 Were the COVID-19 tests completed in-house or sent out to a government lab? 05:35 The arrival of the first cases. Then… and now. 07:03 What percent of your daily volume is due to COVID-19 patients? 08:17 Are COVID-19 patients diverted to a regional facility? 09:13 Are you still testing patients for COVID-19 today? 09:57 What is your current medication protocol? 10:35 Which antivirals are you currently using? 10:54 Hydroxychloroquine 11:14 Do you use non-invasive ventilation? 13:35 What kind of isolation do you use, airborne or droplet? 14:46 Do you put on new PPE as you go room to room? 15:21 What PPE do you currently use? 15:38 When did you create dirty and clean zones in the emergency department? 16:45 Do you have a dirty and clean side in the waiting room? 17:03 What is your annual emergency department volume? Daily volume? 18:04 How many treatment rooms are in your emergency department? 18:38 What percent of patients are admitted? Do you have borders? 19:54 Where do discharged patients go? 20:14 Have you personally been infected? 20:58 Do you test your staff who are ill? What is your protocol for infected staff? 22:46 What percent of the ED staff were sick at any given time? And inpatient nurses? 24:00 How did you deal with so many inpatient nurses being sick? 24:36 What are your surgeons, who cannot operate, currently doing? 25:35 Are you running out of non-invasive ventilation equipment? 26:20 Summary of current workflow for infected staff. 26:36 How do you use ultrasound for COVID-19 patients in the ED? 29:50 What criteria must a patient meet to be discharged? 31:00 EMS and their role in community screening. 32:20 What are you looking for on ultrasound examination? 34.42 What size chest tube are you utilizing for a pneumothorax in a patient with positive pressure ventilation? 26:33 What inpatient location are patients sent to? By what criteria? 37:05 Have you seen any infected pregnant patients or staff? 38:02 Have you seen any infected children? 38:43 Are you still testing patients? How many times are you testing them? 39:21 What psychological support do you have for staff? 42:25 What would you have liked to know early on, that yo

In this episode of EMplify, Dr. Sam Ashoo interviews Drs. Al Giwa and Akash Desai, the authors of Emergency Medicine Practice’s recent article: Novel Coronavirus COVID-19: An Overview for Emergency Clinicians. This episode, designed specifically for emergency clinicians, discusses Coronavirus COVID-19, including: The cause and history of the virus How it’s transmitted/spread and prevention methods Tools for management and treatment in the ED Which patients should be tested for Coronavirus The role of telehealth, and when patients should go to the ED Using vital signs to triage patients in the ED And more! 00:00 Intro 01:01 Why should we care about Coronavirus? 02:22 What is zoonotic transmission? 03:56 SARS and MERS and previous coronaviruses. 04:38 What are typical Coronavirus symptoms? 04:55 What is R0 (R naught)? 06:46 Why is there so much concern about this Coronavirus strain? 10:05 Is there concern that COVID-19 is more lethal? 12:45 What tools do we have to combat pandemics? Containment 14:38 Treatment and vaccines 16:32 Fecal oral transmission 19:01 Airborne and droplet transmission 21:20 Recommendations for the public 22:00 Recommendations for healthcare workers 23:24 Who should get tested? 24:47 How to get patients tested? 25:51 What do you do with a patient you want to be tested? 30:28 Closing