Emguidewire's Podcast

Join the crew from EMGuidewire as they are joined, once again, by Drs. Diurba and Folk for their unique perspectives from an intern's point of view. This month's Intern Nugget will cover sign-out and transition of care tips as well as some learning point on pediatric dehydration management and BRUE.

Join the EMGuideWire Team as they welcome back Dr. Chelsea Rushnell, prior Chief Resident at CMC Emergency Residency, to discuss the management of the anticoagulated trauma patient. Perhaps just flooding individuals with FFP is not the best strategy. Dr. Rushnell will review the evidence for the use of 4 Factor PCC.

Join the EMGuideWire team from CMC EM residency as they hear a fresh perspective... from newly minted residency Interns, Drs. Destiny Folk and Sofiya Diurba.  For this Intern Nugget, they address: 1) Imposter Syndrome and how to overcome it. 2) Complex Regional Pain Syndrome and how to manage it. 3) Analgesia options in the ED

Join the EMGuidewire team at Carolinas Medical Center Emergency Medicine program as they discuss important topics. This week, Drs. Cravens and Kastner discuss Penetrating Cardiac Injury (PCI): -The diagnosis of PCI is made in the trauma bay with repeat cardiac ultrasound exams and chest x-ray. If suspicion remains high despite inconclusive imaging, operative subxiphoid pericardial window is the definitive diagnostic modality. -Large pericardial injury, especially from ballistic injuries, can result in PCI without positive pericardial fluid on FAST, if the blood is draining into the hemithorax. This would result in hemothorax, but not always with high enough drainage to mandate operative intervention if PCI is not kept with high index of suspicion. -ED management of PCI is stabilization until the patient can be managed in the OR with sternotomy and external cardiac repair. In the pulseless patient with recent arrest, ED thoracotomy is indicated, provided operating room intervention is available immediately fol

Join the EMGuideWire Team from CMC EM group as they explore the initial thoughts and management of a patient who presents with severe Diabetic Ketoacidosis (DKA). For this episode, Drs. Claire Milam and Travis Barlock explore the initial considerations and practical management tips. Definitions of severity of DKA: Mild pH: 7.25-7.3 CO2: 15-18 mEq/L Anion Gap: > 10 mEq/L Mental Status: Alert Blood Glucose: >250 mg/dl Urine and Serum Ketones: Positive   Moderate pH: 7.0-7.24 CO2: 10-15 mEq/L Anion Gap: >12 mEq/L Mental Status: Alert to Drowsy Blood Glucose: >250 mg/dl Urine and Serum Ketones: Positive   Severe pH: < 7.0 CO2: < 10 mEq/L Anion Gap: > 12 mEq/L Mental Status: Stuporous to Comatose Blood Glucose: >250 mg/dl Urine and Serum Ketones: Positive

Join the Drs. Ray and Barlock from the EMGuideWire team as the discuss the initial assessment and evaluation of some ocular complaints with specific attention to pathology of the Posterior Eye. SHOWNOTES: Key PointsAlways get visual acuity for any eye complaint Swinging flashlight test can help with your diagnosis Dilate the eyes for optimal fundoscopic exam Optic neuritis -> give IV steroids Use U/S to look for papilledema along with optic nerve sheath diameter Find the optic nerve when evaluating retinal detachment vs vitreous hemorrhage CRAO= “stroke of the eye” CRVO= “DVT of the eye” Optic NeuritisOnset: Acute Pain: With EOMI, can be painless Visual Acuity: Decreased Laterality: Usually unilateral, can be bilateral Classic presentation: Young female (15-45) with acute vision loss Exam: + APD Associations: MS, infection (lyme, herpes, syphilis), autoimmune, methanol, DM Treatment: IV steroids Papilledema Onset: Subacute to chronic Pain: Headache Visual Acuity: Normal initially Laterality: Bilateral Classic

Join the EMGuidewire team as Drs. Serven and Blackwell discuss the management of the patient presenting with Severe Status Asthmaticus in the Emergency Department. Don't forget to review the basic concepts that were published earlier... this time the focus is on the critically ill patient.

Join the EMGuidewire Team as they address how to prepare for the arrival of a trauma patient in your Emergency Department. Drs. Serven and Blackwell from Carolinas Medical Center Emergency Medicine Residency Program will give us some insight and pearls on how to manage the potential chaos. 

Join the EMGuideWire team as Drs. Serven and Shreve are joined by Dr. Trigonis to discuss simple strategies to make sure your room is set up and you are prepared for performing an emergent intubation on your patients in the Emergency Department. Shownotes - Once through start to finish:  Set up suction  Set up pre-oxygenation (nasal cannula, NRB, BVM as backup) Choose a tube + back up tube  Lube the tube, check the tube  Choose a stylet Set up video and DL  Ask nurse for meds (nicely)  Check hemodynamics  Acknowledge preoxygenation  Positioning  Give meds  Wait for paralytic medications to work Tube ‘em   Call out your tube positioning  Leave the blade in place until tube placement assured  Confirm with color change, EtO2, bilateral breath sounds  Wait for RT to secure the tube Call for post-intubation meds  Check CXR for position 

Join Drs. Alyssa Thomas and Victoria Serven from Carolinas Medical Center Emergency Medicine Residency Program and the EMGuideWire Team as they discuss how they initially evaluate and manage the patient who present with acute pulmonary edema and hypertension. 

Join the EMGuideWire team as they explore the use of Point-of-Care Ultrasound for the evaluation of patients with possible COVID-19 infection. Dr. Patrick Lam, from the Carolinas Medical Center Department of Emergency Medicine Department Division of Ultrasound, will guide us on the techniques and pro-tips for this application.

Join EMGuideWire team as they listen in to EM Residency Conference at Carolinas Medical Center (in Charlotte, NC) and learn from Emily MacNeill, MD as she discusses "What Happens When a Disease Management System Crashes into a Public Health Crisis."

Join the EMGuideWire team as they learn from one of the world's foremost experts in neurologic emergencies, Dr. Andrew Asimos. This episode will address the Neurologic Manifestations and Complications of the COVID-19 Infection.

Join the EMGuideWire team as they listen to Dr. Geib discuss how to recognize and manage Hydroxychloroquine toxicity, which may become more prevalent during the current COVID-19 pandemic.

Join the EMGuideWire team as they learn from Critical Care fellow, Dr. Russell Trigonis while he addresses the important aspects of managing ARDS in patients with COVID-19 infections.

OB Trauma Core Concepts Physiologic changes of pregnancy: physiologic anemia, decreased SVR, increased HR, increased RR, and pelvic vessel engorgement  Traumatic complications: placental abruption, preterm labor (PTL), uterine rupture, and pelvic fx Abruption triad = abd pain, large for dates uterus, vaginal bleeding Perform cervical check to eval for PTL Obtain Type and Screen and KB test Give Rhogam if mom is Rh neg. 50 mcg if 12 wks Check fetal HR after E-FAST, nml is 120-160     -Travis Barlock

Join the EMGuideWire Crew from CMC EM Residency Program as they discuss Ludwig's Angina and the management Priorities!!! BACKGROUND Angina = “Strangling” Bilateral infection of submental, submandibular, and sublingual spaces 70-85% of cases arise from odontogenic source Periapical abscesses of mandibular molars Piercings (frenulum) URI more common cause in children Source of infection often polymicrobial Most commonly viridans; also Staphylococcus and Bacteroides species Patients usually 20-60 years-old; more common in males1 Mortality in treated Ludwig’s Angina = 8%7 ***Airway compromise = leading cause of death8 Who Is At Risk? Diabetes mellitus Chronic alcohol abuse IVDA HIV/AIDS Malnutrition Poor oral hygiene Smokers Anatomy & Pathophysiology Mylohyoid subdivides submandibular space: Sublingual space Submaxillary (submylohyoid) space Infection extends posteriorly and superiorly, elevating tongue against hypopharynx If left untreated, can extend inferiorly to retropharyngeal space and i

Join the EMGuideWire team as they discuss Superior Vena Cava Syndrome! Shownotes: Definition: Any condition leading to obstruction of blood flow through the SVC Pathophysiology: Pathology in adjacent anatomy (lung, lymph node, thymus, mediastinum) or within the SVC itself obstructs venous return to the right atrium. As the SVC is compressed, venous collaterals form alternative pathways returning blood to the right atrium which can dilate over several weeks. As a result, upper body venous pressure increases, which in extreme cases lead to airway congestion and venous cerebrovascular congestion and edema. Hemomdynamic compromise is most often by direct compression of the heart, not from SVC obstruction. Risk factors: Indwelling device through the SVC (Central line, dialysis catheter, pacemaker) Lung cancer Lymphoma Thymoma Presentation: Signs – plethoric appearance, dilated neck and chest veins, swollen face/neck/chest Symptoms – congestive symptoms (head fullness, swelling), cardiopulmonary symptoms (ch

October was Domestic Violence month and in an effort to help highlight this very important topic, join Drs. Salzman, Dragoo, and Richardson from Carolinas Emergency Medicine Residency while they discuss the very important presentation of Strangulation. This is not a mere gesture of power, it may be our last opportunity to save this patient's life! Pearls Strangulation victims are 750% more likely to become a homicide victim. Strangulation is not choking. Call it what it is.  External exam findings are often not present and do not rule out internal injury. History is key. Look for neck pain, dizziness, vision/hearing changes, dysphagia, and SOB.  Most common internal injury is hyoid fracture. Suspect strangulation? Get CTA neck. Neuro findings? Get non-con CT head + MRI brain.  Summarized by Travis Barlock, MD PGY-1

Join the EMGuideWire crew as they discuss some tips and pearls on how to skillfully run a medical resuscitation. Pearls Preparation is everything. Get your staff, and get your stuff!  Call out names, be redundant, and say what you are thinking out loud.  Don’t go for the tube! Supraglottic airways are quicker and safer!  High quality compressions are life saving.  V-tach and V-fib are usually ischemic. PEA is usually non-cardiac.  PEA? Is it Wide or Narrow? Narrow - think procedural. Wide - think chemical. Ultrasound is your friend. RV strain, pericardial tamponade, and pneumothorax can all be quickly found! Wide complex (but not V-tach) is hyperkalemia until proven otherwise. Provide Calcium Chloride (not gluconate).  Summarized by Travis Barlock, MD PGY-1