EMGuidewire's Podcast

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.

-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

Join the EMGuideWire Crew as they discuss Ludwig's Angina and the management Priorities!!! - Secure the airway EARLY! - Prepare and be ready for a difficult airway — expect that the patient will require a surgical airway - Prevent the development of septic shock and multi-organ failure — give antibiotics early

Join the EMGuideWire team as they discuss Superior Vena Cava Syndrome!

Topic: Nonfatal Strangulation -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

-Preparation is everything. Get your staff, and get your stuff!  -Call out names and say what you are thinking out loud.  -Don’t go for the tube! Supraglottic airways are quicker and safer!  -High quality compressions!  -V-tach/V-fib are usually ischemic. PEA is usually non-cardiac.  -PEA? Is it Wide or Narrow? -U/S is your friend. -Wide complex (but not V-tach) is hyperkalemia until proven otherwise. Provide Calcium Chloride (not gluconate). 

Discuss how the patient with Sepsis has their care continued in the ICU! -Start pressors with IVF (30-40cc/kg). NE at 7mcg/min peripherally can always be stopped. -If low BP, Increase NE until at 20mcg/min, then add a 2nd pressor (Vasopressin @ 0.03units/min and 100mg Hydrocortisone Q8h). -Start abx early. Identify source. CXR, US lungs/abd, UA, CT abd?  -Procalcitonin is helpful for stopping abx. Doesn’t change ED treatment. -Don’t order Vitamin C or thiamine in ED. -by Travis Barlock, MD

Pediatric Sepsis -Screening should be age adjusted -HR & RR > 2 standard deviations of nml -Screen: high risk medical history + abnormal vital signs -Check cap refill, mental status, + appearance -Severe sepsis = sepsis + organ dysfunction. Check lactate, CBC, CMP, and blood cultures -Start 20cc/kg bolus LR and reassess. May need 40-60ml/kg. -Still hypotensive? Start 0.1 mcg/kg/min of EPI (peripheral or IO). -Early antibiotics saves lives. Summarized by: Travis Barlock, MD PGY1

This week's Episode's Pearls: - Early fluids save lives. Give 40cc/kg bolus in first 3 hours. - U/S the heart and lungs: evidence of fluid overload? Be more cautious with fluids. - Goal in all patients is to establish an adequate MAP ASAP! - Start low dose NE (10mcg/min); if still in shock, initiate vasopressin (0.04 units/min); do not wait on providing vasopressin if EPI is readily available.  - NE can be initiated peripherally- don’t wait for a central line!

Episode 3 of Sepsis Awareness month: Antibiotics for Sepsis -Obtain history and chart biopsy first! -Check local antibiogram and prior culture results. -Septic shock - Start broad spectrum antibiotics! -Stable patient - find and control the source! Some patients need surgery!  -Antibiotic choice in septic shock: #1 Piperacillin/Tazobactam; #2 Choose based on patient characteristics

Sepsis Awareness Month continues! Join the EMGuideWire Team as they dive into the issues of Fluid selection for resuscitation.  1) Fluids are not all created equal. Use balanced fluids for large volume resuscitation. 2) Lactated Ringers is likely the best choice available in the ED. Plasmalyte is also a good option, if you have it. 3) You can start low dose vasopressors peripherally if you need to, rather than continuing to flood patients with fluids for hypotension.