Arizona EMCast

Happy September everyone! Here in Tucson, the air is thick with pumpkin spiced lattes, influenza and tension over health care policy decisions. Jarrod had the bright idea to discuss healthcare policy which I fought tooth and nail  . . . until I realized that I was being an ignorant coward and avoiding an incredibly important topic that affects us all. Couple of ground rules:  1) Our aim is to DEFINE 10 healthcare policy terms that we felt were important for all EM docs to know 2) We did our best to remain impartial and leave our personal opinons out of this. 3) We failed horribly at goal #2. While there is some evidence that we cite and some Turkey's flocking about, there is a TON of opinion, presumption and guessing throughout the episode. Fortunately we have TWO peer reviewers with opposite opinions about health care policy and whether or not our podcast is any good. They will be on next month because they had so much to offer that we split it into its own episode. They did both agree that this is an important topic that most providers get very little training on so I hope we can at least start a converstaion which they can steer in the right direction next month. Listen, but take each word with a pound of salt and look into these terms and how they affect you and your patients. The AZEMCast Team

Happy August Everyone!   The ED is full of fun technology: ultrasounds, video laryngoscopes, the Playstation that’s supposed to be “just for sick children.” But there’s a whole group of toys that ED docs need to know how to work: the bipap vent and high flow nasal cannula. These toys can help optimize your airway before intubation or even replace intubation all together, in the right circumstance. But what are those right circumstances? Who is at risk failure? Can’t I just do whatever the respiratory therapists tells me to do? Never fear, Dr. Jarrod Mosier is here to explain how these new-fangled machines work and who you should be using them on.    Don’t forget to take your screen shots and read up!   The AZEMCast Team   Peer Review by Dr. Raj Joshi and Dr. Ian Butler   Email: aleetch@aemrc.arizona.edu Twitter: @arizonaemcast

Happy July everyone!   We thought we’d start off the new year with an exciting and high acuity condition . . . chronic pain!    Ok, I know it’s not the sexiest thing we do in the ED but it’s incredibly important to figure out how you’re going to manage this daily issue. To say that the practice variation is broad is an understatement. Some people bleed opioids while others keep a vice grip on the script pad. Whoever you are and however you decide to practice, an evidence-based and consistent approach to chronic pain is important. We are joined this month by Dr. Howard Roemer, an EM doc who now seeks to mitigate this issue as the medical director for Cenpatico behavioral health here in Tucson. He has some interesting experience and ideas on how to help this issue and how to help us as providers in the ED.    While listening to this discussion I encourage you to separate in your mind the  chronic pain patient from the drug seeking patient, although I admit this can be tough to do. Don’t forget to take your screen shots and read up! The AZEMCast Team Peer Review by Dr. Amol Desai

Happy June everyone! As hot as it is here in Tucson, takes some time to slow down and think about the amazing job we have and all the opportunities you have to help on a daily basis. We have a great job but it has it’s high highs and low lows. That’s why we wanted to give you all something to muse on for the summer as you transition into the next phase of your career with a selection of Rosenisms past and present. Peter talks about everything from our role in the ED to standard of care to how you establish trust with a patient you just met. Listen to this one a few times over because even the ones I recorded a few years ago have taken on new meaning as time rolls on.  The AZEMCast Team 

Happy May Everyone! Syncope: a Greek word meaning "to cut off" such as to cut off blood flow to the brain or light to the eyes. Dun fell out: an American word meaning kind the same thing but pretty much whatever it wants to mean.  Seizure: Any (and I mean ANY) movement observed by a lay person after someone has experience syncope or has dun fell out.  What is it? How to I treat it? What do I do with it? No matter how you define these words, it is a pain in the neck to figure out what's going on with a patient with this complaint. Fortunately, we here at AZEMCast have devised a simple, easy way to be just as confused as we are ;) Take a lesiurely stroll with us through the literature, through some cases and through the minefield that is the syncopal patient. Aaron, Jarrod, Brian and Chris Peer Review by Dr. Matt Kostura   Email: aleetch@aemrc.arizona.edu Twitter: @arizonaemcast   https://itunes.apple.com/us/podcast/arizona-emcast/id685439303?mt=2https://azemcast.podbean.com/feed/

Happy April Everyone!   April’s podcast is in the can or rather in the pak . . . the Z-pak that is. This month we discuss the pros, cons, risks, benefits, myths and folklore surrounding our patients’ favorite drug, Azithromycin. Easy to write for, easy to take, questionable efficacy, potential harm, anti-inflammatory effects and antiviral properties? There are a lot new ideas on azithromycin that may need be considered and a lot of old ones that may need to be abandoned. Thanks to our fantastic ED pharmacist Chris Edwards for providing some validity to our little show. My apologies that the recording is not up to par this month, but on the other hand the educational value is average!   And beware of flocks of turkeys . . . they’re everywhere in this episode. Aaron, Jarrod, Brian and Chris Peer Review by Dr. Casey Solem

Happy March everyone . . . . Ok, I was hoping that the April Fools Day thing would help me smooth over the fact I missed yesterday’s publish date but I promise you it will be worth the wait.   This month Chris Williams, Steve Irving and I discuss ovarian torsion. We always seem to be looking for ovary problems but we rarely get that frantic radiology phone call. So when should we pull the trigger on an ultrasound because the patient is high risk and when are we just ordering a test to be able to sign out quicker (you know who you are). All these questions and more will be answered . . . or at least discussed on this month’s AZEMCast!   Aaron, Jarrod, Brian and Chris   Peer Review: "Dr." Matt Thompson

Happy February! As a special Valentine's Day present to all you residents listening, we give you an EARLY episode chock full of Trauma in-training exam goodness. Think of it as a heart-shaped box of chocolates. Much of it is the traditional chocolate training that you already know. Some of it is the disturbing marscapone/coconut anecdote that you wish you didn't bite into. But somewhere in that box is the glorious factoid that you need for your exam in a few weeks that is totally worth the filler you had to sift through to get it. Listen well, find those last pearls of wisdom before the test and score big! Hugs and kisses, Aaron, Jarrod, Brian and Chris

Happy February! As a special Valentine's Day present to all you residents listening, we give you an EARLY episode chock full of Trauma in-training exam goodness. Think of it as a heart-shaped box of chocolates. Much of it is the traditional chocolate training that you already know. Some of it is the disturbing marscapone/coconut anecdote that you wish you didn't bite into. But somewhere in that box is the glorious factoid that you need for your exam in a few weeks that is totally worth the filler you had to sift through to get it. Listen well, find those last pearls of wisdom before the test and score big! Hugs and kisses, Aaron, Jarrod, Brian and Chris

I told you we'd be back for 2017 but Jarrod, Brian, Chris and I are taking a back seat to our peer reviewers who truly outdid themselves this time. Dr. Clay Josephy and Dr. Mike McLaughlin from Lake Tahoe gave us an exceptional peer review that was so good, we gave them their own episode. And to add to their community experience we enlisted the sage advice of Dr. Peter Rosen to give you even more to chew on. So enjoy a fresh take as we give our pipes and our opinions a rest. Aaron, Jarrod, Brian and Chris

I told you we'd be back for 2017 but Jarrod, Brian, Chris and I are taking a back seat to our peer reviewers who truly outdid themselves this time. Dr. Clay Josephy and Dr. Mike McLaughlin from Lake Tahoe gave us an exceptional peer review that was so good, we gave them their own episode. And to add to their community experience we enlisted the sage advice of Dr. Peter Rosen to give you even more to chew on. So enjoy a fresh take as we give our pipes and our opinions a rest. Aaron, Jarrod, Brian and Chris

The end of the 2016 is almost here and we are pretty sure that there will still be a 2017 tomorrow. So certain in fact that we split this episode into 2 parts. The use of MRI in the ED led to a very in depth discussion of how emergency physicians think. Specifically, how do we deal with clinical uncertainty, that cross roads you encounter multiple times per shift where you don't have a diagnosis, but you're pretty sure the patient will be ok. It's tough to learn in residency and even tougher to implement as a new attending, but over time you begin to develop your gestalt and each person develops that differently. Jarrod, Brian, Chris and I discuss our own personal opinions (shocker, I know) along with some actual evidence to help you create the mental schema that gets you through work every day.  Our Peer Review by Drs. Clay Josephy and Mike McLaughlin was so good this time around that we will highlight it for January's episode as well as more deep thoughts by Dr. Peter Rosen.  Happy New Year! Aaron, Jarrod, Brian and Chris

The end of the 2016 is almost here and we are pretty sure that there will still be a 2017 tomorrow. So certain in fact that we split this episode into 2 parts. The use of MRI in the ED led to a very in depth discussion of how emergency physicians think. Specifically, how do we deal with clinical uncertainty, that cross roads you encounter multiple times per shift where you don't have a diagnosis, but you're pretty sure the patient will be ok. It's tough to learn in residency and even tougher to implement as a new attending, but over time you begin to develop your gestalt and each person develops that differently. Jarrod, Brian, Chris and I discuss our own personal opinions (shocker, I know) along with some actual evidence to help you create the mental schema that gets you through work every day.  Our Peer Review by Drs. Clay Josephy and Mike McLaughlin was so good this time around that we will highlight it for January's episode as well as more deep thoughts by Dr. Peter Rosen.  Happy New Year! Aaron, Jarrod, Brian and Chris

Greetings from the frozen desert (hey, it's a dry freeze). This month we discuss the use of MRI in the ED for reasons you may have never considered. It does brains, it does appendices, it does ovarians and PEs! The posibilities seems to be limitless except by those two things we seems to have the least of in the ED: time and money. Jarrod, Brian, Chris and I discuss the MRI guidelines at the University of Arizona and when you could, should or might be able to use MRI as an imaging modality.  Aaron, Jarrod, Brian and Chris ***Guest Peer Review by Dr. Tammer El Aini, radiologist and current pulmonary critical care fellow***

Happy October! We decided to go spooky this month and discuss some scary, scary stuff -- A patient in need of an airway who may code on your while you're putting the tube in. How do you optimize these patient's prior to intubation? This looks like a job for . . . Airway Man! Dr. John Sakles himself helps us navigate the treacherous airways of the hypoxic, the hypotensive and the all around critically ill who need your help. Pull up a bucket of your kids' candy and let's dive in. Aaron, Jarrod and Brian *Peer Review by Dr. Casey Solem