Arizona EMCast

We here at AZEMCast like to keep it simple. Real simple. So basic that it's really cheating to call this an educational podcast. But this month we are branching out into the new wave of ultrasound-guided hemodynamic (UGH) resuscitation. And that acronym is on purpose because that was my feeling when I started learning about this technique of bedside ultrasound to drive you fluid and inotropic management. For that reason, our critical care expert, Dr. Jarrod Mosier, is back and with him we have ultrasound Jedi Dr. Lori Stolz to explain what to do with the ultrasound probe and why it can help you save a life. And if you are still hesitant, Dr. Peter Rosen will help give some perspective by reflecting on the changes in medicine he has witnessed over the years. Aaron, Jarrod and Brian *Peer Review by Dr. Dan Falvey

August = College Students = Alcohol and in preparation for those Friday nights (and sometimes Wednesday mornings), we are discussing too much and too little alcohol. Brian Drummond and Chris Williams drop sake bombs of clinical expertise in discussing who needs a blood alcohol level, who's safe for discharge and what we do with the patient scratching at their non-existent bug bites. Be sure to check out our happy hour menu of evidence-based medicine below and take those opinions with a grain of salt (and a lime) in this month's tall, refreshing pint of AZEMCast. The AZEMCast team References: Pitzele HZ & Tolia VM “Twenty Per Hour: Altered Mental State Due to Ethanol Abuse and Withdrawal” Emerg Med Clin North Am, 2010 PMID: 20709249 Roberts JR & Dollard D “Alcohol Levels Do Not Accurately Predict Physical or Mental Impairment in Ethanol-Tolerant Subjects” J Med Tox, 2010 PMID: 20358415 Ward FE, et al “Effects of Ethanol Ingestion on the Severity and Outcome of Trauma” Am J Surg, 1982 PMID: 7091524 Amato L, et al “Efficacy and Safety of Pharmacological Interventions for the Treatment of Alcohol Withdrawal Syndrome” Cochrane Database, 2011 PMID: 21678378 Young GP, et al “Intravenous Phenobarbital for Alcohol Withdrawal and Convulsions” Ann Emerg Med, 1987 PMID: 3619162 Brotherton AL, et al “Propofol for Treatment of Refractory Alcohol Withdrawal Syndrome: A Review of the Literature” Pharmacotherapy, 2016 PMID: 26893017 Rosenson J, et al “Phenobarbital for Acute Alcohol Withdrawal: A Prospective Randomized Double-Blinded Placebo-Controlled Study” J Emerg Med, 2013 PMID: 22999778 Maldonado JR, et al “The Prediction of Alcohol Withdrawal Severity Scale: Systematic Literature Review and Pilot Study” Alcohol, 2014 PMID: 24657098

Happy July everyone! Welcome new ‘terns to the 4th year of AZEMCast! This month we discuss the pros and cons of vomiting. Generally, we are against vomiting and recommend a variety of way to stop it in its tracks and make sure that it’s not the symptom of a more insidious disease. Peter Rosen adds to the discussion with his opinion of finding the dangerous needle in the haystack of pukers this summer. Finally, we round our with a peer review from alumnus Dr. Allison Peasley. -Aaron, Jarrod and Brian

Happy June everyone! Congrats to all the graduating senior residents! Apologies to our non-physician and current resident listeners but this one is for the new grads. As a parting gift, we sat down with Dr. Sam Keim, a soon-to-be board member for the American Board of Emergency Medicine, to discuss how to achieve and how to maintain your board certification in Emergency Medicine. Lots of hard work went into this on your part so listen up and make sure you know the steps to hold onto the crown jewel of your training. Aaron, Jarrod and Brian

May is a beautiful time of year where I phone in the month's episode and go on vacation. Some have told me these are the best of the year to which I say, thanks, thanks a lot.  This year I am fortunate to rip off Dr. Taylor Shekell's talk entitled "The Third Party, the Fifth Achievement, the 18th Camel:  This is a subject that we face on a daily . . . no, probably hourly basis and we get really go at it( or so we think). Recognizing and Resolving Conflict. Aside from being an awesome title, Dr. Shekell does an excellent job of describing conflict management strategies and applying them to our job in the Emergency Department. So find your happy place and enjoy Dr. Shekell’s superb talk on managing conflict in the ED. -Aaron, Jarrod and Brian

May is a beautiful time of year where I phone in the month's episode and go on vacation. Some have told me these are the best of the year to which I say, thanks, thanks a lot.  This year I am fortunate to rip off Dr. Taylor Shekell's talk entitled "The Third Party, the Fifth Achievement, the 18th Camel:  This is a subject that we face on a daily . . . no, probably hourly basis and we get really go at it( or so we think). Recognizing and Resolving Conflict. Aside from being an awesome title, Dr. Shekell does an excellent job of describing conflict management strategies and applying them to our job in the Emergency Department. So find your happy place and enjoy Dr. Shekell’s superb talk on managing conflict in the ED. -Aaron, Jarrod and Brian

Happy April AZEMCast listeners. This month, we cover the mother of all EM controversies: thrombolytics in acute ischemic stroke. Guaranteed to spice up any EM/Neuro mixer, this topic is hotly debated throughout the literature so we dive in head first in the papers that set the guidelines and standards.  No peer review this month (too hot to handle, too cold to hold), but Brian and Chris more than make up for it with their deadly accurate editorials. Happy listening! Aaron, Jarrod, and Brian Peer Review: Dr. Arthur Smolensky - University of Tennessee

Happy April AZEMCast listeners. This month, we cover the mother of all EM controversies: thrombolytics in acute ischemic stroke. Guaranteed to spice up any EM/Neuro mixer, this topic is hotly debated throughout the literature so we dive in head first in the papers that set the guidelines and standards.  No peer review this month (too hot to handle, too cold to hold), but Brian and Chris more than make up for it with their deadly accurate editorials. Happy listening! Aaron, Jarrod, and Brian Peer Review: Dr. Arthur Smolensky - University of Tennessee

March brings a new set of interns and a new episode of AZEMCast. We welcome our new Match group as well as some new contributors to the program. This month we discuss the pulmonary embolism in all its mysterious glory. Chris Williams and I discuss how and in whom to chase them, Brian Drummond says to send them home and Jarrod Mosier and Raj Joshi ask you to please talk to them (maybe personally) before thrombolysing. We close with an exceptional peer review by Dr. Steve Groke, class of 2014. Happy listening, Aaron, Jarrod and Brian

March brings a new set of interns and a new episode of AZEMCast. We welcome our new Match group as well as some new contributors to the program. This month we discuss the pulmonary embolism in all its mysterious glory. Chris Williams and I discuss how and in whom to chase them, Brian Drummond says to send them home and Jarrod Mosier and Raj Joshi ask you to please talk to them (maybe personally) before thrombolysing. We close with an exceptional peer review by Dr. Steve Groke, class of 2014. Happy listening, Aaron, Jarrod and Brian

February in Tucson brings warm weather and cold sweats to all the residents prepping for the EM Inservice Exam. But never fear! AZEMCast is here to add a few more points to your score with the annual inservice exam review. Jarrod is away and Brian is filling in as we banter about all things HEENT.  As a disclaimer, we do not know what is on your inservice exam (although took five of them during residency) and listening to this podcast as the sole method of studying is sure fire way to bomb your test. Read a book, do some practice questions but listen on your drive or ride to work. Every little bit helps! Aaron, Brian and Jarrod

February in Tucson brings warm weather and cold sweats to all the residents prepping for the EM Inservice Exam. But never fear! AZEMCast is here to add a few more points to your score with the annual inservice exam review. Jarrod is away and Brian is filling in as we banter about all things HEENT.  As a disclaimer, we do not know what is on your inservice exam (although took five of them during residency) and listening to this podcast as the sole method of studying is sure fire way to bomb your test. Read a book, do some practice questions but listen on your drive or ride to work. Every little bit helps! Aaron, Brian and Jarrod

They new year brings a new episode of AZEMCast with an entirely new focus. That’s right it’s the PEDIATRIC AHA guidelines! C'mon, you knew it was coming.  But this time it's more than Jarrod, Brian and I jabbering on and on. Instead, we talk with Dr. Marc Berg, a pediatric intensivist and one of the co-authors of the pediatric guidelines. Marc shares with us the science, history and back story behind how these new guidelines came into being. Our Peer Review this month is by Dr. Art Sanders who provides his own insight into resuscitation research and future.  Next month is the Resident inservice exam prep and then I promise to get back to whatever it is we used to do before the AHA guidelines. -Aaron, Jarrod and Brian

They new year brings a new episode of AZEMCast with an entirely new focus. That’s right it’s the PEDIATRIC AHA guidelines! C'mon, you knew it was coming.  But this time it's more than Jarrod, Brian and I jabbering on and on. Instead, we talk with Dr. Marc Berg, a pediatric intensivist and one of the co-authors of the pediatric guidelines. Marc shares with us the science, history and back story behind how these new guidelines came into being. Our Peer Review this month is by Dr. Art Sanders who provides his own insight into resuscitation research and future.  Next month is the Resident inservice exam prep and then I promise to get back to whatever it is we used to do before the AHA guidelines. -Aaron, Jarrod and Brian

2015 has come to a close and we have saved the best for last! Part 2 of our review of the 2015 American Heart Guidelines covers post-arrest care and ACS management with a great Rosen anecdote and an AMAZING peer review by two or our alumni: Dr. Clay Josephy and Dr. Mike McLaughlin. These guys work in the settings we only have nightmares about and their review is on point!  Aaron, Jarrod and Brian