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Hosts, Alex Finch, MD and Venk Bellamkonda, MD explore topics relevant to the practice, education or research of emergency medicine. Enjoy interviews with people on the front lines, thought leaders from around the world, and the comedy and drama of life when it intersects with emergency care. Follow us on X: @AlwaysOnEM Email: AlwaysOnEM@gmail.com
Episodes
Thursday Sep 14, 2023
Thursday Sep 14, 2023
In this chapter, Dr. Alex Niven, renowned critical care physician and educator, provides a mirror for us to see our current state of emergency airway management - for its opportunities for improvement, innovations and best practices. This evidence fueled presentation is a must-listen for any emergency healthcare physician or provider.
CONTACTS
Youtube -https://www.youtube.com/@AlwaysonEM
X - @AlwaysOnEM; @VenkBellamkonda
Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch
Email - AlwaysOnEM@gmail.com
Friday Sep 01, 2023
Friday Sep 01, 2023
Dr. Nayantara Coelho-Prabhu, Mayo Clinic gastroenterologist specializing in the care of patients with gastrointestinal bleeding and endoscopy, talks through many aspects of acute GI bleeding. She helps to clarify the prioritization of medications, when to incorporate imaging, broadens our differentials for upper and lower GI bleeding, gives mindblowing advice on stool guiac testing and SO much more in this over-stuffed (or should we say constipated) chapter of Always on EM. There is also a special cameo from Dr. Luke Wood going over how to insert a Minnesota tube (esophageal balloon tamponade device)!
CONTACTS
X - @AlwaysOnEM; @VenkBellamkonda
Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch
Email - AlwaysOnEM@gmail.com
RECOMMENDATION:
- Dieulafoy lesion video from New England Journal of Medicine: https://youtu.be/tzJQDen1nug?si=zOmywZ1VN3VvA004
REFERENCES:
- Drescher MJ, Stapleton S, Britstone Z, Fried J, Smally AJ. A call for reconsideration of the use of fecal occult blood testing in emergency medicine. Journal of Emerg Med. 2020. 58(1)54-58
- Mathews BK, Ratcliffe T, Sehgal R, Abraham JM, Monash B. Fecal Occult Blood testing in hospitalized patients with upper gastrointestinal bleeding. Journal of Hospital Medicine. 2017. 12(7)567-569
- Harewood GC, McConnell JP, Harrington JJ, Mahoney DW, Ahlquist DA. Detection of occult upper gastrointestinal bleeding: performance in fecal occult blood tests. Mayo Clin Proc. 2002 Jan;77(1):23-28
- Blatchford O, et al. A risk score to predict need for treatment for upper gastrointestinal haemorrhage. Lancet 2000. Oct 14;356(9238):1318-21
- Blatchford O, Davidson LA, Murray WR, Blatchford M, Pell J. Acute upper gastrointestinal haemorrhage in west of scotland: case ascertainment study. BMJ 1997. Aug 30;315(7107):510-4
- Chen IC, Hung MS, Chiu TF, Chen JC, Hsiao CT. Risk scoring systems to predict need for clinical intervention for patients with nonvariceal upper gastrointestinal tract bleeding. Am J Emerg Med. 2007 Sep;25(7):774-9
- Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. Am J Gastroenterol. 2021 May 1;116(5):899-917
- Roberts I, Shakur-STill H, Afolabi A, et al. Effects of High-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial. Lancet 2020. 395(10241):1927-1936
- Aziz M, Haghbin H, Gangwani MK, Weissman S, Patel AR, Randhawa MK, Samikanu LB, Alyousif ZA, Lee-Smith W, Kamal F, Nawras A, Howden CW. Erythromycin improves the quality of esophagogastroduodenoscopy in upper gastrointestinal bleeding: a network meta-analysis. Dig Dis Sci 2023. Apr;68(4):1435-1446
- Abraham NS, Barkun AN, Sauer BG, et al. American College of Gastroenterology-Canadian Association of Gastroenterology Clinical Practice Guideline: Management of anticoagulants and antiplatelets during acute gastrointestinal bleeding and the periendoscopic period. Am J Gastroenterol 2022;00:1-17
- Vigano GL, Mannucci PM, Lattuada A, Harris A, Remuzzi G. Subcutaneous desmopressin (DDAVP) shortens the bleeding time in uremia. Am J Hematol 1989. May;31(1):32-5
- Chavez-Tapia NC, Barrientos-Gutierrez T, Tellez-Avila FL, Soares-Weiser K, Uribe M. Antibiotic prophylaxis for cirrhotic patients with upper gastrointestinal bleeding. Cochrane Database Syst Rev 2010. Sep 8;2010(9):CD002907
- Gao Y, Qian B, Zhang X, Liu H, Han T. Prophylactic antibiotics on patients with cirrhosis and upper gastrointestinal bleeding: A meta-analysis. PLoS One 2022. Dec 22;17(12):e0279496
- Steffen R, Knapp J, Hanggi M, Iten M. Use of the REBOA catheter for uncontrollable upper gastrointestinal bleeding with hemorrhagic shock. Anaesthesiologie 2023. May;72(5):332-337
- Sato M, Kuriyama A. Countering hemorrhagic shock due to duodenal variceal rupture with resuscitative endovascular balloon occlusion of the aorta. Am J Emerg Med 2023. Feb;64:204.e1-204.e3
Monday Aug 14, 2023
Monday Aug 14, 2023
Is healthcare more like an airplane, a flock of birds, or a mayonnaise? Why does it matter? In this talk, Dr. McNamara, emergency physician and patient safety champion, explores the question through the story of how she found herself at the intersection of complexity theory, safety science, and emergency medicine. She will discuss multiple perspectives on safety science, including specific strategies for clinicians to apply in their daily practice to survive amidst the complexity.
CONTACTS
X (formerly Twitter) - @AlwaysOnEM; @VenkBellamkonda; @ShannonOMac
Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch
Email - AlwaysOnEM@gmail.com
Tuesday Aug 01, 2023
Tuesday Aug 01, 2023
Drs. Alex Finch and Venk Bellamkonda talk through tick related infectious diseases including Lyme Disease, Rocky Mountain Spotted Fever, Ehrlichiosis, Babesiosis and more! Tick related illnesses are prevalent this time of year, so take a moment to brush up on how to manage them.
CONTACTS
Twitter - @AlwaysOnEM; @VenkBellamkonda
Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch
Email - AlwaysOnEM@gmail.com
REFERENCES & LINKS
Society guidelines:
- United States
- CDC
- Tickborne diseases of the US
- Anaplasmosis - information for healthcare providers
- Babesiosis - resources for healthcare professionals
- Ehrlichiosis
- Lyme Disease
- RMSF
- A reference manual for healthcare providers 2017
- American Academy of Pediatrics has several publications on babesiosis, borrelia infections other than Lyme, Ehrlichia, anaplasma, Lyme itself, RMSF
- Infectious Disease society of America
- Clinical practice guideline on diagnosis and management of babesiosis 2020
- Canada
- Canadian pediatric society
- Practice point on Lyme disease in Canada - focus on children 2021
- Society of OB / Gyn of Canada
- Committee opinion for management of tick bites and Lyme disease during pregnancy 2020
- Australia - New Zealand
- Australian government department of health released An Australian guideline on the diagnosis of overseas - acquired Lyme disease / borreliosis in 2015
- Japan
- choosing wisely Japan - Lyme disease 2018
- India
- Department of health research - Indian council of medical research (ICMR) - guidelines for diagnosis and management of rickettsial diseases in India in 2015
- UK
- National institute for health and care Excellence (NICE)
- quality standards on Lyme disease 2019
- Guideline on Lyme disease 2018
- British Infection Association (BIA)
- National institute for health and care Excellence (NICE)
- Canadian pediatric society
- CDC
Friday Jul 14, 2023
Friday Jul 14, 2023
Dr. Kharmene Sunga, Mayo Clinic emergency medicine consultant physician, specializing in simulation, diversity equity and inclusion, and education shares a guide for how to communicate (both through listening and speaking) most effectively when it counts.
TEASER
There's no place like the Emergency Department. Patients are in pain, scared, and anxious. Staff are distracted, fatigued, frustrated - and sometimes, well, also scared and anxious. How can Emergency Physicians speak to rise above the fray, to best care for patients, lead a team, and ensure that everyone feels heard? Join Dr. Kharmene Sunga as she discusses insights from sources ranging from medicine to business and even child psychology to cut through the proverbial noise.
CONTACTS
Twitter - @AlwaysOnEM; @VenkBellamkonda
Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch
Email - AlwaysOnEM@gmail.com
Saturday Jul 01, 2023
Chapter 20 - Relaxin to the maxin - Intrathecal baclofen pumps in the ED
Saturday Jul 01, 2023
Saturday Jul 01, 2023
Ms Lisa Beck, assistant professor of nursing and a clinical nurse specialist in the department of physical medicine and rehabilitation, shares her experiences over a career in caring for persons with intrathecal baclofen pumps for managing spinal cord injury related spasticity. Baclofen related complications such as withdrawal and overdose can both be fatal and pump specific complications as well require timely expertise from the emergency care team – but not often discussed in emergency medicine. Check out the episode to learn more!
CONTACTS
Twitter - @AlwaysOnEM; @VenkBellamkonda
Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch
Email - AlwaysOnEM@gmail.com
REFERENCES & LINKS
- Singh NK, Agarwal A, Salazar L, Henkle JQ. Osborn waves in hypothermia induced by baclofen overdose. BMJ Case Rep 2009; 2009.
- Sullivan R, Hodgman MJ, Kao L, Tormoehlen LM. Baclofen overdose mimicking brain death. Clin Toxicol (Phila) 2012;50:141
- Alden TD, Lytle RA, Park TS, et al. Intrathecal baclofen withdrawal: a case report and review of the literature. Childs Nerv Syst 2002;18:522
Wednesday Jun 14, 2023
Wednesday Jun 14, 2023
This is really two separate episodes put together - Dr. Walker delivered grand rounds on network science applications to emergency medicine and it was inspiring. Though because it was such a visual talk, Alex and I had a conversation with her and Dr. Kohler to better understand the topic and present it in a more easily digestable state for you. Both experiences are presented here for your interest.
Thursday Jun 01, 2023
Chapter 19 - Sugar, we’re goin down swinging! - Pediatric diabetic ketoacidosis
Thursday Jun 01, 2023
Thursday Jun 01, 2023
Dr. Mark Mannenbach, emeritus pediatric emergency medicine faculty of Mayo Clinic and former chairperson of the division of pediatric emergency medicine sits down with Alex and Venk to talk about pediatric diabetic ketoacidosis. We review tips and tricks from a lifetime of caring for sick kids, discuss our Mayo Clinic practice guideline, cerebral edema diagnosis and management, compare the care of pediatric DKA with that of adult DKA and more - Check out this ultra-sweet chapter!
CONTACTS
Twitter - @AlwaysOnEM; @VenkBellamkonda
Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch
Email - AlwaysOnEM@gmail.com
REFERENCES & LINKS
- Wolfsdorf JI, Allgrove J, Craig M, et al. Hyperglycemic crises in pediatric patients with diabetes; a consensus statement from the International Society for Pediatric and Adolescent Diabetes. Pediatr Diabetes. 2014;15(S20):154-179.
- Neu A, Hofer SE, Karges B, et al. Ketoacidosis at diabetes onset is still frequent in children and adolescents. Diabetes Care. 2009;32:1647-1648. doi: 10.2337/dc09-0553. Epub 2009 Jun 23. PMID: 19549730.
- Kuppermann N, Ghetti S, Schunk JE, et al. Clinical trial of fluid infusion rates for pediatric diabetic ketoacidosis. N Engl J Med. 2018;378:2275-2287
- Long B. Lentz S, Koyfman A, Gottlieb M. Euglycemic diabetic ketoacidosis: etiologies, evaluation and management. Am J Emerg Med. 2021 Jun;44:157-160
- Glaser N, Barnett P, McCaslin I. Risk factors for cerebral edema in children with diabetic ketoacidosis: The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. N Engl J Med. 2001;344:264-269.
- Soto-Rivera CL, Asaro LA, Agus MSD, DeCourcey DD. Suspected cerebral edema in diabetic ketoacidosis: Is there still a role for head CT in treatment decisions? Pediatr Crit Care Med. 2017 Mar;18(3):207-212
- Wilkinson K, Sanghamitra S, Nair P, Sanchez J, Ambati S. Utility of head CT scan in treatment decisions for suspected cerebral edema in children with DKA. J Pediatr Endocrinol Metab. 2022 Sep 29;35(10):1257-1263
Sunday May 14, 2023
Sunday May 14, 2023
This is a recording of Dr. Kyle Hess, emergency medicine pharmacy resident, speaking at grand rounds on the utility of high-dose insulin therapy for selected cardiac medication overdoses.
CONTACTS
Twitter - @AlwaysOnEM; @VenkBellamkonda
Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch
Email - AlwaysOnEM@gmail.com
Monday May 01, 2023
Chapter 18 - a Joint Venture - A guided tour of Rheumatoid Arthritis
Monday May 01, 2023
Monday May 01, 2023
Rheumatoid arthritis is a challenging disease with variable presentations and complex medications that can make providing emergency care challenging. Dr. John Davis, Vice Chair of Division of Rheumatology at Mayo Clinic sits down with us to help us move easier through RA for our patients.
CONTACTS
Twitter - @AlwaysOnEM; @VenkBellamkonda
Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch
Email - AlwaysOnEM@gmail.com
REFERENCES & LINKS
- Kaeley et al. The importance of ultrasound in identifying and differentiating patients with early inflammatory arthritis: a narrative review. Arthritis Research & Therapy. 2020;22:1
- Horton SC, Tan AL, Wakefield RJ, et al. Ultrasound-detectable grey scale synovitis predicts future fulfillment of the 2010 ACR/EULAR RA classification criteria in patients with new onset undifferentiated arthritis. RMD Open 2017;3:e000394
- https://youtu.be/7YqGIl6Oqbk - industry sponsored video on POCUS for rheumatoid arthritis. I recommend jumping to the 20 minute mark and watch this area for examples of ultrasounds and the use of the grey scale evaluation for synovitis.