Marco Propersi is back and this time, we're talking about measles and the antivaccination movement.

This week, we discuss diagnosis and management of Wernicke Encephalopathy.

This week, Swami chats with Dr. Katrina D'Amore about some of the finer points of caring for patients with upper GI bleeding.

Swami chats with Marco Propersi about how he gets stuff done.

This week, we discuss spinal epidural abscess with a focus on diagnosis.

This week, we welcome back Katrina D'Amore to talk about the ins and outs of seizures.

This week, we welcome back Marco Propersi to chat about the ins and outs of environmental hyperthermia.

Part II of pneumothorax management welcomes back Dr. Marco Propersi to chat about chest tubes.

Swami chats with Marco Propersi about needle decompression and the right way to do it.

This week, Swami dives into the available evidence on safe N95 reuse.

This week, Swami chats with Miguel Reyes, Chief Resident at Hackensack in NJ, about hyperthyroidism.

This week, Swami chats with Dr. Christine Ju about what she learned from a recent precipitous delivery in the ED.

This week, Swami welcomes back Dr. Katrina D'Amore to discuss vascular catastrophes with a focus on the limb ischemia.

This week, Swami reviews some pearls from the joint EM conference held at St. Joe's at the end of January.

This week, Jenny and Swami discuss the elusive diagnosis of endocarditis and what we can do to avoid the miss.

This week, Jenny and Swami dive into lactated ringers and whether using balanced solutions matters.

This week, Jenny and Swami discuss osteomyelitis, how to diagnose it and, how to treat it.

This week, Swami gives a brief discussion of stroke care in the era of endovascular care.

This week, Swami chats with Marco Propersi about Vaping Associated Lung Injury (VALI)

This week, Swami chats about decompensated liver disease and complications associated with it with guest Dr. Katrina D'Amore.

This week, Jenny and Swami discuss the key things to look for on ECGs of syncope patients.

This week, Jenny and Swami discuss Takotsubo Cardiomyopathy focusing on echo findings and management.

This week, Jenny and Swami discuss Acute Angle Closure Glaucoma

This week, Jenny and Swami get into some expert level tips and tricks in the management of diabetic ketoacidosis.

This week, Swami chats with Dr. Nilesh Patel, vice chair of the Emergency Department at St. Joe's in Paterson, NJ, about penetrating neck trauma.

This week, Jenny and Swami dive into decompensated hypothyroidism otherwise known as myxedema coma.

This week, Jenny and Swami discuss a couple of recent publications on syncope and how these effect the way we think about managing this common disorder.

Jenny and Swami discuss all the ins and outs of superficial venous thrombosis with a focus on who needs treatment and what treatment is indicated.

This week we review the basics on measles - how to identify it and how to treat.

Thrombolysis Guided by Perfusion Imaging up to 9 Hours after Onset of Acute Ischemic Stroke

This week, Jenny and Swami explore common emergencies related to tracheostomies including dislodgement, obstruction and bleeding.

This week, Jenny and Swami discuss a case of epiglottitis with a focus on airway management.

Jenny and Swami discuss blunt cardiac injury with a focus on the spectrum of pathology and diagnostics.

Jenny and Swami review a talk from the All NYC EM conference and dive into the nuances of management of peds status epilepticus.

This week we discuss two recent publications in the NEJM and dive into the non-inferiority study design and how it should be used.

This week, Jenny and Swami discuss two uncommon, but life-threatening, oncologic emergencies: hyperviscosity syndrome and tumor lysis syndrome

This week, Jenny and Swami dive into pearls from a grand rounds talk by Zaf Qasim on traumatic arrest.

This week, Jenny and Swami explore the management and critical actions in accidental hypothermia.

Take Home Points

1. Single dose oral dexamethasone is an excellent choice for asthma exacerbations. It takes away the compliance issue for patients who have trouble getting medications or filling medications once they leave the ED.
2. Antibiotics aren’t always indicated in COPD exacerbations, but are used much more frequently than in asthma exacerbations because the structural changes in the patient’s lung lead to increased bacterial colonization. In general, if the patient has increased cough or sputum production, they probably would benefit from a course of antibiotics
3. In general, azithro alone is no longer a good choice as solo covereage for community acquired pneumonia.  Adding either amoxicillin or cefdinir to you amoxicillin should get you good coverage of both strep pneumo and atypicals.

Take Home Points

1. Bed Up Head Elevated (BUHE) position is a simple intervention that can reduce the rate of intubation-related complications.
2. The bougie should be considered standard practice in all intubations and has an NNT = 11 for 1st pass success.
3. Consider using Suction Assisted Laryngoscopy for Airway Decontamination (SALAD) for all intubations to avoid the failed airway due to contamination.

Take Homes

1. Calcium Channel Blocker (CCB) toxicity usually present with bradycardia and hypotension, but with preserved mental status. This can help differential from Beta Blocker (BB) toxicity, where the patients often have altered mental status.
2. Hyperglycemia is the other hallmark of CCB toxicity, which can help you differentiate from BB. This hyperglycemia may be a harbinger of impending circulatory collapse, so be on guard in a pt with CCB overdose, normal vitals and hyperglycemia
3. Don’t be afraid to use and infuse hyperinsulinemia-euglycemia therapy for BB and CCB toxicity. Have a frank and open conversation with your team about how it works to get everyone on board before your start.
4. TCA overdoses present with a a number of signs and symptoms including anticholinergic symptoms, AMS, hypotension and seizures. Once you identify the TCA toxicity, you’re going to start with fluids and pressors and then move on the antidote which is sodium bicarbonate 1-2 mEq/kg as a bolus followed by a drip. You want to keep pushing sodium bicarb until you see the QRS narrow

A short podcast to announce the launch of a new project under the REBEL EM banner!

Apneic Oxygenation During Rapid Sequence Intubation in the ED

Vitamin C in Sepsis

IV Contrast and Acute Kidney Injury

Angiotensin II for the Treatment of Shock

POCUS During Cardipulmonary Resuscitation

Thrombolyisis in Submassive PE

Conservative vs Conventional O2 Among Patients Going to the ICU

Dosing of Low Dose Ketamine for Pain Control

Dosing of IV Ketorolac

Haloperidol in Gastroparesis