Ep 212 PECARN Febrile Young Infant Prediction Tool: When To Safely Forgo LP and Empiric Antibiotics
If you’ve been practicing EM for more than a decade, your approach to the febrile young infant has (appropriately) evolved. For years, the default was LP + empiric antibiotics + admission for almost everyone. That approach prevented missing meningitis, but at the cost of a lot of harm: invasive testing, unnecessary antibiotics, and hospitalization-related complications. The modern approach is a paradigm shift toward risk stratification, biomarkers, and shared decision-making, while still respecting one immutable truth: Missing neonatal bacterial meningitis can be catastrophic. This episode revisits the framework from a prior EM Cases episode and updates it with a landmark study that directly informs how far we can safely go—especially in the 0–28 day group, with the father of multiple well-known PECARN rules Dr. Nathan Kuppermann and lead author Dr. Brett Burstein...
Ep 211 Thyrotoxicosis and Thyroid Storm: Recognition and Management
In this Part 2 of our 2-part podcast series on thyroid emergencies Anton, Dr. George Willis and Dr. Alyssa Louis answer questions such as: When a patient presents with “sepsis without a source,” what bedside features should trigger you to prioritize thyrotoxicosis? How can PoCUS help you decide whether tachycardia is dangerous — or lifesaving — before starting β-blockade? Why can TSH and free T4 be falsely reassuring in a crashing patient, and what labs actually matter early? In which patients does propranolol increase the risk of cardiovascular collapse — and why is esmolol the safer first line medication? Why does the order β-blocker → thionamide → steroid → iodine matter, and what happens if you get it wrong? When is not giving a β-blocker the safest decision in thyroid storm, even in a profoundly tachycardic patient? In an agitated, hyperthermic patient with thyrotoxicosis, why might intubation be more dangerous than helpful in the first hour? How does amiodarone-induced thyrotoxicosis fundamentally change your management — and why can iodine make it worse? and many more...
Ep 210 Decompensated Hypothyroidism Recognition and Management
In the ED, we regularly care for sick patients presenting acutely with abnormal vital signs, altered mental status, and end organ dysfunction. Oftentimes, the culprit ends up being sepsis, or overdose, or organ failure. But it is important that we consider rarer endocrine presentations like decompensated hypothyroidism. In this Part 1 of this two-part podcast with Dr George Willis and Dr Alyssa Louis, we answer questions like: Why is the term myxedema coma a misnomer and should be abandoned? How can we differentiate between sepsis or environmental hypothermia or toxidrome from decompensated hypothyroidism at the bedside? When is it appropriate to order a TSH, a T4 and T3? What are the most important life-threatening triggers that need to be addressed in patients with decompensated hypothyroidism? Why is it important to test for cortisol levels and consider stress-dose steroids in all patients with decompensated hypothyroidism? Why is endotracheal intubation particularly dangerous in decompensated hypothyroidsm? What is the best way to manage hypothermia? Why is the order of medications for treatment of decompensated hypothyroidism so important? and many more... Please consider a donation to EM Cases to ensure continuing Free Open Access Medical Education: https://emergencymedicinecases.com/donation/
Ep 209 Nondisabling Stroke Recognition and Management
In this Part 2 or our 2-part podcast update on ED stroke management with Dr. Katie Lin and Dr. Walter Himmel we explore non-disabling strokes, where symptoms are mild enough that patients can continue daily activities if deficits persist. Yet, non-disabling does not mean benign. Non-disabling strokes occupy the same ischemic continuum as TIAs and carry a substantial risk of early recurrence with disabling stroke. In this EM Cases podcast we answer questions such as: Which patients with non-disabling stroke can safely go home with prompt follow-up and which require urgent investigation or admission? Which stroke mimics do we need to be on the look out for and how do we identify them at the bedside? How dangerous is thrombolysis in a patient with presumed stroke who turns out to be a stroke mimic? What are the key distinguishing features between a stroke and functional neurologic disorder? What are the most common causes of stroke in young people that we commonly miss? How does stroke etiology dictate the management pathway? What are the indications for carotid endarterectomy in patients with non-disabling stroke and what is the ideal timing of the endarderectomy? When is dual antiplatelet therapy vs single antiplatelet thereapy vs anticoagulant therapy indicated? What is the best medication strategy for the patient on a DOAC for atrial fibrillation who presents to the ED with a non-disabling stroke? For patients not on a DOAC for atrial fibrillation who come in with a stroke, when is it safe to start anticoagulation? and many more... Make A Donation: https://emergencymedicinecases.com/donation/.com
Ep 208 Paradigm Shift in Ischemic Stroke Management Part 1: Disabling Strokes
We are amidst a paradigm shift in the emergency management of acute ischemic stroke. The traditional way of categorizing ischemic strokes as 'minor' vs 'major' is no longer relevant to what we do in the ED. It's now about 'disabling' vs 'non-disabling' strokes. And this is no small change. This categorization dictates urgency of ED work-up and treatments, imaging choices, treatment decisions and goals of care. In this Part 1 or our 2-part main episodes EM Cases podcast series on management of ischemic stroke with Dr. Walter Himmel and Dr. Katie Lin, we answer questions like: How can we best rapidly determine if an ischemic stroke is disabling or non-disabling at the bedside? In what ways are 'wake up strokes' managed uniquely and what's the latest thinking on their pathophysiology? How should we best prioritize imaging depending on timing, geography and resources? How do we best predict large vessel occlusion amenable to endovascular therapy (EVT) at the bedside? How can we efficiently establish goals of care at the bedside to inform our emergency decision making around strokes? Which is better for thrombolysis in ischemic stroke - Tenecteplase or Alteplase? How have contraindications to IV thrombolysis changed over the last decade? When should we consider bridge therapy with EVT after IV thrombolysis? What are 4 key items the ED physician should have ready for the stroke neurologist on the first call? and many more... If you enjoy EM Cases content please consider a donation to help support ongoing FOAMed here: https://emergencymedicinecases.com/donation/
Ep 207 Sleep Strategies for Shift Work
Discover evidence-based sleep strategies for shift workers. Optimize performance, recovery, and health with tips from sleep expert Dr. Michael Mak... If you find this beneficial please consider a donation to support EM Cases: https://emergencymedicinecases.com/donation/
