May 28, 2017 @ 6:19 pm

2017 May - Syncope

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
 
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April 30, 2017 @ 5:03 pm

April 2017 - Azithromycin

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
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April 1, 2017 @ 3:02 pm

March 2017 - Ovarian Torsion

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
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February 11, 2017 @ 2:55 pm

February 2017 - Trauma Board Review

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

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January 31, 2017 @ 10:06 pm

January 2017 - Dealing with Clinical Uncertainty - Part 2

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

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December 31, 2016 @ 12:23 pm

December 2016 - Dealing with Clinical Uncertainty - Part 1

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

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December 1, 2016 @ 12:57 am

November 2016 - MRI as an ED Imaging Modality

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***

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October 31, 2016 @ 12:57 pm

October 2016 - The Physiologically Difficult Airway

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
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October 1, 2016 @ 12:56 am

September 2016 - Ultrasound-guided Hemodynamic Resuscitation

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
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August 31, 2016 @ 6:53 pm

August 2016 - Alcohol and Alcohol Withdrawal

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

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