November 28, 2017 @ 7:30 pm

November 2017 - Pediatric Minor Head Injury

Happy November Everyone!

 
Now that the tryptophan has worn off from Thanksgiving, it’s time to have some PECARN pie (not a typo, just a bad pun) and discuss Pediatric Head Trauma. Head bonks are to children what  . . . youth is to children. It happens all day, every day and it’s your job to distinguish between the worried well and the walking time bombs. The good news is most all medical providers know about the landmark PECARN head injury decision rule to help you risk stratify these patients. The bad news is that our patients’ parents are usually not medical providers and have centuries of folklore and medical mythology telling them their child will die without a CT scan. 
 
So how do you use PECARN correctly? What do you do with the intermediate risk patients? And how do you reassure the parents that what you are saying is true?
 
Excellent questions that we intend to answer on this month’s episode of AZEMCast! 
 
The AZEMCast Team
 
Peer Review by Dr. Ilene Claudius
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October 13, 2017 @ 11:50 am

October 2017 - Health Care Policy 2 - The Peer Review

Happy October everyone!

Health care policy strikes back for part 2 of our discussion . . . now with actual experience and knowledge of the subject matter!!!

We knew we had stepped out of our comfort zone a bit last month but felt it was important to cover this topic, in spite of our limited experience or knowledge. We are very fortunate to have Dr. Seth Trueger from University of Chicago and Dr. Arthur Smolensky from the University of Tennessee who have both of those. And they don’t mind disagreeing with us or outright correcting us on points that truly matter. The peer review is an important part of what we do, which is why we dedicated this entire episode to polishing out the rough edges from the episode. 
 
Thanks Arthur and Seth!

The AZEMCast Team

Twitter: @arizonaemcast
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September 30, 2017 @ 1:10 pm

September 2017 - Health Care Policy

Happy September everyone!

Here in Tucson, the air is thick with pumpkin spiced lattes, influenza and tension over health care policy decisions. Jarrod had the bright idea to discuss healthcare policy which I fought tooth and nail  . . . until I realized that I was being an ignorant coward and avoiding an incredibly important topic that affects us all.

Couple of ground rules: 

1) Our aim is to DEFINE 10 healthcare policy terms that we felt were important for all EM docs to know

2) We did our best to remain impartial and leave our personal opinons out of this.

3) We failed horribly at goal #2. While there is some evidence that we cite and some Turkey's flocking about, there is a TON of opinion, presumption and guessing throughout the episode.

Fortunately we have TWO peer reviewers with opposite opinions about health care policy and whether or not our podcast is any good. They will be on next month because they had so much to offer that we split it into its own episode. They did both agree that this is an important topic that most providers get very little training on so I hope we can at least start a converstaion which they can steer in the right direction next month.

Listen, but take each word with a pound of salt and look into these terms and how they affect you and your patients.

The AZEMCast Team

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August 30, 2017 @ 11:13 pm

August 2017 - NIPPV

Happy August Everyone!

 
The ED is full of fun technology: ultrasounds, video laryngoscopes, the Playstation that’s supposed to be “just for sick children.” But there’s a whole group of toys that ED docs need to know how to work: the bipap vent and high flow nasal cannula. These toys can help optimize your airway before intubation or even replace intubation all together, in the right circumstance. But what are those right circumstances? Who is at risk failure? Can’t I just do whatever the respiratory therapists tells me to do? Never fear, Dr. Jarrod Mosier is here to explain how these new-fangled machines work and who you should be using them on. 
 
Don’t forget to take your screen shots and read up!
 
The AZEMCast Team
 
Peer Review by Dr. Raj Joshi and Dr. Ian Butler
 
Twitter: @arizonaemcast
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July 31, 2017 @ 12:03 pm

July 2017- Chronic Pain in the ED

Happy July everyone!
 
We thought we’d start off the new year with an exciting and high acuity condition . . . chronic pain! 
 
Ok, I know it’s not the sexiest thing we do in the ED but it’s incredibly important to figure out how you’re going to manage this daily issue. To say that the practice variation is broad is an understatement. Some people bleed opioids while others keep a vice grip on the script pad. Whoever you are and however you decide to practice, an evidence-based and consistent approach to chronic pain is important. We are joined this month by Dr. Howard Roemer, an EM doc who now seeks to mitigate this issue as the medical director for Cenpatico behavioral health here in Tucson. He has some interesting experience and ideas on how to help this issue and how to help us as providers in the ED. 
 
While listening to this discussion I encourage you to separate in your mind the  chronic pain patient from the drug seeking patient, although I admit this can be tough to do. Don’t forget to take your screen shots and read up!

The AZEMCast Team

Peer Review by Dr. Amol Desai
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June 29, 2017 @ 11:46 pm

June 2017 - Rosenisms

Happy June everyone! As hot as it is here in Tucson, takes some time to slow down and think about the amazing job we have and all the opportunities you have to help on a daily basis. We have a great job but it has it’s high highs and low lows. That’s why we wanted to give you all something to muse on for the summer as you transition into the next phase of your career with a selection of Rosenisms past and present. Peter talks about everything from our role in the ED to standard of care to how you establish trust with a patient you just met. Listen to this one a few times over because even the ones I recorded a few years ago have taken on new meaning as time rolls on. 

The AZEMCast Team 

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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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