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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July 31, 2016 @ 11:49 pm

July 2016: Vomiting

Happy July everyone!

Welcome new ‘terns to the 4th year of AZEMCast! This month we discuss the pros and cons of vomiting. Generally, we are against vomiting and recommend a variety of way to stop it in its tracks and make sure that it’s not the symptom of a more insidious disease. Peter Rosen adds to the discussion with his opinion of finding the dangerous needle in the haystack of pukers this summer. Finally, we round our with a peer review from alumnus Dr. Allison Peasley.

-Aaron, Jarrod and Brian

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June 30, 2016 @ 4:21 pm

June 2016: Board Certification and Maintenance

Happy June everyone!

Congrats to all the graduating senior residents! Apologies to our non-physician and current resident listeners but this one is for the new grads. As a parting gift, we sat down with Dr. Sam Keim, a soon-to-be board member for the American Board of Emergency Medicine, to discuss how to achieve and how to maintain your board certification in Emergency Medicine. Lots of hard work went into this on your part so listen up and make sure you know the steps to hold onto the crown jewel of your training.

Aaron, Jarrod and Brian
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May 30, 2016 @ 7:47 pm

May 2016: Recognizing and Resolving Conflict

May is a beautiful time of year where I phone in the month's episode and go on vacation. Some have told me these are the best of the year to which I say, thanks, thanks a lot. 

This year I am fortunate to rip off Dr. Taylor Shekell's talk entitled "The Third Party, the Fifth Achievement, the 18th Camel:  This is a subject that we face on a daily . . . no, probably hourly basis and we get really go at it( or so we think). Recognizing and Resolving Conflict. Aside from being an awesome title, Dr. Shekell does an excellent job of describing conflict management strategies and applying them to our job in the Emergency Department. So find your happy place and enjoy Dr. Shekell’s superb talk on managing conflict in the ED.

-Aaron, Jarrod and Brian
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May 1, 2016 @ 1:28 am

April 2016: Thrombolytics in Acute Ischemic Stroke

Happy April AZEMCast listeners. This month, we cover the mother of all EM controversies: thrombolytics in acute ischemic stroke. Guaranteed to spice up any EM/Neuro mixer, this topic is hotly debated throughout the literature so we dive in head first in the papers that set the guidelines and standards. 

No peer review this month (too hot to handle, too cold to hold), but Brian and Chris more than make up for it with their deadly accurate editorials.

Happy listening!

Aaron, Jarrod, and Brian

Peer Review: Dr. Arthur Smolensky - University of Tennessee
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