FOAMcast - An Emergency Medicine Podcast

This episode summarizes and breaks down the 54 pages of recommendations from the new American Heart Association/American College of Cardiology guidelines on diagnosis and treatment of PE.

Show notes, graphics, and references: FOAMcast.org

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Lauren Westafer

Disclosure: The views presented represent Lauren Westafer's alone and do not represent the opinions of the AHA/ACC or guideline writing committee

In this episode, we review the BEEPER study evaluating PERC-Peds to exclude pulmonary embolism in pediatric patients.

References: FOAMcast.org

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Lauren Westafer

This episode reviews the basics of cervical spine clearance in adult blunt trauma patients including

References at FOAMcast.org

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Lauren Westafer

In this episode, we review a new clinical policy from the American College of Emergency Physicians (ACEP) on the use of risk stratification tools and D-dimer to exclude non-traumatic thoracic aortic dissection.

Shownotes: FOAMcast.org

Historically, RhD immunoglobulin was recommended in Rh-negative patients presenting after spontaneous or induced abortion. However, guideline recommendations around the world have largely changed, and now recommend forgoing prophylaxis in most of these cases. We review the evidence and guidelines.

Show notes and references: FOAMcast.org

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Lauren Westafer

This episode discusses asthma guidelines and a systemic review and network meta-analysis on the use of inhaled corticosteroids for asthma.

Show notes and references: FOAMcast.org

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Lauren Westafer

In this episode, we discuss treatment of acute ischemic priapism, including some updates from the American Urological Association. 

Show notes and references: FOAMcast.org

In this episode, we review a consensus guideline from the American College of Emergency Physicians on the use of topical anesthetics in corneal abrasions. 

Show notes and references: FOAMcast.org

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Jeremy Faust and Lauren WEstafer

This episode covers emergency medicine-related recommendations from the American Heart Association's (AHA) clinical guideline on atrial fibrillation: 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation Circulation. 2023

Show notes and references: FOAMcast.org

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Lauren Westafer

The AABB recently published updated recommendations for blood transfusion thresholds. This podcast reviews these recommendations and a recent study, the MINT trial, in which patients with anemia and a myocardial infarction were randomized to a restrictive strategy or liberal transfusion strategy.

Show notes / references: FOAMcast.org

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Lauren Westafer

This epsiode reviews the new clinical policy from the American College of Emergency Physicians (ACEP) on medication for acutely agitated patients needing parenteral sedation.

Show notes / references: FOAMcast.org

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Lauren Westafer

In this episode, we review Resuscitative endovascular balloon occlusion of the aorta (REBOA), notably dissecting the recent Jansen et al trial in JAMA.

Shownotes / References:  FOAMcast.org

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Jeremy Faust & Lauren Westafer

Alcohol use disorder (AUD) is commonly encountered in the ED and visits related to alcohol are estimated to be ~4% of all ED visits in the US. Despite this, most EDs offer little support and harm reduction for patients with AUD. In this podcast, we review naltrexone, the first-line medication for patients with AUD, which is starting to be initiated in US EDs by emergency clinicians. 

AAEM position paper

References and show notes: FOAMcast.org

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Lauren Westafer

Recommendations for the use of steroids in community-acquired pneumonia have been mixed. This episode reviews a large multicenter randomized trial in the New England Journal of Medicine by Dequin et al on hydrocortisone for severe community-acquired pneumonia. 

References/show notes: FOAMcast.org

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Lauren Westafer

In this episode we review the CLOVERS trial, a randomized trial of early (first 24 hours) restrictive versus liberal fluids. 

Show notes/references: FOAMcast.org

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Jeremy Faust + Lauren Westafer

This episode reviews guideline recommendations and literature on the management of acute, uncomplicated diverticulitis - highlighting the recommendations to only prescribe antibiotics to select patients.

References/Show Notes: FOAMcast.org

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Lauren WEstafer

This episode reviews a shift from the "lethal triad" in trauma to the "diamond of death," exploring the role of calcium in hemostasis and critically ill patients. We review the literature that is available on hypocalcemia and trauma patients

References/show notes: FOAMcast.org

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Lauren Westafer

This episode is a departure from the typical FOAMcast clinical content, we will be back with strictly clinical content soon.

In May 2022, I came across a fellow passenger and stranger in cardiac arrest in the airport. A small team of strangers, including an emergency medicine resident, Dr. Jason Tanner, and an emergency department technician, Angel, assembled to treat this passenger. Billy Frolick, a writer and our patient that day, shares his perspective on his case with us. 

In addition, we highlight important clinical pearls, notably the importance of continuous chest compressions and early defibrillation. For m...

This episode covers the 2022 American College of Emergency Physicians (ACEP) clinical policy on acute heart failure syndromes with a special focus on high dose nitrates

References and Show Notes: FOAMcast.org

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Lauren Westafer

In this episode, we review the largest trial of double sequential external defibrillation (DSED) and vector change (VC) defibrillation for refractory ventricular fibrillation (VFib): Cheskes S, Verbeek PR, Drennan IR, et al. Defibrillation Strategies for Refractory Ventricular Fibrillation. N Engl J Med. 2022;387(21):1947-1956.

Show notes, references, & infographics: FOAMcast.org

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Jeremy Faust & Lauren Westafer

The American College of Cardiology released a new consensus statement endorsing several signs on the electrocardiogram (ECG) as "STEMI Equivalents." In this podcast, we review these signs.

Show notes / graphics / references: FOAMcast.org

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Lauren Westafer

Since 2010, the American Heart Association guidelines for cardiopulmonary resuscitation (CPR) have de-emphasized pulse checks - such that they recommend against routine pulse checks. Despite this recommendation, may individuals and institutions continue to perform pulse checks. This episode reviews the recommendations and the literature.

References/show notes: FOAMcast.org

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Lauren Westafer

There is a global outbreak of human monkeypox virus cases. In this episode we provide a quick summary of monkeypox to date. Check out our two more in-depth episodes on the topic. 

References/Show notes: FOAMcast.org

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Jeremy Faust & Lauren Westafer

There is a global outbreak of human monkeypox virus cases. In this episode (the second of a 2 part series), we summarize clinical manifestations, complications, and vaccination. 

References/Show notes: FOAMcast.org

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Jeremy Faust & Lauren Westafer

There is a global outbreak of human monkeypox virus cases. In this episode (the first of a 2 part series), we summarize some brief virology, epidemiology, and review the transmission of this virus. 

References/Show notes: FOAMcast.org

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Jeremy Faust & Lauren Westafer

We review the Anorectal emergencies: WSES-AAST guidelines on complicated hemorrhoids that include some practice-changers

References: FOAMcast.org

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Lauren Westafer

Diphenhydramine (Benadryl) and other first-generation antihistamines are commonly used, despite decades of data that there are safer and effective alternatives.  In this podcast, we review the guidelines / data behind common indications.

References at FOAMcast.org

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Lauren Westafer

In this episode we review acute urticaria and new guidelines related to the treatment of urticaria. We review additional relevant trials Palungwachira et al and Barniol et al. 

References/Show notes: FOAMcast.org

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Jeremy Faust and Lauren Westafer

In this podcast we discuss onset of action of various intramuscular agents for chemical sedation for severely agitated patients. This includes a study by Barbic et al on ketamine, the onset of action of midazolam (and association with length of stay), and is droperidol really magic? (Cole et al) 

Shownotes/References: FOAMcast.org

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Jeremy Faust and Lauren Westafer

Outpatient management of pulmonary embolism for low-risk patients has been encouraged for several years. However, little is known about pulmonary embolism diagnosed and managed exclusively in the outpatient setting. In this study, Vinson et al describe the course of patients diagnosed with PE and managed in the outpatient setting in an integrated healthcare delivery system.

Shownotes/References: FOAMcast.org

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Lauren Westafer

The diagnostic algorithm for pulmonary embolism (PE) has evolved over the past few years to include probability or risk-adjusted D-dimer. The YEARS algorithm includes an elevated D-dimer threshold for some risk groups and has been found to be safe and reduce imaging in several studies, including in pregnant patients. Now, this multicenter trial by Freund et al evaluates use of YEARS and age-adjusted D-dimer compared with an age-adjusted approach alone.

Shownotes/References: FOAMcast.org

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Lauren Westafer

A seminal single-center study in 2018 by Driver et al found a 98% first-pass success in patients undergoing endotracheal intubation in the Emergency Department. This multi-center randomized control trial examines bougie vs stylet in a wider array of settings

Show notes/references: FOAMcast.org

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Lauren Westafer

Subsegmental pulmonary embolism (SSPE) is a controversial entity as they have uncertain clinical significance. As a result, the Chest Guidelines  and ACEP guidelines state that a very select group of patients with isolated SSPE and no deep vein thrombosis may be managed with surveillance rather than anticoagulation. In this podcast we review SSPE and a new prospective study by Le Gal and colleagues.

Show notes and references: FOAMcast.org

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Lauren Westafer

We review the FDA briefing document from Pfizer   as well as from the CDC Advisory Council on Immunization Practices that approved the Pfizer-BioNTech COVID-19 vaccine in children ages 5-11.

References and show notes: FOAMcast.org

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Lauren Westafer and Jeremy Faust

We previously covered the management of young febrile infants in a 2017 podcast  but now we have updated guidance from the AAP. In this podcast, we review the 2021 AAP Guidelines for the management of well-appearing febrile infants 8-60 days old, highlight practice-changing recommendations.

Show notes/references: FOAMcast.org

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Lauren Westafer

In this episode, Jeremy discusses what we know about breakthrough infections in the delta variant era and what this may mean for COVID-19 vaccine boosters.

Jeremy's takes can be found at Inside Medicine

Show notes/references: FOAMcast.org

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Lauren Westafer and Jeremy Faust

In this episode, we discuss the current evidence (as of September 24, 2021) on COVID-19 vaccine boosters as well as the CDC recommendations and the details of the Advisory Council on Immunization Practices recommendations/vote.

Show notes/References at FOAMcast.org

Jeremy's takes can be found at Inside Medicine

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Lauren Westafer and Jeremy Faust

In this literature update podcast covering important papers of 2021, we cover Becattini et al on the assessment of right ventricular dysfunction in patients diagnosed with acute pulmonary embolism (PE). We review guidelines on PE risk stratification for severity and discuss this individual patient meta-analysis.

Show notes/references: FOAMcast.org

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Lauren Westafer and Jeremy Faust

This is a quick literature update on practice-changing literature from 2021. Here we discuss Pappal et al in Annals of Emergency Medicine on awareness during paralysis in mechanically ventilated patients

Show notes / References: FOAMcast.org

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Lauren Westafer and Jeremy Faust

This is a quick literature update of important literature in 2021 covering take-home naloxone by Kilaru et al. In this episode, we discuss principles of harm reduction, including naloxone, as well as the study. 

Show notes, references, and resources: FOAMcast.org

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Lauren Westafer and Jeremy Faust