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The Best in FOAM Education

  • Shah, MD

January Conference Pearls

We had a great month of conference to start out the calendar year! Here are some pearls and follow-up resources from January 2018 EM Conference at Stony Brook.

Essentials of EMCrit - Lots at in addition to below

Live Cric - Dr Weingart


Ventricular Storm - Dr Gray

-3 or more sustained episodes of VT/VF in 24 hours

-Approach: electricity, reversible causes, antiarrhythmics, chill them out

-Ortiz M, Martín A, Arribas F, et al. Randomized comparison of intravenous procainamide vs. intravenous amiodarone for the acute treatment of tolerated wide QRS tachycardia: the PROCAMIO study. Eur Heart J. 2016 - PMID 27354046


LR for HyperK - Dr Farkas

-In ED, start with LR when have no info. When labs back, switch to isotonic bicarb




TTP and DIC - Dr Deloughery

-With thombocytopenia, ask if it's TTP or DIC


-overactive platelets

-ADAMTS13 is missing

-primary problem

-Dx - Terrible triad: MAHA (high LDH + schistocytes), thrombocytopenia, end organ damage

-Tx - plasma exchange; FFP and steroids while waiting

-No platelets...they feed the fire!


-increased thrombin generation

-overactivation of coagulation

-secondary problem

-Dx - high INR/PTT/dimer and low platelets/fibrinogen

-Tx - treat primary cause

-Support coagulation - Magic 5: fibrinogen > 150 (give cryo), PLT > 50, Hct > 21, aPTT < 1.5 x control, INR < 2-3

Team Dynamics - Dr Hicks

-4 lines of conflict

-Positions, strategies, or opinions

-sit rep - leader shares state of situation as (s)he sees it

-tactical pause - leader asks "what am I missing"

-Mistrust or undeveloped comm

-don't be passive aggressive nor man-splain

-consistent, short, direct phases don't mean you're impolite

-Power issues and personal agendas

-hot debrief: process and safety issues

-cold debrief: interpersonal and team issues teased out

-Personality clashes

Anemia Workup - Dr Deloughery

-Production - retic count

-Destruction - coombs, LDH, haptoclobin

-Iron deficiency - ferritin

-Macrocytic - folate (homocysteine), B12 (methylmalonic acid)

BRASH - Dr Farkas

-"BRASH" is his word, not yet in literature

-synergistic response to renal failure, hyperK, and AV nodal blocker

-Metabolic therapies: epi infusion, IV Ca, insulin/dextrose

-Fluid prn: isotonic bicarb if < 24; LR if bicarb > 24

-Nephron bomb if severe hyperK; if mild, then not as aggressive

-In anuric and persistent hyperK, dialyze


Mental Prep for badness - Drs Gray and Hicks

Walking down the hall: near field focus - what are immediate issues and plan for them

-review scripts (trauma arrest, ACLS, etc)

-review procedures you might do

In the bay, decrease arousal level:

-take a deep breath

-say something positive to yourself

-trigger word to focus self

-Lauria MJ, Gallo IA, Rush S, Brooks J, Spiegel R, Weingart SD. Psychological Skills to Improve Emergency Care Providers' Performance Under Stress. Ann Emerg Med. 2017 - PMID 28460863

Patients about to come in: prebrief

-What do we know

-What do we do

-What do we change - contingency

-Roles assignment

Perimortem C-section - Drs Gray, Weingart, Boudourakis


BLAST Speaker 1: Bougie

-Bougie all your intubations

BLAST Speaker 2: VT vs SVT with aberrancy

-CRAM to distinguish VT vs SVT with aberrancy. May be SVT if all "no":

-Concordance in all precordial leads

-R-S > 100 msec

-AV dissociation anywhere


-When in doubt, treat as if VT

BLAST Speaker 3


MCI for unprepared - Dr Gray

-Create inside and outside team

-Designate areas where people go

-Outside team: ID patients, triage them, deliver them inside

Status epilepticus - Dr Farkas


Early trauma resusc - Dr Hicks

-Clot formation, not BP chasing

-Controlled resuscitation

-Pick your poison (brain vs hemorrhage)

-Harris T, Davenport R, Mak M, Brohi K. The Evolving Science of Trauma Resuscitation. Emerg Med Clin North Am. 2018;36(1):85-106 - PMID 29132583

-Schreiber MA, Meier EN, Tisherman SA, et al. A controlled resuscitation strategy is feasible and safe in hypotensive trauma patients: results of a prospective randomized pilot trial. J Trauma Acute Care Surg. 2015;78(4):687-95 - PMID 25807399

Thoracotomy - Drs Hicks, Weingart, Boudourakis




Sim Day:

Central Lines:






Cocaine toxicity in body packer + trauma - Sim War case:

-1 hour 18 min mark onward for

TCA Overdose:

Links from AIR Series Tox 2015:



Grand Rounds by Dr Farkas: BRASH, Status Epilepticus, and Lactated Ringer's





Interesting Case by Dr Simms: ruptured AAA presenting as a seizure

“There is no disease more conducive to clinical humility than aneurysm of the aorta.” - Osler

-RUSH your sick patients

-PMID 21293775, 24360026, 18272117 show seizure as possible CC

DVT Ultrasound by Dr Reardon

-Slides @

-AEUS DVT Lecture:

EKGs: Bradycardia by Dr Meyers

-DDx includes DIE: Drugs (e.g. beta blocker, Ca channel blocker, digoxin), Ischemia, Electrolytes (e.g. hyperK)

PGY2 EBM: CTCA/CCTA and Chest Pain by Dr McKenna





-EMRAP Feb 2017: Cardiology Corner: ACS State of the Art Part 1 and 2 by Amal Mattu

-Stony Brook ED Chest Pain Algorithm ( -> Admin Policies):

EBM: Observational studies: can’t live with them, can’t live without them by Dr Singer


FOOSH by Dr Mallon

AIR Series 2016: Upper Extremity Ortho:


Thyroid Disorders by Dr Alexeeva

From AIR Series 2014: Endocrine (



Adrenal/Pituitary Disorders by Dr Sherman




Vascular Trauma by Dr Morley

-Accuracy of Physical Examination, Ankle-Brachial Index, and Ultrasonography in the Diagnosis of Arterial Injury in Patients With Penetrating Extremity Trauma: A Systematic Review and Meta-analysis - Acad EM 2017 - PMID 28493614

-Management of Major Vascular Injuries: Neck, Extremities, and Other Things that Bleed - EM Clinics 2017 - PMID 29132576

Billing by Dr Morley

-ACEP "What Every Graduating Resident Needs To Know About Reimbursement":

-ALiEM ED Charting and Coding: Medical Decision Making (MDM):

Alkalosis by Dr English





Eponymous fractures by Dr Mallon

-Rosen's 9e Table 42.1 Common Fracture Names and Their Origins

Critical Care Journal Club/Case Discussion by Dr Wright/Thompson/Eraso

-Cotter G, Metzkor E, Kaluski E, et al. Randomised trial of high-dose isosorbide dinitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema. Lancet. 1998;351(9100):389-93 – PMID 9482291



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