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Emergency Complications of Cirrhosis

Britt Long, MD and Rob Orman, MD discuss emergency department management of patients with complications of cirrhosis.


The Dying Asthmatic

Few patients are more challenging in the ED than the asthmatic in extremis who is recalcitrant to standard therapy. Asthma is different than other causes of severe respiratory distress. And there are different forms of asthma as well. Besides cricoid pressure, magnesium, and slowing down ventilations, how else might the provider try to reduce the consequences of breath stacking is this case? Weingart prefers noninvasive positive pressure ventilation to BVM early on in the management. In...


Why Epi Might (and might not) Work in Cardiac Arrest

The pendulum never seems to stop swinging when it comes to the efficacy of epinephrine in cardiac arrest. 20-25 years ago, the push was to use escalating doses of epinephrine starting at 1 mg and increasing to 3 mg, then 5 mg, and continuing at 5 mg as needed. Some protocols started directly with 5 mg and continued with 5 mg thereafter. These protocols were based on early studies which suggested that higher doses of epi resulted in improved survival to hospital admission. Subsequent...


Internal Medicine in the Emergency Department

Internist Neda Freyha sprinkles some IM in the ED - how to interpret TSH levels and why aspirin is no longer recommended for a-fib thromboprophylaxis.


Massive GI Bleed on Anticoagulants

Rob and Tom Deloughery discuss management of actively bleeding patients who have been prescribed anticoagulation medications.


Mind of an Addict

Our guest today is Joe Polish. Unlike most guests on this show, Joe is not involved in medicine- heis one of the best known marketing minds on the planet. He is the creator of the Genius Network which is the place high level entrepreneurs go to get their next big breakthrough with access to connection, contribution, and collaboration. Joe is also a best selling author and renown podcaster with I Love Marketing, genius network, Rich Cleanerand 10x Talk. But none of those things are why Joe...



Zubin Damania (ZDoggMD) is an internist and founder of Turntable Health, an innovative healthcare startup that was part of an urban revitalization movement in Las Vegas. During a decade-long hospitalist career at Stanford, he experienced our dysfunctional health care system firsthand leading to burnout and depression. He created videos under the pseudonym ZDoggMD as an outlet to find his voice. This launched a grassroots movement — half a billion youtube views and a passionate tribe...


C Diff Treatment Changes

A few weeks ago, a post on Clay Smith’s Journal Feedabout the new IDSA C diff guidelines caught my attention (specifically, that metronidazole is no longer recommended as first line therapy). Whuut? I tweeted this and @medquestioningtweeted back, "Need to dig to see why they dropped metro in the bucket." Yes, @medquestioning, my thoughts exactly. Mentioned in this episode ERcast 2.0click hereEssentials of Emergency Medicine New IDSA C Diff Guideline Treatment...


Pseudoseizures (PNES)

Walker Foland is an emergency physician practicing in Michigan and in this episode breaks down why pseudoseizures, now termed PNES (Psychogenic Nonepileptic Seizures), are a real disease. Sign up for the ERcast mailing list Are patients with PNES ‘faking it’? Challenges How to tell the difference between an grand mal epileptic seizure vs PNES vs faking it? PNES Procedurettes Faking Seizures Epileptic seizure A 2010 article from the Journal of Neurology Neurosurgery and...


What Canada Can Teach Us About CAT Scans

Joe Habbousche is the CEO of MDCalc, the world's most used online medical calculator. Chances are, you've used it yourself. Joe is a passionate advocate for the practice of evidence based medicine and the proper use of clinical decision tools. In this episode, we dissect one of his favorites: the Canadian CT Head Injury/Trauma Rule Canadian CT Head Injury Rule Two sets of criteria High Risk/Major Criteria Medium Risk/Minor Criteria Who does this not apply to? This is a one...


Winter 2018 Journal Club

In the edition of the Ercast journal club Registration for ConCert (the big board recertification exam we take once a decade) has opened. If this is your year to take the exam, there's only one place to go for board review. The DAWN Trial New England Journal of MedicinePMID:29129157 Rob's take-Adam's take- Skull Fractures in Kids Annals of emergency medicine29174834 Rob's take-Adam's take- Procalcitonin is dead. Long live procalcitonin The Lancet Infectious DiseasesPMID:...


Why Doctors Get Sued for Missed MI

Amal Mattu gives his thoughts on why we actually get sued for missed MI. Is it the patient who has an impeccable workup with shared decision making? Or are there other factors/patient characteristics that commonly show up in lawsuits? In part 2, we talk with Mike Weinstock about criticism of his paper How Do We Balance the Long-Term Health of a Patient With the Short-Term Risk to the Physician? Episode contents Frontmatter Hippo EducationEssentials of Emergency Medicine Part one....


Haloperidol for Analgesia

One of the stress points when a patient taking chronic opioids presents with acute pain is that we feel we have little to offer them. Are more opioids the answer? That's often what happens, but might not be the best next step. In this episode, Reuben Strayer presents the argument in favor of haloperidol for analgesia and why more opioids can do more harm than good. Episode Guide In the introduction, preview of a project we're working on for Essentials of Emergency Medicine (May...


When Consultants Give Bad Advice

Sam Ashoo is an ED doc practicing in Tallahassee, Florida. He has been an ED director, coding and billing chief medical officer, international educator, and runs the Admin EM blog. That blog name might sound nerdy (and it is) but his short write ups on common clinical problems are famously high yield. In this episode, Sam gives his strategies on what to do when the consultant on the other end of the phone call is giving questionable advice. Before jumping in to the episode, take a few...


Anorexia Nervosa may not scare you but it should

Vicky Vella is an emergency physician practicing in the United Kingdom with a special interest and expertise in eating disorders. In December of last year, Vicky had a guest post on the St Emlyn’s blog about the MARSIPAN Guidelines. Never heard of them? Neither had pretty much anybody. MARSIPAN is an acronym for Management of Really Sick Patients with Anorexia Nervosa. Anorexia is often viewed as a chronic condition that doesn't really warrant emergency care, but that's not the case....



Recorded at Essentials of Emergency Medicine 2017, Greg Moran, MD reviews current thinking on cellulitis diagnosis and management. Greg is a professor of emergency medicine at Olive View-UCLA medical center who, in addition to emergency medicine, is fellowship trained in infectious disease and has over 100 publications in journals including: New England Journal of Medicine, British Medical journal, JAMA, Lancet, and Annals of Emergency Medicine. Greg is a thought leader in the field of...


Performance Coach Jason Brooks

Jason Brooks PhD is a performance coach helping health care providers, athletes, and other high level performers live better, work better, and be better. In this episode Jason gives his strategies and tactics on myriad topics including: three techniques for stress inoculation, improving test taking, the unseen costs of hiding ignorance, and what habits are common among high level performers. Episode Contents ERCast episode onePhenomenal DocsStart with Why Book TED Talkmake me better by...


Should I give bicarbonate in DKA?

Should I give bicarbonate to DKA patients with severe acidemia? I've certainly been admonished for NOT doing it. The reason for withholding bicarb has been that I've heard that it doesn't help and may actually be a bad idea. I can't say the action (or inaction) was based on a deep understanding. How could bicarb in DKA be a bad idea if even the American Diabetes Association (ADA) recommends we give a bicarb to DKA patients with pH under 6.9? The argument in favor of giving bicarb is that...


The White Coat Investor

The White Coat Investor (AKA Jim Dahle, MD) talks debt, investing, philanthropy, investment philosophy, and investment strategies for different stages of your career. Key Links from this episode Essentials of Emergency MedicineThe White Coat Investor website White Coat Investor book When Jim was an intern, he didn't know much about finance. His education started with this book Mutual Funds for Dummies Books Jim recommends as foundational reading to understand personal finance The...


Finding the Joy

What gives you fulfillment in your job? If you know it, do you make purposeful choices to keep pointed in that direction?