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Bonus ShortJanuary 2018 - Hotpocket Artwork

January 2018 - Hotpocket

Dr Mason reviews the fact that we have an IV fluid shortage in North America after the recent hurricanes affecting Puerto Rico. View chapters…

9min / one chapter
The Collector ArtworkJanuary 2018

The Collector

Let's get this New Year started with some home cooked medical goodness that can only be EM:RAP. View chapters…

8hr 50min / 25 chapters · 6 CME Hours
C3 - Stroke ArtworkJanuary 2018

C3 - Stroke

In this episode of C3, we review the management of the patient with acute stroke. Although cerebrovascular disease is a leading cause of death worldwide, advances in acute stroke care have been overshadowed to some degree by advances in cardiovascular care. After years of slow and difficult progress, the battle against stroke is picking up steam. Advances in imaging allow us to more precisely define the various stroke syndromes and new interventional techniques now the hold promise of more effective targeted treatments.

1hr 19min
EMA 2018 January ArtworkJanuary 2018

EMA 2018 January

EMA kicks off 2018 with a great episode full of clinically useful papers with our team of contributors tackling some hot topics. Jan and Ramin begin with their editors’ commentary on the January selections then Mel and Stuart give us a quick overview with their Ultra Summary. Jerry Hoffman’s Deep Dive looks at a few of this month’s papers with a particular focus on the many retrospective studies in this month’s episode. Rick’s Rants looks at the opioid crisis and how it relates to emergency medicine while Ken Milne’s Time To Talk A Little Nerdy lecture focuses on managing pediatric UTI’s in the ED. Jerry is back with more Reflections of a Skeptic, this month talking about the importance of clinical judgement and the use of clinical decision aids. Finally, Mel takes a look back in time with his That Was Then This Is Now segment about contrast induced nephropathy.

4hr 21min · 6 CME Hours
Bonus ShortDecember 2017 - Hotpocket Artwork

December 2017 - Hotpocket

The dogma says never put epinephrine in the fingers, nose, penis, or toes, but is there evidence to support (or refute) that? Also in this short… Robbie O says farewell. View chapters…

11min / one chapter
A Pancreas and a Testicle Walk Into a Bar... ArtworkDecember 2017

A Pancreas and a Testicle Walk Into a Bar...

It may be the final installment of EM:RAP for the year, but before we power down for a quick break. We baked up a special December that's full of warm chocolate, bundt cakey medical knowledge goodness. View chapters…

9hr 34min / 24 chapters · 6 CME Hours
EMA 2017 December ArtworkDecember 2017

EMA 2017 December

The December EMA Episode begins with Jan Shoenberger and Billy Mallon discussing this month’s 30 Abstracts. This is followed by Mel and Stuart’s Ultra Summary and Jerry’s Deep Dive. Rick Rants about being a patient while Ken Milne brings us part 2 of his Managing ROSC lecture. Jerry reflects on P-Values and Mel takes a look at the history of reducing the pain of lidocaine infiltration.

4hr 28min · 6 CME Hours
C3 - Painful Red Eye ArtworkDecember 2017

C3 - Painful Red Eye

In this episode of C3, we examine the approach to the patient with a painful red eye(s). The causes of a painful red eye range from benign and self-limited to very serious and sight threatening. We will emphasize a methodical approach and discuss the skills and procedures that we need to be familiar with in the acute care setting.

1hr 20min
Bonus ShortNovember 2017 - Hotpocket Artwork

November 2017 - Hotpocket

Mel and Rob discuss what's on the way for EM:RAP, a paper on opioid vs nonopioid analgesics for extremity pain, and challenge coins. View chapters…

7min / one chapter
C3 - HIV and AIDS ArtworkNovember 2017

C3 - HIV and AIDS

In this month’s C3, we discuss one of the most important and fascinating infectious diseases of our time - HIV/AIDS. The rapid spread of this global pandemic and its evolution from a universally fatal disease to one that can be controlled and prevented, is one of the most compelling stories in modern medicine.

1hr 15min
EMA 2017 November ArtworkNovember 2017

EMA 2017 November

In the November episode of EMA Jerry reflects on medical malpractice, censuring and standard of care, Rick rants about burn out, while Mel looks at the history of warming Lidocaine. Ken gives us part 1 of his lecture on managing ROSC, Jan and Ramin discuss their 30 selected abstracts for the month, Mel and Stuart summarize them all and Jerry selects a few for his Deep Dive.

4hr 15min · 6 CME Hours
Super Sick DKA ArtworkNovember 2017

Super Sick DKA

George Willis is back for more DKA deep diving, but this time it’s the sickest of the sick. How long do we pause for ultrasound heart checks in cardiac arrest patients? Mike Mallin says too long. When creating a presentation, start with the story, that’s the P cubed way. There’s been a lot of talk about lysis of intermediate risk PEs but new evidence says pump the brakes- lytics may not improve long term outcome. Instead of recommending a pill for your patient with an MSK complaint, think about a topical NSAID says Matt Delaney. Dilated eyes, blood spinal taps, road rash, button batteries, infected belly fluid and so much more on this month’s EM:RAP. View chapters…

8hr 41min / 27 chapters · 6 CME Hours
Bonus ShortOctober 2017 - Hotpocket Artwork

October 2017 - Hotpocket

Lessons Hard Learned In The First Year As An Attending View chapters…

19min / one chapter
Bonus ShortBackPassage October 2017 Artwork

BackPassage October 2017

Mel gives an update and insight on what's happening at EM:RAP. View chapters…

5min / one chapter · Free Episode
EMA October 2017 ArtworkOctober 2017

EMA October 2017

This month’s EMA episode includes Reflections of a Skeptic: The History of EMA, That Was Then This is Now: Magnesium in ACS, Time To Talk A Little Nerdy: TIAs, Rick's Rants: Fluoroquinolone Black Box Warning, Jerry’s Deep Dive, The Ultra Summary, and 30 abstracts.

4hr 29min · 6 CME Hours
EMA, Swadron, Herbert & Bundt Cake Goodness! ArtworkOctober 2017

EMA, Swadron, Herbert & Bundt Cake Goodness!

This is a historic month, the month Emergency Medical Abstracts joined EM:RAP! The historic series with 30 plus papers and all new commentaries is now part of EM:RAP, are you kidding me! It also means a new app and web site! Say what! It is the return o da Captain and his Little Ozzie Friend, if only for the month. Also includes: Notes from Uganda, dental infections, what works in cardiac arrest, what to do with “mini-strokes”, should you have MRSA in that cellulitis patient, a bunch of male GU issues, 30 EMA papers, 5 Paper Chase, I mean come on EMRAP just exploded! View chapters…

8hr 50min / 24 chapters · 6 CME Hours
C3 - Atrial Fibrillation ArtworkOctober 2017

C3 - Atrial Fibrillation

Atrial fibrillation (AF) is the most common tachyarrhythmia. As such, AF is bread and butter for the emergency provider. We need to really understand and be comfortable with this rhythm.

1hr 4min
Bonus ShortSeptember 2017 - Hotpocket Artwork

September 2017 - Hotpocket

You’ve probably seen the news story: an ED nurse is handcuffed by a Utah detective for refusing to draw blood on an unconscious accident victim. Nobody wants something like this to happen, but are we compelled to act as agents of the police for evidence collection? Legal experts Scott DeShields and Rich Orman weigh in. View chapters…

15min / one chapter
C3 - Seizures in Pediatric Patients ArtworkSeptember 2017

C3 - Seizures in Pediatric Patients

How should we approach seizures in pediatric patients? How different is this from adults with seizures? We will discuss.

1hr 7min
Mildly Acidotic ArtworkSeptember 2017

Mildly Acidotic

Your next patient is altered and blue. Blue as a blueberry. What on earth could be happening? We travel to the backwoods of the American south to find out. Isn’t it time the Framingham risk factors got a remodel? Amal says yes, but the bigger question might be, “Do we care?” A painful tooth that doesn’t look infected, is there an indication for antibiotics? Vanessa Cardy wonders about the road not taken when managing a critical pregnant patient in the hinterlands. Walker Foland thumps the precordium with surprising results. And the original Swami digs into the infinite sea of trauma myths. View chapters…

8hr 46min / 27 chapters · 6 CME Hours
EMA September 2017 ArtworkSeptember 2017

EMA September 2017

This month’s EMA episode includes 30 abstracts, a bonus lecture “CT Coronary Angiography, Pros And Cons”, an essay “The Ring Of Fire”, an interview “Listener's Memories Of Em Abstracts”, and reflections of a skeptic “Listener's Choice”.

3hr 58min
Bonus ShortAugust - Against Medical Advice Correction Artwork

August - Against Medical Advice Correction

In our AMA segment this month, it was stated that a patient who leaves the ED against medical advice is at risk for their insurance company not paying the bill. We have been inundated with emails saying, “Is that really true? I heard it was a myth…” It turns out that this IS a myth! Thank you for helping us set the record straight. Listen in for details. View chapters…

3min / one chapter
Bonus ShortSuicide Risk in Physicians Artwork

Suicide Risk in Physicians

Mel Herbert MD, Christine Moutier MD, Ramin Tabatabai MD, and Matthieu DeClerck MD touch on suicide risk in physicians. How did we get here and now what do we do about it? View chapters…

26min / one chapter · Free Episode
C3 - Seizures ArtworkAugust 2017

C3 - Seizures

Seizures frighten everybody. They can be distressing not only for patients but also for their families, public bystanders and even emergency providers. Because the convulsions associated with seizures can be so dramatic, we tend to lose our ability to think in a logical manner when a patient is actively seizing. In this episode of C3, we cover the initial approach to the seizing patient, how to manage status epilepticus and how to disposition these patients from the emergency department.

1hr 3min
Challenging Foleys, Conversations, and Intubations ArtworkAugust 2017

Challenging Foleys, Conversations, and Intubations

Rob and Swami kick things off with a case of a patient with a red hot arm who ends up with a surprising diagnosis. Having trouble placing that Foley cath? Not to worry, Jess does a cognitive biopsy of our urology consultant for a bevy of tips and tricks. Vitamin C might not cure the common cold, but can it save septic patients? How often to we intubate for true ‘airway protection’? Strayerisms says not as much as we think. EM stroke expert John Schrock makes sense of BP control in acute stroke patients. Kevin Rodgers and Mike Weinstock are AMA. This, and so much more I'm the August extravaganza... View chapters…

9hr 27min / 27 chapters · 6 CME Hours
EMA August 2017 ArtworkAugust 2017

EMA August 2017

This month’s EMA episode includes 30 abstracts, a bonus lecture “Ketamine Analgesia In The ED”, an essay “The Opioid Epidemic; Is Emergency Medicine To Blame? What Is The Number Needed To Suffer? Is Dr. Stingy Better Than Dr. Feelgood???”, an interview “Do Heroin Overdose Patients Require Observation After Receiving Naloxone?”, and reflections of a skeptic “It's The Malpractice System That Is Negligent”.

4hr 51min
Bonus ShortJuly 2017 Hotpocket Artwork

July 2017 Hotpocket

First some information on the FIX conference with the FEMinEM people. Mel presents ANOTHER case of a sick patient in a plane and lesson learned, and a challenge coin winner Dr. John C. Maino, MD View chapters…

10min / one chapter
EMA July 2017 ArtworkJuly 2017

EMA July 2017

This month’s EMA episode includes 30 abstracts, a bonus lecture “Traps When Assessing The Medical Literature”, an essay “Low Back Pain”, an interview “Digital Pills To Measure Opioid Ingestion Patterns In Emergency Department Patients With Acute Fracture Pain: A Pilot Study”, and reflections of a skeptic “Overuse - What Can We Do About It?”.

5hr 10min
Sugar Up, PE Home, O2 Cranked ArtworkJuly 2017

Sugar Up, PE Home, O2 Cranked

When it comes to preoxygenation, consider the Nigel Tufnel approach of turning the amp up to 11. How much do we really know about OTC analgesics? Delaney is back with some surprising news. Weingart solves the puzzle- how much lack does lactate lack if lactate lacks lactate? There are all sorts of meds we give to ACS patients, but do they do any good? Last month George Willis tackled low sugar, this month, he shoots for the moon. The new drug of abuse may shock you...gabapentin! And just where are we on abx for acute appendicitis? Somewhere in the middle. View chapters…

9hr 32min / 27 chapters · 6 CME Hours
C3 - Bradycardia ArtworkJuly 2017

C3 - Bradycardia

In last month’s C3, we discussed the concept of primacy of rate. Simply stated, the more abnormal the heart rate, the more likely that it is responsible for the patient’s symptoms. In most cases (but not all - e.g. not in hypothermia and myxedema coma) intervening to correct the rate is a high priority in the resuscitation.

53min
Bonus ShortJune 2017 - Hotpocket Artwork

June 2017 - Hotpocket

It seems like the more we know, the less we do. Rob and Mel review two articles in the ‘less is more’ category View chapters…

8min / one chapter
C3 - Tachyarrhythmias ArtworkJune 2017

C3 - Tachyarrhythmias

Managing patients with tachycardia is as central to emergency medicine as airway, breathing, and circulation. In many cases, a rapid heart rate is the most prominent and obvious part of a patient’s presentation – and in some cases it demands immediate action from the treatment team. In this episode of C3, we have attempted to make the approach to patients with tachyarrhythmias simple “but not too simple”, as a great man (Albert Einstein!) once said.

1hr 9min
Don’t Fear The Stink! ArtworkJune 2017

Don’t Fear The Stink!

We are masters of working in malodorous conditions. But just because we can tolerate the toxic sock, doesn’t mean we have to. Strayer soothes the hulk. Is the Hare Traction Splint useful? Amal breaks down the ‘warranty’ on different cardiac studies. Stuart and Billy get super funky with an obs case gone bad. How long do we need to obs a pt who has rebounded from hypoglycemia? Endocrine expert George WIllis breaks it down. Scott W tries to shrink the brain and Vanessa Cardy manages a critical vag bleeder in the hinterlands. View chapters…

8hr 17min / 26 chapters · 6 CME Hours
EMA June 2017 ArtworkJune 2017

EMA June 2017

This month’s EMA episode includes 30 abstracts, a bonus lecture “Errors In Trauma Management 2016 - Part 2”, an essay “Caring For Emergencies In An Aging Society”, an interview “The 2016 Academic Emergency Medicine Consensus Conference, Shared Decision Making In The Emergency Department: Development Of A Policy-relevant Patient-centered Research Agenda”, and reflections of a skeptic “When Doctor Becomes Patient”.

4hr 1min
Bonus ShortMay 2017 - Hotpocket Artwork

May 2017 - Hotpocket

Our recent segments on stoke updates and naloxone dosing have set off a storm of controversy! View chapters…

14min / one chapter
EMA May 2017 ArtworkMay 2017

EMA May 2017

This month’s EMA episode includes 30 abstracts, a bonus lecture “Errors In Trauma Management 2016 - Part 1”, an essay “Unscheduled Pacs And Ehr Downtime: The Most Common Multi-casualty Incidents (Mcis) In Emergency Medicine Today”, an interview “Practice Characteristics Of Emergency Department Extracorporeal Cardiopulmonary Resuscitation (Ecpr) Programs In The United States: The Current Sate Of The Art Of Emergency Department Extracorporeal Membrane Oxygenation (ED Ecmo)”, and reflections of a skeptic “Standard Of Care”.

5hr 5min
Red, Hot, and Shot ArtworkMay 2017

Red, Hot, and Shot

Do you discuss anxiety with your low risk chest pain patients? Jeff Kline says it might not be a bad idea. Kenji and Miz demystify the penetrated extremely. Stroke care continues to evolve, Ryan Radecki tells us how. Is that red, swollen leg really infected, or is a case of pseudocellulitis. Tim Horeczko dissects the tests for septic joints in kids. What is ROSC? It seems an obvious question on the surface, but clinically it's not always clear. Scott Weingart takes it on with alacrity and a rapier wit. This and so much more on this month’s EM:RAP... View chapters…

7hr 57min / 25 chapters · 6 CME Hours
C3 - Epistaxis ArtworkMay 2017

C3 - Epistaxis

Epistaxis, or nosebleed, is among the commonest presentations to the emergency department. Although epistaxis occurs in the majority of people at some point during their lives, most are minor and self-limited. Those patients who arrive to the ED represent a specific subset of nosebleeds - ones that won’t stop. These patients may be quite anxious and fearful. In some cases there are underlying reasons why the bleeding won’t stop. Fortunately, we have a wealth of tools, tips, and procedures to stop the bleeding.

59min
Bonus ShortThe Dark Side of EM Artwork

The Dark Side of EM

Mel Herbert speaks to Ramin Tabatabai about resident wellness and one recently discovered deeply disquieting fact regard physician wellness, or lack of it. View chapters…

8min / one chapter · Free Episode
Bonus ShortSome New P’s for RSI Artwork

Some New P’s for RSI

In this month’s short, Darren Braude connects with Calvin Brown, MD. Calvin is the editor of the upcoming 5th edition of The Manual of Emergency Airway Management. There are lots of new goodies in the book, but the two we focus on are: Pretreatment (it’s out) and Preoxygenation (it’s better). View chapters…

10min / one chapter
EMA April 2017 ArtworkApril 2017

EMA April 2017

This month’s EMA episode includes 30 abstracts, a bonus lecture “Sah Ongoing Diagnostic Challenges”, an essay “Maintenance Of Certification: Is The Juice Worth Squeeze?”, an interview “Comparison Of Intravenous Ketorolac At Three Single-dose Regimens For Treating Acute Pain In The Emergency Department: A Randomized Controlled Trial”, and reflections of a skeptic “Screening - Do The Math”.

4hr 47min
Little Tubes, Little Labs ArtworkApril 2017

Little Tubes, Little Labs

What’s the most powerful computer ever? The one between your ears. Using that to visualize and simulate ED challenges can have profound results. Tim Horeczko gives the skinny on which adult labs also work (or don’t) for kids. Is your patient in a coma? Wendy Chang helps us examine unconscious patients. Bill Reed throws down a call to action for us to use blunt tip needles for LP. And a GSW to the chest in the Great White North.. what do you do when your patient is dying and the closest trauma center is 10 hours away? View chapters…

8hr 18min / 25 chapters · 6 CME Hours
C3 - Dizziness ArtworkApril 2017

C3 - Dizziness

Dizziness is a poorly defined symptom that plagues both patients and clinicians. It is one of the most common chief complaints in both emergency and outpatient settings, accounting for millions of visits to each annually in the U.S. alone. There is often uncertainty surrounding the clinical approach to the dizzy patient and the wide variation in practices is what makes it particularly difficult for new and seasoned practitioners alike.

1hr 30min
Bonus ShortVX Nerve Agent Artwork

VX Nerve Agent

VX has been in the news recently as the suspected agent used to assassinate Kim Jong-nam (half brother of North Korean leader Kim Jong-un). What is this stuff? What’s it do? Stuart Swadron and Sean Nordt cover mechanism of action, presentation, and management of patients exposed to this weaponized organophosphate. View chapters…

15min / one chapter
Bonus ShortAre NSAIDS Lethal? Artwork

Are NSAIDS Lethal?

Headline from The Guardian March 15, 2017: “Calls for ibuprofen sale restrictions after study finds cardiac arrest risk.” Is there now nothing that can be used for analgesia?!? View chapters…

8min / one chapter
C3 - Chest Pain ArtworkMarch 2017

C3 - Chest Pain

Chest pain is the second most common chief complaint in the ED, with over 8 million visits annually in the U.S. alone. Chest pain evaluation is challenging but very manageable with the current systems and protocols in place in many hospitals

1hr 35min
EMA March 2017 ArtworkMarch 2017

EMA March 2017

This month’s EMA episode includes 30 abstracts, a bonus lecture “Evolving Legal Issues In Emergency Medicine”, an essay “Can We Safely Remove The Lumbar Puncture From The Subarachnoid Hemorrhage Work-up?”, an interview “Identifying Vulnerable Older Adults In The ED”, and reflections of a skeptic “Listener's Choice”.

4hr 11min
Crashing Slowly ArtworkMarch 2017

Crashing Slowly

Rob and Swami kick things off with something for which most of us never received formal training: calling an admission. Does your patient need something for pain? Reuben Strayer says be smart about it and use an algorithmic approach to decide whether or not to use opioids. A patient slowly crashes in a rural ED - Scott Weingart breaks down the play by play. How do you figure out a patient's weight for setting tidal volume? Al Sacchetti says, “Use a tape measure.” And did you ever wonder how you should clean and prep a laceration? Probably not, since you’ve done it so many times, but things you learned in the ‘old school’ might be ready for a new approach. View chapters…

8hr 34min / 27 chapters · 6 CME Hours
Bonus ShortBurn Out - Calling a Consultant Artwork

Burn Out - Calling a Consultant

The first in a series on burn out in Emergency Medicine. In this episode, Mel Herbert talks about the anxiety of calling consultants and how he dealt with it. Jess Mason calls for a different approach. View chapters…

8min / one chapter
Bonus ShortInfluenza Treatment Pathway Artwork

Influenza Treatment Pathway

Do you ever feel confused as to whom should be tested and/or treated for influenza? Rest assured, you’re not the only one. Cam Berg simplifies the process with a seasonally topical ‘influenza clinical pathway’. View chapters…

20min / one chapter · Free Episode
Bad Bleeds in the Brain and Pelvis ArtworkFebruary 2017

Bad Bleeds in the Brain and Pelvis

How good are you at accepting a compliment from a patient? Do you take the time to listen, or do you end up giving more attention to complaints and insults. The Happy MD gives tips on how to make expressions of gratitude meaningful for you and your patient. Cam Berg is back with an ADP for the evaluation of subarachnoid. What are the critical tests in a patient with threatened miscarriage? Dave Glaser says there is but one. Jedi Master Chris Hicks imparts wisdom in the ED management of pelvic fractures. View chapters…

8hr 22min / 28 chapters · 4.5 CME Hours / 0.25 Free
C3 - Pediatric Abdominal Pain ArtworkFebruary 2017

C3 - Pediatric Abdominal Pain

As with the elderly, children with abdominal pain are special and require a different diagnostic approach. In this episode of C3, we will consider the general approach to abdominal pain in children.

1hr 31min
EMA February 2017 ArtworkFebruary 2017

EMA February 2017

This month’s EMA episode includes 30 abstracts, a bonus lecture “Sleep And The Em Professional”, an essay “Best Of 2016: Commentators Pick Their Favorites”, an interview “Transvenous Pacemakers In The ED”, and reflections of a skeptic “Patient Satisfaction Vs. Patient Expectation”.

4hr 33min
Bonus ShortHigh Sensitivity Troponin FDA Approved Artwork

High Sensitivity Troponin FDA Approved

It’s been years in the making and, at long last, a high sensitivity troponin assay has been approved for use in the United States. Is it such a good thing? View chapters…

2min / one chapter
Bonus ShortBackPassage Artwork

BackPassage

Mel intros the concept of a new behind the scenes show for the EM:RAP audience...with Rob O and Jess Mason... View chapters…

6min / one chapter · Free Episode
Bonus ShortJanuary - Hotsheet - The Great C-Collar Debate Artwork

January - Hotsheet - The Great C-Collar Debate

In our February 2016 episode, we had a segment titled Do we still need the C-Collar. This caused quite a bit of debate amongst the listenership as well trauma specialists across the globe. We can’t give a definitive answer as to the utility of cervical collars, but what we can give is a ringside seat to both sides of the argument. Andy Buck and Chris Colwell are here for round two pros, cons, and ‘we don’t knows’ of the great c-collar debate. View chapters…

13min / one chapter
Broken Ankles, Ribs, and Pumps ArtworkJanuary 2017

Broken Ankles, Ribs, and Pumps

Happy New Year! Swami kicks off the festivities with a case of fever and tachycardia that’s … not sepsis. Is point of care urinalysis a good idea in kids. Sam Ashoo breaks down the evidence. Orthopod Uma Ramadorai gives a primer on diagnosis and treatment of ankle fractures. How nervous should you be about rib fractures in the elderly? Kenji says, “Be pragmatic.” Weingart rounds off the head trauma trilogy with a masterclass on micro and macro-management. Strayerisms is all about preventing ETOH withdrawal before it even starts. And even though dying palliative care patients may not get critical care procedures, they still warrant active management. View chapters…

8hr 48min / 26 chapters · 4.5 CME Hours / 0.25 Free
EMA January 2017 ArtworkJanuary 2017

EMA January 2017

This month’s EMA episode includes 30 abstracts, a bonus lecture “Management Of The Injured Finger”, an essay “The Fragility Index: Assessing Usefulness Of Randomized Clinical Trials”, an interview “Balance Billing And The Nejm: The Emperor Has No Peer Review?”, and reflections of a skeptic “Opiates - Too Much Or Too Little”.

4hr 52min
C3 - Elderly Abdominal Pain ArtworkJanuary 2017

C3 - Elderly Abdominal Pain

Elderly patients with abdominal pain represent a special population that is much more likely to have a serious life-threatening cause than almost any other presenting complaint.

1hr 10min