Episode Chapters
- Introduction - The Cure for Stink!10:10Strayerisms - Agitation Mitigation15:38Paper Chase 1 - When to get an MRI with Negative C-spine CT6:27Femur Fractures11:06Critical Care Mailbag - Osmotic Therapy in Head Injury13:55Wound Repair Part 4 - Skin Staples, Skin Glue10:16Rural Medicine: Catastrophic Vaginal BleedingFree Chapter15:36Paper Chase 2- Downstream Effects of ED Opioid Prescriptions6:07Cardiology Corner - Chest Pain Discharge7:21Hypoglycemia24:04Patient Experience14:26The Case of the Funky Fish12:31Paper Chase 3 - ED Hyperglycemia (but not DKA)4:58Pharmacology Pearls - Cellulitis and Outpatient Vancomycin6:21The Bleeding Edge of Resuscitation7:23Pape Chase4 - Penis vs Zipper4:03Risk Stratification of Neutropenic Fever9:05Desats in Bronchiolitis7:36Subarachnoid, MRI, and the Case of the Vanishing LP18:25Postpartum Preeclampsia16:04Paper Chase 5 - Kidney vs Contrast4:59Mailbag and Summary18:53EM:RAP 2017 June Canadian Edition24:49EM:RAP 2017 June German Edition1h, 08mEM:RAP 2017 June French29:35EMRAP 2017 June Resumen Español1h, 34m
Nurses Edition Commentary
Lisa Chavez, RN and Kathy Garvin, RN
No me gusta!
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EM:RAP 2017 June Written Summary 647 KB - PDF
In patients with soft tissue infection, the practice of using outpatient IV antibiotics is becoming more commonplace. Vancomycin is one of the most frequently selected agents, but is it being used correctly? Is once a day enough? Bryan Hayes says… no. Most people will clear vancomycin before the 24 hour mark and need to be dosed at least twice daily. But this brings up the larger question- is IV vancomycin the best choice in the first place?
Don’t Fear The Stink! Full episode audio for MD edition 245:23 min - 342 MB - M4AEM:RAP 2017 June Canadian Edition Canadian 24:49 min - 34 MB - MP3EM:RAP 2017 June German Edition Deutsche 68:28 min - 94 MB - MP3EM:RAP 2017 June French Français 29:35 min - 41 MB - MP3EMRAP 2017 June Resumen Español Español 94:49 min - 130 MB - MP3EM:RAP 2017 June Board Review Answers 187 KB - PDFEM:RAP 2017 June Board Review Questions 170 KB - PDFEM:RAP 2017 June MP3 328 MB - ZIPEM:RAP 2017 June Written Summary 647 KB - PDF
Xander Merboo - June 7, 2017 9:59 AM
I'm wondering why we're talking about starting with IV formulations of subsequent PO regimens that have equivalent bioavailability. Seems like there has been a big push lately to NOT start IV abx if the regimen is able to be given PO due to lack of difference in effect
Bryan H. - June 7, 2017 10:11 AM
Great point. Apologies if that was not clear in the podcast. In practice, the decision to start IV antibiotics and 'observe' the patient overnight for improvement is routinely done. Most patients can receive oral antibiotics right from the start without the need for IV. In fact, even one-time dose of IV antibiotics portends higher likelihood of c. diff and antibiotic-associated diarrhea (https://www.ncbi.nlm.nih.gov/pubmed/25149599). One helpful article that might guide who should get IV (vs. PO) outlines risk factors for failing outpatient therapy. Here is a quick summary: https://em.umaryland.edu/educational_pearls/2429/.