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
Reuben Strayer’s stepwise pharmacologic approach to managing the agitated patient. Agitated but cooperative - oral benzo or orally dissolving antipsychotic. Agitated but not dangerous - intramuscular haloperidol plus midazolam. Agitated delirium -IM ketamine.
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
Abrar W. - June 7, 2017 2:49 AM
Thank goodness, we still have Droperidol in Australia.
Reuben Strayer (@emupdates) - June 7, 2017 10:16 AM
https://goo.gl/euycJS
Steve D. - June 16, 2017 1:51 PM
Some of the studies on the agitated patient that I have reviewed show a higher rate of respiratory depression when multiple agents are used. So would using a combination of haloperidol and midazolam increase the risk profile rather than just repeated doses of one agent?
Reuben Strayer (@emupdates) - June 16, 2017 1:54 PM
Midazolam has important respiratory depression effects, haldol much less so, but haldol is slow onset and less effective as monotherapy. This is why I recommend using a relatively large dose of haldol and a small dose of midazolam. Keeping the midaz dose small minimizes the likelihood of respiratory depression but gives you rapid onset of sedation and synergistic effects with the haldol.
Darren - August 25, 2017 3:27 PM
In using ketamine for the undifferentiated patient with agitated delirium (who might have schizophrenia), are you concerned that "known or suspected schizophrenia" is commonly listed (including in ACEP guidelines) as an absolute contraindication to the use of ketamine?
Reuben Strayer (@emupdates) - August 25, 2017 6:45 PM
this contraindication is basically nonsense. lots of literature in attesting to safety undifferentiated agitation (which includes a high proportion of psychiatric etiologies as you would guess, though more substance than psych) and very compelling evidence in prehospital psychiatric transport:
https://goo.gl/W3rzGu