Episode Chapters
- June Introduction10:20Airway Corner - The PART Trial20:34Cardiology Corner - ACEP Clinical Policy on NSTEMI16:55Medicolegal Briefs - The Case of the Wrist Injury18:40EGLS - Echo-Guided Life support19:11Pediatric Pearls - Pediatric Mild Traumatic Brain Injury10:03Heat StrokeFree Chapter21:49Pharmacology Rounds -Newer Medications for Diabetes and Euglycemia DKA10:57Antibiotic Stewardship7:33Critical Care Mailbag - Dexmedetomidine15:20Trauma Surgeons Gone Wild - Kenji's Top 8 Tips on Chest Tube Insertion17:20Child Abuse15:31June Mailbag8:21June MegaSummary35:09EMRAP 2019 June Canadian Edition17:11EMRAP 2019 June German Edition1h, 32mEM:RAP 2019 June Spanish Edition1h, 18mEM:RAP 2019 June French Edition30:59EM:RAP 2019 June Farsi Edition2h, 12mEM:RAP 2019 June Aussie Edition57s
Nurses Edition Commentary
Kathy Garvin, RN and Lisa Chavez, RN
No me gusta!
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EMRAP 2019 June Written Summary 367 KB - PDF
EM:RAP 2019 June Full episode audio for MD edition 227:40 min - 317 MB - M4AEMRAP 2019 June Canadian Edition Canadian 17:11 min - 24 MB - MP3EMRAP 2019 June German Edition Deutsche 92:42 min - 127 MB - MP3EM:RAP 2019 June Spanish Edition Español 78:44 min - 108 MB - MP3EM:RAP 2019 June French Edition Français 30:59 min - 43 MB - MP3EM:RAP 2019 June Farsi Edition Farsi 132:49 min - 182 MB - MP3EM:RAP 2019 June Aussie Edition Australian 0:57 min - 1 MB - MP3EMRAP 2019 06 June Individual MP3s 294 MB - ZIPEMRAP 2019 June Board Review Answers 131 KB - PDFEMRAP 2019 June Board Review Questions 177 KB - PDFEMRAP 2019 June Spanish Written (SPA) 4 MB - PDFEMRAP 2019 June Written Summary 367 KB - PDF
Daniel P. - June 6, 2019 4:55 PM
This was such a great talk. Having an algorithm on what exactly you're trying to rule out in a systematic fashion makes so much sense. Too many times i've just plopped the ultrasound down on the patient hoping to find SOMETHING but not really having those binary decisions in mind (i.e. B-lines yes/no, PTX yes/no move on).
gm - June 11, 2019 11:11 PM
Definitely a great talk! And a hot topic with more handheld US devices on the market. I don't know where to take this, given some evidence doesn't support the use of POCUS in undifferentiated hypotension....I am curious what others think. Certainly I've had anecdotal success once finding tamponade.
https://www.annemergmed.com/article/S0196-0644(18)30325-1/pdf
"this is the first randomized controlled trial to compare point-of-care ultrasonography to standard care without point-of-care ultrasonography in undifferentiated hypotensive ED patients. We did not find any benefits for survival, length of stay, rates of CT scanning, inotrope use, or fluid administration."
Maxime V., M.D. - June 17, 2019 11:41 AM
The 1st thing to keep in mind is that most of the time ultrasound confirms what we already thought as clinicians. It just helps to raise our diagnostic certainty thus helping us to avoid having too much gray hair. It definitely helps to decrease our cognitive load as we are more certain that we're doing "the right thing" and even though I will still get a CT in my massive PE patient, I might choose a better timing to send him there. These are all benefits that are hard to study !
Sporadically, like your tamponnade example, it will radically change the management in a given patient. The same thing holds when you uncover an unsuspected heart failure in a septic patient.
My clinical experience is that ultrasound is definitely helpful when we're faced with a single patient (n=1), but that might end up difficult to prove in populations of patients like those that studies require. Absence of evidence is not evidence of absence !