Episode Chapters
- Introduction5:54Notes From the Community – Accelerated Diagnostic Pathway: PE24:55Mental Health Month - Introduction1:22Community Medicine Rants – Geriatric Patients in the ED19:39Paper Chase 1 – Does the FAST Exam Really Help?7:54Medical Myths – Post LP Headache11:17Back of the Bus – Should Paramedics Intubate Kids?18:31Mental Health Month – Nellie Bly5:49Paper Chase 2 – Can We Rule Out SAH Without a CT Scan?8:07Pediatric Pearls – Pediatric Dental – P121:31Tales From An Administrator – Hemoccult and Point of Care VBG’s7:41Mental Health Month – Joni Mitchell11:29Cardiology Corner - New ACS Guidelines23:19Paper Chase 3 – Progesterone for Traumatic Brain Injury9:17Annals of Emergency Medicine – Temporal Arteritis12:42Pediatric Pearls – Pediatric Dental – Part 214:55Paper Chase 4 – Mr CLEAN the Stroke Machine12:08Mental Health Month – Suicide4:43Doc in the Bay - KetamineFree Chapter21:23Paper Chase 4.5 – Intra-Arterial Stroke Might Be the Real Deal8:13LIN Session – In Flight Emergencies13:22Paper Chase 5 – Does Texting Improve Follow-Up?7:46Summary13:23EM:RAP 2015 May Canadian Edition17:44EM:RAP 2015 Peut Résumé en Francais59:38EM:RAP 2015 Mayo Resumen Español1h, 14mEM:RAP 2015 May Aussie Edition1h, 02m
Nurses Edition Commentary
Mizuho Spangler, DO, Lisa Chavez, RN, and Kathy Garvin, RN
No me gusta!
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EM:RAP 2015 May Written Summary 1 MB - PDF
“If there is a doctor on board, please notify the flight attendant. We promise you won’t get sued….”
A Totally Mental Month of Education! Full episode audio for MD edition 285:23 min - 332 MB - M4AEM:RAP 2015 May Canadian Edition Canadian 17:44 min - 24 MB - MP3EM:RAP 2015 Peut Résumé en Francais Français 59:38 min - 82 MB - MP3EM:RAP 2015 Mayo Resumen Español Español 74:07 min - 85 MB - MP3EM:RAP 2015 May Aussie Edition Australian 62:22 min - 86 MB - MP3EM:RAP 2015 May MP3 329 MB - ZIPEM:RAP 2015 May Written Summary 1 MB - PDFEM:RAP 2015 May Board Review Answers 415 KB - PDFEM:RAP 2015 May Board Review Questions 416 KB - PDFEM:RAP Español Mayo 2015 1 MB - PDF
Chesney F. - May 2, 2015 4:30 AM
Michelle, always appreciate your tips & tricks about EM practice in the real world (Sharpies, a woman after my own heart.) In the future, would you comment about how to minimize the distress of NG tube placement? I've tried nebulized lidocaine, but it hasn't had to desired effect. Maybe our timing of nebulizer to NG tube placement is sub-optimal.
Michelle Lin, MD - May 2, 2015 9:25 PM
Good questions about NGT placement. I haven't found the perfect approach. Nebulized lidocaine's effects are rather short-lived so as soon as it's finished, I tend to place within 1-3 minutes. In addition I use the urojet lidocaine vial to place 2% lido down the nares until they swallow a little bit.
Of course, I challenge that we may be placing NG's too often unnecessarily for patients who report hematemesis. What they need usually is a more definitely EGD rather than NG tube and lavage. http://www.aliem.com/ng-lavage-indicated-or-outdated/
Anyone else with tricks?
Bill Hinckley, MD - May 24, 2015 6:19 PM
The NGT plastic has memory-- use it to your advantage. Once the pt is prepped w/ oxymetazoline + lido, before beginning to place the tube, curl it tightly around 2 or 3 of your fingers to get a nice curved shape memorized in the plastic. Use that curve to "turn the corner" at the back of the nasopharynx. Once you feel the tube turn that corner (and you should be able to feel this definitively), twist the tube 180 degrees so that now the curve you created in the plastic has the tip of the tube pointing posteriorly, so that it's almost guaranteed to go esophageal (as opposed to inadvertently tracheal) as you continue to advance the tube.
Patrick M. - May 31, 2015 8:03 AM
Here is exactly what I have been doing for the past two years and it works remarkably well - I have showed this to the nurses and their success has skyrocketed as well -
http://www.acep.org/Content.aspx?id=70881
In short - great success using the viscous lido - just plug one nostril and have them inhale/snort until it hits the back of the throat and they can taste/cough it.
For placing the tube in the side channel of an OP airway and sticking it in an ice water slurry to have it retain its shape has been the best technique in getting successful placement when other methods failed and is always my first line go-to.
Jennifer M. - July 14, 2015 4:31 PM
I have never traveled with a copy of my physician license. When you copy them on a copier, they come up null/void as I guess the blue backing is a not to be copied. I would assume if the copy said null/void, it would not be accepted. Would your physician id from the hospital work? ACEP membership card? Or what is recommended to carry on the plane. I would hate to have someone hurt and not be able to help because I didn't carry the right documentation. Thanks.
Lindsay M. - August 24, 2015 11:36 PM
In my state (Michigan), any state-issued professional license comes with two pieces of paper: a big one you can pin to your office wall, and a smaller "wallet card" version you can have laminated . Most physicians and nurses I know, myself included, carry the wallet card. In a pinch, I'd imagine anything would do: hospital badge, ACEP or ENA membership card, ACLS provider card, whatever you have. (They may not even ask you to produce any physical documentation. In both of the in-flight emergencies I've responded to, the flight crew only took down my name, address and phone number. I offered my RN license, hospital badge and some other cert cards I had, and they said "That's fine, we only needed your address." Perhaps they do a license lookup? They have to have your personal details for the TSA screening, after all...)