Academic Life in Emergency Medicine (ALiEM) Podcast

Nov 09 2020 23 mins 2.9k

This podcast account features all of the audio clips from the Academic Life in Emergency Medicine (ALiEM) educational blog site. http://www.ALiEM.com






ACEP EQUAL Stroke transfer protocolization
Nov 02 2020 22 mins  
In this episode from the ACEP-EQUAL series, guest Dr. William Meurer discuss how to protocolize of transferring stroke patients, how to identify and appropriately chose transfer destinations, and how to better align patient needs with the resources of the receiving sites. Guests: William J. Meurer MD MS Associate Professor of Emergency Medicine and Neurology University of Michigan Host: Jason Woods, MD Audio Editor: Kellen Vu www.acep.org/equal References 1. Saver JL, Goyal M, van der Lugt A, Menon BK, Majoie CB, Dippel DW, Campbell BC, Nogueira RG, Demchuk AM, Tomasello A, Cardona P, Devlin TG, Frei DF, du Mesnil de Rochemont R, Berkhemer OA, Jovin TG, Siddiqui AH, van Zwam WH, Davis SM, Castaño C, Sapkota BL, Fransen PS, Molina C, van Oostenbrugge RJ, Chamorro Á, Lingsma H, Silver FL, Donnan GA, Shuaib A, Brown S, Stouch B, Mitchell PJ, Davalos A, Roos YB, Hill MD; HERMES Collaborators. Time to Treatment With Endovascular Thrombectomy and Outcomes From Ischemic Stroke: A Meta-analysis. JAMA. 2016 Sep 27;316(12):1279-88. doi: 10.1001/jama.2016.13647. PMID: 27673305. 2. Campbell BCV, Mitchell PJ, Churilov L, Yassi N, Kleinig TJ, Dowling RJ, Yan B, Bush SJ, Thijs V, Scroop R, Simpson M, Brooks M, Asadi H, Wu TY, Shah DG, Wijeratne T, Zhao H, Alemseged F, Ng F, Bailey P, Rice H, de Villiers L, Dewey HM, Choi PMC, Brown H, Redmond K, Leggett D, Fink JN, Collecutt W, Kraemer T, Krause M, Cordato D, Field D, Ma H, O'Brien B, Clissold B, Miteff F, Clissold A, Cloud GC, Bolitho LE, Bonavia L, Bhattacharya A, Wright A, Mamun A, O'Rourke F, Worthington J, Wong AA, Levi CR, Bladin CF, Sharma G, Desmond PM, Parsons MW, Donnan GA, Davis SM; EXTEND-IA TNK Part 2 investigators. Effect of Intravenous Tenecteplase Dose on Cerebral Reperfusion Before Thrombectomy in Patients With Large Vessel Occlusion Ischemic Stroke: The EXTEND-IA TNK Part 2 Randomized Clinical Trial. JAMA. 2020 Apr 7;323(13):1257-1265. doi: 10.1001/jama.2020.1511. PMID: 32078683; PMCID: PMC7139271. 3. Prabhakaran S, O'Neill K, Stein-Spencer L, Walter J, Alberts MJ. Prehospital triage to primary stroke centers and rate of stroke thrombolysis. JAMA Neurol. 2013 Sep 1;70(9):1126-32. doi: 10.1001/jamaneurol.2013.293. PMID: 23817961.


ACEP E-QUAL: Intracranial Hemorrhage Scoring and Prognostication
Oct 26 2020 23 mins  
In this episode from the ACEP-EQUAL series, guest Dr. Bruce Lo reviews several common intracerebral hemorrhage scoring systems, the components, and tips on how to use them in real world practice. Guests: Bruce Lo, MD, MBA, FACEP Chief, Department of Emergency Medicine, Sentara Norfolk General Hospital Professor of Emergency Medicine, Eastern Virginia Medical School Host: Jason Woods, MD Audio Editor: Kellen Vu www.acep.org/equal References Hemphill JC 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001 Apr;32(4):891-7. doi: 10.1161/01.str.32.4.891. PMID: 11283388. Clarke JL, Johnston SC, Farrant M, Bernstein R, Tong D, Hemphill JC 3rd. External validation of the ICH score. Neurocrit Care. 2004;1(1):53-60. doi: 10.1385/NCC:1:1:53. PMID: 16174898. Gregório T, Pipa S, Cavaleiro P, Atanásio G, Albuquerque I, Chaves PC, Azevedo L. Assessment and Comparison of the Four Most Extensively Validated Prognostic Scales for Intracerebral Hemorrhage: Systematic Review with Meta-analysis. Neurocrit Care. 2019 Apr;30(2):449-466. doi: 10.1007/s12028-018-0633-6. PMID: 30426449. Pinho J, Costa AS, Araújo JM, Amorim JM, Ferreira C. Intracerebral hemorrhage outcome: A comprehensive update. J Neurol Sci. 2019 Mar 15;398:54-66. doi: 10.1016/j.jns.2019.01.013. Epub 2019 Jan 14. PMID: 30682522. Øie LR, Madsbu MA, Solheim O, Jakola AS, Giannadakis C, Vorhaug A, Padayachy L, Jensberg H, Dodick D, Salvesen Ø, Gulati S. Functional outcome and survival following spontaneous intracerebral hemorrhage: A retrospective population-based study. Brain Behav. 2018 Oct;8(10):e01113. doi: 10.1002/brb3.1113. Epub 2018 Sep 21. PMID: 30240164; PMCID: PMC6192392. Hemphill JC 3rd, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, Fung GL, Goldstein JN, Macdonald RL, Mitchell PH, Scott PA, Selim MH, Woo D; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015 Jul;46(7):2032-60. doi: 10.1161/STR.0000000000000069. Epub 2015 May 28. PMID: 26022637. Houben R, Schreuder FHBM, Bekelaar KJ, Claessens D, van Oostenbrugge RJ, Staals J. Predicting Prognosis of Intracerebral Hemorrhage (ICH): Performance of ICH Score Is Not Improved by Adding Oral Anticoagulant Use. Front Neurol. 2018 Feb 28;9:100. doi: 10.3389/fneur.2018.00100. PMID: 29541054; PMCID: PMC5836590.







ACEP E-QUAL: OUD Access in the Time of COVID
Aug 24 2020 25 mins  
In this episode, a panel of experts talks about the experience with OUD in the time of COVID and specifically efforts to maintain access to MAT during COVID. Note that the original recording contained contributions from Dr. Karen Scott (President, Foundation for Opioid Response Efforts) and Dr. Alister Martin (Emergency Medical Specialist, Founder Get Waivered) but were cut for the podcast due to time constraints. Guests: Gail D’Onofrio, MD, MS Professor and Chair, Department of Emergency Medicine, Yale School of Medicine Chief of Emergency Services, Yale New Haven Hospital Emily Kauffman, DO, MPH Assistant Clinical Professor Ohio State University Wexner Medical Center Sandra Schneider, MD, FACEP Associate Executive Director, Clinical Affairs Past President American College of Emergency Physicians Karen Scott, MD, MPD Present, Foundation for Opioid Response Efforts (FORE) Alister Martin MD, MPP Emergency Medical Specialist, Founder, Get Waivered Host: Jason Woods, MD Audio Editor: Kellen Vu www.acep.org/equal Additional Resources: www.forefdn.org www.getwaivered.com/remote https://www.drugabuse.gov/ed-buprenorphine https://medicine.yale.edu/edbup/ References 1. Volkow ND. Collision of the COVID-19 and Addiction Epidemics. Ann Intern Med. 2020;173(1):61-62. doi:10.7326/M20-1212 2. Hedegaard H, Minino A and Warner M. Drug Overdose Deaths in the United States, 1999-2018. NCHS Data Brief, number 356. Hyattsville, MD: National Center for Health Statistics 2020. 3. Hall OT, Hall OE, Kolodny A, Teater J, McGrath RP. Assessment of Excess Mortality Associated With Drug Overdose in Ohio From 2009 to 2018. JAMA Netw Open. 2020;3(4):e202183. Published 2020 Apr 1. doi:10.1001/jamanetworkopen.2020.2183 4. Hall OT, Hall OE, McGrath RP, Haile ZT. Years of Life Lost due to Opioid Overdose in Ohio: Temporal and Geographic Patterns of Excess Mortality. J Addict Med. 2020;14(2):156-162. doi:10.1097/ADM.0000000000000554




ACEP E-QUAL: Buprenorphine After Opiate Overdose Part 2
Aug 11 2020 22 mins  
This is part 2 of a 2 part discussion with Dr. Andrew Herring on the use of Buprenorphine after an opiate overdose, primarily in the ED. Guest: Andrew Herring MD. Associate Director of Research, Highland Hospital, Alameda Health System Medical Director, Substance Use Disorder Treatment Program Assistant Clinical Professor, University of California San Francisco Host: Jason Woods, MD Audio Editor: Kellen Vu www.acep.com/equal References: 1. Weiner, Scott, et al. One-Year Mortality of Patients After Emergency Department Treatment for Nonfatal Opioid Overdose. Annals of Emergency Medicine. April 2, 2019. doi.org/10.1016/j.annemergmed.2019.04.020 2. Walsh SL, Preston KL, Stitzer ML, Cone EJ, Bigelow GE. Clinical pharmacology of buprenorphine: ceiling effects at high doses. Clin Pharmacol Ther. 1994;55(5):569-580. doi.org/10.1038/clpt.1994.71 3. Dahan A, Yassen A, Romberg R, et al. Buprenorphine induces ceiling in respiratory depression but not in analgesia. Br J Anaesth. 2006;96(5):627-632. doi.org/10.1093/bja/ael051 4. Ciraulo DA, Hitzemann RJ, Somoza E, et al. Pharmacokinetics and pharmacodynamics of multiple sublingual buprenorphine tablets in dose-escalation trials. J Clin Pharmacol. 2006;46(2):179-192. doi.org/10.1177/0091270005284192 5. Ang-Lee K, Oreskovich MR, Saxon AJ, et al. Single dose of 24 milligrams of buprenorphine for heroin detoxification: an open-label study of five inpatients. J Psychoactive Drugs. 2006;38(4):505-512. doi.org/10.1080/02791072.2006.10400589 6. Wang D, Sun X, Sadee W. Different effects of opioid antagonists on mu-, delta-, and kappa-opioid receptors with and without agonist pretreatment. J Pharmacol Exp Ther. 2007;321(2):544-552. doi.org/10.1124/jpet.106.118810 7. Boysen K, Hertel S, Chraemmer-Jørgensen B, Risbo A, Poulsen NJ. Buprenorphine antagonism of ventilatory depression following fentanyl anaesthesia. Acta Anaesthesiol Scand. 1988;32(6):490-492. doi.org/10.1111/j.1399-6576.1988.tb02772.x 8. Zamani N, Buckley NA, Hassanian-Moghaddam H. Buprenorphine to reverse respiratory depression from methadone overdose in opioid-dependent patients: a prospective randomized trial. Crit Care. 2020;24(1):44. Published 2020 Feb 7. doi.org/10.1186/s13054-020-2740-y 9. Phillips RH, Salzman M, Haroz R, Rafeq R, Mazzarelli AJ, Pelletier-Bui A. Elective Naloxone-Induced Opioid Withdrawal for Rapid Initiation of Medication-Assisted Treatment of Opioid Use Disorder. Ann Emerg Med. 2019;74(3):430-432. doi.org/10.1016/j.annemergmed.2019.01.006 10. Tompkins DA, Bigelow GE, Harrison JA, Johnson RE, Fudala PJ, Strain EC. Concurrent validation of the Clinical Opiate Withdrawal Scale (COWS) and single-item indices against the Clinical Institute Narcotic Assessment (CINA) opioid withdrawal instrument. Drug Alcohol Depend. 2009;105(1-2):154-159. doi.org/10.1016/j.drugalcdep.2009.07.001 11. Carroll GG, Wasserman DD, Shah AA, et al. Buprenorphine Field Initiation of ReScue Treatment by Emergency Medical Services (Bupe FIRST EMS): A Case Series [published online ahead of print, 2020 May 4]. Prehosp Emerg Care. 2020;1-5. 10.1080/10903127.2020.1747579

ACEP E-QUAL: Buprenorphine after Opiate Overdose Part 1
Aug 11 2020 22 mins  
This is part 1 of a 2 part discussion with Dr. Andrew Herring on the use of Buprenorphine after an opiate overdose, primarily in the ED. Guest: Andrew Herring MD. Associate Director of Research, Highland Hospital, Alameda Health System Medical Director, Substance Use Disorder Treatment Program Assistant Clinical Professor, University of California San Francisco Host: Jason Woods, MD Audio Editor: Kellen Vu www.acep.com/equal References: 1. Weiner, Scott, et al. One-Year Mortality of Patients After Emergency Department Treatment for Nonfatal Opioid Overdose. Annals of Emergency Medicine. April 2, 2019. https://doi.org/10.1016/j.annemergmed.2019.04.020 2. Walsh SL, Preston KL, Stitzer ML, Cone EJ, Bigelow GE. Clinical pharmacology of buprenorphine: ceiling effects at high doses. Clin Pharmacol Ther. 1994;55(5):569-580. https://doi.org/10.1038/clpt.1994.71 3. Dahan A, Yassen A, Romberg R, et al. Buprenorphine induces ceiling in respiratory depression but not in analgesia. Br J Anaesth. 2006;96(5):627-632. https://doi.org/10.1093/bja/ael051 4. Ciraulo DA, Hitzemann RJ, Somoza E, et al. Pharmacokinetics and pharmacodynamics of multiple sublingual buprenorphine tablets in dose-escalation trials. J Clin Pharmacol. 2006;46(2):179-192. https://doi.org/10.1177/0091270005284192 5. Ang-Lee K, Oreskovich MR, Saxon AJ, et al. Single dose of 24 milligrams of buprenorphine for heroin detoxification: an open-label study of five inpatients. J Psychoactive Drugs. 2006;38(4):505-512. https://doi.org/10.1080/02791072.2006.10400589 6. Wang D, Sun X, Sadee W. Different effects of opioid antagonists on mu-, delta-, and kappa-opioid receptors with and without agonist pretreatment. J Pharmacol Exp Ther. 2007;321(2):544-552. https://doi.org/10.1124/jpet.106.118810 7. Boysen K, Hertel S, Chraemmer-Jørgensen B, Risbo A, Poulsen NJ. Buprenorphine antagonism of ventilatory depression following fentanyl anaesthesia. Acta Anaesthesiol Scand. 1988;32(6):490-492. https://doi.org/10.1111/j.1399-6576.1988.tb02772.x 8. Zamani N, Buckley NA, Hassanian-Moghaddam H. Buprenorphine to reverse respiratory depression from methadone overdose in opioid-dependent patients: a prospective randomized trial. Crit Care. 2020;24(1):44. Published 2020 Feb 7. https://doi.org/10.1186/s13054-020-2740-y 9. Phillips RH, Salzman M, Haroz R, Rafeq R, Mazzarelli AJ, Pelletier-Bui A. Elective Naloxone-Induced Opioid Withdrawal for Rapid Initiation of Medication-Assisted Treatment of Opioid Use Disorder. Ann Emerg Med. 2019;74(3):430-432. https://doi.org/10.1016/j.annemergmed.2019.01.006 10. Tompkins DA, Bigelow GE, Harrison JA, Johnson RE, Fudala PJ, Strain EC. Concurrent validation of the Clinical Opiate Withdrawal Scale (COWS) and single-item indices against the Clinical Institute Narcotic Assessment (CINA) opioid withdrawal instrument. Drug Alcohol Depend. 2009;105(1-2):154-159. https://doi.org/10.1016/j.drugalcdep.2009.07.001 11. Carroll GG, Wasserman DD, Shah AA, et al. Buprenorphine Field Initiation of ReScue Treatment by Emergency Medical Services (Bupe FIRST EMS): A Case Series [published online ahead of print, 2020 May 4]. Prehosp Emerg Care. 2020;1-5. 10.1080/10903127.2020.1747579













ACEP E-QUAL: Headache Clinical Policy
Oct 25 2019 30 mins  
In this episode from the ACEP-EQUAL series, Drs. Godwin and Shih review the recently published ACEP clinical policy regarding the treatment of headaches in the emergency department. Guests: Dr. Steven Godwin, Professor and Chair, Department of Emergency Medicine University of Florida Dr. Richard Shih, Professor of Integrated Medical Science and Program , Charles E Schmidt College of Medicine at Florida Atlantic University Host: Jason Woods, MD www.acep.org/equal References: Perry JJ et al. Clinical decision rules to rule out subarachnoid hemorrhage for acute headache. JAMA. 2013 Sep 25;310(12):1248-55. doi: 10.1001/jama.2013.278018 Carpenter CR et al. Spontaneous Subarachnoid Hemorrhage. A Systematic Review and Meta-analysis Describing the Diagnostic Accuracy of History, Physical Exam, Imaging, and Lumbar Puncture With an Exploration of Test Thresholds. Acad Emerg Med. 2016 Sep;23(9):963-1003. doi: 10.1111/acem.12984. Epub 2016 Sep 6. Perry JJ. Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: prospective cohort study. BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d4277 Dubosh NM et al. Sensitivity of Early Brain Computed Tomography to Exclude Aneurysmal Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis.Stroke. 2016 Mar;47(3):750-5. doi: 10.1161/STROKEAHA.115.011386. Carstairs SD. Computed tomographic angiography for the evaluation of aneruysmal subarachnoid hemorrhage. Acad Emerg Med. 2006 May;13(5):486-92. Epub 2006 Mar 21. El Khaldi M. et al. Detection of cerebral aneurysms in nontraumatic subarachnoid haemorrhage: role of multislice CT angiography in 130 consecutive patients. La radiologia medica. 200 Feb;112(1):123–137. Menke J et al. Diagnosing cerebral aneurysms by computed tomographic angiography: meta-analysis. Ann Neurol. 2011 Apr;69(4):646-54. doi: 10.1002/ana.22270. Friedman BW et al. Randomized study of IV prochlorperazine plus diphenhydramine vs IV hydromorphone for migraine. Neurology. 2017 Nov 14; 89(20): 2075–2082. doi: 10.1212/WNL.0000000000004642






































































































































































































































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