105 Staying Cool Under Pressure or Building Sangfroid

Join Dr. Mike Wallace and Dan McCollum as they discuss the management of patients with gastrointestinal hemorrhage. What is the initial management of these patients? Who requires blood transfusions? Which patients require admission to the floor or the ICU? Pearls and pitfalls in the management of these challenging patients are discussed.  Enjoy!

Join Dr. Alex Koo as he discusses ear and nasal foreign bodies.  He'll give you a brief run-down of anatomy, history, and physical, before diving into comprehensive, key concepts of foreign body removal.  There will be some great tips and tricks shared! -Where do foreign bodies commonly get stuck in the ear and nose? -What important historical and physical examination features should you focus on for these foreign bodies?  What are considered dangerous objects that need immediate removal? -What equipment and techniques can you use for helping visualize the foreign bodies? -What techniques can you use for achieving a more cooperative patient? -What equipment and techniques are available to extract these foreign bodies? -What complications can happen from removal? -Who should be referred for immediate or urgent consultation with an ENT specialist?

Join Jordan Nogle as she discusses how to deliver the very best care for possible victims of Human Trafficking. What are subtle signs that your patient may be a human trafficking victim? What is your initial approach? How can you give your patient multiple options on how to proceed? What resources can you use? Join Jordan as she discusses this and much more!

Join Dr. Alex Koo as he discusses the management of crush injuries. What is crush syndrome? When should you be concerned about compartment syndrome? Why can you not wait for the 6 P's to develop before treating? How should you treat? Join us for this and more!

Join Zac Hodges as he discusses MIS-C with two local experts. Dr. Pushpa Shivaram is a pediatric cardiologist and Dr. Julisa Patel is a pediatric rheumatologist.  They discuss What this syndrome is How to make this tough diagnosis Proper management of patients This is a brand new disease that we all need a refresher on.

Join emergency physician Dan Dworkis as he discusses with Dan McCollum how to remain cool under pressure.  Dan and Dan discuss The importance of being cool under pressure The fallacy of believing experience equals the ability to handle pressure. Strategies for junior learners to build sangfroid This is a joint podcast between EM Basic and the Emergency Mind Podcast.  You can find dozens of other podcasts at https://www.emergencymind.com/ or pick up his excellent new book at https://www.amazon.com/dp/B094GY88RK/ .  Enjoy!

Join Dr. Alex Koo, active duty Army emergency physician, as he discusses dental emergencies, a common emergency department complaint, but an uncommon educational topic.  We'll discuss an approach to collecting a focused history, physical, as well as formulating a thorough differential and treatments for common ED dental emergencies.  Some questions that we'll answer are:  What are the red flags we should be aware about for dental complaints?   What is the basic anatomy and nomenclature for numbering teeth?   What differential should be considered for traumatic and atraumatic dental complaints?  How should we treat dental pain?  How do I splint a tooth in the emergency department?  We answer these questions and more in this episode!

Pediatric intensivist Dr. Will Cagle joins the show to discuss the AAP Maintenance IV fluid guidelines and considerations when choosing IV fluids for pediatric inpatients. What do you need to know from the 2018 AAP maintenance IV fluid guideline?  How common is hyponatremia in hospitalized patients and why does it matter to your practice?  What is SIADH and how does it contribute to hyponatremia in acutely ill children?  How can we prevent hyponatremia in our hospitalized patients?  What are the differences between hypotonic and isotonic fluids?  What are balanced solutions and why might they be preferred as compared to saline in some clinical settings?  All of this and more from the Department of Pediatrics and the Medical College of Georgia.  Check out our website for detailed show-notes: https://www.augusta.edu/mcg/pediatrics/residency/podcast.php Special thanks to Dr. Asif Mansuri and Dr. Gene Fisher for providing peer review for this episode. Questions, comments, or feedback? Please email us at [email protected]  Want Further Reading? Check out the clinical practice guideline from the AAP and our other references below. Feld LG,Neuspiel DR, Foster BA, et al. Clinical Practice Guideline: Maintenance Intravenous Fluids in Children. Pediatrics. 2018;142(6):e20183083. doi:10.1542/peds.2018-3083  Semler MW, Self WH, Wanderer JP, et al. Balanced Crystalloids versus Saline in CriticallyIll Adults. N Engl J Med. 2018;378(9):829-839. doi:10.1056/NEJMoa1711584  CuzzoB, Padala SA, Lappin SL. Vasopressin (Antidiuretic Hormone, ADH) [Updated 2020 Apr 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526069/  Chowdhury, Abeed H. BSc, MRCS*; Cox, Eleanor F. PhD†; Francis, Susan T. PhD†; Lobo, Dileep N. DM, FRCS, FACS*A Randomized, Controlled, Double-Blind Crossover Study on the Effects of 2-L Infusions of 0.9% Saline and Plasma-Lyte® 148 on Renal Blood Flow Velocity and Renal Cortical Tissue Perfusion in Healthy Volunteers, Annals of Surgery: July 2012 - Volume 256 - Issue 1 - p 18-24 doi: 10.1097/SLA.0b013e318256be72  Peti-Peterdi J, Harris RC. Maculadensa sensing and signaling mechanisms of renin release. J Am Soc Nephrol. 2010;21(7):1093-1096. doi:10.1681/ASN.2009070759  Wilcox CS. Regulation of renal blood flow by plasma chloride.J Clin Invest. 1983;71(3):726-735. doi:10.1172/jci110820 

Join EM physicians Mike Samuels and Dan McCollum as they discuss different blood products that can be transfused.  Why don't we commonly use whole blood? Who needs to receive packed red blood cells? Are there any dangers to giving platelets? When is fresh frozen plasma needed?  Episode 100 discussed potential complications, while this episode will discuss why you should be using these products.  Enjoy!

Kawasaki: Dr. Pushpa Shivaram, an assistant professor of pediatrics and pediatric cardiologist at the Medical College of Georgia, joins Dr. Zac Hodges and Sonal Dugar (M4) to discuss this very important topic in pediatric medicine. What exactly is Kawasaki disease and why is this topic so important? How do you make the diagnosis and what other diagnoses should you consider? How can you diagnosis incomplete Kawasaki when the classic features are not all present? What is the first-line treatment? When should you get an echocardiogram? When should you get your referral center involved? All of this and more from the Department of Pediatrics and the Medical College of Georgia.  Check out our website for detailed show-notes: https://www.augusta.edu/mcg/pediatrics/residency/podcast.php Special thanks to Dr. Reda Bassali, Dr. Leizl Domingo and Dr. Julisa Patel for providing peer review for this episode. Questions, comments, or feedback? Please email us at [email protected]  Further Reading? Check out the clinical practice guideline from the American Heart Association with citation below. McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association [published correction appears in Circulation. 2019 Jul 30;140(5):e181-e184]. Circulation. 2017;135(17):e927-e999. doi:10.1161/CIR.0000000000000484