Core EM

FEBRUARY 14, 2025

Author: Jonathan Kobles, MD Warning, this article contains graphic images. Introduction: An 85-year-old male with a history of chronic lymphocytic leukemia (CLL) and atrial fibrillation on Eliquis presents to the emergency department (ED) after a trip and fall in the bathroom. On examination, the following wound is observed: Background: Skin tears are a common injury in the elderly population and are associated with significant morbidity due to impaired wound healing.

Epinephrine 130

Epinephrine ED OR Emergency Department 130

Core EM

FEBRUARY 14, 2025

This procedure video provides a step-by-step guide to performing an ultrasound-guided fascia iliaca nerve block, a crucial technique for managing pain in patients with hip and proximal femur fractures. Dr. Mitchell Foster explains the procedure in detail, covering patient positioning, ultrasound anatomy, needle insertion, hydrodissection confirmation, and anesthetic administration.

130

130

Core EM

FEBRUARY 2, 2025

We discuss the impact of family presence during resuscitations. Hosts: Ellen Duncan, MD, PhD Brian Gilberti, MD [link] Download Leave a Comment Tags: Critical Care , Pediatrics Show Notes Overview Historical Context: The conversation around allowing family members in the room during resuscitation events began gaining attention in 1987. Since then, the practice has been increasingly encouraged.

CPR 130

CPR Critical Care Emergency Department ALS 130

Core EM

JANUARY 29, 2025

Cefepime vs Piperacillin-Tazobactam in Adults Hospitalized With Acute Infection: The ACORN Randomized Clinical Trial. JAMA Network, 2023 Background Author: Nick Scott, MD Editor: Naillid Felipe, MD Empiric antibiotic treatment for infections is a staple of emergency medicine. Standard broad-spectrum regimens for patients include vancomycin and cefepime and vancomycin and piperacillin-tazobactam.

EMS 100

EMS ICU ALS ED 100

Core EM

JANUARY 16, 2025

An EM Residents Guide to Basic Airway Management Authors: Justin Rice, MD Sagar Desai, MD Eunice Monge, MD William Chiang, MD Preface: Airway management is one of the most critical skills in emergency medicine, yet it can be one of the most challenging to master. Residents often receive varying advice from different attendings, each with their own background and expertise, which can lead to confusion.

E-9-1-1 130

E-9-1-1 EMS ALS OR 130

Core EM

JANUARY 1, 2025

We discuss the recognition and treatment of necrotizing fasciitis. Hosts: Aurnee Rahman, MD Brian Gilberti, MD [link] Download Leave a Comment Tags: Critical Care , General Surgery Show Notes Table of Contents 0:00 – Introduction 0:41 – Overview 1:10 – Types of Necrotizing Fasciitis 2:21 – Pathophysiology & Risk Factors 3:16 – Clinical Presentation 4:06 – Diagnosis 5:37 – Treatment 7:09 – Prognosis and Recovery 7:37 – Take Home points Int

Critical Care 130

Critical Care ICU OR 130

Core EM

DECEMBER 1, 2024

We sit down with one of our toxicologists to discuss acetaminophen toxicity. Hosts: Marlis Gnirke, MD Brian Gilberti, MD [link] Download Leave a Comment Tags: Toxicology Show Notes Table of Contents 0:35 – Hidden acetaminophen toxicity in OTC products 3:24 – Pharmacokinetics and toxicokinetics 6:06 – Clinical Course 9:22 – The antidote – NAC 11:02 – The Rumack-Matthew Nomogram 17:36 – Treatment protocols 22:34 – Monitoring and Lab Work 23:23 – Co

Overdose 130

Overdose ED OR 130

Core EM

NOVEMBER 30, 2024

The Case An 88-year-old woman with a history of dementia, major depressive disorder, and hyperlipidemia presented to the ED via EMS after a near syncopal episode. She was running to catch the bus to visit her husband in the hospital when she developed acute onset shortness of breath, nausea,vomiting, and near loss of consciousness. The following ECG was obtained: Initial vitals: BP 85/52, HR 62, RR 22, Temp 98.4F, SpO2 92% on RA EKG Show Details EKG Characteristics Rate 66 Rhythm Normal Sinus Rh

Coronary 130

Coronary STEMI MICU ACS 130

Core EM

NOVEMBER 26, 2024

Diagnosis of acute aortic syndromes with ultrasound and d-dimer: the PROFUNDUS study European Journal of Internal Medicine, 2024 Background Acute aortic syndromes (AAS) are rare causes in patients presenting with chest/abdominal/back pain or syncope. Types of AAS include aortic dissection, intramural aortic hematoma, and penetrating aortic ulcer. Diagnosis of AAS requires urgent advanced aortic imaging (AAI), such as computed tomography angiography (CTA).

EMS 100

EMS OR ED 100

Core EM

NOVEMBER 19, 2024

Introduction: - Ankle sprains are among the most common injuries, affecting both athletes and everyday pedestrians. - The streets of New York City illustrate how treacherous surfaces can lead to ankle injuries. - The ankle is the most commonly injured joint in sports; jogging is a frequent cause. Anatomy of the Ankle: - The ankle joint, or mortise, is formed by the talus bone fitting snugly between the distal fibula and tibia. - Key ligaments securing the ankle include: Medial deltoid ligament S

Emergency Department 130

Emergency Department Ambulance OR 130

Core EM

NOVEMBER 1, 2024

We review Sexually Transmitted Infections and pertinent updates in diagnosis and management. Hosts: Avir Mitra, MD Brian Gilberti, MD [link] Download Leave a Comment Tags: gynecology , Infectious Diseases , Urology Show Notes Table of Contents (1:49) Chlamydia (3:31) Gonorrhea (4:50) PID (6:14) Syphilis (8:08) Neurosyphilis (9:13) Tertiary Syphilis (10:06) Trichomoniasis (11:13) Herpes (12:49) HIV (14:10) PEP (15:13) Mycoplasma Genitalium (18:00) Take Home Points Chlamydia: Prevalence: M

OR 130

OR 130

Core EM

OCTOBER 23, 2024

The Case A 24-year-old man with no past medical or surgical history presented to the emergency department with 5 days of progressively worsening bilateral leg cramping, paresthesias, and multiple falls. The following ECG is obtained: EKG Show Details EKG Characteristics Rate 88 Rhythm Sinus Rhythm with PAC's Intervals Normal PR and QRS interval, Prolonged QTc interval (619 ms) Axis Normal ST Segments Normal Additional Features Diffuse, prominent, prolonged T-waves Diagnosis Diagnosis : Hypokalem

Emergency Department 130

Emergency Department ICU Critical Care Ambulance 130

Core EM

OCTOBER 16, 2024

Author : Allison Tu About me: I’m a second-year medical student at NYU planning to pursue a career in emergency medicine. I graduated from Harvard in 2023 with a degree in psychology and global health, and during medical school, I’ve co-directed NYU’s asylum clinic and volunteered for the suicide prevention lifeline. I am also interested in teaching, and I hope to pursue a medical education fellowship in the future.

ED 100

ED EMS Critical Care OR 100

Core EM

OCTOBER 16, 2024

We discuss migraines with one of the authorities in the field. Hosts: Benjamin Friedman, MD of Montefiore Brian Gilberti, MD [link] Download Leave a Comment Tags: Neurology Show Notes Initial Approach to Diagnosing Migraines: Differentiating between primary headaches (migraine, tension-type, cluster) and secondary causes (e.g., subarachnoid hemorrhage).

ED 130

ED OR 130

Core EM

OCTOBER 16, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% Febrile Non-hemolytic (FNHTR) – 1% Transfusion-associated circulatory overload (TACO) – 1% Transfusion-related acute lung injury (TRALI) – <0.01% Anaphylaxis/ABO incompatibility –

Allergic Reaction 188

Allergic Reaction Plasma ED Epinephrine 188

Core EM

OCTOBER 2, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% Febrile Non-hemolytic (FNHTR) – 1% Transfusion-associated circulatory overload (TACO) – 1% Transfusion-related acute lung injury (TRALI) – <0.01% Anaphylaxis/ABO incompatibility –

Allergic Reaction 100

Allergic Reaction Plasma ED Epinephrine 100

Core EM

OCTOBER 1, 2024

We discuss migraines with one of the authorities in the field. Hosts: Benjamin Friedman, MD of Montefiore Brian Gilberti, MD [link] Download Leave a Comment Tags: Neurology Show Notes Initial Approach to Diagnosing Migraines: Differentiating between primary headaches (migraine, tension-type, cluster) and secondary causes (e.g., subarachnoid hemorrhage).

ED 130

ED OR 130

Core EM

SEPTEMBER 24, 2024

Author : Allison Tu About me: I’m a second-year medical student at NYU planning to pursue a career in emergency medicine. I graduated from Harvard in 2023 with a degree in psychology and global health, and during medical school, I’ve co-directed NYU’s asylum clinic and volunteered for the suicide prevention lifeline. I am also interested in teaching, and I hope to pursue a medical education fellowship in the future.

ED 100

ED EMS Critical Care OR 100

Core EM

SEPTEMBER 16, 2024

The Case A 96-year-old female with a history of coronary artery disease, hypertension, and complete heart block status post dual-chamber pacemaker (remote) presents to the ED by EMS with generalized weakness and lethargy. EKG Show Details EKG Characteristics Rate 130 Rhythm Wide Complex Tachycardia, Paced Intervals QRS 180, QT/QTc 406/596 Axis Left axis deviation ST Segments Non-specific Additional Features Paced Rhythm with LBBB morphology Diagnosis Pacemaker-Mediated Tachycardia Questions What

Coronary 130

Coronary ED EMS OR 130

Core EM

SEPTEMBER 11, 2024

The Case A 96-year-old female with a history of coronary artery disease, hypertension, and complete heart block status post dual-chamber pacemaker (remote) presents to the ED by EMS with generalized weakness and lethargy. EKG Show Details EKG Characteristics Rate 130 Rhythm Wide Complex Tachycardia, Paced Intervals QRS 180, QT/QTc 406/596 Axis Left axis deviation ST Segments Non-specific Additional Features Paced Rhythm with LBBB morphology Diagnosis Pacemaker-Mediated Tachycardia Questions What

Coronary 130

Coronary ED EMS OR 130

Core EM

SEPTEMBER 8, 2024

We discuss a new class of medications, Immune Checkpoint Inhibitors, and their side effects. Hosts: Avir Mitra, MD Brian Gilberti, MD [link] Download Leave a Comment Tags: Oncology Show Notes Overview of Immune Checkpoint Inhibitors (ICIs) ICIs are a relatively new class of oncologic drugs that have revolutionized cancer treatment. Unlike chemotherapy, ICIs help the immune system develop memory against cancer cells and adapt as the cancer mutates.

OR 230

OR 230

Core EM

SEPTEMBER 2, 2024

We discuss a new class of medications, Immune Checkpoint Inhibitors, and their side effects. Hosts: Avir Mitra, MD Brian Gilberti, MD [link] Download Leave a Comment Tags: Oncology Show Notes Overview of Immune Checkpoint Inhibitors (ICIs) ICIs are a relatively new class of oncologic drugs that have revolutionized cancer treatment. Unlike chemotherapy, ICIs help the immune system develop memory against cancer cells and adapt as the cancer mutates.

OR 130

OR 130

Core EM

AUGUST 28, 2024

We discuss a case of ataxia in children and how to approach the evaluation of these pts. Hosts: Ellen Duncan, MD, PhD Brian Gilberti, MD [link] Download Leave a Comment Tags: Neurology , Pediatrics Show Notes Introduction The episode focuses on ataxia in children, which can range from self-limiting to life-threatening conditions. Pediatric emergency medicine specialist shares insights on the topic.

Emergency Department 130

Emergency Department ED OR 130

Core EM

AUGUST 28, 2024

- Importance of Catheter Selection: - The catheter’s diameter and length are critical factors affecting the flow rate. - Shorter, wider catheters provide a higher flow rate, making them preferable for rapid resuscitation. - Diameter and Flow Rate: - A larger diameter increases flow rate, and this relationship is proportional to the fourth power. For instance, doubling the diameter results in a 16-fold increase in maximum flow rate. - Peripheral 16-gauge IVs can sometimes outtransfuse larger cent

OR 100

OR 100

Core EM

AUGUST 28, 2024

Medical Education Fellowship NYU Langone’s Ronald O. Perelman Department of Emergency Medicine is excited to introduce our new fellowship, starting July 2025. The Medical Education Fellowship is designed for emergency physicians aspiring to advance their careers in medical education. This two-year fellowship provides an extensive curriculum aimed at developing skills necessary for roles such as program directors, clerkship directors, and academic leaders in the field of emergency medicine.

Emergency Department 130

Emergency Department OR 130

Core EM

AUGUST 6, 2024

Medical Education Fellowship NYU Langone’s Ronald O. Perelman Department of Emergency Medicine is excited to introduce our new fellowship, starting July 2025. The Medical Education Fellowship is designed for emergency physicians aspiring to advance their careers in medical education. This two-year fellowship provides an extensive curriculum aimed at developing skills necessary for roles such as program directors, clerkship directors, and academic leaders in the field of emergency medicine.

Emergency Department 130

Emergency Department OR 130

Core EM

AUGUST 1, 2024

- Importance of Catheter Selection: - The catheter’s diameter and length are critical factors affecting the flow rate. - Shorter, wider catheters provide a higher flow rate, making them preferable for rapid resuscitation. - Diameter and Flow Rate: - A larger diameter increases flow rate, and this relationship is proportional to the fourth power. For instance, doubling the diameter results in a 16-fold increase in maximum flow rate. - Peripheral 16-gauge IVs can sometimes outtransfuse larger cent

OR 198

OR Critical Care 198

Core EM

AUGUST 1, 2024

We discuss a case of ataxia in children and how to approach the evaluation of these pts. Hosts: Ellen Duncan, MD, PhD Brian Gilberti, MD [link] Download Leave a Comment Tags: Neurology , Pediatrics Show Notes Introduction The episode focuses on ataxia in children, which can range from self-limiting to life-threatening conditions. Pediatric emergency medicine specialist shares insights on the topic.

Emergency Department 130

Emergency Department ED OR 130

Core EM

JULY 23, 2024

The Case An elderly male with a past medical history of hypertension and diabetes presents to the emergency department with a chief complaint of diarrhea and shortness of breath. His vital signs are: HR 60, BP 105/65, RR 30, O2 100% on room air, oral T 98.6 F, and FSG 120. EKG Show Details EKG Characteristics Rate 60 BPM Rhythm Regular, no discernible P-waves Intervals PR na; QRS complex > 160 ms; QT Prolonged Axis LAD ST Segments Wide QRS complexes slurring into very large pointed T waves Diagn

Plasma 130

Plasma Emergency Department Overdose OR 130

Core EM

JULY 23, 2024

We review threatened abortion and the complexities in its care. Hosts: Stacey Frisch, MD Brian Gilberti, MD [link] Download One Comment Tags: OBGYN Show Notes Background Defined as vaginal bleeding during early pregnancy (before 20 weeks) with a closed cervical os, no passage of fetal tissue, and IUP on ultrasound Occurs in 20-25% of all pregnancies.

OR 130

OR 130

Core EM

JULY 23, 2024

The Case A 71-year-old male with a history of chronic obstructive pulmonary disease, hyperlipidemia, and peptic ulcer disease presents to the emergency department with substernal chest pain radiating down the right arm and dyspnea that began acutely while “running” up the stairs from the subway. The following ECG is obtained upon arrival to the emergency department.

STEMI 189

STEMI Coronary Emergency Department OR 189

Core EM

JULY 23, 2024

High risk and low prevalence diseases: Blast injuries American Journal of Emergency Medicine, 2023 Background Blast injuries stem from the instantaneous transformation of a substance from solid or liquid to gas, releasing energy in the form of heat, light, pressure, and sound. While rare, blast injuries carry a high rate of morbidity and mortality. Blast injuries commonly have a mixed presentation of blunt and penetrating trauma.

EMS 100

EMS Emergency Medical Services OR Coronary 100

Core EM

JULY 23, 2024

Author: Mallika Singh, MD Editor: Jonathan Kobles, MD Background Unintentional or intentional exposure to radiological material represents a potential threat to human health on the individual to mass-casualty scale. Radioactive sources include medical isotopes, fuel rods, generators, and other industrial sources. Due to their availability, iridium-192, Cesium-137, and Cobalt-60 are often viewed as the substances posing the greatest threat for intentional radiation exposure.

ALS 130

ALS OR Emergency Department ED 130

Core EM

JULY 23, 2024

We review Acute Respiratory Distress Syndrome Hosts: Sadakat Chowdhury, MD Brian Gilberti, MD [link] Download Leave a Comment Tags: Critical Care , Pulmonary Show Notes Definition of ARDS: Non-cardiogenic pulmonary edema characterized by acute respiratory failure. Berlin criteria for diagnosis include acute onset within 7 days, bilateral pulmonary infiltrates on imaging, not fully explained by cardiac failure or fluid overload, and impaired oxygenation with PaO2/FiO2 ratio <300 mmHg, even wi

Critical Care 130

Critical Care OR 130

Core EM

JULY 23, 2024

Optimizing Trauma Resuscitation Education: A Year-Long In-Situ Simulation Curriculum Ashika Jain, MD, Nelly Parisot, MD, Michael J. Klein, MD, Janice Shin-Kim, MD, Brian Lin, MD, Julia Paris, MD, Shannon McNamara, MD, Jessica Strauss, MD, Soma Pathak, MD Delivering optimal care in a trauma resuscitation requires a highly coordinated and skilled team.

ALS 100

ALS 100

Core EM

JULY 23, 2024

We discuss an approach to the acutely agitated patient and review medications commonly used. Hosts: Jonathan Kobles, MD Brian Gilberti, MD [link] Download Leave a Comment Tags: Agitation , psychiatry , Toxicology Show Notes Background/Epidemiology • Definition and Scope : Agitation encompasses behaviors from restlessness to severe altered mental states.

Emergency Department 233

Emergency Department OR 233

Core EM

JUNE 3, 2024

We discuss an approach to the acutely agitated patient and review medications commonly used. Hosts: Jonathan Kobles, MD Brian Gilberti, MD [link] Download Leave a Comment Tags: Agitation , psychiatry , Toxicology Show Notes Background/Epidemiology • Definition and Scope : Agitation encompasses behaviors from restlessness to severe altered mental states.

Emergency Department 130

Emergency Department OR 130