ICEP EM on Tap Podcast: Episode 01 – Introduction & Resident Competition

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ICEP EM on Tap is the Illinois College of Emergency Physicians’ podcast for all things emergency medicine. ICEP EM on Tap provides an online resource of up-to-date and relevant information as it pertains to the practice of emergency medicine: literature review, procedural techniques, current topics of interest, and more. The goal of ICEP EM on Tap is to harness the wealth of academic emergency medicine potential in Illinois while offering a resource of insightful feedback and dialogue from the ICEP community.

Sit back as Dr. Christopher Colbert and Dr. Dan Robinson introduce the program. Then, let the knowledge flow in with the 3 winners of the spring 2017 Resident Podcast Competition:

1st Place

Ultrasound to Confirm Endotracheal Tube Placement

Jonathan D. Alterie, DO PGY-1
Dallas Holladay, DO PGY-4
Midwestern University

2nd Place

The History of Sepsis: What Do the Trials Show?

Racheal A. Gilmer, MD
Michael Ward, MD
University of Chicago

3rd Place

Project REVISE: A Novel Approach to Pediatric Fever

Orhay Mirzapolos, DO
Midwestern University Emergency Medicine Residency

Shownotes:

Ultrasound to Confirm Endotracheal Tube Placement

I.    What we discuss in this podcast: We will be discussing the use of ultrasound in confirming endotracheal tube placement. This topic has been touched upon as early as 1994 when it was mentioned by American College of Emergency Physicians as one of the modalities to confirming ETT placement, and it has been reviewed numerous times by ACEP.

II.    Why is this important? There are already a number of well-established methods for confirming ET tube placement. These include the classics like condensation in the tube, bilateral breath sounds, lack of epigastric gurgling, colorimetric CO2 confirmation as well as end-tidal CO2 and of course, the gold standard: visualizing the tube passing through the cords. However, these all have limitations. The use of US for ETT placement confirmation is a great method to confirm tube placement, with sound evidence supporting its use. With some US practice, you can begin to implement this into your own armamentarium and use it for quick placement confirmation.

III.    Who to use it on and who not to use it on is discussed.

IV.    How to use US for ETT placement is explained; however, we recommend using the cited sources below to view images of the different techniques. And as always, you can visit our Midwestern University EM page for more ultrasound technique videos!
http://emergencymed.wixsite.com/mwuem

Thank you so much for listening and be on the look out for more podcasts! If you have any questions or comments you can email either one of us at jalterie66@midwestern.edu or Dallas.Holladay@gmail.com or on Twitter: @JonathanDominck @Dallas_Holladay

Download complete show notes with article references

The History of Sepsis: What Do the Trials Show?

This podcast is a 10-minute history lesson all things sepsis. We will discuss how and why sepsis had to be defined with such scrutiny. We identify who created the definitions for sepsis and septic shock and why. We discuss the key trails surrounding sepsis treatment past and future. If you want to know how we got to where we are today, listen to this podcast!

Project REVISE: A Novel Approach to Pediatric Fever

Project REVISE: Reducing Excessive Variability in Infant Sepsis Evaluation is an ongoing study organized by the Value in Pediatrics network (VIP), a subset of the American Academy of Pediatrics.

• No change in the management of well appearing infants >29 days.
  • Partial septic work up with a respiratory viral panel and CXR only if respiratory symptoms are present and +/- an LP.
  • With a benign work up, these patients can be discharged home with follow up in 24 hours and no empiric antibiotics.
• Infants <7 days old, have a greater than 10% incidence of bacterial infections.
  • Obtain a full septic work up including CBC, Blood culture, UA, respiratory panel, CXR and LP (including a PCR for HSV).
  • Admission and empiric antibiotics are indicated.
• THE CHANGE: Well appearing infants 7-28 days old.
  • Only 10% febrile infants in this age group will have bacterial infection. Most have UTI, only 1% have meningitis.
  • Obtain UA, CBC, Blood culture, respiratory panel, CRP or procalcitonin, and CXR if respiratory symptoms are present.
  • Determine if child meets Low Risk Criteria:
    • Born full-term, or >37 weeks gestation
    • No prior hospitalizations
    • No prolonged newborn nursery course
    • WBC 5-15,000
    • <15 bands
    • UA negative for leukesterase and nitrites with <5 WBCs on the micro
    • Negative CRP or procalcitonin
    • No chronic illnesses
    • No prior antibiotics
    • No unexplained hyperbilirubinemia
  • If all of these criteria are met, the infant is low risk and the incidence of meningitis is <0.5% so no LP is indicated.
    • Admit with no empiric antibiotics until cultures are negative.
    • If they test positive for a respiratory virus, discharged after 24 hours of negative cultures.
    • If the respiratory panel is negative, discharged after 24-36 hours of negative cultures.
    • If empiric antibiotics are started, then an LP should be performed prior to the administration of antibiotics.
• A free mobile app from Children’s Mercy Hospital called CMPeds is available and walks you through this algorithm in a step by step approach.

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