We discuss the impact of family presence during resuscitations.
Hosts:
Ellen Duncan, MD, PhD
Brian Gilberti, MD
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Family_Presence_During_Resuscitation.mp3
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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.
Current Practices in Pediatrics:
Family presence during pediatric resuscitations remains inconsistent, with healthcare provider acceptance ranging from 15% to 85%.
Many subspecialists and consultants still request that families step out, often due to outdated concerns.
Common Concerns & Myths:
Interference in resuscitation → Studies show minimal disruption.
Legal risks → No increased litigation risk has been demonstrated.
Family trauma → Research suggests that presence may help with grieving and reduce PTSD symptoms.
Evidence from the Literature
New England Journal of Medicine study on Family Presence During Cardiopulmonary Resuscitation (Jabre et al., 2013):
In a randomized controlled trial of 570 relatives, PTSD-related symptoms were significantly higher in family members who were not offered the oppo...
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Episode 204: Necrotizing Fasciitis
We discuss the recognition and treatment of necrotizing fasciitis.
Hosts:
Aurnee Rahman, MD
Brian Gilberti, MD
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Necrotizing_Fasciitis.mp3
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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
Introduction
Necrotizing soft tissue infections can be easily missed in routine cases of soft tissue infection.
High mortality and morbidity underscore the need for vigilance.
Definition
A rapidly progressive, life-threatening infection of the deep soft tissues.
Involves fascia and subcutaneous fat, causing fulminant tissue destruction.
High mortality often due to delayed recognition and treatment.
Types of Necrotizing Fasciitis
Type I (Polymicrobial)
Involves aerobic and anaerobic organisms (e.g., Bacteroides, Clostridium, Peptostreptococcus).
Common in immunocompromised patients or thos...
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Episode 203: Acetaminophen Toxicity
We sit down with one of our toxicologists to discuss acetaminophen toxicity.
Hosts:
Marlis Gnirke, MD
Brian Gilberti, MD
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Acetaminophen_Toxicity.mp3
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Tags: Toxicology
Show Notes
Table of Contents
0:35 – Hidden acetaminophen toxicity in OTC products
3:24 – Pharmacokinetics and toxicokineticsÂ
6:06 – Clinical Course
9:22 – The antidote – NAC
11:02 – The Rumack-Matthew NomogramÂ
17:36 – Treatment protocols
22:34 – Monitoring and Lab Work
23:23 – Considerations when treating pediatric patients
23:57 – IV APAP overdose, fomepizoleÂ
25:42 – Take Home Points
Acetaminophen vs. Tylenol:
The importance of recognizing that acetaminophen is found in many products beyond Tylenol.
Common medications containing acetaminophen, such as Excedrin, Fioricet, Percocet, Dayquil/Nyquil, and others.
The risk of unintentional overdose due to combination products.
Prevalence of Acetaminophen Toxicity:
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Episode 202: Sexually Transmitted Infections 2.0
We review Sexually Transmitted Infections and pertinent updates in diagnosis and management.
Hosts:
Avir Mitra, MD
Brian Gilberti, MD
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Sexually_Transmitted_Infections_2_0.mp3
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Tags: gynecology, Infectious Diseases, Urology
Show Notes
Table of Contents
(1:49) ChlamydiaÂ
(3:31) Gonorrhea
(4:50) PID
(6:14) Syphilis
(8:08) NeurosyphilisÂ
(9:13) Tertiary Syphilis
(10:06) TrichomoniasisÂ
(11:13) Herpes
(12:49) HIV
(14:10) PEP
(15:13) Mycoplasma GenitaliumÂ
(18:00) Take Home Points
Chlamydia:
Prevalence:
Most common STI.
High percentage of asymptomatic cases (40% to 96%).
Presentation:
Urethritis, cervicitis, pelvic inflammatory disease (PID), prostatitis, proctitis, pharyngitis, arthritis.
Importance of considering ...
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Episode 201: Migraines
We discuss migraines with one of the authorities in the field.
Hosts:
Benjamin Friedman, MD of Montefiore
Brian Gilberti, MD
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Migraines.mp3
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Tags: Neurology
Show Notes
Initial Approach to Diagnosing Migraines:
Differentiating between primary headaches (migraine, tension-type, cluster) and secondary causes (e.g., subarachnoid hemorrhage).
The importance of patient history and reevaluation after initial treatment.
Recognizing the unique presentation of cluster headaches and their management implications.
Effective Acute Migraine Treatments:
First-line treatments including anti-dopaminergic medications like metoclopramide (Reglan) and prochlorperazine (Compazine), and parenteral NSAIDs like ketorolac (Toradol).
The limited role of triptans in the ED due to side effects and less efficacy compared to anti-dopaminergics.
The use of nerve blocks (greater occipital nerve block and sphenopalatine ganglion block) as effective treatments without systemic side effects.
Treatments to Avoid or Use with Caution:
Diphenhydramine (Benadryl): Studies show it does not prevent akathisia from anti-dopaminergics nor improve migraine outcomes.
IV Fluids: Routine use is not supported unless the patient shows signs of dehydration.
Magnesium: Conflicting evidence with some studies showing no benefit or even harm.
Managing Refractory Migraines:
Second-line treatments including additional doses of metoclopramide combined with NSAIDs or dihydroergotamine (DHE).
Considering opioids as a last resort when other treatments fail.
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