Palliative Care in the Emergency Department

Mind the Osmolar Gap: Toxic Alcohols

In this episode, Jocelyn and Elizabeth interview Dr Tang Dilin on the intriguing topic of Toxic Alcohols.  Timestamps 00:40 Brief overview  01:20 Methanol, Ethylene Glycol, Isopropyl Alcohol - Comparing and contrasting  04:20 Approach to undifferentiated high osmolar gap or high anion gap  08:04 Osmolar gap, hockey stick diagram  12:18 Treatment of toxic alcohol including Fomepizole  21:13 Role of Haemodialysis 23:49 Cofactors 24:44 Considerations for intubation 25:20 Isopropyl Alcohol  27:17 Key takeaways References https://emergencymedicinecases.com/toxic-alcohols/ [https://emergencymedicinecases.com/toxic-alcohols/] https://litfl.com/toxic-alcohol-ingestion/ [https://litfl.com/toxic-alcohol-ingestion/]  https://litfl.com/osmolar-gap/ [https://litfl.com/osmolar-gap/]  Credits Music: Life-line by Colorful Sound via Pixabay  SGH Podcast Studio Any comments or feedback? Suggestions for future episodes? Send us a message! [https://www.buzzsprout.com/2397764/fan_mail/new] https://semspodcast.buzzsprout.com/

Palliative Care in the Emergency Department

In this episode, Dr Joanna Chan and Dr Matthew Low interview Dr Kei Ouchi, Associate Professor at Harvard Medical School, on the topic of Palliative Emergency Medicine. His work focuses on improving care for adults with palliative care needs through high quality serious illness communications in the ED setting. Tune in to find out more!  Timestamps 00:56 What first drew you to the topic of bringing palliative care to the ED?  04:49 Could you explain why it is important for an ED doctor to be able to handle these situations well?  06:26 What does a goals of care discussion in the emergency department sound like in your practice? 08:59 How can you direct the conversation to help patients and families understand the gravity of their present crisis? 13:21 Tips on high-yield questions that help to bring out the wishes of a patient in a new crisis situation that can help the doctor to make a sound recommendation? 15:41 Navigating situations where patients have deferred serious illness decision-making to their family members 20:48 How much time do you budget for your communication when it is your first time meeting the family? 22:55 In terms of communication, what are the common blind spots that you would like to highlight?     25:19 What ED innovation of the future is likely to have the most impact on ED Palliative Care delivery; What highlights have you seen from your time here with us, and how could we feasibly and meaningfully advance from here?  References https://pmc.ncbi.nlm.nih.gov/articles/PMC8219473/ [https://pmc.ncbi.nlm.nih.gov/articles/PMC8219473/]  https://connects.catalyst.harvard.edu/Profiles/display/Person/125411 [https://connects.catalyst.harvard.edu/Profiles/display/Person/125411]  Credits Music: Life-line by Colorful Sound via Pixabay/SGH Podcast Studio Any comments or feedback? Suggestions for future episodes? Send us a message! [https://www.buzzsprout.com/2397764/fan_mail/new] https://semspodcast.buzzsprout.com/

Geriatric Emergency Medicine

In this episode, Dr Eunizar Omar interviews Dr Colin Ong and Dr Juliana Poh on the  topic of Geri EM! They discuss CFS, safe discharge measures, falls, frailty and gait assessments and more! Tune in to find out more.  Timestamps 01:03 Tell us about GeriEm in your department? 04:50 Clinical Frailty Scale (CFS): Why it is important, evidence supporting it, and applicability.  06:03 Falls: What are the issues with the term “mechanical fall”, and what questions should we be asking to uncover the truth behind the fall? 07:51 Minimum falls history; SPLATT mnemonic (Symptoms, Previous falls, Location, Activity, Time of fall, Trauma/ post fall complications) 09:36 Reversible causes of falls to look out for MAPHD (Medications, visual Acuity, Postural Hypotension, 4 Ds - Delirium, Dementia, Depression, Vitamin D)  10:47 Gait assessment: Timed up and go test, Gait Speed Test 13:56 Safe alternatives to admissions 17:17 Polypharmacy High risk meds mnemonic: ABCS (anticholinergics, benzodiazepines and sedating drugs, cardiovascular medications).  22:33 Safe discharge measures  24:36 Advice for those who would like to learn more about the GeriEM scene 26:13 Practical takeaways References 1. Sri-on J, Tirrell GP, Lipsitz LA, Liu SW. Is there such a thing as a mechanical fall? Am J Emerg Med. 2016 Mar;34(3):582-5. doi: 10.1016/j.ajem.2015.12.009. Epub 2015 Dec 12. PMID: 26795891; PMCID: PMC6785031. 2. American College of Surgeons Geriatric Trauma Management: Best Practice Guidelines Nov 2023 3. https://www.facs.org/media/ubyj2ubl/best-practices-guidelines-geriatric-trauma.pdf [https://www.facs.org/media/ubyj2ubl/best-practices-guidelines-geriatric-trauma.pdf] 4. GeriatricsCareOnline.org [http://geriatricscareonline.org] 5. https://gedcollaborative.com/ [https://gedcollaborative.com/]  Credits Music: Life-line by Colorful Sound via Pixabay  SGH Podcast Studio Any comments or feedback? Suggestions for future episodes? Send us a message! [https://www.buzzsprout.com/2397764/fan_mail/new] https://semspodcast.buzzsprout.com/

Hyperacute Stroke in the ED

In this episode, Matthew and Elizabeth interview Dr Sohil Pothiawala and Dr Nijanth M Raj about hyperacute stroke in the Emergency Department. Ever wondered what was the evidence behind the time cut-offs for thrombolysis, tried to recall all the relative and absolute contraindications for thrombolysis, or wondered what was the optimal blood pressure for your patient and which anti-hypertensive to choose? Tune in to find out more!  Timestamps 02:52 NINDS trial 04:20 ECASS III trial  04:59 RTPA absolute (ABCDES mnemonic) and relative contraindications, pearls and pitfalls  08:44 BP targets and preferred antihypertensives for BP control  10:03 Permissive Hypertension  12:22 Alteplase vs Tenecteplase (AcT trial, TIMELESS trial, ETERNAL-LVO trial)  16.27 Thrombectomy (EXTEND IA trial, MR CLEAN trial, SWIFT PRIME trial, DAWN & DEFUSE-3 trials) 18.08 LVO (Large Vessel Occlusion)  20:25 Basilar strokes/ Posterior Circulation Strokes 24:33 Combining Thrombolysis and EVT  27:05 WAKE-UP trial 28:52 More on the DAWN & DEFUSE-3 trials 30:39 What works for shortening door to intervention times?  32.40 What’s on the horizon?  Credits Music: Life-line by Colorful Sound via Pixabay/ SGH Podcast Studio References 1. Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Acute Ischemic Stroke. Ann Emerg Med. 2023 Aug;82(2):e17-e64. doi: 10.1016/j.annemergmed.2023.03.007. 2. American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Thrombolytics; Lo BM et al. Clinical Policy: Use of Thrombolytics for the Management of Acute Ischemic Stroke in the Emergency Department. Ann Emerg Med. 2024 Dec;84(6):e57-e86. doi: 10.1016/j.annemergmed.2024.07.023. PMID: 39578010. Note: This episode was recorded in 2025. Any comments or feedback? Suggestions for future episodes? Send us a message! [https://www.buzzsprout.com/2397764/fan_mail/new] https://semspodcast.buzzsprout.com/

Lung Ultrasound in the ED

In this episode, Jocelyn and Dr Lokesh interview Dr Francis Lee about the exciting topic of Lung Ultrasound in the ED! Tune in to learn about when to do lung ultrasound, tips for how to improve your lung ultrasound skills, and what’s potentially in the future for lung ultrasound.  Timestamps:  3:00 Lung US basics  8.31 Conditions and scenarios where Lung US is useful 12:14 BLUE protocol  19:11 Tips for EPs hoping to improve in Lung US skills 21:13 Future Directions for Lung US in ED   Credits Music: Life-line by Colorful Sound via Pixabay  SGH Podcast Studio References Lichtenstein DA. Lung ultrasound in the critically ill. Ann Intensive Care. 2014 Jan 9;4(1):1. doi: 10.1186/2110-5820-4-1. PMID: 24401163; PMCID: PMC3895677. Any comments or feedback? Suggestions for future episodes? Send us a message! [https://www.buzzsprout.com/2397764/fan_mail/new] https://semspodcast.buzzsprout.com/