Em Pulse

As emergency physicians, we are very familiar with giving naloxone to patients with concern for opioid overdose. Our EMS colleagues give naloxone all the time in the prehospital setting. We know it works well for patients who are obtained due to opioids, but what about for patients who have an out-of-hospital cardiac arrest? Our expert on todays episode, Dr. David Dillon, set out to find out.  Were you surprised by the findings in Dr. Dillon’s study? Does it change your practice? Hit us up on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Guests: David Dillon, M.D., M.Phil., Ph.D, Assistant Professor of Emergency Medicine at UC Davis Resources: Dillon DG, Montoy JCC, Nishijima DK, Niederberger S, Menegazzi JJ, Lacocque J, Rodriguez RM, Wang RC. Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California. JAMA Netw Open. 2024 Aug 1

Acetaminophen overdose is one of the most common medication concerns we see in the ED. It is important to know when to be concerned and when to treat as true overdoses can cause liver failure and death. UC Davis medical toxicologist, Dr. Hoan Nguyen, joins us in this episode to discuss a new consensus statement published in JAMA Network Open in August 2023: Managing of Acetaminophen Poisoning in the US and Canada. We discuss the updated approach and walk through as hypothetical case. At the end of this episode, you’ll be able to identify high risk patients, know what labs to draw, when to start NAC, transfer, and call your local toxicologist. Do these updated guidelines change your practice? Hit us up on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Guests: Dr. HoanVu Nguyen, Military Emergency Physician and Medical Toxicologist at UC Davis.  Resour

This is the next episode of our Push Dose Pearls miniseries with ED Clinical Pharmacist, Chris Adams. In this ongoing series we’ll dig into some of the questions we all have about medications we commonly see and use in the ED. This episode focuses on naloxone. Naloxone is a staple in every ED docs toolbox but it can save more lives if it’s immediately available in the community. We’ll discuss ED based naloxone programs, why they are important, how to get funding, and which patients could benefit.  Do you give out naloxone in your ED? Is it readily available in your community? We’d love to hear your experience. Hit us up on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Guests: Christopher Adams, PharmD, Emergency Department Senior Clinical Pharmacist and former Assistant Professor at UC Davis Resources: Kids Considered Podcast - Naloxone and Opioid

In this special episode, we celebrate the incredible 19-year tenure of Dr. Nate Kuppermann as Chair of the UC Davis Emergency Department. As he transitions to his new role as Executive Vice President, Chief Academic Officer, and Chair of Pediatrics at Children’s National Hospital in Washington, D.C., Dr. Kuppermann reflects on the growth and evolution of the department since he started in 2006. He shares insights on the challenges and accomplishments throughout his career, offers advice for aspiring department chairs, and discusses the importance of social media in building a department's presence. Join us as we bid farewell and thank Dr. Kuppermann for his remarkable contributions. What would you like to hear more of on EM Pulse? Hit up on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Guests: Dr. Nate Kuppermann, Professor of Pediatric Emergency Med

Many of our ED patients come in because they were told to. Whether it’s by an advice nurse, primary care provider, urgent care, call center, specialty coordinator, etc., it often feels to us like the default is “go to the ED”. But, of course, that’s not the case. There are myriad reasons why patients may be sent to the ED. In this episode, we talk with two of our favorite outpatient physicians - a Pediatrician and an Internist - about when and why they refer patients to the ED, as well as what they do to try to keep them out of the ED!  Did you learn something new? Please share this podcast with your colleagues! Hit us up on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Guests: Dr. Olivia Campa, Assistant Clinical Professor of Internal Medicine at UC Davis Dr. Lena van der List , General Pediatrician at UC Davis, Host of Kids Considered Podcast Res

Oncologic Emergencies: Part 2 In this two-part series, we dive into the world of oncological emergencies with guest expert, Dr. Monica Wattana. In part 1, we covered everything from making new cancer diagnoses in the ED, to hypercalcemia, febrile neutropenia, and tumor lysis syndrome. We also discussed some of the tricky complications that often accompany cancer treatments, like mucositis, vomiting and diarrhea, anemia, and neuropathic pain. In part 2, we tackle pain management, palliative care, and some tough ethical dilemmas. The goal is to make sure we're all equipped to provide the best care possible for our patients with cancer.  Did you learn something new that changed your practice? We’d love to hear about it. Hit us up on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Guests: Dr. Monica Wattana, Associate Professor and Education Director for

In this two-part series, we dive into the world of oncological emergencies. Our guest expert, Dr. Monica Watana, an emergency physician specializing in this area. In part 1, we cover everything from making new cancer diagnoses in the ED, to hypercalcemia, febrile neutropenia, and tumor lysis syndrome. We also talk about some of the tricky complications that often accompany cancer treatments, like mucositis, vomiting and diarrhea, anemia, and neuropathic pain. The goal is to make sure we're all equipped to provide the best care possible for our patients with cancer. Stay tuned for part two, when we’ll tackle pain management, palliative care, and some tough ethical dilemmas.  Did you learn something new that changed your practice? We’d love to hear about it. Hit us up on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Guests: Dr. Monica Wattana, Associa

In this episode of Push Dose Pearls, we delve into the use of push dose pressors in emergency medicine. Dr. Chris Adams talks about their use, potential side effects, and the importance of a clear plan for the administration of push dose pressors. Did this episode change your practice? Let us know on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Guests: Christopher Adams, PharmD, Emergency Department Senior Clinical Pharmacist and Assistant Professor at UC Davis *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Managing pregnant patients in the ED can be stressful - especially because you have (at least) two patients to think about! Emergency physicians are generally comfortable managing first trimester emergencies but are less familiar with complications in the later stages of pregnancy. It is these complications that contribute in part to the maternal health crisis in the US. In this episode, we delve into the realm of obstetric emergencies in the ED with Dr. Jenna White, an EM physician with a special interest in OB. She introduces us to resources developed by the American College of Obstetrics and Gynecology (ACOG) to help ED providers identify common pathologies and navigate high-stakes scenarios, including screening for cardiovascular disorders, managing hypertension, and tackling the dreaded eclampsia. How does your ED manage OB emergencies? Have you implemented the ACOG algorithms? Share your experience with us on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Sarah Medeiros, Associate Profes

In this episode we talk with Dr. Julie Leonard about the PECARN C-spine Rule that was just officially published! Dr. Leonard is the senior author of the study and walks us through the findings, why its important, and how she uses the rule in her own clinical practice. Host: Dr. Julia Magaña, Associate Professor of Emergency Medicine at UC Davis Guest: Dr. Julie Leonard, MD, MPH, Professor of Pediatrics at Nationwide Children's Hospital and the Ohio State University College of Medicine. Resources: prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study. EMSC Innovation and Improvement Center PEAK toolkits *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

In this episode of our ongoing miniseries "Push Dose Pearls," we discuss the use of intranasal medications in the emergency department with Chris Adams, an ED clinical pharmacist at UC Davis. We talk about the benefits of intranasal administration, intranasal medications, and advantages for pediatric patients. Did this episode change your practice? Let us know on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Guests: Christopher Adams, PharmD, Emergency Department Senior Clinical Pharmacist and Assistant Professor at UC Davis *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.    

Navigating breastfeeding as an EM physician In the previous two episodes, we explored some of the challenges related to fertility and pregnancy for EM physicians. In the final episode of our three part series, we take it one step further to discuss yet another challenge: breastfeeding. Of course, fed is always best, and there are many reasons to formula feed, but providing breastmilk is very important to many families. For EM physicians, choosing to breastfeed usually means figuring out how to pump and store milk while you’re on shift. This can be daunting, especially for residents and junior physicians. How do you find time to sneak away? Is there an easily accessible pumping room close by? Will you feel supported by colleagues and your department? We cover these questions and much more with experts, Dr. Claire Abramoff, and Dr. Shada Rouhani.  Does your ED have policies to support breastfeeding and pumping? Share your experience with us on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Juli

In this episode, we delve into a pivotal multi-center study validating the Pediatric Emergency Care Applied Research Network (PECARN) prediction rules for using CT imaging in children with blunt abdominal and minor head trauma. We discuss with the authors the study's impact, how these validated rules can optimize pediatric trauma care, minimize radiation risks, and what this means for emergency practices worldwide. This conversation not only sheds light on the study's intricate processes and outcomes, but also emphasizes the vital role of evidence-based guidelines in enhancing patient safety and care quality. Host: Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Guests: Dr. Nate Kuppermann, Pediatric Emergency Physician, Professor and Chair of the UC Davis Department of Emergency Medicine, Founding Chair of the PECARN Steering Committee Dr. James Holmes, Professor of Emergency Medicine at UC Davis Resources: Holmes JF, Yen K, Ugalde IT, Ishimine P, Chaudhari PP, Atigap

Pregnancy is common during medical training and in the early years as an attending physician, as these stages often align with individuals’ reproductive potential. The experience can vary widely depending on factors such as workplace dynamics, scheduling, and the physical demands of the job. But let’s be real - running around a busy ED while carrying extra weight, feeling nauseated (maybe vomiting), and managing all of the physical and emotional changes that come with pregnancy is a real challenge that many of us have lived. There are numerous considerations to navigate, from how we wish to be perceived as a team member to the risks posed by the workload on our bodies. Additionally, departmental or hospital policies may have financial implications that further complicate the situation. Join us as and Dr. Katren Tyler - EM physician and mother of two - as we break it all down. This the second episode in our three part series on infertility, pregnancy and breastfeeding as an Emergency Physician. If  you missed

This the first episode in our three part series on infertility, pregnancy and breastfeeding as an Emergency Physician. In this installment, we shine a light on the often unspoken struggles of infertility among physicians, specifically focusing on the emergency medicine community. Join us and expert, Dr. Melissa Parsons, as we delve into the personal experiences, professional challenges, and nuanced perspectives of emergency physicians navigating the complex journey of infertility. In part two, we’ll explore what it’s like to be a pregnant as an EM physician, and in our final episode of the series, we’ll talk about some of the challenges surrounding breastfeeding and pumping in the ED.  Do you have questions about fertility as an EM Physician? Or want to share your own experience?  Hit us up on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis G

If you practice in emergency medicine you probably live on the look out for sepsis.  You likely follow the 2016 Sepsis-3 guidelines for adults which really was a paradigm shift from an infection-associated SIRS, to infection-associated organ dysfunction with the SOFA score or sequential organ failure assessment score of at least 2 points in patients with suspected infection. However, the definition of sepsis in kids was not updated at that time in part because SOFA was not studied in children. That means that our current pediatric guidelines are from 2005! Good news though! The Phoenix sepsis criteria for sepsis and septic shock in children were derived and validated by the international SCCM Pediatric Sepsis Definition Task Force and we interviewed two of the task force members to help us operationalize it on our podcast. Connect with us on social media @empulsepodcast or at ucdavisem.com Host: Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Guests: Dr. Halden Scott, As

People living with sickle cell disease can experience severe “pain crises”, or vaso-occlusive episodes (VOE), and are at increased risk for infections, strokes, heart failure, and other serious disease processes. When patients are out sickle cell present to the ED, it is crucial to initiate their evaluation and treatment as soon as possible. So what does this mean practically for us as clinicians? Hematologist and Sickle Cell expert, Dr. Bimpe Adesina, and Emergency Physician and researcher, Dr. Bryn Mumma, join us to explore this topic in depth.  In part 1, we delved into assessment and management of patients presenting with VOE. In part 2, we spoke with Dr. Chris Rees about the benefits of early opioid pain control for kids presenting with VOE.   In the final episode of our series we’re back with Dr. Mumma and Dr. Adesina to discuss the management of other emergent presentations related to sickle cell disease. Did this episode change your practice? Let us know on social media @empulsepodcast or at ucdavi

People living with sickle cell disease can experience severe “pain crises”, or vaso-occlusive episodes (VOE), and are at increased risk for infections, strokes, heart failure, and other serious disease processes. In this 3 part series, we’re talking with experts to learn more about sickle cell disease and its complications and how we can best advocate for and treat these patients in the ED. In part 1, we delved into assessment and management of patients presenting with VOE. In this episode, we focus specifically on kids presenting with VOE. We know these patients have usually exhausted their home pain control options and are still in excruciating pain when they arrive in the ED. We interviewed Dr. Chris Rees about his recent paper on the benefits of treating kids with VOE with an initial dose of intranasal fentanyl.  The results are pretty impressive!  Stay tuned for Part 3 of our series where we’ll explore the management of other emergent presentations related to sickle cell disease! Did this episode chan

People living with sickle cell disease can experience severe “pain crises”, or vaso-occlusive episodes (VOE), and are at increased risk for infections, strokes, heart failure, and other serious disease processes. When patients are out sickle cell present to the ED, it is crucial to initiate their evaluation and treatment as soon as possible. So what does this mean practically for us as clinicians? Hematologist and Sickle Cell expert, Dr. Bimpe Adesina, and Emergency Physician and researcher, Dr. Bryn Mumma, join us to explore this topic in depth.  In part 1, we delve into assessment and management of patients presenting with VOE. Stay tuned for parts 2 and 3, where we’ll explore the use of intranasal fentanyl and the management of other emergent presentations related to sickle cell disease! Did this episode change your practice? Let us know on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Dr. Julia Magaña, Associate Profe

This is the next episode of our Push Dose Pearls miniseries with ED Clinical Pharmacist, Chris Adams. In this ongoing series we’ll dig into some of the questions we all have about medications we commonly see and use in the ED. This episode focuses on RSI (rapid sequence intubation) meds - stuff every ED doc needs to know! What has changed and what are the latest recommendations? We’ll answer these questions and more!  Did this episode change your practice? Let us know on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Sarah Medeiros, Associate Professor of Emergency Medicine at UC Davis Dr. Julia Magaña, Associate Professor of Pediatric Emergency Medicine at UC Davis Guests: Christopher Adams, PharmD, Emergency Department Senior Clinical Pharmacist and Assistant Professor at UC Davis Resources: Acquisto NM, Mosier JM, Bittner EA, Patanwala AE, Hirsch KG, Hargwood P, Oropello JM, Bodkin RP, Groth CM, Kaucher KA, Slampak-Cindric AA, Manno EM, Mayer SA, Peterson LN, Fulmer J, Galton C, Bleck