FOAMcast: Recent Episodes
FOAMcast
Apple Podcasts, Spotify, Listen Here
Prior literature on pediatric patients with pulmonary embolism (PE) is limited – mostly consisting of patients with malignancy or indwelling lines. Now, we have a prospective study on venous thromboembolism (VTE) evaluation in pediatric patients. The major result is that VTE was common….6.3% of patients with documented medical decision making considering PE, D-dimer, or imaging for PE had objective diagnosis of VTE. The podcast reviews this article: Ellison et al. PERC-Peds rule for bedside exclusion of pulmonary embolism without radiation in children in the USA (BEEPER): a multicentre, prospective, observational, diagnostic accuracy study. Lancet Resp Medicine. 2026. https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00086-X/abstract
Apple Podcasts, Spotify, Listen Here
In this episode, we review a new clinical policy from the American College of Emergency Physicians (ACEP) on the use of risk stratification tools (ADD-RS) and D-dimer to exclude non-traumatic thoracic aortic dissection.
https://onlinelibrary.wiley.com/doi/10.1111/acem.13356 Promes SB, Westafer L, Byyny R, Diercks DB et al Critical Issues in the Evaluation and Management of Adult Patients With Suspected Acute Nontraumatic Thoracic Aortic Dissection. Ann Emerg Med. 2025 Jul;86(1):e12-e26. PMID: 40543988. https://pubmed.ncbi.nlm.nih.gov/40543988/Nazerian Pet al. Diagnostic Accuracy of the Aortic Dissection Detection Risk Score Plus D-Dimer for Acute Aortic Syndromes: The ADvISED Prospective Multicenter Study. Circulation. 2018 Jan 16;137(3):250-258. PMID: 29030346. https://pubmed.ncbi.nlm.nih.gov/29030346/Nazerian P, Mueller C, Vanni S, et al. Integration of transthoracic focused cardiac ultrasound in the diagnostic algorithm for suspected acute aortic syndromes. Eur Heart J. 2019 Jun 21;40(24):1952-1960. PMID: 31226214. https://pubmed.ncbi.nlm.nih.gov/31226214/
Apple Podcasts, Spotify, Listen Here
Historically, care of patients in the emergency department (ED) in the first trimester with any kind of abortion (e.g. spontaneous “miscarriage”) underwent blood type and Rh testing followed by RhD immunoglobulin prophylaxis if Rh+. However, many guidelines now recommend foregoing this process in first trimester abortion (spontaneous or induced). In this episode, we dive into the evidence behind these varying recommendations.
Visscher RD, Visscher HC Do Rh-negative women with an early spontaneous abortion need Rh immune prophylaxis? Am J Obstet Gynecol. 1972 May 15;113(2):158-65. PMID: 4623673.
Apple Podcasts, Spotify, Listen Here
Summary in ACEPNow can be found here
Rayner DG et al. Inhaled Reliever Therapies for Asthma: A Systematic Review and Meta-Analysis. JAMA. 2025 Jan 14;333(2):143-152. doi: 10.1001/jama.2024.22700. PMID: 39465893; PMCID: PMC11519786.
Rayner DG et al. Inhaled Reliever Therapies for Asthma: A Systematic Review and Meta-Analysis. JAMA. 2025 Jan 14;333(2):143-152. doi: 10.1001/jama.2024.22700. PMID: 39465893; PMCID: PMC11519786.
Asthma Management Guidelines: Focused Updates 2020
Apple Podcasts, Spotify, Listen Here
This episodes reviews the treatment of acute ischemic priapism, focusing the guidelines from the American Urological Association.
Apple Podcasts, Spotify, Listen Here
In this episode, we review a new consensus guideline from the American College of Emergency Physicians (initially developed with the American Academy of Ophthalmology) on the use of topical anesthetics in corneal abrasions.
Apple Podcasts, Spotify, Listen Here
The American Heart Association (AHA) released new clinical practice guidelines on atrial fibrillation (AF). This episode reviews the emergency medicine-related guidelines.
Ramesh T, Lee PYK, Mitta M, Allencherril J. Intravenous magnesium in the management of rapid atrial fibrillation: A systematic review and meta-analysis. J Cardiol. 2021 Nov;78(5):375-381. doi: 10.1016/j.jjcc.2021.06.001. Epub 2021 Jun 20. PMID: 34162502.Bouida W, et al. Low-dose Magnesium Sulfate Versus High Dose in the Early Management of Rapid Atrial Fibrillation: Randomized Controlled Double-blind Study (LOMAGHI Study). Acad Emerg Med. 2019 Feb;26(2):183-191. PMID: 30025177.
Apple Podcasts, Spotify, Listen Here
The Association for the Advancement of Blood & Biotherapies (AABB) released 2023 International Red Blood Cell Transfusion Guidelines. This podcast reviews the guidelines as well as a recently released trial evaluating restrictive versus liberal transfusion strategy in patients with myocardial infarction. Carson et al. Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia. NEJM 2023. DOI: 10.1056/NEJMoa2307983.
AABB Red Blood Cell Transfusion 2023 International GuidelinesCarson et al. Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia. NEJM 2023. DOI: 10.1056/NEJMoa2307983Carson et al. Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia. NEJM 2023. DOI: 10.1056/NEJMoa2307983Carson et al. Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia. NEJM 2023. DOI: 10.1056/NEJMoa2307983
Apple Podcasts, Spotify, Listen Here
The American College of Emergency Physicians (ACEP) just released a clinical policy on the management of emergency department patients presenting with severe agitation. This podcast reviews the clinical policy. We previously covered parenteral agents and a small trial of ketamine in this podcast. The policy committee was unable to make any Level A recommendations due to limitations in included studies. The recommendations the clinical policy committee was able to make are based largely on class II studies. This field of research is limited by few direct, head-to-head comparisons of medications using similar doses via the same route, resulting in some indirect evidence and conclusions.
Disclosure: Lauren Westafer is a member of the ACEP Clinical Policy Committee but the views and opinions represented in this post/podcast are hers alone and do not represent those of the ACEP Clinical Policy Committee.
Apple Podcasts, Spotify, Listen Here
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive way of providing resuscitative aortic occlusion in severe hemorrhage to gain temporary hemorrhage control as a bridge to definitive procedures. Despite initial enthusiasm for widespread use, there are minimal data suggesting significant mortality benefit. A joint statement from the American College of Surgeons Committee on Trauma (ACS COT) and the American College of Emergency Physicians (ACEP)regarding the clinical use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) states: “No current, high-grade evidence clearly demonstrates REBOA improves outcomes or survival compared to standard treatment of severe hemorrhage.” However, “REBOA is less invasive than resuscitative thoracotomy and in skilled hands may be more rapidly applied as compared with resuscitative thoracotomy.” As a result, Jansen et al. undertook a pragmatic RCT to investigate the use of REBOA in trauma. In this podcast we review the trial and contextualize the results as emergency physicians.
(JAMA. 2023 JAMA. Published online October 12, 2023. doi:10.1001/jama.2023.20850)(JAMA. 2023 JAMA. Published online October 12, 2023. doi:10.1001/jama.2023.20850)(JAMA. 2023 JAMA. Published online October 12, 2023. doi:10.1001/jama.2023.20850)
Apple Podcasts, Spotify, Listen Here Alcohol-related emergency department (ED) visits are common – estimated to be comprise nearly 4% of all ED visits and up to 6% of hospitalizations. Historically, EDs have had little engagement in harm reduction around alcohol use disorder (AUD) and provision of medication for AUD. Often efforts to help patients with dangerous or
The post Naltrexone for Alcohol Use Disorder first appeared on FOAMcast.
Apple Podcasts, Spotify, Listen Here
The role of steroids in pneumonia is controversial. Steroids were found to reduce mortality in COVID-19 patients requiring at least supplemental oxygen but are not associated with a mortality benefit in influenza. In 2019, the Infectious Disease Society of America recommended against the routine use of steroids in hospitalized patients with community-acquired pneumonia (CAP) while the Society for Critical Care Medicine recommends steroids in these patients. Studies of steroids in pneumonia continue to have mixed results (e.g. ESCAPe found no benefit in their trial of a continuous infusion of methylprednisolone in severely ill patients with CAP). In this podcast episode, we review a new multicenter randomized trial of hydrocortisone in severe CAP.
References:
- Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67.
- Pastores SM, Annane D, Rochwerg B; Corticosteroid Guideline Task Force of SCCM and ESICM. Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part II): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. Intensive Care Med. 2018 Apr;44(4):474-477. doi: 10.1007/s00134-017-4951-5. Epub 2017 Oct 31. PMID: 29090327.
- Stern A, Skalsky K, Avni T, Carrara E, Leibovici L, Paul M. Corticosteroids for pneumonia. Cochrane Database Syst Rev. 2017 Dec 13;12(12):CD007720. doi: 10.1002/14651858.CD007720.pub3. PMID: 29236286; PMCID: PMC6486210.
The post Steroids for Severe Community-Acquired Pneumonia first appeared on FOAMcast.
Apple Podcasts, Spotify, Listen Here
References:
- National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Clinical Trials Network, Shapiro NI, Douglas IS, et al. Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. N Engl J Med. 2023;388(6):499-510.
- Surviving Sepsis Campaign guidelines 2021. Society of Critical Care Medicine (SCCM). Accessed February 14, 2023. https://www.sccm.org/Clinical-Resources/Guidelines/Guidelines/Surviving-Sepsis-Guidelines-2021
- PRISM Investigators, Rowan KM, Angus DC, et al. Early, Goal-Directed Therapy for Septic Shock – A Patient-Level Meta-Analysis. N Engl J Med. 2017;376(23):2223-2234.
The post CLOVERS Trial: Restricted vs Liberal Fluids in Sepsis-Induced Hypotension first appeared on FOAMcast.
Apple Podcast, Spotify, Listen Here
Although antibiotics have been the cornerstone of treatment of diverticulitis, recommendations have pivoted away from this routine practice. This episode reviews the literature and guideline recommendations for the treatment of acute, uncomplicated diverticulitis.
References:
- Stollman N, Smalley W, Hirano I, AGA Institute Clinical Guidelines Committee. American Gastroenterological Association Institute Guideline on the Management of Acute Diverticulitis. Gastroenterology. 2015;149(7):1944-1949.
- Qaseem A, Etxeandia-Ikobaltzeta I, Lin JS, et al. Diagnosis and Management of Acute Left-Sided Colonic Diverticulitis: A Clinical Guideline From the American College of Physicians. Ann Intern Med. 2022;175(3):399-415.
- Hall J, Hardiman K, Lee S, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Treatment of Left-Sided Colonic Diverticulitis. Dis Colon Rectum. 2020;63(6):728-747.
- Fugazzola P, Ceresoli M, Coccolini F, et al. The WSES/SICG/ACOI/SICUT/AcEMC/SIFIPAC guidelines for diagnosis and treatment of acute left colonic diverticulitis in the elderly. World J Emerg Surg. 2022;17(1):5.
- Chabok A, Påhlman L, Hjern F, Haapaniemi S, Smedh K; AVOD Study Group. Randomized clinical trial of antibiotics in acute uncomplicated diverticulitis. Br J Surg. 2012 Apr;99(4):532-9. doi: 10.1002/bjs.8688. Epub 2012 Jan 30. PMID: 22290281.
- Daniels L, Ünlü Ç, de Korte N, van Dieren S, Stockmann HB, Vrouenraets BC, Consten EC, van der Hoeven JA, Eijsbouts QA, Faneyte IF, Bemelman WA, Dijkgraaf MG, Boermeester MA; Dutch Diverticular Disease (3D) Collaborative Study Group. Randomized clinical trial of observational versus antibiotic treatment for a first episode of CT-proven uncomplicated acute diverticulitis. Br J Surg. 2017 Jan;104(1):52-61. doi: 10.1002/bjs.10309. Epub 2016 Sep 30. PMID: 27686365.
The post Management of Acute, Uncomplicated Diverticulitis first appeared on FOAMcast.
Apple Podcasts, Spotify, or Listen Here
References:
- Wray JP, Bridwell RE, Schauer SG, Shackelford SA, Bebarta VS, Wright FL, Bynum J, Long B. The diamond of death: Hypocalcemia in trauma and resuscitation. Am J Emerg Med. 2021 Mar;41:104-109. doi: 10.1016/j.ajem.2020.12.065. Epub 2020 Dec 28. PMID: 33421674.
- Giancarelli A, Birrer KL, Alban RF, Hobbs BP, Liu-DeRyke X. Hypocalcemia in trauma patients receiving massive transfusion. J Surg Res. 2016 May 1;202(1):182-7. doi: 10.1016/j.jss.2015.12.036. Epub 2015 Dec 30. PMID: 27083965.
- Webster S, Todd S, Redhead J, Wright C. Ionised calcium levels in major trauma patients who received blood in the Emergency Department. Emerg Med J. 2016 Aug;33(8):569-72. doi: 10.1136/emermed-2015-205096. Epub 2016 Feb 4. PMID: 26848163.
The post The “Diamond of Death” in Trauma – Hypocalcemia first appeared on FOAMcast.
Apple Podcasts, Spotify, or Listen Here
This episode is a departure from the typical FOAMcast clinical content, we will be back with strictly clinical content soon.
In May 2022, I came across a fellow passenger and stranger in cardiac arrest at the Charlotte airport. A small team of strangers, including an emergency medicine resident, Dr. Jason Tanner, and an emergency department technician, Angel, assembled to treat this passenger. Billy Frolick, a writer and our patient that day shares his perspective on his case with us. This story is a reminder of the importance of continuous chest compressions, early defibrillation, and that what we do in emergency and prehospital medicine matters. For more on why we should, in accordance with guidelines, abandon routine pulse checks, see this podcast: https://foamcast.org/2022/09/04/pulse-checks-during-cardiopulmonary-resuscitation/ or this article: https://www.acepnow.com/article/stop-performing-routine-pulse-checks-during-cpr/
The post A Cardiac Arrest Story: Patient Interview first appeared on FOAMcast.
Apple Podcasts, Spotify, Listen Here
This episode covers the 2022 American College of Emergency Physicians (ACEP) clinical policy on acute heart failure syndromes with a special focus on high-dose nitrates The 2007 ACEP clinical policy can be found here.
References:
- American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Acute Heart Failure Syndromes. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Heart Failure Syndromes: Approved by ACEP Board of Directors, June 23, 2022. Ann Emerg Med. 2022 Oct;80(4):e31-e59. doi: 10.1016/j.annemergmed.2022.05.027. PMID: 36153055.
- Silvers SM, Howell JM, Kosowsky JM, Rokos IC, Jagoda AS; American College of Emergency Physicians. Clinical policy: Critical issues in the evaluation and management of adult patients presenting to the emergency department with acute heart failure syndromes. Ann Emerg Med. 2007 May;49(5):627-69. doi: 10.1016/j.annemergmed.2006.10.024. Epub 2007 Apr 3. Erratum in: Ann Emerg Med. 2010 Jan;55(1):16. PMID: 17408803.
- Levy P, Compton S, Welch R, Delgado G, Jennett A, Penugonda N, Dunne R, Zalenski R. Treatment of severe decompensated heart failure with high-dose intravenous nitroglycerin: a feasibility and outcome analysis. Ann Emerg Med. 2007 Aug;50(2):144-52. doi: 10.1016/j.annemergmed.2007.02.022. Epub 2007 May 23. PMID: 17509731.
- Cotter G, Metzkor E, Kaluski E, Faigenberg Z, Miller R, Simovitz A, Shaham O, Marghitay D, Koren M, Blatt A, Moshkovitz Y, Zaidenstein R, Golik A. Randomised trial of high-dose isosorbide dinitrate plus low-dose furosemide versus high-dose furosemide plus low-dose isosorbide dinitrate in severe pulmonary oedema. Lancet. 1998 Feb 7;351(9100):389-93. doi: 10.1016/S0140-6736(97)08417-1. PMID: 9482291.
- Wilson SS, Kwiatkowski GM, Millis SR, Purakal JD, Mahajan AP, Levy PD. Use of nitroglycerin by bolus prevents intensive care unit admission in patients with acute hypertensive heart failure. Am J Emerg Med. 2017 Jan;35(1):126-131. doi: 10.1016/j.ajem.2016.10.038. Epub 2016 Oct 18. PMID: 27825693.
- Wang K, Samai K. Role of high-dose intravenous nitrates in hypertensive acute heart failure. Am J Emerg Med. 2020 Jan;38(1):132-137. doi: 10.1016/j.ajem.2019.06.046. Epub 2019 Jun 25. PMID: 31327485.
- Perlmutter MC, Cohen MW, Stratton NS, Conterato M. Prehospital Treatment of Acute Pulmonary Edema with Intravenous Bolus and Infusion Nitroglycerin. Prehosp Disaster Med. 2020 Dec;35(6):663-668. doi: 10.1017/S1049023X20001193. Epub 2020 Oct 7. PMID: 33023684.
The post ACEP Clinical Policy on Heart Failure Syndromes & High Dose Nitrates first appeared on FOAMcast.
Apple Podcasts, Spotify, Listen Here
In this episode, we review the largest trial of double sequential external defibrillation (DSED) and vector change (VC) defibrillation for refractory ventricular fibrillation (VFib): Cheskes S, Verbeek PR, Drennan IR, et al. Defibrillation Strategies for Refractory Ventricular Fibrillation. N Engl J Med. 2022;387(21):1947-1956.
The post Refractory Ventricular Fibrillation: Double Sequential Defibrillation/Vector Change first appeared on FOAMcast.
Apple Podcasts, Spotify, or Listen Here The American College of Cardiology released a new consensus statement, “Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department: A Report of the American College of Cardiology Solution Set Oversight Committee“. This document has several algorithms for managing chest pain –
The post STEMI Equivalent Update – 2022 ACC Consensus Statement first appeared on FOAMcast.
Apple Podcasts, Spotify, Listen Here Since 2010, the American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) have recommended against routine pulse checks during CPR. More than a decade has elapsed since this time, yet many people are continuing to perform pulse checks every couple of minutes during CPR. In this episode, and in this
The post Pulse Checks During Cardiopulmonary Resuscitation first appeared on FOAMcast.
Apple Podcasts, Spotify Updated July 29, 2022 In a three-part series, we review the current status of the monkeypox outbreak. Episode 1: Virology, Transmission, Epidemiology Episode 2: Clinical Manifestations, Treatment, Vaccination Episode 3: The TLDR Quick Summary Patel A et al. Clinical features and novel presentations of human monkeypox in a central London centre during the
The post Monkeypox first appeared on FOAMcast.
Apple Podcasts, Spotify, Listen Here There are practice-changing updates in the guidelines from the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST), found here. In this podcast, we review hemorrhoids and management.
The post Hemorrhoids first appeared on FOAMcast.
Apple Podcasts , Spotify, Listen Here Diphenhydramine and other first-generation antihistamines are ubiquitous in medicine cabinets across the globe. Clinicians commonly recommend or administer diphenhydramine (Benadryl) for a variety of diseases – anaphylaxis, allergic reactions, urticaria, benign headaches/migraines, and as a sleep aid. However, professional societies have recommended against many of these indications for decades and, in
The post The End of Diphenhydramine first appeared on FOAMcast.
Apple Podcasts , Spotify, Listen Here In this podcast, we review acute urticaria (<6 weeks in duration). We review the recent international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria (Zuberbier et al) In addition, we review some of the controversy regarding the administration of steroids for acute urticaria.
The post Urticaria first appeared on FOAMcast.
Apple Podcasts , Spotify, Listen Here Intramuscular chemical sedation is commonly used in the emergency department (ED) for severe agitation and physical assault when other attempts at de-escalation and agitation control (verbal de-escalation, space, etc) are unsuccessful. The “cocktails” people use are often institution-based. In this podcast, we review commonly used intramuscular agents along with recent papers including
The post Intramuscular Sedation for Severe Agitation first appeared on FOAMcast.
Apple Podcasts , Spotify, Listen Here Guidelines have recommended outpatient management for patients with low-risk pulmonary embolism (PE) for many years. Despite this, few patients in the US diagnosed with acute PE are discharged from the Emergency Department (Westafer et al). Little is known about the course of patients managed exclusively or primarily in the outpatient setting. In
The post Primary Care Management of Pulmonary Embolism first appeared on FOAMcast.
Apple Podcasts , Spotify, Listen Here The diagnostic algorithm for pulmonary embolism (PE) has evolved over the past few years to include probability or risk-adjusted D-dimer. The YEARS algorithm includes an elevated D-dimer threshold for some risk groups and has been found to be safe and reduce imaging in several studies, including in pregnant patients. Now, this multicenter
The post Pulmonary Embolism Diagnosis Update first appeared on FOAMcast.
Apple Podcasts , Spotify, Listen Here A single-center randomized trial in 2018 by Driver et al found an incredible 98% first-pass success for endotracheal intubation in the group randomized to a structured bougie-first approach, compared with 87% in those randomized to stylet. In this podcast, we review a multi-center study by Driver et al examining bougie vs stylet
The post Bougie Vs Stylet for Endotracheal Intubation first appeared on FOAMcast.
Apple Podcasts , Spotify, Listen Here Subsegmental pulmonary embolism (SSPE) is a controversial entity as they have uncertain clinical significance. As a result, the Chest and ACEP guidelines state that a very select group of patients with isolated SSPE and no deep vein thrombosis may be managed with surveillance rather than anticoagulation. In this podcast, we review SSPE
The post Subsegmental Pulmonary Embolism first appeared on FOAMcast.
Apple Podcasts , Spotify, Listen Here On November 2, 2021, the US CDC Advisory Council on Immunization Practices recommended the Pfizer-BioNTech mRNA covid-19 vaccine for children ages 5-11. In this podcast we review the data in the Pfizer briefing document to the FDA as well as that presented at the ACIP meeting. References for myocarditis: Witberg et al
The post COVID-19 mRNA vaccine ages 5-11 first appeared on FOAMcast.