Core EM - Emergency Medicine Podcast – Détails, épisodes et analyse

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Core EM - Emergency Medicine Podcast

Core EM

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Fréquence : 1 épisode/18j. Total Éps: 235

Core EM Emergency Medicine Podcast

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Données mises à jour le 27/10/2026

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Episode 229: Iron Poisoning

Épisode 229

lundi 26 octobre 2026 • Durée 12:20

https://coreem.net/podcast/episode-229-iron-poisoning/

Iron overdose in the ED: five stages, elemental iron math, decontamination, and deferoxamine.

Hosts:
Brian Chastain, MD
Brian Gilberti, MD

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Iron_Poisoning.mp3 Download Leave a Comment Tags: Toxicology Podcast Video Show Notes Core EM Modular CME Course

Maximize your commute with the new Core EM Modular CME Course, featuring the most essential content distilled from our top-rated podcast episodes. This course offers 12 audio-based modules packed with pearls! Information and link below. Course Highlights:

Credit: 12.5 AMA PRA Category 1 Credits™
Curriculum: Comprehensive coverage of Core Emergency Medicine, with 12 modules spanning from Critical Care to Pediatrics.
Cost:
- Free for NYU Learners
- $250 for Non-NYU Learners

Click Here to Register and Begin Module 1 Iron Poisoning Stages at a Glance Stage Timing What’s happening 1 · GI 30 min–6 h Direct corrosive GI injury; abd pain, vomiting 2 · Latent 6–24 h GI sx improve; iron redistributing into tissues 3 · Shock / acidosis 6–72 h Profound metabolic acidosis → shock, MSOF 4 · Hepatotoxicity 12–96 h Hepatotoxicity → fulminant liver failure 5 · GI scarring 2–8 wks Gastric outlet obstruction, GI tract scarring The Case

31M w/ hx depression, anxiety; found minimally responsive at home by family
EMS: HR 67, SpO2 96% on 2 L NC, BP 46/21; withdraws to pain, not opening eyes → 2 L IVF + push-dose epi en route
ED: BP ↑ to 90/61, other VS unchanged; dried vomit on lips/shirt; breathing comfortably, protecting airway
POC VBG: pH 7.24, pCO2 33, pO2 25, HCO3 14, lactate 2.5
ECG: NSR, otherwise unremarkable → get an ECG in any possible toxic ingestion
Additional 30 mL/kg bolus + norepi gtt
Family arrives → bottle of iron pills under the pt’s bed

Pathophysiology

Free iron = multisystem oxidative injury
Primary mechanism: free radical generation + lipid peroxidation → damages cellular and mitochondrial membranes throughout the body
Profound metabolic acidosis via 2 routes: uncoupled oxidative phosphorylation → anaerobic metabolism → lactate; Fe³⁺ reacts w/ water → releases 3 H⁺ → excess acid
Direct mucosal necrosis in the gut (corrosive injury)
Negative inotrope on the myocardium → hypotension, cardiogenic shock in large ingestions

Clinical Stages

Classic progression after large ingestions; stages overlap and pts can present anywhere along the timeline
Stage 1, GI (30 min–6 h): direct GI tract injury; abd pain, vomiting. Persistent vomiting = very sensitive indicator of a serious ingestion
Stage 2, latent (6–24 h): GI sx improve, but iron is redistributing into the tissues → ongoing damage
The latent-phase trap: pts look like they’re turning the corner right before they crump. Contrast: pts never symptomatic >6 h after ingestion are unlikely to develop toxicity (AAPCC 2005); GI sx that improve ≠ never symptomatic
Stage 3, shock (6–72 h): tissue iron → profound acidosis → shock, MSOF
Stage 4, hepatotoxicity (12–96 h): hepatotoxicity → fulminant liver failure
Stage 5, GI scarring (2–8 wks): gastric outlet obstruction, GI tract scarring from the initial corrosive injury

Diagnosis / Workup Imaging

Emergent plain-film abd XR in any suspected iron ingestion → intact adult iron tabs are radiopaque
Confirms pills still in the stomach/GI tract → helps decide on WBI
Negative XR ≠ no ingestion: chewables, liquid formulations and already-dissolved tabs often don’t show up

Serum Iron

Draw 4–6 h post-ingestion for regular formulations, ~8 h for extended release
Often hard to interpret → time of ingestion and formulation frequently unknown
>500 mcg/dL → serious systemic toxicity
>1,000 mcg/dL → very significant mortality

Elemental Iron Math

Toxicity tracks the elemental iron dose, not the mass of the pill

Salt Elemental Fe Per 325 mg tab Ferrous sulfate ~20% ~65 mg Ferrous fumarate ~33% 106 mg Ferrous gluconate ~12% ~36–38 mg

<20 mg/kg elemental Fe → usually asymptomatic
20–60 mg/kg → GI sx likely; systemic toxicity possible, esp. at the upper end
>60 mg/kg → threshold for serious toxicity, possible death
AAPCC out-of-hospital guideline: refer to an ED for ≥40 mg/kg elemental Fe (adult ferrous salt formulations) or severe/persistent sx; any self-harm ingestion → ED regardless of amount (Manoguerra 2005)
AAPCC: children’s chewable vitamins w/ iron, and unintentional carbonyl iron or polysaccharide-iron complex ingestions → home obs w/ f/u

Management Decontamination

Activated charcoal: no role. Iron is a metal → doesn’t bind; ↑ aspiration and other complications
Whole bowel irrigation (WBI) = main decontamination strategy, esp. w/ pills on XR → flush tablets before further GI injury and systemic absorption
PEG-ELS (polyethylene glycol electrolyte solution) until rectal effluent is clear; large volume → often via NG tube
PEG-ELS rates: 1.5–2 L/h adolescents/adults (as on air); peds 500 mL/h (9 mo–6 y), 1 L/h (6–12 y) (AACT/EAPCCT 1997)
AACT/EAPCCT: consider WBI after substantial iron ingestions; contraindicated w/ bowel obstruction, perforation, ileus, hemodynamic instability or a compromised unprotected airway (Thanacoody 2015)
Gastric lavage: generally not used unless a large pill burden remains in the stomach → aspiration, direct GI injury; ED unfamiliarity ↑ complications
Get toxicology and your local poison center on the line early

Deferoxamine (DFO)

Mechanism: chelator isolated from bacteria → binds iron in the blood (ferrioxamine) → renal excretion in the urine
Indications: shock · AMS · profound metabolic acidosis · persistent GI sx (persistent vomiting) · serum iron >500 mcg/dL · predicted severe ingestion (>60 mg/kg elemental Fe) in a symptomatic pt
Reported dose >60 mg/kg in a pt w/o sx or acidosis → discuss w/ toxicology/poison center rather than chelating on pill count alone
Dosing: start 5 mg/kg/h IV → titrate to ~15 mg/kg/h. Some protocols go higher, up to ~30 mg/kg/h in the first 24 h.
Watch for hypotension: DFO can worsen existing hypotension.
FDA label: IV only for cardiovascular collapse, by slow infusion; ≤15 mg/kg/h initially; max 6 g/24 h; ARDS reported w/ excessively high IV doses; ↑ risk of Yersinia infxn.
Urine: classic “vin rosé” (red-orange) urine = ferrioxamine being excreted → helpful but not quantitative. Its absence doesn’t exclude significant toxicity or effective chelation; don’t use urine color to guide duration.
Stop when the pt is clinically well and the anion gap acidosis has resolved.

Pitfalls

Waiting for a level → a level that hasn’t peaked or looks low doesn’t exclude toxicity in a sick pt
Being reassured by GI improvement in the latent phase
Being reassured by a negative XR (chewables, liquids, dissolved tabs)
Dosing by tablet weight instead of elemental iron
Giving activated charcoal
Using urine color (or its absence) to decide when to stop DFO

Take-Home Points

Treat the patient, not the number. Shock or profound metabolic acidosis → start DFO even if the serum iron hasn’t peaked or is lower than expected; very little harm in starting it, other than hypotension
Calculate elemental iron. Formulations differ in elemental content → helps predict whether the dose is toxic
Get an X-ray. Plain film confirms tablets and guides the decision on WBI
Beware the latent phase. GI improvement ≠ toxicity over → often precedes cardiovascular collapse and shock as iron moves into the tissues

Links & References Guidelines

Manoguerra AS, et al. Iron ingestion: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila). 2005;43(6):553–570. — DOI (AAPCC)
Dart RC, et al. Expert consensus guidelines for stocking of antidotes in hospitals that provide emergency care. Ann Emerg Med. 2018;71(3):314–325.e1. — DOI

Decontamination Position Statements (AACT/EAPCCT)

Tenenbein M. Position statement: whole bowel irrigation. American Academy of Clinical Toxicology; European Association of Poisons Centres and Clinical Toxicologists. J Toxicol Clin Toxicol. 1997;35(7):753–762. — DOI
Thanacoody R, et al. Position paper update: whole bowel irrigation for gastrointestinal decontamination of overdose patients. Clin Toxicol (Phila). 2015;53(1):5–12. — DOI
Chyka PA, et al. Position paper: single-dose activated charcoal. Clin Toxicol (Phila). 2005;43(2):61–87. — DOI
Benson BE, et al. Position paper update: gastric lavage for gastrointestinal decontamination. Clin Toxicol (Phila). 2013;51(3):140–146. — DOI

Poison Center

Poison Help line (US): 1-800-222-1222

Music

Outro music: “Metalmania” Kevin MacLeod (incompetech.com). Licensed under Creative Commons: By Attribution 4.0 License

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Episode 228: Tickborne Illnesses

Épisode 228

lundi 19 octobre 2026 • Durée

https://coreem.net/podcast/episode-228-tickborne-illnesses/

Tickborne illnesses in the ED: attachment time, the rash, the smear, prophylaxis, & treatment.

Hosts:
Samantha Nakos, MD
Brian Gilberti, MD

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Tickborne_Illnesses_1_.mp3 Download Leave a Comment Tags: Babesiosis, Ehrlichiosis, Infectious Diseases, Lyme Disease, Tick-Borne Illnesses Podcast Video Show Notes Core EM Modular CME Course

Lyme, Anaplasmosis, Ehrlichiosis & Babesiosis at a Glance Lyme Anaplasmosis Ehrlichiosis Babesiosis Organism (spirochete) (protozoan) Vector Lone star tick Attachment time ≥36–48 h Can be <24 h No data Mostly >48 h Key clue EM rash ↓WBC, ↓plt, ↑LFTs ↓WBC, ↓plt, ↑LFTs Hemolysis, ↓plt Smear — Morulae in neutrophils Morulae in monocytes Intra-RBC parasites, Maltese cross Confirm Clinical (EM) Smear, PCR Smear, PCR Smear, PCR Treat Doxy × 10–14 d Doxy × 10 d Doxy until ≥3 d afebrile Atovaquone + azithro × 7–10 d Background Lyme: The Rash and the Serology Erythema Migrans Serology The Other Three: Labs and the Smear Babesiosis Anaplasmosis & Ehrlichiosis Management Post-Bite Prophylaxis (Lyme) Active Disease Severe Babesiosis The Case Pitfalls Take-Home Points Links & References Guidelines Key Studies CDC

Episode 227: Diarrhea

Épisode 227

jeudi 24 septembre 2026 • Durée 14:58

https://coreem.net/podcast/episode-227-diarrhea/

Acute diarrhea in the ED: stool testing, treatment, and a spotlight on Cyclospora.

Hosts:
Neya Vishwanath, MD
Brian Gilberti, MD

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Diarrhea.mp3 Download Leave a Comment Tags: Gastrointestinal, Gastrointestinal Diseases Podcast Video Show Notes Core EM Modular CME Course

Credit: 12.5 AMA PRA Category 1 Credits™
Curriculum: Comprehensive coverage of Core Emergency Medicine, with 12 modules spanning from Critical Care to Pediatrics.
Cost:
- Free for NYU Learners
- $250 for Non-NYU Learners

Framing the Patient Don’t-Miss Mimics History & Exam Who Gets Testing Management Disposition Cyclospora Take Home Points

Episode 226: Superwarfarin Toxicity

Épisode 226

mardi 11 août 2026 • Durée 13:54

https://coreem.net/podcast/episode-226-superwarfarin-toxicity/

Superwarfarin toxicity: recognition, reversal, and prolonged vitamin K therapy.

Hosts:
Mac Josh Reandelar, DO
Avir Mitra, MD

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Superwarfarin_Toxicity.mp3 Download Leave a Comment Tags: Toxicology Show Notes Toxicology & Pathophysiology

Long-acting vitamin K antagonists (LA-VKAs), developed as potent rodenticides
Examples: brodifacoum, bromadiolone, difenacoum, chlorophacinone
Much more potent + far longer acting than warfarin
MOA: inhibits VKORC1 → ↓ vitamin K recycling → impaired γ-carboxylation
↓ factors II, VII, IX, X + proteins C/S
Highly lipophilic → extensive tissue/fat sequestration + slow redistribution
Effect can persist weeks-months; occasionally much longer
Not dialyzable
Exposure: large acute ingestion OR repeated low-dose exposure

Presentation Labs & Diagnosis Elevated INR: Differential ED Management Major/Life-Threatening Bleeding No Major Bleeding, Critical INR Poison Control The Long Game Take Home Points

Episode 225: Group A Strep

Épisode 225

mardi 14 juillet 2026 • Durée

https://coreem.net/podcast/episode-225-group-a-strep/

Group A strep in the pediatric ED: from strep throat to invasive disease and toxic shock.

Host:
Ellen Duncan, MD, PhD
Brian Gilberti, MD

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Group_A_Strep.mp3 Download Leave a Comment Tags: Infectious Diseases, Pediatrics Show Notes

Background

Group A strep = Streptococcus pyogenes — gram-positive organism that colonizes the pharynx, but also the perianal and genital mucosa (worth remembering when the source isn’t the throat).
Extremely common. The episode cites an estimated ~289 million cases/yr of strep pharyngitis in children 5–14 (NIH). For a U.S.-specific, verifiable anchor: the CDC estimates strep throat drives in people <65.

Pathophysiology — the throughline Clinical Presentation Diagnosis / Workup Centor / Modified (McIsaac) Score Testing Who to test Management The Bounce-Back / Treatment Failure Complications Invasive Group A Strep (iGAS) Why it’s on the radar The spectrum The trap — nonspecific early presentation Workup Management The Kawasaki overlap Take-Home Points Links & References Calculators Guidelines CDC

Episode 224: Kidney Stones

Épisode 224

lundi 8 juin 2026 • Durée

https://coreem.net/podcast/episode-224-kidney-stones/

A guide to diagnosing, imaging, and managing acute renal colic and nephrolithiasis in the ED.

Hosts:
Brian Gilberti, MD
Avir Mitra, MD

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Nephrolithiasis.mp3 Download Leave a Comment Tags: Kidney Stones, Urology Show Notes 1. CLINICAL CORE & PHYSIOLOGIC FRAMEWORK

Epidemiologic Risk Profiles
- Lifetime incidence parameters hover around 1 in 11, presenting with a prominent male sex skew.
- Peak demographic manifestation concentrated within the 30–60 age band.
- High-yield temporal parameter: 50% recurrence vector within a 5-year post-initial-insult window.
Mineralogical Composition Vectors
- Calcium oxalate crystals represent the predominant structural matrix.

2. EXCLUSION DIAGNOSES & CRITICAL PATHWAY RED FLAGS 3. LABORATORY TESTING & PHYSIOLOGIC EVALUATION 4. IMAGING MODALITIES & ALGORITHMIC CLINICAL SELECTION 5. 6. IMAGING SELECTION MATRIX 7. EMERGENCY PHARMACOTHERAPY & COLIC MANAGEMENT 8. MEDICAL EXPULSIVE THERAPY (MET) CLINICAL PARAMETERS 9. SPONTANEOUS PASSAGE PROBABILITIES 10. ADMISSION ARCHITECTURE & UROLOGIC CONSULTATION CRITERIA Refractory Symptom Complexes 11. OUTPATIENT DISCHARGE MATRICES & SAFETY NETTING 12. CLINICAL PEARLS & QUICK-REFERENCE SUMMARY NOTES

Episode 223: Thyroid Storm

Épisode 223

vendredi 15 mai 2026 • Durée 09:16

https://coreem.net/podcast/episode-223-thyroid-storm/

Diagnosis, workup, and the four-step treatment protocol for thyroid storm.

Hosts:
Annaliese Elam, MD
Brian Gilberti, MD

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Thyroid_Storm.mp3 Download Leave a Comment Tags: Critica Care, Endocrine, Thyroid Storm Show Notes I. Pathophysiology & Diagnosis

Definition: Life-threatening hypermetabolic state resulting from decompensated thyrotoxicosis.

Hormonal Profile: Absolute levels of total T₄/T₃ often mirror uncomplicated thyrotoxicosis; storm is driven by rapid rate of rise, increased catecholamine sensitivity, or increased free T₄/T₃ concentrations.

Clinical Presentation:

II. Laboratory & Ancillary Findings III. Management: The Four-Step Blocking Strategy IV. Supportive Care & Avoidance Measures Take Home Points I. Diagnostic Essentials II. The Four-Step Blocking Strategy III. Critical Supportive Care

Episode 222: Local Anesthetic Systemic Toxicity (LAST)

Épisode 222

mardi 7 avril 2026 • Durée

https://coreem.net/podcast/episode-222-local-anesthetic-systemic-toxicity-last/

We discuss this ominous complication of providing local anesthesia.

Hosts:
Elaine Jonas, MD
Brian Gilberti, MD

https://media.blubrry.com/coreem/content.blubrry.com/coreem/LAST.mp3 Download Leave a Comment Tags: Critical Care, Toxicology Show Notes I. Pathophysiology & Mechanisms

Definition: Systemic toxicity secondary to local anesthetic (LA) via accidental intravascular injection or excessive systemic absorption.
Threshold: Occurs when plasma concentration exceeds the safety threshold for cardiac and neural tissue.
Agent Profile: Bupivacaine (High Risk)
- Highly lipophilic with high protein binding.
- “Fast-on, Slow-off” Kinetics: Strong Na+ channel binding with extremely slow dissociation during diastole.

II. Risk Assessment & Prevention Patient-Specific Risk Factors Procedural Risk Factors Prevention Mandates III. Clinical Presentation Neurologic Phase (Early to Late) Cardiovascular Phase IV. Immediate Management Algorithm 1. Initial Actions 2. Seizure Control 3. Lipid Emulsion Therapy 20% 4. Modified ACLS V. Differential Diagnosis for the Peri-Procedural Patient VI. Post-Resuscitation & Complications VII. Clinical “Red Flags” for Toxicity

Episode 221: High-Output Heart Failure

Épisode 221

mardi 24 mars 2026 • Durée

https://coreem.net/podcast/episode-221-high-output-heart-failure/

We discuss the diagnosis and treatment of one of EM's paradoxes: High-Output Heart Failure.

Hosts:
Nicolas Gonzalez, MD
Brian Gilberti, MD

https://media.blubrry.com/coreem/content.blubrry.com/coreem/HOHF.mp3 Download Leave a Comment Tags: Cardiology Show Notes Core EM Modular CME Course

Course Highlights:

Credit: 12.5 AMA PRA Category 1 Credits™
Curriculum: Comprehensive coverage of Core Emergency Medicine, with 12 modules spanning from Critical Care to Pediatrics.
Cost:
- Free for NYU Learners
- $250 for Non-NYU Learners

Click Here to Register and Begin Module 1 1. Core Definition & Hemodynamic Profile 2. Pathophysiology: The Hemodynamic Paradox 3. Differential Diagnosis: Etiological “Buckets” Category A: Increased Metabolic Demand (Systemic) Category B: Peripheral Vascular Effects (Shunting/Vasodilation) 4. Special Focus: Hemodialysis Access-Induced HOHF Physiologic Phases of AVF Creation: 5. Point-of-Care Physical Exam & Maneuvers 6. Diagnostic Workup (Technical Targets) POCUS / Echocardiography: Laboratory Evaluation: 7. Management Strategy: A Stepwise Approach Phase 1: Immediate Stabilization (Volume Offloading) Phase 2: Targeted Therapy (Etiology Specific) Phase 3: Surgical/Interventional Salvage (Refractory AVF Cases) 8. Key Clinical Takeaways

Episode 220: Post-ROSC Care

Épisode 220

mardi 3 mars 2026 • Durée

https://coreem.net/podcast/episode-220-post-rosc-care/

We explore how to refine and optimize care in the vital minutes following ROSC.

Hosts:
Jonathan Elmer, MD, MS
Brian Gilberti, MD

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Post-ROSC_care.mp3 Download Leave a Comment Show Notes Core EM Modular CME Course

Course Highlights:

Credit: 12.5 AMA PRA Category 1 Credits™
Curriculum: Comprehensive coverage of Core Emergency Medicine, with 12 modules spanning from Critical Care to Pediatrics.
Cost:
- Free for NYU Learners
- $250 for Non-NYU Learners

Click Here to Register and Begin Module 1 I. Phase 1: Stabilization (Minutes 0–10) The “Rearrest” Window & Pathophysiology Immediate Resuscitative Actions II. Phase 2: Diagnostic Workup (Minutes 10–40) Etiology Epidemiology The “Broad Net” Strategy III. Hemodynamic & Respiratory Targets Mean Arterial Pressure (MAP) Ventilation and Oxygenation IV. Neurological Prognostication & Communication The “Stunned” Brain Family Engagement

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Core EM - Emergency Medicine Podcast – Détails, épisodes et analyse

Détails du podcast

Classements récents

Apple Podcasts

Spotify

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Other99+

U.S. National Library of Medicine99+

DOI Foundation17

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Historique des publications

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Podcasts Similaires Basées sur le Contenu

Podcasts Similaires Basées sur le Contenu

Other99+

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DOI Foundation17

Apple Podcasts

Spotify