ICEP EM on Tap Podcast: Episode 04 – 2019 Resident Competition

Congratulations to the winners of the 2019 Resident Podcast Competition! This episode of ICEP EM on Tap features the top three entries:

1st Place

Res EM Podcast: Trends in Drug Culture

Evan Sands, MD
Casey Collier, MD, FACEP
AMITA Health Resurrection Medical Center, Chicago, IL

2nd Place

Dual Sequential Defibrillation for Refractory Ventricular Fibrillation

Jonathan Alterie, DO
Nicholas Gross, DO
Midwestern University, Chicago, IL

3rd Place

The Algo-rhythm Series: Routine Wound Management and Tetanus Prophylaxis

Karan Thakkar, MS4
Nova Southeastern University College of Osteopathic Medicine, Plantation, FL

Show Notes:

Res EM Podcast: Trends in Drug Culture

In this edition of the Res EM Podcast, we explore some of the recent changes in the ever-evolving world of mainstream drug culture and how it shapes the practice of emergency medicine. Dr. Evan Sands discusses a wide range of topics, including:

• MDMA and its derivatives
• Kratom
• Cathinones, or “bath salts”
• The advancement and complexity of heroin

Dual Sequential Defibrillation for Refractory Ventricular Fibrillation

This podcast will discuss the use of dual sequential defibrillation in refractory ventricular
fibrillation. We will address the proper setup and pad placement for dual sequential
defibrillation, the theories on why it works, the research behind it, and the patient
populations that would most likely benefit.

How does it work – It’s simple! It requires two defibrillators, for a total of four pads,
placed in either anterior-posterior plus anterior-lateral, or both in the anterior-lateral
positions. Just make sure they are not touching. Charge both machines as you would
normally, and push the discharge buttons at the same time.

Which patient population benefit from dual sequential defibrillation? – A small
percentage of patients who go into ventricular fibrillation go on to develop refractory
ventricular fibrillation, a stubborn, deadly arrhythmia that you’ll likely come face to face
with in your practice. Most authors agree that the definition of refractory ventricular
fibrillation is ventricular fibrillation that persists or recurs despite standard pharmacologic
therapy and at least 3 attempts of defibrillation. These patients who go into refractory
ventricular fibrillation are those you may want to use dual sequential defibrillation onhowever,
there are no strict guidelines or recommendations at this time.

What does the research show – There are no great meta-analyses or large prospective
studies for this topic. The initial studies were done by cardiologist on canines in the
1980’s. They concluded that sequential shocks with different vectors reduce both the
energy and the voltage required to terminate an arrythmia. Since then, there have been
case studies and retrospective reviews in the Emergency Medicine and prehospital
world that show some evidence of terminating refractory ventricular fibrillation, which
has a mortality of 97%. Dual sequential defibrillation has shown improvement in
termination of the arrhythmia, but no significant change in mortality. Future research
may investigate whether earlier use of dual sequential defibrillation is more beneficial,
as most studies have utilized dual sequential defibrillation only after 3 attempts using a
single unit defibrillator.

The Algo-rhythm Series: Routine Wound Management and Tetanus Prophylaxis

In this podcast series titled “Algo-Rhythm”,  Karan breaks down diagnostic and treatment algorithms and layers them over self-produced instrumentals in which musical elements are introduced in a stepwise fashion, in parallel with the algorithm being taught. In this special edition of Algo-Rhythm, Karan reviews common terms and indications for the administration of Td, Tdap, and TIG, simplifying routine wound management for students approaching clinical vignettes or seeing a patient presenting to the ED after suffering a physical insult to the skin.