We dive into the recognition and management of blast crisis.
Hosts:
Sadakat Chowdhury, MD
Brian Gilberti, MD
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Blast_Crisis.mp3
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Tags: Hematology, Oncology
Show Notes
Topic Overview
Blast crisis is an oncologic emergency, most commonly seen in chronic myeloid leukemia (CML).
Defined by:
>20% blasts in peripheral blood or bone marrow.
May include extramedullary blast proliferation.
Without treatment, median survival is only 3–6 months.
Pathophysiology & Associated Conditions
Usually occurs in CML, but also in:
Myeloproliferative neoplasms (MPNs)
Myelodysplastic syndromes (MDS)
Transition from chronic to blast phase often reflects disease progression or treatment resistance.
Risk Factors
10% of CML patients progress to blast crisis.
Risk increased in:
Patients refractory to tyrosine kinase inhibitors (e.g., imatinib).
Those with Philadelphia chromosome abnormalities.
WBC >100,000, which increases risk for leukostasis.
Clinical Presentation
Symptoms often stem from pancytopenia and leukostasis:
Anemia: fatigue, malaise.
Functional neutropenia: high WBC count, but increased infection/sepsis risk.
Thrombocytopenia: bleeding, bruising.
Leukostasis/hyperviscosity effects by system:
Neurologic: confusion, visual changes, stroke-like symptoms.
Cardiopulmonary: ARDS, myocardial injury.
Others: priapism, limb ischemia, bowel infarction.
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Episode 208: Geriatric Emergency Medicine
We explore the expanding field of Geriatric Emergency Medicine.
Hosts:
Ula Hwang, MD
Brian Gilberti, MD
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Geriatric_Emergency_Medicine.mp3
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Tags: Geriatric
Show Notes
Key Topics Discussed
Importance and impact of geriatric emergency departments.
Optimizing care strategies for geriatric patients in ED settings.
Practical approaches for non-geriatric-specific EDs.
Challenges in Geriatric Emergency Care
Geriatric patients often present with:
Multiple chronic conditions
Polypharmacy
Functional decline (mobility issues, cognitive impairments, social isolation)
Adapting Clinical Approach
Core objective remains acute issue diagnosis and treatment.
Additional considerations for geriatric patients:
Review and caution with medications to prevent adverse reactions.
Address functional limitations and cognitive impairments.
Emphasize safe discharge and care transitions to prevent unnecessary hospitalization.
Identifying High-Risk Geriatric Patients
Screening tools:
Identification of Seniors at Risk (ISAR)
Frailty screens
Alignment with the “Age-Friendly Health Systems” initiative focusing on:
Mentation
Mobility
Medications
Patient preferences (what matters most)
Mistreatment (elder abuse awareness)
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Episode 207: Smoke Inhalation Injury
We discuss the injuries sustained from smoke inhalation.
Hosts:
Sarah Fetterolf, MD
Brian Gilberti, MD
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Smoke_Inhalation.mp3
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Tags: Environmental, Toxicology
Show Notes
Table of Contents
00:37 – Overview of Smoke Inhalation Injury
00:55 – Three Key Pathophysiologic Processes
01:41 – Physical Exam Findings to Watch For
02:12 – Airway Management and Early Intervention
03:23 – Carbon Monoxide Toxicity
04:24 – Workup and Initial Treatment of CO Poisoning
06:14 – Cyanide Toxicity
07:19 – Treatment Options for Cyanide Poisoning
09:12 – Take-Home Points and Clinical Pearls
Physiological Effects of Smoke Inhalation:
Thermal Injury:
Direct upper airway damage from heated air or steam.
Leads to swelling, inflammation, and possible airway obstruction.
Chemical Irritation:
Causes bronchospasm, mucus plugging, and inflammation in the lower airways.
Increases capillary permeability, potentially causing pulmonary edema.
Systemic Toxicity:
Primarily involves carbon monoxide and cyanide poisoning.
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Episode 206: Acute Back Pain
We discuss the evaluation of and treatment options for acute back pain.
Hosts:
Benjamin Friedman, MD
Brian Gilberti, MD
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Acute_Back_Pain.mp3
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Tags: Musculoskeletal, Orthopaedics
Show Notes
**Please fill out this quick survey to help us develop additional resources for our listeners: Core EM Survey**
Clinical Evaluation:
Primary Goal: Distinguish benign musculoskeletal pain from serious pathology.
Red Flags: Look for indicators of spinal infection, spinal bleed, or space-occupying lesions (e.g., tumors, large herniated discs).
Assessment: A thorough history and neurological exam (strength testing, gait) is essential.
Additional Tools: Use bedside ultrasound for post-void residual assessment in suspected cauda equina syndrome
Imaging Guidelines:
Routine Imaging: Generally not indicated for young, healthy patients without red flags.
ACEP Recommendations: Avoid lumbar X-rays in patients under 50 without risk factors, as they do not change management and may increase costs and ED time.
Advanced Imaging: Reserve MRI for patients with red flags, neurological deficits, or suspected cauda equina syndrome; CRP may be a part of your calculus when evaluating for infectious causes of back pain
Treatment Options:
Evidence-Based First-Line:
NSAIDs offer modest benefit.
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Episode 205: Family Presence during Resuscitation
We discuss the impact of family presence during resuscitations.
Hosts:
Ellen Duncan, MD, PhD
Brian Gilberti, MD
https://media.blubrry.com/coreem/content.blubrry.com/coreem/Family_Presence_During_Resuscitation.mp3
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Tags: Critical Care, Pediatrics
Show Notes
Overview
Historical Context: The conversation around allowing family members in the room during resuscitation events began gaining attention in 1987. Since then, the practice has been increasingly encouraged.
Current Practices in Pediatrics:
Family presence during pediatric resuscitations remains inconsistent, with healthcare provider acceptance ranging from 15% to 85%.
Many subspecialists and consultants still request that families step out, often due to outdated concerns.
Common Concerns & Myths:
Interference in resuscitation → Studies show minimal disruption.
Legal risks → No increased litigation risk has been demonstrated.
Family trauma → Research suggests that presence may help with grieving and reduce PTSD symptoms.
Evidence from the Literature
New England Journal of Medicine study on Family Presence During Cardiopulmonary Resuscitation (Jabre et al., 2013):
In a randomized controlled trial of 570 relatives, PTSD-related symptoms were significantly higher in family members who were not...
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