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Always On EM - Mayo Clinic Emergency Medicine: Daily Summaries Delivered
by Alex Finch; Venk Bellamkonda
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- Dec 1, 20251h 2m
GRAND ROUNDS - Dr. Neha Raukar - Head's Up! When is that lump more than a bump?
In this final chapter of the 2025 season of Always on EM, Alex and Venk are thrilled to share an amazing Grand Rounds recording from the esteemed educator and clinician, Dr. Neha Raukar. She is renowned for her expertise in many areas - among them, concussion and traumatic brain injury, particularly of athletes. She breaks down imaging guidelines, evaluation of TBI, prognosis, counseling of patients and more in this fantastic talk essential for any emergency healthcare professional to hear! CONTACTS X - @AlwaysOnEM; @VenkBellamkonda; @NehaRaukarMD YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch; @NehaRaukarMD Email - AlwaysOnEM@gmail.com WANT TO WORK AT MAYO? EM Physicians: https://jobs.mayoclinic.org/emergencymedicine EM NP PAs: https://jobs.mayoclinic.org/em-nppa-jobs Nursing/Techs/PAC: https://jobs.mayoclinic.org/Nursing-Emergency-Medicine EMTs/Paramedics: https://jobs.mayoclinic.org/ambulanceservice All groups above combined into one link: https://jobs.mayoclinic.org/EM-Jobs
- Nov 1, 20251h 13m
Chapter 47 - Hidden Killer of the Healthy - An "Intimal" Discussion of Spontaneous Coronary Artery Dissection
Dr Sharonne Hayes, Professor of cardiovascular medicine and founding director of Mayo Clinic women’s heart clinic, and Dr. Marysia Tweet, Associate Professor of cardiovascular medicine, and co-leader of the Spontaneous Coronary Artery Dissection Registry and leader in women’s heart health join the show for this amazing November chapter of Always on EM. They are world experts on Spontaneous Coronary Artery Dissection authoring over 60 peer reviewed articles on the topic and in this chapter we explore with them the pitfalls and pearls related to making this diagnosis in the ED. SCAD is an important cause of myocardial infarction especially in patients who would not otherwise seem to be at risk for heart attacks for example active young women without comorbidities, and its imperitive that we as emergency physicians are current on this diagnosis. DONATE TO DR JIM GREGOIRE SCHOLARSHIP FUND To honor the life of Dr. Jim Gregoire, dear friend of this show, consider donating to his scholarship fund. Go to https://give.mayoclinic.org/give/616870/#!/donation/checkout Go to: What would you like your donation to support? Choose “other” Enter: James Gregoire Scholarship Fund CONTACTS X - @AlwaysOnEM; @VenkBellamkonda; @Marysia_Tweet; @SharonneHayes YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch; @SharonneHayes Email - AlwaysOnEM@gmail.com DO YOU HAVE SCAD? DOES YOUR PATIENT HAVE SCAD? WANT TO GET CONNECTED? SCAD Research: www.scadresearch.org National Coalition for Women with Heart Disease: www.womenheart.org Mayo Clinic Womens Heart clinic: https://www.mayoclinic.org/departments-centers/womens-heart-clinic/overview/ovc-20442061 REFERENCES & LINKS Saleh G, Al-Abcha A, Chaaban K, Adi MZ, Tweet M, Collins JD, Alkhouli M, Gulati R. Concomitant Takotsubo Cardiomyopathy and Spontaneous Coronary Artery Dissection: Exploring the Role of Cardiac Mechanics on Coronary Disruption. JACC Cardiovasc Imaging. 2025 Oct;18(10):1161-1166. doi: 10.1016/j.jcmg.2025.05.020. Epub 2025 Aug 5. PMID: 40758075. Baqal O, Karikalan SA, Hasabo EA, Tareen H, Futela P, Qasba RK, Shafqat A, Qasba RK, Hayes SN, Tweet MS, El Masry HZ, Lee KS, Shen WK, Sorajja D. In- hospital and long-term outcomes in spontaneous coronary artery dissection with concurrent cardiac arrest: Systematic review and meta-analysis. Heart Rhythm O2. 2025 Apr 24;6(6):843-853. doi: 10.1016/j.hroo.2025.03.023. PMID: 40717849; PMCID: PMC12287955. Morosato M, Gaspardone C, Romagnolo D, Pagnesi M, Baldetti L, Dormio S, Federico F, Scandroglio AM, Chieffo A, Godino C, Margonato A, Adamo M, Metra M, Tchetche D, Dumonteil N, Tweet MS, Saw J, Beneduce A. Left Main Spontaneous Coronary Artery Dissection: Clinical Features, Management, and Outcomes. JACC Cardiovasc Interv. 2025 Apr 28;18(8):975-983. doi: 10.1016/j.jcin.2025.01.427. Epub 2025 Apr 9. PMID: 40208153; PMCID: PMC12290918. Tweet MS, Pellikka PA, Gulati R, Gochanour BR, Barrett-O'Keefe Z, Raphael CE, Best PJM, Hayes SN. Coronary Artery Tortuosity and Spontaneous Coronary Artery Dissection: Association With Echocardiography and Global Longitudinal Strain, Fibromuscular Dysplasia, and Outcomes. J Am Soc Echocardiogr. 2024 May;37(5):518-529. doi: 10.1016/j.echo.2024.02.013. Epub 2024 Mar 11. PMID: 38467311; PMCID: PMC11605948. Tweet MS, Hayes SN, Grimaldo ABG, Rose CH. Pregnancy After Spontaneous Coronary Artery Dissection: Counseling Patients Who Intend Future Pregnancy. JACC Adv. 2023 Dec;2(10):100714. doi: 10.1016/j.jacadv.2023.100714. Epub 2023 Nov 14. PMID: 38915307; PMCID: PMC11194843. Tarabochia AD, Tan NY, Lewis BR, Slusser JP, Hayes SN, Best PJM, Gulati R, Deshmukh AJ, Tweet MS. Association of Spontaneous Coronary Artery Dissection With Atrial Arrhythmias. Am J Cardiol. 2023 Jan 1;186:203-208. doi: 10.1016/j.amjcard.2022.09.032. Epub 2022 Oct 31. PMID: 36328832; PMCID: PMC10403149. Murugiah K, Chen L, Dreyer RP, Bouras G, Safdar B, Lu Y, Spatz ES, Gupta A, Khera R, Ng VG, Bueno H, Tweet MS, Spertus JA, Hayes SN, Lansky A, Krumholz HM. Depression and Perceived Stress After Spontaneous Coronary Artery Dissection and Comparison With Other Acute Myocardial Infarction (the VIRGO Experience). Am J Cardiol. 2022 Jun 15;173:33-38. doi: 10.1016/j.amjcard.2022.03.005. Epub 2022 Mar 29. PMID: 35365290; PMCID: PMC9133198. Johnson AK, Tweet MS, Rouleau SG, Sadosty AT, Hayes SN, Raukar NP. The presentation of spontane
- Sep 1, 20251h 20m
Chapter 46 - Dont be salty, be phosphorescent! - Sodium, magnesium, and phosphorus in the ED
Dr. Jim Gregoire, consultant nephrologist and master educator, joins the show again to talk about electrolytes this time. He breaks down practicalities in caring for patients with sodium, magnesium, and phosphorus disorders - who is at risk, what history and exam findings to look for, what testing to do and how to correct the problems. Join Alex and Venk as they learn the nuances of care for these conditions that we see every single shift. CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com
- Aug 1, 202535 min
Grand Rounds - Dr. John Schupbach - Battling big food, big pharma, and big health
In this chapter, Dr. Schupbach analyzes the business of healthcare and a way he believes can let patients wage war on the mis-alligned incentives. This is a continuation of our Grand Rounds sequence. Come join Alex and Venk on this adventure! TEASER Specifically, childhood obesity is skyrocketing--1 in 5 children are now above the 95th percentile BMI for age and sex. A recent NEJM article showed Liraglutide (a medication that costs approximately $12,000 per year) was effective in children as young as 6 years old. This is just one example of many where cheap foods, expensive drugs, and band-aid solutions are generating record profits for the most powerful voices at the table. But are we truly acting in the best interests of our patients? What are the unintended consequences of these misaligned incentives? What is our responsibility in all this and where do we start if we want to be part of the solution?
- Jul 5, 20251h 13m
Chapter 45 - Airway to Heaven: A Primer on Mechanical Ventilation for Emergency Providers
Dr. Harish Kinni, a triple-board-certified emergency medicine and critical care physician and assistant professor at the Mayo Clinic, provides an overview of the fundamentals of ventilator care for emergency department professionals. We will review key modes that we should know, the variables to set, how to adjust them for your patient’s needs, and provide troubleshooting tips and tricks for when things suddenly go awry. This is sure to be one of the most helpful chapters of Always on EM, but don’t let it take your breath away! CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS Swart P, Nijbroek SGLH, Paulus F, Neto AS, Schultz MJ. Sex Differences in Use of Low Tidal Volume Ventilation in COVID-19-Insights From the PRoVENT-COVID Study. Front Med (Lausanne). 2022 Jan 3;8:780005. doi: 10.3389/fmed.2021.780005. PMID: 35300177; PMCID: PMC8923734. McNicholas BA, Madotto F, Pham T, Rezoagli E, Masterson CH, Horie S, Bellani G, Brochard L, Laffey JG; LUNG SAFE Investigators and the ESICM Trials Group. Demographics, management and outcome of females and males with acute respiratory distress syndrome in the LUNG SAFE prospective cohort study. Eur Respir J. 2019 Oct 17;54(4):1900609. doi: 10.1183/13993003.00609-2019. PMID: 31346004. Swart P, Deliberato RO, Johnson AEW, Pollard TJ, Bulgarelli L, Pelosi P, de Abreu MG, Schultz MJ, Neto AS. Impact of sex on use of low tidal volume ventilation in invasively ventilated ICU patients-A mediation analysis using two observational cohorts. PLoS One. 2021 Jul 14;16(7):e0253933. doi: 10.1371/journal.pone.0253933. PMID: 34260619; PMCID: PMC8279424. Evans, Laura1; Rhodes, Andrew2; Alhazzani, Waleed3; Antonelli, Massimo4; Coopersmith, Craig M.5; French, Craig6; Machado, Flávia R.7; Mcintyre, Lauralyn8; Ostermann, Marlies9; Prescott, Hallie C.10; Schorr, Christa11; Simpson, Steven12; Wiersinga, W. Joost13; Alshamsi, Fayez14; Angus, Derek C.15; Arabi, Yaseen16; Azevedo, Luciano17; Beale, Richard18; Beilman, Gregory19; Belley-Cote, Emilie20; Burry, Lisa21; Cecconi, Maurizio22; Centofanti, John23; Coz Yataco, Angel24; De Waele, Jan25; Dellinger, R. Phillip26; Doi, Kent27; Du, Bin28; Estenssoro, Elisa29; Ferrer, Ricard30; Gomersall, Charles31; Hodgson, Carol32; Hylander Møller, Morten33; Iwashyna, Theodore34; Jacob, Shevin35; Kleinpell, Ruth36; Klompas, Michael37; Koh, Younsuck38; Kumar, Anand39; Kwizera, Arthur40; Lobo, Suzana41; Masur, Henry42; McGloughlin, Steven43; Mehta, Sangeeta44; Mehta, Yatin45; Mer, Mervyn46; Nunnally, Mark47; Oczkowski, Simon48; Osborn, Tiffany49; Papathanassoglou, Elizabeth50; Perner, Anders51; Puskarich, Michael52; Roberts, Jason53; Schweickert, William54; Seckel, Maureen55; Sevransky, Jonathan56; Sprung, Charles L.57; Welte, Tobias58; Zimmerman, Janice59; Levy, Mitchell60. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Critical Care Medicine 49(11):p e1063-e1143, November 2021. | DOI: 10.1097/CCM.0000000000005337 Fan E, Del Sorbo L, Goligher EC, Hodgson CL, Munshi L, Walkey AJ, Adhikari NKJ, Amato MBP, Branson R, Brower RG, Ferguson ND, Gajic O, Gattinoni L, Hess D, Mancebo J, Meade MO, McAuley DF, Pesenti A, Ranieri VM, Rubenfeld GD, Rubin E, Seckel M, Slutsky AS, Talmor D, Thompson BT, Wunsch H, Uleryk E, Brozek J, Brochard LJ; American Thoracic Society, European Society of Intensive Care Medicine, and Society of Critical Care Medicine. An Official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine Clinical Practice Guideline: Mechanical Ventilation in Adult Patients with Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. 2017 May 1;195(9):1253-1263. doi: 10.1164/rccm.201703-0548ST. Erratum in: Am J Respir Crit Care Med. 2017 Jun 1;195(11):1540. doi: 10.1164/rccm.19511erratum. PMID: 28459336. Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, Oczkowski S, Levy MM, Derde L, Dzierba A, Du B, Aboodi M, Wunsch H, Cecconi M, Koh Y, Chertow DS, Maitland K, Alshamsi F, Belley-Cote E, Greco M, Laundy M, Morgan JS, Kesecioglu J, McGeer A, Mermel L, Mammen MJ, Alexander PE, Arrington A, Centofanti JE, Citerio G, Baw B, Memish ZA, Hammond N, Hayden FG, Evans L, Rhodes A. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Crit Care Med. 2020 Jun;48(6):e440-e469. doi: 10.1097/CCM.0000000000004363. PMID: 32224769; PMCID: PMC7176264. Wang W, Scharfstein D, Wang C, Daniels C, Needham D, Brower R, NHLBI ARDS Clinical Network. Estimating the Causal Effect of Low Tidal Volume Ventilation on Survival in Patients with Acute Lung
- Jun 15, 202552 min
Grand Rounds - Dr. Taylor Christian - First do no harm: the history and origin of medical racism
This is a capstone presentation from Chief Resident of Mayo Clinic Emergency Medicine, Dr. Taylor Christian. Teaser: Can we fulfill our oath to “do no harm” if we ignore the harm of racial injustice in medicine? Understanding the historical roots and persistent impact of medical racism isn’t just informative; it is a call to action. This presentation is an opportunity to learn, reflect, and act to become better advocates. CONTACTS X - @AlwaysOnEM; @VenkBellamkonda; @TayMChristian YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch; @drtaylormonet Email - AlwaysOnEM@gmail.com REFERENCES & LINKS Meisel ZF, Shofer FS, Dolan AR, Goldberg E, Cannuscio CC, Rhodes KV, Perrone J, Hess EP, Rogers M, Bellamkonda V, Bell J, Zyla M, Becker L, McCollum S, Schapira M. Comparing Three Ways to Help Patients with Acute Pain Learn about Opioid Risks — The Life STORRIED Study [Internet]. Washington (DC): Patient-Centered Outcomes Research Institute (PCORI); 2021 Oct. PMID: 39383261. Engel-Rebitzer E, Dolan AR, Aronowitz SV, Shofer FS, Nguemeni Tiako MJ, Schapira MM, Perrone J, Hess EP, Rhodes KV, Bellamkonda VR, Cannuscio CC, Goldberg E, Bell J, Rodgers MA, Zyla M, Becker LB, McCollum S, Meisel ZF. Patient Preference and Risk Assessment in Opioid Prescribing Disparities: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2021 Jul 1;4(7):e2118801. doi: 10.1001/jamanetworkopen.2021.18801. PMID: 34323984; PMCID: PMC8322998. Racic M, Roche-Miranda MI, Fatahi G. Twelve tips for implementing and teaching anti-racism curriculum in medical education. Med Teach. 2023 Aug;45(8):816-821. doi: 10.1080/0142159X.2023.2206534. Epub 2023 May 3. PMID: 37134226. Sahai A, Corley AMS, Lipps L, Lawton R, DeBlasio D, Klein M. A Locally-Focused Structural Racism Curriculum for Pediatric Primary Care Residents. Acad Pediatr. 2023 Nov-Dec;23(8):1510-1512. doi: 10.1016/j.acap.2023.06.012. Epub 2023 Jun 9. PMID: 37302703. Carrera D, Tejeda C, Kakani P, Napolitano J. Addressing Racism in Medical Education: A Longitudinal Antiracism Discussion Curriculum for Medical Students. Med Sci Educ. 2023 Apr 28;33(3):639-643. doi: 10.1007/s40670-023-01788-x. PMID: 37501797; PMCID: PMC10368613. Seegmiller Renner AM, Gross JR, Laughlin-Tommaso SK. Paving a Path to Inclusion, Diversity, Anti-Racism, and Equity: A Curriculum Roadmap. Mayo Clin Proc. 2023 Dec;98(12):1755-1762. doi: 10.1016/j.mayocp.2023.08.026. PMID: 38043992.
- Jun 1, 202549 min
Chapter 44 - Withdrawal warriors battle with barbs! Phenobarbital as a treatment for alcohol withdrawal
Is it possible that the cutting edge therapy for alcohol withdrawal care is one of the older tools in our bag? Possibly! In this chapter, one of the rising stars, Dr. Brandy Hernandez, Emergency Pharmacist, discusses the case for phenobarbital for helping patients for with their acute alcohol withdrawal symptoms. Find out when it may be preferable, what we don’t know yet, what the pitfalls are, and more!
- May 14, 202551 min
Grand Rounds - Dr Fiterman Molinari - Cardiac Arrest: when Standard Care is Not Enough
In this grand rounds, Dr. Daniel Fiterman Molinari challenges the status quo of cardiac arrest care with thought provoking takes on the literature. Take a listen to his Capstone presentation and find yourself pondering whether you agree or disagree, and whether you need to go revisit the literature yourself. You may find your own heart skips a beat in this great episode.
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About Always On EM - Mayo Clinic Emergency Medicine
Hosts, Alex Finch, MD and Venk Bellamkonda, MD explore topics relevant to the practice, education or research of emergency medicine. Enjoy interviews with people on the front lines, thought leaders from around the world, and the comedy and drama of life when it intersects with emergency care.Follow us on X: @AlwaysOnEMEmail: AlwaysOnEM@gmail.com
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