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Read MoreSGEM#222: Rhythm is Gonna Get You – Into an Atrial Fibrillation Pathway
Podcast Link: SGEM222 Date: June 12th, 2018 Reference: DeMeester S et al. Implementation of a Novel Algorithm to Decrease Unnecessary Hospitalizations in Patients Presenting to a Community Emergency Department With Atrial Fibrillation. AEM June 2018 Guest Skeptic: Dr. Morgenstern is an emergency physician and the Director of Simulation Education at Markham Stouffville Hospital in Ontario. He is the creator of the excellent #FOAMed project called First10EM.com and an amazing photographer. Case: A 62-year-old Canadian is on vacation in up-state Michigan, and after a celebratory evening, presents to your emergency department with palpitations. “I’ve had atrial fibrillation a number of time before. Usually they just shock me and send me home.” Local practice is usually to treat rapid atrial fibrillation with a calcium channel blocker infusion and admit to hospital. As the conversation progresses, you wonder whether it might be safe to discharge some atrial fibrillation patients home for outpatient follow-up. Background: Atrial fibrillation, rate control vs. rhythm control. This is a debate that has gone on for many years. It is like normal saline vs. Ringer’s lactate for fluid resuscitation, steroids vs. no steroids for sepsis, or Coke vs. Pepsi. Atrial fibrillation is one of the most common dysrhythmias and patients often present to the emergency department with increased heart rates, chest pain and weakness among other presentations. The debate has been going on for years as to which is the best strategy to address these patients, rate or rhythm control. In patients with chronic atrial fibrillation or unknown time of onset and a rapid ventricular response, rate control and consideration and initiation of anticoagulation therapy are the standard emergency department approach. Both beta-blockers and calcium channel blockers are commonly used for rate control in the emergency department. SGEM#133 reviewed a study by Fromm C et al. comparing diltiazem vs. metoprolol in the management of atrial fibrillation or flutter with rapid ventricular rate in the emergency department (J Emerg Med 2015). The SGEM bottom line was that the best available evidence shows that diltiazem will achieve more rapid rate control in patients with atrial fibrillation than metoprolol (NNT 2). Dr. Ian Stiell and colleagues published an article in 2011 in Annals of EM looking at variation in recent-onset atrial fibrillation management in Canada and found a lot of variability. Rhythm control was selected in 42-85% of patients across hospitals and electricity was chosen as the primary strategy for rhythm control in 7-69%. In the USA there is a fear of cardioverting someone in atrial fibrillation because it could cause them to throw...
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Read MoreSGEM#221: Smells Like Isopropyl Alcohol for Nausea
Podcast Link: SGEM221 Date: June 8th, 2018 Reference: April MD, et al. Aromatherapy Versus Oral Ondansetron for Antiemetic Therapy Among Adult Emergency Department Patients: A Randomized Controlled Trial. Ann Emerg Med 2018 Guest Skeptic: Meghan Groth is a pharmacist who has been practicing in emergency medicine for the past six years. She’s recently transitioned into industry, taking on a position as a medical science liaison in New England. She’s been a contributor for the Academic Life in Emergency Medicine and Emergency Medicine PharmD blogs and is a member of the ALiEMU Capsules team. Case: A 32-year-old woman presents to your emergency department with complaints of nausea (nausea VAS is about a 5 on a scale of 0 to 10) and states she’s worried she’s coming down with some sort of stomach flu. She’s hemodynamically stable and looks a bit queasy but isn’t actively retching when you see her. Background: Nausea and vomiting are frequent complaints of patients presenting to the emergency department, accounting for just under five million visits per year. A number of prescription medications are available to treat these symptoms, including ondansetron, droperidol, metoclopramide, promethazine, and prochlorperazine. The most commonly utilized antiemetic in US emergency departments is ondansetron, a 5-HT 3 antagonist. Despite its widespread use, a dose of intravenous ondansetron takes about 30 minutes to take effect, which has led to an interest in more rapidly acting interventions for actively nauseous patients on the verge of vomiting. A new Cochrane Review by Hines et al published in 2018 looked at aromatherapy for post-operative nausea and vomiting. They concluded that aromatherapy may have similar effectiveness to placebo based on low-quality evidence. There’s some data supporting the use of an inhalation of isopropyl alcohol in emergency department patients (Beadle, et al Ann Emerg Med 2015). We covered that paper on the SGEM in Episode #144. The SGEM bottom line from that critical review was that for patients presenting to the emergency department with complaints of nausea and vomiting, a nasal inhalation of isopropyl alcohol is a quick, inexpensive way that may transiently improve symptoms without evidence of harm. Clinical Question: Does nasally inhaled isopropyl alcohol reduce nausea in adult emergency department patients with or without oral ondansetron? Reference: April MD, et al. Aromatherapy Versus Oral Ondansetron for Antiemetic Therapy Among Adult Emergency Department Patients: A Randomized Controlled Trial. Ann Emerg Med 2018 Population: Patients greater than 17-years-old presenting to the emergency department with a chief complaint of nausea, with self-reported nausea severity of three...
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Read MoreSGEM Xtra: Don’t Give Up – The Power of Kindness with Brian Goldman
Podcast Link: SGEM Xtra Kindness with Brian Goldman Date: May 26th, 2018 This is a SGEM Xtra book review. I had the honour of meeting and interviewing Dr. Brian Goldman at the Canadian Association of Emergency Physician (CAEP) annual scientific assembly in Calgary. Dr. Goldman is an Emergency Medicine physician who works at Mount Sinai hospital in Toronto. He is the host of CBC radio show White Coat Black Art and the author of the bestselling books The Night Shift and the Secret language of Doctors. Dr. Goldman has a fantastic new book called The Power of Kindness: Why Empathy is essential in Everyday life. Listen to the podcast on iTunes to hear Brian answers questions about kindness: Define kindness, what is difference between kindness and empathy and what is synchrony? What is one of your favourite stories from the book about kindness? Is kindness nature or nurture (are we born kind or do we learn to be kind)? Do healthcare workers have their sense of empathy dulled over the years? Is there anything we can do as people who work in the emergency department to be more kind? We made a BatDoc video which can be viewed by clicking on the link or the thumbnail picture. The SGEM will be back next week with a structured critical review of a recent publication trying to cut the knowledge translation window down from over ten years to less than one year. Remember to be skeptical of anything you learn, even if you heard it on the Skeptics’ Guide to Emergency Medicine. SGEM Xtra: Don't Give Up - The Power of Kindness with Brian Goldman [ 47:45 ] Play Now | Play in Popup |...
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Read MoreSGEM#220: Acupuncture vs. Morphine for Renal Colic
Podcast Link: SGEM220 Date: May 16th, 2018 Reference: Beltaief K et al. Acupuncture versus titrated morphine in acute renal colic: a randomized controlled trial. J Pain Res. 2018 Guest Skeptic: Dr. Tony Seupaul is the Chairman of the Department of Emergency Medicine, University of Arkansas. Dr. Cordell Cunningham is a PGY 2 in Emergency Medicine at University of Arkansas for Medical Sciences Case: A 51-year-old man presents to the emergency department complaining of right flank pain radiating to his groin like his previous episodes of renal colic. He states the pain comes in “waves,” is associated with nausea but no vomiting. On exam, he is afebrile and appears very uncomfortable while grabbing his right flank. He has used ketorolac, acetaminophen and tamsulosin in the past. He really wants to avoid taking any opioids and is wondering if acupuncture could work? Background: We have covered renal colic a number of times on the SGEM: SGEM#4: Getting Un-Stoned (Renal Colic and Alpha Blockers) SGEM#32: Stone Me (Fluids and Diuretics for Renal Colic) SGEM#71: Like a Rolling Kidney Stone SGEM#97: Hippy Hippy Shake – Ultrasound Vs. CT Scan for Diagnosing Renal Colic SGEM#154: Here I Go Again, Kidney Stone SGEM#202: Lidocaine for Renal Colic? Here are the SGEM bottom lines on the management of renal colic from those previous episode: Expulsive therapy is unnecessary for ureteric stones < 5mm. There is some weak evidence that tamsulosin may help passage of larger stones (5 to 10 mm). You don’t need to push fluids (oral/IV) or use diuretics to pass kidney stones. Bedside emergency department ultrasound is safe and has several advantages over CT for the diagnosis of kidney stones. Lidocaine cannot be recommended for the treatment of renal colic at this time. We have also covered a couple of acupuncture papers on the SGEM. Watch for a new episode coming up on battlefield ear acupuncture to treat low back pain in the emergency department. SGEM#187: Pin Cushion – Acupuncture in the Emergency Department SGEM#211: Pins and Needles – Acupuncture for Migraine Prophylaxis The summary from those two critical reviews were: There is no high-quality evidence that acupuncture works for patients presenting to the emergency department with back pain, ankle sprains or migraines. The study on acupuncture to prevent the re-occurrence of migraine headaches in patients without aura does not provide any evidence of the efficacy. The authors of the trial we are going to look at today say that acupuncture has been proven have efficacy treatingrenal colic pain. Kaymar M et...
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Read MoreSGEM#219: Shout, Shout, PERC Rule Them Out
Podcast Link: SGEM219 Date: May 16, 2018 Reference: Freund et al. Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial. JAMA February 2018. Guest Skeptic: Dr. Jeffrey Kline (@klinelab) is the Vice Chair of Research in Emergency Medicine and a professor of physiology, Indiana University School of Medicine. He is the editor in chief of AEM, creator of Pulmonary Embolism Rule-out Criteria (PERC) Rule and has published extensively in the area of pulmonary emboli. We have even made a Batdoc Video together on pulmonary embolism. Case: A 47-year-old woman presents to the emergency department with a 24-hour history of chest pain and shortness of breath. She has a past medical history of hypothyroidism and gastroesophageal reflux disease. She is on levo-thyroxine and a proton pump inhibitor. Vital signs are normal (HR 72, BP 130/80, RR 12, O2 Sat 97% and 37.1C) and physical examination does not indicate the cause of her complaint. ECG, chest x-ray and routine lab work is also normal, including a troponin. You risk stratify her by gestalts and Well’s criteria as not high risk and wondering if you can PERC Rule her out and not order a d-dimer. Background: The Pulmonary Embolism Rule-out Criteria (PERC) Rule is an eight-item clinical decision instrument. The eight-items include the following clinical criteria. If the answer to any of these questions is positive a d-dimer is indicated. Listen to the podcast on iTunes to hear Dr. Kline discuss some background information on the diagnosing of pulmonary embolism and the PERC Rule. The History of the PERC Rule – How did it come about, why eight-items instead of five and when did you publish the first PERC paper? The Controversy of its Use in Europe – Why do the Europeans seem not to like the PERC Rule? The Power of Gestalt – How does it compare to risk stratifying tools like Well’s Criteria? The Inference about Sub-Segmental PE and Possible Over – Diagnosis? How to Use PERC Rule and Why this Differs from YEARS? Clinical Question: Does PERC Rule work in France? Reference: Freund et al. Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial. JAMA February 2018. PROPER stands for PERC Rule to Exclude Pulmonary Embolism in the Emergency Department. It was a crossover cluster-randomized clinical non-inferiority trial conducted in France. Population: Adult patients presenting to the emergency department with...
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Read MoreSGEM#218: Excited Delirium Syndrome
Podcast Link: SGEM218 Date: May 12th, 2018 Reference: Gonin P et al. Excited Delirium: A Systematic Review. AEM May 2018. Guest Skeptic: Dr. Chris Bond is an emergency physician and clinical lecturer at the University of Calgary. He is currently the host of CAEP Casts, which highlights educational innovations from emergency medicine residency programs across Canada. Chris also has his own #FOAMed blog called Standing on the Corner Minding My Own Business (SOCMOB). Case: A 24-year-old male is brought into the emergency department by police. He was running around wearing a Batman suit, jumping on cars and screaming he is Batman. He is brought to the emergency department extremely agitated and despite being held down by two police and three security guards he is still trying to bite the staff. You cannot obtain any vital signs and this patient is a danger to himself and staff. How will you manage this patient? Background: Cases of extreme agitation have been described since the 19thcentury, with Luther Bell’s eponymous “Bell’s mania” being published in the American Journal of Insanity (now American Journal of Psychiatry) in October, 1849 [1]. Bell distinguished these cases of extreme agitation from delirium tremens, diseases of the meninges and advanced typhoid based on a list of clinical criteria, as well as autopsy results from the brains and intestines of the patients. Bell’s case mortality rate for this condition was approximately 75%, though this was by no means rigorous data analysis. Interestingly, physicians of the day did not think these cases of extreme agitation would benefit from venesection (blood-letting) but did recommend this for the differential diagnoses. We have covered Alexander Hamilton’s blood-letting experiment from 1816 on camp fever with Dr. Rob Leeper on SGEM#200. The number needed to harm (death) with blood-letting for soldiers with camp fever was four (NNH 4) and therefore we could not recommend blood-letting as a treatment modality for camp fever. The term excited delirium syndrome (ExDS) was coined in the 1980s, after a flurry of deaths of individuals in custody or during arrests following extremeagitation [2]. ExDS usually involved men in their 30s after cocaine, methamphetamine, or ecstacy abuse [3-5]. These cases were not limited to patients in custody, however, and fatal cases of ExDS appeared in the hospital without any trauma, physical restraint or police intervention [5]. Given the significant morbidity and mortality rate of 8-10%, this syndrome remains of great importance to the emergency provider [6,7]. Over 150 years since it was first described, there is still...
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Read MoreSGEM#217: The Batman Effect on Improving Perseverance
Podcast Link: SGEM217 Date: March 6th, 2018 Reference: White et al. The “Batman Effect”: Improving Perseverance in Young Children. Child Development December 2016. Guest Skeptic: Dr. Casey Parker is a rural Generalist working in Broome, Australia. He has particular interests in Emergency Care, Aboriginal Health, Paediatrics, Trauma and Women’s Anaesthesia. Casey has this great blog and podcast called Broome Docs. Casey and I made a #Batdoc video at SMACCdub. Case: It is flu season and there is an endless stream of patients with sniffles, snot and sneezes! The waiting room is moaning with mildly unwell men; all with ‘the worst cold ever!” The residents are working double shifts in order to cover their fallen comrades. They are doing their best to avoid prescribing antibiotics whilst avoiding being coughed upon and writing endless, uninspiring discharge letters to the primary care docs. It is a Sisyphean task of tremendous tedium. As the senior doctor in the emergency department you wonder, how can you keep their spirits up and maintain the momentum – we need to maximize perseverance and limit distraction from the tedium. Background: Working in the emergency department is very tough. Sometimes it feels like it would take super human strength and skills to finish a shift. There are comic book super heroes that are physicians. Most people are probably familiar with Marvel’s Dr. Strange. He was a neurosurgeon who had his hands injured in a car accident. In a desperate search to cure his injuries he turns to occult eastern mysticism. Soranik Natu is also a neurosurgeon, daughter of Sinestro and a member of the Green Lanter Corp. Thor the god of thunder was transformed into a physician named Donald Blake in the earlier comic book series? Batman Fun Facts: Bruce Wayne, Batman’s secret identity, came from two historical figures (Robert the Bruce, a Scottish national hero and Mad Anthony Wayne, a hero of the American Revolution) There was a Batman course taught at the University of Victoria in Canada called the Science of Batman Andy Warhol directed the first-ever Batman movie in 1964 but it was made without the consent of DC Comics. Clinical Question: Does self-distancing by dressing up as Batman enhance perseverance at a tedious task? Reference: White et al. The “Batman Effect”: Improving Perseverance in Young Children. Child Development December 2016. Population: Typically developing four- and six-year-old children from the Minneapolis area Exclusions: None listed Intervention: Impersonating an exemplar other (such as Batman) while doing a repetitive task for 10 minutes....
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Read MoreSGEM Xtra: Petition to Retire the Surviving Sepsis Campaign Guidelines
Recently the SGEM was contacted by a group of doctors organizing a petition. They were concerned about the new Surviving Sepsis Campaign (SCC) guidelines that were just released. Specifically, the fluid, antibiotics and pressor requirements within the first hour of being triaged in the emergency department. The SGEM was invited to be involved in a global effort to express the concerns about the SSC guidelines. Below is the letter being released from a number of #FOAMed people from around the world today with a link to an online petition. Please review the information and consider signing the petition. The next SGEM episode will be a standard critical appraisal of a recent publication. The goal remains to try and cut the knowledge translation window down from over ten years to less than one year using social media. We ultimately want patients to get the best care, based on the best evident. Surviving Sepsis Campaign Petition Friends, Concern regarding the Surviving Sepsis Campaign (SSC) guidelines dates back to their inception. Guideline development was sponsored by Eli Lilly and Edwards Life Sciences as part of a commercial marketing campaign (1). Throughout its history, the SSC has a track record of conflicts of interest, making strong recommendations based on weak evidence, and being poorly responsive to new evidence (2-6). The original backbone of the guidelines was a single-center trial by Rivers defining a protocol for early goal-directed therapy (7). Even after key elements of the Rivers protocol were disproven, the SSC continued to recommend them. For example, SSC continued to recommend the use of central venous pressure and mixed venous oxygen saturation after the emergence of evidence that they were nonbeneficial (including the PROCESS and ARISE trials). These interventions eventually fell out of favor, despite the slow response of SSC that delayed knowledge translation. SSC has been sponsored by Eli Lilly, manufacturer of Activated Protein C. The guidelines continued recommending Activated Protein C until it was pulled from international markets in 2011. For example, the 2008 Guidelines recommended this, despite ongoing controversy and the emergence of neutral trials at that time (8,9). Notably, 11 of 24 guideline authors had financial conflicts of interest with Eli Lilly (10). The Infectious Disease Society of America (IDSA) refused to endorse the SSC because of a suboptimal rating system and industry sponsorship (1). The IDSA has enormous experience in treating infection and creating guidelines. Septic patients deserve a set of guidelines that meet the IDSA standards. Guidelines should...
Most Recent Articles
SGEM#222: Rhythm is Gonna Get You – Into an Atrial Fibrillation Pathway
Podcast Link: SGEM222 Date: June 12th, 2018 Reference: DeMeester S et al. Implementation of a Novel Algorithm to Decrease Unnecessary Hospitalizations in Patients Presenting to a Community Emergency Department With Atrial Fibrillation. AEM June 2018 Guest Skeptic: Dr. Morgenstern is an emergency physician and the Director of Simulation Education at Markham Stouffville Hospital in Ontario. He is the creator of the excellent #FOAMed project called First10EM.com and an amazing photographer. Case: A 62-year-old Canadian is on vacation in up-state Michigan, and after a celebratory evening, presents to your emergency department with palpitations. “I’ve had atrial fibrillation a number of time before. Usually they just shock me and send me home.” Local practice is usually to treat rapid atrial fibrillation with a calcium channel blocker infusion and admit to hospital. As the conversation progresses, you wonder whether it might be safe to discharge some atrial fibrillation patients home for outpatient follow-up. Background: Atrial fibrillation, rate control vs. rhythm control. This is a debate that has gone on for many years. It is like normal saline vs. Ringer’s lactate for fluid resuscitation, steroids vs. no steroids for sepsis, or Coke vs. Pepsi. Atrial fibrillation is one of the most common dysrhythmias and patients often present to the emergency department with increased heart rates, chest pain and weakness among other presentations. The debate has...
Read More
SGEM#221: Smells Like Isopropyl Alcohol for Nausea
Podcast Link: SGEM221 Date: June 8th, 2018 Reference: April MD, et al. Aromatherapy Versus Oral Ondansetron for Antiemetic Therapy Among Adult Emergency Department Patients: A Randomized Controlled Trial. Ann Emerg Med 2018 Guest Skeptic: Meghan Groth is a pharmacist who has been practicing in emergency medicine for the past six years. She’s recently transitioned into industry, taking on a position as a medical science liaison in New England. She’s been a contributor for the Academic Life in Emergency Medicine and Emergency Medicine PharmD blogs and is a member of the ALiEMU Capsules team. Case: A 32-year-old woman presents to your emergency department with complaints of nausea (nausea VAS is about a 5 on a scale of 0 to 10) and states she’s worried she’s coming down with some sort of stomach flu. She’s hemodynamically stable and looks a bit queasy but isn’t actively retching when you see her. Background: Nausea and vomiting are frequent complaints of patients presenting to the emergency department, accounting for just under five million visits per year. A number of prescription medications are available to treat these symptoms, including ondansetron, droperidol, metoclopramide, promethazine, and prochlorperazine. The most commonly utilized antiemetic in US emergency departments is ondansetron, a 5-HT 3 antagonist. Despite its widespread use, a dose of intravenous ondansetron takes about 30 minutes to...
Read More
SGEM Xtra: Don’t Give Up – The Power of Kindness with Brian Goldman
Podcast Link: SGEM Xtra Kindness with Brian Goldman Date: May 26th, 2018 This is a SGEM Xtra book review. I had the honour of meeting and interviewing Dr. Brian Goldman at the Canadian Association of Emergency Physician (CAEP) annual scientific assembly in Calgary. Dr. Goldman is an Emergency Medicine physician who works at Mount Sinai hospital in Toronto. He is the host of CBC radio show White Coat Black Art and the author of the bestselling books The Night Shift...
Read More
SGEM#220: Acupuncture vs. Morphine for Renal Colic
Podcast Link: SGEM220 Date: May 16th, 2018 Reference: Beltaief K et al. Acupuncture versus titrated morphine in acute renal colic: a randomized controlled trial. J Pain Res. 2018 Guest Skeptic: Dr. Tony Seupaul is the Chairman of the Department of Emergency Medicine, University of Arkansas. Dr. Cordell Cunningham is a PGY 2 in Emergency Medicine at University of Arkansas for Medical Sciences Case: A 51-year-old man presents to the emergency department complaining of right flank pain radiating to his groin like his previous episodes of renal...
Read More
SGEM#219: Shout, Shout, PERC Rule Them Out
Podcast Link: SGEM219 Date: May 16, 2018 Reference: Freund et al. Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial. JAMA February 2018. Guest Skeptic: Dr. Jeffrey Kline (@klinelab) is the Vice Chair of Research in Emergency Medicine and a professor of physiology, Indiana University School of Medicine. He is the editor in chief of AEM, creator of Pulmonary Embolism Rule-out Criteria (PERC) Rule and has published extensively in the...
Read More
SGEM#218: Excited Delirium Syndrome
Podcast Link: SGEM218 Date: May 12th, 2018 Reference: Gonin P et al. Excited Delirium: A Systematic Review. AEM May 2018. Guest Skeptic: Dr. Chris Bond is an emergency physician and clinical lecturer at the University of Calgary. He is currently the host of CAEP Casts, which highlights educational innovations from emergency medicine residency programs across Canada. Chris also has his own #FOAMed blog called Standing on the Corner Minding My Own Business (SOCMOB). Case: A 24-year-old male is brought into the emergency department by police....
Read More
SGEM#217: The Batman Effect on Improving Perseverance
Podcast Link: SGEM217 Date: March 6th, 2018 Reference: White et al. The “Batman Effect”: Improving Perseverance in Young Children. Child Development December 2016. Guest Skeptic: Dr. Casey Parker is a rural Generalist working in Broome, Australia. He has particular interests in Emergency Care, Aboriginal Health, Paediatrics, Trauma and Women’s Anaesthesia. Casey has this great blog and podcast called Broome Docs. Casey and I made a #Batdoc video at SMACCdub. Case: It is flu season and there is an endless stream of patients with...
Read More
SGEM Xtra: Petition to Retire the Surviving Sepsis Campaign Guidelines
Recently the SGEM was contacted by a group of doctors organizing a petition. They were concerned about the new Surviving Sepsis Campaign (SCC) guidelines that were just released. Specifically, the fluid, antibiotics and pressor requirements within the first hour of being triaged in the emergency department. The SGEM was invited to be involved in a global effort to express the concerns about the SSC guidelines. Below is the letter being released from a number of #FOAMed people from around...
Read More
SGEM#216: Pump It Up – Corticosteroids for Patients with Pneumonia Admitted to Hospital
Podcast Link: SGEM216 Date: April 25th, 2018 Reference: Stern A et al, Corticosteroids for pneumonia (Review). Cochrane Database of Systematic Reviews. December 2017. Guest Skeptic: Dr. Jake Turner, a foundation doctor working in the UK. Case: A 72-year-old gentleman presents to your emergency department. He has been generally unwell for around one week, with a worsening cough, shortness of breath and fever. He is now feeling extremely short of breath, appears confused and is pyrexial at 39 degrees centigrade. His observations are heart...
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SGEM#215: Love Will Tear Us Apart – Diagnostic Challenges of Aortic Dissection
Podcast Link: SGEM215a Date: April 12th, 2018 Reference: Ohle R et al. Clinical Examination for Acute Aortic Dissection: A Systematic Review and Meta-analysis. AEM April 2018 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. He is also the CME editor for Academic Emergency Medicine (AEM). Case: You are in the emergency department caring for a 65-year-old man with sharp chest pain radiating to the back. Blood pressure is elevated, and his pain was sudden in onset. His chest x-ray is...
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SGEM#214: Woman – The TXA Trial for Post-Partum Hemorrhage
Podcast Link: SGEM214 Date: April 13th, 2018 Reference: Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. The Lancet 2017 Guest Skeptic: Dr. Nick Papalia completed his MD at Western University. He is currently completing his third year of Obstetrics and Gynecology residency at the University of Calgary. Case: 37-year-old primiparous woman has a spontaneous vaginal delivery following an induction of labour at 39 weeks for gestational diabetes...
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SGEM Xtra: The Danger Within Us
Podcast Link: SGEM Xtra Danger Within Us Date: March 23rd, 2018 This is a SGEM Xtra book review. I had the pleasure of interviewing Jeanne Lenzer. She is an award-winning independent medical investigative journalist who has written for the BMJ. Jeanne has also written for the Atlantic, the New York Times Magazine, Mother Jones, Huffington Post and Slate. Jeanne book is called The Danger Within Us: America’s Untested, Unregulated Medical Device Industry and One Man’s Battle to Survive It. In the book, she takes a critical look at the medical...
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