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Read MoreSGEM#215: Love Will Tear Us Apart – Diagnostic Challenges of Aortic Dissection
Podcast Link: SGEM215 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 normal, and there is no sign of asymmetric pulses. The EKG and laboratory tests are normal. You are wondering if you need to order a CT to rule out an aortic dissection. Background: Aortic dissection is a rare but deadly disease which can confound the emergency physician’s diagnostic abilities. Some estimates are that up to 38% of cases are initially missed [1]. Mortality is up to 40% in the acute phase [2] , and 70% by two weeks [3]. The most common feature of aortic dissection is pain, in the chest, back, and/or abdomen, but with aortic dissection being so rare and pain being so prevalent a complaint, diagnosing aortic dissection becomes difficult. Data is lacking on predictive value of clinical features; much of the prior literature focuses on patients already diagnosed with aortic dissection. There are two clinical prediction tools for the diagnosis of aortic dissection. One is from the American Heart Association called the aortic dissection detection (ADD) risk score. Our good friend over at REBEL EM, Salim Rezaie put together a nice table showing the score that we will include in the show notes. If any one of the predisposing conditions, pain features or physical exam findings are positive you add one point to the score. The other is a simpler three-variable rule called the Von Kodolitsch score. This tool includes aortic pain (immediate-onset tearing or ripping pain), mediastinal/aortic widening on chest x-ray, or pulse/BP differential. American College of Emergency Physicians (ACEP) published a guideline in 2015 for the diagnosis of acute aortic dissection. ACEP gives level C recommendations for the use of existing clinical decision tools: “In an attempt to identify patients at very low risk for acute non-traumatic thoracic aortic dissection, do not use existing clinical decision rules alone. The decision to pursue further workup for acute non-traumatic aortic dissection should be at the discretion of the treating physician.” [4] Clinical Question: What is the diagnostic accuracy in aortic dissection of various clinical features (history...
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Read MoreSGEM#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 for which she is treated with insulin. She delivered a vigorous 3800g boy following a brief episode of shoulder dystocia. She is otherwise healthy but does have a remote history of asthma. Aside from insulin and prenatal vitamins, she takes no medications. Approximately five minutes after delivery of the placenta, as you are evaluating her perineum, she begins to have a moderate amount of vaginal bleeding. Her nurse performs fundal massage which temporarily improves her flow. Background: Utako and Shosuke Okamoto discovered TXA in the 1950’s while searching for a treatment for postpartum hemorrhage [1]. TXA is a synthetic analog of the amino acid lysine. The normal process is for plasminogen to breakdown fibrin and prevent blood clots. TXA acts as an antifibrinolytic agent. It binds to lysine receptor sites on plasminogen blocking its action on fibrin. The ultimate result is the fibrin matrix structure is maintained and bleeding is reduced. Post-partum hemorrhage (PPH) is defined by the World Health Organization (WHO) as: “a cumulative blood loss of greater than or equal to 1,000 mL or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after the birth process”. PPH is one of the leading causes of maternal mortality around the world [2]. We have covered the use of TXA for trauma (CRASH-2) with Dr. Anand Swaminathan. This trial showed TXA is safe and effective treatment in patients with hemorrhagic shock from trauma in reducing mortality. We also did a couple of podcasts on TXA being effective for epistaxis (SGEM#210 and SGEM#53). The American College of Obstetricians and Gynecologists (ACOG) published guidelines for the management of postpartum hemorrhage including the use of TXA. They give TXA a Level B recommendation (based on limited or inconsistent scientific evidence): [3] “Given the mortality reduction findings, tranexamic acid should be considered in the setting of obstetric hemorrhage when initial medical therapy fails.” There was also a commentary published in the issue of Obstetrics and Gynecology by Pacheco et al. [4] They...
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Read MoreSGEM 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 device industry. One of the main inspiration for her book is the Legend of Emergency Medicine Dr. Jerome Hoffman. He is also one of my mentors who taught me to be skeptical of the medical literature. Listen to the podcast on iTunes as Jeanne describes some of the problems with the medical device industry. Some of the disturbing facts she provides include: Medical interventions have become the third leading cause of death in America. The FDA does not require clinical testing for most high-risk implanted devices. The death rate caused by medical devices is unknown, because no one is keeping track. Jeanne provides some of examples of patients who experienced significant harm instead of benefit with implantable medical devices like a vagus nerve stimulator or metal on metal artificial hip. We also discuss some of the possible solutions to the medical device industry and mention some additional resources: Choosing Wisely, Lown Institute, Right Care Alliance, ClinicalTrials.gov, John Ioannidis, and James McCormick. Let me know if you like this type of SGEM Xtra and if the responses are positive I will consider doing more book reviews. 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: The Danger Within Us [ 47:27 ] Play Now | Play in Popup |...
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Read MoreSGEM#213: Upside Down You Convert Me Out of SVT?
Podcast Link: SGEM213 SVT Date: March 30th, 2018 Reference: Bronzetti et al. Upside-down position for the out of hospital management of children with supraventricular tachycardia. International Journal of Cardiology. February 2018. Guest Skeptic: Dr. Robert Edmonds is an Emergency physician in the US Air Force. This is his 6th visit to the SGEM. DISCLAIMER: The views and opinions of this podcast do not represent the United States Government or the US Air Force. Case:A seven-year-old girl presents to your emergency department complaining of palpitations. On exam she appears anxious and begs you not to give “that drug that makes my heart stop like that last doctor did.” You know vagal maneuvers are first-line, but there’s variation in techniques. As the patient already tried breathing out of her clenched nose, you wonder if there is another safe method you can try prior to medications. Background: Supraventricular tachycardia (SVT) has a prevalence anywhere from 1 in 250 to 1 in 1,000 in children and is the most common arrhythmia in children. Forty percent of patients experience the first episode of SVT in the first month of life, and over 50% have their first episode in their first year of life [1]. Vagal maneuvers are thought to be first-line treatment as they are non-invasive and can rapidly resolve the episode when successful. Several methods exist, such as carotid sinus massage, mammalian dive reflex, and the Valsalva maneuver [2]. We have covered SVT on the SGEM a couple of times. The first time was a Cochrane systematic review done by Smith et al on the effectiveness of the Valsalva maneuver for reversion of SVT (SGEM#67). Only one study in that review was from the emergency department and it reported a reversion rate of 19%. The second time we covered SVT was a critical review of the REVERT Trial (SGEM#147). It was an randomized control trial using a modified Valsalva maneurer to convert SVT. The result was a return to sinus rhythm at one minute in 43% of patients treated with the modified Valsalva vs. 17% of patients treated with the standard Valsalva. This gives an NNT of 4. Four patients needed to be treated with the modified Valsalva for one more patients to return to sinus rhythm at one minute. The authors of the study we are talking about today were aware of case studies of a modification to the Valsalva maneuver in children [3-5]. The maneuver involves the child doing a handstand or being held upside down. Clinical Question: Is...
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Read MoreSGEM#212: Holding Back the Years – Risk Factors for Adverse Outcomes in Older Adults with Blunt Chest Trauma
Podcast Link: SGEM212 Date: March 20th, 2018 Reference: Sawa et al. Risk factors for adverse outcomes in older adults with blunt chest trauma: A systematic review. CJEM March 2018 Guest Skeptic: Dr. Christina Shenvi is an Emergency Physician at University of North Carolina. She is fellowship trained in Geriatric Emergency Medicine and has a podcast called GEMCAST. Christina loves serving as the assistant residency director, writing things, reading things, teaching people, and having kids. Case: An 85-year-old woman with a history of chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and type-2 diabetes (DM-2), and her 65-year-old otherwise healthy daughter present to the emergency department after a car accident. It was a low speed motor vehicle collision (MVC) in which they rear-ended a stationary car. However, they were both unrestrained. They both have a Glasgow Coma Scale (GCS) of 15 on arrival and are complaining of chest pain. The physician in the emergency department is deciding what imaging to obtain and will ultimately have to decide the disposition. Background: Older adults who sustain a blunt traumatic injury to the chest are at higher risk for greater injury severity for a given mechanism, longer lengths of stay, loss of independence, and higher morbidity and mortality than younger patients. However, it is not a homogeneous population. Some older adults will do relatively well, while others will be at particularly high risk for adverse outcomes. Clinical Question: What are the main factors that are associated with adverse outcomes in older adults with blunt chest trauma? Reference: Sawa et al. Risk factors for adverse outcomes in older adults with blunt chest trauma: A systematic review. CJEM March 2018 Population: Older adults defined as 65-years of age and over. Blunt chest trauma defined as “blunt chest injury resulting in chest wall contusion or rib fractures, with or without immediate life-threatening injury to the lungs or other organ systems.” Excluded: Review articles, case reports, or case-series Population not meeting inclusion criteria Did not analyze risk factors for outcome of interest Did not examine an outcome of interest Intervention: Not applicable Comparison: The comparison was prognostic factors for outcomes of interest. The factors were grouped into three categories: Patient Factors: Any underlying features, conditions, or demographics present before the injury such as age, sex, co-morbidities. Disease Factors: Any risk factors related to the traumatic event such as number of rib fractures, flail chest, mechanism, other associated trauma. Institutional Factors: These had to do with the hospital and emergency department such...
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Read MoreSGEM#211: Pins and Needles – Acupuncture for Migraine Prophylaxis
Podcast Link: SGEM211 Date: March 18th, 2018 Reference: Zhao et al. The Long-Term Effect of Acupuncture for Migraine Prophylaxis: A Randomized Clinical Trial. JAMA Internal Medicine 2017 Guest Skeptic: Dr. Alfred Sacchetti is a full time practicing Emergency Physician, who is also the Chief of Emergency Medicine at Our Lady of Lourdes Medical Center in Camden, New Jersey, USA, an Assistant Clinical Professor of Emergency Medicine, an Active Researcher and faculty member for the Emergency Medicine and Acute Care course. Case: 40-year-old male appears with what he describes as his typical migraine that has failed his usual home therapies. In the emergency department after six hours and multiple medications, the patient’s pain is finally under control. While being discharged he asks if there anything you can offer to prevent headaches from coming back. He states: “I have to fly to Chengdu University of Traditional Chinese Medicine next week on a sales call and don’t want to have the headache return while I am there.” Background: More than 10% of people (6% men and 18% women) suffer from migraines. This condition represents a significant source of both medical costs and lost productivity. Direct costs are estimated at approximately 17 billion dollars a year. There are also indirect costs of about 15 billion dollars a year mainly due to missed work. There are many options for treating migraine headaches in the emergency department. When every you see so many treatments for the same problem it is an indication that none of them work very well. One of the best treatment options is just to give the patient a quiet/dark space and time to get some sleep. If that does not work, one good therapy to try is IV metoclopramide. A very good drug that is no longer widely available is droperidol. Sometimes opioids are required to treat bad headaches in the emergency department. We have covered ketorolac on SGEM#66 as a possible therapy for acute migraine in the emergency department. The bottom line from that episode was that ketorolac is a reasonable second-line agent. Don’t forget that there is a ceiling effect for NSAIDs that was covered with Chris Bond SGEM#175 featuring a paper by Sergey Motov. Up to half of patients presenting to the emergency department with their migraines will “bounce-back” to the emergency department within a few days. Dexamethasone has been tried in randomized control trials to prevent bounce-backs. We covered a SRMA by Coleman et al from the BMJ on SGEM#28: Bang Your...
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Read MoreSGEM#210: (Don’t) Let it Bleed – TXA for Epistaxis in Patients on Anti-Platelet Drugs
Podcast Link: SGEM210 Date: March 6th, 2018 Reference: Zahed et al. Topical Tranexamic Acid Compared With Anterior Nasal Packing for Treatment of Epistaxis in Patients Taking Antiplatelet Drugs: Randomized Controlled Trial. AEM March 2018. Guest Skeptic: Dr. Justin 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 Case: A 77-year-old woman with known coronary artery disease is on clopidogrel and aspirin because of a stent placed four month ago. She has epistaxis that has not resolved despite twenty minutes of well applied anterior pressure. As you are preparing your equipment, she tells you that this is her third episode of epistaxis, and she is really hoping there is some alternative to the anterior packing she had the last two times. Background: About 60% of the population will experience a nose bleed. There is a bimodal distribution (<10yrs and > 60yrs) with the majority of refractory hemorrhages are seen in the elderly. In more than two-thirds of the time no cause is identified An anterior bleed is much more common than a posterior bleed and often occurs at the Kiesselbach’s Plexus. It is usually easy to diagnose anterior versus posterior epistaxis with direct visualization. There are many causes of epistaxis and a variety of treatments. For the adult management of epistaxis there is something called the Dundee Protocol. We will put a link in the show notes to the protocol. The American College of Chest Physicians published some evidence-based recommendations in 2012 on anticoagulation therapy [1]. We will summarize some of the recommendations for emergent anticoagulation reversal in the emergency department in the show notes. TXA is a synthetic derivative of lysine that inhibits fibrinolysis and thus stabilizing clots that are formed. TXA has been widely used in elective surgical cases and has shown decreased need for blood transfusion and reduction in mortality. It made sense to look at it for the treatment of epistaxis. Zahed et al did a randomized control trial (RCT) in 2013 on using TXA for the treatment of anterior epistaxis [2]. They excluded patients on anticoagulation medications but not those taking antiplatelet drugs We reviewed that RCT on SGEM#53 and the bottom line was that for patients with anterior epistaxis, consider soaking the packing in TXA to stop the bleeding and get them home sooner. The SGEM also reviewed the use of TXA in the CRASH-2 on SGEM#80 with Anand Swaminathan. And coming...
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Read MoreSGEM#209: Cephalexin – You Are My Only One for Uncomplicated Cellulitis
Podcast Link: SGEM209 Date: February 27th, 2018 Reference: Moran et al. Effect of Cephalexin plus Trimethoprim-Sulfamethoxazole vs Cephalexin Alone on Clinical Cure of Uncomplicated Cellulitis – A Randomized Clinical Trial. JAMA May 2017. Guest Skeptic: Chip Lange is an Emergency Medicine Physician Assistant (PA) working primarily in rural Missouri in community hospitals. He also hosts a great #FOAMed blog and podcast called TOTAL EM. Case: A 22-year-old male with no significant past medical history arrives to your department for an area of tender erythema to the right forearm for two days that has grown in size without purulence or drainage. With point of care ultrasound, you diagnose cellulitis without the presence of an abscess affecting a 6cm diameter area. When deciding how to treat for this condition, you have read recently that cephalexin could be used alone and that trimethoprim-sulfamethoxazole (TMP-SMX) may not be needed to cover for methicillin-resistant staphylococcus aureus (MRSA). Background: There have been multiple SGEM episodes on abscesses but only one on cellulitis. It was with Meghan Groth (@EMPharmGirl). The SGEM bottom line was for patients with uncomplicated cellulitis, TMP-SMX may represent an alternative to clindamycin in patients with no major co-morbidities (SGEM#131). Typically, with cellulitis we lack a specimen to obtain a culture and blood cultures are frequently not helpful. With the difficulty to definitively determine the source, Beta-hemolytic streptococci are presumed to be the dominant pathogens. In the case of purulent skin infections though, MRSA is the most common cause. Currently, the Infectious Diseases Society of America (IDSA) guidelines for patients with cellulitis without systemic signs of infection, penetrating trauma, injection drug use, or other evidence of MRSA recommend only prescribing antibiotics against streptococci (1). Clinical Question: Does cephalexin plus TMP-SMX result in higher clinical cure rates in uncomplicated cellulitis versus cephalexin alone? Reference: Moran et al. Effect of Cephalexin plus Trimethoprim-Sulfamethoxazole vs Cephalexin Alone on Clinical Cure of Uncomplicated Cellulitis – A Randomized Clinical Trial. JAMA May 2017. Population – Patients over twelve years of age with uncomplicated cellulitis (erythema without an abscess, purulent drainage, or wound believed to be of infectious etiology present for less than one week with at least 2cm diameter area of involvement). Exclusions: There were 26 exclusions in their supplemental documentation. Some of the exclusions were patients with allergy to study drug, pregnancy/nursing or expected pregnancy, underlying skin conditions in the affected area, history of IV drug use with fever, concurrent infection at another site, or immunosuppression. Intervention – Cephalexin 500mg...
Most Recent Articles
SGEM#215: Love Will Tear Us Apart – Diagnostic Challenges of Aortic Dissection
Podcast Link: SGEM215 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 normal, and there is no sign of asymmetric pulses. The EKG and laboratory tests are normal. You are wondering if you need to order a CT to rule out an aortic dissection. Background: Aortic dissection is a rare but deadly disease which can confound the emergency physician’s diagnostic abilities. Some estimates are that up to 38% of cases are initially missed [1]. Mortality is up to 40% in the acute phase [2] , and 70% by two weeks [3]. The most common feature of aortic dissection is pain, in the chest, back, and/or abdomen, but with aortic dissection being so rare and pain being so prevalent a complaint, diagnosing aortic dissection becomes difficult. Data is lacking on predictive value of clinical features; much of the prior literature focuses on patients already diagnosed with aortic dissection....
Read More
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 for which she is treated with insulin. She delivered a vigorous 3800g boy following a brief episode of shoulder dystocia. She is otherwise healthy but does have a remote history of asthma. Aside from insulin and prenatal vitamins, she takes no medications. Approximately five minutes after delivery of the placenta, as you are evaluating her perineum, she begins to have a moderate amount of vaginal bleeding. Her nurse performs fundal massage which temporarily improves her flow. Background: Utako and Shosuke Okamoto discovered TXA in the 1950’s while searching for a treatment for postpartum hemorrhage [1]. TXA is a synthetic analog of the amino acid lysine. The normal process is for plasminogen to breakdown fibrin and prevent blood clots. TXA acts as an antifibrinolytic agent. It binds to lysine receptor sites on plasminogen blocking its action...
Read More
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...
Read More
SGEM#213: Upside Down You Convert Me Out of SVT?
Podcast Link: SGEM213 SVT Date: March 30th, 2018 Reference: Bronzetti et al. Upside-down position for the out of hospital management of children with supraventricular tachycardia. International Journal of Cardiology. February 2018. Guest Skeptic: Dr. Robert Edmonds is an Emergency physician in the US Air Force. This is his 6th visit to the SGEM. DISCLAIMER: The views and opinions of this podcast do not represent the United States Government or the US Air Force. Case:A seven-year-old girl presents to your emergency department complaining of palpitations. ...
Read More
SGEM#212: Holding Back the Years – Risk Factors for Adverse Outcomes in Older Adults with Blunt Chest Trauma
Podcast Link: SGEM212 Date: March 20th, 2018 Reference: Sawa et al. Risk factors for adverse outcomes in older adults with blunt chest trauma: A systematic review. CJEM March 2018 Guest Skeptic: Dr. Christina Shenvi is an Emergency Physician at University of North Carolina. She is fellowship trained in Geriatric Emergency Medicine and has a podcast called GEMCAST. Christina loves serving as the assistant residency director, writing things, reading things, teaching people, and having kids. Case: An 85-year-old woman with a history of chronic obstructive...
Read More
SGEM#211: Pins and Needles – Acupuncture for Migraine Prophylaxis
Podcast Link: SGEM211 Date: March 18th, 2018 Reference: Zhao et al. The Long-Term Effect of Acupuncture for Migraine Prophylaxis: A Randomized Clinical Trial. JAMA Internal Medicine 2017 Guest Skeptic: Dr. Alfred Sacchetti is a full time practicing Emergency Physician, who is also the Chief of Emergency Medicine at Our Lady of Lourdes Medical Center in Camden, New Jersey, USA, an Assistant Clinical Professor of Emergency Medicine, an Active Researcher and faculty member for the Emergency Medicine and Acute Care course. Case: 40-year-old male...
Read More
SGEM#210: (Don’t) Let it Bleed – TXA for Epistaxis in Patients on Anti-Platelet Drugs
Podcast Link: SGEM210 Date: March 6th, 2018 Reference: Zahed et al. Topical Tranexamic Acid Compared With Anterior Nasal Packing for Treatment of Epistaxis in Patients Taking Antiplatelet Drugs: Randomized Controlled Trial. AEM March 2018. Guest Skeptic: Dr. Justin 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 Case: A 77-year-old woman with known coronary artery disease is on clopidogrel and aspirin because of a stent...
Read More
SGEM#209: Cephalexin – You Are My Only One for Uncomplicated Cellulitis
Podcast Link: SGEM209 Date: February 27th, 2018 Reference: Moran et al. Effect of Cephalexin plus Trimethoprim-Sulfamethoxazole vs Cephalexin Alone on Clinical Cure of Uncomplicated Cellulitis – A Randomized Clinical Trial. JAMA May 2017. Guest Skeptic: Chip Lange is an Emergency Medicine Physician Assistant (PA) working primarily in rural Missouri in community hospitals. He also hosts a great #FOAMed blog and podcast called TOTAL EM. Case: A 22-year-old male with no significant past medical history arrives to your department for an area of...
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SGEM#208: It Makes No Difference – Glucocorticoids for the Treatment of Septic Shock
Podcast Link: SGEM208 Date: February 14th, 2018 Reference: Venkatesh S et al. Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. NEJM January 2018. Guest Skeptic: Dr. Rory Spiegel (@EMNerd_) is a clinical instructor at University of Maryland, a recent graduate of Stony Brook’s Resuscitation Fellowship, and a current Critical Care fellow at University of Maryland. He writes an excellent blog called EM Nerd, which he describes as nihilistic ramblings. Case: 64-year-old male presents to your emergency department with worsening abdominal pain, nausea,...
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SGEM#207: Ahh (Don’t) Push It – Pre-Hospital IV Antibiotics for Sepsis.
Podcast Link: SGEM207 Date: February 14th, 2018 Reference: Alam N et al. Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial. The Lancet Nov 2017. Guest Skeptics: Jay Loosley is the Superintendent of Education at Middlesex-London Paramedic Service. Jenn Doyle is a paramedic educator at Middlesex-London Paramedic Service. Case: EMS is dispatched to a retirement home. They have a 73-year-old man who complains of weakness and a cough for the last 48 hours. You arrive and find the...
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SGEM#206: I’m Wheezy Like A Pre-Schooler – Prednisolone for Wheezy Children
Podcast Link: SGEM206a Date: February 6th, 2018 Reference: Foster SJ et al. Oral prednisolone in preschool children with virus-associated wheeze: a prospective, randomised, double-blind, placebo-controlled trial. Lancet January 2018 Guest Skeptic: Dr. Tessa Davis is a Pediatrician specialising in Pediatric Emergency Medicine and currently practicing in a central London hospital. She is also the co-founder of Don’t Forget the Bubbles and on the FeminEM Speaker Bureau. Case: Tom is a 4-year-old boy who comes into the emergency department with a wheeze following a viral illness....
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SGEM#205: Twist & Shout – Testicular Torsion
Podcast Link: SGEM205 Date: January 31st, 2018 Reference: Frohlich LC, et al. Prospective validation of clinical score for males presenting with an acute scrotum. AEM Dec 2017. Guest Skeptic: Dr. Melissa Langhan is an Associate Professor of Pediatric Emergency Medicine at Yale University in New Haven, CT. Melissa is passionate about clinical and translational research and focuses most of her work on the use of capnography or end-tidal carbon dioxide monitoring. In her spare time, Melissa also enjoys being the fellowship director to an...
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