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Read MoreSGEM#183: Don’t RINSE, Don’t Repeat
Podcast Link: SGEM183 Date: June 20th, 2017 Reference: Bernard et al. Induction of Therapeutic Hypothermia During Out-of-Hospital Cardiac Arrest Using a Rapid Infusion of Cold Saline The RINSE Trial (Rapid Infusion of Cold Normal Saline). Circulation 2016. Guest Skeptic: Jay Loosley is a Registered Nurse, and an Advanced Care Paramedic in London. His background includes working as a Research Assistant with the Ottawa Hospital Research Institute, Professor at Fanshawe College and currently, Superintendent of Education for Middlesex-London EMS, in London, Ontario, Canada. Case: A 71-year-old woman has a witnessed arrest while watching her granddaughter’s soccer game. By-standard CPR is started and EMS is called. They arrive quickly and take over the resuscitation. She is not in a shockable rhythm. They continue CPR, get intravenous access, give a round of epinephrine and then wonder if they should start rapid cooling en-route to the hospital with some cold saline. Background: Therapeutic hypothermia post cardiac arrest has received a great deal of attention since 2002. Two relatively small randomized control trials published in the NEJM showed that hypothermia post cardiac arrest resuscitation was neuroprotective (Bernard et al and The Hypothermia after Cardiac Arrest Study Group). The Cochrane Collaboration updated their review on hypothermia for neuroprotection in adults after CPR in 2012. They concluded: “Conventional cooling methods to induce mild therapeutic hypothermia seem to improve survival and neurologic outcome after cardiac arrest. Our review supports the current best medical practice as recommended by the International Resuscitation Guidelines.” The SGEM was skeptical of prehospital cooling for OHCA after reviewing two studies on the subject (SGEM#21 and SGEM#54). Both papers showed no patient oriented benefit to pre-hospital cooling in patients with OHCA and return of spontaneous circulation (ROSC). Then came the Targeted Temperature Management (TTM) Trial (Nielsen et al NEJM 2013). The bottom line was the TTM trial did not demonstrate a benefit of a targeted temperature of 33C vs. 36C for survival of OHCA (SGEM#82). Clinical Question: Does rapid cooling by EMS with large volumes of 4C normal saline improve outcome in patients with OHCA receiving CPR? Reference: Bernard et al. Induction of Therapeutic Hypothermia During Out-of-Hospital Cardiac Arrest Using a Rapid Infusion of Cold Saline The RINSE Trial (Rapid Infusion of Cold Normal Saline). Circulation 2016. Population: Adults with OHCA that resuscitation was started, had IV access and were still in cardiac arrest after initial resuscitation efforts. Excluded: OCHA due to trauma, suspected intracranial bleed, known or suspected pregnancy, already cool (<34.5C) or patients with DNR. Intervention: Rapid infusion of 30ml/kg...
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Read MoreSGEM Xtra: FeminEM – Stronger Together
Podcast Link: SGEM Xtra FeminEM Date: June 20th, 2017 Guest Skeptic: Dr. Dara Kass is an Emergency Physician, mother of three, wife of one and champion for the evolution of women in medicine. She is also the Editor in Chief of FeminEM (Females in Emergency Medicine). This is an SGEM Xtra so we will not be doing a structured critical review of a recent paper trying to cut the knowledge translation window down for over 10 years to less than one year using the power of social media. The next episode of the SGEM will be a formal critical appraisal of a recent publication. Five Questions about FeminEM Why FeminEM? What is FeminEM? What is your Story? What is FIX2017? What are the Ultimate Goals of FeminEM? Listen to the podcast on iTunes to hear Dr. Dara Kass discuss these questions with me. For more information about FeminEM you can go to their website, like them on Facebook and follow them on Twitter. Other Resources on the Issue of Gender Equity Why do women physicians experience burnout more than men? Gender Gap: Do Male or Female Physicians Do More Housework? Female representation at Australasian specialty conferences Are there too few women presenting at emergency medicine conferences? When will we have enough women speakers in emergency medicine? Speaker Introductions at Internal Medicine Grand Rounds: Forms of Address Reveal Gender Bias Remember to be skeptical of anything you learn, even if you heard it on the Skeptics’ Guide to Emergency Medicine SGEM Xtra: FeminEM - Stronger Together [ 32:55 ] Play Now | Play in Popup |...
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Read MoreSGEM Xtra: IAEMC 2017 #Puravida
Date: June 14th, 2017 I had the pleasure of presenting at the Intra America Emergency Medicine Conference (#IAEMC17) held in Costa Rica last month. Thank you to Dr. Manrique Umana for inviting me and the conference organizers for putting on such an amazing and educational event. I had a fantastic time meeting so many wonderful people from South, Central and North America. I gave two talks during the conference and promised that all the material would be available for free as part of the FOAMed movement. Talk I: Knowledge Translation in the Digital Age The first talk was on knowledge translation (KT) in the digital age. It has been said that it can take 17 years for 14% of research to reach the patients’ bedside (Morris et al 2011). A number of examples of the KT problem were provided. The Pathman Leaky Pipe Model was used to illustrate seven leaks in KT. Social Media (FOAMed) was offered as a possible solution to the KT problem. Criticism of social media dating back 2,500 years were discussed (Tom Standage). A short list, not a complete list, of some quality FOAMed sites were provided. Copies of the slides can be downloaded from this link: KT in Digital Age PDF. Talk II: Five SGEM Episodes The second talk was five SGEM episodes selected by Dr. Manrique Umana. Manrique and his team are responsible for SGEM Global Spanish. They have done a number of translations into Spanish to remove language as a knowledge translation barrier and help cut the KT window down to less than one year. The most recent episode reviewed by the SGEM Global Spanish team is the Ottawa Heart Failure Risk Scale. A Star Wars theme was used for the presentation with an opening crawler written in Spanish. You can click on this link to view the video (The SGEM Returns Spanish). Five SGEM Episodes: The HEART Pathway: The HEART Pathway appears to have the potential to safely decrease objective cardiac testing, increase early discharge rates and cut median length of stay in low risk chest pain patients presenting to the emergency department with suspicion of acute coronary syndrome.. SGEM#151 Medical Expulsive Therapy for Kidney Stones: 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). SGEM#154 Simple Abscesses and Antibiotics: The addition of TMP/SMX to the treatment of uncomplicated cutaneous abscesses represents an opportunity for shared decision-making. SGEM#164 Management of Bronchiolitis: There seems to be a knowledge...
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Read MoreSGEM#182: Platelet Transfusions for Intracerebral Hemorrhage (PATCH) – Don’t Do It.
Podcast Link: SGEM182 Date: June 5th, 2017 Reference: Baharoglu et al. Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial. Lancet 2016. Guest Skeptic: Dr. Robert Edmonds is an Emergency Medicine staff physician in Newport News, VA and a recent graduate of the University of Missouri-Kansas City EM residency. DISCLAIMER – The views and opinions of this podcast/blog do not reflect the views and opinions of the US Air Force, the United States Government, or Langley Air Force Base. Case: Your next patient is a 68-year-old with sudden onset right sided hemiparesis and facial droop. Non-contrast head CT shows a hemorrhagic stroke. On review of the patient’s medications you notice the patient is taking daily aspirin. You wonder if they would benefit from a platelet transfusion. Background: In the US, daily or every other day aspirin use has been reported to be as high as 61% in adults aged 65 or older (Ajani et al Am J Prev Med 2006). Taking antiplatelet therapy prior to a hemorrhagic stroke raises the risk of death by 27% and in high income countries more than 25% of patients with incident intracerebral hemorrhages were taking antiplatelet therapy (Thompson et al Neurology 2010). Many physicians are faced with patients with intracerebral hemorrhage on antiplatelets, and how to best manage them. The reversal of antiplatelet medications in intracerebral hemorrhage was covered in a Best Available Evidence (Martin and Conlon Ann Emerg Med 2013). It stated that “none of these studies showed a mortality benefit or improved functional outcome with platelet transfusion in patients with spontaneous or traumatic intracerebral hemorrhage who were receiving antiplatelet medications.” That review further elaborated that for these patients there were “no compelling data currently supporting the use of platelet transfusion” and that “it would be within the standard of care to withhold platelet transfusion in patients with either spontaneous or traumatic intracerebral hemorrhage who are receiving antiplatelet therapy.” The review did note that the existing evidence at that time were all based on relatively small and retrospective. However, recommendations from the neurosurgical perspective differ. A 2010 World of Neurosurgery literature review on the topic by Campbell et al “at present, the literature contains insufficient information to establish any guidelines or treatment recommendations. In light of this, the current authors have proposed a protocol for antiplatelet reversal in both spontaneous and traumatic acute ICH.” Clinical Question: Does platelet transfusion reduce death...
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Read MoreSGEM#181: Did You Ever Have to Make Up Your Mind, Pan Scan or Leave Other Scans Behind?
Podcast Link: SGEM181 Date: June 3rd, 2017 Reference: Sierink et al. Immediate total-body CT scanning versus conventional imaging and selective CT scanning in patients with severe trauma (REACT-2): a randomised controlled trial. Lancet August 2016. Guest Skeptic: Dr. Marcel Emond is an Associate Professor, Laval University, Emergency Physician at the Level 1 Trauma Center of the CHU de Québec, a Senior Clinician-Scientist, Chair of CAEP Trauma and Injury prevention committee, BEEM faculty member and the host of SGEM Global French. Case: A 53-year-old woman in good health is brought in by ambulance after a motor vehicle collision. She did not lose consciousness but did bump her head. Her main complaint is chest pain with difficulty breathing. She is tachycardic, tachypnic and has some mild abdominal pain. You suspect a flail chest on your clinical examination. A FAST examination is performed and is negative. Question: Should trauma patients get an immediate total-body (pan scan) CT or should you do usual X-rays followed by selective CT scanning? Background: When we assess head or cervical spine injuries there are good clinical decision tools available to Emergency Physicians to guide our care (Canadian CT Head Rules and Canadian C-Spine Rules). However, when we assess major trauma that includes chest, abdominal and pelvic trauma, the initial radiologic evaluation is left to the treating physician’s judgement. There is no validated clinical decision tool to help guide our decisions. Many studies (most retrospective) have assessed the use of pan scanning as an initial radiologic evaluation. Huber-Wagner et al (Lancet 2009) showed a mortality reduction in a retrospective database study of patients who have had a pan scan. The NNT varied from 17 to 32 according to the injury severity. A systematic review by the authors of the present study confirmed a possible benefit of the pan scan, but it showed a need for a well-designed, large, prospective randomized clinical trial with patient oriented outcomes (Sierink et al 2012). Reference: Sierink et al. Immediate total-body CT scanning versus conventional imaging and selective CT scanning in patients with severe trauma (REACT-2): a randomised controlled trial. Lancet August 2016. Population: Adults (18 years or older) with severe injury, suspicion of life-threatening injuries or compromised vital signs. Exclusions: Pregnant, referred from another hospital, low-energy trauma with blunt injury mechanism, stab wound in only one body region, and patients too unstable to undergo a CT scan who require CPR or immediate operation because death is imminent Intervention: Immediate total-body CT scan (vertex to pubic symphysis)...
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Read MoreSGEM#180: The First Cut is the Deepest – N.O.T. for Paediatric Appendicitis
Podcast Link: SGEM180 Date: May 24th, 2017 Reference: Georgiou et al. Efficacy and Safety of Nonoperative Treatment for Acute Appendicitis: A Meta-analysis. Pediatrics 2017. Guest Skeptic: Dr. Ross Fisher is a Paediatric Surgeon in Sheffield, England. When he is not waxing lyrical about presentation skills (P Cubed) over at ffolliet.com, giving the Greatest Presentation in the World at SMACC or expounding his views on paediatric trauma management he can be found at Sheffield Children’s Hospital principally dealing with surgical oncology, vascular access and all sorts of neonatal surgical problems. Case: It is 7pm on a quiet evening in the emergency department and Bobby comes in. He’s 12 years old and complains of a belly ache, pointing to his right iliac fossa pain. It has been going on for about 36 hours now, initially peri-umbilical and associated with nausea, poor appetite and malaise. It has increased in severity and is now localized in his right iliac fossa. He is particularly worried as he is ice hockey captain. Their hockey team is playing in the regional finals in two weeks’ time. His blood work shows an elevated WBC count and the ultrasound is consistent with acute uncomplicated appendicitis (AUA). Background: Appendicitis is the most common paediatric surgical emergency. It has a lifetime risk of over 7% but the peak incidence is in the second decade of life. Acute, uncomplicated appendicitis if promptly diagnosed can be effectively treated by surgery, the recovery from which, is relatively short. There is a small but increasing number of publications in the adult literature proposing management of the problem using simply intravenous antibiotics. This is called Non Operative Treatment of Appendicitis (N.O.T.A). This would avoid the risks of general anaesthesia, any surgical scar and allow quicker return to full activity. We have covered N.O.T.A. on the SGEM#115 – Complicated. Appendicitis management used to be so easy. The diagnosis was made, the surgeon was called and the appendix was removed. For over a century the mainstay treatment of acute appendicitis has been an appendectomy. There have been refinements to the surgical procedure since Fitz first described it in 1886. My approach in this case would be to remove the appendix thru a small, 3cm incision particularly in a boy: less number of scars, quicker procedure, similar pain relief and recovery. In girls I would probably use a laparoscope. REBEL EM covered the issue of N.O.T.A. in adults when it reviewed a pilot study by Dr. David Talan (Ann Emerg Med 2016). Paediatric surgery is completely separate...
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Read MoreSGEM#179: Chase the Dragon and Naloxone
Podcast Link: SGEM179 Date: May 19th, 2017 Reference: Willman et al. Do heroin overdose patients require observation after receiving naloxone? Clinical Toxicology 2017. Guest Skeptic: Dr. Richard Hamilton (@RJHamiltonMD) is Chair of the Department of Emergency Medicine at Drexel University College of Medicine. He is also the host of EMToxCast and gave a talk at the Association of Academic Chairs of Emergency Medicine Annual Retreat called: Can Social Media Save Emergency Medicine? Case: A 45-year-old male arrives via emergency medical services (EMS) complaining that he wants to be discharged. EMS states they found him unresponsive and with paraphernalia consistent with intravenous heroin use. His prehospital vital signs were oxygen saturation of 89% and respiratory rate of six breaths per minute prior to administration of oxygen and 1 mg of naloxone. After naloxone administration he is alert and oriented times three with a normal pulse oximetry and clear lung fields. It is 20 minutes after he received naloxone and he is asking to be discharged. Background: Heroin use has been increasing in the USA since 2007 (1). Opioids depress the heart rate and breathing and overdoses can result in death. With the increase in heroin use there has also been an increase in the number of heroin deaths (2). Naloxone is the specific treatment for heroin overdoses and is becoming widely available to first responders of all sorts (Police, Fire, First Aiders, lay people and EMS). It is an opioid antagonist that binds competitively to opioid receptors in the central nervous system and gastrointestinal tract. It can be administered in multiple ways (intranasal, subcutaneously, intramuscularly, intravenously, nebulization or endotracheal tube). The American Heart Association (AHA) discussed opioid overdoses and the use of naloxone Part 10: Special Circumstances of Resuscitation in their 2015 Guidelines (3). There were two new recommendations. One was about education and naloxone training and distribution. The second new recommendation was about opioid overdose treatment. CanadiEM summarized the Top 5 changes to AHA 2015 Guidelines in a series of infographics (4). One infographic focused on Special Circumstances and said “trained providers should administer naloxone to respiratory arrest patients with suspected opioid overdose. Lay-people likely to see opioid overdoses may be trained to administer naloxone during targeted BLS training” (5). Some heroin users may refuse further treatment or transport to the emergency department after receiving naloxone in the field and awaking. If transported to hospital, they may also refuse further treatment or observation in the emergency department. Three Clinical Questions: What are the medical risks to a heroin user...
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Read MoreSGEM#178: Mindfulness – It’s not Better to Burnout than it is to Rust
Podcast Link: SGEM178 Date: May 12th, 2017 Reference: Ireland et al. A randomized controlled trial of mindfulness to reduce stress and burnout among intern medical practitioners. Medical Teacher 2017. Guest Skeptic: Dr. Diane Birnbaumer is a Senior Clinical Faculty at Harbor-UCLA Medical Center in Torrance, CA. She is also an Emeritus Professor of Medicine at the David Geffen School of Medicine at UCLA. Case: A resident comes to you looking for advice. He is having trouble feeling tired, short-tempered and it is affecting his work interactions and personal sense of satisfaction with his job. You suspect he is suffering from early burnout. Background: Burnout is certainly a hot topic, and mindfulness has hit the front pages of the New York Times and Time Magazine, putting it front and center in the public eye. Burnout was a term coined by Herbert Freudenberger in 1974 (1). There are a number of ways to define burnout but one of the most widely known is by Maslach, known for the Burnout Inventory (MBI) Score. It has three components including emotional exhaustion, depersonalization and reduced feelings of personal accomplishment (2). Some ACEP members know about the MBI as it has been available as part of the Wellness Booth at the ACEP Scientific Assembly for over 20 years. Physicians have reported a high level of burnout. A recent study of US physicians showed that more 50% had at least one symptom of burnout. Emergency physicians reported the highest prevalence of burnout at around 70% (3). Burnout can have negative consequences on physicians and may lead to depression (4), suicidal ideation (5), illness (6), and increased alcohol use (7). It has also been associated with negative impacts on patient care including self-perceived medical error (8), risk of medical errors (9), and quality of care (10 and 11). Many factors are correlated with burnout during emergency medicine residency (12), and a significant concern is the number of young physicians identified as suffering from burnout early in their careers. A systematic review and meta-analysis has been published on interventions to prevent and reduce physician burnout (13). One intervention shown to have a positive impact on reducing burnout is mindfulness-based approaches. Mindfulness is paying attention to both the internal and external world, being in the present moment and being non-judgmental. Mindfulness meditation was started about 2,500 years ago by Buddha, not to cure illness but rather to end mental suffering. It spread out from Northeastern India near Nepal and eventually was discovered by the Western world in the...
Most Recent Articles
SGEM#183: Don’t RINSE, Don’t Repeat
Podcast Link: SGEM183 Date: June 20th, 2017 Reference: Bernard et al. Induction of Therapeutic Hypothermia During Out-of-Hospital Cardiac Arrest Using a Rapid Infusion of Cold Saline The RINSE Trial (Rapid Infusion of Cold Normal Saline). Circulation 2016. Guest Skeptic: Jay Loosley is a Registered Nurse, and an Advanced Care Paramedic in London. His background includes working as a Research Assistant with the Ottawa Hospital Research Institute, Professor at Fanshawe College and currently, Superintendent of Education for Middlesex-London EMS, in London, Ontario, Canada. Case: A 71-year-old woman has a witnessed arrest while watching her granddaughter’s soccer game. By-standard CPR is started and EMS is called. They arrive quickly and take over the resuscitation. She is not in a shockable rhythm. They continue CPR, get intravenous access, give a round of epinephrine and then wonder if they should start rapid cooling en-route to the hospital with some cold saline. Background: Therapeutic hypothermia post cardiac arrest has received a great deal of attention since 2002. Two relatively small randomized control trials published in the NEJM showed that hypothermia post cardiac arrest resuscitation was neuroprotective (Bernard et al and The Hypothermia after Cardiac Arrest Study Group). The Cochrane Collaboration updated their review on hypothermia for neuroprotection in adults after CPR in 2012. They concluded: “Conventional cooling methods to induce mild therapeutic hypothermia seem to...
Read More
SGEM Xtra: FeminEM – Stronger Together
Podcast Link: SGEM Xtra FeminEM Date: June 20th, 2017 Guest Skeptic: Dr. Dara Kass is an Emergency Physician, mother of three, wife of one and champion for the evolution of women in medicine. She is also the Editor in Chief of FeminEM (Females in Emergency Medicine). This is an SGEM Xtra so we will not be doing a structured critical review of a recent paper trying to cut the knowledge translation window down for over 10 years to less than one year using the power of social media. The next episode of the SGEM will be a formal critical appraisal of a recent publication. Five Questions about FeminEM Why FeminEM? What is FeminEM? What is your Story? What is FIX2017? What are the Ultimate Goals of FeminEM? Listen to the podcast on iTunes to hear Dr. Dara Kass discuss these questions with me. For more information about FeminEM you can go to their website, like them on Facebook and follow them on Twitter. Other Resources on the Issue of Gender Equity Why do women physicians experience burnout more than men? Gender Gap: Do Male or Female Physicians Do More Housework? Female representation at Australasian specialty conferences Are there too few women presenting at emergency medicine conferences? When will we have enough women speakers in emergency medicine? Speaker Introductions...
Read More
SGEM Xtra: IAEMC 2017 #Puravida
Date: June 14th, 2017 I had the pleasure of presenting at the Intra America Emergency Medicine Conference (#IAEMC17) held in Costa Rica last month. Thank you to Dr. Manrique Umana for inviting me and the conference organizers for putting on such an amazing and educational event. I had a fantastic time meeting so many wonderful people from South, Central and North America. I gave two talks during the conference and promised that all the material would be available for free as part of the FOAMed movement....
Read More
SGEM#182: Platelet Transfusions for Intracerebral Hemorrhage (PATCH) – Don’t Do It.
Podcast Link: SGEM182 Date: June 5th, 2017 Reference: Baharoglu et al. Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial. Lancet 2016. Guest Skeptic: Dr. Robert Edmonds is an Emergency Medicine staff physician in Newport News, VA and a recent graduate of the University of Missouri-Kansas City EM residency. DISCLAIMER – The views and opinions of this podcast/blog do not reflect the views and opinions of the US...
Read More
SGEM#181: Did You Ever Have to Make Up Your Mind, Pan Scan or Leave Other Scans Behind?
Podcast Link: SGEM181 Date: June 3rd, 2017 Reference: Sierink et al. Immediate total-body CT scanning versus conventional imaging and selective CT scanning in patients with severe trauma (REACT-2): a randomised controlled trial. Lancet August 2016. Guest Skeptic: Dr. Marcel Emond is an Associate Professor, Laval University, Emergency Physician at the Level 1 Trauma Center of the CHU de Québec, a Senior Clinician-Scientist, Chair of CAEP Trauma and Injury prevention committee, BEEM faculty member and the host of SGEM Global French. Case: A...
Read More
SGEM#180: The First Cut is the Deepest – N.O.T. for Paediatric Appendicitis
Podcast Link: SGEM180 Date: May 24th, 2017 Reference: Georgiou et al. Efficacy and Safety of Nonoperative Treatment for Acute Appendicitis: A Meta-analysis. Pediatrics 2017. Guest Skeptic: Dr. Ross Fisher is a Paediatric Surgeon in Sheffield, England. When he is not waxing lyrical about presentation skills (P Cubed) over at ffolliet.com, giving the Greatest Presentation in the World at SMACC or expounding his views on paediatric trauma management he can be found at Sheffield Children’s Hospital principally dealing with surgical oncology, vascular access and all...
Read More
SGEM#179: Chase the Dragon and Naloxone
Podcast Link: SGEM179 Date: May 19th, 2017 Reference: Willman et al. Do heroin overdose patients require observation after receiving naloxone? Clinical Toxicology 2017. Guest Skeptic: Dr. Richard Hamilton (@RJHamiltonMD) is Chair of the Department of Emergency Medicine at Drexel University College of Medicine. He is also the host of EMToxCast and gave a talk at the Association of Academic Chairs of Emergency Medicine Annual Retreat called: Can Social Media Save Emergency Medicine? Case: A 45-year-old male arrives via emergency medical services (EMS) complaining that he wants to be discharged....
Read More
SGEM#178: Mindfulness – It’s not Better to Burnout than it is to Rust
Podcast Link: SGEM178 Date: May 12th, 2017 Reference: Ireland et al. A randomized controlled trial of mindfulness to reduce stress and burnout among intern medical practitioners. Medical Teacher 2017. Guest Skeptic: Dr. Diane Birnbaumer is a Senior Clinical Faculty at Harbor-UCLA Medical Center in Torrance, CA. She is also an Emeritus Professor of Medicine at the David Geffen School of Medicine at UCLA. Case: A resident comes to you looking for advice. He is having trouble feeling tired, short-tempered and it is affecting his work...
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SGEM#177: POCUS – A New Sensation for Diagnosing Pediatric Fractures
Podcast Link: SGEM177 Date: May 1st, 2017 Reference: Poonai et al. Point-of-care ultrasound for non-angulated distal forearm fractures in children: test performance characteristics and patient-centered outcomes. Acad Emerg Med May 2017. Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. He is also the CME editor for Academic Emergency Medicine and the associate editor for emergency medicine simulation at the AAEM MedEdPORTAL SGEM HOP: This is another SGEM Hot Off the Press with Academic Emergency Medicine. Here is a reminder of...
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SGEM#176: Somebody’s Watching Me – Cardiac Monitoring for Chest Pain
Podcast Link: SGEM176 Date: April 26th, 2017 Reference: Syed et al. Prospective validation of a clinical decision rule to identify patients presenting to the emergency department with chest pain who can safely be removed from cardiac monitoring. CMAJ Jan 2017 Guest Skeptics: Drs. Ryan Tam and Antony Robert are chief residents from the Royal College Emergency Medicine Program at McGill University. Ryan Tam’s academic interests include quality improvement, ultrasound and simulation. He is also involved with a start-up FOAMed site called EM-bites...
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SGEM#175: Dancing on the Ceiling with Ketorolac for Pain
Podcast Link: SGEM175 Date: April 20th, 2017 Reference: Motov et al. Comparison of Intravenous Ketorolac at Three Single-Dose Regimens for Treating Acute Pain in the Emergency Department: A Randomized Controlled Trial. Ann Emerg Med Dec 2016 Guest Skeptic: Dr. Ken Milne is a front line community emergency medicine physician passionate about skepticism, evidence based medicine and knowledge translation. He is also the moderator for Emergency Medical Abstracts, faculty member of Best Evidence in Emergency Medicine and creator of the Skeptics’ Guide to...
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SGEM#174: Don’t Believe the Hype – Vitamin C Cocktail for Sepsis
Podcast Link: SGEM174 Date: April 6th, 2017 Reference: Marik et al. Hydrocortisone, Vitamin C and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study. Chest Dec 2016 Guest Skeptic: Dr. Jeremy Faust is an attending emergency physician at Brigham and Women’s Hospital in Boston Massachusetts and an instructor at Harvard Medical School. He’s the co-host of FOAMcast with co-host Dr. Lauren Westafer and he’s written about sepsis in the Annals of Emergency Medicine, EM Clinics of North America,...
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