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Read MoreSGEM#239: Febrile Seizure Recurrence – With or Without You Acetaminophen?
http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGEM239_FS.mp3Podcast: Play in new window | DownloadDate: December 13th , 2018 Reference: Murata et al. Acetaminophen and febrile seizure recurrences during the same fever episode. Pediatrics. 2018 Guest Skeptic: Dr. Damian Roland is a Consultant at the University of Leicester NHS Trust and Honorary Associate Professor for the University of Leicester’s SAPPHIRE group. He specialises in Paediatric Emergency Medicine and is a passionate believer that education exists to be shared (#foamed). Damian is part of the Don’t Forget the Bubbles (DFTB) team. They published an epic paper to determine the transit time of a Lego head (Tagg et al). The primary outcome was the FART (Found and Retrieved Time) score. Bowel habit were standardized before the trial started using the SHAT (Stool Hardness and Transit) score. The story was picked up by the BBC, Forbes and even talked about by James Corden on the Late, Late Show. Case: An 18-month-old presents having had a febrile convulsion (febrile seizure) at home. The seizure lasted no more than a minute and now having been in the department for a couple of hours the infant is back to their normal selves. Observations are normal except a low-grade fever and there is a clear focus in a right otitis media for an infection. You start to counsel the parents with likely outcomes for the future and immediate safety netting advice. You tell the parents that regular antipyretics won’t stop another febrile convulsion occurring and they should really only be used to help their child when they are distressed with a fever. After you leave the room a student who had witnessed the consultation asks you why you said you couldn’t stop febrile convulsions when a recent publication from Japan has clearly shown that regular rectal acetaminophen significantly reduces the risk of recurrence? Background: Febrile seizures are very common and very, very scare for care-givers and parents. During winter periods a typical emergency department may well see a child a day presenting with a febrile seizure There was a SRMA by Rosenbloom et al. (Eur J Paediatr Neurol 2013) that concluded antipyretics were ineffective in reducing the recurrence of febrile seizures in children. SGEM#95 covered this paper with Pediatric Super Hero Anthony Crocco. Our bottom line was that antipyretics appear to offer no significant improvement in the recurrence rates of febrile seizures in children. Fever fear is a real concern for parents and they often come to the emergency department for evaluation and reassurance. The American Academy of...
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Read MoreSGEM Xtra: Message in a Book by the SGU
http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGU.mp3Podcast: Play in new window | DownloadDate: December 4th, 2018 Guest Skeptic: Dr. Steven Novella is a Yale Neurologist, host and producer of the popular science podcast called the Skeptics Guide to the Universe and executive editor of Science Based Medicine blog. This is an SGEM Xtra book review. I had the privilege of interviewing Dr. Novella about the new book by the Skeptics’ Guide to the Universe (SGU). I would like to recognize the influence the SGU had on inspiring the SGEM. The SGU has been a big part of my skeptical journey and contributed greatly to my critical thinking skills. Listen to the SGEM podcast on iTunes or your favourite podcast app hear Dr. Novella and me discuss how SGU got started, their new book, how to encourage critical thinking with students and colleagues, how he discusses pseudoscience with colleagues and patients and a few other topics. Five Frivolous Questions for Dr. Novella: Star Trek or Star Wars? Best Captain, Picard or Kirk? If you could have one today, flying car or transporter? Dinner with Newton or Galileo? Would you rather visit Mars or a moon of Jupiter? The SGEMers can order a copy the SGU book for themselves and as a gift by clicking on this BOOK LINK or on the picture below. The SGEM will be back next episode with a structured critical review of a recent publication trying to cut the knowledge translation window from over ten years to less than one year using the power of social media. Remember to be skeptical of anything you learn, even if you heard it on the Skeptics’ Guide to Emergency...
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Read MoreSGEM#238: The Epi Don’t Work for OHCA
http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGEM238.mp3Podcast: Play in new window | DownloadDate: December 6th , 2018 Reference: Perkins et al. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. NEJM 2018. 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: A 51-year-old man experiences a cardiac arrest on the street. You are the first provider on scene with Emergency Medical Services (EMS) and start high-quality Cardiopulmonary Resuscitation (CPR). A cardiac defibrillator is hooked up and the patient is in ventricular fibrillation. He is unsuccessfully shocked. An oral airway is placed, peripheral intravenous (IV) line started successfully and the paramedic asks her partner if you want to administer IV epinephrine? Background: The AHA has five steps in the Chain-of-Survival for out-of-hospital cardiac arrest (OHCA). Step One– Recognition and activation of 911 Step Two– Immediate high-quality CPR Step Three– Rapid defibrillation Step Four– Basic and advanced EMS Step Five– Advanced life support & post arrest care We are going to discuss Step Four that focuses on rapid access to advanced cardiac life support (ACLS) skills such as intubation and intravenous drug therapy. This step is controversial, and we have covered it on the SGEM with the classic OPALS trial by Legend of Emergency Medicine Dr. Ian Stiell (SGEM#64). This was a before and after study to see if advanced cardiac life support (ACLS) techniques, including IV epinephrine, would improve survival to discharge. While there was an improvement in return of spontaneous circulation (ROSC) and survival to hospital admission there was not an increased survival to hospital discharge. There was also no increase in survivors with good neurological outcomes with ACLS. There have been a number of papers published since OPALS that support the findings of not using ACLS drugs like epinephrine for OHCA (Olavseengen et al. JAMA 2009, Hagihara et al. JAMA 2012 and Cournoyer et al. AEM 2017). We reviewed the Cournoyer et al cohort study as part of the #SGEMHOP series with Academic Emergency Medicine (AEM). It demonstrated better ROSC with ACLS but not better survival to hospital discharge (SGEM#189). A limitation of these studies is their observational nature. There is one randomized control trial on epinephrine for OHCA by Jacobs et al. published in Resuscitation 2011. This Australian trial showed better ROSC with epinephrine but not better survival to hospital discharge in 534 patients. Unfortunately, the trial failed to achieve their sample size for a variety of reasons which left it underpowered. This means...
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Read MoreSGEM Xtra: On the Edge of Burnout ACEM18
http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/Edge-of-Burnout-.mp3Podcast: Play in new window | Download Date: November 24th, 2018 As you may know, I was invited to give a keynote address on burnout at the Australasia College of Emergency Medicine 2018 Annual Scientific Meeting (#ACEM18) in Perth, Australia. This turned out to be a very meta event. A few months leading up to the presentation my dad, Dr. Ken Milne Sr. got seriously ill. While he faced this with his usual grace and dignity, I was living on the edge of burnout. He was admitted to hospital shortly before I was scheduled to leave for Australia. We had a number of discussions and he insisted that I go and not cancel the trip. We reviewed my keynote presentation in the hospital and he gave me the thumbs up. He was very proud and was telling all his treating physicians about his son’s honour to be talking at an international medical meeting. I agreed to go to Australia with his blessing but promised I would live stream the presentation to his hospital bed on the SGEM Facebook page. During the talk I gave him a big shout out and shared my story about being on the edge of burnout. Working in the emergency department we are on the edge of life and death and that can lead to burnout. Dr. Michelle Johnston (Dustfall) did a fantastic job the during the ACEM18 opening presentation highlighting what we do everyday. The word burnout was coined by Burnout was a term coined by Herbert Freudenberger in 1974. He defined it as “a state of fatigue or frustration that resulted from professional relationships that failed to produce the expected rewards”. There are a number of other ways to define burnout but one of the most widely known and used to assess burnout is the is the Maslach Burnout Inventory (MBI) Score. It was designed by Christina Maslach and Susan Jackson and published in 1981. Three Components to the Maslach Burnout Inventory: Emotional Exhaustion Depersonalization Reduced Feelings of Personal Accomplishment A recent study of US physicians showed that more 50% had at least one symptom of burnout. The highest prevalence of burnout (70%) was reported by emergency physicians (Shanafelt et al 2015). One of the most common reasons cited for burnout is the electronic medical record (EMR) (Shanafelt et al 2016). Burnout can have negative consequences on physicians. It may lead to depression, suicidal ideation, illness, and increased alcohol use. Burnout has also been associated with negative impacts...
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Read MoreSGEM#237: Screening Tool for Child Sex Trafficking
http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGEM237.mp3Podcast: Play in new window | Download Date: November 10th , 2018 Reference: Kaltiso et al. Evaluation of a Screening Tool for Child Sex Trafficking Among Patients with High-Risk Chief Complaints in a Pediatric Emergency Department. AEM October 2018. Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and clinical lecturer in Calgary. He is also an avid FOAM supporter/producer through various online outlets including TheSGEM. You may have noticed there was no music for the introduction. Part of the SGEM brand is to have some fun and engaging theme music to help with knowledge translation. This topic of child sex trafficking is very serious and disturbing. I struggled with what would be an appropriate song choice. After thinking about it and not coming up with something acceptable I went to twitter to ask my #FOAMed friends. It was Minh Le Cong (@Ketaminh) who suggested no music for this episode and perhaps a period of silence. Mitochondrial Eve (@BrowOfJustice) agreed and said that she uses silence to great effect frequently. I hold both of these wise people high regard and value their opinion. I listened, and I heard what they said and that is why there was silence rather than song to introduce this SGEMHOP episode on child sex trafficking. TRIGGER WARNING: As a warning to those listening to the podcast or reading the blog post, there may be some disturbing things discussed. The SGEM is free and open access trying to cut the knowledge translation down to less than one year. It is intended for clinicians providing care to emergency patients, so they get the best care, based on the best evidence. Some of the material could be considered explicit, graphic, offensive, and/or upsetting. As a trigger warning, if you are feeling upset by the content then please stop listening or reading. There will be resources listed at the end of the blog for those looking for assistance. Case: A 15-year-old girl presents to the emergency department with pelvic pain. She is with a parent and after the initial introductions and history, you have her parent leave the room to ask more sensitive questions. Upon further history, you discover that she has been having pelvic pain with genital discharge and has had more than ten sexual partners in their lifetime. Eventually, you discover that she has also been drinking alcohol and endorses that she has exchanged sex for drugs in the past. Background: Child sex trafficking (CST) is a...
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Read MoreSGEM#236: TXA – Not for Brain Bleeds
http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGEM236.mp3Podcast: Play in new window | Download Date: November 6th , 2018 Reference: Sprigg et al. Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial. Lancet. 2018 Guest Skeptic: Dr. Robert Edmonds is an emergency physician in the US Air Force in Virginia. This is Bob’s eighth 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: Your next patient is a stroke alert for a 67-year-old male living at a nursing home presents with severe right sided upper and lower extremity weakness noticed one hour ago while eating a meal. He obtains a stat head CT which shows an intracerebral hemorrhage. In addition to controlling his elevated blood pressure, you wonder if there is more you can offer this patient to improve his outcome and odds of survival. A resident points out that tranexamic acid (TXA) has been shown to decrease mortality for other hemorrhagic conditions, and questions if that could be helpful. Background: Stroke due to intracerebral hemorrhage (ICH) comprises approximately 20% of all strokes, but about half of all stroke deaths worldwide. Currently the only intervention known to adjust mortality in these cases is blood pressure management. Lowering BP in ICH cases of was covered on SGEM#73: How Low Can You Go. The AHA Guidelines were updated since those episodes and recommend the following (Hemphill et al Stroke 2015): For ICH patients presenting with SBP between 150 and 220 mmHg and without contraindication to acute BP treatment, acute lowering of SBP to 140 mmHg is safe (Class I; Level of Evidence A) and can be effective for improving functional outcome (Class IIa; Level of Evidence B). (Revised from the previous guideline) For ICH patients presenting with SBP >220 mmHg, it may be reasonable to consider aggressive reduction of BP with a continuous intravenous infusion and frequent BP monitoring (Class IIb; Level of Evidence C). (New recommendation) SGEM#172: Don’t Bring My Blood Pressure Down (Intensively) – The ATACH2 Trial did not support intensely lowing blood pressure. There was no statistical difference in death or disability between intensive blood pressure reduction (SBP 110-139 mm Hg) vs. standard blood pressure reduction (SBP 140-179 mm Hg) in patients with acute intracerebral hemorrhage. TXA is a cheap drug that has been shown to improve mortality in trauma (CRASH-2), presumably due to its antifibrinolytic effect. TXA has been discussed on the SGEM a number of...
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Read MoreSGEM#235: Edoxaban for Cancer Associated VTE – Would the NEJM Lie to You?
http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGEM235.mp3Podcast: Play in new window | Download Date: October 30th , 2018 Reference: Raskob GE et al. Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism. NEJM 2018 Guest Skeptic: Dr. Anand Swaminathan is an assistant professor of Emergency Medicine at the St. Joseph’s Regional Medical Center in Patterson, NJ. He is a deputy editor for EM: RAP and, associate editor for REBEL EM. Case: A 43-year old woman with a history of breast cancer currently undergoing chemotherapy presents with mild chest pain. She is hemodynamically stable except for a heart rate of 105 and her pain is increased when she takes a deep breath. The chest x-ray is unremarkable, and you order a CT pulmonary angiogram (CTPA) which demonstrates a right segmental pulmonary embolism. You write a prescription for low molecular weight heparin (LMWH) and advise the patient that she will be taking shots for a couple of months. She tells you that a friend of hers had a clot in her leg and was given an oral blood thinner. She wants to know if you can prescribe that pill, so she doesn’t have to take a shot. Background: Venous thromboembolism (VTE) occurs frequently in patient with cancer. Treatment in this group entails a number of challenges including a higher rate of thrombosis recurrence and a higher risk of bleeding. Standard therapy at this time for both symptomatic and asymptomatic VTE is with LMWH based on results from the CLOT trial (Lee 2003). In non-cancer patients, new oral anticoagulants (NOACs) like rivaroxaban have been shown to be effective in treatment without increasing bleeding events. The NOACs also add ease of use for the patient. We covered using rivaroxaban on SGEM#126 with VTE guru Dr. Jeff Kline. This study suggested it was safe and effective to dry start (no LMWH needed) in certain patients with DVTs and PEs. Though these agents are frequently used in the treatment of cancer-associated VTE, there is a dearth of evidence supporting this practice, in fact, none of the major agents – dabigitran, rivaroxaban, apixaban or edoxaban have undergone a well-done, randomized controlled trial. Clinical Question: Is edoxaban non-inferior to LMWH in the treatment of cancer-associated VTE? Reference: Raskob GE et al. Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism. NEJM 2018 Population: Adult patients with active cancer or cancer diagnosed within the previous two years with acute symptomatic or asymptomatic deep-vein thrombosis (DVT) or pulmonary embolism (PE). Exclusions:See link to the list of exclusions in the Supplementary...
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Read MoreSGEM#234: Contrast Induced Nephropathy – A Unicorn?
http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGEM234.mp3Podcast: Play in new window | Download Date: October 17th , 2018 Reference #1: Aycock, Westafer et al. Acute Kidney Injury After Computed Tomography: A Meta-analysis. Ann Emerg Med 2018 (CRD42017056195) Reference #2: Weisbord SD, Gallagher M, Jneid H, et al; PRESERVE Trial Group. Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine. NEJM 2018 (ClinicalTrials.gov NCT01467466.) Guest Skeptic: Dr. Lauren Westafer is a board certified emergency physician at Baystate Medical Center and instructor in the Department of Emergency Medicine at the University of Massachusetts Medical School. She is author of the blog, The Short Coat, and cofounder of the emergency medicine podcast, FOAMcast. Lauren is currently funded by an NHLBI K12 grant (1K12HL138049-01) studying the implementation of evidence-based diagnosis of pulmonary embolism in the emergency department. Case: A 64-year-old woman with type-2 diabetes. She presents to the emergency department with chest pain and some shortness of breath. The acute coronary syndrome work-up is negative but she is Well’s high and needs a CTPA to rule-out a pulmonary embolism. Her GFR is 50 and you are wondering if the contrast needed for the CT will cause an acute kidney injury (AKI) and if so, can you do anything to mitigate causing an AKI? Background: There has been a huge increase in the number of CT scans performed with more than 75 million CT scans performed in the US in 2013. Some scans require intravenous contrast (CTPA and CTCA) while in other cases it may improve image quality. There has been a lot of ink spilled over contrast-induced nephropathy (CIN). It came out of case reports and non-controlled studies. Historically the CTs were done with high osmolar contrast material and these non-controlled studies showed a rise in AKI. However, we now use iso-osmolar or low osmolar contrast and we are not seeing kidneys die as a result. Multiple observational studies have been published demonstrating that AKI in the modern era does not exist. Part of the difficulty with this topic is the inconsistent definition of contrast-induced nephropathy. A common definition is an increase in creatinine level by 25% or an absolute increase of 0.3 to 0.5 mg/dL within 3 days. These are all disease-oriented outcomes (change in laboratory values) not patient-oriented outcomes like death or need for dialysis. Clinical Question #1: Is CT contrast associated with acute kidney injury? Reference: Aycock, Westafer et al. Acute Kidney Injury After Computed Tomography: A Meta-analysis. Ann Emerg Med 2018 (CRD42017056195) Population: Adult humans Exclusions: Pediatrics, non-human studies, studies of contrast enhanced...
Most Recent Articles
SGEM#239: Febrile Seizure Recurrence – With or Without You Acetaminophen?
http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGEM239_FS.mp3Podcast: Play in new window | DownloadDate: December 13th , 2018 Reference: Murata et al. Acetaminophen and febrile seizure recurrences during the same fever episode. Pediatrics. 2018 Guest Skeptic: Dr. Damian Roland is a Consultant at the University of Leicester NHS Trust and Honorary Associate Professor for the University of Leicester’s SAPPHIRE group. He specialises in Paediatric Emergency Medicine and is a passionate believer that education exists to be shared (#foamed). Damian is part of the Don’t Forget the Bubbles (DFTB) team. They published an epic paper to determine the transit time of a Lego head (Tagg et al). The primary outcome was the FART (Found and Retrieved Time) score. Bowel habit were standardized before the trial started using the SHAT (Stool Hardness and Transit) score. The story was picked up by the BBC, Forbes and even talked about by James Corden on the Late, Late Show. Case: An 18-month-old presents having had a febrile convulsion (febrile seizure) at home. The seizure lasted no more than a minute and now having been in the department for a couple of hours the infant is back to their normal selves. Observations are normal except a low-grade fever and there is a clear focus in a right otitis media for an infection. You start to counsel the parents with...
Read More
SGEM Xtra: Message in a Book by the SGU
http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGU.mp3Podcast: Play in new window | DownloadDate: December 4th, 2018 Guest Skeptic: Dr. Steven Novella is a Yale Neurologist, host and producer of the popular science podcast called the Skeptics Guide to the Universe and executive editor of Science Based Medicine blog. This is an SGEM Xtra book review. I had the privilege of interviewing Dr. Novella about the new book by the Skeptics’ Guide to the Universe (SGU). I would like to recognize the influence the SGU had on inspiring the SGEM. The SGU has been a big part of my skeptical journey and contributed greatly to my critical thinking skills. Listen to the SGEM podcast on iTunes or your favourite podcast app hear Dr. Novella and me discuss how SGU got started, their new book, how to encourage critical thinking with students and colleagues, how he discusses pseudoscience with colleagues and patients and a few other topics. Five Frivolous Questions for Dr. Novella: Star Trek or Star Wars? Best Captain, Picard or Kirk? If you could have one today, flying car or transporter? Dinner with Newton or Galileo? Would you rather visit Mars or a moon of Jupiter? The SGEMers can order a copy the SGU book for themselves and as a gift by clicking on this BOOK LINK or on the picture below....
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SGEM#238: The Epi Don’t Work for OHCA
http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGEM238.mp3Podcast: Play in new window | DownloadDate: December 6th , 2018 Reference: Perkins et al. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. NEJM 2018. 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: A 51-year-old man experiences a cardiac arrest on the street. You are the first provider on scene with Emergency Medical Services (EMS) and start high-quality Cardiopulmonary Resuscitation (CPR). A cardiac defibrillator is...
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SGEM Xtra: On the Edge of Burnout ACEM18
http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/Edge-of-Burnout-.mp3Podcast: Play in new window | Download Date: November 24th, 2018 As you may know, I was invited to give a keynote address on burnout at the Australasia College of Emergency Medicine 2018 Annual Scientific Meeting (#ACEM18) in Perth, Australia. This turned out to be a very meta event. A few months leading up to the presentation my dad, Dr. Ken Milne Sr. got seriously ill. While he faced this with his usual grace and dignity, I was living...
Read More
SGEM#237: Screening Tool for Child Sex Trafficking
http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGEM237.mp3Podcast: Play in new window | Download Date: November 10th , 2018 Reference: Kaltiso et al. Evaluation of a Screening Tool for Child Sex Trafficking Among Patients with High-Risk Chief Complaints in a Pediatric Emergency Department. AEM October 2018. Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and clinical lecturer in Calgary. He is also an avid FOAM supporter/producer through various online outlets including TheSGEM. You may have noticed there was no music for the introduction. Part of the...
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SGEM#236: TXA – Not for Brain Bleeds
http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGEM236.mp3Podcast: Play in new window | Download Date: November 6th , 2018 Reference: Sprigg et al. Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial. Lancet. 2018 Guest Skeptic: Dr. Robert Edmonds is an emergency physician in the US Air Force in Virginia. This is Bob’s eighth 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: Your next patient is a...
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SGEM#235: Edoxaban for Cancer Associated VTE – Would the NEJM Lie to You?
http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGEM235.mp3Podcast: Play in new window | Download Date: October 30th , 2018 Reference: Raskob GE et al. Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism. NEJM 2018 Guest Skeptic: Dr. Anand Swaminathan is an assistant professor of Emergency Medicine at the St. Joseph’s Regional Medical Center in Patterson, NJ. He is a deputy editor for EM: RAP and, associate editor for REBEL EM. Case: A 43-year old woman with a history of breast cancer currently undergoing chemotherapy presents with mild chest...
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SGEM#234: Contrast Induced Nephropathy – A Unicorn?
http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGEM234.mp3Podcast: Play in new window | Download Date: October 17th , 2018 Reference #1: Aycock, Westafer et al. Acute Kidney Injury After Computed Tomography: A Meta-analysis. Ann Emerg Med 2018 (CRD42017056195) Reference #2: Weisbord SD, Gallagher M, Jneid H, et al; PRESERVE Trial Group. Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine. NEJM 2018 (ClinicalTrials.gov NCT01467466.) Guest Skeptic: Dr. Lauren Westafer is a board certified emergency physician at Baystate Medical Center and instructor in the Department of Emergency Medicine at the University...
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SGEM#233: Larry in the Den with Kiwis (LDK) – Low Dose Ketamine vs. Opioids for Acute Pain
http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGEM233.mp3Podcast: Play in new window | Download Date: October 10th , 2018 Reference: Karlow et al. A Systematic Review And Meta-Analysis of Ketamine as an Alternative to Opioids for Acute Pain in the Emergency Department. AEM Oct 2018. Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. He is also the CME Editor for Academic Emergency Medicine. Case: You are caring for a 38-year-old male (Larry) who presented to the emergency department with lower back pain. During your evaluation,...
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SGEM#232: I Can See Clearly Now the Collar is Gone – Thanks to the Triage Nurse
http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGEM232.mp3Podcast: Play in new window | Download Date: October 5th , 2018 Reference: Stiell et al. A Multicenter Program to Implement the Canadian C-Spine Rule by Emergency Department Triage Nurses. Annals of EM Oct 2018 Guest Skeptic: Alison Armstrong is an Emergency Department Nurse, TNCC Course Director, Trauma Program Coordinator and Canadian C-Spine Rule Nurse Champion. Case: There are two case scenarios this week to try and capture the two common ways patients present to the triage nurse. Case 1: A 51-year-old...
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SGEM#231: You’re So Vein – IO vs. IV Access for OHCA
http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGEM231.mp3Podcast: Play in new window | Download Date: September 21st, 2018 Reference: Kawano et al. Intraosseous Vascular Access Is Associated With Lower Survival and Neurologic Recovery Among Patients With Out-of-Hospital Cardiac Arrest. Annals of EM May 2018 Guest Skeptic: Andrew Merelman is a critical care paramedic and first year medical student at Rocky Vista University in Colorado. His primary interests are resuscitation, prehospital critical care, airway management, and point-of-care ultrasound. Case: A 46-year-old man has a cardiac arrest at home, witnessed by...
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SGEM#230: Tamsulosin – You’ve Lost that Loving Feeling – For Renal Colic
http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGEM230.mp3Podcast: Play in new window | Download Date: September 17th, 2018 Reference: Meltzer, A. et al. Effect of Tamsulosin on Passage of Symptomatic Ureteral Stones: A Randomized Clinical Trial. JAMA Internal Med, 2018. Guest Skeptics: Dr. Tony Seupaul, Professor and Chair, University of Arkansas for Medical Sciences Department of Emergency Medicine. Dr. Daniel Holleyman, Chief Resident at University of Arkansas for Medical Sciences Emergency Medicine Residency. Case: A 51-year-old man presents to the emergency department (ED) with five-hour history of acute onset left flank...
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