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Read MoreSGEM#237: Screening Tool for Child Sex Trafficking
Podcast Link: SGEM237 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 global human rights violation and...
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Read MoreSGEM#236: TXA – Not for Brain Bleeds
Podcast Link: SGEM236 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 times for epistaxis, trauma and...
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Read MoreSGEM#235: Edoxaban for Cancer Associated VTE – Would the NEJM Lie to You?
Podcast Link: SGEM235 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 Appendix Intervention: LMWH for five...
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Read MoreSGEM#234: Contrast Induced Nephropathy – A Unicorn?
Podcast Link: SGEM234 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 procedures (ex: coronary angiography), interventional...
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Read MoreSGEM#233: Larry in the Den with Kiwis (LDK) – Low Dose Ketamine vs. Opioids for Acute Pain
Podcast Link: SGEM233 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, he tells you he doesn’t want any narcotic pain medication. You wonder if there are alternative options, and a colleague reminds you that ketamine has recently gained a lot of exposure as a possible alternative. Background: The amelioration of pain and suffering should be one of the top priorities of emergency physicians. In 2001, JACHO made pain the 5th vital sign to address the issue of oligoanalgesia, which unfortunately created many problems. Opiates became a very common treatment for acute pain in the ED setting after JACHO and the introduction of new and powerful opioids like oxycodone. However, in recent years, an increased desire for alternatives has been prompted in an attempt to reduce opiate usage. The pendulum is swinging to opiophobia. This can leave the patient left in the middle with ineffective pain management. One alternative or adjunct to limit the use of opioids in the ED is low dose ketamine (LDK). Several studies have been performed evaluating low dose ketamine (LDK) for acute pain, with a variety of methodological designs, time endpoints, and doses. We have covered some of those papers and watched the literature develop over the years on the SGEM. SGEM#111: Comfortably Numb – Low dose Ketamine as Adjunct for ED Pain Control SGEM Bottom Line: High-quality published evidence to support the use of sub dissociative-dose ketamine to quickly reduce acute pain in emergency department settings is lacking, but lower quality studies inconsistently demonstrate effectiveness with uniformly low risk of adverse effects. SGEM#130: Low Dose Ketamine for Acute Pain Control in the Emergency Department (reviewed two ketamine papers) SGEM Bottom Line: For patients who have a contraindication to opioids such as allergy or hypotension, sub dissociative ketamine would be a reasonable option to consider for treating acute pain. SGEM Bottom Line: While further validation in other settings is needed, this study suggests ketamine as a relatively safe option for patients who do not achieve analgesia with high doses of morphine or are unable to tolerate them. SGEM#198: Better Slow Down – Push vs. Short Infusion...
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Read MoreSGEM#232: I Can See Clearly Now the Collar is Gone – Thanks to the Triage Nurse
Podcast Link: SGEM232 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 male patient presents to triage in a collar on a back-board via EMS following a rear-end motor vehicle collision (MVC) at a stop light. He was a belted driver with no past medical history and GCS 15. The driver of the car that hit him was texting and did not appear to slow before striking the rear of the patient’s car at about 50 km/hr. The patient complains of left shoulder and neck pain. Case 2: A 45-year-old female presents to triage at 20:30 walking stating that she fell from a chair this morning. She went to work all day as she thought she was unhurt initially, but pain has started to set in so she stopped by the emergency department on the way home complaining of right wrist and neck pain and stiffness all over. She is worried she may have a serious injury to her neck. Background: Clearing the c-spines is a regular activity in the emergency department (ED). This can be done clinically using the Canadian C-Spine Rules/Tools or with imaging. The vast majority of these patients (>99%) do not have a fractured cervical spine diagnosed. Blunt trauma patients transported via EMS often arrive on a backboard, c-collar and head restraints. They remain this way often complaining to the nurse until they can be assessed by a physician and have their c-spine cleared. There are protocols to get blunt trauma patients off spine boards urgently. However, they still can remain in c-spine precautions for a long time waiting to be assessed. This adds to patient discomfort, occupies valuable acute ED space and can contribute to crowding. The Canadian C-Spine Rule (CCR) is a clinical decision instrument developed to allow clinicians to clear the c-spine without imaging (1). This instrument has been validated to be safe and decrease use of diagnostic imaging (2,3). Canadian C-Spine Rule (CCR) The CCR applies to alert (GCS=15) and stable trauma patients where cervical spine injury is a concern Dangerous Mechanism Fall from elevation>=3 feet/ 5 stairs Axial load to...
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Read MoreSGEM#231: You’re So Vein – IO vs. IV Access for OHCA
Podcast Link: SGEM231 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 family. Bystander CPR is initiated prior to EMS arrival. EMS arrives on scene and initiates high quality basic life support (BLS). One defibrillation for ventricular fibrillation (VF) is provided but the patient remains in VF. As part of their protocol, they attempt vascular access to administer epinephrine and an antidysrhythmic. They wonder whether it would be better to attempt a peripheral intravenous (IV) line or intraosseous access first? Background: Cardiac arrest care has evolved drastically over the past couple of decades, but not in the way many may have expected. We now know that an emphasis on the basics (high quality chest compressions and defibrillation) are the most important aspects of resuscitation. More advanced skills such as airway management, vascular access, and cardiac medications are being de-emphasized. It was the classic OPALS paper covered on SGEM#64 by the Legend of Emergency Medicine Dr. Ian Stiell that demonstrated no advantage to ACLS vs. BLS for out-of-hospital cardiac arrest (OHCA). There have been other SGEM episodes that question the efficacy of various interventions: Man vs. mechanical CPR for OHCA (SGEM#136) ACLS for OHCA (SGEM#189) Not Stayin’ Alive More Often with Amiodarone or Lidocaine (SGEM#162) Remote ischemic conditioning for OHCA (SGEM#116) Pre-hospital therapeutic hypothermia (SGEM#21, SGEM#54, SGEM#82 and SGEM#183) The resuscitation science community has been struggling to find advanced interventions that can show a benefit in mortality and, most importantly survival with good neurological outcome. Intraosseous access has become a mainstay of cardiac arrest care due to its speed and reliability. However, no randomized trial has compared intravenous access to intraosseous access with a primary outcome of good neurologic function. Clinical Question: Is intraosseous vascular access in the pre-hospital setting for OHCA associated with better neurologic outcomes compared to intravenous vascular access? 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 Population: Out-of-hospital, non-traumatic, adult cardiac arrest patients Excluded: Unsuccessful attempt or more than one access site. Patients were also excluded if incarcerated or pregnant,...
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Read MoreSGEM#230: Tamsulosin – You’ve Lost that Loving Feeling – For Renal Colic
Podcast Link: SGEM230 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 pain. The pain comes in waves, radiates into his left groin and is associated with nausea and vomiting. He noticed darkening of his urine, but does not have dysuria, fever, testicular pain, or penile discharge. You work him up and the urine analysis shows large blood, negative nitrites, negative bacteria. CT abdomen/pelvis without contrast is done which identifies a 7mm radiopaque stone in the left distal ureter. The patient receives 15mg ketorolac IV (SGEM#175) because you know there is a ceiling to the analgesic effect of non-steroidal anti-inflammatory drugs (NSAIDs). His pain improves significantly, and he is ready for discharge. He is given a referral to Urology for follow up of his ureteral stone, a prescription for oral antiemetics, and advised to take over-the-counter (OTC) NSAIDs. He asks if there is anything he could do or take to help the stone pass faster? Background: We have covered renal colic many times on the SGEM. This has included the medical expulsive therapy using alpha blockers, lidocaine for pain control, pushing IV fluids or diuretics to pass stones, ultrasound vs. CT scans for diagnosis, and even acupuncture vs. morphine for renal colic pain. SGEM#4: Getting Un-Stoned (Renal Colic and Alpha Blockers) SGEM#32: Stone Me (Fluids and Diuretics for Renal Colic) SGEM#71: Like a Rolling Kidney Stone SGEM#97: Hippy Hippy Shake – Ultrasound Vs. CT Scan for Diagnosing Renal Colic SGEM#154: Here I Go Again, Kidney Stone SGEM#202: Lidocaine for Renal Colic? SGEM#220: Acupuncture Morphine for Renal Colic The SGEM bottom lines on the management of renal colic from those previous episodes were as follows: Expulsive therapy is unnecessary for ureteric stones < 5mm. You don’t need to push fluids (oral/IV) or use diuretics to pass kidney stones. There is some weak evidence that Tamsulosin MAY help passage of larger stones (5 to 10 mm). Bedside emergency department ultrasound is safe and has several advantages over CT for the diagnosis of kidney stones. Lidocaine cannot be recommended for the treatment of renal colic at this time. The evidence does...
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SGEM#237: Screening Tool for Child Sex Trafficking
Podcast Link: SGEM237 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...
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SGEM#236: TXA – Not for Brain Bleeds
Podcast Link: SGEM236 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...
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SGEM#235: Edoxaban for Cancer Associated VTE – Would the NEJM Lie to You?
Podcast Link: SGEM235 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...
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SGEM#234: Contrast Induced Nephropathy – A Unicorn?
Podcast Link: SGEM234 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...
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SGEM#233: Larry in the Den with Kiwis (LDK) – Low Dose Ketamine vs. Opioids for Acute Pain
Podcast Link: SGEM233 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, he tells you he doesn’t...
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SGEM#232: I Can See Clearly Now the Collar is Gone – Thanks to the Triage Nurse
Podcast Link: SGEM232 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 male patient presents to triage...
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SGEM#231: You’re So Vein – IO vs. IV Access for OHCA
Podcast Link: SGEM231 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 family. Bystander CPR is initiated...
Read More
SGEM#230: Tamsulosin – You’ve Lost that Loving Feeling – For Renal Colic
Podcast Link: SGEM230 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 pain. The pain comes in...
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SGEM#229: I Fought the Law and the Law Won – But Would it Matter if I had a Resident?
Podcast Link: SGEM229 Date: September 10th, 2018 Reference: Gurley et al. Comparison of Emergency Medicine Malpractice Cases Involving Residents to Non-Resident Cases. AEM September 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: You are giving an introductory lecture on evidence-based medicine to the incoming class of residents, and after you finish you notice some excited chatter at the...
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SGEM#228: Winds of Change – High Flow Nasal Oxygen for Acute Bronchiolitis?
Podcast Link: SGEM228 Date: September 5th, 2018 Reference: Franklin et al. A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis. NEJM March 2018. Guest Skeptic: Dr. Ben Lawton is a paediatric emergency physician in Brisbane Australia. He divides his time between a tertiary children’s hospital and a community hospital that is busy enough to have its own paediatric emergency department. He is part of the Don’t Forget the Bubbles team. Case: Elsie is five months old and presents on day two...
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SGEM#227: A Message to you Rudy – About Rudeness
Podcast Link: SGEM227 Date: August 22nd, 2018 Reference: Riskin A, Erez A, Foulk TA, et al. Rudeness and Medical Team Performance. Pediatrics. February 2017 Guest Skeptic: Dr. Simon McCormick is an Emergency Medicine Consultant from Northern Ireland who works in Rotherham Hospital in Yorkshire, England. He is currently redeployed in Medical Education on “Burnout Sabbatical” but is hopeful of returning to the shop floor in the near future. He writes a blog called Broken Toy covering topics such as his experience with burnout, medical...
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SGEM Xtra: The Top 10 Ch-ch-ch-changes to ATLS 10th Edition
Podcast Link: SGEM Xtra ATLS Date: August 25th, 2018 Guest Skeptic: Dr. Neil Parry is an Associate Professor of Surgery and Critical Care at Western University. He is the Medical Director of the Trauma Program for London Health Sciences Centre and the Site Chief of Surgery at Victoria Hospital. Dr. Parry is also a national member of the Committee on Trauma for the America College of Surgeons where he serves as a member of the ATLS Committee and as the Chair of the Surgical...
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