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Read MoreSGEM#219: Shout, Shout, PERC Rule Them Out
Podcast Link: SGEM219 Date: May 16, 2018 Reference: Freund et al. Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial. JAMA February 2018. Guest Skeptic: Dr. Jeffrey Kline (@klinelab) is the Vice Chair of Research in Emergency Medicine and a professor of physiology, Indiana University School of Medicine. He is the editor in chief of AEM, creator of Pulmonary Embolism Rule-out Criteria (PERC) Rule and has published extensively in the area of pulmonary emboli. We have even made a Batdoc Video together on pulmonary embolism. Case: A 47-year-old woman presents to the emergency department with a 24-hour history of chest pain and shortness of breath. She has a past medical history of hypothyroidism and gastroesophageal reflux disease. She is on levo-thyroxine and a proton pump inhibitor. Vital signs are normal (HR 72, BP 130/80, RR 12, O2 Sat 97% and 37.1C) and physical examination does not indicate the cause of her complaint. ECG, chest x-ray and routine lab work is also normal, including a troponin. You risk stratify her by gestalts and Well’s criteria as not high risk and wondering if you can PERC Rule her out and not order a d-dimer. Background: The Pulmonary Embolism Rule-out Criteria (PERC) Rule is an eight-item clinical decision instrument. The eight-items include the following clinical criteria. If the answer to any of these questions is positive a d-dimer is indicated. Listen to the podcast on iTunes to hear Dr. Kline discuss some background information on the diagnosing of pulmonary embolism and the PERC Rule. The History of the PERC Rule – How did it come about, why eight-items instead of five and when did you publish the first PERC paper? The Controversy of its Use in Europe – Why do the Europeans seem not to like the PERC Rule? The Power of Gestalt – How does it compare to risk stratifying tools like Well’s Criteria? The Inference about Sub-Segmental PE and Possible Over – Diagnosis? How to Use PERC Rule and Why this Differs from YEARS? Clinical Question: Does PERC Rule work in France? Reference: Freund et al. Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial. JAMA February 2018. PROPER stands for PERC Rule to Exclude Pulmonary Embolism in the Emergency Department. It was a crossover cluster-randomized clinical non-inferiority trial conducted in France. Population: Adult patients presenting to the emergency department with...
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Read MoreSGEM#218: Excited Delirium Syndrome
Podcast Link: SGEM218 Date: May 12th, 2018 Reference: Gonin P et al. Excited Delirium: A Systematic Review. AEM May 2018. Guest Skeptic: Dr. Chris Bond is an emergency physician and clinical lecturer at the University of Calgary. He is currently the host of CAEP Casts, which highlights educational innovations from emergency medicine residency programs across Canada. Chris also has his own #FOAMed blog called Standing on the Corner Minding My Own Business (SOCMOB). Case: A 24-year-old male is brought into the emergency department by police. He was running around wearing a Batman suit, jumping on cars and screaming he is Batman. He is brought to the emergency department extremely agitated and despite being held down by two police and three security guards he is still trying to bite the staff. You cannot obtain any vital signs and this patient is a danger to himself and staff. How will you manage this patient? Background: Cases of extreme agitation have been described since the 19thcentury, with Luther Bell’s eponymous “Bell’s mania” being published in the American Journal of Insanity (now American Journal of Psychiatry) in October, 1849 [1]. Bell distinguished these cases of extreme agitation from delirium tremens, diseases of the meninges and advanced typhoid based on a list of clinical criteria, as well as autopsy results from the brains and intestines of the patients. Bell’s case mortality rate for this condition was approximately 75%, though this was by no means rigorous data analysis. Interestingly, physicians of the day did not think these cases of extreme agitation would benefit from venesection (blood-letting) but did recommend this for the differential diagnoses. We have covered Alexander Hamilton’s blood-letting experiment from 1816 on camp fever with Dr. Rob Leeper on SGEM#200. The number needed to harm (death) with blood-letting for soldiers with camp fever was four (NNH 4) and therefore we could not recommend blood-letting as a treatment modality for camp fever. The term excited delirium syndrome (ExDS) was coined in the 1980s, after a flurry of deaths of individuals in custody or during arrests following extremeagitation [2]. ExDS usually involved men in their 30s after cocaine, methamphetamine, or ecstacy abuse [3-5]. These cases were not limited to patients in custody, however, and fatal cases of ExDS appeared in the hospital without any trauma, physical restraint or police intervention [5]. Given the significant morbidity and mortality rate of 8-10%, this syndrome remains of great importance to the emergency provider [6,7]. Over 150 years since it was first described, there is still...
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Read MoreSGEM#217: The Batman Effect on Improving Perseverance
Podcast Link: SGEM217 Date: March 6th, 2018 Reference: White et al. The “Batman Effect”: Improving Perseverance in Young Children. Child Development December 2016. Guest Skeptic: Dr. Casey Parker is a rural Generalist working in Broome, Australia. He has particular interests in Emergency Care, Aboriginal Health, Paediatrics, Trauma and Women’s Anaesthesia. Casey has this great blog and podcast called Broome Docs. Casey and I made a #Batdoc video at SMACCdub. Case: It is flu season and there is an endless stream of patients with sniffles, snot and sneezes! The waiting room is moaning with mildly unwell men; all with ‘the worst cold ever!” The residents are working double shifts in order to cover their fallen comrades. They are doing their best to avoid prescribing antibiotics whilst avoiding being coughed upon and writing endless, uninspiring discharge letters to the primary care docs. It is a Sisyphean task of tremendous tedium. As the senior doctor in the emergency department you wonder, how can you keep their spirits up and maintain the momentum – we need to maximize perseverance and limit distraction from the tedium. Background: Working in the emergency department is very tough. Sometimes it feels like it would take super human strength and skills to finish a shift. There are comic book super heroes that are physicians. Most people are probably familiar with Marvel’s Dr. Strange. He was a neurosurgeon who had his hands injured in a car accident. In a desperate search to cure his injuries he turns to occult eastern mysticism. Soranik Natu is also a neurosurgeon, daughter of Sinestro and a member of the Green Lanter Corp. Thor the god of thunder was transformed into a physician named Donald Blake in the earlier comic book series? Batman Fun Facts: Bruce Wayne, Batman’s secret identity, came from two historical figures (Robert the Bruce, a Scottish national hero and Mad Anthony Wayne, a hero of the American Revolution) There was a Batman course taught at the University of Victoria in Canada called the Science of Batman Andy Warhol directed the first-ever Batman movie in 1964 but it was made without the consent of DC Comics. Clinical Question: Does self-distancing by dressing up as Batman enhance perseverance at a tedious task? Reference: White et al. The “Batman Effect”: Improving Perseverance in Young Children. Child Development December 2016. Population: Typically developing four- and six-year-old children from the Minneapolis area Exclusions: None listed Intervention: Impersonating an exemplar other (such as Batman) while doing a repetitive task for 10 minutes....
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Read MoreSGEM Xtra: Petition to Retire the Surviving Sepsis Campaign Guidelines
Recently the SGEM was contacted by a group of doctors organizing a petition. They were concerned about the new Surviving Sepsis Campaign (SCC) guidelines that were just released. Specifically, the fluid, antibiotics and pressor requirements within the first hour of being triaged in the emergency department. The SGEM was invited to be involved in a global effort to express the concerns about the SSC guidelines. Below is the letter being released from a number of #FOAMed people from around the world today with a link to an online petition. Please review the information and consider signing the petition. The next SGEM episode will be a standard critical appraisal of a recent publication. The goal remains to try and cut the knowledge translation window down from over ten years to less than one year using social media. We ultimately want patients to get the best care, based on the best evident. Surviving Sepsis Campaign Petition Friends, Concern regarding the Surviving Sepsis Campaign (SSC) guidelines dates back to their inception. Guideline development was sponsored by Eli Lilly and Edwards Life Sciences as part of a commercial marketing campaign (1). Throughout its history, the SSC has a track record of conflicts of interest, making strong recommendations based on weak evidence, and being poorly responsive to new evidence (2-6). The original backbone of the guidelines was a single-center trial by Rivers defining a protocol for early goal-directed therapy (7). Even after key elements of the Rivers protocol were disproven, the SSC continued to recommend them. For example, SSC continued to recommend the use of central venous pressure and mixed venous oxygen saturation after the emergence of evidence that they were nonbeneficial (including the PROCESS and ARISE trials). These interventions eventually fell out of favor, despite the slow response of SSC that delayed knowledge translation. SSC has been sponsored by Eli Lilly, manufacturer of Activated Protein C. The guidelines continued recommending Activated Protein C until it was pulled from international markets in 2011. For example, the 2008 Guidelines recommended this, despite ongoing controversy and the emergence of neutral trials at that time (8,9). Notably, 11 of 24 guideline authors had financial conflicts of interest with Eli Lilly (10). The Infectious Disease Society of America (IDSA) refused to endorse the SSC because of a suboptimal rating system and industry sponsorship (1). The IDSA has enormous experience in treating infection and creating guidelines. Septic patients deserve a set of guidelines that meet the IDSA standards. Guidelines should...
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Read MoreSGEM#216: Pump It Up – Corticosteroids for Patients with Pneumonia Admitted to Hospital
Podcast Link: SGEM216 Date: April 25th, 2018 Reference: Stern A et al, Corticosteroids for pneumonia (Review). Cochrane Database of Systematic Reviews. December 2017. Guest Skeptic: Dr. Jake Turner, a foundation doctor working in the UK. Case: A 72-year-old gentleman presents to your emergency department. He has been generally unwell for around one week, with a worsening cough, shortness of breath and fever. He is now feeling extremely short of breath, appears confused and is pyrexial at 39 degrees centigrade. His observations are heart rate of 102 beats per minute, respiratory rate of 34 breaths per minute, blood pressure of 110/67 mmHg, and oxygen saturation of 91% on room air. Background: There have been a large number of trials on steroids for a variety of conditions in the last year and we have covered some of them on the SGEM: The ADRENAL trial on steroids in septic shock demonstrating no all-cause mortality benefit at 90 days (SGEM#208). Oral prednisolone in preschool children with virus-associated wheeze showed a decrease in emergency department length-of-stay with steroids compared to placebo (SGEM#206). Corticosteroids for sore throats seem to provide some modest benefit (SGEM#203). A single dose of dexamethasone was non-inferior to a three-day course of oral prednisolone in the treatment of children with an acute asthma exacerbation (SGEM#194). The Cochrane collaboration has come out with yet another paper on our favourite panacea, the steroid. This time, it is a systematic review and meta-analysis looking at the effects of steroids in patients presenting with a community acquired pneumonia. This is an update from their previous review on the topic published in 2011. It showed that in most patients with pneumonia, corticosteroids are beneficial for accelerating the time to resolution of symptoms, but lacked enough data to make any recommendations. “In most patients with pneumonia, corticosteroids are generally beneficial for accelerating the time to resolution of symptoms. However, evidence from the included studies was not strong enough to make any recommendations.” [1] Clinical Question: Do steroids safely reduce morbidity and mortality in patients with community acquired pneumonia? Reference:Stern A et al, Corticosteroids for pneumonia (Review). Cochrane Database of Systematic Reviews. December 2017. Population: Adults and or children presenting to the emergency department or primary care settings with a diagnosis of community acquired pneumonia confirmed radiographically. Exclusions: Studies including only neonates, patients with Pneumocystis pneumonia, and patients with HIV. Intervention: Systemic corticosteroids given at any dose, by any mode and for any duration. Steroids that were included were: prednisone, prednisolone, methylprednisolone, betamethasone, dexamethasone, triamcinolone, and...
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Read MoreSGEM#215: Love Will Tear Us Apart – Diagnostic Challenges of Aortic Dissection
Podcast Link: SGEM215a Date: April 12th, 2018 Reference: Ohle R et al. Clinical Examination for Acute Aortic Dissection: A Systematic Review and Meta-analysis. AEM April 2018 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. He is also the CME editor for Academic Emergency Medicine (AEM). Case: You are in the emergency department caring for a 65-year-old man with sharp chest pain radiating to the back. Blood pressure is elevated, and his pain was sudden in onset. His chest x-ray is normal, and there is no sign of asymmetric pulses. The EKG and laboratory tests are normal. You are wondering if you need to order a CT to rule out an aortic dissection. Background: Aortic dissection is a rare but deadly disease which can confound the emergency physician’s diagnostic abilities. Some estimates are that up to 38% of cases are initially missed [1]. Mortality is up to 40% in the acute phase [2] , and 70% by two weeks [3]. The most common feature of aortic dissection is pain, in the chest, back, and/or abdomen, but with aortic dissection being so rare and pain being so prevalent a complaint, diagnosing aortic dissection becomes difficult. Data is lacking on predictive value of clinical features; much of the prior literature focuses on patients already diagnosed with aortic dissection. There are two clinical prediction tools for the diagnosis of aortic dissection. One is from the American Heart Association called the aortic dissection detection (ADD) risk score. Our good friend over at REBEL EM, Salim Rezaie put together a nice table showing the score that we will include in the show notes. If any one of the predisposing conditions, pain features or physical exam findings are positive you add one point to the score. The other is a simpler three-variable rule called the Von Kodolitsch score. This tool includes aortic pain (immediate-onset tearing or ripping pain), mediastinal/aortic widening on chest x-ray, or pulse/BP differential. American College of Emergency Physicians (ACEP) published a guideline in 2015 for the diagnosis of acute aortic dissection. ACEP gives level C recommendations for the use of existing clinical decision tools: “In an attempt to identify patients at very low risk for acute non-traumatic thoracic aortic dissection, do not use existing clinical decision rules alone. The decision to pursue further workup for acute non-traumatic aortic dissection should be at the discretion of the treating physician.” [4] Clinical Question: What is the diagnostic accuracy in aortic dissection of various clinical features (history...
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Read MoreSGEM#214: Woman – The TXA Trial for Post-Partum Hemorrhage
Podcast Link: SGEM214 Date: April 13th, 2018 Reference: Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. The Lancet 2017 Guest Skeptic: Dr. Nick Papalia completed his MD at Western University. He is currently completing his third year of Obstetrics and Gynecology residency at the University of Calgary. Case: 37-year-old primiparous woman has a spontaneous vaginal delivery following an induction of labour at 39 weeks for gestational diabetes for which she is treated with insulin. She delivered a vigorous 3800g boy following a brief episode of shoulder dystocia. She is otherwise healthy but does have a remote history of asthma. Aside from insulin and prenatal vitamins, she takes no medications. Approximately five minutes after delivery of the placenta, as you are evaluating her perineum, she begins to have a moderate amount of vaginal bleeding. Her nurse performs fundal massage which temporarily improves her flow. Background: Utako and Shosuke Okamoto discovered TXA in the 1950’s while searching for a treatment for postpartum hemorrhage [1]. TXA is a synthetic analog of the amino acid lysine. The normal process is for plasminogen to breakdown fibrin and prevent blood clots. TXA acts as an antifibrinolytic agent. It binds to lysine receptor sites on plasminogen blocking its action on fibrin. The ultimate result is the fibrin matrix structure is maintained and bleeding is reduced. Post-partum hemorrhage (PPH) is defined by the World Health Organization (WHO) as: “a cumulative blood loss of greater than or equal to 1,000 mL or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after the birth process”. PPH is one of the leading causes of maternal mortality around the world [2]. We have covered the use of TXA for trauma (CRASH-2) with Dr. Anand Swaminathan. This trial showed TXA is safe and effective treatment in patients with hemorrhagic shock from trauma in reducing mortality. We also did a couple of podcasts on TXA being effective for epistaxis (SGEM#210 and SGEM#53). The American College of Obstetricians and Gynecologists (ACOG) published guidelines for the management of postpartum hemorrhage including the use of TXA. They give TXA a Level B recommendation (based on limited or inconsistent scientific evidence): [3] “Given the mortality reduction findings, tranexamic acid should be considered in the setting of obstetric hemorrhage when initial medical therapy fails.” There was also a commentary published in the issue of Obstetrics and Gynecology by Pacheco et al. [4] They...
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Read MoreSGEM Xtra: The Danger Within Us
Podcast Link: SGEM Xtra Danger Within Us Date: March 23rd, 2018 This is a SGEM Xtra book review. I had the pleasure of interviewing Jeanne Lenzer. She is an award-winning independent medical investigative journalist who has written for the BMJ. Jeanne has also written for the Atlantic, the New York Times Magazine, Mother Jones, Huffington Post and Slate. Jeanne book is called The Danger Within Us: America’s Untested, Unregulated Medical Device Industry and One Man’s Battle to Survive It. In the book, she takes a critical look at the medical device industry. One of the main inspiration for her book is the Legend of Emergency Medicine Dr. Jerome Hoffman. He is also one of my mentors who taught me to be skeptical of the medical literature. Listen to the podcast on iTunes as Jeanne describes some of the problems with the medical device industry. Some of the disturbing facts she provides include: Medical interventions have become the third leading cause of death in America. The FDA does not require clinical testing for most high-risk implanted devices. The death rate caused by medical devices is unknown, because no one is keeping track. Jeanne provides some of examples of patients who experienced significant harm instead of benefit with implantable medical devices like a vagus nerve stimulator or metal on metal artificial hip. We also discuss some of the possible solutions to the medical device industry and mention some additional resources: Choosing Wisely, Lown Institute, Right Care Alliance, ClinicalTrials.gov, John Ioannidis, and James McCormick. Let me know if you like this type of SGEM Xtra and if the responses are positive I will consider doing more book reviews. The SGEM will be back next week with a structured critical review of a recent publication trying to cut the knowledge translation window down from over ten years to less than one year. Remember to be skeptical of anything you learn, even if you heard it on the Skeptics’ Guide to Emergency Medicine. SGEM Xtra: The Danger Within Us [ 47:27 ] Play Now | Play in Popup |...
Most Recent Articles
SGEM#219: Shout, Shout, PERC Rule Them Out
Podcast Link: SGEM219 Date: May 16, 2018 Reference: Freund et al. Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial. JAMA February 2018. Guest Skeptic: Dr. Jeffrey Kline (@klinelab) is the Vice Chair of Research in Emergency Medicine and a professor of physiology, Indiana University School of Medicine. He is the editor in chief of AEM, creator of Pulmonary Embolism Rule-out Criteria (PERC) Rule and has published extensively in the area of pulmonary emboli. We have even made a Batdoc Video together on pulmonary embolism. Case: A 47-year-old woman presents to the emergency department with a 24-hour history of chest pain and shortness of breath. She has a past medical history of hypothyroidism and gastroesophageal reflux disease. She is on levo-thyroxine and a proton pump inhibitor. Vital signs are normal (HR 72, BP 130/80, RR 12, O2 Sat 97% and 37.1C) and physical examination does not indicate the cause of her complaint. ECG, chest x-ray and routine lab work is also normal, including a troponin. You risk stratify her by gestalts and Well’s criteria as not high risk and wondering if you can PERC Rule her out and not order a d-dimer. Background: The Pulmonary Embolism Rule-out Criteria (PERC) Rule is an eight-item clinical decision instrument....
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SGEM#218: Excited Delirium Syndrome
Podcast Link: SGEM218 Date: May 12th, 2018 Reference: Gonin P et al. Excited Delirium: A Systematic Review. AEM May 2018. Guest Skeptic: Dr. Chris Bond is an emergency physician and clinical lecturer at the University of Calgary. He is currently the host of CAEP Casts, which highlights educational innovations from emergency medicine residency programs across Canada. Chris also has his own #FOAMed blog called Standing on the Corner Minding My Own Business (SOCMOB). Case: A 24-year-old male is brought into the emergency department by police. He was running around wearing a Batman suit, jumping on cars and screaming he is Batman. He is brought to the emergency department extremely agitated and despite being held down by two police and three security guards he is still trying to bite the staff. You cannot obtain any vital signs and this patient is a danger to himself and staff. How will you manage this patient? Background: Cases of extreme agitation have been described since the 19thcentury, with Luther Bell’s eponymous “Bell’s mania” being published in the American Journal of Insanity (now American Journal of Psychiatry) in October, 1849 [1]. Bell distinguished these cases of extreme agitation from delirium tremens, diseases of the meninges and advanced typhoid based on a list of clinical criteria, as well as autopsy results from the brains and intestines of...
Read More
SGEM#217: The Batman Effect on Improving Perseverance
Podcast Link: SGEM217 Date: March 6th, 2018 Reference: White et al. The “Batman Effect”: Improving Perseverance in Young Children. Child Development December 2016. Guest Skeptic: Dr. Casey Parker is a rural Generalist working in Broome, Australia. He has particular interests in Emergency Care, Aboriginal Health, Paediatrics, Trauma and Women’s Anaesthesia. Casey has this great blog and podcast called Broome Docs. Casey and I made a #Batdoc video at SMACCdub. Case: It is flu season and there is an endless stream of patients with...
Read More
SGEM Xtra: Petition to Retire the Surviving Sepsis Campaign Guidelines
Recently the SGEM was contacted by a group of doctors organizing a petition. They were concerned about the new Surviving Sepsis Campaign (SCC) guidelines that were just released. Specifically, the fluid, antibiotics and pressor requirements within the first hour of being triaged in the emergency department. The SGEM was invited to be involved in a global effort to express the concerns about the SSC guidelines. Below is the letter being released from a number of #FOAMed people from around...
Read More
SGEM#216: Pump It Up – Corticosteroids for Patients with Pneumonia Admitted to Hospital
Podcast Link: SGEM216 Date: April 25th, 2018 Reference: Stern A et al, Corticosteroids for pneumonia (Review). Cochrane Database of Systematic Reviews. December 2017. Guest Skeptic: Dr. Jake Turner, a foundation doctor working in the UK. Case: A 72-year-old gentleman presents to your emergency department. He has been generally unwell for around one week, with a worsening cough, shortness of breath and fever. He is now feeling extremely short of breath, appears confused and is pyrexial at 39 degrees centigrade. His observations are heart...
Read More
SGEM#215: Love Will Tear Us Apart – Diagnostic Challenges of Aortic Dissection
Podcast Link: SGEM215a Date: April 12th, 2018 Reference: Ohle R et al. Clinical Examination for Acute Aortic Dissection: A Systematic Review and Meta-analysis. AEM April 2018 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. He is also the CME editor for Academic Emergency Medicine (AEM). Case: You are in the emergency department caring for a 65-year-old man with sharp chest pain radiating to the back. Blood pressure is elevated, and his pain was sudden in onset. His chest x-ray is...
Read More
SGEM#214: Woman – The TXA Trial for Post-Partum Hemorrhage
Podcast Link: SGEM214 Date: April 13th, 2018 Reference: Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. The Lancet 2017 Guest Skeptic: Dr. Nick Papalia completed his MD at Western University. He is currently completing his third year of Obstetrics and Gynecology residency at the University of Calgary. Case: 37-year-old primiparous woman has a spontaneous vaginal delivery following an induction of labour at 39 weeks for gestational diabetes...
Read More
SGEM Xtra: The Danger Within Us
Podcast Link: SGEM Xtra Danger Within Us Date: March 23rd, 2018 This is a SGEM Xtra book review. I had the pleasure of interviewing Jeanne Lenzer. She is an award-winning independent medical investigative journalist who has written for the BMJ. Jeanne has also written for the Atlantic, the New York Times Magazine, Mother Jones, Huffington Post and Slate. Jeanne book is called The Danger Within Us: America’s Untested, Unregulated Medical Device Industry and One Man’s Battle to Survive It. In the book, she takes a critical look at the medical...
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SGEM#213: Upside Down You Convert Me Out of SVT?
Podcast Link: SGEM213 SVT Date: March 30th, 2018 Reference: Bronzetti et al. Upside-down position for the out of hospital management of children with supraventricular tachycardia. International Journal of Cardiology. February 2018. Guest Skeptic: Dr. Robert Edmonds is an Emergency physician in the US Air Force. This is his 6th visit to the SGEM. DISCLAIMER: The views and opinions of this podcast do not represent the United States Government or the US Air Force. Case:A seven-year-old girl presents to your emergency department complaining of palpitations. ...
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SGEM#212: Holding Back the Years – Risk Factors for Adverse Outcomes in Older Adults with Blunt Chest Trauma
Podcast Link: SGEM212 Date: March 20th, 2018 Reference: Sawa et al. Risk factors for adverse outcomes in older adults with blunt chest trauma: A systematic review. CJEM March 2018 Guest Skeptic: Dr. Christina Shenvi is an Emergency Physician at University of North Carolina. She is fellowship trained in Geriatric Emergency Medicine and has a podcast called GEMCAST. Christina loves serving as the assistant residency director, writing things, reading things, teaching people, and having kids. Case: An 85-year-old woman with a history of chronic obstructive...
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SGEM#211: Pins and Needles – Acupuncture for Migraine Prophylaxis
Podcast Link: SGEM211 Date: March 18th, 2018 Reference: Zhao et al. The Long-Term Effect of Acupuncture for Migraine Prophylaxis: A Randomized Clinical Trial. JAMA Internal Medicine 2017 Guest Skeptic: Dr. Alfred Sacchetti is a full time practicing Emergency Physician, who is also the Chief of Emergency Medicine at Our Lady of Lourdes Medical Center in Camden, New Jersey, USA, an Assistant Clinical Professor of Emergency Medicine, an Active Researcher and faculty member for the Emergency Medicine and Acute Care course. Case: 40-year-old male...
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SGEM#210: (Don’t) Let it Bleed – TXA for Epistaxis in Patients on Anti-Platelet Drugs
Podcast Link: SGEM210 Date: March 6th, 2018 Reference: Zahed et al. Topical Tranexamic Acid Compared With Anterior Nasal Packing for Treatment of Epistaxis in Patients Taking Antiplatelet Drugs: Randomized Controlled Trial. AEM March 2018. Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the Director of Simulation Education at Markham Stouffville Hospital in Ontario. He is the creator of the excellent #FOAMed project called First10EM.com Case: A 77-year-old woman with known coronary artery disease is on clopidogrel and aspirin because of a stent...
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