Make it So: BEEM Appraisal Tools
The Skeptics’ Guide to Emergency Medicine has been very successful in a short period of time due to the power of social media. People like you reading the blog, listening to the podcast on iTunes, following on Twitter, liking on Facebook and sharing the content. Many of you have asked for the BEEM Appraisal Tools used to critically assess the literature. As you know, BEEM was started by Dr. Andrew Worster of McMaster University. Dr. Worster developed a very unique system of creating high quality, clinically relevant and evidence based content. Check out the YouTube video on the BEEM process. The process starts by electronically searching the vast literature published daily using the Health Information Research Unit to find practice-changing emergency medicine papers. End users (Emergency Physicians around the world) are then engaged on a monthly basis to assess the relevance of these...
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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 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...
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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 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...
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SGEM#208: It Makes No Difference – Glucocorticoids for the Treatment of Septic Shock
Podcast Link: SGEM208 Date: February 14th, 2018 Reference: Venkatesh S et al. Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. NEJM January 2018. Guest Skeptic: Dr. Rory Spiegel (@EMNerd_) is a clinical instructor at University of Maryland, a recent graduate of Stony Brook’s Resuscitation Fellowship, and a current Critical Care fellow at University of Maryland. He writes an excellent blog called EM Nerd, which he describes as nihilistic ramblings. Case: 64-year-old male presents to your emergency department with worsening abdominal pain, nausea, vomiting and anorexia for the past week. On presentation he is lethargic and hypotensive. He requires control of his airway and is given a 30 cc/kg fluid bolus and started on norepinephrine. His urine analysis is consistent with a urinary tract infection. Over the course of his emergency department stay he has escalating vasopressor requirements. After starting vasopression, you ask...
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SGEM Xtra: Every Day I Write the Book – SGEM Season#3
Podcast Link: SGEM Xtra Season#3 Date: December 25th, 2017 Happy holidays to all the SGEMers. Please accept this PDF book of Season#3. It is a holiday gift from me to you to say thank you for all the support and encouragement over the last few years. There are now close to 35,000 subscribers and the SGEM is translated into four other languages. Who would have thought back in 2012 that an emergency medicine physician from Canada could reach so many people around the world? The goal of the SGEM continues to be to cut the knowledge translation window down from over ten years to less than one year. It does this by doing a structured critical review of a recent publication and then disseminates the information using the power of social media. We want patients to get the best care based...
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SGEM#195: Some Like It Hot – ED Temperature and ICU Survival
Podcast Link: SGEM195 Date: November 11th, 2017 Reference: Sundén-Cullberg et al. Fever in the Emergency Department Predicts Survival of Patients With Severe Sepsis and Septic Shock Admitted to the ICU. Critical Care Medicine 2017. Guest Skeptic: Jesse Spurr works as a Nurse Educator in the Emergency Department at Redcliffe Hospital in Australia. Outside his family and work, Jesse pours energy into his professional hobbies: healthcare simulation podcast Simulcast, nursing practice development blog and podcast Injectable Orange and faculty and team member of The Teaching Coop. Jesse classes himself a lifelong student of teaching, learning, health and human performance. Case: You are working night shift in the emergency department. Two patients present to the front desk in close succession, brought in by concerned family members. Both are similarly hypotensive and tachypnoeic,drowsy but orientated, with hot, reddened and increasingly painful cellulitis. Following the triage sepsis pathway,...
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SGEM#194: Highway to the Dexamethasone – For Pediatric Asthma Exacerbations
Podcast Link: SGEM194 Date: November 9th, 2017 Reference: Cronin JJ et al. A Randomized Trial of Single-Dose Oral Dexamethasone Versus Multidose Prednisolone for Acute Exacerbations of Asthma in Children Who Attend the Emergency Department. Ann Emerg Med 2016 Guest Skeptic: Dr. Michael Falk is a Pediatric Emergency Medicine provider who works at Harlem Hospital Center in New York and Children’s National Medical Center in Washington, DC. He was Director of Emergency Department Simulation and the Co-Fellowship Director at ST Luke’s-Roosevelt Hospital in New York and is a Best Evidence in Emergency Medicine (BEEM) presenter and author. This episode is based upon a BEEM critical review. Case: A four-year old male who is a known asthmatic presents to the emergency department with an asthma exacerbation. He has been sick with an upper respiratory infection for the last two days. He is getting worse despite his...
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SGEM#181: Did You Ever Have to Make Up Your Mind, Pan Scan or Leave Other Scans Behind?
Podcast Link: SGEM181 Date: June 3rd, 2017 Reference: Sierink et al. Immediate total-body CT scanning versus conventional imaging and selective CT scanning in patients with severe trauma (REACT-2): a randomised controlled trial. Lancet August 2016. Guest Skeptic: Dr. Marcel Emond is an Associate Professor, Laval University, Emergency Physician at the Level 1 Trauma Center of the CHU de Québec, a Senior Clinician-Scientist, Chair of CAEP Trauma and Injury prevention committee, BEEM faculty member and the host of SGEM Global French. Case: A 53-year-old woman in good health is brought in by ambulance after a motor vehicle collision. She did not lose consciousness but did bump her head. Her main complaint is chest pain with difficulty breathing. She is tachycardic, tachypnic and has some mild abdominal pain. You suspect a flail chest on your clinical examination. A FAST examination is performed and is...
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SGEM#176: Somebody’s Watching Me – Cardiac Monitoring for Chest Pain
Podcast Link: SGEM176 Date: April 26th, 2017 Reference: Syed et al. Prospective validation of a clinical decision rule to identify patients presenting to the emergency department with chest pain who can safely be removed from cardiac monitoring. CMAJ Jan 2017 Guest Skeptics: Drs. Ryan Tam and Antony Robert are chief residents from the Royal College Emergency Medicine Program at McGill University. Ryan Tam’s academic interests include quality improvement, ultrasound and simulation. He is also involved with a start-up FOAMed site called EM-bites focused on providing point of care resources. When he is not working, he is an enthusiastic photographer, foodie and adventure traveler. Antony Robert’s academic interests include resuscitation, medical education, research, ultrasound and medical informatics. He is also the CEO of a new medical education start up, and is currently working on the first prototype. When he is not working, he...
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SGEM#169: Stuck in the Middle with Food (Glucagon for Esophageal Foreign Body Impaction)
Podcast Link: SGEM169 Date: February 2nd, 2017 Reference: Bodkin et al. Effectiveness of glucagon in relieving esophageal foreign body impaction: a multicenter study. AJEM June of 2016 Guest Skeptic: : Meghan Groth (@EMpharmGirl) is an emergency medicine pharmacist. She has contributed to the Academic Life in Emergency Medicine (AliEM) and Emergency Medicine PharmD blogs, and is a member of the ALiEMU Capsules team. Case: It’s the day after St. Patrick’s Day, and you have a 28-year-old man that presents to the emergency department with difficulty swallowing. He was enjoying a feast of corned beef and cabbage several hours prior to arrival when he said it felt like “something got stuck” in his throat. He does have a history of esophageal strictures, and this has happened to him before but he thought if he washed the food down with enough Guinness he wouldn’t have...
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