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SGEM#215: Love Will Tear Us Apart – Diagnostic Challenges of Aortic Dissection

Posted by on Apr 21, 2018 in Cardiac, Featured, Podcasts | 0 comments

Podcast Link: SGEM215 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...

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SGEM#213: Upside Down You Convert Me Out of SVT?

Posted by on Apr 1, 2018 in Cardiac, Featured, Pediatrics, Podcasts | 5 comments

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.  On exam she appears anxious and begs you not to give “that drug that makes my heart stop like that last doctor did.”  You know vagal maneuvers are first-line, but there’s variation in techniques.  As the patient already tried breathing out of her clenched nose, you wonder if there is another safe method you can try prior to medications. Background: Supraventricular...

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SGEM#197: Die Trying – Intubation of In-Hospital Cardiac Arrests

Posted by on Dec 3, 2017 in Cardiac, Featured, Podcasts | 10 comments

Podcast Link: SGEM197 Date: November 24th, 2017 Reference: Andersen et al. Association Between Tracheal Intubation During Adult In-Hospital Cardiac Arrest and Survival. JAMA 2017 Guest Skeptic: Dr. Bob Edmonds is an Emergency Physician in the US Air Force.  He is currently deployed, practicing emergency medicine in an undisclosed location. DISCLAIMER: The views and opinions of this podcast do not represent the United States Government or the US Air Force. Case: You are working a regular shift in the emergency department when you hear a code blue called. You are the first physician to respond and you begin to resuscitate the patient. Your respiratory therapist is adequately ventilating the patient with a bag valve mask, and they ask you if they should prepare to intubate at the pulse and rhythm check. Background: We have talked about out-of-hospital cardiac arrests (OHCA) many times on...

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SGEM#192: Sometimes, All You Need is the Air that You Breathe

Posted by on Oct 22, 2017 in Cardiac, Featured, Podcasts | 6 comments

Podcast Link: SGEM192 Date: October 19th, 2017 Reference: Hofmann et al. Oxygen Therapy in Suspected Acute Myocardial Infarction. NEJM Sept 2017. Guest Skeptic: Marcus Prescott is a nurse in Norway. He is also now a first-year medical student. Case: A 68-year-old man with a history of hypertension and dyslipidemia develops chest pain while grocery shopping. Emergency medical services are called, arrive quickly and find a man with 7/10 chest pain. His vitals are: heart rate of 72 beats per minute, blood pressure of 150/90, respiratory rate of 14 breaths per minute and oxygen saturation of 93%. The ECG shows an inferior ST-Elevated Myocardial Infarction (STEMI). They give him 180mg of ASA to chew and package him for transportation to the hospital. While preparing to depart, they wonder if they should provide him with supplemental oxygen? Background: Oxygen is a drug and...

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SGEM#189: Bring Me To Life in OHCA

Posted by on Sep 24, 2017 in Cardiac, Featured, Podcasts | 9 comments

Podcast Link: SGEM189 Date: September 19th, 2017 Reference: Cournoyer et al. Prehospital advanced cardiac life support for out-of-hospital cardiac arrest: a cohort study. Academic Emergency Medicine. September 2017. Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. He is also the CME editor for Academic Emergency Medicine and the associate editor for emergency medicine simulation at the AAEM MedEdPORTAL. Case: You are the medical director of an EMS system in a large city deciding on whether to respond to all out of hospital cardiac arrests (OHCA) with ACLS capabilities, or if resources should be directed to those candidates for extracorporeal CPR. Background: There are about ½ million sudden cardiac arrests in the USA each year. About half of these cardiac arrests are OHCA and the survival rate is pretty poor. We have covered the topic of OHCA on the SGEM...

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SGEM#184: We Weren’t Born to Follow-Up – The PEITHO Long-Term Follow-up Study

Posted by on Jul 2, 2017 in Cardiac, Featured, Hematologic, Podcasts, Pulmonary | 2 comments

Podcast Link: SGEM184 Date: June 21st, 2017 Reference: Konstantinides et al. Impact of Thrombolytic Therapy
 on the Long-Term Outcome of Intermediate-Risk Pulmonary Embolism. JACC March 2017 Guest Skeptic: Dr. Kirsty Challen (@KirstyChallen) is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals Trust (North West England). She did her Medical School at Manchester, with a History of Medicine BSc at the same time. Kirsty did her residency in North West England and has a PhD in Health Services Research from Sheffield. Kirsty is also the creator of a knowledge translation project called #PaperinaPic. Case: A 22-year-old patient presents to the emergency department with sudden onset shortness of breath. She takes the oral contraceptive pill and was placed in a below-knee plaster cast for a fibula fracture 2 weeks ago. She is alert and talking, with a systolic blood pressure of 110 mmHg, but CTPA...

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