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SGEM#176: Somebody’s Watching Me – Cardiac Monitoring for Chest Pain

Posted by on Apr 30, 2017 in Cardiac, Featured, Podcasts | 2 comments

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#170: Don’t Go Breaking My Heart – Ottawa Heart Failure Risk Scale

Posted by on Mar 5, 2017 in Cardiac, Featured, Podcasts | 26 comments

Podcast Link: SGEM170 Date: March 2nd, 2017 Reference: Stiell et al. Prospective and Explicit Clinical Validation of the Ottawa Heart Failure Risk Scale, With and Without Use of Quantitative NT-proBNP. AEM March 2017 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the Director of Simulation Education at Markham Stouffville Hospital in Ontario. He is the author of the excellent #FOAMed blog called First10EM.com and is an associate editor of Emergency Medicine Cases. Case: A 68-year-old woman with a history of congestive heart failure, hypertension, and hyperlipidemia presents to the emergency department with a three-day history of shortness of breath on exertion, orthopnea and mild leg edema, but with normal vital signs. Her renal function is normal and troponin is negative. Her ECG is normal. After a dose of intravenous furosemide, she says she feels a lot better and would...

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SGEM#163: Shuffle off to Buffalo to Talk Thrombolysis for Acute Pulmonary Embolism

Posted by on Oct 10, 2016 in Cardiac, Featured, Podcasts, Pulmonary | 2 comments

Podcast Link: SGEM163 Date: October 6th, 2016 Reference: Piazza et al. A Prospective, Single-Arm, Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism. JACC 2015 Guest Skeptic: Dr. Essie Reed is one of the Chief Residents in the Department of Emergency Medicine at the University of Buffalo. Case: A 75-year-old female with a past medical history of hypertension and non-insulin dependent diabetes presents with chest pain. She describes the pain as sharp, stabbing, and exacerbated with deep inspiration. She reports associated shortness of breath. She denies syncope, nausea, and diaphoresis. The pain has been present for one week, and is nearly constant. She reports that she traveled to Florida to visit her grandchildren three weeks ago. She has no fever, chills, cough, or sputum production. She is complaining of ongoing chest pain, 5/10, increased to 7/10 when asked...

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SGEM#162: Not Stayin’ Alive More Often with Amiodarone or Lidocaine in OHCA

Posted by on Oct 2, 2016 in Cardiac, Featured, Podcasts | 2 comments

Podcast Link: SGEM162 Date: September 29th, 2016 Reference: Kudenchuk et al. Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest. NEJM April 2016 Guest Skeptic: Dr. Rory Spiegel is a clinical instructor at University of Maryland and a recent graduate of Stony Brook’s Resuscitation Fellowship. He writes an excellent blog called EM Nerd, which he describes as nihilistic ramblings. Case: Your local EMS agency has asked your opinion on which anti-arrhythmic medication, if any, their ambulances should stock for the management of ventricular fibrillation or pulseless ventricular tachycardia refractory to defibrillation. Additionally, they want to know how best to incorporate these agents into their current resuscitation protocol? Background: The American Heart Association estimates there are about 350,000 EMS-assessed out-of-hospital cardiac arrests in the United States each year. Half of these arrests are witnessed with the other half being un-witnessed. Many out-of-hospital cardiac arrests...

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SGEM#160: Oh Baby, You’re Too Sensitive – High Sensitivity Troponin

Posted by on Sep 12, 2016 in Cardiac, Featured, Podcasts | 25 comments

Podcast Link: SGEM160 Date: September 8th, 2016 Reference: Body et al. The use of very low concentrations of high sensitivity troponin T to rule out acute myocardial infarction using a single blood test. AEM Sept 2016. Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the director of simulation education at Markham Stouffville Hospital in Ontario. He is the author of the excellent #FOAMed blog called First10EM.com and is an associate editor of Emergency Medicine Cases. This is a SGEM Hot Off the Press episode.  Here is a summary of the process but you can click on the SGEMHOP link for more details and previous episodes: A peer reviewed paper is selected pre-publication from AEM or CJEM that we think will be of interest to the SGEMers. We do a structured critical review of the paper using the quality check list developed by...

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SGEM#152: Movin’ on Up – Higher Floors, Lower Survival for OHCA

Posted by on Apr 24, 2016 in Cardiac, Featured, Podcasts | 11 comments

Podcast Link: SGEM152OHCA Date: April 22nd, 2016 Guest Skeptic: Jay Loosley. Jay is a Registered Nurse, Paramedic and Research Assistant. He was a Professor at Fanshawe College but is currently the Superintendent of Education for Middlesex-London Emergency Medical Services. Case: A 43 male patient calls with chest pain from 14th floor of a downtown high-rise apartment building. After the 911 dispatcher gets the address and details of the chest pain, the patient stops responding and the dispatcher can hear no voice. The paramedic response time is 4 minutes with lights and sirens to the apartment. The paramedics enter the controlled access area and buzz the apartment number. Of course the patient doesn’t answer because he is vital signs absent. The paramedics look on the control panel for a building superintendent, and attempt to buzz them. Of course he isn’t in his...

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