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SGEM#231: You’re So Vein – IO vs. IV Access for OHCA

Posted by on Sep 29, 2018 in Cardiac, Featured, Podcasts | 0 comments

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#222: Rhythm is Gonna Get You – Into an Atrial Fibrillation Pathway

Posted by on Jun 16, 2018 in Cardiac, Featured, Podcasts | 0 comments

Podcast Link: SGEM222 Date: June 12th, 2018 Reference: DeMeester S et al. Implementation of a Novel Algorithm to Decrease Unnecessary Hospitalizations in Patients Presenting to a Community Emergency Department With Atrial Fibrillation. AEM June 2018 Guest Skeptic: Dr. 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 and an amazing photographer.   Case: A 62-year-old Canadian is on vacation in up-state Michigan, and after a celebratory evening, presents to your emergency department with palpitations. “I’ve had atrial fibrillation a number of time before. Usually they just shock me and send me home.” Local practice is usually to treat rapid atrial fibrillation with a calcium channel blocker infusion and admit to hospital. As the conversation progresses, you wonder whether it might be safe to discharge some atrial fibrillation...

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SGEM#219: Shout, Shout, PERC Rule Them Out

Posted by on May 19, 2018 in Cardiac, Featured, Podcasts, Pulmonary | 0 comments

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...

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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: 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...

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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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