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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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SGEM#151: Groove is in the HEART Pathway

Posted by on Apr 17, 2016 in Cardiac, Featured, Podcasts | 6 comments

Podcast Link: SGEM151 Date: April 10th, 2016 Guest Skeptic: Dr. Salim Rezaie. Salim is an Associate Clinical Professor of Emergency Medicine Internal Medicine University of Texas Health Science Center at San Antonio and the creator/founder of REBEL EM @srrezaie. Salim is also part of The Teaching Course. Case: A 40 year-old male arrives to the emergency department via EMS with substernal chest pain that has lasted for three days without any relief. He denies shortness of breath, radiation, nausea/vomiting, diaphoresis, or palpitations. He has no past medical history, does not smoke, but states his father died of a myocardial infarction at the age of 70, which is why this chest pain concerned him. He runs four times a week without any difficulty, but has had some increased stress at his work place. Your evaluation in the emergency department shows an ECG with...

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SGEM#147: This is a SVT and I’m Gonna REVERT It – Using a Modified Valsalva Manoeuvre

Posted by on Feb 15, 2016 in Cardiac, Featured, Podcasts | 4 comments

Podcast Link: SGEM147 Date: February 12th, 2016 Guest Skeptic: Dr. Robert Edmonds. Bob is a third year Emergency Medicine Resident at the University of Missouri at Kansas City. Prior to medical school, he graduated from the US Air Force Academy, and when he completes his training will rejoin the Air Force for nine years as an Emergency Medicine physician. Case: A 24-year-old female presents to the emergency department with palpitations. She feels anxious but is hemodynamically stable and her ECG demonstrates supra ventricular tachycardia (SVT). This condition has happened several times before and she hates the medication she is usually given in the emergency department that makes her feel like she is dying. Background:  Patients with SVT often present to the emergency department. Life in the Fast Lane has a good blog posting about SVT. Restoring patents back to a sinus rhythm can...

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