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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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SGEM#143: Call Me Maybe for Bystander CPR

Posted by on Jan 18, 2016 in Cardiac, Featured, Podcasts | 8 comments

Podcast Link: SGEM143 Date: January 14th, 2016 Guest Skeptics: Dave Harrison, Carl Berdahl and Todd Schneberk are Emergency Medicine residents in the Department of Emergency Medicine at the Keck School of Medicine of the University of Southern California. Case: A 78-year-old man with a history of hypertension and coronary artery disease suddenly collapses at home in front of his wife. She calls 911 but is unable to get on her knees and provide CPR due to her comorbidities. Background: Sudden cardiac arrest is common with approximately 500,000 cardiac arrests each year in the USA. More than half of these cardiac arrests are out of hospital cardiac arrests (OHCA) and the survival rate is pretty poor. The American Heart Association came out with updated CPR & ECC Guidelines in 2015 that included its “Chain-of-Survival”. There are five steps in the Chain-of-Survival for OHCA. Step One...

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SGEM#136: CPR – Man or Machine?

Posted by on Nov 16, 2015 in Cardiac, Featured, Podcasts | 3 comments

Podcast Link: SGEM136 Date: November 13th, 2015 Guest Skeptic: Dr. Salim Rezaie. Salim is an associate clinical professor of Emergency Medicine/Internal Medicine at the University of Texas Health Science Center at San Antonio, Texas. He is the creator/founder of the REBEL EM Blog and REBEL Cast. Case: A 65-year old male has a witnessed cardiac arrest. He receives immediate CPR, early defibrillation, as well as one round of ACLS medications. He arrives via EMS to your emergency department, where they tell you that he has had a total of 10 – 15 minutes of CPR with no return of spontaneous circulation. You are working in a small community ER with limited staffing. The patient was already intubated by EMS, but the patient is still requiring CPR. There is a mechanical CPR device in your department and you are considering using it....

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SGEM#135: The Answer My Friend is Blowin’ in your Nose – High Flow Nasal Oxygen

Posted by on Nov 8, 2015 in Cardiac, Featured, Podcasts, Pulmonary | 1 comment

Podcast Link: SGEM135 Date: October 28th, 2015 Guest Skeptic: Dr. Justin Morgenstern. Justin is an emergency physician and the director of simulation education at Markham Stouffville Hospital in Ontario. He loves skepticism and medical education, especially when it is free and open access. He is the author of the #FOAMed blog First10EM.com and is an associate editor of Emergency Medicine Cases. Case: A 60-year-old male with no major past medical history presents to your community emergency department with a three-day history of cough, fever and increasing shortness of breath. He is tachypneic with a respiratory rate of 28 and an oxygen saturation of 89% despite facemask oxygen, but he is mentating normally. Your Respiratory Therapist asks you whether you want her to try the new high flow nasal oxygen machine we have? Background: High flow nasal oxygen is a novel device that actively...

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SGEM#133: Just Beat It (Atrial Fibrillation) with Diltiazem or Metoprolol?

Posted by on Oct 25, 2015 in Cardiac, Featured, Podcasts | 7 comments

Podcast Link: SGEM133 Date: October 23rd, 2015 Guest Skeptic: Dr. Anand Swaninathan is an assistant program director at NYU/Bellevue Hospital in the Department of Emergency Medicine. He is also part of REBEL EM, The Teaching Course, Emergency Medical Abstracts and a new FOAM site – Core EM. Case: A 53 year-old woman with no past medical history presents to the emergency department with palpitations for four days. She says she has felt fatigued and a bit short of breath. Vitals reveal a blood pressure of 153/72 and a heart rate of 137 beats per minute. On physical examination, you notice that her heart rate is irregularly irregular and a 12-lead EKG confirms that the patient is in atrial fibrillation with rapid ventricular response. Background: Atrial fibrillation is a commonly encountered dysrhythmia in the Emergency Department. Atrial flutter is less common but...

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SGEM#128: One Hour AMI Rule Out/Rule In (Harder, Better, Faster?)

Posted by on Sep 20, 2015 in Cardiac, Featured, Podcasts | 0 comments

Podcast Link: SGEM128 Date: September 10th, 2015 Guest Skeptic: Daniel McCollum. Daniel is an Assistant Residency Director at Georgia Regents University in beautiful Augusta, GA. He loves craft beer, evidence based medicine, and Batman.  Case: A 53 year-old man presents with left sided chest pain that started 90 minutes ago. The pain radiates to his left arm and he has nausea without vomiting. The pain began while he was doing yard work and he has never had pain like this before. His initial ECG is unremarkable. Background: Only about 5% of all consecutive patients presenting with acute chest pain will have a ST elevated myocardial infarction (STEMI) (Apple et al). These are the easy ones to diagnose and manage. This leaves the other 95% of chest pain patients. These are the hard ones. We need to figure out who will rule-in vs. rule-out...

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