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SGEM#164: Cuts Like a Knife – But you Might Also Need Antibiotics for Uncomplicated Skin Abscesses

Posted by on Oct 17, 2016 in Dermatologic, Featured, Infectious, Podcasts | 4 comments Play in new window | Download Date: October 13th, 2016 Reference: Talan et al. Trimethoprim–Sulfamethoxazole versus Placebo for Uncomplicated Skin Abscess. NEJM March 2016 Guest Skeptic: Chip Lange is an Emergency Medicine Physician Assistant working primarily in rural Missouri in community hospitals. He has international experience in critical care and emergency medicine. He has a new blog called TOTAL EM, which stands for Tools Of the Trade and Academic Learning in Emergency Medicine. He has recently started podcasting and is always looking to expand this new project. He cares about providing TOTAL care everywhere and wants us all to be excellent when we see and treat out patients. Case: A 40 year-old male with a history of MRSA presents complaining of an area of redness and swelling consistent with an abscess developing on his arm. He says that he has...

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SGEM#110: I Saw the Signs of Angioedema

Posted by on Mar 8, 2015 in Dermatologic, Featured, Podcasts | 7 comments Play in new window | Download Date: March 7th, 2015 Guest Skeptic: Dr. Eric Schneider. Eric is a Community Emergency Medicine Physician in Kansas City, Missouri, who has a drive to bring the most pragmatic, evidence-based and cost-effective care to his patients at an inner city trauma hospital. He’s a father of three, married to a Pathologist, and an avid musician. Case: 65yo African American male presents to emergency department complaining of swelling of the tongue/lips. It started when he woke at 08:30. He went to Urgent Care and was treated with intramuscular steroids, benadryl and epinephrine. The swelling did not get any better. The patient was referred to emergency department. Swelling started >4 hours ago when you see him. He states no change in the swelling. On examination is vital signs are normal, no stridor, no respiratory distress, no hypoxia...

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SGEM#63: Goldfinger (More Dogma of Wound Care)

Posted by on Feb 23, 2014 in Dermatologic, Featured, Infectious, Podcasts | 1 comment Play in new window | Download Date:  February 22, 2014 Guest Skeptic: Eve Purdy, Queens’ University Case Scenario: An otherwise health 24-year-old man was out at the bar and got into a bit of a tussle at around 11pm. When he woke up the next morning he was surprised to see a 3cm laceration on the back of his right hand. He finally figures that he should have it checked out and makes it into the emergency department at noon the next day.  This is more than 12 hours later. Questions: Would you suture this wound? Background: We have spoken before about the dogma of wound care on the SGEM#9.  This addressed five myths about simple lacerations in the emergency department. Patients have priorities (function/cosmetic) and infection is not number one The solution is dilution and tap water is just fine Non-sterile...

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SGEM#57: Should I Stay or Should I Go (Biphasic Anaphylactic Response)

Posted by on Dec 15, 2013 in Dermatologic, Featured, Podcasts, Pulmonary | 4 comments Play in new window | Download Date:  December 13, 2013 Guest Skeptic: Dr. Anand Swaminathan or Swami. He is an assistant program director at NYU/Bellevue Hospital in the department of EM. Swani’s interests are in resident education, critical care and EBM. Swami loves debunking urban legends in EM and is a strong supporter of FOAMed. Case Scenario: 25yo medical student who is allergic to peanuts accidentally eats a cookie at the school holiday party. He arrives to the emergency department covered in hives, hypotensive, short of breath and vomiting. The resident diagnoses him with anaphylaxis and does a great job in treating the reaction. The patient is stable and you are considering discharging him home. However, what about that thing called a biphasic anaphylactic response? Question: How long should you observe someone after anaphylaxis? Background: Definition of anaphylaxis.  Simons FER et al....

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SGEM#27: Bad to the Bone (Diabetic Osteomyelitis)

Posted by on Mar 10, 2013 in Dermatologic, Endocrine, Featured, Infectious, Musculoskeletal | 0 comments Play in new window | Download Date:  10 March 2013 Case Scenario: 62 year-old man presents to the emergency department feeling weak. His vital signs at triage are normal but his glucometer reading is high. He is a known type 2 diabetic and states his sugars have been running a little high lately. After conducting an appropriate history and directed physical examination you have not yet determined the cause of his generalized weakness. There is nothing to suggest respiratory or urinary tract infection. Before leaving the room you take off his socks to check out his feet. What you see and smell is a diabetic foot ulcer on the plantar aspect of his left foot. Question: Does this patient with diabetes have osteomyelitis of the lower extremity? Background: Complications from diabetes are common presentations to the emergency department. These emergency department...

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Podcast #13: Better Out than In (Simple Cutaneous Abscesses)

Posted by on Dec 2, 2012 in Dermatologic, Featured, Infectious, Podcasts | 0 comments Play in new window | Download Date: 2 December 2012 Case Presentation: Healthy 45-year-old man presents with a 3cm abscess under left arm. There is no surrounding cellulitis. He is not an  intravenous drug user and never had an abscess before. You make the diagnosis of an uncomplicated superficial cutaneous abscess. You know that antibiotics are probably not necessary after incision and drainage (I&D). However, the patient gets nervous after you describe the I&D process. He wants to know if you can do anything to make this procedure less painful and if packing is really necessary? Your Inside Voice Says: Why to men have such low pain tolerance Mmmm, pus…time for lunch Suck it up butter cup Of course there is something we can do regarding oligoanalgesia To pack or not to pack, that is the question Background: Simple cutaneous...

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