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SGEM#198: Better Slow Down – Push vs. Short Infusion of Low Dose Ketamine for Pain in the Emergency Department

Posted by on Dec 9, 2017 in Featured, Pharmacology/Toxicology, Podcasts | 1 comment

Podcast Link: SGEM198 Date: November 28th, 2017 Reference: Motov S et al. A Prospective Randomized, Double-Dummy Trial Comparing Intravenous Push Dose of Low Dose Ketamine to Short Infusion of Low Dose Ketamine for Treatment of Moderate to Severe Pain in the Emergency Department. AJEM 2017. Guest Skeptic: Dr. Salim Rezaie is a faculty physician at Greater San Antonio Emergency Physicians (GSEP) in San Antonio, Texas. He is the founder and creator of REBEL EM and REBEL Cast. Case: A 54-year old female patient with acute back pain comes to your emergency department for her forth visit in seven days for recurring pain.  She was lifting something heavy and felt a“pop” in her back.  She denies bowel or bladder issues, saddle paresthesia, lower extremity weakness, but does feel radicular pain down both of her legs.  She has been given intravenous hydromorphone, diazepam, and ketorolac without relief...

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SGEM#197: Die Trying – Intubation of In-Hospital Cardiac Arrests

Posted by on Dec 3, 2017 in Cardiac, Featured, Podcasts | 8 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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SGEM#196: Gastroparesis – I Feel Like Throwing Up

Posted by on Nov 26, 2017 in Featured, GastroIntestinal, Podcasts | 13 comments

Podcast Link: SGEM196 Date: November 24th, 2017 Reference: Roldan et al. Trial Comparing Haloperidol Combined With Conventional Therapy to Conventional Therapy Alone in Patients With Symptomatic Gastroparesis. AEM November 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 creator of the excellent #FOAMed project called First10EM.com Case: You charge nurse approaches as you finish charting on the trauma patient who was just transferred out. “Mrs. G. is back again, vomiting and screaming in pain. This is the third time this month, and nothing ever seems to help. Is there anything we can do for her?” Mrs. G is a 37-year-old female with gastroparesis secondary to diabetes. You know her well, and none of the usual anti-emetics seem to help her symptoms. While inwardly wishing you worked in...

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SGEM#195: Some Like It Hot – ED Temperature and ICU Survival

Posted by on Nov 19, 2017 in Featured, Infectious, Podcasts | 3 comments

Podcast Link: SGEM195 Date: November 11th, 2017 Reference: Sundén-Cullberg et al. Fever in the Emergency Department Predicts Survival of Patients With Severe Sepsis and Septic Shock Admitted to the ICU. Critical Care Medicine 2017. Guest Skeptic: Jesse Spurr works as a Nurse Educator in the Emergency Department at Redcliffe Hospital in Australia. Outside his family and work, Jesse pours energy into his professional hobbies: healthcare simulation podcast Simulcast, nursing practice development blog and podcast Injectable Orange and faculty and team member of The Teaching Coop. Jesse classes himself a lifelong student of teaching, learning, health and human performance. Case: You are working night shift in the emergency department. Two patients present to the front desk in close succession, brought in by concerned family members. Both are similarly hypotensive and tachypnoeic,drowsy but orientated, with hot, reddened and increasingly painful cellulitis. Following the triage sepsis pathway,...

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SGEM#194: Highway to the Dexamethasone – For Pediatric Asthma Exacerbations

Posted by on Nov 12, 2017 in Featured, Pediatrics, Podcasts | 9 comments

Podcast Link: SGEM194 Date: November 9th, 2017 Reference: Cronin JJ et al. A Randomized Trial of Single-Dose Oral Dexamethasone Versus Multidose Prednisolone for Acute Exacerbations of Asthma in Children Who Attend the Emergency Department. Ann Emerg Med 2016 Guest Skeptic: Dr. Michael Falk is a Pediatric Emergency Medicine provider who works at Harlem Hospital Center in New York and Children’s National Medical Center in Washington, DC.  He was Director of Emergency Department Simulation and the Co-Fellowship Director at ST Luke’s-Roosevelt Hospital in New York and is a Best Evidence in Emergency Medicine (BEEM) presenter and author. This episode is based upon a BEEM critical review. Case: A four-year old male who is a known asthmatic presents to the emergency department with an asthma exacerbation. He has been sick with an upper respiratory infection for the last two days. He is getting worse despite his...

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SGEM#193: Stop, In the Name of Love

Posted by on Oct 29, 2017 in Featured, Pediatrics, Podcasts | 4 comments

Podcast Link: SGEM193 Date: October 24th, 2017 Reference: Harrison et al. Sweet Solutions to Reduce Procedural Pain in Neonates: A Meta-analysis. Pediatrics 2017 Guest Skeptic: Dr. Anthony Crocco is a Pediatric Emergency Physician and is the Medical Director & Division Head of the Division of Pediatric Emergency at McMaster’s Children’s Hospital. Anthony is also the creator of SketchyEBM. Case: A 12-day old girl presents with fever and is otherwise well. You are planning to begin a full septic workup including some painful procedures including bloodwork.  You wonder whether there is a way to mitigate the painful experience for the child. Background: Painful procedures are common in the neonatal period, including bloodwork, lumbar punctures and bladder catheterization. There is evolving evidence to the long-term neuro-developmental harms associated with pain in the preterm infants (Field T. Infant Behavior and Development 2017) We have covered pain...

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