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SGEM#137: A Foggy Day – Endovascular Treatment for Acute Ischemic Stroke

Posted by on Nov 22, 2015 in Featured, Neurologic, Podcasts | 2 comments

Podcast Link: SGEM137 Date: November 21st, 2015 Guest Skeptic: Dr. Rory Spiegel is an Emergency Medicine resident in New York City. Rory is doing a resuscitation fellowship at Stony Brook University School of Medicine. He also writes a blog called EM Nerd about nihilism, medicine and the art of doing nothing. Case: An 78-year-old woman presents to your emergency department with right arm weakness and slurred speech for the last two hours.  She has a history of hypertension and diabetes. A CTA is performed that shows an Intracranial arterial occlusion of the right M1 middle cerebral artery segment. Background: Prior to the publication of MR CLEAN and the four trials published in its wake, the data regarding endovascular therapy has been consistently negative. Over the past year five RCTs examining endovascular therapy for acute ischemic stroke have been published. In direct contrast to...

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SGEM#136: CPR – Man or Machine?

Posted by on Nov 16, 2015 in Cardiac, Featured, Podcasts | 2 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 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#134: Listen, to what the British Doctors Say about LPs post CT for SAH

Posted by on Nov 1, 2015 in Featured, Neurologic, Podcasts | 19 comments

Podcast Link: SGEM134 Date: October 27th, 2015 Guest Skeptic: Dr. David Sayer is a physician completing his general practice training in the United Kingdom. Case Scenario: A 34-year-old woman presents with acute onset of headache peaking in 30 minutes with no recent trauma, focal deficits and a normal neurologic examination. Background: Headaches represent around 2% of all emergency department visits. Of these presentations 1-3% turn out to be a subarachnoid hemorrhage (SAH)  (Edlow, Vermeulen, Perry, Morgenstern). About 5% of SAH are misdiagnosed on the first emergency department assessment (Vermeulen). This is partly because 50% of SAH present with no neurologic deficit (Weir). Dr. Jeff Perry and his team have tried to create a clinical decision tool to rule out SAH for acute headaches (SGEM#48). The Ottawa SAH Tool contains six variables to decide if a CT scan is necessary. Applying the tool could decrease the...

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SGEM Xtra: The Reality Check

Posted by on Oct 26, 2015 in Featured | 0 comments

I had the pleasure of being a guest panelist on The Reality Check (TRC) podcast this week. TRC is “Canada’s weekly podcast that explores a wide range of controversies and curiosities using science and critical thinking.” They invited me on to discuss some of my favourite things like evidence based medicine, knowledge translation and FOAMed. Listen to the show by clicking on this link to the MP3 file or subscribing to TRC on iTunes. We had lots of fun discussing how social media can cut the knowledge translation window down from over ten years to less than one year. I also got to participate in a “riveting” trivia game called Name That about the Nobel Prizes. The Reality Check: “The Reality Check podcast was created by the Ottawa Skeptics, an organization which aims to promote the use of the scientific method, critical...

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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 | 4 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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