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SGEM#238: The Epi Don’t Work for OHCA

Posted by on Dec 7, 2018 in Cardiac, Featured, Podcasts | 0 comments Play in new window | DownloadDate: December 6th , 2018 Reference: Perkins et al. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. NEJM 2018. Guest Skeptics: Jay Loosley is the Superintendent of Education at Middlesex-London Paramedic Service. Jenn Doyle is a paramedic educator at Middlesex-London Paramedic Service. Case: A 51-year-old man experiences a cardiac arrest on the street. You are the first provider on scene with Emergency Medical Services (EMS) and start high-quality Cardiopulmonary Resuscitation (CPR). A cardiac defibrillator is hooked up and the patient is in ventricular fibrillation. He is unsuccessfully shocked. An oral airway is placed, peripheral intravenous (IV) line started successfully and the paramedic asks her partner if you want to administer IV epinephrine? Background: The AHA has five steps in the Chain-of-Survival for out-of-hospital cardiac arrest (OHCA). Step One– Recognition and activation of 911 Step Two–...

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SGEM#237: Screening Tool for Child Sex Trafficking

Posted by on Nov 16, 2018 in Featured, Podcasts | 0 comments Play in new window | Download Date: November 10th , 2018 Reference: Kaltiso et al. Evaluation of a Screening Tool for Child Sex Trafficking Among Patients with High-Risk Chief Complaints in a Pediatric Emergency Department. AEM October 2018. Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and clinical lecturer in Calgary. He is also an avid FOAM supporter/producer through various online outlets including TheSGEM. You may have noticed there was no music for the introduction. Part of the SGEM brand is to have some fun and engaging theme music to help with knowledge translation. This topic of child sex trafficking is very serious and disturbing. I struggled with what would be an appropriate song choice. After thinking about it and not coming up with something acceptable I went to twitter to ask my #FOAMed friends. It was Minh...

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SGEM#235: Edoxaban for Cancer Associated VTE – Would the NEJM Lie to You?

Posted by on Oct 31, 2018 in Featured, Hematologic, Podcasts | 0 comments Play in new window | Download Date: October 30th , 2018 Reference: Raskob GE et al. Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism. NEJM 2018 Guest Skeptic: Dr. Anand Swaminathan is an assistant professor of Emergency Medicine at the St. Joseph’s Regional Medical Center in Patterson, NJ. He is a deputy editor for EM: RAP and, associate editor for REBEL EM. Case: A 43-year old woman with a history of breast cancer currently undergoing chemotherapy presents with mild chest pain. She is hemodynamically stable except for a heart rate of 105 and her pain is increased when she takes a deep breath. The chest x-ray is unremarkable, and you order a CT pulmonary angiogram (CTPA) which demonstrates a right segmental pulmonary embolism. You write a prescription for low molecular weight heparin (LMWH) and advise the patient that she will...

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SGEM#234: Contrast Induced Nephropathy – A Unicorn?

Posted by on Oct 20, 2018 in Featured, Podcasts | 0 comments Play in new window | Download Date: October 17th , 2018 Reference #1: Aycock, Westafer et al. Acute Kidney Injury After Computed Tomography: A Meta-analysis. Ann Emerg Med 2018 (CRD42017056195) Reference #2: Weisbord SD, Gallagher M, Jneid H, et al; PRESERVE Trial Group. Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine. NEJM 2018 ( NCT01467466.) Guest Skeptic: Dr. Lauren Westafer is a board certified emergency physician at Baystate Medical Center and instructor in the Department of Emergency Medicine at the University of Massachusetts Medical School. She is author of the blog, The Short Coat, and cofounder of the emergency medicine podcast, FOAMcast. Lauren is currently funded by an NHLBI K12 grant (1K12HL138049-01) studying the implementation of evidence-based diagnosis of pulmonary embolism in the emergency department. Case: A 64-year-old woman with type-2 diabetes. She presents to the emergency department with chest pain...

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SGEM#233: Larry in the Den with Kiwis (LDK) – Low Dose Ketamine vs. Opioids for Acute Pain

Posted by on Oct 13, 2018 in Featured, Podcasts | 0 comments Play in new window | Download Date: October 10th , 2018 Reference: Karlow et al. A Systematic Review And Meta-Analysis of Ketamine as an Alternative to Opioids for Acute Pain in the Emergency Department. AEM Oct 2018. Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. He is also the CME Editor for Academic Emergency Medicine. Case: You are caring for a 38-year-old male (Larry) who presented to the emergency department with lower back pain. During your evaluation, he tells you he doesn’t want any narcotic pain medication. You wonder if there are alternative options, and a colleague reminds you that ketamine has recently gained a lot of exposure as a possible alternative. Background: The amelioration of pain and suffering should be one of the top priorities of emergency physicians.  In 2001, JACHO made pain the 5th vital sign...

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SGEM#231: You’re So Vein – IO vs. IV Access for OHCA

Posted by on Sep 29, 2018 in Cardiac, Featured, Podcasts | 0 comments Play in new window | Download Date: September 21st, 2018 Reference: Kawano et al. Intraosseous Vascular Access Is Associated With Lower Survival and Neurologic Recovery Among Patients With Out-of-Hospital Cardiac Arrest. Annals of EM May 2018 Guest Skeptic: Andrew Merelman is a critical care paramedic and first year medical student at Rocky Vista University in Colorado. His primary interests are resuscitation, prehospital critical care, airway management, and point-of-care ultrasound. Case: A 46-year-old man has a cardiac arrest at home, witnessed by family. Bystander CPR is initiated prior to EMS arrival. EMS arrives on scene and initiates high quality basic life support (BLS). One defibrillation for ventricular fibrillation (VF) is provided but the patient remains in VF. As part of their protocol, they attempt vascular access to administer epinephrine and an antidysrhythmic. They wonder whether it would be better to attempt a...

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