SGEM#215: Love Will Tear Us Apart – Diagnostic Challenges of Aortic Dissection
Podcast Link: SGEM215 Date: April 12th, 2018 Reference: Ohle R et al. Clinical Examination for Acute Aortic Dissection: A Systematic Review and Meta-analysis. AEM April 2018 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. He is also the CME editor for Academic Emergency Medicine (AEM). Case: You are in the emergency department caring for a 65-year-old man with sharp chest pain radiating to the back. Blood pressure is elevated, and his pain was sudden in onset. His chest x-ray is normal, and there is no sign of asymmetric pulses. The EKG and laboratory tests are normal. You are wondering if you need to order a CT to rule out an aortic dissection. Background: Aortic dissection is a rare but deadly disease which can confound the emergency physician’s diagnostic abilities. Some estimates are that up to 38% of cases are initially...
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SGEM#214: Woman – The TXA Trial for Post-Partum Hemorrhage
Podcast Link: SGEM214 Date: April 13th, 2018 Reference: Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. The Lancet 2017 Guest Skeptic: Dr. Nick Papalia completed his MD at Western University. He is currently completing his third year of Obstetrics and Gynecology residency at the University of Calgary. Case: 37-year-old primiparous woman has a spontaneous vaginal delivery following an induction of labour at 39 weeks for gestational diabetes for which she is treated with insulin. She delivered a vigorous 3800g boy following a brief episode of shoulder dystocia. She is otherwise healthy but does have a remote history of asthma. Aside from insulin and prenatal vitamins, she takes no medications. Approximately five minutes after delivery of the placenta, as you are evaluating her perineum, she begins to have...
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SGEM Xtra: The Danger Within Us
Podcast Link: SGEM Xtra Danger Within Us Date: March 23rd, 2018 This is a SGEM Xtra book review. I had the pleasure of interviewing Jeanne Lenzer. She is an award-winning independent medical investigative journalist who has written for the BMJ. Jeanne has also written for the Atlantic, the New York Times Magazine, Mother Jones, Huffington Post and Slate. Jeanne book is called The Danger Within Us: America’s Untested, Unregulated Medical Device Industry and One Man’s Battle to Survive It. In the book, she takes a critical look at the medical device industry. One of the main inspiration for her book is the Legend of Emergency Medicine Dr. Jerome Hoffman. He is also one of my mentors who taught me to be skeptical of the medical literature. Listen to the podcast on iTunes as Jeanne describes some of the problems with the medical device industry. Some of the disturbing facts she provides include: Medical...
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SGEM#213: Upside Down You Convert Me Out of SVT?
Podcast Link: SGEM213 SVT Date: March 30th, 2018 Reference: Bronzetti et al. Upside-down position for the out of hospital management of children with supraventricular tachycardia. International Journal of Cardiology. February 2018. Guest Skeptic: Dr. Robert Edmonds is an Emergency physician in the US Air Force. This is his 6th visit to the SGEM. DISCLAIMER: The views and opinions of this podcast do not represent the United States Government or the US Air Force. Case:A seven-year-old girl presents to your emergency department complaining of palpitations. On exam she appears anxious and begs you not to give “that drug that makes my heart stop like that last doctor did.” You know vagal maneuvers are first-line, but there’s variation in techniques. As the patient already tried breathing out of her clenched nose, you wonder if there is another safe method you can try prior to medications. Background: Supraventricular...
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SGEM#212: Holding Back the Years – Risk Factors for Adverse Outcomes in Older Adults with Blunt Chest Trauma
Podcast Link: SGEM212 Date: March 20th, 2018 Reference: Sawa et al. Risk factors for adverse outcomes in older adults with blunt chest trauma: A systematic review. CJEM March 2018 Guest Skeptic: Dr. Christina Shenvi is an Emergency Physician at University of North Carolina. She is fellowship trained in Geriatric Emergency Medicine and has a podcast called GEMCAST. Christina loves serving as the assistant residency director, writing things, reading things, teaching people, and having kids. Case: An 85-year-old woman with a history of chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and type-2 diabetes (DM-2), and her 65-year-old otherwise healthy daughter present to the emergency department after a car accident. It was a low speed motor vehicle collision (MVC) in which they rear-ended a stationary car. However, they were both unrestrained. They both have a Glasgow Coma Scale (GCS) of 15 on arrival and...
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SGEM#211: Pins and Needles – Acupuncture for Migraine Prophylaxis
Podcast Link: SGEM211 Date: March 18th, 2018 Reference: Zhao et al. The Long-Term Effect of Acupuncture for Migraine Prophylaxis: A Randomized Clinical Trial. JAMA Internal Medicine 2017 Guest Skeptic: Dr. Alfred Sacchetti is a full time practicing Emergency Physician, who is also the Chief of Emergency Medicine at Our Lady of Lourdes Medical Center in Camden, New Jersey, USA, an Assistant Clinical Professor of Emergency Medicine, an Active Researcher and faculty member for the Emergency Medicine and Acute Care course. Case: 40-year-old male appears with what he describes as his typical migraine that has failed his usual home therapies. In the emergency department after six hours and multiple medications, the patient’s pain is finally under control. While being discharged he asks if there anything you can offer to prevent headaches from coming back. He states: “I have to fly to Chengdu University of Traditional...
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