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SGEM#213: Upside Down You Convert Me Out of SVT?

Posted by on Apr 1, 2018 in Cardiac, Featured, Pediatrics, Podcasts | 5 comments

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

Posted by on Mar 25, 2018 in Featured, Podcasts, Trauma | 5 comments

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

Posted by on Mar 18, 2018 in Featured, Neurologic, Podcasts | 2 comments

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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SGEM#210: (Don’t) Let it Bleed – TXA for Epistaxis in Patients on Anti-Platelet Drugs

Posted by on Mar 10, 2018 in Featured, Hematologic, Podcasts | 7 comments

Podcast Link: SGEM210 Date: March 6th, 2018 Reference: Zahed et al. Topical Tranexamic Acid Compared With Anterior Nasal Packing for Treatment of Epistaxis in Patients Taking Antiplatelet Drugs: Randomized Controlled Trial. AEM March 2018. 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: A 77-year-old woman with known coronary artery disease is on clopidogrel and aspirin because of a stent placed four month ago. She has epistaxis that has not resolved despite twenty minutes of well applied anterior pressure. As you are preparing your equipment, she tells you that this is her third episode of epistaxis, and she is really hoping there is some alternative to the anterior packing she had the last two times. Background: About 60% of the...

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SGEM#209: Cephalexin – You Are My Only One for Uncomplicated Cellulitis

Posted by on Mar 4, 2018 in Featured, Infectious, Podcasts | 6 comments

Podcast Link: SGEM209 Date: February 27th, 2018 Reference: Moran et al. Effect of Cephalexin plus Trimethoprim-Sulfamethoxazole vs Cephalexin Alone on Clinical Cure of Uncomplicated Cellulitis – A Randomized Clinical Trial. JAMA May 2017. Guest Skeptic: Chip Lange is an Emergency Medicine Physician Assistant (PA) working primarily in rural Missouri in community hospitals. He also hosts a great #FOAMed blog and podcast called TOTAL EM. Case: A 22-year-old male with no significant past medical history arrives to your department for an area of tender erythema to the right forearm for two days that has grown in size without purulence or drainage.  With point of care ultrasound, you diagnose cellulitis without the presence of an abscess affecting a 6cm diameter area.  When deciding how to treat for this condition, you have read recently that cephalexin could be used alone and that trimethoprim-sulfamethoxazole (TMP-SMX) may...

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SGEM#208: It Makes No Difference – Glucocorticoids for the Treatment of Septic Shock

Posted by on Feb 24, 2018 in Featured, Infectious, Podcasts | 11 comments

Podcast Link: SGEM208 Date: February 14th, 2018 Reference: Venkatesh S et al. Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. NEJM January 2018. Guest Skeptic: Dr. Rory Spiegel (@EMNerd_) is a clinical instructor at University of Maryland, a recent graduate of Stony Brook’s Resuscitation Fellowship, and a current Critical Care fellow at University of Maryland. He writes an excellent blog called EM Nerd, which he describes as nihilistic ramblings. Case: 64-year-old male presents to your emergency department with worsening abdominal pain, nausea, vomiting and anorexia for the past week. On presentation he is lethargic and hypotensive. He requires control of his airway and is given a 30 cc/kg fluid bolus and started on norepinephrine. His urine analysis is consistent with a urinary tract infection. Over the course of his emergency department stay he has escalating vasopressor requirements. After starting vasopression, you ask...

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