Pages Navigation Menu

Meet 'em, greet 'em, treat 'em and street 'em

SGEM#144: That Smell of Isopropyl Alcohol for Nausea in the Emergency Department

Posted by on Jan 24, 2016 in Featured, GastroIntestinal, Podcasts | 3 comments

Podcast Link: SGEM144 Date: January 20th, 2016 Guest Skeptic: Meghan Groth (@EMPharmGirl). Meghan is the emergency medicine pharmacy specialist at the University of Vermont Medical Center, and an adjunct professor of pharmacy at the Albany College of Pharmacy and Health Sciences. Case: A 34-year-old male presents to your emergency department with complaints of severe nausea for the past 24 hours. He’s vomited a number of times at home and on a scale of zero to ten (ten being the worst nausea he’s ever experienced), he rates his current nausea at an eight. As the triage nurse brings him back to get settled into his room, you observe him holding an emesis basin and dry heaving. He has no significant past medical history and no known drug allergies. Background: Nausea and vomiting is a very common complaint for patients presenting to the...

Read More

SGEM#139: One Thing Leads to Another – Idarucizumab for Dabigatran Reversal?

Posted by on Dec 6, 2015 in Featured, GastroIntestinal, Hematologic, Podcasts | 4 comments

Podcast Link: SGEM139 Date: December 3rd, 2015 Guest Skeptics: Dr. Ryan Radecki is Clinical Practice Lead at Kaiser Permanente North West and Clinical Assistant Professor of Emergency Medicine – The University of Texas Medical School at Houston. He has a blog called Emergency Medicine Literature of Note.   Case: A 67-year-old man presents with a history of atrial fibrillation and hypertension. He takes metoprolol 50mg twice daily and dabigatran 150mg twice daily. He had been having mild epigastric pain for about one week and had one episode of coffee ground emesis that night. He arrives via ambulance with a blood pressure of 120/70, heart rate of 74 beats per minute and O2 saturation of 98% on room air. Background: Dabigatran is a non-vitamin K antagonist anticoagulant that works by inhibiting thrombin. It is approved for the prevention and treatment of venous thromboembolism....

Read More

SGEM#117: Diarrhea – Hard to Spell, Easy to Smell and Easy to Cause with IV Antibiotics

Posted by on Apr 26, 2015 in Featured, GastroIntestinal, Infectious, Podcasts | 3 comments

Podcast Link: SGEM117 Date: April 24th, 2015 Guest Skeptics: Meghan Groth (@EMPharmGirl). Meghan is the emergency medicine pharmacy specialist at the University of Vermont Medical Center in Burlington, Vermont and an adjunct professor of pharmacy at the Albany College of Pharmacy and Health Sciences. Case: A 58 year old male presents to your emergency department complaining of a warm, painful, reddened area on his left thigh. His past medical history is only significant for generalized anxiety disorder and he has no known drug allergies. On exam, you find no evidence of an abscess, and you find his labs and vital signs are within normal limits. You confidently give him a diagnosis of uncomplicated cellulitis and need to determine an antibiotic regimen. You’d like to send him home with a five day course of cephalexin, but are thinking about giving him an intravenous (IV) dose...

Read More

SGEM#115: Complicated – Non-Operative Treatment of Appendicitis (NOTA)

Posted by on Apr 12, 2015 in Featured, GastroIntestinal, Podcasts | 0 comments

Podcast Link: SGEM115 Date: April 11th, 2015 Guest Skeptics: Dr. Bret Batchelor. Bret is a general practitioner with Enhanced Surgical Skills currently working in Vanderhoof, BC. He is the host of the newly created podcast that can be found on iTunes called Really Rural Surgery. Case: A 35 year-old man presents to the emergency room with right lower quadrant pain for approximately 18 hours. You assess the patient and find that his Alvarado Score is 7. You then ask for an ultrasound, as his body mass index is in the normal range. The ultrasound shows that he has an enlarged appendix >6mm that is not compressible and there is no intraperitoneal fluid present. You make a presumptive diagnosis of uncomplicated acute appendicitis. You relay this finding to the patient and he turns to you and asks, “Hey doc, I heard that...

Read More

SGEM#101: Puke – Antiemetics in Adult Emergency Department Patients

Posted by on Jan 4, 2015 in Featured, GastroIntestinal, Podcasts | 0 comments

Podcast Link: SGEM101 Puke Date: January 4th, 2015 Guest Skeptics: Eve Purdy. She is a 4th year medical student from Queen’s University. Eve is interested in all things medicine but especially emergency medicine, rural medicine, medical education and social media. She is the creative force behind the excellent medical student blog Manu et Corde (Hand and Heart). She is also an editor for BoringEM. When not learning to be a doctor, Eve is usually running, playing guitar or planning an outdoor adventure. Case: You are working in the emergency department when you pick up the chart for an otherwise healthy 35-year-old male with the chief complaint of abdominal pain and nausea. On history you learn that he has had crampy generalized abdominal pain for the past 24 hours associated with one episode of emesis. The pain started after he went...

Read More

SGEM#61: Blood on Blood (Transfusion Strategies for Upper GI Bleeds)

Posted by on Jan 29, 2014 in Featured, GastroIntestinal, Podcasts | 8 comments

Podcast Link: SGEM61a Date:  January 28, 2014 Guest Skeptic: Dr. Philippe Rola who graduated from McGill University in Internal Medicine. He is chief of ICU at Santa Cabrini Hospital in Montreal and an attending ICU specialist at Scarborough General Hospital in Toronto. Co-founder and president, critical care and ultrasound institute (www.ccusinstitute.org). A social media newbie (www.thinkingcriticalcare.com @ThinkingCC). Dr. Rola came to my attention because of the great blog post he wrote on the paper we are reviewing today. It was called “But doctor, he’s vomiting blood!!!”. Case Scenario: 62 year old man arrives with hematemesis. BP 112/72, HR 84 and Hgb is 82 (8.2g/dl) Question: Which is better, a conservative or liberal transfusion strategy for upper GI bleeds? Background:  Common ED presentation High morbidity and mortality Transfusions can be lifesaving in massive bleed Controversy for less serious cases Observational studies of...

Read More