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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...

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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...

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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...

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SGEM#46: Don’t Pass the Dutchie (Cannabinoid Hyperemesis Syndrome)

Posted by on Sep 30, 2013 in Featured, GastroIntestinal, Podcasts, Psychiatric | 0 comments

Podcast Link:SGEM#46 Date:  September 27, 2013 Title: Don’t Pass the Dutchie from the Left Hand Side Case Scenario: 22yo man presents for the third time in a week with vomiting. He was worked up extensively in the previous two visits and no cause was found. Nothing seems to stop the vomiting. He has a similar bout of cyclical vomiting a few months ago. You go to assess him and he is very anxious and all he want to do is take a hot shower. Question:  How do you diagnose cannabinoid hyperemesis syndrome? Background: Marijuana is the number one illegal drug used in the USA and the world with psychoactive and physiologic effects. This podcast will not discuss the legality of marijuana or former presidents who apparently did not inhale. The title song “Pass the Dutchie” was a huge reggae song by British band Musical...

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SGEM#23: A Bump Up Ahead (Diagnosis of Appendicitis)

Posted by on Feb 10, 2013 in Featured, GastroIntestinal, Podcasts | 7 comments

Podcast Link:SGEM23 Date:  10 February 2013 Title: A Bump Up Ahead (Diagnosis of Appendicitis) Case Scenario: 28yo woman presents to the ED at 2am with steadily increasing right lower quadrant (RLQ) pain. She has a past medical history of ovarian cysts. Her vital signs are stable, afebrile and tender over the RLQ. The blood work is unremarkable and specifically her pregnancy test is negative. Ultrasound and CT scan are not available overnight. What is your disposition and management of this patient? Background: Undifferentiated abdominal pain is a high volume, high risk complaint. It represents approximately 7% of ED visits. Acute appendicitis is the second most common cause of malpractice litigation in children 6 – 17 years old.  Ten percent of all closed malpractice cases are due to missed diagnoses of appendicitis. It is not practical to image everyone with lower abdominal pain...

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SGEM #16: Ho, Ho, Hold the Proton Pump Inhibitor in Upper Gastrointestinal Bleed

Posted by on Dec 23, 2012 in Featured, GastroIntestinal, Podcasts | 1 comment

Podcast Link:SGEM16 Date: 23 December 2012 Title: Ho, Ho Hold the Proton Pump Inhibitor in Upper Gastrointestinal Bleed Case Scenario: A jolly old man presents to the emergency department vomiting bright red blood all over his fur lined winter coat.  You quickly assess his A,B,Cs. The nurse places two big IVs, you bring the advanced airway cart to the bedside and the laboratory draw appropriate blood work. The nurse then asks if you want to give 80mg pantoprazole IV bolus followed by an 8mg/hr drip.   Background on Upper GI Bleeds: Here is the usual blurb about and the problem…it’s common, it effects millions of patients every year, deadly and it’s expensive. The details: Upper GI bleed the most common reason for ER admit with lots of morbidity and mortality (Gilbert 1990; Longstreth 1997) Usually a result of peptic ulcer (Laine...

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