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SGEM#214: Woman – The TXA Trial for Post-Partum Hemorrhage

Posted by on Apr 14, 2018 in Featured, Gynecologic, Hematologic, Podcasts | 0 comments

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#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#184: We Weren’t Born to Follow-Up – The PEITHO Long-Term Follow-up Study

Posted by on Jul 2, 2017 in Cardiac, Featured, Hematologic, Podcasts, Pulmonary | 2 comments

Podcast Link: SGEM184 Date: June 21st, 2017 Reference: Konstantinides et al. Impact of Thrombolytic Therapy
 on the Long-Term Outcome of Intermediate-Risk Pulmonary Embolism. JACC March 2017 Guest Skeptic: Dr. Kirsty Challen (@KirstyChallen) is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals Trust (North West England). She did her Medical School at Manchester, with a History of Medicine BSc at the same time. Kirsty did her residency in North West England and has a PhD in Health Services Research from Sheffield. Kirsty is also the creator of a knowledge translation project called #PaperinaPic. Case: A 22-year-old patient presents to the emergency department with sudden onset shortness of breath. She takes the oral contraceptive pill and was placed in a below-knee plaster cast for a fibula fracture 2 weeks ago. She is alert and talking, with a systolic blood pressure of 110 mmHg, but CTPA...

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SGEM#182: Platelet Transfusions for Intracerebral Hemorrhage (PATCH) – Don’t Do It.

Posted by on Jun 11, 2017 in Featured, Hematologic, Neurologic, Podcasts | 3 comments

Podcast Link: SGEM182 Date: June 5th, 2017 Reference: Baharoglu et al. Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial. Lancet 2016. Guest Skeptic: Dr. Robert Edmonds is an Emergency Medicine staff physician in Newport News, VA and a recent graduate of the University of Missouri-Kansas City EM residency. DISCLAIMER – The views and opinions of this podcast/blog do not reflect the views and opinions of the US Air Force, the United States Government, or Langley Air Force Base. Case: Your next patient is a 68-year-old with sudden onset right sided hemiparesis and facial droop.  Non-contrast head CT shows a hemorrhagic stroke.  On review of the patient’s medications you notice the patient is taking daily aspirin. You wonder if they would benefit from a platelet transfusion. Background: In...

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SGEM Xtra: Talk Trauma 2017- Tales from the Outer Rim

Posted by on Apr 7, 2017 in Conferences, Featured, Hematologic, Musculoskeletal, Podcasts, Trauma | 0 comments

Date: April 7th, 2017 Superstar Nurse Brenda Palsa and I had a wonderful time presenting at Talk Trauma 2017 this week in London, Ontario. It is a one day conference for nurses, allied health & EMS professionals involved in providing care for adult and paediatric trauma patients. Talk Trauma is put on by the London Health Science Centre (LHSC). We were honoured to return for a second year in a row to talk about managing trauma patients in the periphery.   Our idea was to demonstrate that you could provide excellent evidence based care before transferring patients to the trauma centre (LHSC). This resulted in Episode II – Tales from the Outer Rim (Talk Trauma Intro Trailer). I was inspired by ZdoggMD and dress up as Doc Vader while Brenda became Nurse Leia.   The entrance went well as we...

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SGEM#172: Don’t Bring My Blood Pressure Down (Intensively) – The ATACH2 Trial

Posted by on Mar 26, 2017 in Featured, Hematologic, Neurologic, Podcasts | 3 comments

Podcast Link: SGEM172 Date: March 21st, 2017 Reference: Qureshi et al. Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage. NEJM June 2016 Guest Skeptic: Chip Lange is an Emergency Medicine Physician Assistant working primarily in rural Missouri in community hospitals. He has international experience in critical care and emergency medicine. He hosts a blog and podcast called TOTAL EM, which stands for Tools Of the Trade and Academic Learning in Emergency Medicine. Although Chip’s focus is to educate those working in rural and remote settings, his goal has been to help others provide total care everywhere. Case: A 68 year-old female arrives via EMS for left sided weakness starting two hours prior to arrival in the emergency department. She does not take blood thinners and has lived independently prior to her complaint today. Her head CT without contrast demonstrates a...

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