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SGEM#236: TXA – Not for Brain Bleeds

Posted by on Nov 7, 2018 in Hematologic, Neurologic, Podcasts | 0 comments

http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGEM236.mp3Podcast: Play in new window | Download Date: November 6th , 2018 Reference: Sprigg et al. Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial. Lancet. 2018 Guest Skeptic: Dr. Robert Edmonds is an emergency physician in the US Air Force in Virginia. This is Bob’s eighth 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: Your next patient is a stroke alert for a 67-year-old male living at a nursing home presents with severe right sided upper and lower extremity weakness noticed one hour ago while eating a meal.  He obtains a stat head CT which shows an intracerebral hemorrhage.  In addition to controlling his elevated blood pressure, you wonder if there is more you can offer this patient to...

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SGEM#235: Edoxaban for Cancer Associated VTE – Would the NEJM Lie to You?

Posted by on Oct 31, 2018 in Featured, Hematologic, Podcasts | 0 comments

http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGEM235.mp3Podcast: Play in new window | Download Date: October 30th , 2018 Reference: Raskob GE et al. Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism. NEJM 2018 Guest Skeptic: Dr. Anand Swaminathan is an assistant professor of Emergency Medicine at the St. Joseph’s Regional Medical Center in Patterson, NJ. He is a deputy editor for EM: RAP and, associate editor for REBEL EM. Case: A 43-year old woman with a history of breast cancer currently undergoing chemotherapy presents with mild chest pain. She is hemodynamically stable except for a heart rate of 105 and her pain is increased when she takes a deep breath. The chest x-ray is unremarkable, and you order a CT pulmonary angiogram (CTPA) which demonstrates a right segmental pulmonary embolism. You write a prescription for low molecular weight heparin (LMWH) and advise the patient that she will...

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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

http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGEM214.mp3Podcast: Play in new window | Download 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...

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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

http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGEM210.mp3Podcast: Play in new window | Download 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....

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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

http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGEM184.mp3Podcast: Play in new window | Download 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...

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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

http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGEM182.mp3Podcast: Play in new window | Download 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...

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