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SGEM#166: Which febrile child with sickle cell disease should get a chest x-ray?

Posted by on Dec 4, 2016 in Featured, Hematologic, Pediatrics, Podcasts, Pulmonary | 15 comments

Podcast Link: SGEM166 Date: November 21st, 2016 Reference: Eisenbrown et al. Which Febrile Children with Sickle Cell Disease Need a Chest X-Ray? AEM November 2016 Guest Skeptic: Dr. Corey Heitz is an associate professor of emergency medicine at the Virginia Tech Carilion School of Medicine in Roanoke Virginia. He is also the CME editor for Academic Emergency Medicine and the associate editor for emergency medicine simulation at the AAEM MedEdPORTAL. Case: You are working in the Emergency Department on an overnight pediatric coverage shift. A worried mother brings her 2-year-old child in with a fever of 38.6C (that’s 101.5F). The female child’s medical history is significant for sickle cell disease. On exam, the child is uncomfortable appearing, tachycardic, tachypnic and febrile. Mom says the child has had a runny nose and a mild cough along with the fever. Background: Children with sickle...

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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....

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SGEM#109: One Platelet, One Plasma and One RBC – PROPPR Trial

Posted by on Mar 1, 2015 in Featured, Hematologic, Podcasts, Trauma | 2 comments

Podcast Link: SGEM109 Date: February 28th, 2015 Guest Skeptic: Dr. Salim R. Rezaie. Salim is faculty member at University of Texas Health Science Center at San Antonio, TX. He is currently the creator/founder of REBEL EM blog and REBEL Cast available on iTunes. Case: 28 year-old male is involved in an altercation and shot multiple times in the chest and presents to the emergency department. His initial vital signs include a BP 72/46, HR 140, RR 30, O2 sat 89% on NRB and a temp of 98.7F. You intubate the patient successfully, begin intravenous fluids, and place bilateral chest tubes with significant blood return from the right chest tube. Due to the patients blood loss you initiate damage control resuscitation including: permissive hypotension, source control of bleeding, and a massive transfusion protocol. Background: In the United States, trauma is the...

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SGEM#80: CRASH-2 (Classic Paper)

Posted by on Jun 22, 2014 in Featured, Hematologic, Musculoskeletal, Podcasts | 0 comments

Podcast Link: SGEM80 Date:  June 12th, 2014  Guest Skeptic: Dr. Anand Swaninathan is an assistant program director at NYU/Bellevue Hospital in the Department of Emergency Medicine. Case Scenario: You are working in a busy urban trauma center when EMS slams through the doors with a 22-year-old man who was in a major MVC. The patient has significant abdominal and pelvic trauma and is hypotensive and tachycardic. You mobilize your resources and within minutes, the patient is intubated, his pelvis is placed in a binder and blood is being infused through a peripheral intravenous line. Your trauma colleagues are waiting to take the patient to the operating room for an exploratory laparotomy based on your positive FAST exam. Before they leave, one of you bright residents asks if you should start Tranexamic acid on the patient. Question: Does tranexamic acid (TXA) reduce mortality...

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SGEM#65: Relax, Don’t Do It (Top 5 List for Emergency Medicine)

Posted by on Mar 9, 2014 in Featured, Hematologic, Musculoskeletal, Podcasts | 2 comments

Podcast Link: SGEM65 Date:  March 6, 2014 Each week I usually put my skeptical eye on a recent publication. This is an attempt to cut the knowledge translation window down from an average of 10 years to 1 year. I use the Best Evidence in Emergency Medicine (BEEM) Appraisal Tools to do a structured critical review. However, every so often I like to take a break from the usual format. Step back and discuss a larger issue. Sort through the forest and the trees. Talk about an  important emergency medicine topic. We have done this before on a number of occasions: SGEM#15 Choosing Wisely SGEM#20 Hit Me with your Best Shot SGEM#35 We are Young (Social Media and Medical Education) SGEM#49 Five Stages of Evidence Based Medicine Grief SGEM#56 BEEM Me Up (Impact Factor in the Age of Social Media)...

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SGEM#53: Sunday, Bloody Sunday (Epistaxis and Tranexamic Acid)

Posted by on Nov 17, 2013 in Featured, Hematologic, Podcasts | 13 comments

Podcast Link: SGEM53 Date:  November 17, 2013 Title: Sunday, Bloody Sunday – Epistaxis and Tranexamic Acid Guest Skeptic: Dr. Erich Hanel, Assistant Professor of Emergency Medicine at McMaster University and the newest member of the BEEM Dream Team Case Scenario: 72 year old man presents with epistaxis. He has no history of coagulopathy but does have a history of hypertension, coronary artery disease and osteoarthritis. His vital signs are BP 154/92, HR 70 and RR 14. He is taking an ACE-I, hydrochlorothiazide 25mg and ASA 81mg. Question: Is topical tranexamic acid (TXA) better than nasal packing for an anterior epistaxis Eleven Questions Concerning Epistaxis:  1. What is the incidence of epistaxis? 60% of the population will experience a nose bleed Bimodal distribution (<10yrs and > 60yrs) Majority of admissions for refractory hemorrhage in elderly 60-70 years In the US 2005 there...

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