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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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SGEM#31: She’s Got Legs (Deep Vein Thrombosis and Thrombophlebitis)

Posted by on Apr 8, 2013 in Featured, Hematologic, Podcasts | 1 comment

Podcast Link:SGEM31 Date:  April 7, 2013 Title: She’s Got Legs (Deep Vein Thrombosis and Thrombophlebitis) Case Scenario: A 58-year-old woman arrives to the ED with a painful leg. You do an appropriate history and physical examination. She is Well’s criteria low so you order a d-dimer. The d-dimer comes back elevated so you ask for an ultrasound. This imaging test comes back saying “no evidence of deep vein thrombosis”. You make the diagnosis of superficial thrombophlebitis. Question: What should you do to treat this woman’s superficial thrombophlebitis (NSAIDs, coumadin, LMWH, surgery, nothing)? Background: Superficial thrombophlebitis is a common problem usually involving the superficial veins of the leg. The two components of this condition are clot (thrombus) and inflammation of the vein (phlebitis). Besides local pain, superficial thrombophlebitis can cause red, itchy skin with hardening of the surrounding tissue. There has been a concern that superficial thrombophlebitis...

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