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SGEM#228: Winds of Change – High Flow Nasal Oxygen for Acute Bronchiolitis?

Posted by on Sep 8, 2018 in Featured, Infectious, Pediatrics, Podcasts | 0 comments

Podcast Link: SGEM228 Date: September 5th, 2018 Reference:  Franklin et al. A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis. NEJM March 2018. Guest Skeptic: Dr. Ben Lawton is a paediatric emergency physician in Brisbane Australia. He divides his time between a tertiary children’s hospital and a community hospital that is busy enough to have its own paediatric emergency department. He is part of the Don’t Forget the Bubbles team. Case: Elsie is five months old and presents on day two of a bronchiolitic illness. She has taken just under half of her usual feeds so far today and has a respiratory rate of 58 breaths per minute and oxygen saturation of 90% on room air with moderate work of breathing. She is not clinically dehydrated and has a temp of 38.2C with clear rhinorrhea, red ears, a red throat and...

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SGEM Xtra: Petition to Retire the Surviving Sepsis Campaign Guidelines

Posted by on May 2, 2018 in Featured, Infectious, Podcasts | 0 comments

Recently the SGEM was contacted by a group of doctors organizing a petition. They were concerned about the new Surviving Sepsis Campaign (SCC) guidelines that were just released. Specifically, the fluid, antibiotics and pressor requirements within the first hour of being triaged in the emergency department. The SGEM was invited to be involved in a global effort to express the concerns about the SSC guidelines. Below is the letter being released from a number of #FOAMed people from around the world today with a link to an online petition. Please review the information and consider signing the petition. The next SGEM episode will be a standard critical appraisal of a recent publication. The goal remains to try and cut the knowledge translation window down from over ten years to less than one year using social media. We ultimately want...

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SGEM#216: Pump It Up – Corticosteroids for Patients with Pneumonia Admitted to Hospital

Posted by on Apr 28, 2018 in Featured, Infectious, Podcasts, Pulmonary | 0 comments

Podcast Link: SGEM216 Date: April 25th, 2018 Reference: Stern A et al, Corticosteroids for pneumonia (Review). Cochrane Database of Systematic Reviews. December 2017. Guest Skeptic: Dr. Jake Turner, a foundation doctor working in the UK. Case: A 72-year-old gentleman presents to your emergency department. He has been generally unwell for around one week, with a worsening cough, shortness of breath and fever. He is now feeling extremely short of breath, appears confused and is pyrexial at 39 degrees centigrade. His observations are heart rate of 102 beats per minute, respiratory rate of 34 breaths per minute, blood pressure of 110/67 mmHg, and oxygen saturation of 91% on room air. Background: There have been a large number of trials on steroids for a variety of conditions in the last year and we have covered some of them on the SGEM: The ADRENAL trial on...

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SGEM#209: Cephalexin – You Are My Only One for Uncomplicated Cellulitis

Posted by on Mar 4, 2018 in Featured, Infectious, Podcasts | 6 comments

Podcast Link: SGEM209 Date: February 27th, 2018 Reference: Moran et al. Effect of Cephalexin plus Trimethoprim-Sulfamethoxazole vs Cephalexin Alone on Clinical Cure of Uncomplicated Cellulitis – A Randomized Clinical Trial. JAMA May 2017. Guest Skeptic: Chip Lange is an Emergency Medicine Physician Assistant (PA) working primarily in rural Missouri in community hospitals. He also hosts a great #FOAMed blog and podcast called TOTAL EM. Case: A 22-year-old male with no significant past medical history arrives to your department for an area of tender erythema to the right forearm for two days that has grown in size without purulence or drainage.  With point of care ultrasound, you diagnose cellulitis without the presence of an abscess affecting a 6cm diameter area.  When deciding how to treat for this condition, you have read recently that cephalexin could be used alone and that trimethoprim-sulfamethoxazole (TMP-SMX) may...

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SGEM#208: It Makes No Difference – Glucocorticoids for the Treatment of Septic Shock

Posted by on Feb 24, 2018 in Featured, Infectious, Podcasts | 11 comments

Podcast Link: SGEM208 Date: February 14th, 2018 Reference: Venkatesh S et al. Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. NEJM January 2018. Guest Skeptic: Dr. Rory Spiegel (@EMNerd_) is a clinical instructor at University of Maryland, a recent graduate of Stony Brook’s Resuscitation Fellowship, and a current Critical Care fellow at University of Maryland. He writes an excellent blog called EM Nerd, which he describes as nihilistic ramblings. Case: 64-year-old male presents to your emergency department with worsening abdominal pain, nausea, vomiting and anorexia for the past week. On presentation he is lethargic and hypotensive. He requires control of his airway and is given a 30 cc/kg fluid bolus and started on norepinephrine. His urine analysis is consistent with a urinary tract infection. Over the course of his emergency department stay he has escalating vasopressor requirements. After starting vasopression, you ask...

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SGEM#207: Ahh (Don’t) Push It – Pre-Hospital IV Antibiotics for Sepsis.

Posted by on Feb 17, 2018 in Featured, Infectious, Podcasts | 9 comments

Podcast Link: SGEM207 Date: February 14th, 2018 Reference: Alam N et al. Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial. The Lancet Nov 2017. Guest Skeptics: Jay Loosley is the Superintendent of Education at Middlesex-London Paramedic Service. Jenn Doyle is a paramedic educator at Middlesex-London Paramedic Service. Case: EMS is dispatched to a retirement home. They have a 73-year-old man who complains of weakness and a cough for the last 48 hours. You arrive and find the man lying in bed looking ill. He has a history of hypertension, benign prostatic hypertrophy and osteoarthritis. His medications include ramapril, hydrochlorothiazide and tamsulosin. On examination, he has a temperature of 38.7C, heart rate of 105 beats per minute, respiratory rate of 26, oxygen saturation of 88%. and a blood pressure of 88/50 mmHg. You load him on the stretcher,...

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