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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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SGEM#206: I’m Wheezy Like A Pre-Schooler – Prednisolone for Wheezy Children

Posted by on Feb 10, 2018 in Featured, Infectious, Pediatrics, Podcasts, Pulmonary | 10 comments

Podcast Link: SGEM206a Date: February 6th, 2018 Reference: Foster SJ et al. Oral prednisolone in preschool children with virus-associated wheeze: a prospective, randomised, double-blind, placebo-controlled trial. Lancet January 2018 Guest Skeptic: Dr. Tessa Davis is a Pediatrician specialising in Pediatric Emergency Medicine and currently practicing in a central London hospital. She is also the co-founder of Don’t Forget the Bubbles and on the FeminEM Speaker Bureau. Case: Tom is a 4-year-old boy who comes into the emergency department with a wheeze following a viral illness. He has been taking salbutamol at home today but he’s still not improving. He has mild work of breathing and a bilateral wheeze. His oxygen saturation is 94% on room air. Tom has no other previous medical history. You start to write up the salbutamol, but should you give him a dose of prednisolone too? Background: We see “little wheezers”...

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SGEM#203: Let Me Clear My Sore Throat with a Corticosteroid

Posted by on Jan 20, 2018 in Featured, Infectious, Pharmacology/Toxicology, Podcasts, Pulmonary | 5 comments

Podcast Link: SGEM203 Date: January 15th, 2018 Reference: Sadeghirad B, et al. Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials. BMJ 2017 Guest Skeptic: Meghan Groth is an Emergency Medicine Pharmacist at the UMass Memorial Medical Center in Worcester, Massachusetts. She has contributed to the Academic Life in Emergency Medicine and EM PharmD blogs, and is a part of the ALiEM Capsules Team.  Case: 50-year-old man presents with a one day history of sore throat, cough and low-grade fever. He is otherwise healthy with only sports related injuries. The ibuprofen did not help and he is requesting antibiotics so he can get back to work sooner. Background: Patients present commonly to their primary care providers (PCPs) and to the emergency department (ED) with complaints of a sore throat. In the US, adults accounted for 6.6 million visits...

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SGEM#200: Dr. Alexander Hamilton and Bloodletting for Camp Fever

Posted by on Dec 23, 2017 in Featured, Holiday, Infectious, Podcasts | 1 comment

Podcast Link: SGEM200 Date: December 19th, 2017 Reference: Lesassier Hamilton A. Dissertatio Medica lnauguralis De Synocho Castrensi [Inaugural medical dissertation on camp fever]. Edinburgh: J Ballantyne, 1816. Guest Skeptic: Dr. Robert Leeper is an assistant professor of surgery at Western University and the London Health Sciences Centre.  His practice is in trauma, emergency general surgery, and critical care with an academic interest in ultrasound and medical simulation. This is the 200th episode of the SGEM and it is the 2017 holiday edition. The idea for this episode came after seeing a twitter photo on Halloween of Dr. Leeper (@Rob_Leeper) doing rounds dressed up as Alexander Hamilton. To be clear, Dr. Alexander Lesassier Hamilton was a Scottish physician who lived around the early 1800s. He is a completely different person than one of the founding fathers of the United States. The American Alexander Hamilton family was...

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