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SGEM#121: Internal or External Shoulder Immobilization (It Don’t Matter to Me)

Posted by on May 24, 2015 in Featured, Musculoskeletal, Podcasts | 2 comments

Podcast Link: SGEM121 Date: May 22nd, 2015 Guest Skeptics: Dagny Kane-Haas. Dagny is a physiotherapist who just completed her Masters degree in Clinical Science in Manipulative Therapy. Case: 24 year-old man is goofing around on the Memorial Day long weekend at the beach. He falls and dislocates his shoulder for the first time. An examination shows it is an isolated injury and x-rays demonstrate an anterior dislocation of his shoulder without fracture. Procedural sedation is performed with no complications. Post procedure image shows a reduced shoulder joint. You are getting ready to immobilize him and wonder whether it would be best in external or internal rotation. Background: The shoulder joint has the widest range of motion of any joint in the human body. This makes it very useful and very susceptible to injury. These injuries include dislocation, fracture, rotator cuff tears...

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SGEM#89: Preventing Falling to Pieces

Posted by on Oct 6, 2014 in Featured, Musculoskeletal, Podcasts | 28 comments

Podcast Link: SGEM89 Date: October 5th, 2014 Guest Skeptics: Dr. Chris Carpenter. Associate Professor, Emergency Medicine. Director, Evidence Based Medicine, Washington University. C0-Author of Evidence Based Emergency Care- Diagnostic, Testing and Clinical Decision Rules. @SAEMEBM The goal of the SGEM continues to be to cut the knowledge translation window down from over ten years to less than one year. There are about 3,800 biomedical publications every day on PUBMED alone. Bastian et al published in PloS 2010 that there are about 75 RCT and 11 Systematic reviews released daily. They asked the question “How could anyone every keep up”? The answer is no one could possibly keep up. No wonder it takes so long for high quality clinically relevant evidence to reach the bedside. A study by Morris et al in 2011 called discusses how it can take an average of 17...

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SGEM#87: Let Your Back Bone Slide (Paracetamol for Low-Back Pain)

Posted by on Sep 21, 2014 in Featured, Musculoskeletal, Podcasts | 0 comments

Podcast Link: SGEM87 Date:  September 17th, 2014  Guest Skeptics: Dr. Pal Ager-Wick is from Norway. Consultant at Legevakten in Drammen, which is a GP run ED handling most things except major trauma. Keen interest in everything evidence based especially ultrasound. Pal is bringing Matt and Mike from the Ultrasound podcast to Norway. Case Scenario: 35 year old man presents to ED with mechanical back pain after doing some heavy lifting on the weekend. He has not “red flags”. Question: Does paracetamol improve time to recovery from pain compared to placebo in patients with low-back pain? Background: The leading cause of disability worldwide is low-back pain. Guidelines recommend paracetamol (acetaminophen) as the first-line agent. There have been no randomized control trials comparing paracetamol vs. placebo for low-back pain. 1) Cancer Related Red Flags with Low Back Pain History of cancer Unexplained weight loss >10 kg within...

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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 Skeptics: Dr. Anand Swaninathan or Swami as his is better known. He is an assistant program director at NYU/Bellevue Hospital in the Department of Emergency Medicine. Case Scenario: You’re 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...

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SGEM#74: Broken Arms (Diagnosing Rotator Cuff Disease)

Posted by on May 11, 2014 in Featured, Musculoskeletal, Podcasts | 0 comments

Podcast Link: SGEM74 Date:  May 1st, 2014  Guest Skeptic: Physiotherapist Dagny Kane-Haas. Dagny is a currently studying for her Masters degree in Clinical Science in Manipulative Therapy. Case Scenario: A 54 year old man presents with increasing pain in his right shoulder. Question: Does this patient with shoulder pain have rotator cuff disease? Background: Shoulder pain is the third most common MSK reason for seeking medical attention. There are 4.5 million visits per year in the USA. Rotator cuff disease is the most common cause. It can have a big impact on quality of life especially if it is the dominant arm. Majority of these conditions are treated medically with only few requiring surgery. Anatomy of the rotator cuff beyond just remembering the SITS nemonic. Supraspinatus – ABducts the arm (suprascapular nerve -C5) Infraspinatus – Externally rotates the arm (suprascapular nerve C5-6) Teres Minor...

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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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