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SGEM#137: A Foggy Day – Endovascular Treatment for Acute Ischemic Stroke

Posted by on Nov 22, 2015 in Featured, Neurologic, Podcasts | 2 comments

Podcast Link: SGEM137 Date: November 21st, 2015 Guest Skeptic: Dr. Rory Spiegel is an Emergency Medicine resident in New York City. Rory is doing a resuscitation fellowship at Stony Brook University School of Medicine. He also writes a blog called EM Nerd about nihilism, medicine and the art of doing nothing. Case: An 78-year-old woman presents to your emergency department with right arm weakness and slurred speech for the last two hours.  She has a history of hypertension and diabetes. A CTA is performed that shows an Intracranial arterial occlusion of the right M1 middle cerebral artery segment. Background: Prior to the publication of MR CLEAN and the four trials published in its wake, the data regarding endovascular therapy has been consistently negative. Over the past year five RCTs examining endovascular therapy for acute ischemic stroke have been published. In direct contrast to...

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SGEM#134: Listen, to what the British Doctors Say about LPs post CT for SAH

Posted by on Nov 1, 2015 in Featured, Neurologic, Podcasts | 19 comments

Podcast Link: SGEM134 Date: October 27th, 2015 Guest Skeptic: Dr. David Sayer is a physician completing his general practice training in the United Kingdom. Case Scenario: A 34-year-old woman presents with acute onset of headache peaking in 30 minutes with no recent trauma, focal deficits and a normal neurologic examination. Background: Headaches represent around 2% of all emergency department visits. Of these presentations 1-3% turn out to be a subarachnoid hemorrhage (SAH)  (Edlow, Vermeulen, Perry, Morgenstern). About 5% of SAH are misdiagnosed on the first emergency department assessment (Vermeulen). This is partly because 50% of SAH present with no neurologic deficit (Weir). Dr. Jeff Perry and his team have tried to create a clinical decision tool to rule out SAH for acute headaches (SGEM#48). The Ottawa SAH Tool contains six variables to decide if a CT scan is necessary. Applying the tool could decrease the...

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SGEM#124: Ultrasound for Skull Fractures – Little Bones

Posted by on Jun 14, 2015 in Featured, Musculoskeletal, Neurologic, Pediatrics, Podcasts, Trauma | 2 comments

Podcast Link: SGEM124 Little Bones Date: June 11th, 2015 Guest Skeptic: Dr. Greg Hall. Greg is Director of EM Ultrasound at the Brantford General Hospital in Brantford Ontario and Assistant Clinical Professor at McMaster University.  He is Vice President of the Canadian Emergency Ultrasound Society, co-author of Point-of-care Ultrasound for Emergency Physicians, co-creator of the EDE 2 Course: Advanced Emergency Department Echo, and director of the EDE 3 Course, a leading edge POCUS workshop. Case: An 18 month old male presents to your small emergency department having a witnessed fall off a couch and hit his head on a hardwood floor.  He threw up once and cried immediately at the scene.  There was no loss of consciousness. The parents are concerned about a serious head injury, particularly with the large hematoma, but understandably are not thrilled with the idea of the...

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SGEM#112: Bang Your Head – Paediatric Concussions

Posted by on Mar 22, 2015 in Featured, Neurologic, Pediatrics, Podcasts | 0 comments

Podcast Link: SGEM112 Concussion Date: March 7th, 2014 Guest Skeptic: Dr. Anthony Crocco. Associate Professor, McMaster University, Medical Director and Division Head McMaster Children’s Hospital Emergency Department. Case: 11yo snowboarder fails to land epic jump. She was wearing helmet. There was a brief loss of consciousness and she is amnestic to the event. The only complaint is a mild headache. Her examination is normal and a shared decision is made to observe her rather than getting a CT scan. She is ultimately diagnosed with a concussion. When leaving the department she wants to know when can she go back shreddin’ the gnar? Background: Pediatric traumatic brain injury (TBI) is a leading cause of death and disability. The Center for Disease Control (CDC) has called it a national health problem. TBIs are responsible for close to 500,000 ED visits, over 35,000 hospitalizations...

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SGEM#111: Comfortably Numb – Low dose Ketamine as Adjunct for ED Pain Control

Posted by on Mar 15, 2015 in Featured, Neurologic, Podcasts | 8 comments

Podcast Link: SGEM111 Ketamine Date: March 11th, 2015 Guest Skeptic: Billy Sin. Billy is an Assistant Professor of Pharmacy Practice Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Clinical Pharmacy Educator Emergency Medicine, The Brooklyn Hospital Center Case: 27yo woman presents to the emergency department again with severe back pain radiating to her legs. She has tried analgesics, anti-inflammatories, narcotics and even trigger point injections. You have been reading more and more papers suggesting a sub dissociative-dose of ketamine (SDDK) could work. SGEM-HOP Process: We pick a manuscript in conjunction with AEM’s Editorial Board that has been submitted, peer-reviewed, and ultimately accepted for AEM but not published yet. The SGEM then put a skeptical eye upon the manuscript using a modified BEEM critical appraisal tool. One of the authors of the paper is invited to discuss...

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SGEM#108: You Spin Me Right Round Baby Like Benign Paroxysmal Positional Vertigo

Posted by on Feb 22, 2015 in Featured, Neurologic, Podcasts | 0 comments

Podcast Link: SGEM108 BPPV Date: February 20th, 2015 Guest Skeptics: Dr. Tony Seupaul and Dr. Chris Fowler. Tony is the Chair of the Department Emergency Medicine, University of Arkansas. Chris is a second year EM resident in Arkansas. He did his medical school in Arizona and Undergrad at Brigham Young University in Utah.  Case: 58 year old woman with diabetes and hypertension presents with two days of feeling “dizzy”. Her symptoms worsen when she turns her head. She has also noticed that is much worse when bending over and looking up while turning her head. She has extreme nausea and has had several episodes of vomiting. She has had some improvement in her symptoms with lying flat and closing her eyes. She is very worried about something serious and asks what can be done to help with her symptoms. Background:...

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