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SGEM#182: Platelet Transfusions for Intracerebral Hemorrhage (PATCH) – Don’t Do It.

Posted by on Jun 11, 2017 in Featured, Hematologic, Neurologic, Podcasts | 3 comments

Podcast Link: SGEM182 Date: June 5th, 2017 Reference: Baharoglu et al. Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial. Lancet 2016. Guest Skeptic: Dr. Robert Edmonds is an Emergency Medicine staff physician in Newport News, VA and a recent graduate of the University of Missouri-Kansas City EM residency. DISCLAIMER – The views and opinions of this podcast/blog do not reflect the views and opinions of the US Air Force, the United States Government, or Langley Air Force Base. Case: Your next patient is a 68-year-old with sudden onset right sided hemiparesis and facial droop.  Non-contrast head CT shows a hemorrhagic stroke.  On review of the patient’s medications you notice the patient is taking daily aspirin. You wonder if they would benefit from a platelet transfusion. Background: In...

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SGEM#172: Don’t Bring My Blood Pressure Down (Intensively) – The ATACH2 Trial

Posted by on Mar 26, 2017 in Featured, Hematologic, Neurologic, Podcasts | 3 comments

Podcast Link: SGEM172 Date: March 21st, 2017 Reference: Qureshi et al. Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage. NEJM June 2016 Guest Skeptic: Chip Lange is an Emergency Medicine Physician Assistant working primarily in rural Missouri in community hospitals. He has international experience in critical care and emergency medicine. He hosts a blog and podcast called TOTAL EM, which stands for Tools Of the Trade and Academic Learning in Emergency Medicine. Although Chip’s focus is to educate those working in rural and remote settings, his goal has been to help others provide total care everywhere. Case: A 68 year-old female arrives via EMS for left sided weakness starting two hours prior to arrival in the emergency department. She does not take blood thinners and has lived independently prior to her complaint today. Her head CT without contrast demonstrates a...

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SGEM#150: Hypertonic Saline for Traumatic Brain Injury

Posted by on Mar 27, 2016 in Featured, Neurologic, Podcasts, Trauma | 22 comments

Podcast Link: SGEM150 Date: March 24th, 2016 Guest Skeptic: Dr. Chris Bond. Chris is an emergency physician and clinical lecturer at the University of Calgary. He is currently the host of CAEP Casts, which highlights educational innovations from emergency medicine residency programs across Canada. Chris also has his own #FOAMed blog called Standing on the Corner Minding My Own Business (SOCMOB). Lead Author: Dr. Elyse Pelletier. Elyse works at the Centre de Recherche CHU de Québec, Population Health and optimal Health Practices Unit. She is also in the Department of Family and Emergency Medicine, Université Laval, Québec, QC, Canada. Case: A 21-year-old male is standing on the corner, minding his own business (SOCMOB) when he is hit in the head with a bat and suffers a severe traumatic brain injury. He is brought into the trauma room and appears to have...

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SGEM#140: CT Scans to Rule Out Subarachnoid Hemorrhages In A Non-Academic Setting

Posted by on Dec 13, 2015 in Featured, Neurologic, Podcasts | 3 comments

Podcast Link: SGEM140JC Date: December 9th, 2015 Guest Skeptics: Dr. Fareen Zaver is a Chief Resident in Emergency Medicine at the George Washington University, specifically in charge of the medical education resident curriculum and Grand Rounds schedule. She is the co-founder and lead editor of the ALiEM AIR-Pro series and is pursuing an academic career in Medical Education. She was born and raised in Calgary, Alberta and has constantly stood out with her Canadian accent and roots. She will always be a diehard Calgary Flames fan and is joining the University of Calgary Emergency Medicine department in August when she completes her residency. Dr. Stefanie Gilbert is a Chief Resident in Emergency Medicine at The George Washington University in the heart of the nation’s capital. Her career interests include ED administration with a focus on operations and quality improvement. Prior to residency, she completed a...

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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 | 4 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 | 20 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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