SGEM#219: Shout, Shout, PERC Rule Them Out
Podcast Link: SGEM219 Date: May 16, 2018 Reference: Freund et al. Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial. JAMA February 2018. Guest Skeptic: Dr. Jeffrey Kline (@klinelab) is the Vice Chair of Research in Emergency Medicine and a professor of physiology, Indiana University School of Medicine. He is the editor in chief of AEM, creator of Pulmonary Embolism Rule-out Criteria (PERC) Rule and has published extensively in the area of pulmonary emboli. We have even made a Batdoc Video together on pulmonary embolism. Case: A 47-year-old woman presents to the emergency department with a 24-hour history of chest pain and shortness of breath. She has a past medical history of hypothyroidism and gastroesophageal reflux disease. She is on levo-thyroxine and a proton pump inhibitor. Vital signs are normal (HR...
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SGEM#218: Excited Delirium Syndrome
Podcast Link: SGEM218 Date: May 12th, 2018 Reference: Gonin P et al. Excited Delirium: A Systematic Review. AEM May 2018. Guest Skeptic: Dr. Chris Bond 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). Case: A 24-year-old male is brought into the emergency department by police. He was running around wearing a Batman suit, jumping on cars and screaming he is Batman. He is brought to the emergency department extremely agitated and despite being held down by two police and three security guards he is still trying to bite the staff. You cannot obtain any vital signs and this patient is a danger to himself and...
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SGEM#217: The Batman Effect on Improving Perseverance
Podcast Link: SGEM217 Date: March 6th, 2018 Reference: White et al. The “Batman Effect”: Improving Perseverance in Young Children. Child Development December 2016. Guest Skeptic: Dr. Casey Parker is a rural Generalist working in Broome, Australia. He has particular interests in Emergency Care, Aboriginal Health, Paediatrics, Trauma and Women’s Anaesthesia. Casey has this great blog and podcast called Broome Docs. Casey and I made a #Batdoc video at SMACCdub. Case: It is flu season and there is an endless stream of patients with sniffles, snot and sneezes! The waiting room is moaning with mildly unwell men; all with ‘the worst cold ever!” The residents are working double shifts in order to cover their fallen comrades. They are doing their best to avoid prescribing antibiotics whilst avoiding being coughed upon and writing endless, uninspiring discharge letters to the primary care docs. It is a...
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SGEM Xtra: Petition to Retire the Surviving Sepsis Campaign Guidelines
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
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#215: Love Will Tear Us Apart – Diagnostic Challenges of Aortic Dissection
Podcast Link: SGEM215a Date: April 12th, 2018 Reference: Ohle R et al. Clinical Examination for Acute Aortic Dissection: A Systematic Review and Meta-analysis. AEM April 2018 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. He is also the CME editor for Academic Emergency Medicine (AEM). Case: You are in the emergency department caring for a 65-year-old man with sharp chest pain radiating to the back. Blood pressure is elevated, and his pain was sudden in onset. His chest x-ray is normal, and there is no sign of asymmetric pulses. The EKG and laboratory tests are normal. You are wondering if you need to order a CT to rule out an aortic dissection. Background: Aortic dissection is a rare but deadly disease which can confound the emergency physician’s diagnostic abilities. Some estimates are that up to 38% of cases are initially...
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