SGEM#233: Larry in the Den with Kiwis (LDK) – Low Dose Ketamine vs. Opioids for Acute Pain
Podcast Link: SGEM233 Date: October 10th , 2018 Reference: Karlow et al. A Systematic Review And Meta-Analysis of Ketamine as an Alternative to Opioids for Acute Pain in the Emergency Department. AEM Oct 2018. Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. He is also the CME Editor for Academic Emergency Medicine. Case: You are caring for a 38-year-old male (Larry) who presented to the emergency department with lower back pain. During your evaluation, he tells you he doesn’t want any narcotic pain medication. You wonder if there are alternative options, and a colleague reminds you that ketamine has recently gained a lot of exposure as a possible alternative. Background: The amelioration of pain and suffering should be one of the top priorities of emergency physicians. In 2001, JACHO made pain the 5th vital sign to address the issue of...
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SGEM#232: I Can See Clearly Now the Collar is Gone – Thanks to the Triage Nurse
Podcast Link: SGEM232 Date: October 5th , 2018 Reference: Stiell et al. A Multicenter Program to Implement the Canadian C-Spine Rule by Emergency Department Triage Nurses. Annals of EM Oct 2018 Guest Skeptic: Alison Armstrong is an Emergency Department Nurse, TNCC Course Director, Trauma Program Coordinator and Canadian C-Spine Rule Nurse Champion. Case: There are two case scenarios this week to try and capture the two common ways patients present to the triage nurse. Case 1: A 51-year-old male patient presents to triage in a collar on a back-board via EMS following a rear-end motor vehicle collision (MVC) at a stop light. He was a belted driver with no past medical history and GCS 15. The driver of the car that hit him was texting and did not appear to slow before striking the rear of the patient’s car at about 50 km/hr....
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SGEM#231: You’re So Vein – IO vs. IV Access for OHCA
Podcast Link: SGEM231 Date: September 21st, 2018 Reference: Kawano et al. Intraosseous Vascular Access Is Associated With Lower Survival and Neurologic Recovery Among Patients With Out-of-Hospital Cardiac Arrest. Annals of EM May 2018 Guest Skeptic: Andrew Merelman is a critical care paramedic and first year medical student at Rocky Vista University in Colorado. His primary interests are resuscitation, prehospital critical care, airway management, and point-of-care ultrasound. Case: A 46-year-old man has a cardiac arrest at home, witnessed by family. Bystander CPR is initiated prior to EMS arrival. EMS arrives on scene and initiates high quality basic life support (BLS). One defibrillation for ventricular fibrillation (VF) is provided but the patient remains in VF. As part of their protocol, they attempt vascular access to administer epinephrine and an antidysrhythmic. They wonder whether it would be better to attempt a peripheral intravenous (IV) line or...
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SGEM#230: Tamsulosin – You’ve Lost that Loving Feeling – For Renal Colic
Podcast Link: SGEM230 Date: September 17th, 2018 Reference: Meltzer, A. et al. Effect of Tamsulosin on Passage of Symptomatic Ureteral Stones: A Randomized Clinical Trial. JAMA Internal Med, 2018. Guest Skeptics: Dr. Tony Seupaul, Professor and Chair, University of Arkansas for Medical Sciences Department of Emergency Medicine. Dr. Daniel Holleyman, Chief Resident at University of Arkansas for Medical Sciences Emergency Medicine Residency. Case: A 51-year-old man presents to the emergency department (ED) with five-hour history of acute onset left flank pain. The pain comes in waves, radiates into his left groin and is associated with nausea and vomiting. He noticed darkening of his urine, but does not have dysuria, fever, testicular pain, or penile discharge. You work him up and the urine analysis shows large blood, negative nitrites, negative bacteria. CT abdomen/pelvis without contrast is done which identifies a 7mm radiopaque stone in the left...
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SGEM#229: I Fought the Law and the Law Won – But Would it Matter if I had a Resident?
Podcast Link: SGEM229 Date: September 10th, 2018 Reference: Gurley et al. Comparison of Emergency Medicine Malpractice Cases Involving Residents to Non-Resident Cases. AEM September 2018 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the Director of Simulation Education at Markham Stouffville Hospital in Ontario. He is the creator of the excellent #FOAMed project called First10EM.com Case: You are giving an introductory lecture on evidence-based medicine to the incoming class of residents, and after you finish you notice some excited chatter at the back of the room. Thinking that you have found some EBM keeners/gunners, you wander over to join the discussion, but find yourself in a heated discussion. One of the senior residents was recently named in a lawsuit, and the junior residents are worried. How likely are they to be sued? What can they do to prevent such a harrowing event?...
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SGEM#228: Winds of Change – High Flow Nasal Oxygen for Acute Bronchiolitis?
Podcast Link: SGEM228 Date: September 5th, 2018 Reference: Franklin et al. A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis. NEJM March 2018. Guest Skeptic: Dr. Ben Lawton is a paediatric emergency physician in Brisbane Australia. He divides his time between a tertiary children’s hospital and a community hospital that is busy enough to have its own paediatric emergency department. He is part of the Don’t Forget the Bubbles team. Case: Elsie is five months old and presents on day two of a bronchiolitic illness. She has taken just under half of her usual feeds so far today and has a respiratory rate of 58 breaths per minute and oxygen saturation of 90% on room air with moderate work of breathing. She is not clinically dehydrated and has a temp of 38.2C with clear rhinorrhea, red ears, a red throat and...
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