SGEM#235: Edoxaban for Cancer Associated VTE – Would the NEJM Lie to You?
http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGEM235.mp3Podcast: Play in new window | Download Date: October 30th , 2018 Reference: Raskob GE et al. Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism. NEJM 2018 Guest Skeptic: Dr. Anand Swaminathan is an assistant professor of Emergency Medicine at the St. Joseph’s Regional Medical Center in Patterson, NJ. He is a deputy editor for EM: RAP and, associate editor for REBEL EM. Case: A 43-year old woman with a history of breast cancer currently undergoing chemotherapy presents with mild chest pain. She is hemodynamically stable except for a heart rate of 105 and her pain is increased when she takes a deep breath. The chest x-ray is unremarkable, and you order a CT pulmonary angiogram (CTPA) which demonstrates a right segmental pulmonary embolism. You write a prescription for low molecular weight heparin (LMWH) and advise the patient that she will...
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SGEM#234: Contrast Induced Nephropathy – A Unicorn?
http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGEM234.mp3Podcast: Play in new window | Download Date: October 17th , 2018 Reference #1: Aycock, Westafer et al. Acute Kidney Injury After Computed Tomography: A Meta-analysis. Ann Emerg Med 2018 (CRD42017056195) Reference #2: Weisbord SD, Gallagher M, Jneid H, et al; PRESERVE Trial Group. Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine. NEJM 2018 (ClinicalTrials.gov NCT01467466.) Guest Skeptic: Dr. Lauren Westafer is a board certified emergency physician at Baystate Medical Center and instructor in the Department of Emergency Medicine at the University of Massachusetts Medical School. She is author of the blog, The Short Coat, and cofounder of the emergency medicine podcast, FOAMcast. Lauren is currently funded by an NHLBI K12 grant (1K12HL138049-01) studying the implementation of evidence-based diagnosis of pulmonary embolism in the emergency department. Case: A 64-year-old woman with type-2 diabetes. She presents to the emergency department with chest pain...
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SGEM#233: Larry in the Den with Kiwis (LDK) – Low Dose Ketamine vs. Opioids for Acute Pain
http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGEM233.mp3Podcast: Play in new window | Download 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...
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SGEM#232: I Can See Clearly Now the Collar is Gone – Thanks to the Triage Nurse
http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGEM232.mp3Podcast: Play in new window | Download 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...
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SGEM#231: You’re So Vein – IO vs. IV Access for OHCA
http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGEM231.mp3Podcast: Play in new window | Download 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...
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SGEM#230: Tamsulosin – You’ve Lost that Loving Feeling – For Renal Colic
http://media.blubrry.com/thesgem/p/content.blubrry.com/thesgem/SGEM230.mp3Podcast: Play in new window | Download 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...
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