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#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#206: I’m Wheezy Like A Pre-Schooler – Prednisolone for Wheezy Children
Podcast Link: SGEM206a Date: February 6th, 2018 Reference: Foster SJ et al. Oral prednisolone in preschool children with virus-associated wheeze: a prospective, randomised, double-blind, placebo-controlled trial. Lancet January 2018 Guest Skeptic: Dr. Tessa Davis is a Pediatrician specialising in Pediatric Emergency Medicine and currently practicing in a central London hospital. She is also the co-founder of Don’t Forget the Bubbles and on the FeminEM Speaker Bureau. Case: Tom is a 4-year-old boy who comes into the emergency department with a wheeze following a viral illness. He has been taking salbutamol at home today but he’s still not improving. He has mild work of breathing and a bilateral wheeze. His oxygen saturation is 94% on room air. Tom has no other previous medical history. You start to write up the salbutamol, but should you give him a dose of prednisolone too? Background: We see “little wheezers”...
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SGEM#203: Let Me Clear My Sore Throat with a Corticosteroid
Podcast Link: SGEM203 Date: January 15th, 2018 Reference: Sadeghirad B, et al. Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials. BMJ 2017 Guest Skeptic: Meghan Groth is an Emergency Medicine Pharmacist at the UMass Memorial Medical Center in Worcester, Massachusetts. She has contributed to the Academic Life in Emergency Medicine and EM PharmD blogs, and is a part of the ALiEM Capsules Team. Case: 50-year-old man presents with a one day history of sore throat, cough and low-grade fever. He is otherwise healthy with only sports related injuries. The ibuprofen did not help and he is requesting antibiotics so he can get back to work sooner. Background: Patients present commonly to their primary care providers (PCPs) and to the emergency department (ED) with complaints of a sore throat. In the US, adults accounted for 6.6 million visits...
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SGEM#186: Apneic and the O, O, O2 for Rapid Sequence Intubation
Podcast Link: SGEM186 Date: September 2nd, 2017 Reference: Caputo et al. EmergeNcy Department use of Apneic Oxygenation versus usual care during rapid sequence intubation: A randomized controlled trial (The ENDAO Trial). AEM 2017. Guest Skeptic: Dr. Rory Spiegel is a clinical instructor at University of Maryland and a recent graduate of Stony Brook’s Resuscitation Fellowship. He writes an excellent blog called EM Nerd, which he describes as nihilistic ramblings. Case: A 68-year-old female presents with shortness of breath. She has experienced fever, chills and a productive cough worsening over the past five days. Chest X-ray demonstrated bilateral infiltrates consistent with multifocal pneumonia. Over her emergency department course the patients starts to decompensate despite high-flow nasal cannula and broad-spectrum antibiotics. The decision is made to intubate the patient. The question arises whether apneic oxygenation should be used during the rapid sequence intubation. Background: Much...
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SGEM#184: We Weren’t Born to Follow-Up – The PEITHO Long-Term Follow-up Study
Podcast Link: SGEM184 Date: June 21st, 2017 Reference: Konstantinides et al. Impact of Thrombolytic Therapy on the Long-Term Outcome of Intermediate-Risk Pulmonary Embolism. JACC March 2017 Guest Skeptic: Dr. Kirsty Challen (@KirstyChallen) is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals Trust (North West England). She did her Medical School at Manchester, with a History of Medicine BSc at the same time. Kirsty did her residency in North West England and has a PhD in Health Services Research from Sheffield. Kirsty is also the creator of a knowledge translation project called #PaperinaPic. Case: A 22-year-old patient presents to the emergency department with sudden onset shortness of breath. She takes the oral contraceptive pill and was placed in a below-knee plaster cast for a fibula fracture 2 weeks ago. She is alert and talking, with a systolic blood pressure of 110 mmHg, but CTPA...
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