Date:  December 19, 2013

Guest Skeptic: Alia Dharamsi

This will not be a traditional episode of the SGEM. We usually present a case, ask a specific question, review background material on the topic and then do a critical review of a recent publication. All of this to try and cut the knowledge translation window down from over 10 years to less than 1 year. We always hope to provide you with high-quality, clinically relevant, evidence based and patient centred information. The ultimate goal of the SGEM is to help you provide the best care to patients based on the best evidence.

Today will be different. It is near the end of the year and I wanted to take some time to reflect back on what we have done so far on the SGEM. Also talk about holiday time and it’s affect on emergency care workers. And finally I have a gift for everyone who listens to the podcast, provides feedback and just cares about emergency medicine.

Alia-DharamsiTo help me do this I have invited a special guest skeptic. Ms. Alia Dharamsi is a fourth year medical student from the University of British Colombia. She was a guest on Episode#35: We are Young. She participated in a panel discussion on social media, medical education and generational challenges. Alia is very interested in emergency medicine, social inequity and global health. She the one who taught me how to use twitter. Any program will be lucky to get her in the residency match (hint, hint).

Alia, it is great to have back on the SGEM. So let’s talk about some of our favorite podcasts so far this year. It was hard for me to pick a few because there were so many awesome shows like having my EBM guru on Dr. Andrew Worster talking about high sensitivity troponin (One is the Loneliest Number), Dr. David Newman to discuss presidential care (Hail to the Chief) or even the Don’t Pass the Dutchie episode about cannabinoid hyperemesis syndrome. But we did need to narrow it down so here are our top three picks.

Alia’s 1st Pick


SGEM#50: Under Pressure Journal Club (Vasopressin, Steroids and Epinephrine in Cardiac Arrest). I am so glad you picked this one. Going to Montreal and recording the first SGEM-Journal Club at McGill University where Dr. William Osler started the concept was amazing. The residents were super and they treated me like a rock star.

One of the great benefits of social media is that the time for knowledge translation from the time of a study, through journals and publication, to staff and attendings, and then to us as medical students can be cut down from 10 years, to less than a year, and in some cases into a few days or weeks. What that means is that research being done right now, can be used right now and I think that leads to more interesting and relevant discussion on research, regardless of whether or not it changes our practice. This is really why I’m so interested In social media—shaking up the norms! It also addressed a somewhat esoterically based question that I’ve had as a medical student, very green and new to the world of ER: for the number of cardiac arrest resuscitations we do, how many have return of spontaneous circulation, and how many survive to discharge. This podcast provided some numbers, but more importantly demonstrated a format for how to asses and evaluate papers in a journal club format, something I’ve only seen done a few times, and have yet to attempt.

Ken’s 1st Pick


SGEM#48 Thunderstruck (Subarachnoid hemorrhage). This was done with Dr. Jeff Perry from Ottawa. We were discussing whether or not a clinical decision rule (TOOL) could be used to rule out subarachnoid hemorrhage (SAH). How great is it to have the principle investigator of a study interviewed less than a month after its publication in JAMA? Having Jeff explain why they used fancy statistics like multivariant recursive partitioning was great EBM content. The bottom line was the Ottawa SAH Tool was not ready for prime time to rule out low risk patients from investigations.

Alia’s 2nd Pick

images-1SGEM#52: Breakfast at Glenfield (Asthma, Social Media and Knowledge Translation). This is also a favorite because Tapas from the UK, with a smartphone and a set of asthma guidelines, proved that with a little imagination and a pulse on social media, medicine and healthcare can be changed in less than 5 minutes. If you don’t believe me you have to watch the YouTube video Breakfast at Glenfield. It’s an absolute travesty it wasn’t featured at the Much Music Video Awards this year

Tapas is a superstar. I hope he will make more medical education videos. He manifested how social media can be used effectively for knowledge translation. Tapas did promise to visit Canada on his world tour.

Ken’s 2nd Pick

Hanel_Erich_webSGEM#53: Sunday Bloody Sunday (Epistaxis and Tranexamic Acid). This introduced the SGEM listeners to the newest member of the BEEM Dream Team Dr. Erich Hanel. What I really liked about this podcast is it covered a very common presentation in the ED. We all face this bread and butter situation of an older person with a nosebleed. The background information Erich put together was golden but then we got to discuss a very cool new treatment for epistaxis. While this is only one small RCT of 216 patients it had some impressive results. They demonstrated using tranexamic acid soaked packing they could stop nosebleed 71% of the time in less than 10 minutes. Even more impressive was 95% of patients were discharged in <2hrs with no bleeding, no packing and very satisfied. This is practice changing for me and something I will be trying out in 2014

Alia’s 3rd Pick

BEEM me upSGEM #56 Beem Me Up (Impact factor in the age of SoMe). I would be totally remiss to leave out #56…which featured one of my role models in social media, Brent Thoma. For anyone who hasn’t seen his website BoringEM you really should check it out. It has great resources on social media in medicine, navigating CaRMS and study tools like his “boring cards” and new chalk talks. This podcast provided me lots of guidance about how to answer the age-old question, “what’s the use of social media anyways” talking about impact factor in social media. I’ve noticed that the more involved I get in social media, the more I talk about it, and the more people want to know what’s the point anyways. For myself even it’s an important question I’ve been pondering—is this the best use of my time, and how can we begin to measure the value of social media. Since my interests fall into social media and innovation, in medicine and in education, impact factor has become a theme in gauging what groups of people and what themes garner the most discussion, and how can we leverage social media to impact the future of medicine. A lot of people ask me what I get out of social media, whether it’s worth my time, and how it actually advances medicine. This podcast was a great tool to start the discussion.

Ken’s 3rd Pick

2061c0b2eae6f437683226ea02eb9cf2SGEM#57 Should I Stay or Should I Go (Biphasic Anaphylactic Response) with the Dr. Anand Swaminathan (Swami) from NYC. People just loved this core content stuff. Swami did a great job defining anaphylaxis and discussing the treatment options. We then went on to discuss this feared complication of a biphasic reaction. This large retrospective chart review from Canada was not even in print yet. It was only available as an early electronic release on Annals of Emergency Medicine web site. Talk about cutting down the KT window?

The data suggested that these biphasic anaphylactic responses we fear are black swan events happening rarely (0.1%). The bottom line was that prolonged observation is likely unnecessary in patients who’s symptoms resolve with therapy in the ED.

The Skeptics’ Guide to Emergency Medicine 2014 – Here are some of the exciting things we are planning to do in 2014 on the SGEM:

  • SGEM – Journal Club
  • PUBcast with the BEEM Dream Team
  • RANThony with Dr. Anthony Crocco
  • Many great articles


Holiday Stress and Healthcare:

Screen Shot 2013-12-20 at 1.43.22 PMAlia and Ken discuss the joys and stress of being a student, resident and emergency health care worker during the holidays.

We have the privilege of being involved with people at the best of times and the worst of times. Remember to be good to each other not just during the holidays but all year round. Appreciate the great team you work with every day. Thank that student/resident who may be away from home for the first time over the holidays. Let them know they are valued and you empathize with how tough medical training can be at times. Watch and listen for signs of fatigue not only in our self, co-workers and those we care for. Make sure you get enough sleep, eat healthy foods and get some exercise.

For those of us who have to work over the holidays, social media can be a way to stay connected. It is easy to send a quick email or text to family and friends. Even cooler, is how we can reach out around the world with skype/facetime or google hangout.

Gift from the SGEM

Screen Shot 2013-12-20 at 1.34.07 PM

Alia helped me put together all of Season#1 of The Skeptics’ Guide to Emergency Medicine into a PDF book. It has all the episodes you love including; Who Let the Dogs Out, Ho, Ho, Hold the PPI and Honey, Honey. There are hyperlinks out to all the additional resources and Dr. Chris Carpenter even wrote a chapter on evidence based medicine.

This is our small way of saying thanks to all of you for caring enough to want to give your patients the best care based on the best evidence. It also demonstrates my commitment to the free open access to medication (FOAMed) movement. Please feel free to share this book with anyone. Click HERE to get your free copy of The SGEM Season#1.

Keener Kontest: Last weeks winner was Anna (no last name) who knew that three big categories for anaphylactic triggers were food, medication and insect bites. There is no Keener Kontest for this week but be ready to win a cool skeptical prize in 2014.

I hope everyone has a safe and happy holiday and all the best in 2014.

Remember to be skeptical of anything you learn, even if you heard it on the Skeptics’ Guide to Emergency Medicine.