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SGEM Xtra: Dogmalysis 2021

The Skeptics' Guide to EM

Date: February 19th, 2021 This is an SGEM Xtra episode. I had the honour of presenting at the Lehigh Valley Health Network Grand Rounds on February 4th, 2021. Date: February 19th, 2021 This is an SGEM Xtra episode. I had the honour of presenting at the Lehigh Valley Health Network Grand Rounds on February 4th, 2021.

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High sensitivity cardiac troponins for ED chest pain evaluation (2022 ACC pathway)

ALiEM

This is endorsed in the 2022 ACC pathway [1] and the 2021 AHA chest pain guidelines [7]. References Writing Committee, Kontos MC, de Lemos JA, et al. 2022.08.750 Collet JP, Thiele H, Barbato E, et al. 2021 May 14;42(19):1908] [published correction appears in Eur Heart J. 2021 May 13;:]. 2021 May 13;:].

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SGEM#437: Don’t Be Fooled by the Meds I Got, I Still Need an ESP Block – For My Rib Fractures

The Skeptics' Guide to EM

The evidence was not robust enough back in 2021 to confidently use this potential tool. A clinical decision tool called the STUMBL score was derived and validated by Battle et al in 2014 [3]. An attempt was made to externally validate this tool in New Zealand by Murkerji et al 2021 [4].

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SGEM#405: We’re Off To Never-Never Land – But Should We Use Etomidate for the Rapid Sequence Intubation?

The Skeptics' Guide to EM

Date: June3, 2023 Reference: Kotani et al. Date: June3, 2023 Reference: Kotani et al. There was a SRMA in 2021 that reported an associated increase in adrenal suppression and mortality with etomidate. Reference: Kotani et al. first appeared on The Skeptics Guide to Emergency Medicine. Journal of Critical Care April 2023

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Post-Intubation Sedation and Analgesia

Core EM

Patients in this trial were on relatively low doses of both dexmedetomidine and propofol and higher doses of fentanyl which may limit the ability to adequately compare the two agents well ( Hughes 2021 ). Shehabi Y, Howe BD, Bellomo R, Arabi YM, et al: Early Sedation with Dexmedetomidine in Critically Ill Patients. Crit Care Med.

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Updates in High dose Insulin and Euglycemia Therapy (HIET) for the treatment of Beta-adrenergic Receptor and Calcium Channel Antagonists Overdose

Core EM

References: Yuan TH, Kerns WP, Tomaszewski CA, et al. von Lewinski D, Bruns S, Walther S, et al. Cole JB, Corcoran JN, Engebretsen KM, et al. Holger JS, Engebretsen KM, Fritzlar SJ, et al. Kerns W, Schroeder D, Williams C, et al. Kline JA, Tomaszewski CA, Schroeder JD, et al. Disposition to ICU. Circulation.

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Glasgow Coma Scale in Children

Pediatric EM Morsels

Gag reflex is much better predictor (45% vs 6%) [Conzelmann 2021] Positive predictive value of GCS indicating aspiration in intoxication was only 3%. Holmes, James F et al. Conzelmann M, Hoidis A, Bruckner T , et al. BMJ Open 2021; 11: e053619. 2021 Jan 1;90(1):21-26. Acad Emerg Med. 2016 Aug;23(8):878-84.