Journal Jam 10 Part 2 Endovascular Therapy for Stroke

In this part 2 of EM Cases Journal Jam podcast on Thrombolysis and Endovascular Therapy for Stroke Justin Morgenstern, Rory Spiegel and Anton Helman do a deep dive into the world's literature on endovascular therapy for stroke. While the evidence for endovascular therapy is stronger than that for IV systemic thrombolysis for stroke outcomes at 90 days, a closer look at the literature reveals that a very small minority of patients are eligible for endovascular therapy and we still don't know which patients benefit most from endovascular therapy...

Journal Jam 10 Thrombolysis & Endovascular Therapy for Stroke Part 1

In this two part EM Cases Journal Jam podcast Justin Morgenstern, Rory Spiegel and Anton Helman do a deep dive into the world's literature on systemic thrombolysis for ischemic stroke followed by an analysis of endovascular therapy for stroke. We elucidate the important issues related to p-values, ordinal analysis, fragility index, heterogeneity of studies, stopping trials early and conflicts of interest related to this body of evidence. While "calling a code stroke" is now considered standard for most stroke patients and tPA for stroke is considered a class 1A drug, a close look at the literature tells us that the evidence is not as strong as our stroke protocols suggest...

Journal Jam 9 – D-dimer to Rule Out Aortic Dissection

The EM Cases Team is very excited to bring you not only a new format for the Journal Jam podcast but a new member of the team, Dr. Rory Spiegel, aka @EM_Nerd an Emergency Medicine physician from The University Maryland Medical Center in Baltimore, the founder of the EM Nerd blog and the co-host of the Annals of EM podcast. The new format sees Justin Morgenstern, Teresa Chan, Rory Spiegel and Anton Helman doing deep dives into the world's literature on specific practical questions while highlighting some important evidence-based medicine concepts. The question we ask in this Journal Jam podcast: Is there a role for D-dimer testing in the workup of aortic dissection in the ED?

BEEM Cases 2 – Renal Colic Imaging, Analgesia, Fluids & Medical Expulsive Therapy

Urolithiasis is one of the more frequent diagnoses we are faced with in the Emergency Department, with an estimated 1 million ED visits due to renal colic. As such we are tasked with its diagnosis, prognosis and treatment. The following is a brief summation of the evidence regarding some of the most frequent questions encountered when diagnosing and managing urolithiasis. Four questions are answered by Rory Spiegel on this BEEM Cases. What is the optimal initial imaging modality for the diagnostic work-up of urolithiasis? Once the diagnosis of renal colic has been made what is the most efficacious analgesic strategy? Is there clinical utility to IV fluid administration in the management of renal colic? What is the use of medical expulsion therapy in the management of urolithiasis?

Journal Jam 4 – Low Dose Ketamine Analgesia

You’d think ketamine was in the ED drinking water! Not only has this NMDA receptor antagonist been used effectively for procedural sedation and rapid sequence intubation, but also, for delayed sequence intubation to buy time for pre-oxygenation, for life-threatening asthma as it has bronchodilatory and anxiolytic effects, for severely agitated psychiatric patients and excited delirium syndrome to dissociate them and get them under control; ketamine has even been used for refractory status epilepticus and for head injured patients as it is thought to have neuroprotective effects. The big question is: How effective is low dose ketamine analgesia for patients with moderate to severe pain in the ED as an adjunct to opiods? Low dose ketamine seems not only to help control pain, but it also has this almost magical effect of making patients indifferent to the pain. Pain is everywhere. And oligoanalgesia occurs in up to 43% of patients in EDs. Can we relieve suffering with low dose ketamine analgesia in the ED?....