SEMS Podcast

In this episode, Jocelyn and Elizabeth interview Prof Phua Dong Haur about the exciting topic of Plant Toxicology! Interested to find out what makes plant poisoning unique, what are the common toxidromes and clinical features as well as management? Tune in to find out more! 

References 

1. D Frohne Et Al.Poisonous Plants: A Handbook For Pharmacists, Doctors, Toxicologists, Biologists And Veterinarians, 2nd Edition 2005
2. Kent R. Olson, Et Al. Poisoning & Drug Overdose, 7th Ed.
3. Neal Flomenbaum, Et Al. Goldfrank's Toxicologic Emergencies, Eighth Edition
4. Phua DH, Cham G, Seow E. Two instances of Chinese herbal medicine poisoning in Singapore. Singapore Med J. 2008 May;49(5):e131-3. PMID: 18465037.
5. Fuchs J, Rauber-Lüthy C, Kupferschmidt H, Kupper J, Kullak-Ublick GA, Ceschi A. Acute plant poisoning: analysis of clinical features and circumstances of exposure. Clin Toxicol (Phila). 2011 Aug;49(7):671-80. doi: 10.3109/15563650.2011.597034. Epub 2011 Aug 2. PMID: 21809910.
6. Krenzelok EP, Mrvos R. Friends and foes in the plant world: a profile of plant ingestions and fatalities. Clin Toxicol (Phila). 2011 Mar;49(3):142-9. doi: 10.3109/15563650.2011.568945. PMID: 21495882.

Credits

Music: Life-line by Colorful Sound via Pixabay, Best Day by OctoSound via Pixabay/ SGH Podcast Studio/ SEMS

All recordings should not be taken by users/ audience as medical advice. Everyone is encouraged to see their physicians for proper medical consultation. 

Any comments or feedback? Suggestions for future episodes? Send us a message!

https://semspodcast.buzzsprout.com/ 

In this episode, Dr Liu Zhenghong interviews Dr Koh Shao Hui about Sepsis in the ED, including definitions, the Marik and Rivers studies, treatment principles and goals as well as the evidence behind them, and future directions. 

Timestamps:
01:51 Sepsis definitions (SOFA, qSOFA, NEWS, Sepsis 3, Septic shock)

09:37 Treatment principles and goals: Fluid Resuscitation 

11.03 POCUS directed fluid resuscitation & Passive Leg Raise

14:23 Vasopressors in Sepsis

17:57 Time to Antibiotics 

20:29 Steroids in Sepsis 

21:36 Marik & Rivers studies 

25:30 Target Hb/ Glucose control 

28:43 Intubating a septic patient

30:22 (More about) POCUS in septic patients 

33.41 Disposition 

36:21 Future Directions

For more on use of vasopressors in shock, check out Episode 8. Keen listeners may find some differences in nuances across episodes; we strive to represent this diversity and complexity in our field, and encourage listeners to engage with the evidence and contextualise it to their own practice.

References:

1. Evans et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Critical Care Medicine 49(11):p e1063-e1143, November 2021. 
2. Bannard-Smith J et al. The efficacy, safety and effectiveness of hyperoncotic albumin solutions in patients with sepsis: A systematic review and meta-analysis. J Intensive Care Soc. 2024;25(3):308-318. 
3. Deng J et al. Efficacy and Safety of Hydrocortisone, Ascorbic Acid, and Thiamine Combination Therapy for the Management of Sepsis and Septic Shock: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Int Arch Allergy Immunol. 2024;185(10):997-1018. 
4. Fernando SM et al. Methylene Blue in Septic Shock: A Systematic Review and Meta-Analysis. Crit Care Explor. 2024;6(7):e1110.
5. Killu K et al. The association between integrating echocardiography use in the management of septic shock patients and outcomes in the intensive care unit: a systematic review and meta-analysis. J Ultrasound. 2024 Oct 17. 

Credits: 

Music: Life-line by Colorful Sound via Pixabay

SGH Podcast Studio

SEMS 

Any comments or feedback? Suggestions for future episodes? Send us a message!

https://semspodcast.buzzsprout.com/ 

In this episode, Dr Elizabeth Tan and Dr Lenard Cheng interview Dr Tallie Chua about Vasopressors. We discuss a recent article published in The Journal of Emergency Medicine 2024 entitled: A Clinical Review of Vasopressors in Emergency Medicine. 

Timestamps

• 02:03 Case Scenario (Hypothetical) 
• 05:52 Hypovolemic Shock
• 07:04 CENSER
• 08:14 CLOVERS
• 09:23 SOAP II 
• 09:43 Second line Vasopressors 
• 10:54 Peripheral vasopressors
• 16:37 Push Dose pressors 
• 20:14 Optimal MAP
• 22:29 Cardiogenic Shock 
• 26:10 Obstructive Shock 
• 28:37 Vasopressor unresponsive shock - PACT
• P = pH (acidosis)
• A= adrenal insufficiency
• C = hypocalcemia
• T - Hypothyroidism

References

1. Stampfl M, DeBlieux P. A Clinical Review of Vasopressors in Emergency Medicine. J Emerg Med. 2024 Jul;67(1):e31-e41. doi: 10.1016/j.jemermed.2024.03.004. Epub 2024 Mar 12. PMID: 38789351.
2. Permpikul C, Tongyoo S, Viarasilpa T, Trainarongsakul T, Chakorn T, Udompanturak S. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER). A Randomized Trial. Am J Respir Crit Care Med. 2019 May 1;199(9):1097-1105. doi: 10.1164/rccm.201806-1034OC. PMID: 30704260.
3. National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Clinical Trials Network; Shapiro NI, Douglas IS, Brower RG, Brown SM, Exline MC, Ginde AA, Gong MN, Grissom CK, Hayden D, Hough CL, Huang W, Iwashyna TJ, Jones AE, Khan A, Lai P, Liu KD, Miller CD, Oldmixon K, Park PK, Rice TW, Ringwood N, Semler MW, Steingrub JS, Talmor D, Thompson BT, Yealy DM, Self WH. Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. N Engl J Med. 2023 Feb 9;388(6):499-510. doi: 10.1056/NEJMoa2212663. Epub 2023 Jan 21. PMID: 36688507; PMCID: PMC10685906.
4. De Backer D, Biston P, Devriendt J, Madl C, Chochrad D, Aldecoa C, Brasseur A, Defrance P, Gottignies P, Vincent JL; SOAP II Investigators. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010 Mar 4;362(9):779-89. doi: 10.1056/NEJMoa0907118. PMID: 20200382.
5. Hawn JM, Bauer SR, Yerke J, Li M, Wang X, Reddy AJ, Mireles-Cabodevila E, Sacha GL. Effect of Phenylephrine Push Before Continuous Infusion Norepinephrine in Patients With Septic Shock. Chest. 2021 May;159(5):1875-1883. doi: 10.1016/j.chest.2020.11.051. Epub 2020 Dec 13. PMID: 33316239. 

Credits

Music: Life-line by Colorful Sound via Pixabay/Best Day by OctoSound via Pixabay 

SGH Podcast Studio

SEMS

All recordings should not be taken by users/ audience as medical advice. Everyone is encouraged to see their physicians for proper medical consultation.

Any comments or feedback? Suggestions for future episodes? Send us a message!

https://semspodcast.buzzsprout.com/ 

In this episode, Elizabeth and Matthew discuss Paracetamol Toxicity with Dr Ng Mingwei. We cover the 2 Bag versus 3 Bag regimens, when to stop NAC, RSTI, what to do for anaphylactoid reactions, massive paracetamol OD, and the paracetamol multiplication product.

Timestamps 

01:57 Case #1

03:01 Mechanism of Toxicity 

04:00 Risk profiling and Rumack-Matthew Nomogram 

06:20 Case #2 

08.25: NAC/ 2 bag vs 3 bag regimen 

11:24 Paracetamol Guidelines

12:56 Paracetamol Multiplication Product* 

*Note: The study quoted was in a population treated with NAC. 

14:53 Anaphylactoid reactions

15:37 When to cease NAC

16:24 RSTI

18:04 Massive Paracetamol OD

19:58 Liver transplant

20:47 3 Takeaways 

Thank you for listening!

Credits

Music: Life-line by Colorful Sound via Pixabay

SGH Podcast Studio

SEMS

Dr Mong Rupeng for reviewing this episode

References

1. Chiew AL, Reith D, Pomerleau A, Wong A, Isoardi KZ, Soderstrom J, Buckley NA. Updated guidelines for the management of paracetamol poisoning in Australia and New Zealand. Med J Aust. 2020 Mar;212(4):175-183. doi: 10.5694/mja2.50428. Epub 2019 Dec 1. PMID: 31786822.
2. Wong A, Isbister G, McNulty R, Isoardi K, Harris K, Chiew A, Greene S, Gunja N, Buckley N, Page C, Graudins A. Efficacy of a two bag acetylcysteine regimen to treat paracetamol overdose (2NAC study). EClinicalMedicine. 2020 Mar 19;20:100288. doi: 10.1016/j.eclinm.2020.100288. PMID: 32211597
3. Wong A, Sivilotti MLA, Graudins A. Accuracy of the paracetamol-aminotransferase multiplication product to predict hepatotoxicity in modified-release paracetamol overdose. Clin Toxicol (Phila). 2017 Jun;55(5):346-351. doi: 10.1080/15563650.2017.1290253. Epub 2017 Feb 15. PMID: 28421844. 

All recordings should not be taken by users/ audience as medical advice. Everyone is encouraged to see their physicians for proper medical consultation. 

Any comments or feedback? Suggestions for future episodes? Send us a message!

https://semspodcast.buzzsprout.com/ 

Ever had a busy shift where you had to teach at the same time, and wondered how to juggle it all, or a less busy shift where you wondered how to teach without an abundance of clinical material? In this episode, we talk with Dr Derek Heng about ways to teach more effectively on shift! 

Timestamps 

• 03:09 What is a good teaching shift? 
• 07:01 How to go about it? 
• 07:36 Setting expectations
• 11:18 Tailoring to patient acuity 
• 23:30 Metacognition 
• 25:49 Wrapping up
• 28:16 Enjoying the process - the secret sauce? 

Credits:

• SEMS
• SGH Podcast Studio
• Music: Life-line by Colorful Sound via Pixabay

All recordings should not be taken by users/ audience as medical advice. Everyone is encouraged to see their physicians for proper medical consultation. 

https://semspodcast.buzzsprout.com/

Any comments or feedback? Suggestions for future episodes? Send us a message!

https://semspodcast.buzzsprout.com/ 

In Part 1 of this episode, Elizabeth and Jocelyn go through a brief Introduction to Toxicology with the RRSIDEAD approach and common toxidromes, and in Part 2, Matthew and Elizabeth interview Dr Loo Kee Vooi about the exciting topic of Methemoglobinemia!
Thank you for listening!

Timestamps
Introduction to Toxicology
01:45 RRSIDEAD
05:55 MDAC (ABCDQ Mnemonic)
06:45 Dialyzable toxins (PLASMA TV) 
07:33 Antidote Quiz
10:11 Toxidromes
10:38 Sedative Hypnotic
11:08 Anticholinergic Toxidrome
11:46 Cholinergic Toxidrome (SLUDGE/DUMBBELLS)
13:38 Sympathomimetic Toxidrome
14:39 Serotonin Syndrome
15:28 Neuroleptic Malignant Syndrome
15:56 Malignant Hyperthermia

Methemoglobinemia 
18:47 Overview and Case Scenario 
20:24 Initial Management and Diagnostic Clues
23:17 Why is the SpO2 85%?
24:06: Common causes
25:06 Diagnosis
28:13 Considerations when giving Methylene Blue

Credits
Music: Life-line by Colorful Sound via Pixabay/ Best Day by Octosound via Pixabay 
SGH Podcast Studio
SEMS
Dr Mong Rupeng for reviewing the Introduction to Tox Segment 

References
https://litfl.com/approach-to-acute-poisoning/
https://emcrit.org/ibcc/methemoglobinemia/ 
Toxicology Handbook by Jason Armstrong/ Ovidiu Pascu (4th Ed) 
Goldfrank’s Toxicologic Emergencies (11th Ed) 

All recordings should not be taken by users/ audience as medical advice. Everyone is encouraged to see their physicians for proper medical consultation. 

Any comments or feedback? Suggestions for future episodes? Send us a message!

https://semspodcast.buzzsprout.com/ 

Ever had a patient with giddiness and felt overwhelmed with the dizzying array of tests one is supposed to know? In this episode, Matthew and Elizabeth discuss the SAEM GRACE-3 Giddiness Guidelines! 

Timestamps:
05:07: GRACE-3 Guideline Recommendations
08:34:Timing and Triggers approach (Acute Vestibular Syndrome, Spontaneous Episodic Vestibular Syndrome, Triggered Episodic Vestibular Syndrome)
11:56: HINTS exam (for AVS)
20:28: HINTS+
22:21: Differential Diagnosis
25:45: STANDING algorithm
29:29: Dix Hallpike
34:36: Supine Head Roll

References:
1) Edlow JA et al. Guidelines for reasonable and appropriate care in the emergency department 3 (GRACE-3): Acute dizziness and vertigo in the emergency department. Acad Emerg Med. 2023 May;30(5):442-486.
2) https://emcrit.org/emcrit/dizziness-still-makes-me-dizzy/ 

Credits
Music: Life-line by Colorful Sound via Pixabay
SGH Podcast Studio
SEMS

All recordings should not be taken by users/ audience as medical advice. Everyone is encouraged to see their physicians for proper medical consultation. 

Any comments or feedback? Suggestions for future episodes? Send us a message!

https://semspodcast.buzzsprout.com/ 

In this episode, Matthew and Elizabeth discuss the Junior Resident to Senior Resident transition with Dr Desiree Lim, Dr Georgina Kwek and Dr Timothy Wong.
 
1:46 What was it like when first turning Senior Resident?
7:30 What advice would you give the JR turning SR?
14:42 Managing the shopfloor
25:45 Growth in non-clinical aspects/ Admin Responsibilities/Teaching

Thank you for listening!

Credits
Music: Life-line by Colorful Sound via Pixabay/Best Day by Octosound via Pixabay 
SGH Podcast Studio
SEMS

All recordings should not be taken by users/ audience as medical advice. Everyone is encouraged to see their physicians for proper medical consultation

Any comments or feedback? Suggestions for future episodes? Send us a message!

https://semspodcast.buzzsprout.com/ 

In this episode, Matthew and Elizabeth interview Dr Lee Weifeng, SEMS ASM 2025 Scientific Chair, about the upcoming SEMS ASM 2025! 

Timestamps

0:29 Experience organizing a conference
1:02 Pre-conference Workshops
2:50 Plenary Speakers
4:10 Scientific Programme
7:35 Taiwan-HK-SG Resident’s Forum
8:35 Joy at Work Award
9:08 SIMWARS

Do visit the SEMS ASM 2025 website at https://semsasm.com/ for the full list of the available pre-conference workshops and tracks in the scientific programme! 

Thank you for listening!

Credits
Music: Life-line by Colorful Sound via Pixabay 
SGH Podcast Studio
SEMS

All recordings should not be taken by users/ audience as medical advice. Everyone is encouraged to see their physicians for proper medical consultation.

Any comments or feedback? Suggestions for future episodes? Send us a message!

https://semspodcast.buzzsprout.com/ 

In this episode, we have Part 2 of Ventilator Settings, where Matthew and Elizabeth go through the prototypes of Metabolic Acidosis, Obstructive Lung Disease, and raised ICP with Dr Alexander Ng.
Thank you for listening!

Timestamps
01:28 Metabolic Acidosis
05:35 Obstructive Lung Disease
11:30 Raised ICP

Credits
Music: Life-line by Colorful Sound via Pixabay/ Best Day by Octosound via Pixabay SGH Podcast Studio
SEMS

All recordings should not be taken by users/ audience as medical advice. Everyone is encouraged to see their physicians for proper medical consultation. 

Any comments or feedback? Suggestions for future episodes? Send us a message!

https://semspodcast.buzzsprout.com/