Emergency Medicine Cases

By Dr. Anton Helman

Listen to a podcast, please open Podcast Republic app. Available on Google Play Store.


Category: Medicine

Open in iTunes


Open RSS feed


Open Website


Rate for this podcast


Description

Emergency Medicine Cases – Where the Experts Keep You in the Know. For complete episodes please visit emergencymedicinecases.com

Episode Date
Ep 113 Pulmonary Embolism Challenges in Diagnosis Part 1
1:33:53
<p>Dr. Kerstin DeWit and Dr. Eddy Lang answer the questions that plague us on almost every shift: Which patients require any work-up at all for PE? What’s the utility of PERC and Well’s scores? Should the newer YEARS decision tool supplant Well’s? When should we order a D-dimer? What’s the diagnostic role of CXR, ECG, POCUS, CTA and VQ? How should we work up pregnant patients for PE? How can we use shared decision making strategies for PE to help us do what’s best for our patients, and many more...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/pulmonary-embolism-challenges-diagnosis-part-1/">Ep 113 Pulmonary Embolism Challenges in Diagnosis Part 1</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Aug 14, 2018
BCE 74 Coding in the Scanner
22:03
<p>In anticipation of EM Cases Episode 113 Diagnosis an Workup of Pulmonary Embolism with Dr. Kerstin DeWit and Dr. Eddy Lang, we have Dr. Peter Reardon telling us his Best Case Ever (Coding in the Scanner) of a young woman who presents with a seizure followed by hemodynamic instability, who codes while in the CT scanner...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/bce-74-coding-in-the-scanner/">BCE 74 Coding in the Scanner</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Aug 01, 2018
Ep 112 Tachydysrhythmias with Amal Mattu and Paul Dorion
1:29:07
<p>In this EM Cases main Episode 112 Tachydysrhythmias with Amal Mattu and Paul Dorion we discuss a potpurri of clinical goodies for the recognition and management of both wide and narrow complex tachydysrhythmias and answer questions such as: Which patients with stable Ventricular Tachycardia (VT) require immediate electrical cardioversion, chemical cardioversion or no cardioversion at all? Are there any algorithms that can reliably distinguish VT from SVT with aberrancy? What is the "verapamil death test"?  While procainamide may be the first line medication for stable VT based on the PROCAMIO study, what are the indications for IV amiodarone for VT? How should we best manage patients with VT who have an ICD? How can the Bix Rule help distinguish Atrial Flutter from SVT? What is the preferred medication for conversion of SVT to sinus rhythm, Adenosine or Calcium Channel Blockers (CCBs)? Why is amiodarone contraindicated in patients with WPW associated with atrial fibrillation? What are the important differences in the approach and treatment of atrial fibrillation vs. atrial flutter? How can we safely curb the high bounce-back rate of patients with atrial fibrillation who present to the ED? and many more...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/tachydysrhythmias/">Ep 112 Tachydysrhythmias with Amal Mattu and Paul Dorion</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jul 17, 2018
BCE 73 Esmolol in Refractory Ventricular Fibrillation
10:08
<p>In anticipation of EM Cases Episode 112 on Tachydysrhthmias with Amal Mattu and Paul Dorion, Melanie Baimel tells her Best Case Ever of a previously healthy young man who presents in refractory ventricular fibrillation after receiving multiple single shocks, ongoing chest compressions, several rounds of epinephrine, amiodarone and dual sequence defibrillation without ROSC...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/esmolol-refractory-ventricular-fibrillation/">BCE 73 Esmolol in Refractory Ventricular Fibrillation</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jul 03, 2018
Ep 111 Effective Learning Strategies in Emergency Medicine
1:26:34
<p>In this episode we explore the most effective learning strategies while debunking 5 myths in learning, and answer questions such as: How do we maximize our learning in the face of an ever-growing body of knowledge and procedure skill set so that we can become better doctors? What can we learn from the Dunning-Kruger effect? How do we best minimize distractions while we learn? How do we improve retrieval strength for easy recall? How can deliberate practice inform learning procedures? How can social learning improve our knowledge base? and many more...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/learning-strategies-emergency-medicine/">Ep 111 Effective Learning Strategies in Emergency Medicine</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jun 19, 2018
BCE 72 Overinvestigation in Emergency Medicine
21:35
<p>With increased access to timely advanced diagnostic testing in ED rational resource utilization is becoming ever more important. In his Best Case Ever Dr. Shabhaz Syed argues that a patient at Janus General who presented to the ED with chest pain, died as a result of overinvestigation, and explains how understanding the factors that contribute to overinvestigation, Baysian theory, diagnostic decision analysis, radiation risk, and teaching "dogma" may help prevent overinvestigation in Emergency Medicine...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/overinvestigation-emergency-medicine/">BCE 72 Overinvestigation in Emergency Medicine</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jun 05, 2018
Ep 110 Airway Pitfalls – Live from EMU 2018
40:09
<p>The last decade has seen a torrent of literature and expert opinion on emergency airway management. It is challenging to integrate all this new information into a seamless flow when faced with a challenging airway situation. In this live podcast recorded at North York General's Emergency Medicine Update Conference 2018, Scott Weingart and Anton Helman put together the latest in emergency airway management by outlining  6 common airway pitfalls: Failure to prepare for failure, failure to position the patient properly, failure to optimize oxygenation, failure to optimize hemodynamics, failure to consider an awake intubation and failure to prepare for a cricothyrotomy...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/airway-pitfalls-emu/">Ep 110 Airway Pitfalls – Live from EMU 2018</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
May 22, 2018
BCE 71 Cricothyrotomy and the Value of Simulation Training
12:04
<p>In anticipation of EM Cases Episode 110 Airway Pitfalls Live from EMU 2018 with Scott Weingart, we have Dr. Shira Brown tell her Best Case Ever of a pediatric trauma patient who required a cricothyrotomy. She explains how, despite working in a non-trauma center with limited resources, her team was well prepared because of the robust simulation program specifically designed for practicing emergency physicians that she had developed in her region. We also discuss the advantages and disadvantages of the scalpel-Bougie vs scalpel-finger-Bougie cricothyrotomy techniques and to maintain an optimistic attitude in seemingly futile cases...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/cricothyrotomy-simulation-training/">BCE 71 Cricothyrotomy and the Value of Simulation Training</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
May 15, 2018
BCE 70 Female Urinary Retention – The Return of Carr’s Cases!
18:57
<p>Urinary retention is 13 times less common in woman than it is in men, and the differential diagnosis is wide. In this EM Cases Best Case Ever we have the return of Dr. David Carr describing a woman with an unusual diagnosis who presents with urinary retention. We discuss issues around the appropriate use of chaperones and what to do in the situation when you are in over your head...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/female-urinary-retention/">BCE 70 Female Urinary Retention – The Return of Carr’s Cases!</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
May 08, 2018
Ep 109 Skin and Soft Tissue Infections – Cellulitis, Skin Abscesses and Necrotizing Fasciitis
1:21:15
<p>How do you distinguish cellulitis from the myriad of cellulitis mimics? At what point do we consider treatment failure for cellulitis? What is the best antibiotic choice for patients who are allergic to cephalosporins? Which patients with cellulitis or skin abscess require IV antibiotics? Coverage for MRSA? What is the best and most resource wise method for analgesia before I&D of a skin abscess? What is the best method for drainage of a skin abscess? Which patients with skin abscess require a swab? Irrigation? Packing? Antibiotics? With the goal of sharpening your diagnostic skills when it comes to skin and soft tissue infections – there are lots of cellulitis mimics - and choosing wisely when it comes to treatment, we’ll be discussing best practices for management of cellulitis and skin abscesses, when to cover for MRSA, how to pick up nec fasc before it’s too late and a lot more…</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/skin-soft-tissue-infections/">Ep 109 Skin and Soft Tissue Infections – Cellulitis, Skin Abscesses and Necrotizing Fasciitis</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Apr 24, 2018
BCE 69 Necrotizing Fasciitis
8:17
<p>In anticipation of EM Cases Episode 109 Recognition and Management of Skin and Soft Tissue Infections with Melanie Baimel and Andrew Morris we have Dr. Morris telling us his Best Case Ever of a nurse that he worked with diagnosed with Necrotizing Fasciitis. We discuss some of the diagnostic pearls for this difficult diagnosis as well as issues around privacy when health care workers become patients at their hospital.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/necrotizing-fasciitis/">BCE 69 Necrotizing Fasciitis</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Apr 17, 2018
BCE 68 Ectopic Pregnancy Pitfalls in Diagnosis
19:49
<p>This month's EM Cases Best Case Ever podcast features Dr. Catherine Varner, Emergency Physician at Sinai Health System and researcher at Schwartz-Reisman Emergency Medicine Institute (SREMI) discussing the key pitfalls in the diagnosis of ectopic pregnancy and ruptured ectopic pregnancy. It turns out that we're missing the diagnosis more than we'd like to admit. Dr. Varner debunks much of the traditional teaching around ectopic pregnancy so that we can improve our diagnostic skills for this potentially life threatening diagnosis...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/ectopic-pregnancy-pitfalls-diagnosis/">BCE 68 Ectopic Pregnancy Pitfalls in Diagnosis</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Apr 11, 2018
Ep 108 Pediatric Physical Abuse Recognition and Management
1:19:37
<p>Just one case of missed pediatric physical abuse I consider a travesty. The sad state of affairs is that thousands of cases of paediatric physical abuse are missed on initial presentation to EDs across North America. And a small but significant minority of these children die. In fact, 20-30% of children who died from abuse and neglect had previously been evaluated by medical providers for abusive injuries that were not recognized as abuse. Every child that presents to the ED with a suspicious injury gives the treating physician an opportunity to intervene. We have to get better at identifying these kids when there’s still something we can do to protect them, before it’s too late. In this EM Cases main episode podcast on Pediatric Physical Abuse Recognition and Management Dr. Carmen Coombs and Dr. Alyson Holland discuss the 6 B's of child abuse, the TEN-4 FACE decision rule, the Pittsburgh Infant Brain Injury Score, disclosure tips, screening tests, reporting responsibilities and more...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/pediatric-physical-abuse/">Ep 108 Pediatric Physical Abuse Recognition and Management</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Mar 26, 2018
JJ 12 BNP for Diagnosis of Acute CHF
49:43
<p>BNP is currently in use in many EDs across North America and Europe. In this Journal Jam podcast we discuss the clinical utility of BNP and pro-NT-BNP in the work-up of the dyspneic ED patient. We ask the questions: does BNP add much beyond physician gestalt? Which patients might BNP be useful for? Should we abandon BNP as a dichotomous rule-in/rule-out variable and instead use it as a continuous variable? Does using BNP effect patient oriented outcomes? Is lung POCUS a better test? Are prediction models that include BNP useful? and many more....</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/bnp-diagnosis-acute-chf/">JJ 12 BNP for Diagnosis of Acute CHF</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Mar 13, 2018
BCE 67 Child Abuse – Sentinel Injuries
10:58
<p>In anticipation of EM Cases Episode 107 on Pediatric Physical Abuse with Dr. Carmen Coombs and Dr. Alyson Holland, Dr. Coombs tells her Best Case Ever (actually worst case ever) that inspired her to pursue expertise in pediatric physical abuse...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/child-abuse/">BCE 67 Child Abuse – Sentinel Injuries</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Mar 13, 2018
Ep 107 Blunt Ocular Trauma Live from The EM Cases Course
58:58
<p>In this live podcast on Blunt Ocular Trauma from The EM Cases Course 2018 with Anna MacDonald we discuss the most important diagnoses to consider, describe how physical exam in queen while CT can misguide you, explain a simple approach to orbital compartment syndrome with retrobulbar hematoma, give you tips on lateral canthotomy, how to pick up subtle hyphemas, why sickle cell patients are high risk, describe the key clinical clues to subtle globe rupture, the role of tranexamic acid in eye bleeds and much more...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/ocular-trauma/">Ep 107 Blunt Ocular Trauma Live from The EM Cases Course</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Feb 27, 2018
BCE 66 CHD with Bronchiolitis: A Delicate Balance
15:57
<p>When patients with known congenital heart disease present to the ED with common illnesses we need to consider how their physiology might alter our approach to those common illnesses. Max Ben-Yakov guides us through his Best Case Ever of a CHD patient who presents with bronchiolitis and gives us some tips on how best to approach these fragile patients in a crisis situation...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/chd-bronchiolitis/">BCE 66 CHD with Bronchiolitis: A Delicate Balance</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Feb 13, 2018
Ep 106 Toxic Alcohols – Minding the Gaps
1:17:40
<p>We see patients with toxic alcohol poisoning most commonly in three clinical scenarios. One, after an intentional suicide attempt where they tell you exactly what they took; two, when they come in agitated and won’t give you a history and the three, the inebriated patient found down. Alcohol is everywhere, and inevitably inebriated people show up at your ED with a myriad of medical and psychiatric problems. It’s our job as ED professionals, not only to identify traumatic, medical and psychiatric catastrophes in these patients but also to identify and manage the relatively rare but potentially life and sight threatening toxicologic diagnoses in the inebriated or agitated patient. And that isn’t so easy - especially when it comes to toxic alcohols. In this episode we help give you the knowledge of toxic alcohol poisoning recognition, clinical and lab clues, limitations of the osmolar gap, goals of management, time sensitive treatments and more...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/toxic-alcohols/">Ep 106 Toxic Alcohols – Minding the Gaps</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jan 30, 2018
BCE 65 Intimate Partner Violence – A Silent Epidemic
13:23
<p>I was taken aback when I came across the statistic that approximately every 6 days a woman in Canada is killed by her intimate partner. Victims of intimate partner violence and domestic violence that we see in the ED typically involve an abuse story of repeated escalating violence over time that ends up in a crisis situation. The woman is often financially dependent on her abuser and has no one to turn to for help. In one of her worst cases ever from Janus General, Dr. Meeta Patel and I discuss the notions that Emergency providers have a unique opportunity to identify patients who are victims of intimate partner violence; that we should begin by thinking of how we can screen every woman of childbearing age about intimate partner violence in a private, safe and respectful way. We describe the quick Partner Violence Screen and finally how to offer supportive, empowering statements and connect your patients with resources like assaulted women’s helpline and shelters in your community...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/intimate-partner-violence/">BCE 65 Intimate Partner Violence – A Silent Epidemic</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jan 23, 2018
Ep 105 Commonly Missed Ankle Injuries
1:20:02
<p>You probably can't remember the last time you worked a shift in the ED and didn’t see at least one patient with an ankle injury. While almost all of these patients are relatively straightforward to diagnose and manage a small but significant minority of these patients will have a more elusive diagnosis, that if not identified early, could lead to significant morbidity...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/commonly-missed-ankle-injuries/">Ep 105 Commonly Missed Ankle Injuries</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jan 09, 2018
Ep 104 Emergency Management of Intracerebral Hemorrhage – The Golden Hour
1:38:32
<p>There exists a kind of self-fulfilling prognostic pessimism when it comes to ICH. And this pessimism sometimes leads to less than optimal care in patients who otherwise might have had a reasonably good outcome if they were managed aggressively. Despite the poor prognosis of these patients overall, there is some evidence to suggest that early aggressive medical management may improve outcomes. As such, the skill with which you manage your patient with ICH in those first few hours could be the most important determinant of their outcome. In this Golden Hour you have a chance to prevent hematoma expansion, stabilize intracerebral perfusion and give your patient the best chance of survival with neurologic recovery.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/intracerebral-hemorrhage-golden-hour/">Ep 104 Emergency Management of Intracerebral Hemorrhage – The Golden Hour</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Dec 19, 2017
BCE 64 Salicylate Poisoning
19:53
<p>In this EM Cases Best Case Ever Hans Rosenberg and Rajiv Thavanathan discuss recognition and management pearls and pitfalls in salicylate poisoning. They answer question such as: What are the most important diagnostic clues of salicylate poisoning in the patient who presents with undifferentiated fever and altered level of awareness? What is the best timing and ventilation strategy for intubation? Which electrolyte abnormalities do you need to be on the lookout for? and many more...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/salicylate-poisoning-2/">BCE 64 Salicylate Poisoning</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Dec 05, 2017
Journal Jam 11 Post Contrast Acute Kidney Injury – PCAKI
1:09:30
<p>Lauren Westafer joins Justin Morgenstern, Rory Spiegel and Anton Helman in a deep dive discussion on the world's literature on Post Contrast Acute Kidney Injury (PCAKI) in this Journal Jam podcast. Hospitals continue to insist on time consuming, and potentially dangerous protocols for administration of fluids to patients with renal dysfunction prior to CT IV contrast despite the lack of evidence that Contrast Induced Nephropathy (CIN) even exists. Would you choose a different imaging modality if your radiologist suggested that a patient with renal dysfunction who required a CT with IV contrast should forgo the contrast risking a missed diagnosis?</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/journal-jam-post-contrast-acute-kidney-injury-pcaki/">Journal Jam 11 Post Contrast Acute Kidney Injury – PCAKI</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Nov 21, 2017
Ep 103 Preventing Burnout and Promoting Wellness in Emergency Medicine
1:38:08
<p>Burnout – it’s the elephant in the room that we all know about but prefer not to discuss. Yet according to a 2013 Medscape survey, 40% of physicians reported burnout in U.S. In this episode, Sara Gray and Chris Trevelyan present an honest approach to preventing burnout and promoting wellness, outlining strategies both at the individual and systems levels. They explain why wellness matters, how you can strive to achieve it and how to recognize when you or a colleague are unwell so that you can get the help you need...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/preventing-burnout-promoting-wellness-emergency-medicine/">Ep 103 Preventing Burnout and Promoting Wellness in Emergency Medicine</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Nov 07, 2017
BCE 63 Failing Up after Medical Error
12:53
<p>Dr. Sarah Gray tells us the story of her worst case ever and what she learned from it. About 50% of North American physicians involved in a serious medical error report increased anxiety for future errors, decreased confidence in their job, decreased job satisfaction, insomnia, PTSD, panic disorder – the list goes on. Dr. Gray shares how and why many of us react to medical error - the embarrassment, the shame, the guilt and sense of failure. She then explains the notion of acceptance that we all fail, that perfection is a myth, and how she learned that "failing up" after of the most difficult case of her career is the best choice after making a medical error...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/failing-up-medical-error/">BCE 63 Failing Up after Medical Error</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Oct 31, 2017
Episode 102 GI Bleed Emergencies Part 2
29:51
<p>In Part 2 of our two part podcast on GI Bleed Emergencies Anand Swaminathan and Salim Rezaie kick off with a discussion on the evidence for benefit of various medications in ED patients with upper GI bleed. PPIs, somatostatin analogues such as Octreotide, antibiotic prophylaxis and prokinetics have varying degrees of benefit, and we should know which ones to prioritize. We then discuss the usefulness of the Glasgow-Blatchford and Rockall scores for risk stratification and disposition of patient with upper GI bleeds and hit it home with putting it all together in a practical algorithm. Enjoy!</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/gi-bleed-emergencies-part-2/">Episode 102 GI Bleed Emergencies Part 2</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Oct 17, 2017
Episode 101 GI Bleed Emergencies Part 1
1:35:35
<p>In this Part 1 of our two part podcast on GI bleed emergencies we answer questions such as: How do you distinguish between an upper vs lower GI bleed when it's not so obvious clinically? What alterations to airway management are necessary for the GI bleed patient? What do we need to know about the value of fecal occult blood in determining whether or not a patient has a GI bleed? Which patients require red cell transfusions? Massive transfusion? Why is it important to get a fibrinogen level in the sick GI bleed patient? What are the goals of resuscitation in a massive GI bleed? What's the evidence for using an NG tube for diagnosis and management of upper GI bleeds?  In which patients should we give tranexamic acid and which patients should we avoid it in? How are the indications for massive transfusion in GI bleed different to the trauma patient? What are your options if the bleeding can't be stopped on endoscopy? and many more...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/gi-bleed-emergencies-part-1/">Episode 101 GI Bleed Emergencies Part 1</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Oct 10, 2017
Best Case Ever 62 Penetrating Upper Airway Injury Awake Intubation Do’s & Don’ts
26:41
<p>If you were faced with stab wound to the neck and had to act fast, would you have a well-thought out plan that you are comfortable with? In this EM Cases Best Case Ever podcast we discuss the do's and don'ts of penetrating upper airway injury awake intubation with airway expert George Kovacs....</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/penetrating-upper-airway-injury-awake-intubation/">Best Case Ever 62 Penetrating Upper Airway Injury Awake Intubation Do’s & Don’ts</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Sep 26, 2017
Episode 100 Disaster Medicine
1:32:32
<p>As ED docs we’re particularly well suited to take a lead in disaster medicine. We own this. In this EM Cases podcast, with the help of Laurie Mazurik, Daniel Kollek and Joshua Bezanson we will help you become familiar with a general approach to mass casualties, how to handle critical infrastructure disruption in your ED, management of biohazards including airway management, chemical hazards including decontamination and finally evacuation principles in the case of a natural disaster...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/disaster-medicine/">Episode 100 Disaster Medicine</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Sep 12, 2017
Best Case Ever 61 Biohazard Preparedness: The Protected Code Blue
11:59
<p>In anticipation of EM Cases Main Episode 100 on Disaster Medicine with Laurie Mazurik, David Kollek and Joshua Bezanson, Dr. Mazurik tells of her experience as a disaster medicine leader with keeping health care workers safe during the SARS era. If you were faced with a patient with suspected Ebola or drug resistant TB or any other biohazard patient who required intubation, would you know how to handle the situation so that you and your colleagues were safe...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/biohazard-preparedness-protected-code-blue/">Best Case Ever 61 Biohazard Preparedness: The Protected Code Blue</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Aug 28, 2017
Episode 99 Highlights from EMU 2017
1:07:47
<p>North York General Hospital's 30th Annual Emergency Medicine Update (EMU) Conference 2017 featured some of the best talks I've ever heard from the likes of Sara Gray, Amal Mattu, David Carr and many more. I had a hard time choosing which talks to feature on this EM Cases podcast. I settled on a potpourri of clinical topics and practice tips: Leeor Sommer on Lyme disease, Chris Hicks on signover, Matt Poyner on patient complaints and Walter Himmel on acute vestibular syndrome...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-99-highlights-emu-2017/">Episode 99 Highlights from EMU 2017</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Aug 15, 2017
Best Case Ever 60 What we can learn from Prehospital Trauma Management
12:50
<p>In this EM Cases podcast Dr. Joel Lockwood tells his Best Case Ever of a prehospital trauma resuscitation, bringing to light the challenges faced by EMS with the complicated trauma patient. He discusses the importance of checklists, practice and simulation to help streamline the process, offloading some cognitive burden, prepare the team, reduce the change of errors, improve efficiency and etch actions into each team member's muscle memory.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/prehospital-trauma/">Best Case Ever 60 What we can learn from Prehospital Trauma Management</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Aug 01, 2017
Episode 98 Teaching on Shift
1:17:36
<p>We discuss some quick, easy tips on how you can take your educating skills to the next level, from orienting the learner and establishing expectations at the start of the shift, to key questioning techniques to use in case presentations, to the lost art of active observation, to the One Minute Preceptor model, to giving effective end-of-shift feedback, medicine’s white whale. We end with a surprise appearance by another master educator who gives his top pearls on teaching on shift. This podcast is about how, on your next ED shift, you can make the most of every teachable moment...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/teaching-on-shift/">Episode 98 Teaching on Shift</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jul 18, 2017
Journal Jam 10 Part 2 Endovascular Therapy for Stroke
40:05
<p>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...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/endovascular-therapy-stroke/">Journal Jam 10 Part 2 Endovascular Therapy for Stroke</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jul 04, 2017
Journal Jam 10 Thrombolysis & Endovascular Therapy for Stroke Part 1
1:29:10
<p>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...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/thrombolysis-endovascular-therapy-for-stroke/">Journal Jam 10 Thrombolysis & Endovascular Therapy for Stroke Part 1</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jul 04, 2017
Best Case Ever 59 Management of Acute Renal Failure with Volume Overload
14:06
<p>Sometimes our renal failure patients present short of breath with volume overload and we don't have immediate access to dialysis. What then? Dr. Mike Betzner, EM doc and medical director of STARS air ambulance service and collaborator on EM Cases CritCases blog tells his Best Case Ever and his approach to this challenging clinical situation. He offers two commonly used solutions: nitroglycerin and BiPAP as well as two not so common solutions: phlebotomy and rotating BP cuffs blown to above SBP...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/acute-renal-failure-volume-overload/">Best Case Ever 59 Management of Acute Renal Failure with Volume Overload</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jun 28, 2017
Episode 97 EM Literature Review 2016 from EMU & Whistler Conferences
58:47
<p>Quick and insightful reviews of 17 important adult and pediatric emergency medicine studies from 2016: The PROCAMIO study for stable VT, platelets for head bleeds (PATCH), BP lowering in ICH (ATACH II), antibiotics for abscesses, work up of subarachnoid hemorrhage, dosing IV ketorolac, the PESIT trial, ketamine dosage for sedation in pediatrics, instructions after minor head injury, Salter-Harris I fractures of the lateral malleolus, interpreting oxygen saturation for disposition making in children with bronchiolitis, clinical pathways in pediatric asthma and sepsis and more...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/em-literature-review-2016/">Episode 97 EM Literature Review 2016 from EMU & Whistler Conferences</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jun 13, 2017
Best Case Ever 58 Euglycemic DKA
14:56
<p>It's not only run of the mill DKA, starvation and alcoholic ketoacidosis that can cause a metabolic acidosis with elevated ketones. Euglycemic DKA can be caused by the newer diabetes medications sodium-glucose co-transporter 2 inhibitors like Canagliflozin; and it's important to recognize this tricky diagnosis early and initiate treatment for DKA despite a normal serum glucose level...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/euglycemic-dka/">Best Case Ever 58 Euglycemic DKA</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jun 06, 2017
Episode 96 Beyond ACLS Cardiac Arrest – Live from EMU Conference 2017
20:58
<p>This is the first ever video podcast on EM Cases with Jordan Chenkin from EMU Conference 2017 discussing how to optimize three aspects of cardiac arrest care: persistent ventricular fibrillation, optimizing pulse checks and PEA arrest, with code team videos contrasting the ACLS approach to an optimized approach...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/beyond-acls-cardiac-arrest/">Episode 96 Beyond ACLS Cardiac Arrest – Live from EMU Conference 2017</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
May 23, 2017
Episode 95 Pediatric Trauma
1:40:01
<p>Management of the pediatric trauma patient is challenging regardless of where you work. In this EM Cases episode, with the help of two leading pediatric trauma experts, Dr. Sue Beno from Hospital for Sick Children in Toronto and Dr. Faud Alnaji from Children's Hospital of Eastern Ontario in Ottawa we answer such questions as: what are the most important physiologic and anatomic differences between children and adults that are key to managing the trauma patient? How much fluid should be given prior to blood products? What is the role of POCUS in abdominal trauma? Which patients require abdominal CT? How do you clear the pediatric c-spine? Are atropine and fentanyl recommended as pre-induction agents in the pediatric trauma patient? How can the BIG score help us prognosticate? Is tranexamic acid recommended in early pediatric trauma like it is in adults? Is the Pediatric Trauma Score helpful in deciding which patients should be transferred to a trauma center? and many more...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/pediatric-trauma-2/">Episode 95 Pediatric Trauma</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
May 09, 2017
Best Case Ever 57 PREPARE mnemonic for Airway Management
34:12
<p>Airway management requires a lot things; it requires not only technical skills and specific considerations of anatomy and physiology but a co-ordinated team who can communicate clearly and react to a whole slew of potentially challenging situations. On this month's Best Case Ever podcast we use the framework of a new mnemonic PREPARE to discuss human factors, situational awareness and some airway tips and tricks with intensivist Peter Brindley, human factors expert Chris Hicks and EM-intensivist Sara Gray...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/prepare-mnemonic-airway-management/">Best Case Ever 57 PREPARE mnemonic for Airway Management</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Apr 25, 2017
Episode 94 UTI Myths and Misconceptions
1:33:24
<p>In 2014, the CDC reported that UTI antibiotic treatment was avoidable at least 39% of the time. Why? Over-diagnosis and treatment results from the fact that asymptomatic bacteriuria is very common in all age groups, urine cultures are frequently ordered without an appropriate indication, and urinalysis results are often misinterpreted. Think of the last time you prescribed antibiotics to a patient for suspected UTI – what convinced you that they had a UTI? Was it their story? Their exam? Or was it the urine dip results the nurse handed to you before you saw them? Does a patient’s indwelling catheter distort the urinalysis? How many WBCs/hpf is enough WBCs to call it a UTI? Can culture results be trusted if there are epithelial cells in the specimen? Can a “dirty” urine in an obtunded elderly patient help guide management?...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/uti-myths-misconceptions/">Episode 94 UTI Myths and Misconceptions</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Apr 12, 2017
Best Case Ever 56 Anion Gap Metabolic Acidosis
20:45
<p>In this month's Best Case Ever on EM Cases Dr. Ross Claybo and Dr. Keerat Grewal tell the story of a patient with a complicated anion gap metabolic acidosis. We discuss how to sort through the differential diagnosis with a better mnemonic than MUDPILES, the controversy around administering sodium bicarbonate for metabolic acidosis, the indications for fomepizole and the value of taking time to to build a therapeutic relationship with your ED patients...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/metabolic-acidosis/">Best Case Ever 56 Anion Gap Metabolic Acidosis</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Mar 28, 2017
Episode 93 – PALS Guidelines
1:24:50
<p>I remember when I started practicing emergency medicine a decade and a half ago it seemed that any kid who came to our ED in cardiac arrest died. I know, depressing thought. But, over the past 15 years, survival to discharge from pediatric cardiac arrest has markedly improved, at least for in-hospital arrests. This is probably mostly due to an emphasis on high-quality CPR and advances in post-resuscitation care; nonetheless the more comfortable, knowledgeable and prepared we are for the always scary critically ill pediatric patient, the more likely we will be able to resuscitate them successfully - which is always a huge save.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/pals-guidelines/">Episode 93 – PALS Guidelines</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Mar 14, 2017
Best Case Ever 55 Pediatric Cerebral Herniation
11:24
<p>In anticipation of the upcoming EM Cases main episode on Pediatric Polytrauma Dr. Suzanne Beno, Co-director of the Trauma Program at the Hospital for Sick Children in Toronto, tells her Best Case Ever of a child who suffers a severe traumatic head injury with signs of raised intracranial pressure and cerebral herniation. She discusses the importance of being vigilant when presented with classic patterns of injury, the use of hypertonic saline, crisis resource management and shared decision making with consultants...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/pediatric-cerebral-herniation/">Best Case Ever 55 Pediatric Cerebral Herniation</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Mar 07, 2017
Episode 92 – Aortic Dissection Live from The EM Cases Course
49:23
<p>While missing aortic dissection was considered "the standard" in the late 20th century, our understanding of the clinical diagnoses has improved considerably since the landmark International Registry of Aortic Dissection (IRAD) study in 2000. Nonetheless, aortic dissection remains difficult to diagnosis with 1 in 6 being missed at the initial ED visit. With the help of Dr. David Carr we’ll discuss how to pick up atypical presentations of aortic dissection without over-imaging as well as manage them like pros by reviewing: 1. The 5 Pain Pearls, 2. The concepts of CP +1 and 1+ CP, 3. Physical exam pearls, 4. CXR pearls and blood test pitfalls, and 5. The importance of the correct order and aggressive use of IV medications. So with these objectives in mind…</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/aortic-dissection-em-cases-course/">Episode 92 – Aortic Dissection Live from The EM Cases Course</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Feb 21, 2017
Journal Jam 9 – D-dimer to Rule Out Aortic Dissection
46:12
<p>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?</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/ddimer-aortic-dissection/">Journal Jam 9 – D-dimer to Rule Out Aortic Dissection</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Feb 07, 2017
Episode 91 Occult Knee Injuries Pearls and Pitfalls
1:34:43
<p>There are a whole slew of very important occult knee injuries - those that have a normal or near normal x-ray – that can cause serious morbidity if you miss them, and for the catchall soft tissue injuries there are some subtleties in diagnosis and management that will make a real difference to our patients. Arun Sayal and Hossein Mehdian answer questions such as: When should we suspect a spontaneously reduced knee dislocation? Do all patients suspected of a spontaneous knee dislocation require a CT angiogram to rule out vascular injury? Which patients with a low energy mechanism are at risk for knee dislocation and vascular complications? How can you increase the accuracy of the active straight leg raise in assessing for quadriceps and patella tendon rupture? What is an easy way to identify patella baja and patella alta on a knee x-ray? What are the indications for ultrasound of the knee? What are the true indications for a knee immobilizer and how can knee immobilizers kill our patients? and many more...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/occult-knee-injuries/">Episode 91 Occult Knee Injuries Pearls and Pitfalls</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jan 24, 2017
Best Case Ever 54 Missed Fracture and Apologizing to Patients
12:47
<p>In anticipation of EM Cases Episode 91 Knee Injuries Pearls and Pitfalls Dr. Arun Sayal, creator of the CASTED course, tells his Best Case Ever concerning missed fractures and apologizing to patients. Dr. Sayal reminds us of two basic concepts that are all too often skipped over in our assessment of minor injuries and the effect of apologizing to the patient when you've missed a fracture...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/missed-fracture-apologizing-to-patients/">Best Case Ever 54 Missed Fracture and Apologizing to Patients</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jan 17, 2017
Episode 90 – Low and Slow Poisoning
1:36:19
<p>One of the things we need to think about whenever we see a patient who’s going low and slow with hypotension and bradycardia is an overdose. B-blockers, calcium channel blockers (CCB) and digoxin are some of the most frequently prescribed cardiovascular drugs. And inevitably we’re gonna be faced with both intentional and unintentional overdoses from these drugs in the ED. If we can recognize these overdoses early and manage them appropriately, well - we’ll save some lives...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/low-slow-poisoning/">Episode 90 – Low and Slow Poisoning</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jan 03, 2017
Best Case Ever 53 – TTP
8:55
<p>As EM Cases has grown and expanded over the past 7 years I've had the pleasure of working with a team of talented people. This Best Case Ever was produced by two all-star EM residents from Ottawa, podcaster Dr. Rajiv Vairavanathan and editor Dr. Richard Hoang. In this all-resident Best Case Ever we interview Dr. Chris Belcher from University of Kentucky about TTP - Thrombotic Thrombocytopenic Purpura, that rare but often elusive clotting disorder that picks off multiple organs and has a near 100% mortality rate without treatment...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/ttp/">Best Case Ever 53 – TTP</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Dec 20, 2016
Best Case Ever 52 – Pediatric Hypothermia Cardiac Arrest
5:23
<p>In anticipation of EM Cases Episode 90 on the Pediatric Advanced Life Support (PALS) guidelines with the lead author Dr. Allan DeCaen and Dr. Anthony Crocco, Dr. DeCaen tells his Best Case Ever showing us the value of orchestrated team work and a great example of the saying, "they're not dead until they're warm and dead"...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/pediatric-hypothermia-cardiac-arrest/">Best Case Ever 52 – Pediatric Hypothermia Cardiac Arrest</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Dec 06, 2016
Episode 89 – DOACs Part 2: Bleeding and Reversal Agents
53:45
<p>In this Part 2, DOACs Bleeding and Reversal we discuss the management of bleeding in patients taking DOACs with minor risk bleeds, like epistaxis where local control is easy to access, moderate risk bleeds, like stable GI bleeds and high risk bleeds, like intracranial hemorrhage. We answer questions such as: How do we weigh the risks and benefits of stopping the DOAC? When is reversal of the DOAC is advised? How best do we accomplish the reversal of DOACs? Is there any good evidence for the newest reversal agent? When should we stop DOACs for different procedures, and when should we delay the procedure?</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/doacs-bleeding-reversal-agents/">Episode 89 – DOACs Part 2: Bleeding and Reversal Agents</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Dec 06, 2016
Episode 88 – DOACs Part 1: Use and Misuse
1:14:55
<p>As we get better at picking up thromboembolic disease, and the indications for Direct Oral Anticoagulants (DOACs) widen, we're faced with increasingly complex decisions about when to start these medications, how to start them, when to stop them and how to manage bleeding associated with them. There’s a lot that we need to know about these drugs to minimize the risk of thromboembolism in our patients while at the same time minimizing their risk of bleeding...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/doacs-use-misuse/">Episode 88 – DOACs Part 1: Use and Misuse</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Nov 22, 2016
Journal Jam 8 – Dilute Apple Juice for Pediatric Gastroenteritis
43:03
<p>This is EM Cases Journal Jam podcast on a randomized control trial of dilute apple juice vs PediaLyte for mild pediatric gastroenteritis. While IV rehydration is required in cases of severe gastroenteritis (which we rarely see in North America) and oral rehydration with electrolyte maintenance solutions is still the mainstay in treating moderate gastroenteritis, could better-tasting, more cost-effective fluids such as diluted apple juice be just as effective as traditional electrolyte solutions in milder cases? Listen to Dr. Justin Morgenstern (@First10EM) interviewing Dr. Stephen Freedman, the world-renowned pediatric EM researcher who put ondansetron for pediatric gastroenteritis on the map and who was one of our guest experts on our main episode on Pediatric Gastroenteritis, Constipation and Bowel Obstruction, about this practice-changing paper. This is followed by a hilarious rant on the topic from Dr. Anthony Crocco ("Ranthony"), the Division head and medical director of pediatric EM at Hamilton Health Sciences.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/dilute-apple-juice-pediatric-gastroenteritis/">Journal Jam 8 – Dilute Apple Juice for Pediatric Gastroenteritis</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Nov 08, 2016
Best Case Ever 51 – Anticoagulants and GI Bleed with Walter Himmel
9:40
<p>In anticipation of Episode 88 and 89: DOACs Use, Misuse and Reversal with the president of Thrombosis Canada and world renowned thrombosis researcher Dr. Jim Douketis, internist and thrombosis expert Dr. Benjamin Bell and 'The Walking Encyclopedia of EM' Dr. Walter Himmel, we have Dr. Himmel telling us the story of his Best Case Ever on anticoagulants and GI bleed. He discusses the most important contraindication to DOACs, the importance of not only attempting to reverse the effects of anticoagulants in a bleeding patient but managing the bleed itself as well as more great pearls. In the upcoming episodes we'll run through 6 cases and cover the clinical use of DOACs, how they work, safety, indications, contraindications, management of minor, moderate and severe bleeding, the new DOAC reversal agents, management of DVT with DOAC anticoagulants, stroke prevention in atrial fibrillation with DOACs and much more...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/anticoagulants-gi-bleed-walter-himmel/">Best Case Ever 51 – Anticoagulants and GI Bleed with Walter Himmel</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Nov 08, 2016
Episode 87 – Alcohol Withdrawal and Delirium Tremens: Diagnosis and Management
1:26:24
<p>Alcohol withdrawal is everywhere. We see over half a million patients in U.S. EDs for alcohol withdrawal every year. Despite these huge volumes of patients and the diagnosis of alcohol withdrawal seeming relatively straightforward, it’s actually missed more often than we’d like to admit, being confused with things like drug intoxication or sepsis. Or it’s not even on our radar when an older patient presents with delirium. What’s even more surprising is that even if we do nail the diagnosis, observational studies show that in general, alcohol withdrawal is poorly treated. So, to help you become masters of alcohol withdrawal management, our guest experts on this podcast are Dr. Bjug Borgundvaag, an ED doc and researcher with a special interest in emergency alcohol related illness and the director of Schwartz-Reismann Emergency Medicine Institute, Dr. Mel Kahan, an addictions specialist for more than 20 years who’s written hundreds of papers and books on alcohol related illness, and the medical director of the substance use service at Women’s College Hospital in Toronto, and Dr. Sara Gray, ED-intensivist at St. Michael's Hospital...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/alcohol-withdrawal-delirium-tremens/">Episode 87 – Alcohol Withdrawal and Delirium Tremens: Diagnosis and Management</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Oct 25, 2016
Best Case Ever 50 – Delirium Tremens
18:00
<p>In anticipation of EM Cases Episode 87 on Alcohol Withdrawal Dr. Sara Gray describes her Best Case Ever of severe alcohol withdrawal and Delirium Tremens from Janus General.</p> <p>Also on this podcast Dr. Anand Swaminathan reacts to Episode 86 Emergency Management of Hyperkalemia and discusses the use of calcium in the setting of digoxin toxicity.</p> <p>Early recognition and treatment of Delirium Tremens - a rapid onset of severe alcohol withdrawal accompanied by delirium and autonomic instability about 3-10 days after the appearance of withdrawal symptoms - is key to preventing long term morbidity and mortality...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/delirium-tremens/">Best Case Ever 50 – Delirium Tremens</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Oct 11, 2016
Episode 86 – Emergency Management of Hyperkalemia
1:09:37
<p>This is 'A Nuanced Approach to Emergency Management of Hyperkalemia' on EM Cases.<br /> Of all the electrolyte emergencies, hyperkalemia is the one that has the greatest potential to lead to cardiac arrest. And so, early in my EM training I learned to get the patient on a monitor, ensure IV access, order up an ECG, bombard the patient with a cocktail of kayexalate, calcium, insulin, B-agonists, bicarb, fluids and furosemide, and get the patient admitted, maybe with some dialysis to boot. Little did I know that some of these therapies were based on theory alone while others were based on a few small poorly done studies. It turns out that some of these therapies may cause more harm than good, and that precisely when and how to give these therapies to optimize patient outcomes is still not really known...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/emergency-management-hyperkalemia/">Episode 86 – Emergency Management of Hyperkalemia</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Sep 27, 2016
Best Case Ever 49 – Post-Arrest Hyperkalemia
4:26
<p>Melanie Baimel's Best Case Ever on Post-Arrest Hyperkalemia on EM Cases.<br /> Post arrest patients can sometimes be challenging. We need to think of a variety of underlying causes of the arrest, antiarrhythmics, possible cath lab activation, targeted temperature management, sedation and more. To add to this, many post arrest patients do not have ideal vital signs that require attention. In this Best Case Ever, in anticipation of our upcoming episode on A Rational Approach to Hyperkalemia Dr. Melanie Baimel describes a post arrest patient who remains bradycardic and hypotensive despite multiple pressors....</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-49-post-arrest-hyperkalemia/">Best Case Ever 49 – Post-Arrest Hyperkalemia</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Sep 13, 2016
Episode 85 – Medical Clearance of the Psychiatric Patient
1:14:05
<p>Psychiatric chief complaints comprise about 6 or 7% of all ED visits, with the numbers of psychiatric patients we see increasing every year. The ED serves as both the lifeline and the gateway to psychiatric care for millions of patients suffering from acute behavioural or psychiatric emergencies. As ED docs, besides assessing the risk of suicide and homicide, one of the most important jobs we have is to determine whether the patient’s psychiatric or behavioral emergency is the result of an organic disease process, as opposed to a psychological one. There is no standard process for this. With the main objective in mind of picking up and appropriately managing organic disease while improving flow, decreasing cost and maintaining good relationships with our psychiatry colleagues, we have Dr. Howard Ovens, Dr. Brian Steinhart and Dr. Ian Dawe discuss this controversial topic...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/medical-clearance-psychiatric-patient/">Episode 85 – Medical Clearance of the Psychiatric Patient</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Aug 30, 2016
Best Case Ever 48 – Organic vs Psychiatric Illness
11:37
<p>Sometimes what initially appears to be a psychiatric illness turns out to be an organic illness, and vise versa. In our assessment of the patient with altered behaviour, it is critical to drill down and dissect apart the type of hallucinations a patient might be displaying, whether the demented patient is simply suffering from worsening dementia or alternatively has acute delirium (which carries a high mortality rate), and whether their somatic complaints might be due to depression or a psychotic psychiatric illness. In anticipation of our upcoming episode on Medical Clearance of the Psychiatric Patient Dr. Brian Steinhart tells the story of his Best Case Ever, reminding us of some of the clinical clues that can help us in our approach to the patient with altered behaviour, so that we avoid misdiagnosing a psychiatric illness with an organic one, or even worse, an organic illness with a psychiatric one...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/organic-vs-psychiatric-illness/">Best Case Ever 48 – Organic vs Psychiatric Illness</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Aug 23, 2016
Episode 84 – Congenital Heart Disease Emergencies
1:08:41
<p>Congenital Heart Disease Emergencies on EM cases with Gary Joubert and Ashley Strobel.</p> <p>You might be surprised to learn that the prevalence of critical cardiac disease in infants is almost as high as the prevalence of infant sepsis. And if you’re like me, you don’t feel quite as confident managing sick infants with critical heart disease as you do managing sepsis. Critical congenital heart defects are often missed in the ED. For a variety of reasons, there are currently more children with congenital heart disease presenting to the ED than ever before and these numbers will continue to grow in the future. When I was in medical school I vaguely remember learning the complex physiology and long lists of congenital heart diseases, which I’ve now all but forgotten. What we really need to know about congenital heart disease emergencies is what actions to take in the ED when we have a cyanotic or shocky baby in front of us in the resuscitation room. So with the goal of learning a practical approach to congenital heart disease emergencies using the child’s age, colour and few simple tests, Dr. Strobel and Dr. Joubert will discuss some key actions, pearls and pitfalls so that the next time you’re faced with that crashing baby in the resuscitation room, you’ll know exactly what to do.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/congenital-heart-disease-emergencies-2/">Episode 84 – Congenital Heart Disease Emergencies</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Aug 11, 2016
Journal Jam 7 – Amiodarone vs Lidocaine vs Placebo in Cardiac Arrest: The ALPS Trial
1:08:36
<p>Journal Jam 7 - Amiodarone vs Lidocaine vs Placebo in Cardiac Arrest: The ALPS Trial.</p> <p>In our most popular EM Cases episode to date - ACLS Guidelines Cardiac Arrest Controversies, we boldly stated, that there has never been an antiarrhythmic medication that has shown any long term survival benefit in cardiac arrest. The use of medications in cardiac arrest has been one of those things that we all do, but that we know the evidence isn’t great for. Yet Amiodarone is still in the newest AHA adult cardiac arrest algorithm for ventricular fibrillation or pulseless ventricular tachycarida – 300mg IV after the 3rd shock with the option to give it again at 150mg after that. Anti-arrhythmics have been shown in previous RCTs to increase the rate of return of spontaneous circulation and even increased survival to hospital admission, however none of them have been able to show a decrease in mortality or a favourable neurological outcome at hospital discharge. In other words, there has never been shown a long term survival or functional benefit - which is a bit disconcerting.</p> <p>But now, we have a recent large randomized, controlled trial that shines some new light on the role of anti-arrythmics in cardiac arrest - The ALPS trial: Amiodarone vs Lidocaine vs placebo in out of hospital cardiac arrest. In this Journal Jam podcast, Justin Morgenstern and Anton Helman interview two authors of the ALPS trial, Dr. Laurie Morrison a world-renowned researcher in cardiac arrest and Dr. Paul Dorian, a cardiac electrophysiologist and one of Canada's leading authorities on arrhythmias about what we should take away from the ALPS trial. It turns out, it's not so simple. We also discuss the value of dual shock therapy for shock resistant ventricular fibrillation and the future of cardiac arrest care.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/amiodarone-vs-lidocaine-vs-placebo-alps-trial/">Journal Jam 7 – Amiodarone vs Lidocaine vs Placebo in Cardiac Arrest: The ALPS Trial</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jul 26, 2016
Best Case Ever 47 – Cyanotic Infant
8:24
<p>In anticipation of EM Cases' upcoming episode, Congenital Heart Disease Emergencies we have Dr. Gary Joubert a double certified Pediatric EM and Pediatric Cardiology expert telling his Best Case Ever of a four month old infant who presents with intermittent cyanosis. The Cyanotic Infant can present a significant challenge to the EM provider as the differential is wide, ranging from benign causes such as GERD to life threatening heart disease that may present atypically in a well-appearing child. Dr. Joubert gives us some simple sweet clinical pearls to help us along the way...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/cyanotic-infant/">Best Case Ever 47 – Cyanotic Infant</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jul 26, 2016
Episode 83 – 5 Critical Care Controversies from SMACC Dublin
31:54
<p>EM Cases Episode 83 - 5 Critical Care Controversies from SMACC Dublin: I had the great opportunity to gather some of the brightest minds in Emergency Medicine and Critical Care from around the world (Mark Forrest from U.K., Chris Nickson from Australia, Chris Hicks from Canada and Scott Weingart from U.S.) at the SMACC Dublin Conference and ask them about 5 Critical Care Controversies and concepts:</p> <p>How to best prepare your team for a resuscitation<br /> Optimum fluid management in sepsis<br /> Direct vs. video laryngoscopy as first line tool for endotracheal intubation<br /> Early vs. late trauma intubation<br /> Whether or not to attempt a thoracotomy in non-trauma centres</p> <p>The discussion that ensued was enlightening...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/critical-care-controversies-smacc/">Episode 83 – 5 Critical Care Controversies from SMACC Dublin</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jul 05, 2016
Best Case Ever 46 – Chris Nickson on Hickam’s Dictum
11:34
<p>EM Cases Best Case Ever - Chris Nickson on Hickam's Dictum.</p> <p>Usually we use the heuristic of Occam's razor to help us arrive at one diagnosis that makes sense of all the data points that a particular patient presents to us. However sometimes it's not so straight forward and we need to think about multiple diagnoses that explain a patient's condition - Hickam's Dictum. Dr. Chris Nickson, the brains behind the Life in the Fast Lane blog tells his Best Case Ever from the SMACC Conference in Dublin, in which a patient thrombolysed for massive pulmonary embolism suffers a cardiac arrest, and the thought process he went through to discover the surprising complicating diagnoses that ensue...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/hickams-dictum/">Best Case Ever 46 – Chris Nickson on Hickam’s Dictum</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jun 21, 2016
Episode 82 – Emergency Radiology Controversies
1:08:39
<p>EM Cases Episode 82 Emergency Radiology Controversies, pearls and pitfalls: Which patients with chest pain suspected of ACS require a CXR? What CXR findings do ED docs tend to miss? How should we workup solitary pulmonary nodules found on CXR or CT? Is the abdominal x-ray dead or are there still indications for it's use? Which x-ray views are preferred for detecting pneumoperitoneum? When should we consider ultrasound as a screening test instead of, or before, CT? What are the indications for contrast in abdominal and head CT? How should we manage the patient who has had a previous CT contrast reaction who really needs a CT with contrast? What is the truth about CT radiation for shared decision making? And much more...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/emergency-radiology-controversies/">Episode 82 – Emergency Radiology Controversies</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jun 07, 2016
Episode 81 – A Balanced View on Recent EM Literature with Joel Yaphe
37:57
<p>EM Cases - A Balanced View on recent EM Literature with Joel Yaphe</p> <p>Being an optimist, I'm constantly searching for EM literature that will change my practice in a positive way and ultimately improve the care that I deliver. The past year was filled with promising papers, some of which received a lot of attention. I'm not the only one who is biased towards craving a positive paper - so are the researchers, the journal editors and the public. We all want our field to mightily move forward!</p> <p>Enter Dr. Joel Yaphe. An EM Residency Program Director at University of Toronto and an ED doc who I admire for his balanced, sensible and practical approach to appraising the literature. In this episode Dr. Yaphe, at University of Toronto's Update in EM Conference - Whistler, leads us through a few key articles from the past year including the REVERT trial to convert SVT, medical expulsive therapy for urolithiasis, steroids in anaphylaxis, and analgesics for low back pain, and discusses whether they should (or rather, should not) change our practice. He challenges authors' conclusions and questions whether the findings are relevant to our patients....</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/balanced-view-recent-em-literature-joel-yaphe/">Episode 81 – A Balanced View on Recent EM Literature with Joel Yaphe</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
May 24, 2016
Best Case Ever 45 – Mike Winters on Cardiac Arrest
24:26
<p>I had the great pleasure of meeting Dr. Mike Winters on his first ever visit to Canada at North York General's Emergency Medicine Update Conference, where he gave two fantastic presentations. His credentials are impressive: He is the Medical Director of the Emergency Department, Associate Professor in both EM and IM, EM-IM-Critical Care Program co-director and Residency Program Director of EM-IM at the University of Maryland in Baltimore.</p> <p>Sometimes we are so caught up with the job we need to get done during cardiac arrest that we forget about the important and profound effect that this event has on patients' families. On this Best Case Ever Dr. Winters tells the story of witnessing his grandfather's cardiac arrest, being present in the ED during the resuscitation attempts, and how that experience has coloured his practice. We discuss some pearls on communication with patients' families after death, colour-coded cardiac arrest teams and how to integrate POCUS into cardiac arrest care while minimizing chest compressions.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/mike-winters-cardiac-arrest/">Best Case Ever 45 – Mike Winters on Cardiac Arrest</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
May 10, 2016
Episode 80 – Presentation Skills
1:07:13
<p>Whether you’re a first year resident or a veteran of EM, you’ve probably given, or will be giving at least one presentation at some point in your career. On the one hand, presentations can be intimidating, time consuming to prepare for and frightening to perform, but on the other hand, if you’re well-prepared and know the tricks of the trade, they can be fun, educational and hugely rewarding. Giving a memorable and educational talk requires skill. It requires serious thoughtful planning, dedicated practice and creativity. The good news is that these skills can be easily taught.</p> <p>What we know about giving great talks comes from non-medical fields. We can learn about how to use our voices, eyes and body language effectively during a presentation from stage actors. We can learn how to build great slides from experts in design. We can learn how to use stories to help engage an audience and improve their retention of the material from writers, broadcasters and storytellers. We can learn how to inspire people from professional speech writers, and we can employ strategies to help improve retention of the material from cognitive neuroscientists and educators.</p> <p>As EM providers, we’re much too busy to read dozens of books on effective presenting, so with the help of two EM physicians and master educators, Dr. Eric Letovsky who has studied the art of public speaking and has been giving presentations for more than 30 years, and Dr. Rick Penciner who has been scouring the world’s literature on this topic for 20 years, we’ll distill down for you the key secrets, tips and tricks, theories and approaches, pearls and pitfalls of presentation skills so that the next time you get up in front of your colleagues to give a talk, you’ll blow their minds...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/presentation-skills/">Episode 80 – Presentation Skills</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Apr 26, 2016
Episode 79 – Management of Acute Pediatric Asthma Exacerbations
1:09:19
<p>In this EM Cases episode on Pediatric Asthma we discuss risk stratification (including the PASS and PRAM scores), indications for CXR, the value of blood gases, MDIs with spacer vs nebulizers for salbutamol and ipatropium bromide, the best way to give corticosteroids, the value of inhaled steroids, the importance of early administration of magnesium sulphate in the sickest kids, and the controversies around the use of ketamine, heliox, high flow nasal cannuala oxygen, NIPPV, epinephrine and IV salbutamol in severe asthma exacerbations. So, with the multinational and extensive experience of Dr. Dennis Scolnik, the clinical fellowship Program Director at The Hospital for Sick Children in Toronto and Dr. Sanjay Mehta, multiple award winning educator who you might remember from his fantastic work on our Pediatric Orthopedics episode, we'll help you become more comfortable the next time you are faced with a child with asthma who is crashing in your ED...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/pediatric-asthma/">Episode 79 – Management of Acute Pediatric Asthma Exacerbations</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Apr 12, 2016
Journal Jam 6 – Outpatient Topical Anesthetics for Corneal Abrasions
25:59
<p>This is EM Cases Journal Jam Podcast 6 - Outpatient Topical Anesthetics for Corneal Abrasions.</p> <p>I’ve been told countless times by ophthalmologists and other colleagues NEVER to prescribe topical anesthetics for corneal abrasion patients, with the reason being largely theoretical - that tetracaine and the like will inhibit re-epithelialization and therefore delay epithelial healing as well as decrease corneal sensation, resulting in corneal ulcers. With prolonged use of outpatient topical anesthetics for corneal abrasions, corneal opacification could develop leading to decreased vision.</p> <p>Now this might be true for the tetracaine abuser who pours the stuff in their eye for weeks on end, but when we look at the literature for toxic effects of using topical anesthetics in the short term, there is no evidence for any clinically important detrimental outcomes. Should we ignore the dogma and use tetracaine anyway? Is there evidence that the use of topical anesthetics after corneal abrasions is safe and effective for pain control without adverse effects or delayed epithelial healing?</p> <p>To discuss the paper "The Safety of Topical Anesthetics in the Treatment of Corneal Abrasions: A Review" by Drs. Swaminathan, Otterness, Milne and Rezaie published in the Journal of Emergency Medicine in 2015, we have EM Cases’ Justin Morgenstern, a Toronto-based EM Doc, EBM enthusiast as well as the brains behind the First10EM blog and Salim Rezaie, Clinical Assistant Professor of EM and Internal Medicine at University of Texas Health Science Center at San Antonio as well as the Creator & Founder of the R.E.B.E.L. EM blog and REBELCast podcast.</p> <p>In this Journal Jam podcast, Dr. Morgenstern and Dr. Rezaie also discuss a simple approach to critically appraising a systematic review article, how to handle consultants who might not be aware of the literature and/or give you a hard time about your decisions and much more...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/outpatient-topical-anesthetics-for-corneal-abrasions/">Journal Jam 6 – Outpatient Topical Anesthetics for Corneal Abrasions</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Mar 29, 2016
Episode 78 Anaphylaxis and Anaphylactic Shock – Live from The EM Cases Course
50:53
<p>Anaphylaxis is the quintessential medical emergency. We own this one. While the vast majority of anaphylaxis is relatively benign, about 1% of these patients die from anaphylactic shock. And usually they die quickly. Observational data show that people who die from anaphylaxis and anaphylactic shock do so within about 5-30mins of onset, and in up to 40% there’s no identifiable trigger. The sad thing is that many of these deaths are because of two simple reasons: 1. The anaphylaxis was misdiagnosed and 2. Treatment of anaphylaxis and anaphylactic shock was inappropriate.</p> <p>So there’s still lots of room for improvement when it comes to anaphylaxis and anaphylactic shock management.</p> <p>With the help of Dr. David Carr of Carr's Cases fame, we’ll discuss how to pick up atypical presentations of anaphylaxis, how to manage the challenging situation of epinephrine-resistant anaphylactic shock, whether or not we should abandon steroids, a rare but ‘must know’ diagnosis related to anaphylaxis, and much more. Plus, we have a special guest apperance by George Kovacs, airway guru, to walk us through an approach to the impending airway obstruction we might face in anaphylaxis.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/anaphylaxis-anaphylactic-shock/">Episode 78 Anaphylaxis and Anaphylactic Shock – Live from The EM Cases Course</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Mar 15, 2016
Episode 77 Fever in the Returning Traveler
1:07:24
<p>In this EM Cases episode with Dr. Nazanin Meshkat, multinational ED doc and Dr. Matthew Muller, infectious disease specialist, we discuss the most common tropical disease killers that we see in patients who present with Fever in the Returning Traveler. Every year an increasing number of people travel abroad, and travelers to tropical destinations are often immunologically naïve to the regions they’re going to. It’s very common for travelers to get sick. In fact, about 2/3 of travelers get sick while they’re traveling or soon after their return, and somewhere between 3 and 19% of travelers to developing countries will develop a fever.</p> <p>Imported diseases, like Malaria, Dengue, Ebola, and Zyka can be acquired abroad and brought back to your ED in unsuspecting individuals. This is serious stuff - you might be surprised to learn that Malaria is responsible for more morbidity and mortality worldwide than any other illness.</p> <p>According to a study in CJEM most emergency physicians have minimal or no specific training in tropical diseases and emergency physicians indicated an unacceptably low level of comfort when faced with patients with tropical disease symptoms. In fact, 40% of the cases were incorrectly diagnosed or managed. And Canadian ED docs aren’t the only ones who’s skill isn’t stellar in this department - a similar 2006 study of UK physicians showed a 78% misdiagnosis rate. This misdiagnosis rate isn’t wholly because of lack of knowledge – it almost certainly also has to do with the vague presentations and huge amount of overlap between so many tropical disease.</p> <p>You might be thinking that it’s impossible to learn all the thousands of details of the dozens of different tropical diseases - true. However, in the ED, while we don’t need to know every detail of every tropical disease, and don’t necessarily need to make the exact diagnosis right away, we do need to have a rational, organized approach to diagnosing and managing fever in the returning traveler, so that we can identify some of the more common serious illnesses like Malaria, Dengue and Typhoid fever, and start timely treatment in the ED.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/fever-returning-traveler/">Episode 77 Fever in the Returning Traveler</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Mar 01, 2016
Best Case Ever 44 Low Risk Pulmonary Embolism
20:40
<p>Dr. Salim Rezaie of R.E.B.E.L. EM tells his Best Case Ever of a Low Risk Pulmonary Embolism that begs us to consider a work-up and management plan that we might not otherwise consider. With new guidelines suggesting that subsegmental pulmonary embolism need not be treated with anticoagulants, exceptions to Well's Score and PERC rule to help guide work-ups, the adaptation of outpatient management of pulmonary embolism, and the option of NOACs for treatment, the management of pulmonary embolism in 2016 has evolved considerably. In which situations would you treat subsegmental pulmonary embolism? How comfortable are you sending patients home with pulmonary embolism? How does the patient's values play into these decisions? Listen to Dr. Rezaie provide an insightlful perspective on these important issues and much more...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-low-risk-pulmonary-embolism/">Best Case Ever 44 Low Risk Pulmonary Embolism</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Feb 23, 2016
Episode 76 Pediatric Procedural Sedation
59:53
<p>In this EM Cases episode on Pediatric Procedural Sedation with Dr. Amy Drendel, a world leader in pediatric pain management and procedural sedation research, we discuss how best to manage pain and anxiety in three situations in the ED: the child with a painful fracture, the child who requires imaging in the radiology department and the child who requires a lumbar puncture. Without a solid understanding and knowledge of the various options available to you for high quality procedural sedation, you inevitably get left with a screaming suffering child, upset and angry parents and endless frustration doe you. It can make or break an ED shift. With finesse and expertise, Dr. Drendel answers such questions as: What are the risk factors for a failed Pediatric Procedural Sedation? Why is IV Ketamine preferred over IM Ketamine? In what situations is Nitrous Oxide an ideal sedative? How long does a child need to be observed in the ED after Procedural Sedation? Do children need to have fasted before procedural sedation? What is the anxiolytic of choice for children requiring a CT scan? and many more...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/pediatric-procedural-sedation/">Episode 76 Pediatric Procedural Sedation</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Feb 09, 2016
Best Case Ever 43 Ruptured AAA
11:44
<p>I caught up with Dr. Anand Swaminathan, otherwise known as EM Swami, at The Teaching Course in NYC where he told his Best Case Ever from Janus General of his heroic and collaborative attempts at saving the life of a gentleman who presented to the ED with a classic story for a ruptured AAA. As William Olser famously said, "There is no disease more conducive to clinical humility than aneurysm of the aorta."</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-ruptured-aaa/">Best Case Ever 43 Ruptured AAA</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jan 26, 2016
Episode 75 Decision Making in EM – Cognitive Debiasing, Situational Awareness & Preferred Error
1:04:35
<p>While knowledge acquisition is vital to developing your clinical skills as an EM provider, using that knowledge effectively for decision making in EM requires a whole other set of skills. In this EM Cases episode on Decision Making in EM Part 2 - Cognitive Debiasing, Situational Awareness & Preferred Error, we explore some of the concepts introduced in Episode 11 on Cognitive Decision Making like cognitive debiasing strategies, and some of the concepts introduced in Episode 62 Diagnostic Decision Making Part 1 like risk tolerance, with the goal of helping you gain insight into how we think and when to take action so you can ultimately take better care of your patients. Walter Himmel, Chris Hicks and David Dushenski answer questions such as: How do expert clinicians blend Type 1 and Type 2 thinking to make decisions? How do expert clinicians use their mistakes and reflect on their experience to improve their decision making skills? How can we mitigate the detrimental effects of affective bias, high decision density and decision fatigue that are so abundant in the ED? How can we use mental rehearsal to not only improve our procedural skills but also our team-based resuscitation skills? How can we improve our situational awareness to make our clinical assessments more robust? How can anticipatory guidance improve the care of your non-critical patients as well as the flow of a resuscitation? How can understanding the concept of preferred error help us make critical time-sensitive decisions? and many more important decision making in EM nuggets...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/decision-making-in-em/">Episode 75 Decision Making in EM – Cognitive Debiasing, Situational Awareness & Preferred Error</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jan 12, 2016
Journal Jam 5 One Hour Troponin to Rule Out and In MI
45:36
<p>Traditionally we've run at least 2 troponins 6 or 8 hours apart to help rule out MI and recently in algorithms like the HEART score we've combined clinical data with a 2 or 3 hour delta troponin to help rule out MI. The paper we'll be discussing here is a multicentre/multinantional study from the Canadian Medical Association Journal from this year out of Switzerland entitled "Prospective validation of a 1 hour algorithm to rule out and rule in acute myocardial infarction using a high sensitivity cardian troponin T assay" with lead author Tobias Reichlin. It not only looks at whether or not we can rule out MI using a delta troponin at only 1 hour but whether or not we can expedite the ruling in of MI using this protocol.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/one-hour-troponin/">Journal Jam 5 One Hour Troponin to Rule Out and In MI</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Dec 22, 2015
Episode 74 Opioid Misuse in Emergency Medicine
57:00
<p>Pain leads to suffering. Opioid misuse leads to suffering. We strive to avoid both for our patients. On the one hand, treating pain is one of the most important things we do in emergency medicine to help our patients and we need to be aggressive in getting our patients' pain under control in a timely, [...]</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/opioid-misuse-emergency-medicine/">Episode 74 Opioid Misuse in Emergency Medicine</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Dec 15, 2015
Episode 73 Emergency Management of Pediatric Seizures
1:06:24
<p>Pediatric seizures are common. So common that about 5% of all children will have a seizure by the time they’re 16 years old. If any of you have been parents of a child who suddenly starts seizing, you’ll know intimately how terrifying it can be.</p> <p>While most of the kids who present to the ED with a seizure will end up being diagnosed with a benign simple febrile seizure, some kids will suffer from complex febrile seizures, requiring some more thought, work-up and management, while others will have afebrile seizures which are a whole other kettle of fish. We need to know how to differentiate these entities, how to work-them up and how to manage them in the ED. At the other end of the spectrum of disease there is status epilepticus – a true emergency with a scary mortality rate - where you need to act fast and know your algorithms like the back of your hand. This topic was chosen based on a nation-wide needs assessment study conducted by TREKK (Translating Emergency Knowledge for Kids), a collaborator with EM Cases.</p> <p>With the help of two of Canada’s Pediatric Emergency Medicine seizure experts hand picked by TREKK, Dr. Lawrence Richer and Dr. Angelo Mikrogianakis, we’ll give you the all the tools you need to approach the child who presents to the ED with seizure with the utmost confidence.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/emergency-management-of-pediatric-seizures/">Episode 73 Emergency Management of Pediatric Seizures</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Dec 01, 2015
Best Case Ever 42 Pediatric Cardiac Arrest
21:01
<p>When was the last time you saw ventricular fibrillation in a 4 month old? Dr. Simard tells his Best Case Ever of a Pediatric Cardiac Arrest in which meticulous preparation, sticking to his guns, early activation of the transportation service, and clever use of point of care ultrasound helped save the life of a child. He explains the importance of debriefing your team after an emotionally charged case.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-42-pediatric-cardiac-arrest/">Best Case Ever 42 Pediatric Cardiac Arrest</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Nov 18, 2015
Episode 72 ACLS Guidelines 2015 Post Arrest Care
1:04:37
<p>Once we've achieved ROSC our job is not over. Good post-arrest care involves maintaining blood pressure and cerebral perfusion, adequate sedation, cooling and preventing hyperthermia, considering antiarrhythmic medications, optimization of tissue oxygen delivery while avoiding hyperoxia, getting patients to PCI who need it, and looking for and treating the underlying cause. Dr. Lin and Dr. Morrison offer us their opinion on the new simplified approach to diagnosing the underlying cause of PEA arrests. We'll also discuss when it's time to terminate resuscitation or 'call the code' as well as some fascinating research on gender differences in cardiac arrest care. These co-authors of the guidelines will give us their vision of the future of cardiac arrest care and we'll wrap up the episode with a third opinion, so to speak: Dr. Weingart's take on the whole thing....</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/acls-guidelines-2015-post-arrest-care/">Episode 72 ACLS Guidelines 2015 Post Arrest Care</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Nov 03, 2015
Episode 71 ACLS Guidelines 2015 – Cardiac Arrest Controversies Part 1
1:07:07
<p>A lot has changed over the years when it comes to managing the adult in cardiac arrest. As a result, survival rates after cardiac arrest have risen steadily over the last decade. With the release of the 2015 American Heart Association ACLS Guidelines 2015 online on Oct 16th, while there aren’t a lot a big changes, there are many small but important changes we need to be aware of, and there still remains a lot of controversy. In light of knowing how to provide optimal cardio-cerebral resuscitation and improving patient outcomes, in this episode we’ll ask two Canadian co-authors of The Guidelines, Dr. Laurie Morrison and Dr. Steve Lin some of the most practice-changing and controversial questions.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/acls-guidelines-2015-cardiac-arrest/">Episode 71 ACLS Guidelines 2015 – Cardiac Arrest Controversies Part 1</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Oct 21, 2015
Best Case Ever 41 Opiate Misuse and Physician Compassion
7:50
<p>Opiate misuse is everywhere.</p> <p>Approximately 15-20% of ED patients in the US are prescribed outpatient opiates upon discharge. In Ontario, about 10 people die accidentally from prescription opiates every week. Between 1990 and 2010, drug overdose deaths in the US increased by almost four fold, eclipsing the rate of death from motor vehicle collisions in 2009. This was driven by deaths related to prescription opiates, which now kill more people than heroin and cocaine combined. Opiates are the most prescribed class of medication in the US. In 2010, one out of every eight deaths among persons aged 25 to 34 years was opiate-related. Four out of 5 new heroin users report that their initial drug was a prescription opiate. In Ontario, three times the people died from opiate overdose than from HIV in 2011.</p> <p>Yet, we are expected to treat pain aggressively in the ED.</p> <p>Dr. Reuben Strayer, the brains behind the fantastic blog EM Updates tells his Best Case Ever, in which he realizes the importance of physician compassion in approaching the challenging drug seekers and malingerers that we manage in the ED on a regular basis.</p> <p>This Best Case Ever is in anticipation of an upcoming main episode in which Dr. Strayer and toxicologist Dr. David Juurlink discuss how to strike a balance between managing pain effectively and providing the seed for perpetuating a drug addiction or feeding a pre-existing drug addiction, and how we best take care of our patients who we suspect might have a drug misuse problem.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/opiate-misuse-physician-compassion/">Best Case Ever 41 Opiate Misuse and Physician Compassion</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Oct 13, 2015
Episode 70 End of Life Care in Emergency Medicine
1:07:49
<p>Most of us in North America live in cultures that almost never talk about death and dying. And medical progress has led the way to a shift in the culture of dying, in which death has been medicalized. While most people wish to die at home, every decade has seen an increase in the proportion of deaths that occur in hospital. Death is often seen as a failure to keep people alive rather than a natural dignified end to life. This is at odds with what a lot of people actually want at the end of their lives: 70% of hospitalized Canadian elderly say they prefer comfort measures as apposed to life-prolonging treatment, yet as many as ⅔ of these patients are admitted to ICUs.</p> <p>Quality End of Life Care in Emergency Medicine is not widely taught. Most of us are not well prepared for death in our EDs – and we should be. There’s no second chance when it comes to a bad death like there is if you screw up a central line placement, so you need the skills to do it right the first time.</p> <p>To recognize when comfort measures and compassion are what will be best for our patients, is just as important as knowing when to intervene and treat aggressively in a resuscitation. Emergency physicians should be able to recognize not only the symptoms and patterns that are common in the last hours to days of life, but also understand the various trajectories over months or years toward death, if they’re going to provide the high quality end of life care that patients deserve.</p> <p>So, with the help of Dr. Howard Ovens, a veteran emergency physician with over 25 years of experience who speaks at national conferences on End of Life Care in Emergency Medicine, Dr. Paul Miller, an emergency physician who also runs a palliative care unit at McMaster University and Dr. Shona MacLachlan who led the palliative care stream at the CAEP conference in Edmonton this past June, we'll help you learn the skills you need to assess dying patients appropriately, communicate with their families effectively, manage end of life symptoms with confidence and much more...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/end-of-life-care-in-emergency-medicine/">Episode 70 End of Life Care in Emergency Medicine</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Sep 29, 2015
Best Case Ever 40 End of Life Care & Consultant Communication
8:28
<p>Dr. Paul Miller, emergency physician and head of a palliative care unit at McMaster Univeristy tells the story of his Best Case Ever on End of Life Care. He shows us that clear consultant communication can make the difference between end of life care that takes into account patients' wishes and values and end of life care that fails. The upcoming episode on End of Life Care and Palliative Care in Emergency Medicine with Dr. Miller, Dr. Howard Ovens and Dr. Shona McLachlan will elucidate some strategies to manage some of the most challenging situations in Emergency Medicine such as critically ill patients with 'Full Code' status who have no chance of meaningful survival, and cancer patients near the end of life who have false hopes of a cure and request aggressive medical management over aggressive palliative care. We review the most important treatment options for symptom management for the dying patient including pain, dyspnea and terminal delirium and much more...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/end-of-life-care-consultant-communication/">Best Case Ever 40 End of Life Care & Consultant Communication</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Sep 23, 2015
Episode 69 Obesity Emergency Management
1:05:33
<p>Current estimates of the prevalence of obesity are that a quarter of adult Canadians and one third of Americans are considered obese with approximately 3% being morbidly obese. With the proportion of patients with a BMI>30 growing every year, you’re likely to manage at least one obese patient on every ED shift. Obese patients are at high risk of developing a host of medical complications including diabetes, hypertension, coronary artery disease, peripheral vascular disease, biliary disease, sleep apnea, cardiomyopathy, pulmonary embolism and depression, and are less likely compared to non-obese adults to receive timely care in the ED.</p> <p>Not only are these patients at higher risk for morbidity and mortality, but obesity emergency management is complicated by the patient’s altered cardiopulmonary physiology and drug metabolism. This can make their acute management much more challenging and dangerous. To help us gain a deeper understanding of the challenges of managing obese patients and elucidate a number of important differences as well as practical approaches to obesity emergency management, we welcome Dr. Andrew Sloas, the founder and creator of the fantastic pediatric EM podcast PEM ED, Dr. Richard Levitan, a world-famous airway management educator and innovator and Dr. David Barbic a prominent Canadian researcher in obesity in emergency medicine from University of British Columbia....</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/obesity-emergency-management/">Episode 69 Obesity Emergency Management</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Sep 08, 2015
Best Case Ever 39 – Airway Strategy & Mental Preparedness in EM Procedures with Richard Levitan
14:44
<p>I caught up with airway educator, innovator and self-described enthusiast Dr. Richard Levitan at SMACC in Chicago this past June. In this Best Case Ever on Airway Strategy and Mental Preparedness in EM Procedures, Dr. Levitan uses a great save of his in a penetrating trauma case as a basis for discussion on mental preparedness and how we've been thinking about our general approach to emergency procedures the wrong way. Rather than fixating on the final goal of a procedure, which can often be daunting and lead us astray, he suggests a methodical incrementalized and compartmentalized approach to EM procedures that reduces stress and fear, improves confidence and enhances success. He runs through several examples including intubation, cricothyrotomy and initial approach to hypoxia to explain his Simple Incremental Approach to EM Procedures. Could this be a paradigm shift in the way we think about procedures in EM?....</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/airway-strategy-mental-preparedness-em-procedures-richard-levitan/">Best Case Ever 39 – Airway Strategy & Mental Preparedness in EM Procedures with Richard Levitan</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Sep 01, 2015
Episode 68 Emergency Management of Sickle Cell Disease
1:01:01
<p>A recent needs assessment completed in Toronto found that Emergency providers are undereducated when it comes to the Emergency Management of Sickle Cell Disease. This became brutally apparent to me personally, while I was researching this topic. It turns out that we’re not so great at managing these patients. Why does this matter?</p> <p>These are high risk patients.</p> <p>In fact, Sickle Cell patients are at increased risk for a whole slew of life threatening problems. One of the many reasons they are vulnerable is because people with Sickle Cell disease are functionally asplenic, so they’re more likely to suffer from serious bacterial infections like meningitis, osteomyelitis and septic arthritis. For a variety of reasons they’re also more likely than the general population to suffer from cholycystitis, priapism, leg ulcers, avascular necrosis of the hip, stroke, acute coronary syndromes, pulmonary embolism, acute renal failure, retinopathy, and even sudden exertional death. And often the presentations of some of these conditions are less typical than usual.</p> <p>Those of you who have been practicing long enough, know that patients with Sickle Cell Disease can sometimes present a challenge when it comes to pain management, as it’s often difficult to discern whether they’re malingering or not. It turns out that we’ve probably been under-treating Sickle Cell pain crisis pain and over-diagnosing patients as malingerers.</p> <p>Then there are the sometimes elusive Sickle Cell specific catastrophes that we need to be able to pick up in the ED to prevent morbidity, like Aplastic Crisis for example, where prompt recognition and swift treatment are paramount. A benign looking trivial traumatic eye injury can lead to vision threatening hyphema in Sickle Cell patients and can be easy to miss.</p> <p>In this episode, with the help of Dr. Richard Ward, Toronto hematologist and Sickle Cell expert, and Dr. John Foote, the Residency Program Director for the CCFP(EM) program at the University of Toronto, we’ll deliver the key concepts, pearls and pitfalls in recognizing some important sickle cell emergencies, managing pain crises, the best fluid management, appropriate use of supplemental oxygen therapy, rational use of transfusions and more...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/emergency-management-of-sickle-cell-disease/">Episode 68 Emergency Management of Sickle Cell Disease</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Aug 18, 2015
Best Case Ever 38 Sickle Cell Acute Chest Syndrome
6:18
<p>Sickle Cell Acute Chest Syndrome remains the leading cause of death in patients suffering from Sickle Cell Disease. In his Best Case Ever, Dr. Richard Ward, a hematologist with a special interest in Sickle Cell Disease, describes a case of a Sickle Cell Disease patient who presents with what appears to be a simple pain crisis, but turns out to be a devastating Acute Chest Syndrome. He gives us the key clinical pearls and pitfalls to make this often elusive diagnosis early so that life-saving treatment can be initiated in a timely manner. This is in anticipation of the upcoming episode on The Emergency Management of Sickle Cell Pain Crisis with Dr. Ward and Dr. John Foote.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/sickle-cell-acute-chest-syndrome/">Best Case Ever 38 Sickle Cell Acute Chest Syndrome</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Aug 11, 2015
Journal Jam 4 – Low Dose Ketamine Analgesia
38:24
<p>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.</p> <p>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.</p> <p>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?....</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/low-dose-ketamine-analgesia/">Journal Jam 4 – Low Dose Ketamine Analgesia</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jul 31, 2015
Episode 67 Pediatric Pain Management
1:06:37
<p>Pain is the most common reason for seeking health care. It accounts for 80% of ED visits. The WHO has declared that “optimal pain treatment is a human right”. As has been shown in multiple ED-based Pediatric pain management studies, Pediatric pain is all too often under-estimated and under-treated. Why does this matter? Under-estimating and under-treating pediatric pain may have not only short term detrimental effects but life-long detrimental effects as well; not to mention, screaming miserable children disturbing other patients in your ED and complaints to the hospital from parents. Whether it’s venipuncture, laceration repair, belly pain or reduction of a fracture we need to have the skills and knowledge to optimize efficient and effective pain management in all the kids we see in the ED. What are the indications for intranasal fentanyl? intranasal ketamine? Why should codeine be contra-indicated in children? How do triage-initaited pain protocols improve pediatric pain management? Which are most effective skin analgesics for venipuncture? To help you make these important pediatric pain management decisions, in this podcast we have one of the most prominent North American researchers and experts in Emergency Pediatric pain management, Dr. Samina Ali and not only the chief of McMaster Children’s ED but also the head of the division of Pediatric EM at McMaster University, Dr. Anthony Crocco.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/pediatric-pain-management/">Episode 67 Pediatric Pain Management</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jul 07, 2015
Best Case Ever 37 Neonatal Lazy Feeder
8:03
<p>On this EM Cases Best Case Ever Dr. Anthony Crocco, the Head and the Division Head of Pediatric EM at McMaster University and Medical Director of Pediatric Emergency Medicine at Hamilton Health Sciences Hosptial, discusses an approach to the neonatal lazy feeder and why we should abandon the use of codeine in pediatrics as well as in breastfeeding mothers. The approach to the neonatal lazy feeder should be considered as an approach to altered level of awareness with a wide differential diagnosis, and there is one question that should always be asked of the neontal lazy feeder....</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-37-neonatal-lazy-feeder/">Best Case Ever 37 Neonatal Lazy Feeder</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jun 16, 2015
Episode 66 Backboard and Collar Nightmares from Emergency Medicine Update Conference
22:14
<p>In the first of our series on Highlights from North York General's Emergency Medicine Update Conference, Dr. Kylie Bosman discusses Backboard and Collar Nightmares. The idea that backboards and c-spine collars prevent spinal cord injuries came from level 3 evidence in the 1960's and there has never been an RCT to prove this theory. In fact a Cochrane review on the topic in 2007 concluded that "the effect of pre-hospital spinal immobilisation on mortality, neurological injury, spinal stability and adverse effects in trauma patients remains uncertain" and that "the possibility that immobilisation may increase mortality and morbidity cannot be excluded". There have subsequently been several observational studies that describe increased morbidity and mortality associated with backboard and collars in a subset of patients. Dr. Bosman argues that the time has long past that a major paradigm shift needs to occur toward a safer more rational use of backboards and collars in our trauma patients.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/backboard-and-collar-nightmares-emergency-medicine-update-conference/">Episode 66 Backboard and Collar Nightmares from Emergency Medicine Update Conference</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jun 09, 2015
Best Case Ever 36 Tracheo-innominate Fistula
14:12
<p>In this Best Case Ever with Dr. Scott Weingart, the brains behind EMcrit.org, we hear the devastating story of a tracheostomy gone bad. Dr. Weingart shares with us what he has learned about how to manage massive hemoptysis in tracheostomy patients, and in particlar, a step-wise approach to managing a tracheo-innominate fistula. We discuss the balance between providing maximal aggrressive critical care while maintaining a deep respect for the risks associated with the procedures we perform. Recorded at North York General's EM Update Conference 2015.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/tracheo-innominate-fistula/">Best Case Ever 36 Tracheo-innominate Fistula</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jun 02, 2015
Episode 65 – IV Iron for Anemia in Emergency Medicine
1:06:33
<p>For years we’ve been transfusing red cells in the ED to patients who don’t actually need them. A study looking at trends in transfusion practice in the ED found that about 1/3 of transfusions given were deemed totally inappropriate. As we explained in previous EM Cases episodes, there have been a whole slew of articles in the literature over the years that have shown that morbidity and mortality outcomes with lower hemoglobin thresholds, like 70g/L for transfusing ICU patients (TRICC trial), patients in septic shock (TRISS trial), and patients with GI bleeds are similar to outcomes with traditional higher hemoglobin thresholds of 90 or 100g/L. We’re simply transfusing blood way too much! The American Association of Blood Banks in conjunction with the American Board of Internal Medicine’s Choosing Wisely campaign, as one of its 5 statements on overuse of procedures, stated, “don’t transfuse iron deficiency without hemodynamic instability”.</p> <p>So, in this episode with the help of Transfusion specialist, researcher and co-author of the American Association of Blood Banks transfusion guidelines Dr. Jeannie Callum, Transfusion specialist and researcher Dr. Yulia Lin, and 'the walking encyclopedia of EM' Dr. Walter Himmel, we give you an understanding of why it’s important to avoid red cell transfusions in certain situations, why IV iron is sometimes a better option in a significant subset of anemic patients in the ED, and the practicalities of exactly how to administer IV iron.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/iv-iron-for-anemia-in-emergency-medicine/">Episode 65 – IV Iron for Anemia in Emergency Medicine</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
May 27, 2015
Journal Jam 3 – Ultrasound vs CT for Renal Colic
30:12
<p>In this Journal Jam we have Dr. Michelle Lin from Academic Life in EM interviewing two authors, Dr. Rebecca Smith‑Bindman, a radiologist, and Dr. Ralph Wang an EM physician both from USCF on their article “Ultrasonography versus Computed Tomography for suspected Nephrolithiasis” published in the New England Journal of Medicine in 2014. There is currently a wide practice variation in the imaging work-up of the patient who presents to the ED with a high suspicion for renal colic. On the one extreme, some EM physicians use CT to screen all patients who present with renal colic, while on the other extreme, other EM physicians do not use any imaging on any patient who has had previous imaging. The role of POCUS and radiology department ultrasound as an alternative to CT in the work up of renal colic has not been clearly defined in the ED setting. This study was a pragmatic multi-centre randomized control trial of patients in whom the primary diagnostic concern was renal colic, that tried to answer the question: is there a significant difference in the serious missed diagnosis rate, serious adverse events rate, pain, return visits, admissions to hospital, radiation dose and diagnostic accuracy if the EM provider chose POCUS, radiology department ultrasound or CT for their initial imaging modality of choice. This Journal Jam is peer review by EMNerd's Rory Spiegel.</p> <p>[wpfilebase tag=file id=618 tpl=emc-play /]</p> <p>[wpfilebase tag=file id=619 tpl=emc-mp3 /]</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/ultrasound-vs-ct-for-renal-colic/">Journal Jam 3 – Ultrasound vs CT for Renal Colic</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
May 21, 2015
Episode 64 Highlights from Whistler’s Update in EM Conference 2015 Part 2
41:22
<p>In this Part 2 of EM Cases' Highlights from Whistler's Update in EM Conference 2015 Dr. David Carr gives you his top 5 pearls and pitfalls on ED antibiotic use including when patients with sinusitis really require antibiotics, when oral antibiotics can replace IV antibiotics, how we should be dosing Vancomycin in the ED, the newest antibiotic regimens for gonorrhea and the mortality benefit associated with antibiotic use in patients with upper GI bleeds. Dr. Chris Hicks gives you his take on immediate PCI in post-cardiac arrest patients with a presumed cardiac cause and The Modified HEART Score to safely discharge patients with low risk chest pain.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/highlights-whistlers-update-in-em-conference-2015-part-2/">Episode 64 Highlights from Whistler’s Update in EM Conference 2015 Part 2</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
May 14, 2015
Episode 63 – Pediatric DKA
1:00:01
<p>Pediatric DKA was identified as one of key diagnoses that we need to get better at managing in a massive national needs assessment conducted by the fine folks at TREKK – Translating Emergency Knowledge for Kids – one of EM Cases’ partners who’s mission is to improve the care of children in non-pediatric emergency departments across the country. You might be wondering - why was DKA singled out in this needs assessment?</p> <p>It turns out that kids who present to the ED in DKA without a known history of diabetes, can sometimes be tricky to diagnose, as they often present with vague symptoms. When a child does have a known history of diabetes, and the diagnosis of DKA is obvious, the challenge turns to managing severe, life-threatening DKA, so that we avoid the many potential complications of the DKA itself as well as the complications of treatment - cerebral edema being the big bad one.</p> <p>The approach to these patients has evolved over the years, even since I started practicing, from bolusing insulin and super aggressive fluid resuscitation to more gentle fluid management and delayed insulin drips, as examples. There are subtleties and controversies in the management of DKA when it comes to fluid management, correcting serum potassium and acidosis, preventing cerebral edema, as well as airway management for the really sick kids. In this episode we‘ll be asking our guest pediatric emergency medicine experts Dr. Sarah Reid, who you may remember from her powerhouse performance on our recent episodes on pediatric fever and sepsis, and Dr. Sarah Curtis, not only a pediatric emergency physician, but a prominent pediatric emergency researcher in Canada, about the key historical and examination pearls to help pick up this sometimes elusive diagnosis, what the value of serum ketones are in the diagnosis of DKA, how to assess the severity of DKA to guide management, how to avoid the dreaded cerebral edema that all too often complicates DKA, how to best adjust fluids and insulin during treatment, which kids can go home, which kids can go to the floor and which kids need to be transferred to a Pediatric ICU.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/pediatric-dka/">Episode 63 – Pediatric DKA</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Apr 28, 2015
Episode 62 Diagnostic Decision Making in Emergency Medicine
1:06:02
<p>This is Part 1 of EM Cases' series on Diagnostic Decision Making with Walter Himmel, Chris Hicks and David Dushenski discussing the intersection of evidence-based medicine, cognitive bias and systems issues to effect our diagnostic decision making in Emergency Medicine. In this episode we first discuss 5 strategies to help you master evidence-based diagnostic decision making to minimize diagnostic error, avoid over-testing and improve patient care including:</p> <p>1. The incorporation of patients' values and clinical expertise into evidence-based decisions</p> <p>2. Critically appraising diagnostic studies</p> <p>3. Understanding that diagnostic tests are not perfect</p> <p>4. Using the concept of test threshold to guide work-ups</p> <p>5. Understanding that the predictive value of a test depends on the prevalence of disease</p> <p>We then go on to review some of the factors that play into the clinician’s and patient’s risk tolerance in a given clinical encounter, how this plays into shared decision making and the need to adjust our risk tolerance in critical situations. Finally, we present some strategies to prevent over-testing while improving patient care, patient flow and ethical practice.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/diagnostic-decision-making-in-emergency-medicine/">Episode 62 Diagnostic Decision Making in Emergency Medicine</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Apr 15, 2015
Best Case Ever 35: Taking Action in Emergency Medicine
10:44
<p>In anticipation of our series of podcasts on Diagnostic Decision Making with Dr. Walter Himmel, Dr. Chris Hicks and Dr. David Dushenski we have Dr. Hicks presenting his Best Case Ever. Taking action in Emergency Medicine requires not only careful consideration of the best evidence, the experience of the clinician, the patient's values and the system that you work in, but also the will to act. Dr. Hicks describes a case of a patient who suffers a cardiac arrest, where the diagnosis is quite obvious to everyone in the room (and the required action is as well), yet a delay in treatment occurs nonetheless.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/taking-action-in-emergency-medicine/">Best Case Ever 35: Taking Action in Emergency Medicine</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Apr 07, 2015
Episode 61 Whistler’s Update in EM Conference 2015 Highlights Part 1
50:23
<p>This EM Cases episode is Part 1 of The Highlights of The University of Toronto, Divisions of Emergency Medicine, Update in EM Conference from Whistler 2015 with Paul Hannam on Pearls and Pitfalls of Intraosseus Line Placement, Anil Chopra on who is at risk and how to prevent Contrast Induced Nephropathy, and Joel Yaphe on the Best of EM Literature from 2014, including reduction of TMJ dislocations, the TRISS trial (on transfusion threshold in sepsis), PEITHO study for thrombolysis in submassive PE, Co-trimoxazole and Sudden Death in Patients Receiving ACE inhibitors or ARBs, the effectiveness and safety of outpatient Tetracaine for corneal abraisons, chronic effects of shift work on cognition and much more...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-61-whistlers-update-in-em-conference-2015-highlights-part-1/">Episode 61 Whistler’s Update in EM Conference 2015 Highlights Part 1</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Mar 26, 2015
Best Case Ever 34: Inferior MI Presenting with Abdominal Pain
9:05
<p>In a previous Best Case Ever, 'Thinking Outside the Abdominal Box', Dr. Brian Steinhart reviewed some important can't-miss-diagnoses that can present elusively with abdominal pain. In this Carr's Cases Series on Inferior MI Presenting with Abdominal Pain, we continue in the theme of 'Thinking Outside the Abdominal Box' with David Carr explaining how he figured out that a man presenting with classic biliary colic was diagnosed with an inferior MI with right ventricular extension.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-34-inferior-mi-presenting-with-abdominal-pain/">Best Case Ever 34: Inferior MI Presenting with Abdominal Pain</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Mar 19, 2015
Episode 60: Emergency Management of Hyponatremia
1:05:24
<p>In this EM Cases episode Dr. Melanie Baimel and Dr. Ed Etchells discuss a simple and practical step-wise approach to the emergency management of hyponatremia:</p> <p>1. Assess and treat neurologic emergencies related to hyponatremia with hypertonic saline</p> <p>2. Defend the intravascular volume</p> <p>3. Prevent further exacerbation of hyponatremia</p> <p>4. Prevent rapid overcorrection</p> <p>5. Ascertain a cause</p> <p>Dr. Etchells and Dr. Baimel answer questions such as: What are the indications for giving DDAVP in the emergency management of hyponatremia? What is a simple and practical approach to determining the cause of hyponatremia in the ED? How fast should we aim to correct hyponatremia? What is the best fluid for resuscitating the patient in shock who has a low serum sodium? Why is the management of the marathon runner with hyponatremia counter-intuitive? What strategies can we employ to minimize the risk of Osmotic Demyelination Syndrome (OSD) and cerebral edema in the emergency management of hyponatremia? and many more...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-60-emergency-management-hyponatremia/">Episode 60: Emergency Management of Hyponatremia</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Mar 03, 2015
Best Case Ever 33: Over-correction of Hyponatremia
6:44
<p>Rapid over-correction of Hyponatremia can have devastating consequences: for one, osmotic demyelination syndrome (ODS) can result in destruction of the pons and a locked-in state. We don't see ODS very much as it's onset is delayed and usually sets in after the patient is admitted to hospital (or worse, sent home). Nonetheless, we need to know how to manage Hyponatremia in the ED so that we prevent ODS from ever happening. In this Best Case Ever, Dr. Melanie Baimel describes the case of a young woman who came in to the ED after drinking alcohol and taking Ecstasy, wanted to leave AMA after her Hyponatremia had inadvertently been corrected too rapidly, and the conundrum that ensues.</p> <p>In the upcoming episode, Dr. Baimel and the first ever Internal Medicine specialist on EM Cases, Dr. Ed Etchels, discuss a rational step-wise approach to managing Hyponatremia, tailored for the EM practitioner; when you might consider giving DDAVP in the ED, the best way to correct Hyponatremia, how to manage the patient who's Hyponatremia has been corrected too quickly, and an easy approach to the differential diagnosis. Get a sneak peak at the algorithm that will be explained and reviewed in the upcoming episode......</p> <p>[wpfilebase tag=file id=577 tpl=emc-play /]</p> <p>[wpfilebase tag=file id=578 tpl=emc-mp3 /]</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-33-correction-hyponatremia/">Best Case Ever 33: Over-correction of Hyponatremia</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Feb 27, 2015
Episode 59b: Amy Plint on the Management of Bronchiolitis
11:34
<p>In response to Episode 59 with Dr. Sanjay Mehta and Dr. Dennis Scolnik on the emergency department diagnosis and management of Bronchiolitis, Dr. Amy Plint, one of Canada's most prominent researchers in Bronchiolitis and the Chair of Pediatric Emergency Research Canada, tells her practical approach to choosing medications in the emergency department, the take home message from her landmark 2009 NEJM study on the use of nebulized epinephrine and dexamethasone for treating Bronchiolitis, and the future of Bronchiolitis research.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-59b-amy-plint-management-bronchiolitis/">Episode 59b: Amy Plint on the Management of Bronchiolitis</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Feb 19, 2015
Episode 59: Bronchiolitis
1:03:47
<p>This EM Cases episode is on the diagnosis and management of Bronchiolitis. Bronchiolitis is one of the most common diagnoses we make in both general and pediatric EDs, and like many pediatric illnesses, there’s a wide spectrum of severity of illness as well as a huge variation in practice in treating these children. Bronchiolitis rarely requires any work up yet a lot of resources are used unnecessarily. We need to know when to worry about these kids, as most of them will improve with simple interventions and can be discharged home, while a few will require complex care. Sometimes it’s difficult to predict which kids will do well and which kids won’t. Not only is it difficult to predict the course of illness in some of these children but the evidence for different treatment modalities for Bronchiolitis is all over the place, and I for one, find it very confusing. Then there’s the sphincter tightening really sick kid in severe respiratory distress who’s tiring with altered LOC. We need to be confident in managing these kids with severe disease.</p> <p>So, with the help of Dr. Dennis Scolnik, the clinical fellowship program director at Toronto’s only pediatric emergency department and Dr. Sanjay Mehta, an amazing educator who you might remember from his fantastic work on our Pediatric Ortho episode, we’ll sort through how to assess the child with respiratory illness, how to predict which kids might run into trouble, and what the best evidence-based management of these kids is.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-59-bronchiolitis/">Episode 59: Bronchiolitis</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Feb 10, 2015
Best Case Ever 32 Carr’s Cases – Endocarditis and Blood Culture Interpretation
13:43
<p>David Carr discusses his top 10 pearls on endocarditis and blood culture interpretation in this Carr's Cases Best Case Ever on EM Cases - Endocarditis and Blood Culture Interpretation.</p> <p>[wpfilebase tag=file id=560 tpl=emc-play /]</p> <p>[wpfilebase tag=file id=561 tpl=emc-mp3 /]</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-32-carrs-cases-endocarditis-and-blood-culture-interpretation/">Best Case Ever 32 Carr’s Cases – Endocarditis and Blood Culture Interpretation</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Feb 05, 2015
Episode 29b: Hand Emergencies Part 2
28:37
<p>Part 2 of Hand Emergencies with Dr. Laura Tate & Dr. Andrew Arcand.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-29b-hand-emergencies-part-2/">Episode 29b: Hand Emergencies Part 2</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jan 25, 2015
Episode 58: Tendons and Ligaments – Commonly Missed Uncommon Orthopedic Injuries Part 2
46:26
<p>In part 2 of our round-table discussion on EM Cases with sports medicine guru Dr. Ivy Cheng and orthopedic surgeon Dr. Hossein Mehdian we elucidate some key commonly missed uncommon orthopedic injuries that if mismanaged, carry significant long term morbidity. Injuries of the tendons and ligaments are often overlooked by emergency providers as relatively benign injuries and generally are not well understood.</p> <p>Syndesmosis Injuries typically occur in impact sports. They are missed in about 20% of cases, as x-rays findings are often subtle or absent. The mechanism, physical exam findings, such as the Hopkin's Test, and associated injuries are important to understand to help make the diagnosis and provide appropriate ED care.</p> <p>Distal Biceps Tendon Rupture is almost exclusively a male injury and occurs in a younger age group compared to the Proximal Biceps Rupture. It is important to distinguish these injuries as their management and outcomes are different. The mechanism and physical exam findings of Distal Biceps Tendon Rupture, such as the Hook Test, are key in this respect.</p> <p>Quadriceps Tendon Rupture is often misdiagnosed as a simple ‘knee sprain’, but should be consideration for surgical intervention. Quadriceps tendon ruptures are more commonly seen in patients older than 40 years and are more common than patella tendon ruptures which are more commonly seen in patients under 40 years of age. Interestingly, up to 1/3 of patients present with bilateral quadriceps tendon ruptures, so comparing to the contralateral knee may be misleading. There is a spectrum of knee extensor injuries that should be understood in order to provide proper care, with the Straight-Leg-Raise Test being abnormal in all of them. This is of the most important physical exam maneuvers to perform on every ED patient with a knee injury. The x-ray findings of these injuries may be subtle or absent, and proper immobilization of these injuries is important to prevent recoil of the tendon.</p> <p>Patients with calf pain and Gastrocnemius Tears are often misdiagnosed as having a DVT. In fact, one small study showed that gastrocnemius tears were misattributed to DVT in 29% of patients. This confusion occurs because sometimes patients who suffer a gastrocnemius tear report a prodrome of calf tightness several days before the injury, suggesting a potential chronic predisposition. With a good history and physical, and POCUS if you’re skilled at it, needless work-ups for DVT can be avoided.</p> <p>For well thought out approaches, pearls and pitfalls, to these 4 Commonly Missed Uncommon Orthopedic Injuries, listen to the podcast and read the rest of this blog post....</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-58-tendons-ligaments-missed-orthopedic-injuries/">Episode 58: Tendons and Ligaments – Commonly Missed Uncommon Orthopedic Injuries Part 2</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jan 20, 2015
Best Case Ever 31: Emergency Pericardiocentesis
9:34
<p>On this EM Cases Best Case Ever, Andrew Sloas, the brains behinds the fabulous PEM-ED podcast tells the tale of a pericardiocentesis gone bad and what he learned from it. Emergency pericardicentesis can be life saving, but it also carries risks. Dr. Sloas reviews the steps to take to ensure that the pericardiocentesis needle is the the correct place to minimize the risk of intubating the right ventricle of the heart. A discussion of errors of omission and ones of commission follows....</p> <p>[wpfilebase tag=file id=540 tpl=emc-play /]</p> <p>[wpfilebase tag=file id=541 tpl=emc-mp3 /]</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/emergency-pericardiocentesis/">Best Case Ever 31: Emergency Pericardiocentesis</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jan 14, 2015
Episode 57: The Stiell Sessions 2 – Update in Atrial Fibrillation 2014
29:39
<p>In this bonus EM Cases podcast, The Stiell Sessions 2, we have Dr. Ian Stiell discussing an update in Atrial Fibrillation 2014 management including the age-old question of rate control vs rhythm control, the new CHADS-65 algorithm for oral anticogulant therapy, the need to initiate anticoagulant therapy in the ED, the more aggressive use of the Ottawa Aggressive Protocol, the dangers of attempting to cardiovert unstable patients who are in permanent Atrial Fibrillation, the new 150 rule to help determine the likelihood of successful cardioversion and much more. Thanks to all the listeners who did the survey on clinical decision rules and the post-listen survey.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-57-stiell-sessions-2-update-atrial-fibrillation-2014/">Episode 57: The Stiell Sessions 2 – Update in Atrial Fibrillation 2014</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jan 01, 2015
Episode 56 The Stiell Sessions: Clinical Decision Rules and Risk Scales
59:24
<p>There are hundreds of clinical decision rules and risk scales published in the medical literature, some more widely adopted than others. Ian Stiell, the father of clinical decision rules, shares with us his views and experiences gained from co-creating some of the most influential CDRs and risk scales to date. He explains the criteria for developing a CDR, the steps to developing a valid CDR, how best to apply CDRs and risk scales to clinical practice, and the hot-off the-press new Ottawa COPD Risk Score and Ottawa Heart Failure Risk Score for helping you with disposition decisions. It turns out that in Canada, we discharge about two thirds of the acute decompensated heart failure patients that we see in the ED, while the US almost all patients with decompensated heart failure are admitted to hospital. Dr. Stiell's new risk scores may help physicians in Canada make safer disposition decisions while help physicians in the US avoid unnecessary admissions.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-56-stiell-sessions-clinical-decision-rules-risk-scales/">Episode 56 The Stiell Sessions: Clinical Decision Rules and Risk Scales</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Dec 30, 2014
Episode 55: Fluids in Sepsis, Post-intubation Analgesia and Sedation
51:42
<p>In this second part of the Weingart-Himmel Sessions on critical care pearls for the community ED on the EM Cases podcast, we discuss the many controversies and recent changes in fluid management in severe sepsis and septic shock. With the recently published ARISE trial, and some deviations from Early Goal Directed Therapy, we are changing the way we think about fluids in sepsis: the type of fluid, the volume of fluid, the rate of fluid administration, the timing of introducing vasopressors and the goals of fluid resuscitation. In the next section of the podcast we discuss the PAD mnemonic for post-intubation analgesia and sedation, the prevention of delirium, and medication choices to minimize time on the ventilator, and improve prognosis.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-55-weingart-himmel-sessions-2-fluids-in-sepsis-post-intubation-analgesia-sedation/">Episode 55: Fluids in Sepsis, Post-intubation Analgesia and Sedation</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Dec 17, 2014
Journal Jam 2: Small Bore Chest Tube and Outpatient Management of Pneumothorax
34:29
<p>It makes sense that the treatment of primary spnontaneous pneumothorax would lend itself well to outpatient management, since patients are usually young and otherwise healthy, and the mortality and morbidity from these air leaks are really very low. Most patients would rather be managed as an outpatient rather than admitted to hospital and sending these patients home would probably end up saving the system resources and money. In this month's Journal Jam Podcast on small bore chest tube and outpatient management of pneumothorax, the highlighted article that Anton Helman and Teresa Chan discuss is Voison et al. on the “Ambulatory Management of Large Spontaneous Pneumothorax With Pigtail Catheters.” We hear from Michelle Lin, Seth Trueger, Heather Murray and the lead author himself, Stephan Jouneau. Questions posed include: In what ways is the use of small bore catheters with Heimlich valves for spontaneous pneumothorax better than needle aspiration? Is it necessary to repeat a CXR after placement of the catheter? Who should follow up these patients after they are discharged from the hospital? How can we minimize kinking and dislodgement of the catheter? and many more.....</p> <p>[wpfilebase tag=file id=523 tpl=emc-play /]</p> <p>[wpfilebase tag=file id=524 tpl=emc-mp3 /]</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/journal-jam-2-small-bore-chest-tube-pneumothorax/">Journal Jam 2: Small Bore Chest Tube and Outpatient Management of Pneumothorax</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Dec 09, 2014
Episode 54: Preoxygenation and Delayed Sequence Intubation
46:52
<p>Hot on the heels of Dr. Weingart's latest publication in the Annal of EM on Preoxygenation & Delayed Sequence Intubation, we have Dr. Weingart, perhaps the world's most influential critical care educator, and Dr. Walter Himmel, 'The Walking Encyclopedia of EM' discussing how the community ED doc can use preoxygenation, apneic oxygenation and delayed sequence intubation to help improve airway management knowledge and skills. Whether you work in a rural setting or a big urban community hospital, Dr. Himmel and Dr. Weingart explain how these concepts and skills are easily adaptable to your work environment. We introduce the Triple 15 Rule for preoxygenation as a memory aid that will help you the next time you're faced with a critically ill patient who's oxygen saturation isn't good enough on a non-rebreather.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-54-weingart-himmel-sessions-preoxygenation-delayed-sequence-intubation/">Episode 54: Preoxygenation and Delayed Sequence Intubation</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Nov 25, 2014
Best Case Ever 30 Rob Rogers’ Mother
19:39
<p>I caught up with my friend and education innovation mentor Dr. Rob Rogers at ACEP in Chicago where he told me the tale of his mother's devastating illness - the only EM Cases occurrence of a second Best Case Ever. This powerful story begs many questions, some of which we discuss in the podcast: The importance of considering a lumbar puncture in the setting of altered mental status NYD, cognitive de-biasing strategies and the importance of being a humble patient advocate. We discuss a diagnosis that we should never miss in the ED, how to recognize it early, some pearls and pitfals, as well as how to manage it effectively. We touch how to recover from personal tragedy in anticipation of his upcoming SMACC talk in June 2015. Enough of this.....listen.</p> <p>[wpfilebase tag=file id=517 tpl=emc-play /]</p> <p>[wpfilebase tag=file id=518 tpl=emc-mp3 /]</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-30-rob-rogers-mother/">Best Case Ever 30 Rob Rogers’ Mother</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Nov 18, 2014
Episode 53 Pediatric POCUS
1:04:21
<p>In this Episode, a follow up to Episode 18 Point of Care Ultrasound Pearls and Pitfalls, which covered pericardial effusion, pneumothorax, undifferentiated shock, cardiac arrest & DVT, we bring you 4 of North America’s Pediatric Point of Care Ultrasound gurus recorded live from Toronto during the first ever P2 Conference (PEM POCUS) - Pediatric Emergency Medicine Point of Care Ultrasound.</p> <p>The format will be a bit different for this episode. I’ve asked each our P2 gurus to describe a case that illustrates their favorite point of care ultrasound application, why they think it is useful, how it improves patient care, a step by step description of how to perform the application, the pearls and pitfalls of the application, and bit about what the literature says about the application. Dr. Jason Fischer on ultrasound-guided nerve blocks, Dr. Alyssa Abo on pediatric lung POCUS, Dr. Adam Sivitz on pediatric appendicitis POCUS and Dr. Alex Arroyo on intussesception.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-52-pediatric-pocus/">Episode 53 Pediatric POCUS</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Nov 05, 2014
A Rational Approach to Emergency Ebola Preparedness
15:31
<p>In this special 15 minute EM Cases podcast on Ebola preparedness we bring you an interview with Professor Howard Ovens, the director of emergency medicine at Mount Sinai Hospital in Toronto. As an EM physician who took care of many SARS patients and the chief of the ED during the SARS outbreak, Dr. Ovens has a very rational approach to how to prepare our emergency departments for patients who present with fever who have been traveling in an Ebola outbreak region, including triaging and personal protective equipment (PPE).</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/emergency-ebola-preparedness/">A Rational Approach to Emergency Ebola Preparedness</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Oct 21, 2014
Episode 52: Commonly Missed Uncommon Orthopedic Injuries
53:04
<p>We rarely discuss medico-legal issues on EM Cases because it misguides us a bit from good patient centered care – which is what emergency medicine is really all about.</p> <p>Nonetheless, missed orthopedic injuries are the most common reason for an emergency doc to be sued in Canada. This is partly because missed orthopedic injuries are far more common than missed MIs for example, but it’s also because it’s easy to miss certain orthopedic injuries – especially the ones that aren’t super common. And orthopedics is difficult to learn and remember for the EM practitioner as there are so many injuries to remember.</p> <p>And so, you guessed it – on this episode we’re going to run through some key not-so-common, easy to miss orthopedic injuries, some of which I, personally had to learn about the hard way, if you know what I mean.</p> <p>After listening to this episode, try some cognitive forcing strategies – for every patient with a FOOSH that you see, look for and document a DRUJ injury. Wait, hold on….I don’t wanna give it all away at the top of the post.</p> <p>Let’s hear what EM doc and sports medicine guru Ivy Cheng, and the orthopedic surgeon who everyone at North York General turns to when they need help with a difficult ortho case, Hossein Medhian, have to say about Commonly Missed Uncommon Orthopedic Injuries.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-52-commonly-missed-uncommon-orthopedic-injuries/">Episode 52: Commonly Missed Uncommon Orthopedic Injuries</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Oct 13, 2014
Episode 51 Effective Patient Communication – Managing Difficult Patients
1:06:55
<p>If you believe that coping with some of the people we deal with in emergency medicine is difficult or impossible, you’re not alone. We all feel this way from time to time. Managing difficult patients can be a challenge to the health care provider and to the entire ED. The hostile aggressive patient, the demanding patient, the know-it-all, the excessively anxious patient, and the incessant complainer, are some of the folks that we need to know how to manage effectively. If we fail to handle these patients appropriately, they may receive suboptimal care, grind patient flow to a halt, and delay care of other patients. If the staff has to deal with a multitude of these patients on a given shift, there’s a sort of swarm-based escalation in frustration and sometimes, unfortunately, a total breakdown of effective patient communication and care.</p> <p>But don't fret. In this one-of-a-kind podcast on effective patient communication and managing difficult patients, Dr. Walter Himmel, Dr. Jean-Pierre Champagne and RN Ann Shook take us through specific strategies, based on both the medical and non-medical literature, on how we can effectively manage these challenging patients. As a bonus, we address the difficult situation of breaking bad news with a simple mnemonic and discuss tips on how to deliver effective discharge instructions to help improve outcomes once your patient leave the ED.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-51-effective-patient-communication-managing-difficult-patients/">Episode 51 Effective Patient Communication – Managing Difficult Patients</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Sep 30, 2014
Best Case Ever 29: Drug Induced Aseptic Meningitis
9:52
<p>Dr. David Carr presents his third of EM Cases' Carr's Cases. This series features potentially debilitating diagnoses that may be thought of as 'zebras', but actually have a higher incidence then we might think - and if diagnosed early, can significantly effect patient outcomes. Dr. Carr tells the story of young woman with an MRSA supra pateller abscess who was put on trimethoprim sulfamethoxazole and presents looking very ill with a severe headache.</p> <p>Not only has trimethoprim sulfamethoxazole been implicated in aseptic meningitis, but NSAIDS, immunomodulators and antibiotics have also been implicated. The reason this is so important for ED practitioners to know, is that case reports of drug-induced aseptic meningitis have shown that symptoms will resolve completely within 24 hours, once the offending drug has been stopped. Not only that, but if the patient receives the drug again in the future, they are at risk for a more severe case of drug induced aseptic meningitis.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-29-carrs-cases-drug-induced-aseptic-meningitis/">Best Case Ever 29: Drug Induced Aseptic Meningitis</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Sep 23, 2014
Journal Jam 1: Age Adjusted D-dimer with Jeff Kline and Jonathan Kirschner
34:29
<p>In this first ever episode of the Journal Jam podcast, a collaboration between EM Cases, Academic Life in EM and The Annals of Emergency Medicine's Global Emergency Medicine Journal Club, Teresa Chan and I, along with Jeff Kline, Jonathan Kirschner, Anand Swaminathan, Salim Rezaie and Sam Shaikh from ALiEM, discuss the potential for Age Adjusted D-dimer to rule out pulmonary embolism in low risk patients over the age of 50.</p> <p>We discuss 4 key questions about the ADJUST-PE Study from JAMA in March 2014 including: Would you order a CTPA on a 60 year old woman with an age adjusted D-dimer of 590 ng/L?</p> <p>The problem until now has been that the older the patient, the more likely the D-dimer is to be positive whether they have a PE or not, so many of us have thrown the D-dimer out the window in older patients and go straight to CTPA, even in low risk patients. If you are a risk averse doc, this strategy will lead to over-utilization of resources, huge costs, length of stay, radiation effects etc; and if you’re not so risk averse, then you might decide not to work up the low risk older patient at all and miss clinically important PEs.</p> <p>expert peer reviewFor all the questions discussed on this podcast, the original Google Hangout interview from which this podcast was based, and the crowd sourced opinions from around world, visit the ALiEM website. Many thanks to all the talented people who made this podcast possible. Together, we're smarter!</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/journal-jam-1-age-adjusted-d-dimer-jeff-kline-jonathan-kirschner/">Journal Jam 1: Age Adjusted D-dimer with Jeff Kline and Jonathan Kirschner</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Sep 15, 2014
Episode 50 Recognition and Management of Pediatric Sepsis and Septic Shock
37:35
<p>Kids aren't little adults. Pediatric sepsis and septic shock usually presents as 'cold shock' where as adult septic shock usually presents as 'warm shock', for example. In this episode, a continuation of our discussion on Fever from with Ottawa PEM experts, Sarah Reid and Gina Neto, we discuss the pearls and pitfalls in the recognition and management of pediatric sepsis and septic shock. We review the subtle clinical findings that will help you pick up septic shock before it's too late as well as key maneuvers and algorithms to stabilize these patients. We cover tips for using IO in children, induction agents of choice, timing of intubation, ionotropes of choice, the indications for steroids in septic shock, and much more.....</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-50-recognition-management-pediatric-sepsis-septic-shock/">Episode 50 Recognition and Management of Pediatric Sepsis and Septic Shock</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Aug 26, 2014
Episode 49 Effective Patient Communication, Patient Centered Care and Patient Satisfaction
1:14:22
<p>If you believe that coping with some of the people we deal with in emergency medicine is difficult or impossible, you’re not alone. We all feel this way from time to time. We all work in stressful environments where it may feel as though we have too little time for effective patient communication, patient centered care and patient satisfaction. You and your patients may often have mismatched views of what’s important. You may have a specific medical agenda and they might have a very different agenda.</p> <p>Then there’s the difficult patient – we all know who these people are – the hostile aggressive patient, the demanding patient, the know-it-all, the excessively anxious patient, and the incessant complainer, among others. If we don’t know how to handle these patients appropriately, they may receive suboptimal care, grind patient flow to a halt, and delay care of other patients. And of course, if the staff has to deal with a multitude of these patients on a given shift, there’s a sort of swarm-based escalation in frustration and sometimes, unfortunately, a total breakdown of effective care. These frustrations don’t only come out when we’re presented with multiple sequential difficult patients, but for some of us, the more we practice, the more we become desensitized to the needs of all of our patients and their families and, we run the risk of destroying the doctor-patient relationship, as well as making most of our patient interactions frustrating, unsatisfying, – even detrimental to our health and the outcomes of our patients.</p> <p>How you communicate in the ED can improve patient outcomes and enhance job satisfaction, yet there is little education on patient centered care for EM practitioners. After listening to this episode, it is my hope that what you learn from the literature and from expert opinion,and then apply to the way you communicate with your patients, will effectively make you a happier health care professional.</p> <p>Dr.Walter Himmel, Dr. Jean Pierre Champagne and RN Ann Shook guide us in this round table discussion on effective patient communication, patient centered care and patient satisfaction – this has evolved my practice into what I perceive as a higher level of personal satisfaction as well as patient care….I hope it will do the same for you.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-49-patient-centered-care/">Episode 49 Effective Patient Communication, Patient Centered Care and Patient Satisfaction</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Aug 11, 2014
Best Case Ever 28: Anti-NMDA Receptor Encephalitis
13:31
<p>Dr. David Carr presents his second of Carr's Cases. This series features some potentially life-threatening diagnoses that may be perceived as zebras, but actually have a higher incidence then we might think - and if diagnosed early, can significantly effect patient outcomes. This Best Case Ever is about Anti-NMDA Receptor Encephalitis, a diagnosis that was only discovered in 2005, and has only recently been recognized by the Emergency Medicine community. Anti-NMDA Receptor Encephalitis may mimic a first presentation of schizophrenia or Neuraleptic Malignant Syndrome. It may present with seizure, altered mental status, autonomic instability or movement disorder in the absence of drug exposure. When you are faced with any of these presentations and no other diagnosis seems to fit, do an LP and send the CSF for anti-NMDA receptor antibodies. The time-sensitive treatment is IVIG and steroids. Anti-NMDA receptor Encephalitis is a must know diagnosis for all emergency medicine practitioners. Learn how to pick up this important diagnosis by listening to Dr. Carr's Best Case Ever and following the links to further resources.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-28-david-carr-anti-nmda-receptor-encephalitis/">Best Case Ever 28: Anti-NMDA Receptor Encephalitis</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Aug 06, 2014
Episode 48 – Pediatric Fever Without A Source
1:14:16
<p>Have you ever seen a child in your emergency department with a fever - he asks sarcastically? At the ginormous community hospital where I work, we see about 25,000 kids each year in our ED and about half of them present with fever. Yes, there still exists fever phobia in our society, which brings hoards of worried parents into the ED with their febrile kids. For most of these kids it's relatively straight forward: Most kids with fever have clinical evidence of an identifiable source of infection – a viral respiratory infection, acute otitis media, gastro, or a viral exanthem. However, about 20% have Fever Without a Source despite your thorough history and physical exam.</p> <p>A small but significant number of this 20% without an identifiable source of fever will have an occult bacterial infection - UTI, bacteremia, pneumonia, or even the dreaded early bacterial meningitis. These are all defined as Serious Bacterial Infections (SBI), with occult UTI being the most common SBI especially in children under the age of 2 years.</p> <p>In the old days we used to do a full septic work-up including LP for all infants under the age of 3 months, but thankfully, times have changed in the post-Hib and pneumoccocal vaccine age, and we aren’t quite so aggressive any more with our work-ups. Nonetheless, it's still controversial as to which kids need a full septic workup, which kids need a partial septic workup, which kids need just a urine dip and which kids need little except to reassure the parents.</p> <p>In this episode, with the help of Dr. Sarah Reid and Dr. Gina Neto from the Children's Hospital of Eastern Ontario, we will elucidate how to deal with fever phobia, when a rectal temp is necessary, how to pick out the kids with fever that we need to worry about, how to work up kids with fever depending on their age, risk factors and clinical picture, who needs a urinalysis, who needs a CXR, who needs blood cultures and who needs an LP, and much more....</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-48-pediatric-fever-without-source/">Episode 48 – Pediatric Fever Without A Source</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jul 23, 2014
Best Case Ever 27: Pediatric Shock
6:19
<p>Ottawa this year, I had the pleasure of discussing pediatric shock and sepsis with Dr. Sarah Reid, a good medical school friend of mine from the Gretzky Year ('99) graduating class. I knew back then that she was heading for PEM educator stardom. Lo and behold, she is the now the director of CME at the Children's Hospital of Eastern Ontario and a national PEM speaker extraordinaire. After recording an eye-opening session on Pediatric Fever Without a Source and Pediatric Sepsis, she told me the story of her Best Case Ever where the initial presumptive diagnosis was sepsis.</p> <p>Maximize your learning and submit your questions on 'Pediatric Fever Without a Source' on the Next Time on EM Cases page.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-27-sarah-reid-pediatric-shock/">Best Case Ever 27: Pediatric Shock</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jul 16, 2014
Episode 47: Evidence Based Medicine from NYGH EMU Conference 2014
48:53
<p>Dr. Walter Himmel (the 'walking encyclopedia of EM') gave a fantastic talk from North York General's Emergency Medicine Update Conference in Toronto, which have edited into a podcast with key commentary and summaries. Dr. Himmel eloquently shows us, through absolutely stunning personal cases, how evidence based medicine can be appropriately or inappropriately applied in real practice, resulting in major outcome differences for your patients. He elucidates the importance of clinical experience, patient values and ED resources in helping apply the medical literature to your practice. He reviews the essence of critical appraisal, the hierarchy of evidence and how to keep up with the emergency medicine literature. The famous NINDS thrombolysis for stroke trial is distilled down to a few key considerations and the NEJM transfusion for upper GI bleed trial from last year is dissected, analyzed and then applied to Dr. Himmel's personal cases, to help us understand exactly how to apply the literature to our daily practice.</p> <p>Blog post and written summary prepared by Keerat Grewal, edited by Anton Helman July 2014</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-47-walter-himmel-evidence-based-medicine-nygh-emu-conference-2014/">Episode 47: Evidence Based Medicine from NYGH EMU Conference 2014</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jul 08, 2014
Best Case Ever 26: Chloral Hydrate Poisoning and Cardiac Arrest
9:07
<p>I met up with Mike Betzner at North York General's Update in EM Conference in Toronto. He is the medical director of Air Transport STARS air ambulance out of Calgary and an amazing speaker on the national lecturing circuit. His Best Case Ever on Chloral Hydrate poisoning & cardiac arrest describes a young man in cardiac arrest with resistant Ventricular Fibrillation and Torsades de Pointes. There is only one class of drugs that can get him back into normal sinus rhythm. Dr. Betzner describes how he recognized that this patient was suffering from Chloral Hydrate poisoning and how he saved his life with one simple intervention.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-26-mike-betzner-chloral-hydrate-poisoning-cardiac-arrest/">Best Case Ever 26: Chloral Hydrate Poisoning and Cardiac Arrest</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jul 03, 2014
Episode 46 – Social Media and Emergency Medicine Learning
1:10:28
<p>In early June of this year I caught up with Dr. Rob Rogers of iTeach EM and The Teaching Course, Dr. Ken Milne of The Skeptics Guide to EM and Dr. Brent Thoma of Academic Life in EM and Boring EM at the Canadian Association of Emergency Medicine Conference in Ottawa to chat about the evolution of Social Media & Emergency Medicine Learning. In this podcast, we discuss how Social Media can enhance your career, tips on how to get the most out of FOAMed without getting overwhelmed by the volume of material, swarm-based medicine, tacit knowledge sharing, the flipped classroom, the use of FOAMed in emergency medicine training curricula, how Twitter, Google+, Google Hangout and Google Glass have changed the face of medical education, and much more.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-46-social-media-emergency-medicine-learning/">Episode 46 – Social Media and Emergency Medicine Learning</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jun 24, 2014
Best Case Ever 25: Social Media in EM Education
6:28
<p>One of Emergency Medicine's most cutting edge educators Dr. Rob Rogers, the brains behind iTeach EM podcast & blog as well as the director of The Teaching Course tells us the story of his Best Case Ever where he used Social Media as an EM Education tool that led to a life saved and a difficult diagnostic pick-up. In the upcoming episode on Social Media (SoMe) in EM education and FOAMed (Free Open Access Medical Education) with three prominent educators in the FOAM movement, Brent Thoma of Boring EM and Academic Life in EM, Ken Milne of The Skeptics Guide to EM & Rob Rogers, we discuss how SoMe can enhance your career, tips on how to get the most out of FOAMed without getting overwhelmed by the volume of material, swarm-based medicine, tacit knowledge sharing, the flipped classroom, the use of FOAMed in emergency medicine training curricula, how Twitter, Google+, Google Hangout and Google Glass have changed the face of medical education, and much more. To have your questions about SoMe and FOAMed answered by our guest experts and find key references go here.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-25-rob-rogers-social-media-em-education/">Best Case Ever 25: Social Media in EM Education</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jun 18, 2014
Episode 45: NYGH EM Update Conference 2014
1:01:40
<p>This past May in Toronto, the largest and, in my opinion, best Canadian EM conference, North York General Hospital's Emergency Medicine Update Conference, attracted 'Captain Cortex' himself, Stuart Swadron, a Toronto native to talk about his approach to vertigo, which highlights how not to miss a posterior circulation stroke. For the seventh year running the EMU conference was proud to have one of the worlds most well known EM educators, Amal Mattu who presented the most important Cardiology Literature from the past year. This podcast includes edited versions of their talks with commentary and summaries.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-45-swadron-vertigo-mattu-cardiology-literature-em-update-2014/">Episode 45: NYGH EM Update Conference 2014</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jun 06, 2014
Best Case Ever 24: COPD, Baggging and Vent Settings
17:51
<p>In anticipation of the Highlights from North York General's Emergency Medicine Update Conference 2014 we have the master educator himself, Dr. Amal Mattu's Best Case ever of a patient who presented with a COPD exacerbation, that we recorded at the conference in Toronto just a couple of weeks ago. Dr. Mattu gives you a string of pearls and pitfalls when it comes to management of COPD, bagging & vent settings that you will never forget. In the upcoming episode Dr. Mattu will review his favorite papers from the cardiology literature of the past year and Dr. Stuart Swadron will give you his approach to the challenges of the patient with vertigo. This will the first of two parts of the highlights from the conference - the largest and best EM conference in Canada.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-24-amal-mattu-copd-bagggin-vent-settings/">Best Case Ever 24: COPD, Baggging and Vent Settings</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
May 27, 2014
Best Case Ever 23: The Effect of Medical Insurance on ED Care
11:43
<p>EM Cases brings you Canada's brightest minds in Emergency Medicine. Dr. Stuart Swadron, EM:RAP's 'Captain Cortex' in fact went to medical school at the University of Toronto and practiced in British Columbia before he headed down to Los Angeles to complete his Emergency Medicine Residency and become the residency program director at USC. So he is just the man to tell us his Best Case Ever about The Effect of Medical Insurance on ED Care and highlight some of the differences between the U.S. and Canadian health care systems. This is in anticipation of our upcoming EM Cases episode on North York General's 'Highlights of the Emergency Medicine Update Conference 2014', Canada's largest and best EM Conference where Dr. Swadron spoke eloquently about his approach to Vertigo in the ED including the value of the HINTS exam. In this upcoming episode we will also have Dr. Amal Mattu talking about the most important Cardiology Literature from the past year. We would love to hear your opinion on how the Canadian and U.S. health care systems could be changed to help improve patient care in our emergency departments. Please post your comments below.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-23-stuart-swadron-effect-medical-insurance-ed-care/">Best Case Ever 23: The Effect of Medical Insurance on ED Care</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
May 19, 2014
Episode 44 – Whistler Update in Emergency Medicine Conference 2014
1:30:06
<p>In this episode on Whistler's Update in Emergency Medicine Conference 2014 Highlights we have... Chapter 1 with David Carr on his approach to Shock, including the RUSH protocol, followed by a discussion on Thrombolysis for Submassive Pulmonary Embolism.... Then in Chapter 2 Lisa Thurgur presents a series of Toxicology Cases packed with pearls, pitfalls and surprises and reviews the use of Lipid Emulsion Therapy in toxicology....Finally in Chapter 3 Joel Yaphe reviews the most important articles from 2013 including the Targeted Temperature Managment post-arrest paper, the use of Tranexamic Acid for epistaxis, return to play concussion guidelines and clinical decision rules for subarachnoid hemorrhage. Another Whistler's Update in Emergency Medicine Conference to remember.......</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-44-whistlers-update-in-emergency-medicine-conference-2014-highlights/">Episode 44 – Whistler Update in Emergency Medicine Conference 2014</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
May 13, 2014
Best Case Ever 22: Nonconvulsive Status Epilepticus (NCSE)
8:39
<p>In the first of our series on Best Case Ever of 'Carr's Cases' we have, the legend himself, Dr. David Carr. This series will run on the theme of interesting diagnoses that we don't think of too often, but that are not as rare as we might think and can make a significant difference to your patient's outcome if you pick up on them early - and maybe even make you look as smart as David! Dr. Carr will be highlighted in our upcoming episode on Whistler's Update in EM Conference highlights 2014 when he will be speaking about his approach to the shocky patient as well as the controversial management of submassive pulmonary embolism. He will be featured along with Dr. Lisa Thurgur speaking about lipid emulsion therapy and other toxicologic goodies and Joel Yaphe will give us his take on the best of the EM literature from 2013 including the TTM trial, tranexamic acid for epistaxis, return to sport after concussion guidelines and more. Please go to the 'Next Time on EM Cases' page to submit your question about these topics.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-22-nonconvulsive-status-epilepticus-ncse/">Best Case Ever 22: Nonconvulsive Status Epilepticus (NCSE)</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
May 05, 2014
Episode 43 – Appendicitis Controversies
1:12:22
<p>In this episode on Appendicitis Controversies, we have the continuation of our discussion on abdominal pain emergencies with Dr. Brian Steinhart & Dr. David Dushenski. We kick off the discussion with key clinical pearls and pitfalls in the history and physical exam with their respective liklihood ratios when assessing patients with abdominal pain for appendicitis - a diagnosis that is still sometimes missed despite its prevalence. Dr. Dushenski hacks apart the Alvarado and Appendicitis Inflammatory Response Scores and we discuss the value of WBC, CRP and urinalysis in the work-up of appendicitis. Next up are the controversies of imaging algorithms using ultrasound and CT abdomen, as well as the factors affecting which imaging algorithm you might pursue. We wrap up the discussion on Appendicitis Controversies with a critical look at the value of antibiotics in the ED for appendicitis and which patients might be appropriate for non-surgical management.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-43-appendicitis-controversies/">Episode 43 – Appendicitis Controversies</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Apr 22, 2014
Episode 42: Mesenteric Ischemia and Pancreatitis
1:23:20
<p>In this episode Dr. Steinhart, (one of my biggest mentors – the doc that everyone turns to when no one can figure out what’s going on with a patient in the ED), & Dr. Dave Dushenski, (a master of quality assurance and data analysis, who would give David Newman a run for his money), discuss the 4 diagnoses that make up the deadly & difficult diagnosis of Mesenteric Ischemia, it’s key historical and physical exam features, the value of serum lactate, D-dimer & blood gas, when CT can be misleading, ED management of Mesenteric Ischemia, the difficult post-ERCP abdominal pain patient, the pitfalls in management of Pancreatitis, the BISAP score for Pancreatitis compared to the APACHE ll & Ranson Score, the comparative value of amylase and lipase, ultrasound vs CT for pancreatitis and much more…</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-42-mesenteric-ischemia-pancreatitis-3/">Episode 42: Mesenteric Ischemia and Pancreatitis</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Mar 29, 2014
Best Case Ever 21 Abdominal Pain – Thinking Outside the Box
8:58
<p>As a bonus to Episode 42 on Mesenteric Ischemia & Pancreatitis, Dr. Brian Steinhart presents his Best Case Ever of Abodominal Pain – Thinking Outside the Box. While about 10% of abdominal pain presentations to the ED are surgical, there are a variety of abdominal pain presentations that have diagnoses outside the abdomen – so one needs to be thinking outside the box. In the related episode, Dr. Steinhart, (one of my biggest mentors – the doc that everyone turns to when no one can figure out what’s going on with a patient in the ED), & Dr. Dave Dushenski, (a master of quality assurance and data analysis, who would give David Newman a run for his money), discuss the 4 diagnoses that make up the deadly & difficult diagnosis of Mesenteric Ischemia, it’s key historical and physical exam features, the value of serum lactate, D-dimer & blood gas, when CT can be misleading, ED management of Mesenteric Ischemia, the difficult post-ERCP abdominal pain patient, the pitfalls in management of Pancreatitis, the BISAP score for Pancreatitis compared to the APACHE ll & Ranson Score, the comparative value of amylase and lipase, ultrasound vs CT for pancreatitis and much more…</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-21-abdominal-pain-thinking-outside-box/">Best Case Ever 21 Abdominal Pain – Thinking Outside the Box</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Mar 26, 2014
Episode 41: Hypertensive Emergencies
1:08:39
<p>In this episode on Hypertensive Emergencies, Dr. Joel Yaphe, EM residency program director at the University of Toronto & Dr. Clare Atzema, one of Canada's leading cardiovascular EM researchers will discuss the controversies of how to manage patients who present to the ED with high blood pressure and evidence of end organ damage related to the high blood pressure. Hypertensive emergencies are a grab bag of diagnoses that all need to be treated differently. Hypertensive Encephalopathy, Aortic Dissection, Acute Pulmonary Edema, Pre-eclampsia & Eclampsia, Acute Renal Failure, Subarachnoid Hemorrhage and Intracranial Hemorrhage all need individualized blood pressure management.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-41-hypertensive-emergencies/">Episode 41: Hypertensive Emergencies</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Mar 24, 2014
Episode 40: Asymptomatic Hypertension
1:10:10
<p>University of Toronto EM Residency program director, Joel Yaphe and cardiovascular EM researcher, Clare Atzema discuss the guidelines, controversies, pearls & pitfalls of Asymptomatic Hypertension in the ED. The literature is thin in this area, and there are many controversies: Does an elevated BP measured in the ED represent true essential hypertension? Do these patients need to be worked up? Are they at risk of serious morbidity and mortality? Should we treat these patients in the ED with antihypertensives? Should we send them home on antihypertensives? and many more......</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/asymptomatic-hypertension-2/">Episode 40: Asymptomatic Hypertension</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Feb 20, 2014
Episode 39: Update in Trauma Literature
2:27:54
<p>Dr. Dave MacKinnon & Dr. Mike Brzozowski return for an Update in Trauma Literature since the epic Episode 10: Trauma Pearls & Pitfalls. In this episode we discuss predicting the sick trauma patient, videolaryngoscopy vs traditional laryngoscopy, Damage Control Resuscitation, Occult Hemothorax, Blunt Thoracic Aorta and Cardiac Injury, Sternal Fractures, Tranexamic Acid, Communication in the trauma bay and much more......</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-39-update-trauma-literature/">Episode 39: Update in Trauma Literature</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Feb 04, 2014
Best Case Ever 20: CPR in Trauma
5:30
<p>BEST CASE EVER 20: CPR in Trauma?!?! Closed Chest Compressions in Traumatic Arrest?!?! Is CPR ever successful in the trauma patient? Dr. Dave MacKinnon, Trauma Team Leader at St. Michael's Hospital in Toronto, gives you his Best Case Ever in the cardiac arrest trauma patient.</p> <p>The literature is full of case series of zero survival in trauma patients requiring CPR. For example, this report in CJEM. Normally, we should not be thinking of CPR in traumatic arrests, but instead, ED thoracotomy as Scott Weingart of emcrit describes in his podast 36 - Traumatic Arrest. But just wait until you here Dave's Best Case Ever..........</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-20-cpr-in-trauma/">Best Case Ever 20: CPR in Trauma</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Dec 03, 2013
Episode 38: ENT Emergencies Pearls, Pitfalls, Tips and Tricks
2:29:32
<p>Dr. Leeor Sommer who runs ENT hands-on workshops and Dr. Maria Ivankovic, lecturer extraordinaire on ENT emergencies discuss ENT Emergencies Pearls, Pitfalls, Tips & Tricks:</p> <p>Dr. Ivankovic's stepwise approach to managing epistaxis including the best local anesthetics, the use of ice to decrease nasal flow, who requires antibiotics, the management of hypertension in epistaxis, tranexamic acid for nose bleeds and managing posterior bleeds, tips for nasal and ear foreign body removal including the use of tissue adhesive, how to pick up and work up the dreaded Malignant Otitis Externa including key diagnostic pearls the best tests, sudden sensorineural hearing loss ('The Bells' Palsy of the Ear') including how to save a patient from losing their hearing, Epiglottitis including diagnostic clues and imaging findings, Pharyngitis work-up and treatment: Do we need to work-up and treat with antibiotics at all? & The Toronto Throat Score, Tips and Tricks for peritonsillar abscess drainage, Hereditary and ACE-inhibitor associated Angioedema presentations and management including the use of C1 Esterase inhibitors.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/ent-emergencies/">Episode 38: ENT Emergencies Pearls, Pitfalls, Tips and Tricks</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Nov 19, 2013
Best Case Ever 19: Extubation in the ED
5:09
<p>Dr. Leeor Sommer,who runs annual ENT workshops in Toronto give us his Best Case Ever involving an Extubation in the ED gone bad. In the related Episode 38 - ENT Emergencies - Pearls & Pitfalls, Tips & Tricks, Dr. Leeor Sommer and Dr. Maria Ivankovic, lecturer extrodinaire on ENT emergencies discuss: Dr. Ivankovic's stepwise approach to managing epistaxis, Tips for nasal and ear foreign body removal, How to pick up and work up the dreaded Malignant Otitis Externa, Sudden sensorineural hearing loss ('The Bells' Palsy of the Ear'), Epiglottitis work-up and management, Pharyngitis work-up and treatment - Does anyone with phayrngitis need antibiotics?, Tips and Tricks for peritonsillar abscess drainage, Hereditary and ACE-inhibitor associated Angioedema presentations and management.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/bce-19-extubation-in-ed/">Best Case Ever 19: Extubation in the ED</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Nov 12, 2013
Episode 37: Anticoagulants, PCCs and Platelets
1:41:03
<p>In the second part of this epic 2-part authoritative episode, Anticoagulants, PCCs & Platelets, we have Dr. Walter Himmel (also known as 'The walking encyclopedia of EM') along with Dr. Katerina Pavenski (Head of Transfusion Medicine at St. Michael's Hospital) & Dr. Jeannie Callum (Head of Transfusion Medicine at Sunnybrook Hospital) who will discuss the latest on comparative efficacy and reversal of Warfarin vs Dabigatran vs Rivaroxiban vs Abixaban, the use of prothrombin complex concentrates (PCCs), the ins and outs of thrombocytopenia & platelet transfusions, ITP, TTP, anti-platelet associated intracranial bleeds, indications for Tranexamic Acid & more...</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-37-transfusions-anticoagulants-bleeding-p2/">Episode 37: Anticoagulants, PCCs and Platelets</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Oct 08, 2013
Episode 36: Transfusions, Anticoagulants and Bleeding
1:28:18
<p>In the first part of this epic 2 part must-hear episode, Transfusions, Anticoagulants & Bleeding, we have the triumphant return of Dr. Walter Himmel (also known as 'The walking encyclopedia of EM') along with Dr. Katerina Pavenski (Head of Transfusion Medicine at St. Michael's Hospital) & Dr. Jeannie Callum (Head of Transfusion Medicine at Sunnybrook Hospital) who will update you on the latest in transfusion indications & risks, managing INRs and how Wararin compares to Dabigatran, Rivaroxiban & Apixaban. They give you the authoritative low down on: Indications for red cell transfusions in different clinical scenarios (GI bleed, cardiac disease, vaginal bleeding etc) and how to give them, Risks of red cell transfusions including Host vs Graft Disease, TRALI & TACO and how to manage them, IV Iron as an alternative to red cell transfusions, Managing INRs: indications for Vit K, Prothrombin Complex Concentrates (Octaplex & Beriplex), adjusting Warfarin Dose, liver patients, and much much more.........</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-36-transfusions-anticoagulants-bleeding-part-1/">Episode 36: Transfusions, Anticoagulants and Bleeding</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Sep 20, 2013
Best Case Ever 18: Anticoagulant Reversal in Trauma
5:44
<p>Dr. Katerina Pavenski, on Anticoagulant Reversal in Trauma. A leader in Transfusion Medicine from St. Michael's Hospital, Dr. Pavenski tells us about her Best Case Ever in which a straight forward trauma case turns into a 'bloody disaster', after Prothrombin Complex Concentrates (PCCs) were given in an anticoagulant reversal attempt.</p> <p>In the related two-part epic episode on Antiocagulants, Transfusions & Bleeding, Drs. Pavenski, Dr. Jeannie Callum (Head of Transfusion Medicine at Sunnybrook Hospital & Dr. Walter Himmel (also known as 'The walking encyclopedia of EM') cover: Indications for red cell transfusion in different clinical scenarios (GI bleed, cardiac disease, vaginal bleeding etc), Risks of transfusion including Host vs Graft Disease, TRALI & TACO, Indications for Platelet transfusion in different scenarios (hyporoliferative patients vs ITP, invasive procedures with thrombocytopenia), Managing INRs - indications for Vit K, PCC, adjusting Warfarin Dose, liver patients, Apixaban vs Rivaroxiban vs Dabigatran vs Warfarin and reversal of them, Anti-platelet medication-associated intracranial hemorrhage management, Indications for Tranexamic Acid, and much more........</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-anticoagulant-reversal-in-trauma/">Best Case Ever 18: Anticoagulant Reversal in Trauma</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Sep 04, 2013
Episode 35: Pediatric Orthopedics Pearls and Pitfalls
2:19:54
<p>Dr. Sanjay Mehta & Dr. Jonathan Pirie, two experienced Pediatric EM docs from The Hospital for Sick Children in Toronto discuss their approach to a variety of common, occult, challenging and easy to miss pediatric orthopedics diagnoses including: differentiating Septic Arthritis from Transient Synovitis of the hip, Toddler's Fracture, Tillaux Fracture, Suprachondylar Fracture, ACL tear, tibial spine & Segond fractures. They also debate the value of the Ottawa Knee Rules in kids, non-accidental trauma, pediatric orthopedic pain management, the evidence for the best management of Buckle, Greenstick, Salter 1 and 2 distal radius fractures and lateral malleolus fractures.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episdode-35-pediatric-orthopedics/">Episode 35: Pediatric Orthopedics Pearls and Pitfalls</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Aug 09, 2013
Episode 34: Geriatric Emergency Medicine
1:45:59
<p>In this episode Dr. Don Melady, Canada's leading educator in Geriatric Emergency Medicine (Geri-EM) & Dr. Jaques Lee, one of Canada's leading researchers in Geri-EM, discuss the common yet challenging Geriatric Emergencies: a practical approach to geriatric Delirium, best practice for managing agitation and pain in the older patient, management of recurrent falls, pearls in the assessment of the 'Weak & Dizzy' geriatric patient, atypical presentations of common life threatening emergencies including ACS and surgical abdomen, key drug interactions in the geriatric patient and more..</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-34-geriatric-emergency-medicine/">Episode 34: Geriatric Emergency Medicine</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jul 08, 2013
Best Case Ever 17: Geriatric Emergency Medicine
5:28
<p>As a bonus to Episode 34 on Geriatric Emergency Medicine, Dr. Don Melady, one of Canada's leading educators in Geriatric EM, tells us about his Best Case Ever in which a simple fall turns out to be a multi-facited complicated case with a simple solution.</p> <p>In the related Episode 34 on Geriatric Emergency Medicine Dr. Melady and Dr. Jacques Lee cover an approach to geriatric Delirium, managing agitation, indications for CT head in the delirious older person, management of recurrent falls, pearls in the assessment of the 'Weak & Dizzy' geriatric patient, key drug interactions, pain management, atypical ACS and pearls in Geriatric abdominal pain presentations.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-17-don-melady-geriatric-emergency-medicine/">Best Case Ever 17: Geriatric Emergency Medicine</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jul 02, 2013
Episode 33: Oncologic Emergencies
1:31:20
<p>In this episode on Oncologic Emergencies Dr. John Foote (University of Toronto's CCFP(EM) residency program director) and Dr. Joel Yaphe (the director of the University of Toronto’s Annual Update in Emergency Medicine conference in Whistler), review 5 important presentations in the patient with cancer: fever, shortness of breath, altered mental status, back pain and acute renal failure; with specific attention to key cancer-related emergencies such as febrile neutropenia, hypercalcemia, superior vena cava syndrome, hyperviscosity syndrome and tumor lysis syndrome.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-33-oncologic-emergencies/">Episode 33: Oncologic Emergencies</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
May 22, 2013
Best Case Ever 16: Oncologic Emergencies
6:50
<p>As bonus to Episode 33 on oncologic emergencies, Dr. John Foote, the CCFP(EM) residency program director at the University of Toronto tells us about his Best Case Ever in which he missed an important cancer-related diagnosis.</p> <p>In the related episode with Dr. Foote and Dr. Joel Yaphe, we will review 5 common presentations in the patient with cancer: fever, shortness of breath, altered mental status, back pain and acute renal failure; with specific attention to key cancer-related emergencies such as febrile neutropenia, hypercalcemia, superior vena cava syndrome, hyperviscosity syndrome and tumor lysis syndrome.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-16-oncologic-emergencies/">Best Case Ever 16: Oncologic Emergencies</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
May 07, 2013
Episode 32: Whistler Update in Emergency Medicine Conference 2013
2:07:54
<p>Whistler's Update in Emergency Medicine Conference 2013 in Whistler, British Columbia is U of Toronto's case-based interactive small group EM conference. There were so may great talks with amazing clinical pearls that I decided to wade through the 18 hours of audio recordings and packaged some of the key highlights for you here......EM Literature Review 2012 by Dr. Joel Yaphe, Neonatal Resuscitation Pearls by Dr. Nicole Kester-Greene, Fever of Unknown Origin by Dr. Shirley Lee, Improving Cosmesis in Wound Management by Dr. Maria Ivankovic, Hepato-biliary Disease by Dr. Sara Gray, & Pediatric Cardiac & Respiratory Cases by Dr. Donna Goldenberg.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-32-whistlers-update-in-emergency-medicine-conference-2013/">Episode 32: Whistler Update in Emergency Medicine Conference 2013</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Apr 10, 2013
Episode 31: LP, Spontaneous Pneumothorax and Ultrasound Guided Fracture Reduction
1:07:50
<p>In this episode, Dr. Jordan Chenkin & Dr. Jamie Blicker discuss positioning, landmarking, and best technique for lumbar puncture, how to minimize post-LP headache and traumatic taps, as well as when CT head is not required prior to LP. They discuss the indications, contraindications, trouble-shooting and pros and cons of needle aspiration, small bore pleural catheter with Heimlich valve and large bore chest tube for the treatment of spontaneous pneumothorax. Dr. Chenkin presents an intriguing argument for why he uses ultrasound-guided fracture reduction routinely in the ED, and we end with a few tips and tricks using skin adhesive for some unorthodox indications.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-31-lumbar-puncture-spontaneous-pneumothorax-ultraound-guided-fracture-reduction/">Episode 31: LP, Spontaneous Pneumothorax and Ultrasound Guided Fracture Reduction</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Mar 11, 2013
Episode 30: Central Lines, Surgical Airways and Pericardiocentesis
1:48:45
<p>In this episode dedicated to emergency procedures pearls and pitfalls, tips and tricks, Dr. Jordan Chenkin & Dr. Jamie Blicker take us step by step through how best to perform surgical airways and pericardiocentesis, as well as place central lines and intraosseous lines. They explain the various methods for surgical airways including the bougie-assisted surgical airway. They review the indications, contraindications, and complications for all of these life saving procedures, and give us some amazing tips and tricks on what to do when things aren't going as expected.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-30-central-lines-surgical-airways-pericardiocentesis/">Episode 30: Central Lines, Surgical Airways and Pericardiocentesis</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Feb 11, 2013
Best Case Ever 15: Right Sided Thoracotomy
5:05
<p>Right sided thoracotomy anyone? As a bonus to Episode 30 on Emergency Procedures, Pearls & Pitfalls, Tips & Tricks Dr. Jamie Blicker tells his Best Case Ever of a trauma patient who goes sour after a chest tube insertion.</p> <p>In the related episode dedicated to emergency procedures pearls and pitfalls, tips and tricks, Dr. Jordan Chenkin & Dr. Jamie Blicker take us step by step through how best to perform surgical airways and pericardiocentesis, as well as place central lines and intraosseous lines. They explain the various methods for surgical airways including the bougie-assisted surgical airway. They review the indications, contraindications, and complications for all of these life saving procedures, and give us some amazing tips and tricks on what to do when things aren't going as expected.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/bce-15-right-sided-thoracotomy/">Best Case Ever 15: Right Sided Thoracotomy</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Feb 05, 2013
Episode 29: Hand Emergencies
1:17:28
<p>Dr. Andrew Arcand & Dr. Laura Tate discuss the key clinical pearls and pitfalls in the recognition and management of many apparently benign hand emergencies that have serious morbidity, including high pressure injection injuries, flexor tenosynovitis, gamekeeper's thumb, fight bites, hook of the hammate fractures and many more important hand emergencies.</p> <p>Dr. Tate & Arcand answer such questions as: which lacerations require prophylactic antibiotics? Which hand lacerations do not require sutures? How is rotational deformity best tested for metacarpal fractures? What are the pearls of tendon repair? How do you test for instability when you suspect a Gamekeeper's thumb? How is compartment syndrome of the hand different to compartment syndrome in the leg? What are Kanavel's signs of tenosynovitis? How should felons be managed in the ED? What are the most common errors that plastic surgeons see ED docs make?</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-29-hand-emergencies/">Episode 29: Hand Emergencies</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jan 15, 2013
Best Case Ever 14: High Pressure Injection Injury
4:28
<p>Dr. Laura Tate, plastic surgeon extraordinaire, presents her best hand emergency case.</p> <p>In the upcoming episode, she and Dr. Andrew Arcand will discuss key pearls and pitfalls in the recognition and management of flexor tenosynovitis, high pressure injection injuries, fight bites, hook of the hammate fractures, gamekeeper's thumb and many more potentially devastating hand emergencies.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-14-high-pressure-injection-injury/">Best Case Ever 14: High Pressure Injection Injury</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Dec 26, 2012
Episode 28: Aortic Dissection, Acute Limb Ischemia and Compartment Syndrome
1:09:27
<p>Dr. Anil Chopra & Dr. David Carr discuss the breadth of presentations and key diagnostic clues of Aortic Dissection. They review the value of ECG, CXR and biomarkers as well as compare and contrast the use of Transesophageal Echo and CTA in this sometime elusive diagnosis. Being the authors of the Tintanalli chapter on Occlusive Arterial Disease, they give as lots of clinical pearls and pitfalls when it comes to Acute Limb Ischemia. We end with a discussion on the trials and tribulations of Compartment Syndrome.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-28-aortic-dissection-acute-limb-ischemia-compartment-syndrome/">Episode 28: Aortic Dissection, Acute Limb Ischemia and Compartment Syndrome</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Nov 19, 2012
Best Case Ever 13: Aortic Dissection
6:05
<p>Dr. David Carr, the past author of Tintinalli's chapter on occlusive arterial disease, tells us his Best Case Ever related to Aortic Dissection.</p> <p>In the related Episode 28: Aortic Dissection, Acute Limb Ischemia & Compartment Syndrome, we discuss the breadth of presentations and key diagnostic clues of Aortic Dissection. We review the value of ECG, CXR, biomarkers and the use of Transesophageal Echo and CTA in this sometime elusive diagnosis. We debate lots of clinical pearls and pitfalls when it comes to acute limb ischemia, and end with a discussion on the trials and tribulations of Compartment Syndrome.</p> <p>[wpfilebase tag=file id=398 tpl=emc-play /]</p> <p>[wpfilebase tag=file id=399 tpl=emc-mp3 /]</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-13-aortic-dissection/">Best Case Ever 13: Aortic Dissection</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Nov 12, 2012
Episode 27: Drugs of Abuse – Stimulants and Opiates
1:41:12
<p>Dr. Margaret Thompson & Dr. Lisa Thurgur Canada's toxicologist gurus discuss several cases of stimulant drugs of abuse such as cocaine, MDMA & bath salts, as well as the pearls and pitfalls of managing opiates toxicity. We discuss: The management of the intoxicated patient including seizures, dysrhythmias, cardiac ischemia and hypertensive emergencies related to cocaine toxicity, the recognition and management of necrotizing vasculitis caused by cocaine cut with Levamisole, the differential diagnosis and management of the "hot and crazy" patient, including the role of dantrolene and cyproheptidine, pearls and pitfalls of naloxone, the utility of urine drug screens and much more....</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-27-drugs-of-abuse/">Episode 27: Drugs of Abuse – Stimulants and Opiates</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Oct 15, 2012
Best Case Ever 12: Drugs of Abuse
8:00
<p>As a bonus to Episode 27 on Drugs of Abuse -Stimulants & Opiates, Dr. Margaret Thompson, one of Canada's leading Toxicologists and the medical director of the Ontario Poison Control Centre tells us 2 of her Best Cases Ever about stimulant overdose surprises. In the related Episode, Dr. Margaret Thompson & Dr. Lisa Thurgur Canada's toxicologist gurus discuss several cases of stimulant drugs of abuse such as cocaine, MDMA & bath salts, as well as the pearls and pitfalls of managing opiates toxicity. We discuss: The management of the intoxicated patient including seizures, dysrhythmias, cardiac ischemia and hypertensive emergencies related to cocaine toxicity, the recognition and management of necrotizing vasculitis caused by cocaine cut with Levamisole, the differential diagnosis and management of the "hot and crazy" patient, including the role of dantrolene and cyproheptidine, pearls and pitfalls of naloxone, the utility of urine drug screens and much more....</p> <p>[wpfilebase tag=file id=396 tpl=emc-play /]</p> <p>[wpfilebase tag=file id=397 tpl=emc-mp3 /]</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-12-drugs-of-abuse/">Best Case Ever 12: Drugs of Abuse</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Oct 08, 2012
Episode 26: Low Back Pain Emergencies
2:28:34
<p>In this episode we go through seven cases that display the breadth of presentations of limb or life threatening causes of low back pain emergencies with my huge mentors, Dr. Walter Himmel and Dr. Brian Steinhart. We cover everything from spinal epidural abscess to cauda equina syndrome to retroperitoneal bleeds, elucidating the key historical, physical exam, lab, imaging and treatment pearls for all of these diagnoses. We then go on to review the best management for the most common cause of back pain presentation, lumbosacral strain and debate the various medication options.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-26-low-back-pain-emergencies/">Episode 26: Low Back Pain Emergencies</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Sep 12, 2012
Best Case Ever 11: Cauda Equina Syndrome
6:13
<p>As a bonus to Episode 26 on Low Back Pain Emergencies with Dr. Brian Steinhart & Dr. Walter Himmel, we have Dr. Walter Himmel's own personal incredible case of Cauda Equina Syndrome.</p> <p>In the related Episode we will cover the most serious spinal and vascular causes that present with low back pain including Cauda Equina Syndrome, Spinal Epidural Abscess, Spinal Epidural Hematoma, Metastases to the spine, Abdominal Aortic Aneurysm and Retroperitoneal Hematoma.</p> <p>[wpfilebase tag=file id=394 tpl=emc-play /]</p> <p>[wpfilebase tag=file id=395 tpl=emc-mp3 /]</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-11-cauda-equina-syndrome/">Best Case Ever 11: Cauda Equina Syndrome</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Sep 06, 2012
Episode 25: Pediatric Syncope and Adult Syncope
2:10:25
<p>In this episode on Pediatric Syncope & Adult Syncope, Dr. Eric Letovksy & Dr. Anna Jarvis run through the key clinical pearls of the history, the physical, interpretation of the ECG and the value of clinical decision rules such as the ROSE rule and the San Francisco Syncope Rule in working up these patients. We discuss how to differentiate syncope from seizure, cardiac causes of syncope such as Arrhthmogenic Right Ventricular Cardiomyopthy & Prolonged QT Syndrome, and the indications for Holter monitoring, Echocardiograms and stress testing in patients with Syncope.</p> <p>Dr. Letvosky & Dr. Jarvis answer such questions as: How can we diagnose Hypertrophic Cardiomyopathy in the ED? What is the value of Troponin and BNP in the work-up of syncope? In what ways are patients with Down Syndrome at high risk for serious causes of syncope? In what ways are patients with alcohol dependence at risk for serious causes of syncope? Why is 'Benign' early repolarization not a benign condition in patients with syncope? Which children with syncope should be admitted? and many more....</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-25-pediatric-adult-syncope/">Episode 25: Pediatric Syncope and Adult Syncope</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jul 17, 2012
Best Case Ever 10: Pediatric Syncope
7:08
<p>Pediatric Syncope usually has a benign cause, but may be a warning for sudden death. As a bonus to Episode 25 on ‘Pediatric & Adult Syncope’ with Dr. Eric Letovsky and Dr. Anna Jarvis, 'Canada's mother of Pediatric Emergency Medicine', we have Dr. Jarvis’s Best Case Ever. In the related episode we will cover how to differentiate syncope from seizure, key historical and physical exam clues to determine a cause of syncope, ECG pearls of syncope causing cardiac conditions, from Congenital Prolonged QT Syndrome to Arrhythmogenic Right Ventricular Cardiomyopathy, the value of syncope decision rules such as the ROSE rule and the San Francisco Syncope Rule, the value of ancillary testing, including Holter monitoring, Echocardiograms and Stress Testing and much more......</p> <p>[wpfilebase tag=file id=386 tpl=emc-play /] </p> <p>[wpfilebase tag=file id=387 tpl=emc-mp3 /]</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-10-pediatric-syncope/">Best Case Ever 10: Pediatric Syncope</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jul 09, 2012
Episode 24: COPD and Pneumonia
1:16:27
<p>In this episode we have the continuation of our discussion on Respiratory Emergencies with Dr. Anil Chopra and Dr. John Foote. We discuss key clinical decisions in COPD assessment and management - how to assess for impending respiratory failure, how best to oxygenate the COPD patient, medication pearls and how best to approach intubating the COPD patient. We then review an approach to hemoptysis as well as tricks of the trade for managing massive hemoptysis. Many pearls of pneumonia work-up and management are detailed as well as how to make important disposition decisions.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-24-copd-pneumonia/">Episode 24: COPD and Pneumonia</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jun 14, 2012
Episode 23: Vaginal Bleeding in Early Pregnancy
1:50:42
<p>In this episode on Vaginal Bleeding in Early Pregnancy Dr. David Dushenski & Dr. Ross Claybo run through the key clinical pearls of the history, the physical, interpretation of the BhCG and the value of serum progesterone in working up these patients. The newest on bedside emergency department ultrasound is discussed in the patient with vaginal bleeding in early pregnancy. The various types of spontaneous abortion including septic abortion are reviewed as well as the management of the unstable patient with massive vaginal hemorrhage. Ectopic pregnancy, in all it's various presentations is reviewed with particular attention to the most common pitfalls and how to avoid them.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-23-vaginal-bleeding-in-early-pregnancy/">Episode 23: Vaginal Bleeding in Early Pregnancy</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
May 17, 2012
Best Case Ever 9 Vaginal Bleeding in Early Pregnancy
5:14
<p>As a bonus to Episode 23 on 'Vaginal Bleeding in Early Pregnancy' with Dr. Ross Claybo and Dr. David Dushenski, we have here, Dr. Claybo's Best Case Ever. While vaginal bleeding in early pregnancy is rarely life threatening, there are a significant percentage of woman who will require emergency resuscitation and surgical intervention. We don't have mountains of RCTs on this topic; still Dr. David Dushenski & Dr. Ross Claybo run through the key clinical pearls of the history, the physical, interpretation of the BhCG and the value of serum progesterone in working up these patients. The newest on point of care ultrasound is discussed in the patient with vaginal bleeding in early pregnancy. The various types of spontaneous abortion including septic abortion are reviewed as well as the management of the unstable patient with massive vaginal hemorrhage. Ectopic pregnancy, in all it’s various presentations is reviewed with particular attention to the most common pitfalls and how to avoid them.</p> <p>[wpfilebase tag=file id=388 tpl=emc-play /]</p> <p>[wpfilebase tag=file id=389 tpl=emc-mp3 /]</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-9-vaginal-bleeding-in-early-pregnancy/">Best Case Ever 9 Vaginal Bleeding in Early Pregnancy</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
May 09, 2012
Episode 22b: Whistler Update in Emergency Medicine Conference 2012
1:54:43
<p>In this bonus episode, our second installment of the highlights from Whistler's Update in Emergency Medicine Conference 2012, we have Dr. David Carr updating us on infectious diseases, Dr. Dennis Scolnick giving us the low down on pediatric urological emergencies, Dr. Anil Chopra reviewing the pearls and pitfalls of managing shock states, and much more. In these conference highlights our experts answer such questions as: Which oral antibiotics can replace IV antibiotics in the majority of bacterial infections? What are the most recent recommendations for pelvic inflammatory disease management? Which patients with mammalian bites require antibiotics? How can we best counsel our patients with potential exposure to HIV? Does every child with a painful scrotum require an ultrasound? What is the role of treatment with Bicarb in shock? What are the best antibiotic choices in patients suspected of septic shock? When are steroids indicated for patients in shock? How should you decide between the different vasopressors for shock? and many more.......</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-22b-whistler-update-emergency-medicine-conference-2012-part-2/">Episode 22b: Whistler Update in Emergency Medicine Conference 2012</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Apr 25, 2012
Episode 22a: Whistler Update in Emergency Medicine Conference 2012
1:44:14
<p>In this bonus episode, our second installment of the highlights from Whistler Update in Emergency Medicine Conference 2012, we have Dr. Eric Letovsky talking about complications of MI and the importance of listening for cardiac murmurs. Next, I moderate an expert panel on the current trends on imaging patients who present with renal colic and query appendicitis with Dr. Connie Leblanc, Dr. Joel Yaphe, Dr. David MacKinnon & Dr. Eric Letovsky. We then hear from Dr. Adam Cheng, Dr. Dennis Scolnick & Dr. Anna Jarvis in a pediatric expert panel about the newest on minor head injury, otitis media, mastoiditis and bronchiolitis. Dr. David Carr reviews one of the most important articles in 2011 regarding subarachnoid hemorrhage, and Dr. David MacKinnon gives us tonnes of clinical pearls when it comes to everyone's favourite subject, anorectal disorders.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-22a-whistler-update-in-emergency-medicine-conference-2012-highlights-part1/">Episode 22a: Whistler Update in Emergency Medicine Conference 2012</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Apr 04, 2012
Episode 21: Pulmonary Embolism
1:24:18
<p>In this episode on Pulmonary Embolsim we have the triumphant return of Dr. Anil Chopra, the Head of the Divisions of Emergency Medicine at University of Toronto, and Dr. John Foote the CCFP(EM) residency program director at the University of Toronto. We kick it off with Dr. Foote's approach to undifferentiated dyspnea and explanation of Medically Unexplained Dyspea ('MUD') and go on to discuss how best to develop a clinical pre-test probability for the diagnosis of pulmonary embolism using risk factors, the value of the PERC rule, Well's criteria and how clinical gestalt plays into pre-test probability. Dr. Chopra tells about the appropriate use of D-dimer to improve our diagnostic accuracy without leading to over-investigation and unwarranted anticoagulation. We then discuss the value of V/Q scan in the workup of PE, and the pitfalls of CT angiography. A discussion of anticoagulation choices follows and the controversies around thrombolysis for submassive PE are reviewed.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-21-respiratory-emergencies-1-pulmonary-embolism/">Episode 21: Pulmonary Embolism</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Mar 14, 2012
Best Case Ever 8: Acute Dyspnea
9:05
<p>Acute Dyspnea has a wide differential diagnosis from Metabolic Acidosis to Medically Unexplained Dyspnea. As a bonus to Episode 21 on Pulmonary Embolism and Acute Dyspnea, Dr. John Foote the CCFP(EM) residency program director at the University of Toronto presents his Best Case Ever related to an Acute Dyspnea presentation. In the related episode on Pulmonary Embolism we havet, with Dr. Foote, the triumphant return of Dr. Anil Chopra, the Head of the Divisions of Emergency Medicine at University of Toronto . We kick it off with Dr. Foote’s approach to undifferentiated acute dyspnea and explanation of Medically Unexplained Dyspea (‘MUD’) and go on to discuss how best to develop a clinical pretest probability for the diagnosis of pulmonary embolism using risk factors, the value of the PERC rule, Well’s criteria and how clinical gestalt plays into pretest probability. Dr. Chopra tells about the appropriate use of D-dimer to improve our diagnostic accuracy without leading to over-investigation and unwarranted anticoagulation. We then discuss the value of V/Q scan in the workup of PE, and the pitfalls of CT angiography. A discussion of anticoagulation choices follows and the controversies around thrombolysis for submassive PE closes the podcast.</p> <p>[wpfilebase tag=file id=384 tpl=emc-play /]<br /> [wpfilebase tag=file id=385 tpl=emc-mp3 /]</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-8-dyspnea/">Best Case Ever 8: Acute Dyspnea</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Mar 02, 2012
Episode 20: Atrial Fibrillation
1:29:19
<p>In this episode Dr. Clare Atzema, Dr. Nazanin Meshkat and Dr. Bryan Au discuss the presentation, etiology, precipitants, management and disposition of Atrial Fibrillation in the Emergency Department. The pros and cons of rate and rhythm control are debated, what you need to know about rate and rhythm control medications reviewed, and the strength of the Ottawa Aggressive Protocol discussed. The importance of appropriate anticoagulation is detailed, with a review of the CHADS-VASc score and whether to use Warfarin, Dabigatran or ASA for stroke prevention for patient with Atrial Fibrillation. We end off with a discussion on how to recognize and treat Wolff-Parkinson-White syndrome in the setting of Atrial Fibrillation.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-20-atrial-fibrillation/">Episode 20: Atrial Fibrillation</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Feb 10, 2012
Best Case Ever 7: Atrial Fibrillation
5:28
<p>As a bonus to Episode 20 on Atrial Fibrillation, we present here, Dr. Clare Atzema, a leading EM researcher in Atrial Fibrillation, telling her Best Case Ever related to Afib. What would you do if you needed to cardiovert a patient who was too obese to fit on an ED stretcher? Dr. Atzema, along with Dr. Nazanin Meshkat and Dr. Bryan Au, discuss the presentation, etiology, precipitants, management and disposition of Atrial Fibrillation in the Emergency Department. The pros and cons of rate vs rhythm control are debated, what you need to know about Afib medications, and the value of the Ottawa Aggressive Protocol discussed. The importance of appropriate anticoagulation is detailed, with a review of the CHADS-VASc score and whether to use anticogulants or ASA for stroke prevention for patients with Afib. We end off with a discussion on how to recognize and treat Wolff-Parkinson-White syndrome in the setting of Atrial Fibrillation. </p> <p>[wpfilebase tag=file id=382 tpl=emc-play /]<br /> [wpfilebase tag=file id=383 tpl=emc-mp3 /]</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-7-atrial-fibrillation/">Best Case Ever 7: Atrial Fibrillation</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Feb 02, 2012
Episode 19 Part 2: Pediatric Gastroenteritis, Constipation and Bowel Obstruction
1:38:58
<p>In Part 2 of this pediatric abdominal pain Episode - Pediatric Gastroenteritis, Constipation & Bowel Obstruction, Dr. Anna Jarvis, Canada's "mother of pediatric emergency medicine" and Dr. Stephen Freedman, one of Canada's pre-eminent researchers in pediatric GI emergencies, discuss the assessment, work-up and treatment of pediatric gastroenteritis, with particular attention to gastroenteritis & acute abdomen mimics, how best to assess hydration status, the nuances of the use of ondansetron and the prose and cons of various rehydration methods. A detailed discussion of the most common and lethal causes of acute abdomen bowel obstruction in pediatrics follows, including intussesception and midgut volvulus. Finally, the differential diagnosis and best management of the most common cause of pediatric abdominal pain, constipation, is reviewed.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-19-part-2-pediatric-gastroenteritis-acute-constipation-bowel-obstruction/">Episode 19 Part 2: Pediatric Gastroenteritis, Constipation and Bowel Obstruction</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jan 07, 2012
Episode 19 Part 1: Pediatric Abdominal Pain and Appendicitis
1:20:32
<p>In Part 1 of this Episode on Pediatric Abdominal Pain, Dr. Anna Jarvis, "the mother of pediatric emergency medicine" & Dr. Stephen Freedman, one of the world's pre-eminent pediatric EM researchers, discuss the nuances of the history, physical and work up of Pediatric Abdominal Pain & Appendicitis and key pearls on how to distinguish serious surgical causes from the very common diagnosis of gastroenteritis. An in-depth discussion on the pearls of the history, physical exam, lab tests, imaging including serial ultrasounds vs CT abdomen, clinical decision rules such as the Alvarado Score, best analgesics and antibiotics in pediatric appendicitis follows.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-19-part-1-pediatric-abdominal-pain-appendicitis/">Episode 19 Part 1: Pediatric Abdominal Pain and Appendicitis</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Dec 08, 2011
Episode 18 Part 2: More Point of Care Ultrasound
1:33:51
<p>In Part 2 of this Episode on Emergency Ultrasound or Point of Care Ultrasound (POCUS) Dr. Fischer, Dr. Hannam, Dr. Chenkin & Dr. Hall, Canada's EM ultrasound gurus discuss how POCUS can help our decision-making in the pediatric patient with a limp, in the patient with necrotizing fasciitis, in the pregnant patient with vaginal bleeding and in the common and challenging elderly patient with undifferentiated abdominal pain. They cover POCUS indications from urinary retention to appendicitis and debate the utility of these indications. This is followed by a debate on how best to educate ourselves and the EM community in POCUS and how best to designs quality assurance programs so that point of care ultrasound (POCUS) becomes an accepted tool across the entire medical community.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-18-part-2-more-point-of-care-ultrasound/">Episode 18 Part 2: More Point of Care Ultrasound</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Nov 08, 2011
Episode 18 Part 1: Point of Care Ultrasound Pearls, Pitfalls and Controversies
1:32:02
<p>In this first installment of this Episode, Point of Care Ultrasound Pearls, Pitfalls & Controversies we have a panel of POCUS gurus, Dr. Greg Hall, Dr. Jordan Chenkin, Dr. Paul Hannam & Dr. Jason Fischer. They review the basic criteria for commonly used, practical Point of Care Ultrasound indications at the bedside and then dive into heated debate about specific pearls and pitfalls in Point of Care Ultrasound assessment of the patient with undifferentiated shortness of breath, undifferentiated shock, cardiac arrest and swollen leg. They discuss how best to interpret the massive body of literature for POCUS and when we can hang our hats on our Point of Care Ultrasound findings.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-18-part-1-point-of-care-ultrasound-pearls-pitfalls-controversies/">Episode 18 Part 1: Point of Care Ultrasound Pearls, Pitfalls and Controversies</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Oct 13, 2011
Best Case Ever 6 Can Point of Care Ultrasound Save Lives?
7:12
<p>As a bonus to Episode 18: Point of Care Ultrasound Controversies with the gurus of POCUS, Dr. Greg Hall, Dr. Jordan Chenkin, Dr. Paul Hannam and Dr. Jason Fischer, we present here, Dr. Hall's Best Case Ever.</p> <p>In the related episode our panel of experts answer questions such as: How does 2-point compression Point of Care Ultrasound of the leg compare to radiology department ultrasound for DVT? How does POCUS for pneumothorax compare to CXR and CT? In what situations does cardiac standstill on POCUS not suggest futile resuscitation? Can evaluation of RV function on Point of Care Ultrasound help us decide whether or not to thrombolyse a patient with submassive pulmonary embolism? How can POCUS help in diagnosing CHF? What is the best anatomical approach for pericardiocentesis? How can Point of Care Ultrasound help us in the crashing pediatric patient? and many more……</p> <p>[wpfilebase tag=file id=380 tpl=emc-play /]<br /> [wpfilebase tag=file id=381 tpl=emc-mp3 /]</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-6-point-of-care-ultrasound/">Best Case Ever 6 Can Point of Care Ultrasound Save Lives?</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Oct 05, 2011
Episode 17 Part 2: Stroke, Dabigatran and Intracranial Hemorrhage
1:07:37
<p>In the 2nd part of this episode on Stroke, Dabigitran & Intracranial Hemorrhage Dr. Walter Himmel & Dr. Dan Selchen tell us everything the ED doc needs to know about the oral direct thrombin inhibitor Dabigatran and how to reverse a Dabigatran ICH. The ED treatment of stroke is reviewed including best medications and a simple way to remember BP goals. They review the management of ICH including BP goals, indications for neurosurgery, the role of recombinant Factor Vlla, and how best to reverse Warfarin-associated and platelet-associated ICH.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-17-part-2-stroke-dabigitran-intraranial-hemorrhage/">Episode 17 Part 2: Stroke, Dabigatran and Intracranial Hemorrhage</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Sep 07, 2011
Episode 17 Part 1: Emergency Stroke Controversies
1:24:47
<p>Ep17 P1 StrokeDr. Walter Himmel, "the walking encyclopedia of Emergency Medicine" & Dr. Dan Selchen, the head of the stroke program at St. Micheal's Hospital in Toronto with 30+ years of experience as a stroke neurologist, update us on the literature regarding Emergency Stroke Controversies including the ABCD2 Score to predict Stroke after TIA, as well as the current thinking around the best carotid imaging for patients who have had a TIA. They then review the important findings of the key thrombolysis stroke trials & how we could incorporate these findings into our daily practice. Dr. Selchen reviews the key CT findings we should look for in stroke, & Dr. Himmel takes us through how to manage the dreaded complication of ICH post thrombolysis. This episode is super controversial - so please 'speak your mind' at the bottom of the page.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-17-part-1-emergency-stroke-controversies/">Episode 17 Part 1: Emergency Stroke Controversies</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Sep 07, 2011
Episode 16: Acute Monoarthritis
1:21:58
<p>Ep16 MonoarthritisDr. Joel Yaphe, University of Toronto's Emergency Medicine Residency Program Director and Dr. Indy Ghosh discuss the difficult diagnostic dilemmas when faced with a patient with acute monoarthritis. They review how to distinguish clinically between septic arthritis and gout and which aspects of the presentation and work-up are the most reliable in risk stratifying patients. The key differential diagnosis of Acute Polyarthritis can be even more of a challenge, but fear not: by then end of this podcast and post you will be able to recognize the key diagnoses, how to work them up, and who needs consultation.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-16-acute-monoarthritis/">Episode 16: Acute Monoarthritis</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jul 25, 2011
Best Case Ever 5 Septic Arthritis
4:59
<p>Septic Arthritis is often at the top of our differential for acute monoarthritis. Dr. Joel Yaphe tells his Best Case Ever of a patient with septic arthritis as a bonus to Episode 16: Acute Monoarthritis.</p> <p>In the related episode Dr. Yaphe and Dr. Indy Ghosh discuss such questions as: What are the most important risk factors for septic arthritis? What are the most predictive signs and symptoms of septic arthritis? How does serum WBC, ESR and CRP contribute to the probability of septic arthritis? Should we still be performing arthrocenteses on patient's with overlying cellulitis? with an INR of 6? How can you tell the difference between septic bursitis and septic arthritis and how are they managed differently? What does the literature tell us about how useful the synovial fluid tests are in ruling in or ruling out septic arthritis? What is the role of bedside ultrasound in septic arthritis? Is there a role for steroid therapy in septic arthritis? When would you consider oral NSAIDs vs oral prednisone vs intra-articular methylprednisolone for the treatment of Gout? Is there a role for colchicine in the ED treatment of Gout? What is acute calcific arthritis of hydroxyapatite disease and why is it important for ED docs to know about? What is the most common cause of dermatitis-arthritis? How can one distinguish Reactive Arthritis from Septic Arthritis clinically, and how do their work-ups differ? Is there a role for antibiotics in Reactive Arthritis? How does gonococcal arthritis present compared with nongonococcal septic arthritis? and many more.....</p> <p>[wpfilebase tag=file id=378 tpl=emc-play /]</p> <p>[wpfilebase tag=file id=379 tpl=emc-mp3 /]</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-5-septic-arthritis/">Best Case Ever 5 Septic Arthritis</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jul 19, 2011
Episode 15 Part 2: Acute Coronary Syndromes Management
1:29:11
<p>In Part 2 of this Episode on Acute Coronary Syndromes Risk Stratification & Management, the evidence for various medications for ACS, from supplemental oxygen to thrombolytics are debated, and decision making around reperfusion therapy for STEMI as well as NSTEMI are discussed. Finally, there is a discussion on risk stratification of low risk chest pain patients and all it's attendant challenges as well as disposition and follow-up decisions.</p> <p>Dr. Eric Letovsky, the Head of the CCFP(EM) Program at the University of Toronto, Dr. Mark Mensour & Dr. Neil Fam, an interventional cardiologist answer questions like: What is the danger of high flow oxygen in the setting of ACS? When, if ever, should we be using IV B-blockers in AMI patients? How can you predict, in the ED, who might go on to have an urgent CABG, in which case Clopidogrel is contra-indicated? Which anticoagulant is best for unstable angina, NSTEMI and STEMI - unfractionated heparin (UFH), low molecular weight heparin (LMWH), or fonduparinux? Is there currenly any role for Glycoprotein 2b3a Inhibitors in ACS in the ED? When is thrombolysis better than PCI for STEMI? When should we consider facilitated angioplasty and rescue angioplasty? Which low risk chest pain patients require an early stress test? CT coronary angiography? Stress Echo? Admission to a Coronary Decision Unit (CDU)? and many more.......</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-15-p2-acute-coronary-syndromes-management/">Episode 15 Part 2: Acute Coronary Syndromes Management</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jun 21, 2011
Episode 15 Part 1: Acute Coronary Syndromes Risk Stratification
1:04:09
<p>In Part 1 of this Episode on Acute Coronary Syndromes Risk Stratification Dr. Eric Letovksy, Dr. Mark Mensour and Dr. Neil Fam discuss common pearls and pitfalls in assessing the patient who presents to the ED with chest pain. They review atypical presentations to look out for, what the literature says about the value of traditional and non-traditional cardiac risk factors, the diagnostic utility of recent cardiac testing, and which patients in the ED should have a cardiac work-up. Finally, in the ED work up of Acute Coronary Syndromes Risk Stratification, they highlight some valuable key points in ECG interpretation and how best to use and interpret cardiac biomarkers like troponin.</p> <p>Drs. Letovksy, Mensour & Fam address questions like: How useful are the traditional cardiac risk factors in predicting ACS in the ED? How does a negative recent treadmill stress test, nuclear stress test or angiogram effect the pre-test probability of ACS in the ED? What does recent evidence tell us about the assumption that patients presenting with chest pain and a presumed new LBBB will rule in for MI and require re-perfusion therapy? How can we diagnose MI in the patient with a ventricular pacemaker? What is the difference between Troponin I and Troponin T from a practical clinical perspective? Is one Troponin ever good enough to rule out MI in the patient with a normal ECG? Should we be using a 2hr delta troponin protocol? How will the new ultra-sensitive Troponins change our practice? and many more.....</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-15-p1-acute-coronary-syndromes-risk-stratification/">Episode 15 Part 1: Acute Coronary Syndromes Risk Stratification</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jun 21, 2011
Best Case Ever 4 Acute Coronary Syndrome From Venous Source
6:13
<p>In anticipation of Episode 15, 'Acute Coronary Syndromes' with Dr. Eric Letovsky, Dr. Mark Mensour and Dr. Neil Fam, we present here, Dr. Helman's 'Best Case Ever' of an ACS patient. In Episode 15: 'Acute Coronary Syndromes', Drs. Fam, Mensour , Letovsky and Helman discuss questions like: How does a recent negative stress test or angiogram effect the pre-test probability of ACS in the ED? What does recent evidence tell us about the assumption that patients presenting with chest pain and a presumed new LBBB will rule in for MI and require reperfusion therapy?</p> <p>[wpfilebase tag=file id=376 tpl=emc-play /]</p> <p>[wpfilebase tag=file id=377 tpl=emc-mp3 /]</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-4-acute-coronary-syndrome-from-venous-source/">Best Case Ever 4 Acute Coronary Syndrome From Venous Source</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jun 06, 2011
Best Case Ever 3: Emergency Headache – Importance of Opening Pressure
5:34
<p>In association with Episode 14, 'Headache Pearls & Pitfalls' with Dr. Anil Chopra and Dr. Stella Yiu, we present here, the third of our new 5 minute 'Best Case Ever' series. In Episode 14: Headache Pearls & Pitfalls, which has just been released, Dr. Chopra and Dr. Yiu answer questions like: With the ever improving resolution of CT, should we still be doing LP after negative plain CT head for all our thunderclap headache patients? How can we best minimize the chance of post-LP headache? What evidenced-based treatments can we initiate in the ED for our SAH patients that will improve outcomes? </p> <p>[wpfilebase tag=file id=375 tpl=emc-play /]</p> <p>[wpfilebase tag=file id=374 tpl=emc-mp3 /]</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-3-emergency-headach-importance-opening-pressuree/">Best Case Ever 3: Emergency Headache – Importance of Opening Pressure</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
May 10, 2011
Episode 14 Part 2: Thunderclap Headache – Cerebral Venous Thrombosis and Cervical Artery Dissection
53:12
<p>emergency headacheIn Part 2 of this episode on Thunderclap Headache - Cerebral Venous Thrombosis & Cervical Artery Dissction, Dr. Stella Yiu and Dr. Anil Chopra review the presentation, work-up and management of some of the less common but very serious causes of headache including Cervical Artery Dissection (CAD), Cerebral Venous Thrombosis (CVT) and Idopathic Intracranial Hypertension (IIH). They tell us the most effective ways in which we can minimize the chance of the common Post-LP Headache. They answer questions such as: How does a carotid artery dissection present compared to a vertebral artery dissection? What is the evidence for chiropractic neck manipulation as a cause for Cervical Artery Dissection? How do antiplatelets compare to heparin for the treatment of Cervical Artery Dissection? What is Spontaneous Intracranial Hypotension? What is the differential diagnosis for headache in the peri-partum patient? Does D-dimer have a role in ruling out Cerebral Venous Thrombosis in the low risk patient? What is the imaging modality of choice for suspected Cerebral Venous Thrombosis? What is the value of opening pressure when performing an LP? What are the key headache diagnoses that can be missed on plain CT of the head and would warrant further investigation? and many more.....</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-14-p2-thunderclap-headache-cvt-cervical-artery-dissection/">Episode 14 Part 2: Thunderclap Headache – Cerebral Venous Thrombosis and Cervical Artery Dissection</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
May 09, 2011
Episode 14 Part 1: Migraine Headache and Subarachnoid Hemorrhage
1:04:52
<p>In Part 1 of this episode on Headache Pearls & Pitfalls - Migraine Headache & Subarachnoid Hemorrhage, Dr. Anil Chopra and Dr. Stella Yiu discuss the best evidenced-based management of migraine headache in the ED including the use of dexamethasone, dopamine antagonists, the problems with narcotics and the efficacy of 'triptans'. An easy way to remember the worrisome symptoms of headache indicating a serious cause is reviewed followed by a detailed discussion of the pearls, pitfalls and controversies around the work-up of Subarachnoid Hemorrhage (SAH) in light of some exciting recent literature, including the basis for a new Canadian decision rule for SAH.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-14-part-1-migraine-headache-subarachnoid-hemorrhage/">Episode 14 Part 1: Migraine Headache and Subarachnoid Hemorrhage</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
May 09, 2011
Episode 13 Part 2: Killer Coma Cases – The Intoxicated Patient
59:44
<p>In part 2 of this episode Dr. Helman presents two more cases to Dr. Carr and Dr. Steinhart, who give us their insights into the common conundrums when it comes to the intoxicated ED patient, and some key clues to the not-so-common life threatening toxicological emergencies that we need to be on the look out for.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-13-part-2-killer-coma-cases-intoxicated-patient/">Episode 13 Part 2: Killer Coma Cases – The Intoxicated Patient</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Apr 12, 2011
Episode 13 Part 1: Killer Coma Cases – The Found Down Patient
1:17:21
<p>In Part 1 of Killer Coma Cases - The Found Down Pateint, Dr. Helman presents two challenging cases to Dr. Brian Steinhart and Dr. David Carr, who tell us loads of key clinical pearls in their approaches to the 'found down' patient. They discuss the important components of the neurological exam in the comatose patient, the differential diagnosis of altered mental status and hyperthermia, the controversies around when to get a CT head before performing a lumbar puncture, and much more in this Killer Coma Cases episode. In Part 1 of this episode, we discuss the limitations of plain CT, the interpretation of CSF and the many faces of seizures. Any more information would be giving away the cases.....</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-13-part-1-killer-coma-cases-found-down/">Episode 13 Part 1: Killer Coma Cases – The Found Down Patient</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Apr 12, 2011
Best Case Ever 2 The Found Down Patient
5:56
<p>In relation to Episode 13 on The Found Down Patient with Dr. Brian Steinhart and Dr. David Carr, we present here, the second of our new 5 minute 'Best Case Ever' series.</p> <p>Dr. Steinhart's found down patient</p> <p>In Episode 13 The Found Down Patient, Dr. Helman presents 4 challenging cases of patients who present with altered mental status to Dr. Carr and Dr. Steinhart, who give us loads of key pearls and intriguing controversy in the evaluation and treatment of these difficult patients.</p> <p>[wpfilebase tag=file id=370 tpl=emc-play /]</p> <p>[wpfilebase tag=file id=371 tpl=emc-mp3 /]</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-2-found-down-patient/">Best Case Ever 2 The Found Down Patient</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Apr 01, 2011
Episode 12 Part 2: ACLS Guidelines – Atropine, Adenosine & Therapeutic Hypothermia
1:16:15
<p>In Part 2 of this episode on ACLS Guidelines - Atropine, Adenosine & Therapeutic Hypothermia, Dr. Steven Brooks and Dr. Michael Feldman discuss the removal of Atropine from the PEA/Asystole algorithm, the indications and dangers of Adenosine in wide-complex tachycardias, pressors as a bridge to transvenous pacing in unstable bradycardias, and the key elements of post cardiac arrest care including therapeutic hypothermia and PCI.</p> <p>They answer questions such as: In which arrhythmias can Amiodarone cause more harm than good? Is there any role for transcutaneous pacing for asystole? When should Bicarb be given in the arrest situation? In what situations is Atropine contra-indicated or the dosage need to be adjusted? How has the widespread use of therapeutic hypothermia currently effected our ability to prognosticate post-arrest patients? What are the indications for PCI and thrombolysis in the cardiac arrest patient? Should we be using therapeutic hypothermia in the non-Vfib arrest patient? What is the best method for achieving the target temperature for the patient undergoing therapeutic hypothermia? and many more......</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-12-part-2-acls-guidelines-atropine-adenosine-therapeutic-hypothermia/">Episode 12 Part 2: ACLS Guidelines – Atropine, Adenosine & Therapeutic Hypothermia</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Mar 10, 2011
Episode 12 Part 1: ACLS Guidelines – What’s New & Controversial
49:47
<p>In Part 1 of this episode on the latest ACLS Guidelines, Dr. Steven Brooks and Dr. Michael Feldman review and debate what's new and what's controversial in the the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Within the frameworks of Cardiocerebral Rescusitation and the 3 phase model of rescucitation (electrical, circulatory and metabolic), they discuss the importance of high quality CPR, the de-emphasis on early ventilation and the utility of continuous quantitative waveform capnography. Dr. Brooks and Dr. Feldman answer questions such as: of all the therapeutic manoeuvres we do for the cardiac arrest patient, which ones have been shown to improve survival to hospital discharge? What is the evidence for chest compression machines? What is the utility of bedside ultrasound in the cardiac arrest patient? Why is cardiac arrest survival to discharge in Seattle the best in the world? Should we be performing 'hands-on defibrillation'? and many more.....</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-12-part-1-acls-guidelines-whats-new-controversial/">Episode 12 Part 1: ACLS Guidelines – What’s New & Controversial</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Mar 10, 2011
Best Case Ever 1 Is Thrombolysis Better Than PCI for STEMI?
5:51
<p>Our first Best Case Ever is from Dr. Steven Brooks, a co-author of the 2010 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. This Best Case Ever is a bonus to Episode 12 ACLS Guidelines - What's New & Controversial, in which we discuss the frameworks of Cardiocerebral Rescusitation and the 3 phase model of rescucitation (electrical, circulatory and metabolic), the importance of high quality CPR, the de-emphasis on early ventilation and the utility of continuous quantitative waveform capnography. Dr. Brooks and Dr. Michael Feldman answer questions such as: of all the therapeutic manoeuvres we do for the cardiac arrest patient, which ones have been shown to improve survival to hospital discharge? What is the evidence for chest compression machines? What is the utility of point of care ultrasound (POCUS) in the cardiac arrest patient? Why is cardiac arrest survival to discharge in Seattle the best in the world? Should we be performing 'hands-on defibrillation'? and many more.....</p> <p>[wpfilebase tag=file id=368 tpl=emc-play /]</p> <p>[wpfilebase tag=file id=369 tpl=emc-mp3 /]</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/best-case-ever-1-thrombolysis-better-than-pci-stemi/">Best Case Ever 1 Is Thrombolysis Better Than PCI for STEMI?</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Feb 17, 2011
Episode 11: Cognitive Decision Making and Medical Error
1:37:08
<p>In this episode on Cognitive Decision Making & Medical Error, Dr. Doug Sinclair, CMO of St. Michael's Hospital and Dr. Chris Hicks show us that, while the ED physician's knowledge base may play a small part in predicting medical error, more important might be how we understand and reflect upon our decision-making processes, how we communicate with our staff and patients, and how we cope with the ED environment and shift work. Medical error is the 6th leading cause of death in North America, and despite huge advances in imaging technology and lab testing as well as an explosion of EM literature in recent years, the misdiagnosis rate detected through autopsy studies has not changed significantly over the past century. Studies on diagnostic error in emergency medicine have shown error rates between 1 and 12%, and it's been suggested that cognitive error, or some flaw in the decision making process (as apposed to a lack of knowledge), is present in about 95% of these cases. Dr. Sinclair and Dr. Hicks elucidate for us how to identify and understand cognitive decision making and medical error, and how we can improve our decision making, reduce medical error and optimize the care of our patients.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-11-cognitive-decision-making-medical-error/">Episode 11: Cognitive Decision Making and Medical Error</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Feb 04, 2011
Episode 10 Part 2: Trauma Pearls and Pitfalls
1:19:50
<p>In Part 2 of this episode on Trauma Pearls & Pitfalls Dr. Dave MacKinnon and Dr. Mike Brzozowski go through key management strategies and controversies surrounding head, neck, chest, abdominal, pelvic and extremity trauma, followed by a discussion on how best to prepare the trauma patient for transfer to a trauma centre.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-10-p2-trauma-pearls-pitfalls/">Episode 10 Part 2: Trauma Pearls and Pitfalls</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jan 11, 2011
Episode 10 Part 1: Trauma Pearls and Pitfalls
1:19:02
<p>In this episode on Trauma Pearls and Pitfalls, Dr. Dave MacKinnon and Dr. Mike Brzozowski discuss the latest in trauma controversies. In Part 1 they give us some key pearls and pitfalls on traumaairway management, the value of the C-spine collar, how to clear the C-spine, vascular access options in trauma, 'Damage Control Rescuscitation', the best resuscitation fluids to use including hypertonic saline, hemostatic drugs such as Tranexamic Acid in trauma, the vulue, or lack thereof, of Recombinant Factor 7a in trauma, and the use of Prothrombin Complex Concentrates in trauma.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-10-part-1-trauma-pearls-and-pitfalls/">Episode 10 Part 1: Trauma Pearls and Pitfalls</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jan 11, 2011
Episode 9: Nontraumatic Eye Emergencies
2:16:00
<p>Nontraumatic Eye Emergencies are seldom very satisfying for the emergency physician to manage. However, with systematic approach and timely management they can save a patient's vision. Dr. George Porfiris and Dr. Simon Kingsley discuss four non-traumatic eye emergency presentations. The painful red eye, the painless red eye, acute painful loss of vision and acute painless loss of vision. Several cases are discussed in which an accurate diagnosis and timely ED management are of critical importance in order to prevent permanent vision loss and significant morbidity. A systematic approach to the eye examination is described with particular attention to important maneuvers such as the swinging flashlight test. The utility of ED ultrasound of the eye is debated, and a discussion around systemic diseases that cause eye problems provides fodder for many clinical pearls.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-9-nontraumatic-eye-emergencies/">Episode 9: Nontraumatic Eye Emergencies</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Nov 22, 2010
Episode 8: Emergency Airway Controversies
1:58:13
<p>There are so many emergency airway controversies in emergency medicine! Dr. Jonathan Sherbino, Dr. Andrew Healy and Dr. Mark Mensour debate dozens of these controversies surrounding emergency airway management. A case of a patient presenting with decreased level of awareness provides the basis for a review of the importance, indications for, and best technique of bag-valve-mask (BVM) ventilation, as well as a discussion of how best to oxygenate patients. This is followed by a discussion of what factors to consider in deciding when to intubate and some of the myths of when to intubate. The next case, of a patient with severe head injury who presents with a seizure, is the fodder for a detailed discussion of Rapid Sequence Intubation (RSI). Tips on preparation, pre-oxygenation and positioning are discussed, and some great debates over pre-treatment medications, induction agents and paralytic agents ensues. The new concept of Delayed Sequence Intubation is explained and critiqued. They review how to identify a difficult airway, how best to confirm tube placement and how to avoid post-intubation hypotension. In the last case of a morbidly obese asthmatic they debate the merits of awake intubation vs RSI vs sedation alone in a difficult airway situation and explain the best strategies of ventilation to avoid the dreaded bradysystlolic arrest in the pre-code asthmatic. Finally, some key strategies to help manage the morbidly obese patient's airway effectively are reviewed.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-8-emergency-airway-controversies/">Episode 8: Emergency Airway Controversies</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Oct 07, 2010
Episode 7: Medical and Surgical Emergencies in Pregnancy
1:27:03
<p>The whole playing field changes with pregnant patients in the emergency department. When you're faced with one of the Medical and Surgical Emergencies in Pregnancy that we'll cover in this episode, there are added challenges and considerations. Dr. Shirley Lee and Dr. Dominick Shelton discuss a challenging case of a pregnant patient presenting to the emergency department with shortness of breath and chest pain. They review those diagnoses that the pregnant patient is at risk for and discuss the challenges of lab test interpretation and imaging algorithms in the pregnant patient. Next, they walk us through the management of cardiac arrest in the pregnant patient. In another case of a pregnant patient who presents with abdominal pain and fever, they discuss strategies to minimize delays in diagnosis to prevent serious morbidity and mortality. The pros and cons of abdominal ultrasound, CT and MRI are reviewed as well as the management of appendicitis, pyelonephritis and septic abortion in pregnant patients.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-7-medical-and-surgical-emergencies-in-pregnancy/">Episode 7: Medical and Surgical Emergencies in Pregnancy</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Aug 01, 2010
Episode 6: Transient Ischemic Attack
2:02:57
<p>Transient Ischemic Attack (TIA) can be difficult to diagnose. It's unclear who to work up. It's challenging if the patient is already taking blood thinners. Dr. Walter Himmel and Dr. Daniel Selchen discuss the key historical and physical examination maneuvers to determine whether patients with neurologic complaints have had a TIA or whether they have had a TIA mimic. They review the 3 best risk stratification rules including the ABCD2 Score to help us determine who needs to be admitted and who needs timely investigations to reduce vascular morbidity and mortality. The reasoning behind which patients require urgent carotid imaging, echocardiograms and advanced imaging such as CT Angiogram is explained, and the best medication choices are reviewed, as well as the indications for Clopidogrel, Aggrenox, Warfarin, Heparin and carotid endarterectomy in the managment of Transient Ischemic Attack. In the second part of the episode, a simple and practical approach to the patient with dizziness is presented, and a discussion on which patients with dizziness need urgent work-up and treatment for vertebrobasilar TIA.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/transient-ischemic-attack/">Episode 6: Transient Ischemic Attack</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jul 02, 2010
Episode 5: Renal Colic, Toxicology Update & Body Packers
1:47:44
<p>This Episode is a potpourri of topics - Renal Colic, Toxicology Update & Body Packers. Dr. Lisa Thurgur and Dr. Paul Rosenberg discuss the common presentation of Renal Colic, with perspectives on the mixed evidence for medical expulsive therapy, the overuse of imaging studies and when we need to worry about the patient who presents with excruciating flank pain. Next, Dr. Thurgur gives us an update on the three most important recent advances in Toxicology for emergency physicians - Lipid Emulsion Therapy, Hydroxocobalamin and Insulin therapy for Calcium Channel Blocker toxicity. Finally, Dr. Rosenberg and Dr. Thurgur discuss the 'ins and outs' of body packers. They review the management of both asymptomatic and symptomatic body backers, highlighting common errors and key therapeutic moves to prevent death.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-5-renal-colic-toxicology-update-body-packers/">Episode 5: Renal Colic, Toxicology Update & Body Packers</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Jun 01, 2010
Episode 4: Acute Congestive Heart Failure
1:40:46
<p>Dr. Eric Letovsky and Dr. Brian Steinhart describe a practical way to approach patients with undifferentiated SOB and acute congestive heart failure, the utility of various symptoms and signs in the diagnosis of CHF, as well as the controversies surrounding the best use of BNP and Troponin in the ED. A discussion of the use of ultrasound for patients with SOB as well as the indications for formal Echo are reviewed. In the second part of the episode they discuss the management of acute congestive heart failure based on a practical EM model, as well as the difficulties surrounding disposition of patients with CHF.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-4-acute-congestive-heart-failure/">Episode 4: Acute Congestive Heart Failure</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
May 01, 2010
Episode 3: Pediatric Head Injury
<p>Dr. Rahim Valani and Dr. Jennifer Riley discuss their approach to the workup and management of both minor and major Pediatric Head Injury. They review two recent landmark studies (Kupperman - PECARN & CATCH studies) describing clinical decision rules for performing CT head in minor pediatric head injury, as well as practical tips on instructing parents regarding back to sport activities after discharge. In major pediatric head injury, they discuss key clinical pearls on managing blood pressure, the use of hypertonic saline and managing raised intracranial pressure in the treatment of major head injury.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-3-pediatric-head-injury/">Episode 3: Pediatric Head Injury</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Mar 15, 2010
Episode 2: Excited Delirium
<p>Dr. Margaret Thompson, Canada's toxicology guru and Dr. Dan Cass review the clinical presentation, precipitating factors and important do's and don'ts in managing patients with Excited Delirium Syndrome to prevent sudden death. They update us on the most current guidelines for Excited Delirium Syndrome and discuss the prevalent theories to explain why many of these patients have cardiac arrests.</p> <p>Excited Delirium Syndrome has recently been recognized by the American College of Emergency Physicians as a true medical emergency in which, typically, a young obese male, often under the influence of sympathomimetic drugs, becomes acutely delirious and displays super-human strength, tachypnea, profuse sweating and severe agitation. Usually, there is a prolonged and continued struggle with law enforcement despite physical restraints . Severe acidosis, rhabdomyolysis and hyperkalemia ensue, often leading to a sudden bradyasystolic cardiac arrest. Listen to this fascinating episode to find out how you can recognize and treat this important syndrome.</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-3-excited-delirium/">Episode 2: Excited Delirium</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Mar 09, 2010
Episode 1: Occult Fractures and Dislocations
1:35:21
<p>Dr. Arun Sayal and Dr. Natalie Mamen discuss the key diagnostic considerations in commonly missed occult fractures and dislocations. They review the indications and controversies for the use of Bone Scan, CT and MRI in occult fractures and dislocations and give you some great clinical pearls to use on your next shift.</p> <p>Missed occult fractures and dislocations, in general, may result in significant morbidity for the patient and law suites for you. Six cases are presented in this episode, ranging from common scaphoid fractures to rarer dislocations. Dr. Sayal & Dr. Mamen answer questions such as: Which fractures can mimic ankle sprains and how do you avoid missing them? What are the most reliable signs of scaphoid fracture? In which occult orthopaedic injuries should we anticipate limb threatening ischemia? Which is better to diagnose occult fractures - MRI or CT? Which calcaneus fractures require surgery and which ones can be managed conservatively? and many more......</p> <p>The post <a rel="nofollow" href="https://emergencymedicinecases.com/episode-1-occult-fractures-dislocations/">Episode 1: Occult Fractures and Dislocations</a> appeared first on <a rel="nofollow" href="https://emergencymedicinecases.com">Emergency Medicine Cases</a>.</p>
Mar 09, 2010