Featured Episode

Episode 48 – Pediatric Fever Without A Source

Episode 48 – Pediatric Fever Without A Source

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.

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.

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.

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….

Title
EMC-Ep048-Aug2014PedsFever
Title
EMC-Ep048-Aug2014PedsFever112
 

Learn More »

Best Case Ever

Best Case Ever 27 – Sarah Reid on Pediatric Shock

Best Case Ever 27 – Sarah Reid on Pediatric Shock

dr sarah reid
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. Maximize your learning and submit your questions on 'Pediatric Fever Without a Source' on the Next Time on EM Cases page.
Title
EMC-BCE-027-Jul2014-REID
Title
EMC-BCE-027-Jul2014-REID
 

Read More...

Best Case Ever 26 – Mike Betzner on Chloral Hydrate Poisoning & Cardiac Arrest

Best Case Ever 26 – Mike Betzner on Chloral Hydrate Poisoning & Cardiac Arrest

torsades de pointes
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.
Title
EMC-BCE-026-Jun2014BETZNER
Title
EMC-BCE-026-Jun2014BETZNER
 

Read More...

Best Case Ever 25 Rob Rogers on Social Media in EM Education

Best Case Ever 25 Rob Rogers on Social Media in EM Education

foamed-logo
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.
Title
EMC-BCE-025-Jun2014ROGERS
Title
EMC-BCE-025-Jun2014ROGERS
 

Read More...

Best Case Ever 24 Amal Mattu on COPD, Baggging & Vent Settings

Best Case Ever 24 Amal Mattu on COPD, Baggging & Vent Settings

amal-mattu
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.
Title
EMC-BCE-024-May2014MATTU
Title
EMC-BCE-024-May2014MATTU
 

Read More...

Best Case Ever 23 Stuart Swadron – The Effect of Medical Insurance on ED Care

Best Case Ever 23 Stuart Swadron – The Effect of Medical Insurance on ED Care

medical-insurance-ed-care
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.
Title
EMC-BCE-23-SWADRON
Title
EMC-BCE-23-SWADRON
 

Read More...

Emergency Medicine Cases is entirely FREE OPEN ACCESS MEDICAL EDUCATION

How to get the most out of EM Cases Episodes

  1. Read ‘Next Time on EM Cases’ and submit your questions
  2. Check out the references
  3. Listen to the Podcast
  4. Read the EM Cases Summary
  5. Go through the Q & A on the blog post of the episode
  6. Send your real life case related to the episode to anton@emergencymedicinecases.com