Featured Episode

Episode 55 Weingart Himmel Sessions 2 – Fluids in Sepsis & Post-intubation Analgesia & Sedation

Episode 55 Weingart Himmel Sessions 2 – Fluids in Sepsis & Post-intubation Analgesia & Sedation

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.

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Best Case Ever

Journal Jam 2 – Small Bore Chest Tube & Outpatient Management of Pneumothorax

Journal Jam 2 – Small Bore Chest Tube & Outpatient Management of Pneumothorax

Journal Jam
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.....
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Best Case Ever 30 Rob Rogers’ Mother

Best Case Ever 30 Rob Rogers’ Mother

Dr-Rob-Rogers
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.
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A Rational Approach to Emergency Ebola Preparedness

A Rational Approach to Emergency Ebola Preparedness

Ebola preparedness
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).
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Best Case Ever 29 Carr’s Cases – Drug Induced Aseptic Meningitis

Best Case Ever 29 Carr’s Cases – Drug Induced Aseptic Meningitis

drug induced aseptic meningitis
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. 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.
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Best Case Ever 28 David Carr on Anti-NMDA Receptor Encephalitis

Best Case Ever 28 David Carr on Anti-NMDA Receptor Encephalitis

anti nmda receptor encephalitis
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.
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Quick Links to Recent Emergency Medicine Cases Episodes

Entire EM Cases Library is Free Access

Episode 54 Weingart-Himmel Sessions 1 – Preoxygenation & Delayed Sequence Intubation with Walter Himmel & Scott Weingart

Episode 53 Pediatric Point of Care Ultrasound with Jason Fischer, Alyssa Abo, Alex Arroyo & Adam Sivitz

Episode 52 Uncommon Commonly Missed Orthopedic Injuries with Ivy Cheng & Hossein Mehdian

Episode 51 Managing Difficult Patients with Walter Himmel, Jean Pierre Champagne & Ann Shook

Episode 50 Recognition & Management of Pediatric Sepsis and Septic Shock with Sarah Reid & Gina Neto

Journal Jam 1 Age-Adjusted D-dimer with Jeff Kline & Jonathan Kirschner

Episode 49 Effective Patient Communication, Patient Centered Care & Satisfaction with Walter Himmel, Jean Pierre Champagne & Ann Shook

Episode 48 Pediatric Fever Without a Source with Sarah Reid & Gina Neto

Episode 47 Evidence Based Medicine with Walter Himmel

Episode 46 Social Media in Emergency Medicine Learning with Rob Rogers, Ken Milne & Brent Thoma

Episode 45 Swadron on Vertigo, Mattu on Cardiology Literature from EM Update Conference 2014 with Stuart Swadron & Amal Mattu

Episode 44 Whistler’s Update in EM Conference Highlights 2014 with Joel Yaphe, Lisa Thurgur & David Carr

Episode 43 Appendicitis Controversies with David Dushenski & Brian Steinhart

Episode 42 Mesenteric Ischemia & Pancreatitis with David Dushenski & Brian Steinhart

Episode 41 Hypertensive Emergencies with Joel Yaphe & Clare Atzema

Episode 40 Asymptomatic Hypertension with Joel Yaphe & Clare Atzema

Episode 39 Update in Trauma Literature with Dave MacKinnon & Mike Brzozowski

Episode 38 ENT Emergencies with Leeor Sommer & Maria Ivankovic

Episode 37 Anticoagulants, PCCs & Platelets with Walter Himmel, Katerina Pavenski & Jeannie Callum

Episode 36 Transfustions, Anticoagulants & Bleeding with Walter Himmel, Katerina Pavenski & Jeannie Callum