round table discussions on emergency medicine cases

Episode 101 GI Bleed Emergencies Part 1

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...

By Anton Helman|2022-10-21T15:14:13-04:00October 10th, 2017|Categories: EM Cases, Emergency Medicine, Episodes, Gastroenterology, Medical Specialty, Resuscitation|Tags: Anand Swaminathan, balloon tamponade, Blakemore, endoscopy, FOBT, Jeannie Callum, LGIB, massive transfusion, NG tube, Salim Rezaie, tranexamic acid, TXA, UGIB|2 Comments

Episode 100 Disaster Medicine

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...

By Anton Helman|2022-10-21T15:25:55-04:00September 12th, 2017|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Trauma|Tags: airway, biohazard, bioterrorism, Daniel Kollek, decontamination, HAZMAT, Joshua Bezanson, Laurie Mazurik, natural disaster, SALT, surge capacity|4 Comments

Episode 99 Highlights from EMU 2017

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...

By Anton Helman|2023-06-12T10:29:21-04:00August 15th, 2017|Categories: Conference, EM Cases, Emergency Medicine, Episodes, Medical Specialty, Neurology, NYGH EM Update|Tags: acute vestibular syndrome, Chris Hicks, EMU, Leeor Sommer, Lyme, Matt Poyner, patient complaints, signover, stroke, vertebral artery dissection, vertigo, Walter HImmel|0 Comments

Episode 98 Teaching on Shift

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...

By Anton Helman|2021-03-30T13:37:10-04:00July 17th, 2017|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty|Tags: Amal Mattu, feedback, one minute preceptor, Rick Penciner|1 Comment

Episode 96 Beyond ACLS Cardiac Arrest – Live from EMU Conference 2017

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...

By Anton Helman|2021-04-04T11:54:58-04:00May 23rd, 2017|Categories: Cardiology, Conference, EM Cases, Emergency Medicine, Episodes, NYGH EM Update, Resuscitation, Ultrasound|Tags: cardiac arrest, dual defibrillation, esmolol, Jordan Chenkin, PEA arrest, POCUS, ventricular fibrillation|3 Comments

Episode 95 Pediatric Trauma

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...

By Anton Helman|2022-12-06T07:32:02-05:00May 9th, 2017|Categories: EM Cases, Emergency Medicine, Episodes, Pediatrics, Resuscitation, Trauma|Tags: abdominal trauma, airway, BIG score, c-cpine, chest trauma, head injury, pediatric tauma score, Sue Beno, tranexamic acid|2 Comments

Episode 94 UTI Myths and Misconceptions

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?...

By Anton Helman|2022-10-26T21:35:50-04:00April 12th, 2017|Categories: EM Cases, Emergency Medicine, Episodes, Genitourinary, Medical Specialty|Tags: cystitis, Fosfomycin, pyelonephritis, STI, urinalysis|6 Comments

Episode 93 – PALS Guidelines

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.

By Anton Helman|2022-12-06T07:28:41-05:00March 14th, 2017|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Medical Specialty, Pediatrics, Resuscitation|Tags: amiodarone, atropine, cardiac arrest, chest compressions, CPR, ECMO, fluid management, lidocaine, septic shock, TTM|3 Comments

Episode 92 – Aortic Dissection Live from The EM Cases Course

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…

By Anton Helman|2021-03-30T14:35:40-04:00February 21st, 2017|Categories: Cardiology, Conference, EM Cases, Emergency Medicine, Episodes, Medical Specialty|Tags: David Carr, EM Cases Course, esmolol, labetolol, troponin|0 Comments

Episode 91 Occult Knee Injuries Pearls and Pitfalls

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...

By Anton Helman|2021-04-02T13:30:58-04:00January 24th, 2017|Categories: EM Cases, Emergency Medicine, Episodes, Orthopaedics, Trauma|Tags: Arun Sayal, Hossein Mehdian, knee dislocation, tibial plateau fracture|1 Comment