round table discussions on emergency medicine cases

Ep 161 Red Flag Headaches: General Approach and Cervical Artery Dissections

In this Part 1 or our two part podcast series on Red Flag Headaches we discuss a general approach, tips and tricks to assessing patients who present with headache followed by a deep dive into cervical artery dissections. With the help of Dr. Roy Baskind and Dr. Amit Shah we answers questions such as: what are the big 4 headache diagnoses that are not routinely picked up on plain CT or LP? Why are the symptoms of cervical artery dissection often fluctuating? Why do the symptoms of cervical artery dissection sometimes seem to not fit an anatomical distribution? What are the key clinical features that would trigger you to suspect cervical artery dissection? How do you decide which patients require a CT angiogram? What is the evidence for a causal relationship between chiropractic manipulation and cervical artery dissections? What is evidence for antiplatelet agents, anticoagulants and thrombolysis in the management of cervical artery dissection? Which patients with cervical artery dissection can be safely discharged from the ED and many more...

By Anton Helman|2022-10-29T17:40:37-04:00November 2nd, 2021|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Neurology|Tags: approach to headache, carotid artery dissection, cervical artery dissection, Dr. Amit Shah, Dr. Roy Baskind, vertebral artery dissection|0 Comments

Ep 160 Geriatric Trauma 2 Rib Fractures, Pelvic Fractures, Prognostication, Elder Abuse, Discharge Planning

In Geriatric Trauma Part 2 we answer questions such as: what are the indications for transfer to a trauma center in older patients with rib fractures and why? Can we accurately prognosticate older trauma patients in the ED? How can we best engage family members in goals of care discussions for the older trauma patient? What are the risk factors for elder abuse that we need to be aware of in the ED? How can we best minimize the risk for recurrent falls and bounce backs for the older trauma patient who is discharged from the ED? and many more...

By Anton Helman|2022-10-29T17:43:01-04:00September 7th, 2021|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Special Populations, Trauma|Tags: elder abuse, falls, frailty scale, hip fracture, non-accidental trauma, pelvic fracture, rib fracture|2 Comments

Ep 159 Geriatric Trauma Part 1: The Under-Triaging Problem, Resuscitation, Airway, Head and C-spine Imaging, Clearing the C-spine

Just as pediatric patients are not small adults, geriatric patients are not just old adults. In this Part 1 of our 2-part EM Cases podcast series on Geriatric Trauma, Dr. Barbara Haas, Dr. Camilla Wong and Dr. Bourke Tillman answer questions such as: why are older patients under-triaged to trauma centers and how does that affect outcomes? What is the utility of the Shock Index in older patients? How should we adjust airway management for the older trauma patient? Which older patients do not require head or c-spine imaging after a ground level fall? Why is it challenging, yet of utmost importance, to clear the c-spine of a geriatric trauma patient as soon as possible? When can anticoagulation medications be safely resumed after an older person has sustained a minor head injury? and many more...

By Anton Helman|2022-10-29T17:45:02-04:00August 24th, 2021|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Resuscitation, Special Populations, Trauma|Tags: c-spine, head injury, undertriage|2 Comments

Ep 158 Management of Primary Spontaneous Pneumothorax

In this main episode podcast we discuss the conservative management of large spontaneous pneumothorax, when a pigtail chest tube with Heimlich valve is indicated, detection of persistent air leak, removal of chest tube, surgical indications for spontaneous pneumothorax, management pitfalls and more...

By Anton Helman|2022-10-29T17:47:37-04:00July 27th, 2021|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Respirology, Ultrasound|Tags: air leak, chest tube, Heimlich valve, needle aspiration, pigtail catheter, thoracentesis|5 Comments

Ep157 Neuromuscular Disease for Emergency Medicine

There is a long list of rare neuromuscular diseases. Nonetheless, there are a few that you are likely to see in the ED, that are relevant to Emergency Medicine because they require timely diagnosis and treatment. In this Part 2 of our 2-part series on acute motor weakness with Roy Baskind and George Porfiris, we keep it short and simple by limiting our discussion to the key clinical clues and management strategies of two of the more common acute life-threatening neuromuscular diseases, myasthenia gravis and Guillain Barré syndrome, and how to distinguish them from their mimics...

By Anton Helman|2022-10-29T17:48:25-04:00June 1st, 2021|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Neurology|Tags: GBS, Guillain Barre, myasthenia gravis, neuromuscular disease|4 Comments

Ep156 ED Approach to Acute Motor Weakness

In this Part 1 of our 2-part podcast on Acute Motor Weakness we introduce a five step approach to acute motor weakness with Dr. Roy Baskind Dr. George Porfiris: 1. Does the complaint of weakness represent a true loss of motor power? 2. The geography of weakness - patterns of motor power loss 3. Timing, course and fatigability of acute motor weakness 4. Distinguish upper versus lower motor neuron weakness by degree and speed of movement 5. Differentiate the types of lower motor neuron lesions - peripheral neuropathy vs neuromuscular junction vs myopathy, as well as review the indication for endotracheal intubation for the patient with neuromuscular weakness...

By Anton Helman|2022-10-29T17:58:40-04:00May 18th, 2021|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Neurology|Tags: Dr. George Porfiris, Dr. Roy Baskind, myopathy, neuromuscular disease, neuropathy|11 Comments

Ep 155 Treatment of Bradycardia and Bradydysrhythmias

In Part 1 of our 2-part series on bradycardia and bradydysrhythmias we discussed a practical approach with electrophysiologist Paul Dorian and EM doc Tarlan Hedayati. In this, part 2, we discuss details of treatment. We answer questions such as: When should pacing be prioritized over medications and vice versa? What are the latest recommendations about dosing of atropine and when is atropine likely to be detrimental? How is the treatment of bradycardia different in the patient with hypothermia? Cardiac ischemia? Myxedema coma? AV nodal blocker overdose? What are the most common pitfalls in utilizing transcutaneous and transvenous pacing? and many more...

By Anton Helman|2023-02-06T12:44:08-05:00April 20th, 2021|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Medical Specialty|Tags: atropine, dopamine, epinephrine, isoproterenol, transvenous pacer, transvenous pacing|2 Comments

Ep 154: 4-Step Approach to Bradycardia and Bradydysrhythmias

How do we figure out when bradycardia is due to a medical illness and when it is a primary cardiac problem? What are the 4 immediate life threatening diagnosis that we have to entertain and address in the first few minutes of the sick bradycardic patients? What are some key ECG patterns that are sometimes missed by ED docs that can have devastating consequences? How can we better understand Torsades de Pointes by understanding AV blocks? How can we better understand Mobitz l and ll using 'The Dorian' approach? What is BRASH syndrome and how can we recognize it? In this main episode podcast 4-step Approach to Bradycardia and Bradydysrhythmias with electrophysiologist, educator and researcher Dr. Paul Dorian and Chair of Education for the ED at Cook County Hospital Dr. Tarlan Hedayati, we dig deep into bradycardia...

By Anton Helman|2022-10-29T18:05:51-04:00April 6th, 2021|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Medical Specialty, Resuscitation|Tags: AV block, BRASH syndrome, junctional bradycardia, tachy-brady syndrome, Torsades|1 Comment

Ep 153 Pediatric Minor Head Injury and Concussion

Recent literature suggests that pediatric patients take longer to recover from mild traumatic brain injury compared to adults, and persistent post-concussive symptoms (PPCS) after 1 month occur in up to 30% of children after minor head injury. These children can and should be identified in the ED based on the PPCS clinical risk score. In this EM Cases main episode podcast "Pediatric Minor Head Injury and Concussion" Dr. Sarah Reid and Dr. Roger Zemek discuss how best to incorporate the PECARN and CRASH2 decision tools into your practice, the role of Fast MRI, how to identify children who are at risk for long term sequelae after a minor head injury and how to manage persistent concussion symptoms when a child returns to the ED after a minor head injury...

By Anton Helman|2023-02-06T12:40:37-05:00March 9th, 2021|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Pediatrics|Tags: CATCH2, consussion, PECARN, PPCS risk score, return to sport, VOMS|0 Comments

Ep 152 The 7 Ts of Massive Hemorrhage Protocols

Dr. Jeannie Callum, Dr. Andrew Petrosoniak and Dr. Barbara Haas join Anton in answering the questions: How do you decide when to activate the MHP? How do you know when it is safe to terminate the MHP? What lab tests need to be done, how often, and how should the results be shared with the clinical team? Once the dust settles, what do we need to tell the patient and/or their family about the consequences of being massively transfused? What should be the lab resuscitation targets? Why is serum calcium important to draw in the ED for the patient who is exsanguinating? How do we mitigate the risk of hypothermia? What can hospitals do to mitigate blood wastage? If someone is on anti-platelets or anticoagulants what is the best strategy to ensure the docs in the ED know what to give and how much? Until the results of lab testing come back and hemorrhage pace is slowed, what ratio of plasma to RBCs should we target? What's better, 1:1:1 or 2:1:1? Should we ever consider using Recombinant Factor 7a? If the fibrinogen is low, what is the optimal product and threshold for replacement? When and how much TXA? Anyone you wouldn’t give it to? and many more...

By Anton Helman|2022-06-07T21:34:16-04:00February 9th, 2021|Categories: EM Cases, Emergency Medicine, Episodes, Hematology, Medical Specialty, Trauma|Tags: cryoprecipitate, FFP, fibrinogen, MHP, MTP, PCCs, RABT score, transfusion, TXA|5 Comments