round table discussions on emergency medicine cases

Ep 151 AKI Part 2 – ED Management

In this Part 2 of our AKI series we discuss the timing, volume and IV crystalloid of choice in AKI patients as well as dialysis indications and timing in light of the recent STARRT-AKI trial. We answer the questions: are piperacillin and vancomycin in combination contraindicated in patients with severe AKI? Is vasopressin preferred over norepinephrine in patients with AKI and septic shock? Is there a role for IV sodium bicarbonate in AKI? When should ACEi/ARBs be held in AKI patients? When, if ever, should NSAIDs be given in AKI patients, and if so, how should the dose be modified? and many more....

By Anton Helman|2022-10-26T20:09:33-04:00January 12th, 2021|Categories: EM Cases, Emergency Medicine, Episodes, Genitourinary, Medical Specialty|Tags: acute kidney injury, acute renal failure, dialysis, Dr. Bourke Tillmann, Dr. Ed Etchells, sodium bicarbonate, STARRT-AKI, vasopressin|0 Comments

Ep 150 Acute Kidney Injury – A Simple Emergency Approach to AKI

In this first part of our 2 part podcast series on AKI we answer questions such as: Is there any value in the BUN:Cr ratio in distinguishing prerenal from intrarenal disease? Why is nephritic syndrome one of the most important intrarenal causes to pick up in the ED? Is there any value in urine electrolytes for the ED workup of AKI? Is there a role for bicarb in patients with severe AKI? How can we choose wisely when it comes to imaging for patients with AKI? How can we utilize POCUS best in working up the patient with AKI? What are the indications for ordering a CK to look for rhabdomyolysis? At what CK level do patients typically develop AKI? How can the McMahon score help us manage rhabdomyolysis? What is the value of urine myoglobin in the workup of rhabdomyolysis? What are indications for dialysis in patients with rhabdomyolysis? What are safe discharge criteria for patients with rhabdomyolysis? and many more...

By Anton Helman|2022-10-30T08:42:59-04:00December 21st, 2020|Categories: EM Cases, Emergency Medicine, Episodes, Genitourinary, Medical Specialty|Tags: acute renal failure, AKI, ARF, hyperkalemia, rhabdomyolysis|3 Comments

Ep 149 Liver Emergencies: Thrombosis and Bleeding, Portal Vein Thrombosis, SBP, Paracentesis Tips and Tricks

In this part 2 of our 2 part series on Liver Emergencies we clear up the confusing balance between thrombosis and bleeding in liver patients, the elusive diagnosis of portal vein thrombosis, spontaneous bacterial peritonitis diagnosis and treatment and some tips and tricks on paracentesis with Walter Himmel and Brian Steinhart....

By Anton Helman|2022-06-09T16:21:19-04:00November 24th, 2020|Categories: EM Cases, Emergency Medicine, Episodes, Gastroenterology, Medical Specialty|Tags: albumin, bacterial peritonitis, GI bleed, paracentesis, portal vein thrombosis, PVT, SBP, thromboembolism, TXA|1 Comment

Ep 148 Liver Emergencies: Acute Liver Failure, Hepatic Encephalopathy, Hepatorenal Syndrome, Liver Test Interpretation & Drugs to Avoid

In this 1st part of our 2 part series on Liver Emergencies Walter Himmel, Brian Steinhart and Anton discuss: What are the most important causes of acute liver failure that we need to identify in the ED so we can initiate timely treatment? What are some of the common medications we use in the ED that we should avoid in the liver patient? How should we approach the interpretation of liver enzymes and liver function tests? What are the key management steps in treating acute liver and hepatorenal syndrome? Why do liver failure patients become hypoglycemic and how should hypoglycemia in these patients be treated in the ED? How do we diagnose hepatorenal syndrome in the ED? How can the MELD score help us manage liver patients? What are the indications for IV albumin? What is the role of an ammonia level in the diagnosis of hepatic encephalopathy? Is polyethylene glycol a better alternative to lactulose for treating hepatic encephalopathy? and much more...

By Anton Helman|2022-06-09T16:41:55-04:00November 10th, 2020|Categories: EM Cases, Emergency Medicine, Episodes, Gastroenterology, Medical Specialty, Toxicology|Tags: acute liver failure, albumin, hepatic encephalopathy, hepatorenal syndrome, LFTs, liver enzymes|2 Comments

Ep 147 HHS Recognition and ED Management

In this podcast, Part 2 of our diabetic emergencies series with Melanie Baimel, Bourke Tillmann and Leeor Sommer, we dive into the recognition and ED management of Hyperglycemic Hyperosmolar State (HHS). We answer questions such as: how does one differentiate DKA from HHS clinically? How do patients with HHS become hyperglycemic, dry and altered? Why is finding and treating the cause or trigger of HHS so important in the ED? How does fluid management differ in HHS from DKA? and many more...

By Anton Helman|2022-06-11T06:43:39-04:00October 13th, 2020|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty|Tags: DKA, fluid resuscitation, HHS, insulin|0 Comments

Ep 146 DKA Recognition and ED Management

In this first part of our 2-part podcast on DKA and HHS, Drs Melanie Baimel, Bourke Tillman and Leeor Sommer discuss the importance of identifying the underlying cause or trigger in DKA patients, the pitfall of ruling out DKA in patients with normal pH or normal serum glucose, how to close the gap effectively, why stopping the insulin infusion is almost never indicated, how to avoid cardiac collapse when DKA patients require endotracheal intubation, the best alternatives to plastic in the trachea, why using a protocol improves patient outcomes, how to avoid the common complications of hypoglycemia and hypokalemia, and much more...

By Anton Helman|2022-06-11T07:04:59-04:00September 29th, 2020|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Resuscitation|Tags: cerebral edema, diabetic ketoacidosis, DKA, euglycemic DKA, hypokalemia, metabolic acidosis|9 Comments

Ep 145 Physician Compassion – The Barbara Tatham Memorial Podcast

Dr. Barbara Tatham, EM colleague and educator, died of metastatic sarcoma at the age of 32 in October 2019. During her last year of life, in between surgeries, ICU stays and rounds of chemotherapy and radiation, she gave lectures on compassionate care inspired by her journey as a patient. In August 2019 we met at my summer cottage to record this podcast. We explored the evidence that compassionate care improves patient outcomes and staves off physician burnout. We discussed how compassion can be learned and applied easily and efficiently in your practice. We talked about the do’s and don’ts of compassionate care and ended with a call to action. It is my hope that, through this podcast, her voice and vision will reverberate and she will continue to champion compassionate care into the future…

By Anton Helman|2022-06-11T15:43:03-04:00August 25th, 2020|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty|Tags: compassionate care, Dr. Barbara Tatham, physician communication, physician compassion|6 Comments

Ep 144 Testicular Torsion: A Diagnostic Pathway

In this Part 2 of Urologic Emergencies EM Cases main episode podcasts Dr. Natalie Wolpert and Dr. Yonah Krakowsky answer questions about testicular torsion including: when, after the onset of symptoms, is the testicle salvageable? How sensitive is the presence of cremasteric reflex in ruling out testicular torsion? Are there any set of clinical symptoms and signs or decision tools (such as the TWIST Score) that can rule in or rule out testicular torsion with confidence? How accurate is doppler ultrasound in the diagnosis of testicular torsion? To what degree does Prehn's sign help distinguish epididymitis from testicular torsion? How can you distinguish testicular torsion from torsion of testicular appendage? When is manual de-torsion indicated and how effective is it? and many more...

By Anton Helman|2022-06-11T15:55:59-04:00July 28th, 2020|Categories: EM Cases, Emergency Medicine, Episodes, Genitourinary, Medical Specialty, Pediatrics|Tags: cremasteric reflex, doppler ultrasound, Dr. Natalie Wolpert, Dr. Yonah Krakowsky, Prehn's, TWIST score|0 Comments

Ep 143 Priapism and Urinary Retention: Nuances in Management

This month's main episode podcast on Urologic Emergencies - Priapism and Urinary Retention asks: for priapism how much time to do we have to fix it before there’s irreversible tissue damage? How is priapism managed differently depending on the cause? What is the value of a corporal blood gas for managing priapism? What are the indications for cavernosal phenylephrine injections? What are the common medications that cause urinary retention that we often miss leading to needless recurrent urinary retention? Why is a suprapubic catheter in many respects safer than a urethral catheter for managing urinary retention? Which patients are at high risk for complications of post-obstructive diuresis? and many more...

By Anton Helman|2022-06-11T16:08:20-04:00July 14th, 2020|Categories: EM Cases, Emergency Medicine, Episodes, Genitourinary, Medical Specialty|Tags: phenylephrine, post obstructive diuresis, priapism, triple mix, urethral catheter, urinary retention|4 Comments

Ep142 Neonatal Resuscitation – Airway, Temperature Control, Central Access, Hemodynamics, Glucose Control and Transport

Dr. Hilary Whyte, Dr. Jabeen Fayyaz, Dr. Emily MacNeill discuss a neonatal resuscitation algorithm, airway management, fluid resuscitation, central access tips, glucose and temperature control and transport tips...

By Anton Helman|2022-06-11T16:39:46-04:00May 18th, 2020|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Pediatrics, Resuscitation, Uncategorized|Tags: airway, cardiac arrest, CPR, Dr. Hilary Whyte, newborn resuscitation, NRP|9 Comments