round table discussions on emergency medicine cases

Ep 197 Acute Heart Failure Risk Stratification and Disposition

We over-admit low risk acute heart failure patients and under-admit high risk heart failure patients. In this podcast we discuss the diagnostic accuracy of various clinical features, lab tests and imaging modalities for acute heart failure, the 3 validated risk stratification tools and a simple approach to PoCUS for the diagnosis and prognostication of acute heart failure in the ED to improve our diagnostic accuracy and disposition decisions for patients with acute heart failure... Help Support EM Cases by Giving a Donation here: https://emergencymedicinecases.com/donation/

By Anton Helman|2024-09-07T12:12:26-04:00August 19th, 2024|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Medical Specialty|Tags: BNP, clinical decision rule, Dr. Clare Atzema, Dr. Ian Chernoff, EHMERG score, Lung US, POCUS|0 Comments

Ep 196 Pediatric Meningitis Recognition, Workup and Management

In this episode: recognition, risk stratification, decision tools, indications for lumbar puncture in the febrile pediatric patient, tips and trick on performing LPs in children, and ED management of pediatric meningitis. We answer such questions as: what are the test characteristics of the various clinical features of meningitis across various ages? How does one differentiate between meningitis and retropharyngeal abscess on physical exam? How do the Canadian and American guidelines on work up of well-appearing febrile infants compare when to it comes to indications for lumbar puncture? Which patients with suspected meningitis require imaging prior to lumbar puncture? How do we best interpret the various CSF tests to help distinguish between viral and bacterial meningitis? What are the indications and timing of administering dexamethasone in the pediatric patient with suspected meningitis? and many more.... EM Cases is Free Open Access; please consider a donation to help ensure that EM Cases remains Free Open Access on our donation page https://emergencymedicinecases.com/donation/

By Anton Helman|2024-08-06T17:06:20-04:00July 8th, 2024|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Pediatrics|Tags: dexamethasone, febrile infant, febrile seizure, lumbar puncture|0 Comments

Ep 195 Management of Subarachnoid Hemorrhage

Once the diagnosis of nontraumatic subarachnoid hemorrhage (SAH) has been made, our job is not done. Mortality in SAH patients can be up to 30% even without neurological deficit. Paying attention to the time-sensitive details of ED management of SAH patients can have a significant impact on their outcome. In this second part of our 2-part podcast series on subarachnoid hemorrhage with Dr. Katie Lin and Dr. Jeff Perry we answer questions such as: what are the 4 critical priorities in the initial stabilization of the patient with a suspected massive subarachnoid hemorrhage? When is a CT plus CTA of the head indicated up front in the management of patients with suspected subarachnoid hemorrhage? What is the evidence for oral nimodipine in improving outcomes in patients with subarachnoid hemorrhage and how does it work? What can we do in the ED to prevent rebleeding in patients with subarachnoid hemorrhage? What are the simplest and best prognostic tools available for spontaneous subarachnoid hemorrhage to help counsel families and patients? and more...

By Anton Helman|2024-06-13T16:20:34-04:00May 28th, 2024|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Neurology|Tags: Dr. Jeff Perry, Dr. Katie Lin, nimodipine, raised ICP, SAH|0 Comments

Ep 194 Subarachnoid Hemorrhage – Recognition, Workup and Diagnosis Deep Dive

Anton is joined by the world's leading EM researcher in subarachnoid hemorrhage diagnosis Dr. Jeff Perry and EM-Stroke team clinician Dr. Katie Lin for a deep dive into why we still miss this life-threatening diagnosis, the key clinical clues, proper use of decision tools, indications for CT, indications for CTA, indications for LP and CSF interpretation for the sometimes elusive diagnosis of subarachnoid hemorrhage... Help support EM Cases by making a donation: https://emergencymedicinecases.com/donation/

By Sara Brade|2024-06-18T19:29:10-04:00May 13th, 2024|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Neurology|Tags: CSF interpretation, CT head, Dr. Jeff Perry, Dr. Katie Lin, LP, SAH, SAH decision rule|0 Comments

Ep 193 The Crashing Asthmatic – Recognition and Management of Life Threatening Asthma

In this part 2 of our 2-part podcast on asthma with Dr. Sameer Mal and Dr. Leeor Sommer, we dig into the recognition and management of life-threatening asthma. We answer such questions as: what are the key elements in recognition of threatening asthma? What are the most time-sensitive interventions required to break the vicious cycle of asthma? What are the best options for dosing and administering magnesium sulphate, epinephrine, fentanyl and ketamine in the management of the crashing asthmatic? What is the role of NIPPV in the management of life-threatening asthma? What are the factors we should consider when it comes to indications for endotracheal intubation of the crashing asthmatic? What role do blood gases play in the decision to intubate? What are the most appropriate ventilation strategies in the intubated asthma patient? and many more... Please support EM Cases with a donation: https://emergencymedicinecases.com/donation/

By Anton Helman|2024-06-18T19:36:16-04:00April 2nd, 2024|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Respirology, Resuscitation|Tags: airway management, Dr. Leeor Sommer, Dr. Sameer Mal, endotracheal intubation, fentanyl, ketamine, NIPPV, SABA, salbutamol, ventilation settings|3 Comments

Ep 192 ED Adult Asthma Management Strategies For Improved Prognosis – A Stepwise Approach

In this part 1 of our 2-part podcast series on Asthma Management we explore a systematic approach to managing patients presenting to the ED with asthma exacerbations. Our discussion will emphasize the critical role of a thorough history and physical examination in effectively stratifying patient risk and guiding treatment/disposition decisions. Additionally, we'll examine the importance of providing comprehensive discharge medications and instructions to mitigate both mortality and morbidity associated with asthma exacerbations. We answer questions such as: which patients, if any, require peak expiratory flow measurements in the ED? Why is it so important to add steroid MDI therapy to oral steroid therapy in patients being discharged from the ED after an asthma exacerbation? What are the most predictive variables to risk stratify patients with asthma exacerbations to help guide treatment and disposition? and many more. Stay tuned for Part 2, where we'll delve deep into the management of the crashing asthmatic. Please support EM Cases FOAMed with a donation: https://emergencymedicinecases.com/donation/

By Anton Helman|2024-06-18T19:34:52-04:00March 19th, 2024|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Respirology|Tags: asthma action plan, asthma risk stratification, asthma severity, Dr. Leeor Sommer, Dr. Sameer Mal, ipatropium bromide, MDIs, SABA, salbutamol|3 Comments

Ep 191 The Future of EM – Systems Thinking

In order fix EM, each of us needs to understand systems issues and systems thinking, and advocate for a better system based on sound systems principles and specific solutions. In this main episode EM Cases podcast Anton is joined by Dr. Alecs Chochinov and Dr. Davie Petrie, two systems thinkers and leaders in EM. They discuss solutions for how to fix EM in 5 spheres: having a coordinated mission, optimizing access points, accountability, disaster preparedness and adaptation/evolution. They answer questions such as: What can we glean from how EM has evolved in the last few decades to help shape the future? How can we utilize virtual care to make it work for us and our patients well? How can we improve our EMS systems? How can we change the system to prevent emergency provider burnout? How can we integrate systems thinking into the daily operations of EDs to improve patient flow and outcomes? and many more... -Support EM Cases with a Donation https://emergencymedicinecases.com/donation/

By Anton Helman|2024-02-13T11:44:56-05:00February 13th, 2024|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty|Tags: access block, accountability failure, disaster preparedness, Dr. Alecs Chochinov, Dr. David Petrie, ED overcrowding, health care system, virtual health care|0 Comments

Ep 190 Carpal Bone Injuries – The Big 4

Triquetrum chip fractures, scapholunate injuries, hook of the hamate fractures, and of course, scaphoid fractures can be easily missed with serious consequences for our patients. In this part 2 of our 2-part podcast series on wrist injuries we highlight the "Big 4" most commonly missed and mismanaged carpal bone injuries, elucidating the key historical, physical exam and x-ray findings, as well as management strategies...

By Anton Helman|2024-06-18T19:41:42-04:00January 2nd, 2024|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Orthopaedics|Tags: carpal tunnel view, clenched fist view, hook of hamate fracture, lunate dislocation, lunate injury, perilunate dislocation, scaphoid fracture, scapholunate dissociation, triquetrum fracture|2 Comments

Ep 189 Commonly Missed and Mismanaged Wrist Injuries

In this part 1 or our 2-part podcast series on wrist injuries Dr. Arun Sayal and Dr. Matt DiStefano answer such questions as:when should we suspect a DRUJ injury, why is it important to pick up DRUJ injuries in the ED, and how does it change our management? Why is the lateral x-ray view so important in picking up commonly missed wrist injuries? When it comes to distal radius fractures, how are Colles vs Barton's vs Smith's fractures managed differently in the ED? What are the 2 key x-ray signs we should look for on the AP and the 2 key x-ray signs we should look for on the lateral for every wrist injury? and many more...

By Anton Helman|2024-06-18T19:42:16-04:00December 19th, 2023|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Orthopaedics|Tags: Barton fracture, Colles fracture, Distal Radius Fracture, Galeazzi, Smith's fracture, TFC injury|0 Comments

Ep 188 Hemoptysis – ED Approach and Management

Key principles and approach to management of both non-massive and massive hemoptysis with Dr. Scott Weingart and Dr. Bourke Tillmann, who answer questions such as: What are the factors to consider in the decision to intubate patients with massive hemoptysis? How can one reliably distinguish hemoptysis from pseudohemoptysis? What is the evidence for tranexamic acid in patients with hemoptysis? What are the best strategies for suctioning blood from the airway to improve visualization during endotracheal intubation in crashing hemoptysis patients? What is the role of bronchoscopy and how should it be integrated into the hemoptysis management algorithm? How does one's hemorrhage control strategy change when pulmonary embolism is the underlying diagnosis? and many more... Please support EM Cases with a donation: https://emergencymedicinecases.com/donation/

By Anton Helman|2024-04-02T22:26:04-04:00November 7th, 2023|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Respirology, Resuscitation|Tags: bronchoscopy, ketamine facilitated awake intubation, mainstem intubation, suction catheter, TXA|2 Comments