Emergency Medicine Cases

Best Case Ever 3: Emergency Headache – Importance of Opening Pressure

In association with Episode 14, 'Headache Pearls & Pitfalls' with Dr. Anil Chopra and Dr. Stella Yiu, we present here, the third of our new 5 minute 'Best Case Ever' series. In Episode 14: Headache Pearls & Pitfalls, which has just been released, Dr. Chopra and Dr. Yiu answer questions like: With the ever improving resolution of CT, should we still be doing LP after negative plain CT head for all our thunderclap headache patients? How can we best minimize the chance of post-LP headache? What evidenced-based treatments can we initiate in the ED for our SAH patients that will improve outcomes? [wpfilebase tag=file id=375 tpl=emc-play /] [wpfilebase tag=file id=374 tpl=emc-mp3 /]

By Anton Helman|2016-10-20T13:26:59-04:00May 10th, 2011|Categories: Best Case Ever, EM Cases, Emergency Medicine, Neurology|Tags: Anil Chopra, IIH, lumbar puncture, pseudotumor cerebri, thunderclap headache|1 Comment

Episode 14 Part 2: Thunderclap Headache – Cerebral Venous Thrombosis and Cervical Artery Dissection

emergency headacheIn Part 2 of this episode on Thunderclap Headache - Cerebral Venous Thrombosis & Cervical Artery Dissction, Dr. Stella Yiu and Dr. Anil Chopra review the presentation, work-up and management of some of the less common but very serious causes of headache including Cervical Artery Dissection (CAD), Cerebral Venous Thrombosis (CVT) and Idopathic Intracranial Hypertension (IIH). They tell us the most effective ways in which we can minimize the chance of the common Post-LP Headache. They answer questions such as: How does a carotid artery dissection present compared to a vertebral artery dissection? What is the evidence for chiropractic neck manipulation as a cause for Cervical Artery Dissection? How do antiplatelets compare to heparin for the treatment of Cervical Artery Dissection? What is Spontaneous Intracranial Hypotension? What is the differential diagnosis for headache in the peri-partum patient? Does D-dimer have a role in ruling out Cerebral Venous Thrombosis in the low risk patient? What is the imaging modality of choice for suspected Cerebral Venous Thrombosis? What is the value of opening pressure when performing an LP? What are the key headache diagnoses that can be missed on plain CT of the head and would warrant further investigation? and many more.....

By Anton Helman|2024-08-18T18:53:59-04:00May 9th, 2011|Categories: EM Cases, Emergency Medicine, Episodes, Neurology|Tags: Anil Chopra, CVT, D-dimer, IIH, opening pressure, post-LP headache, pseudotumor cerebri, spontaneous intracrnial hypotension, Stella Yiu|4 Comments

Episode 14 Part 1: Migraine Headache and Subarachnoid Hemorrhage

In Part 1 of this episode on Headache Pearls & Pitfalls - Migraine Headache & Subarachnoid Hemorrhage, Dr. Anil Chopra and Dr. Stella Yiu discuss the best evidenced-based management of migraine headache in the ED including the use of dexamethasone, dopamine antagonists, the problems with narcotics and the efficacy of 'triptans'. An easy way to remember the worrisome symptoms of headache indicating a serious cause is reviewed followed by a detailed discussion of the pearls, pitfalls and controversies around the work-up of Subarachnoid Hemorrhage (SAH) in light of some exciting recent literature, including the basis for a new Canadian decision rule for SAH.

By Anton Helman|2024-08-18T18:53:57-04:00May 9th, 2011|Categories: EM Cases, Emergency Medicine, Episodes, Neurology|Tags: Anil Chopra, clinical decision rules, lumbar puncture, migraine, Stella Yiu, subarchnoid hemorrhage|1 Comment

Episode 13 Part 2: Killer Coma Cases – The Intoxicated Patient

In part 2 of this episode Dr. Helman presents two more cases to Dr. Carr and Dr. Steinhart, who give us their insights into the common conundrums when it comes to the intoxicated ED patient, and some key clues to the not-so-common life threatening toxicological emergencies that we need to be on the look out for.

By Anton Helman|2021-03-31T13:28:03-04:00April 12th, 2011|Categories: EM Cases, Emergency Medicine, Episodes, Neurology, Toxicology|Tags: altered mental status, Brian Steinhart, coma cocktail, David Carr, naloxone|2 Comments

Episode 13 Part 1: Killer Coma Cases – The Found Down Patient

In Part 1 of Killer Coma Cases - The Found Down Pateint, Dr. Helman presents two challenging cases to Dr. Brian Steinhart and Dr. David Carr, who tell us loads of key clinical pearls in their approaches to the 'found down' patient. They discuss the important components of the neurological exam in the comatose patient, the differential diagnosis of altered mental status and hyperthermia, the controversies around when to get a CT head before performing a lumbar puncture, and much more in this Killer Coma Cases episode. In Part 1 of this episode, we discuss the limitations of plain CT, the interpretation of CSF and the many faces of seizures. Any more information would be giving away the cases.....

By Anton Helman|2024-08-18T18:55:50-04:00April 12th, 2011|Categories: EM Cases, Emergency Medicine, Episodes, Neurology|Tags: altered mental status, Brian Steinhart, coma cocktail, CSF analysis, David Carr, found down, lumbar puncture, meningitis, seizure, status epilepticus|5 Comments

Best Case Ever 2 The Found Down Patient

In relation to Episode 13 on The Found Down Patient with Dr. Brian Steinhart and Dr. David Carr, we present here, the second of our new 5 minute 'Best Case Ever' series. Dr. Steinhart's found down patient In Episode 13 The Found Down Patient, Dr. Helman presents 4 challenging cases of patients who present with altered mental status to Dr. Carr and Dr. Steinhart, who give us loads of key pearls and intriguing controversy in the evaluation and treatment of these difficult patients. [wpfilebase tag=file id=370 tpl=emc-play /] [wpfilebase tag=file id=371 tpl=emc-mp3 /]

By Anton Helman|2016-10-20T13:27:39-04:00March 31st, 2011|Categories: Best Case Ever, EM Cases, Emergency Medicine, Neurology|Tags: aortic dissection, Brian Steinhart, coma, found down|0 Comments

Episode 12 Part 2: ACLS Guidelines – Atropine, Adenosine & Therapeutic Hypothermia

In Part 2 of this episode on ACLS Guidelines - Atropine, Adenosine & Therapeutic Hypothermia, Dr. Steven Brooks and Dr. Michael Feldman discuss the removal of Atropine from the PEA/Asystole algorithm, the indications and dangers of Adenosine in wide-complex tachycardias, pressors as a bridge to transvenous pacing in unstable bradycardias, and the key elements of post cardiac arrest care including therapeutic hypothermia and PCI. They answer questions such as: In which arrhythmias can Amiodarone cause more harm than good? Is there any role for transcutaneous pacing for asystole? When should Bicarb be given in the arrest situation? In what situations is Atropine contra-indicated or the dosage need to be adjusted? How has the widespread use of therapeutic hypothermia currently effected our ability to prognosticate post-arrest patients? What are the indications for PCI and thrombolysis in the cardiac arrest patient? Should we be using therapeutic hypothermia in the non-Vfib arrest patient? What is the best method for achieving the target temperature for the patient undergoing therapeutic hypothermia? and many more......

By Anton Helman|2024-08-19T19:27:44-04:00March 9th, 2011|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Resuscitation|Tags: adenosine, atropine, capnography, cardiac arrest, cardiocerebral resuscitation, CPR, Michael Fledman, post arrest care, Steven Brooks|0 Comments

Episode 12 Part 1: ACLS Guidelines – What’s New & Controversial

In Part 1 of this episode on the latest ACLS Guidelines, Dr. Steven Brooks and Dr. Michael Feldman review and debate what's new and what's controversial in the the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Within the frameworks of Cardiocerebral Rescusitation and the 3 phase model of rescucitation (electrical, circulatory and metabolic), they discuss the importance of high quality CPR, the de-emphasis on early ventilation and the utility of continuous quantitative waveform capnography. Dr. Brooks and Dr. Feldman answer questions such as: of all the therapeutic manoeuvres we do for the cardiac arrest patient, which ones have been shown to improve survival to hospital discharge? What is the evidence for chest compression machines? What is the utility of bedside ultrasound in the cardiac arrest patient? Why is cardiac arrest survival to discharge in Seattle the best in the world? Should we be performing 'hands-on defibrillation'? and many more.....

By Anton Helman|2024-08-19T19:27:42-04:00March 9th, 2011|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Resuscitation|Tags: atropine, capnography, cardiocerebral resuscitation, CPR, Michael Fledman, post arrest care, Steven Brooks|0 Comments

Episode 11: Cognitive Decision Making and Medical Error

In this episode on Cognitive Decision Making & Medical Error, Dr. Doug Sinclair, CMO of St. Michael's Hospital and Dr. Chris Hicks show us that, while the ED physician's knowledge base may play a small part in predicting medical error, more important might be how we understand and reflect upon our decision-making processes, how we communicate with our staff and patients, and how we cope with the ED environment and shift work. Medical error is the 6th leading cause of death in North America, and despite huge advances in imaging technology and lab testing as well as an explosion of EM literature in recent years, the misdiagnosis rate detected through autopsy studies has not changed significantly over the past century. Studies on diagnostic error in emergency medicine have shown error rates between 1 and 12%, and it's been suggested that cognitive error, or some flaw in the decision making process (as apposed to a lack of knowledge), is present in about 95% of these cases. Dr. Sinclair and Dr. Hicks elucidate for us how to identify and understand cognitive decision making and medical error, and how we can improve our decision making, reduce medical error and optimize the care of our patients.

By Anton Helman|2021-03-31T13:30:57-04:00February 4th, 2011|Categories: Clinical Practice, EM Cases, Emergency Medicine, Episodes|Tags: Chris Hicks, communication, Doug Sinclair, medical error|2 Comments

Episode 10 Part 2: Trauma Pearls and Pitfalls

In Part 2 of this episode on Trauma Pearls & Pitfalls Dr. Dave MacKinnon and Dr. Mike Brzozowski go through key management strategies and controversies surrounding head, neck, chest, abdominal, pelvic and extremity trauma, followed by a discussion on how best to prepare the trauma patient for transfer to a trauma centre.

By Anton Helman|2025-06-01T13:06:23-04:00January 11th, 2011|Categories: EM Cases, Emergency Medicine, Episodes, Trauma|Tags: FAST, pan-scan, pelvic fracture, penetrating trauma, pneumothorax, POCUS|2 Comments