Dr. Andrew Worster and the BEEM (Best Evidence in Emergency Medicine) group from McMaster University has teamed up with EM Cases, Justin Morgenstern (@First10EM) and Rory Spiegel (@EMNerd_) to bring you a blog that blends the BEEM critical appraisals in a case-based, interactive, practice-changing format. In each post we choose the most important literature on a given topic and run through a case, learning how to apply evidence based medicine to our practice. Welcome to BEEM Cases! And here's BEEM Cases 1 - Pediatric Minor Head Injury... Written by Justin Morgenstern (@First10EM), edited by Anton Helman (@EMCases), adapted from the BEEM Course, Jan 2016 Pediatric Minor Head Injury - Decision Rules, Isolated LOC & Strict Rest The Case... With seconds left in the game, Melissa, an 11 year old girl, drives hard to the basket for a layup. She gets knocked to the ground, and doesn’t see the winning shot pass through the net, because it appeared as though she briefly lost consciousness. She quickly gets back up and celebrates with her friends, but after the celebrations, her parents bring her to your community emergency department to get checked. You confirm that she [...]
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Current estimates of the prevalence of obesity are that a quarter of adult Canadians and one third of Americans are considered obese with approximately 3% being morbidly obese. With the proportion of patients with a BMI>30 growing every year, you’re likely to manage at least one obese patient on every ED shift. Obese patients are at high risk of developing a host of medical complications including diabetes, hypertension, coronary artery disease, peripheral vascular disease, biliary disease, sleep apnea, cardiomyopathy, pulmonary embolism and depression, and are less likely compared to non-obese adults to receive timely care in the ED. Not only are these patients at higher risk for morbidity and mortality, but obesity emergency management is complicated by the patient’s altered cardiopulmonary physiology and drug metabolism. This can make their acute management much more challenging and dangerous. To help us gain a deeper understanding of the challenges of managing obese patients and elucidate a number of important differences as well as practical approaches to obesity emergency management, we welcome Dr. Andrew Sloas, the founder and creator of the fantastic pediatric EM podcast PEM ED, Dr. Richard Levitan, a world-famous airway management educator and innovator and Dr. David Barbic a prominent Canadian researcher in obesity in emergency medicine from University of British Columbia....
I caught up with airway educator, innovator and self-described enthusiast Dr. Richard Levitan at SMACC in Chicago this past June. In this Best Case Ever on Airway Strategy and Mental Preparedness in EM Procedures, Dr. Levitan uses a great save of his in a penetrating trauma case as a basis for discussion on mental preparedness and how we've been thinking about our general approach to emergency procedures the wrong way. Rather than fixating on the final goal of a procedure, which can often be daunting and lead us astray, he suggests a methodical incrementalized and compartmentalized approach to EM procedures that reduces stress and fear, improves confidence and enhances success. He runs through several examples including intubation, cricothyrotomy and initial approach to hypoxia to explain his Simple Incremental Approach to EM Procedures. Could this be a paradigm shift in the way we think about procedures in EM?....
On this EM Cases Best Case Ever, Andrew Sloas, the brains behinds the fabulous PEM-ED podcast tells the tale of a pericardiocentesis gone bad and what he learned from it. Emergency pericardicentesis can be life saving, but it also carries risks. Dr. Sloas reviews the steps to take to ensure that the pericardiocentesis needle is the the correct place to minimize the risk of intubating the right ventricle of the heart. A discussion of errors of omission and ones of commission follows.... [wpfilebase tag=file id=540 tpl=emc-play /] [wpfilebase tag=file id=541 tpl=emc-mp3 /]
The EM Cases Summaries are succinct, written, easily navigable, key point reports of each main episode podcast, authored by Our Team that you can download to your smartphone or tablet to reference and read at the bedside or at your leisure with 4 easy download options: The EM Cases Summaries app from the Apple Store for iphone and ipad or Google Play for android, Evernote or Dropbox. All options provide you with automatic downloads of the newest EM Cases Summary as they are released. Or you can download individual summary pdfs below. Download individual pdf EM Cases Summaries by clicking on the episode title below Episode 121 Elbow Injuries Pitfalls with Arun Sayal & Dale Dantzer Episode 120 Stroke Management in the Age of Endovascular Therapy with Walter Himmel & David Dushenski Episode 119 Trauma - The 1st & Last 15 Mintures Part 2 with Kylie Bosman, Chris Hicks & Andrew Petrosoniak Episode 118 Trauma - The 1st & Last 15 Minutes Part 1 with Kylie Bosman, Chris Hicks & Andrew Petrosoniak Episode 117 TIA update with Walter Himmel & David Dushenski Episode 116 Opioid Misuse, Overdose [...]
There are so many emergency airway controversies in emergency medicine! Dr. Jonathan Sherbino, Dr. Andrew Healy and Dr. Mark Mensour debate dozens of these controversies surrounding emergency airway management. A case of a patient presenting with decreased level of awareness provides the basis for a review of the importance, indications for, and best technique of bag-valve-mask (BVM) ventilation, as well as a discussion of how best to oxygenate patients. This is followed by a discussion of what factors to consider in deciding when to intubate and some of the myths of when to intubate. The next case, of a patient with severe head injury who presents with a seizure, is the fodder for a detailed discussion of Rapid Sequence Intubation (RSI). Tips on preparation, pre-oxygenation and positioning are discussed, and some great debates over pre-treatment medications, induction agents and paralytic agents ensues. The new concept of Delayed Sequence Intubation is explained and critiqued. They review how to identify a difficult airway, how best to confirm tube placement and how to avoid post-intubation hypotension. In the last case of a morbidly obese asthmatic they debate the merits of awake intubation vs RSI vs sedation alone in a difficult airway situation and explain the best strategies of ventilation to avoid the dreaded bradysystlolic arrest in the pre-code asthmatic. Finally, some key strategies to help manage the morbidly obese patient's airway effectively are reviewed.
Learn more about any of Emergency Medicine Cases guest experts bios by clicking on their name below. G to L M to R S to Z A to F Dr. Alyssa Abo is a Pediatric Emergency Physician at Children’s National Medical Center in Washington, D.C. She is the Associate Director of Emergency Ultrasound there. Dr. Fuad Alnaji is a Pediatric Emergency Physician and Intensivist at Children's Hospital of Eastern Ontario (CHEO) in Ottawa. He trained at Arabian Gulf University, Bahrain before beginning his pediatric residency at CHEO, where he also completed subspecialty training in pediatric critical care medicine and pediatric emergency medicine in 2012. Dr. Alnaji works in CHEO’s pediatric critical care unit as well as the emergency department. His interests in transport, trauma, resuscitation and medical simulation have lead him to pursue work as a trauma team leader as well as transport medicine physician with ORNGE. Dr. Andrew Arcand is an Emergency Physician and the chief of the emergency department at Markham Stouffville Hospital near Toronto. Dr. Alex Arroyo is an Emergency Physician and Director of the Pediatric Emergency Department at the Mennonites Medical Center [...]