About Anton Helman

Dr. Anton Helman is an Emergency Physician at North York General in Toronto. He is an Assistant Professor at the University of Toronto, Division of Emergency Medicine and the Education Innovation Lead at the Schwartz-Reisman Emergency Medicine Instititute. He is the founder, editor-in-chief and host of Emergency Medicine Cases.
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Episode 89 – DOACs Part 2: Bleeding and Reversal Agents

In this Part 2, DOACs Bleeding and Reversal we discuss the management of bleeding in patients taking DOACs with minor risk bleeds, like epistaxis where local control is easy to access, moderate risk bleeds, like stable GI bleeds and high risk bleeds, like intracranial hemorrhage. We answer questions such as: How do we weigh the risks and benefits of stopping the DOAC? When is reversal of the DOAC is advised? How best do we accomplish the reversal of DOACs? Is there any good evidence for the newest reversal agent? When should we stop DOACs for different procedures, and when should we delay the procedure?

By |2021-03-30T14:38:50-04:00December 6th, 2016|Categories: EM Cases, Emergency Medicine, Episodes, Gastroenterology, Hematology, Medical Specialty, Neurology|Tags: , , , , , , , , , , |4 Comments
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Episode 88 – DOACs Part 1: Use and Misuse

As we get better at picking up thromboembolic disease, and the indications for Direct Oral Anticoagulants (DOACs) widen, we're faced with increasingly complex decisions about when to start these medications, how to start them, when to stop them and how to manage bleeding associated with them. There’s a lot that we need to know about these drugs to minimize the risk of thromboembolism in our patients while at the same time minimizing their risk of bleeding...

By |2024-08-06T22:19:17-04:00November 22nd, 2016|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Hematology, Medical Specialty|Tags: , , , , , , , |1 Comment
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New EM Cases Feature: Just The Nuggets

We have a brand new free offering to enhance your EM learning: Just The Nuggets, where you receive the key points from the EM Cases main episodes directly into your email inbox. Knowledge comes in little packets. Sign up for Just The Nuggets on The EM Cases Newsletter page.

By |2017-04-25T22:54:24-04:00November 8th, 2016|Categories: EM Cases, News|Tags: , , , |2 Comments
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Journal Jam 8 – Dilute Apple Juice for Pediatric Gastroenteritis

This is EM Cases Journal Jam podcast on a randomized control trial of dilute apple juice vs PediaLyte for mild pediatric gastroenteritis. While IV rehydration is required in cases of severe gastroenteritis (which we rarely see in North America) and oral rehydration with electrolyte maintenance solutions is still the mainstay in treating moderate gastroenteritis, could better-tasting, more cost-effective fluids such as diluted apple juice be just as effective as traditional electrolyte solutions in milder cases? Listen to Dr. Justin Morgenstern (@First10EM) interviewing Dr. Stephen Freedman, the world-renowned pediatric EM researcher who put ondansetron for pediatric gastroenteritis on the map and who was one of our guest experts on our main episode on Pediatric Gastroenteritis, Constipation and Bowel Obstruction, about this practice-changing paper. This is followed by a hilarious rant on the topic from Dr. Anthony Crocco ("Ranthony"), the Division head and medical director of pediatric EM at Hamilton Health Sciences.

By |2018-12-21T19:20:46-05:00November 8th, 2016|Categories: EM Cases, Emergency Medicine, Gastroenterology, Journal Jam, Medical Specialty, Pediatrics|Tags: , , , , , |1 Comment
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Best Case Ever 51 – Anticoagulants and GI Bleed with Walter Himmel

In anticipation of Episode 88 and 89: DOACs Use, Misuse and Reversal with the president of Thrombosis Canada and world renowned thrombosis researcher Dr. Jim Douketis, internist and thrombosis expert Dr. Benjamin Bell and 'The Walking Encyclopedia of EM' Dr. Walter Himmel, we have Dr. Himmel telling us the story of his Best Case Ever on anticoagulants and GI bleed. He discusses the most important contraindication to DOACs, the importance of not only attempting to reverse the effects of anticoagulants in a bleeding patient but managing the bleed itself as well as more great pearls. In the upcoming episodes we'll run through 6 cases and cover the clinical use of DOACs, how they work, safety, indications, contraindications, management of minor, moderate and severe bleeding, the new DOAC reversal agents, management of DVT with DOAC anticoagulants, stroke prevention in atrial fibrillation with DOACs and much more...

By |2017-02-05T14:59:19-05:00November 8th, 2016|Categories: Best Case Ever, EM Cases, Emergency Medicine, Gastroenterology, Hematology, Medical Specialty, Resuscitation|Tags: , , , , |0 Comments
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Episode 87 – Alcohol Withdrawal and Delirium Tremens: Diagnosis and Management

Alcohol withdrawal is everywhere. We see over half a million patients in U.S. EDs for alcohol withdrawal every year. Despite these huge volumes of patients and the diagnosis of alcohol withdrawal seeming relatively straightforward, it’s actually missed more often than we’d like to admit, being confused with things like drug intoxication or sepsis. Or it’s not even on our radar when an older patient presents with delirium. What’s even more surprising is that even if we do nail the diagnosis, observational studies show that in general, alcohol withdrawal is poorly treated. So, to help you become masters of alcohol withdrawal management, our guest experts on this podcast are Dr. Bjug Borgundvaag, an ED doc and researcher with a special interest in emergency alcohol related illness and the director of Schwartz-Reismann Emergency Medicine Institute, Dr. Mel Kahan, an addictions specialist for more than 20 years who’s written hundreds of papers and books on alcohol related illness, and the medical director of the substance use service at Women’s College Hospital in Toronto, and Dr. Sara Gray, ED-intensivist at St. Michael's Hospital...

By |2024-05-21T02:01:40-04:00October 25th, 2016|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Special Populations, Toxicology|Tags: , , , , , , , , |9 Comments
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Best Case Ever 50 – Delirium Tremens

In anticipation of EM Cases Episode 87 on Alcohol Withdrawal Dr. Sara Gray describes her Best Case Ever of severe alcohol withdrawal and Delirium Tremens from Janus General. Also on this podcast Dr. Anand Swaminathan reacts to Episode 86 Emergency Management of Hyperkalemia and discusses the use of calcium in the setting of digoxin toxicity. Early recognition and treatment of Delirium Tremens - a rapid onset of severe alcohol withdrawal accompanied by delirium and autonomic instability about 3-10 days after the appearance of withdrawal symptoms - is key to preventing long term morbidity and mortality...

By |2016-10-17T11:36:05-04:00October 11th, 2016|Categories: Best Case Ever, EM Cases, Emergency Medicine, Medical Specialty, Neurology, Psychiatry, Special Populations, Toxicology|Tags: , , |0 Comments
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Episode 86 – Emergency Management of Hyperkalemia

This is 'A Nuanced Approach to Emergency Management of Hyperkalemia' on EM Cases. Of all the electrolyte emergencies, hyperkalemia is the one that has the greatest potential to lead to cardiac arrest. And so, early in my EM training I learned to get the patient on a monitor, ensure IV access, order up an ECG, bombard the patient with a cocktail of kayexalate, calcium, insulin, B-agonists, bicarb, fluids and furosemide, and get the patient admitted, maybe with some dialysis to boot. Little did I know that some of these therapies were based on theory alone while others were based on a few small poorly done studies. It turns out that some of these therapies may cause more harm than good, and that precisely when and how to give these therapies to optimize patient outcomes is still not really known...

By |2022-02-17T13:42:30-05:00September 27th, 2016|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Medical Specialty, Resuscitation|Tags: , , , , |13 Comments
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BEEM Cases 3 – Acute Respiratory Failure: NIPPV & POCUS

Shortness of breath is a very common chief complaint in the emergency department, but despite our familiarity with this symptom, management is not always straightforward. The differential diagnosis is extensive, including the common cardiorespiratory conditions, but extending to toxicologic, hematologic, neuromuscular, metabolic, and psychiatric causes. Over the past decade, we have seen the widespread adoption of new technologies to help us manage these patients. This post will look at some new evidence on two of those technologies: noninvasive positive pressure ventilation (NIPPV) and ultrasound (POCUS). We will answer 3 questions based on 3 systematic reviews using the BEEM critical appraisal framework...

By |2016-12-19T16:41:25-05:00September 13th, 2016|Categories: BEEM Cases, EM Cases, Emergency Medicine, Medical Specialty, Respirology, Resuscitation|Tags: , , , , , , |2 Comments
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Best Case Ever 49 – Post-Arrest Hyperkalemia

Melanie Baimel's Best Case Ever on Post-Arrest Hyperkalemia on EM Cases. Post arrest patients can sometimes be challenging. We need to think of a variety of underlying causes of the arrest, antiarrhythmics, possible cath lab activation, targeted temperature management, sedation and more. To add to this, many post arrest patients do not have ideal vital signs that require attention. In this Best Case Ever, in anticipation of our upcoming episode on A Rational Approach to Hyperkalemia Dr. Melanie Baimel describes a post arrest patient who remains bradycardic and hypotensive despite multiple pressors....

By |2017-02-03T11:57:58-05:00September 13th, 2016|Categories: Best Case Ever, Cardiology, EM Cases, Emergency Medicine, Medical Specialty, Resuscitation|Tags: , , , |1 Comment
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