CritCases Archives - Emergency Medicine Cases

CritCases is a collaboration between Dr. Mike Betzner, medical director of STARS air ambulance service and EM Cases. There are many approaches and therapeutic options in critical care that do not have a strong evidence base to guide us. We use our clinical judgement, gestalt and basic principles to make rapid decisions. This blog explores therapeutic options to various challenging critical care scenarios through an interactive case-based, Q&A framework. The case unfolds in a step-wise manner, as it would in real practice, and integrates opinions from critical care providers, not only from STARS, but from around the world. Each blog includes an open peer review from an expert on the given topic. Welcome to CritCases!

Crit Cases 14 Bronchopleural Fistula Management

Dr. Mike Misch guides us through this part 2 of a blunt chest trauma case with a presumed bronchopulmonary fistula requiring 3 chest tubes and describes options to optimize one-lung ventilation for safe transport...

By Anton Helman|2020-01-28T14:30:58-05:00January 28th, 2020|Categories: CritCases, EM Cases, Emergency Medicine, Medical Specialty, Respirology, Resuscitation, Trauma|Tags: blunt chest trauma, bonchopleural fistula, bronchial blocker, chest tube, DOPERS, double lumen ETT, one lung ventilation|2 Comments

CritCases 13 Shock and Hypoxia in Blunt Chest Trauma

In this CritCases blog, Shock and Hypoxia in Blunt Chest Trauma, a collaboration between STARS Air Ambulance Service, Mike Betzner and EM Cases, Mike Misch guides us through a hairy thoracic trauma case, reviewing principles of trauma resuscitation, airway considerations, tension pneumothorax management and a rare and challenging trauma diagnosis...

By Anton Helman|2020-01-15T10:56:58-05:00January 14th, 2020|Categories: CritCases, EM Cases, Emergency Medicine, Medical Specialty, Respirology, Resuscitation, Trauma|Tags: bronchopleural fistula, Dr. Mike Misch, hemothorax, tension pneumothorax, trauma resuscitation|4 Comments

CritCases 12 Accidental Hypothermia and Cardiac Arrest

In this CritCases blog Michael Misch takes us through a case of accidental hypothermia and cardiac arrest, reviewing the controversies in management as well as the guidelines for rewarming, the role of ECMO and the alterations to ACLS cardiac arrest medications, CPR and defibrillations...

By Michael Misch|2020-05-15T09:24:15-04:00January 29th, 2019|Categories: CritCases, EM Cases, Emergency Medicine, Medical Specialty, Resuscitation|Tags: cardiac arrest, ECMO, hypothermia, rewarming|3 Comments

CritCases 11 LVAD Management in the GI Bleed Patient

In this CritCases blog Mike Misch presents a case of a patient with a left ventricular assist device (LVAD) with a postoperative acute lower GI bleed and answers practical questions such as: How do you measure blood pressure in a patient with an LVAD? What are the common complications of LVADs that we must be aware of? What information can the LVAD controller provide? Why are LVAD patients at high risk for bleeding? and many more...

By Anton Helman|2018-10-09T15:42:50-04:00October 9th, 2018|Categories: Cardiology, CritCases, EM Cases, Emergency Medicine, Gastroenterology, Medical Specialty|Tags: Dr. Michael Misch, GI bleed, left ventricular assist device, LVAD, massive transfuion, pseudo PEA|1 Comment

CritCases 10 Hyponatremia Associated Seizures

In this EM Cases CritCases blog - a collaboration between STARS Air Ambulance Service, Mike Betzner and EM Cases, a middle aged woman presents to a rural ED with headache and vomiting, normal vital signs with subsequent status epilepticus and serum sodium of 110 mmol/L. What management recommendations would you make to the rural ED physician, the transport team and in your ED with regards to treatment of seizures, safe correction of hyponatremia, airway management, search for underlying cause and prevention of Osmotic Demyelenation Syndrome?

By Anton Helman|2018-06-18T22:47:15-04:00June 19th, 2018|Categories: CritCases, EM Cases, Emergency Medicine, Medical Specialty, Neurology, Resuscitation|Tags: hypertonic saline, ODS, status epilepticus|2 Comments

CritCases 9 Pre-Eclampsia and Preterm Labor – Time Sensitive Management

In this CritCases blog we present a case of a 30 week gestational age pregnant woman with high blood pressure, headache, blurry vision and pelvic cramping. We discuss the management challenges of transporting a patient with severe pre-eclampsia and preterm labor, with special attention to dosing of magnesium, antihypertensive agents choice, and indications for steroids, tocolytics and antibiotics.

By Anton Helman|2020-09-18T15:23:20-04:00February 12th, 2018|Categories: CritCases, EM Cases, Medical Specialty, Obstetrics & Gynecology, Resuscitation|Tags: fetal lung maturity, HELLP, latetolol, MgSO4, nifedipine, tocolytic|5 Comments

CritCases 8 Management of Elevated ICP

In this CritCases blog - a collaboration between STARS Air Ambulance Service, Mike Betzner and EM Cases, we take you through a not uncommon stroke presentation which then develops into a challenge with regard to management of elevated ICP, hypertension and the airway...

By Michael Misch|2017-07-29T22:50:18-04:00August 1st, 2017|Categories: CritCases, EM Cases, Emergency Medicine, Medical Specialty, Neurology, Resuscitation|Tags: ICH, ICP, Peter Brindley|0 Comments

CritCases 7 Pulmonary Hypertension – A Fine Balance

In this CritCases blog - a collaboration between STARS Air Ambulance Service, Mike Betzner and EM Cases we discuss a challenging case of pulmonary hypertension where a fine balance in volume resuscitation, oxygenation and ventilation is critical.

By Michael Misch|2020-05-15T09:16:06-04:00March 28th, 2017|Categories: CritCases, EM Cases, Emergency Medicine, Medical Specialty, Respirology, Resuscitation|Tags: ionotropes, NIPPV, pulmonary artery catheter, RV failure, vasopressors|3 Comments

CritCases 6 – Airway Obstruction

In this EM Cases CritCases blog - a collaboration with STARS Air Ambulance Service, Mike Betzner, we present a challenging airway obstruction case, the limitations of non-rebreather masks, using PEEP on bag-valve-masks, heliox, tips on awake intubation, and the differential for high peak inspiratory pressures in the post intubation period. With commentary by Michael Betzner and Reuben Strayer as well as expert peer review by George Kovacs...

By Patrick Gilbride|2020-05-15T09:16:58-04:00February 7th, 2017|Categories: CritCases, EM Cases, Emergency Medicine, Medical Specialty, Resuscitation|Tags: awake intubation, BIPAP, BVM, difficult airway, George Kovacs, heliox, James Brokenshire, ketamine, NRB, PEEP, preoxygenation, tracheal stent|1 Comment

CritCases 5 – Pediatric Drowning and Hypothermia

In this CritCases blog - a collaboration between STARS Air Ambulance Service, Mike Betzner and EM Cases, Dr. Michael Misch discusses the management controversies around a challenging pediatric drowning and hypothermia case, including the nuances of rewarming, oxygenation, CPR or no CPR, the role of ECMO, dosing of epinephrine and more...

By Michael Misch|2017-02-05T14:57:18-05:00November 8th, 2016|Categories: CritCases, EM Cases, Emergency Medicine, Medical Specialty, Pediatrics, Resuscitation|Tags: Allan De Caen, bradycardia, CPR, ECMO, epinephrine, Michael Misch, rewarming|0 Comments

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