EM Cases Main Episodes are round table in-depth discussions with 2 or more EM Cases guest experts, inherently peer reviewed, and edited for a podcast.

Ep 154: 4-Step Approach to Bradycardia and Bradydysrhythmias

How do we figure out when bradycardia is due to a medical illness and when it is a primary cardiac problem? What are the 4 immediate life threatening diagnosis that we have to entertain and address in the first few minutes of the sick bradycardic patients? What are some key ECG patterns that are sometimes missed by ED docs that can have devastating consequences? How can we better understand Torsades de Pointes by understanding AV blocks? How can we better understand Mobitz l and ll using 'The Dorian' approach? What is BRASH syndrome and how can we recognize it? In this main episode podcast 4-step Approach to Bradycardia and Bradydysrhythmias with electrophysiologist, educator and researcher Dr. Paul Dorian and Chair of Education for the ED at Cook County Hospital Dr. Tarlan Hedayati, we dig deep into bradycardia...

Ep 153 Pediatric Minor Head Injury and Concussion

Recent literature suggests that pediatric patients take longer to recover from mild traumatic brain injury compared to adults, and persistent post-concussive symptoms (PPCS) after 1 month occur in up to 30% of children after minor head injury. These children can and should be identified in the ED based on the PPCS clinical risk score. In this EM Cases main episode podcast "Pediatric Minor Head Injury and Concussion" Dr. Sarah Reid and Dr. Roger Zemek discuss how best to incorporate the PECARN and CRASH2 decision tools into your practice, the role of Fast MRI, how to identify children who are at risk for long term sequelae after a minor head injury and how to manage persistent concussion symptoms when a child returns to the ED after a minor head injury...

Ep 152 The 7 Ts of Massive Hemorrhage Protocols

Dr. Jeannie Callum, Dr. Andrew Petrosoniak and Dr. Barbara Haas join Anton in answering the questions: How do you decide when to activate the MHP? How do you know when it is safe to terminate the MHP? What lab tests need to be done, how often, and how should the results be shared with the clinical team? Once the dust settles, what do we need to tell the patient and/or their family about the consequences of being massively transfused? What should be the lab resuscitation targets? Why is serum calcium important to draw in the ED for the patient who is exsanguinating? How do we mitigate the risk of hypothermia? What can hospitals do to mitigate blood wastage? If someone is on anti-platelets or anticoagulants what is the best strategy to ensure the docs in the ED know what to give and how much? Until the results of lab testing come back and hemorrhage pace is slowed, what ratio of plasma to RBCs should we target? What's better, 1:1:1 or 2:1:1? Should we ever consider using Recombinant Factor 7a? If the fibrinogen is low, what is the optimal product and threshold for replacement? When and how much TXA? Anyone you wouldn’t give it to? and many more...

Ep 151 AKI Part 2 – ED Management

In this Part 2 of our AKI series we discuss the timing, volume and IV crystalloid of choice in AKI patients as well as dialysis indications and timing in light of the recent STARRT-AKI trial. We answer the questions: are piperacillin and vancomycin in combination contraindicated in patients with severe AKI? Is vasopressin preferred over norepinephrine in patients with AKI and septic shock? Is there a role for IV sodium bicarbonate in AKI? When should ACEi/ARBs be held in AKI patients? When, if ever, should NSAIDs be given in AKI patients, and if so, how should the dose be modified? and many more....

Ep 150 Acute Kidney Injury – A Simple Emergency Approach to AKI

In this first part of our 2 part podcast series on AKI we answer questions such as: Is there any value in the BUN:Cr ratio in distinguishing prerenal from intrarenal disease? Why is nephritic syndrome one of the most important intrarenal causes to pick up in the ED? Is there any value in urine electrolytes for the ED workup of AKI? Is there a role for bicarb in patients with severe AKI? How can we choose wisely when it comes to imaging for patients with AKI? How can we utilize POCUS best in working up the patient with AKI? What are the indications for ordering a CK to look for rhabdomyolysis? At what CK level do patients typically develop AKI? How can the McMahon score help us manage rhabdomyolysis? What is the value of urine myoglobin in the workup of rhabdomyolysis? What are indications for dialysis in patients with rhabdomyolysis? What are safe discharge criteria for patients with rhabdomyolysis? and many more...

Ep 149 Liver Emergencies: Thrombosis and Bleeding, Portal Vein Thrombosis, SBP, Paracentesis Tips and Tricks

In this part 2 of our 2 part series on Liver Emergencies we clear up the confusing balance between thrombosis and bleeding in liver patients, the elusive diagnosis of portal vein thrombosis, spontaneous bacterial peritonitis diagnosis and treatment and some tips and tricks on paracentesis with Walter Himmel and Brian Steinhart....

Ep 148 Liver Emergencies: Acute Liver Failure, Hepatic Encephalopathy, Hepatorenal Syndrome, Liver Test Interpretation & Drugs to Avoid

In this 1st part of our 2 part series on Liver Emergencies Walter Himmel, Brian Steinhart and Anton discuss: What are the most important causes of acute liver failure that we need to identify in the ED so we can initiate timely treatment? What are some of the common medications we use in the ED that we should avoid in the liver patient? How should we approach the interpretation of liver enzymes and liver function tests? What are the key management steps in treating acute liver and hepatorenal syndrome? Why do liver failure patients become hypoglycemic and how should hypoglycemia in these patients be treated in the ED? How do we diagnose hepatorenal syndrome in the ED? How can the MELD score help us manage liver patients? What are the indications for IV albumin? What is the role of an ammonia level in the diagnosis of hepatic encephalopathy? Is polyethylene glycol a better alternative to lactulose for treating hepatic encephalopathy? and much more...

Ep 147 HHS Recognition and ED Management

In this podcast, Part 2 of our diabetic emergencies series with Melanie Baimel, Bourke Tillmann and Leeor Sommer, we dive into the recognition and ED management of Hyperglycemic Hyperosmolar State (HHS). We answer questions such as: how does one differentiate DKA from HHS clinically? How do patients with HHS become hyperglycemic, dry and altered? Why is finding and treating the cause or trigger of HHS so important in the ED? How does fluid management differ in HHS from DKA? and many more...

By |2021-03-29T19:57:38-04:00October 13th, 2020|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty|Tags: , , , |0 Comments

Ep 146 DKA Recognition and ED Management

In this first part of our 2-part podcast on DKA and HHS, Drs Melanie Baimel, Bourke Tillman and Leeor Sommer discuss the importance of identifying the underlying cause or trigger in DKA patients, the pitfall of ruling out DKA in patients with normal pH or normal serum glucose, how to close the gap effectively, why stopping the insulin infusion is almost never indicated, how to avoid cardiac collapse when DKA patients require endotracheal intubation, the best alternatives to plastic in the trachea, why using a protocol improves patient outcomes, how to avoid the common complications of hypoglycemia and hypokalemia, and much more...

Ep 145 Physician Compassion – The Barbara Tatham Memorial Podcast

Dr. Barbara Tatham, EM colleague and educator, died of metastatic sarcoma at the age of 32 in October 2019. During her last year of life, in between surgeries, ICU stays and rounds of chemotherapy and radiation, she gave lectures on compassionate care inspired by her journey as a patient. In August 2019 we met at my summer cottage to record this podcast. We explored the evidence that compassionate care improves patient outcomes and staves off physician burnout. We discussed how compassion can be learned and applied easily and efficiently in your practice. We talked about the do’s and don’ts of compassionate care and ended with a call to action. It is my hope that, through this podcast, her voice and vision will reverberate and she will continue to champion compassionate care into the future…

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