round table discussions on emergency medicine cases

Episode 96 Beyond ACLS Cardiac Arrest – Live from EMU Conference 2017

This is the first ever video podcast on EM Cases with Jordan Chenkin from EMU Conference 2017 discussing how to optimize three aspects of cardiac arrest care: persistent ventricular fibrillation, optimizing pulse checks and PEA arrest, with code team videos contrasting the ACLS approach to an optimized approach...

By Anton Helman|2021-04-04T11:54:58-04:00May 23rd, 2017|Categories: Cardiology, Conference, EM Cases, Emergency Medicine, Episodes, NYGH EM Update, Resuscitation, Ultrasound|Tags: cardiac arrest, dual defibrillation, esmolol, Jordan Chenkin, PEA arrest, POCUS, ventricular fibrillation|3 Comments

Episode 95 Pediatric Trauma

Management of the pediatric trauma patient is challenging regardless of where you work. In this EM Cases episode, with the help of two leading pediatric trauma experts, Dr. Sue Beno from Hospital for Sick Children in Toronto and Dr. Faud Alnaji from Children's Hospital of Eastern Ontario in Ottawa we answer such questions as: what are the most important physiologic and anatomic differences between children and adults that are key to managing the trauma patient? How much fluid should be given prior to blood products? What is the role of POCUS in abdominal trauma? Which patients require abdominal CT? How do you clear the pediatric c-spine? Are atropine and fentanyl recommended as pre-induction agents in the pediatric trauma patient? How can the BIG score help us prognosticate? Is tranexamic acid recommended in early pediatric trauma like it is in adults? Is the Pediatric Trauma Score helpful in deciding which patients should be transferred to a trauma center? and many more...

By Anton Helman|2025-06-01T13:08:38-04:00May 9th, 2017|Categories: EM Cases, Emergency Medicine, Episodes, Pediatrics, Resuscitation, Trauma|Tags: abdominal trauma, airway, BIG score, c-cpine, chest trauma, head injury, pediatric tauma score, Sue Beno, tranexamic acid|2 Comments

Episode 94 UTI Myths and Misconceptions

In 2014, the CDC reported that UTI antibiotic treatment was avoidable at least 39% of the time. Why? Over-diagnosis and treatment results from the fact that asymptomatic bacteriuria is very common in all age groups, urine cultures are frequently ordered without an appropriate indication, and urinalysis results are often misinterpreted. Think of the last time you prescribed antibiotics to a patient for suspected UTI – what convinced you that they had a UTI? Was it their story? Their exam? Or was it the urine dip results the nurse handed to you before you saw them? Does a patient’s indwelling catheter distort the urinalysis? How many WBCs/hpf is enough WBCs to call it a UTI? Can culture results be trusted if there are epithelial cells in the specimen? Can a “dirty” urine in an obtunded elderly patient help guide management?...

By Anton Helman|2022-10-26T21:35:50-04:00April 12th, 2017|Categories: EM Cases, Emergency Medicine, Episodes, Genitourinary, Medical Specialty|Tags: cystitis, Fosfomycin, pyelonephritis, STI, urinalysis|6 Comments

Episode 93 – PALS Guidelines

I remember when I started practicing emergency medicine a decade and a half ago it seemed that any kid who came to our ED in cardiac arrest died. I know, depressing thought. But, over the past 15 years, survival to discharge from pediatric cardiac arrest has markedly improved, at least for in-hospital arrests. This is probably mostly due to an emphasis on high-quality CPR and advances in post-resuscitation care; nonetheless the more comfortable, knowledgeable and prepared we are for the always scary critically ill pediatric patient, the more likely we will be able to resuscitate them successfully - which is always a huge save.

By Anton Helman|2025-06-01T12:57:23-04:00March 14th, 2017|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Medical Specialty, Pediatrics, Resuscitation|Tags: amiodarone, atropine, cardiac arrest, chest compressions, CPR, ECMO, fluid management, lidocaine, septic shock, TTM|3 Comments

Episode 92 – Aortic Dissection Live from The EM Cases Course

While missing aortic dissection was considered "the standard" in the late 20th century, our understanding of the clinical diagnoses has improved considerably since the landmark International Registry of Aortic Dissection (IRAD) study in 2000. Nonetheless, aortic dissection remains difficult to diagnosis with 1 in 6 being missed at the initial ED visit. With the help of Dr. David Carr we’ll discuss how to pick up atypical presentations of aortic dissection without over-imaging as well as manage them like pros by reviewing: 1. The 5 Pain Pearls, 2. The concepts of CP +1 and 1+ CP, 3. Physical exam pearls, 4. CXR pearls and blood test pitfalls, and 5. The importance of the correct order and aggressive use of IV medications. So with these objectives in mind…

By Anton Helman|2024-05-21T01:36:54-04:00February 21st, 2017|Categories: Cardiology, Conference, EM Cases, Emergency Medicine, Episodes, Medical Specialty|Tags: David Carr, EM Cases Course, esmolol, labetolol, troponin|0 Comments

Episode 91 Occult Knee Injuries Pearls and Pitfalls

There are a whole slew of very important occult knee injuries - those that have a normal or near normal x-ray – that can cause serious morbidity if you miss them, and for the catchall soft tissue injuries there are some subtleties in diagnosis and management that will make a real difference to our patients. Arun Sayal and Hossein Mehdian answer questions such as: When should we suspect a spontaneously reduced knee dislocation? Do all patients suspected of a spontaneous knee dislocation require a CT angiogram to rule out vascular injury? Which patients with a low energy mechanism are at risk for knee dislocation and vascular complications? How can you increase the accuracy of the active straight leg raise in assessing for quadriceps and patella tendon rupture? What is an easy way to identify patella baja and patella alta on a knee x-ray? What are the indications for ultrasound of the knee? What are the true indications for a knee immobilizer and how can knee immobilizers kill our patients? and many more...

By Anton Helman|2025-06-01T13:09:05-04:00January 24th, 2017|Categories: EM Cases, Emergency Medicine, Episodes, Orthopaedics, Trauma|Tags: Arun Sayal, Hossein Mehdian, knee dislocation, tibial plateau fracture|1 Comment

Episode 90 – Low and Slow Poisoning

One of the things we need to think about whenever we see a patient who’s going low and slow with hypotension and bradycardia is an overdose. B-blockers, calcium channel blockers (CCB) and digoxin are some of the most frequently prescribed cardiovascular drugs. And inevitably we’re gonna be faced with both intentional and unintentional overdoses from these drugs in the ED. If we can recognize these overdoses early and manage them appropriately, well - we’ll save some lives...

By Anton Helman|2021-03-30T14:37:46-04:00January 3rd, 2017|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Toxicology|Tags: activated charcoal, b-blocker, CCB, digifab, digoxin, Emily Austin, gastric lavage, high dose insulin, intralipid, lipid emulsion, Margaret Thompson, whole bowel irrigation|4 Comments

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 Anton Helman|2021-03-30T14:38:50-04:00December 6th, 2016|Categories: EM Cases, Emergency Medicine, Episodes, Gastroenterology, Hematology, Medical Specialty, Neurology|Tags: abixiban, Andexanet Alfa, dabigitran, epistaxis, GI bleed, ICH, Idarucizumab, Jim Douketis, PCCs, rivaroxiban, Walter HImmel|4 Comments

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 Anton Helman|2024-08-06T22:19:17-04:00November 22nd, 2016|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Hematology, Medical Specialty|Tags: Abixaban, atrial fibrillation, CHADS65, dabigitran, DVT, Jim Douketis, rivaroxiban, Walter HImmel|1 Comment

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 Anton Helman|2024-05-21T02:01:40-04:00October 25th, 2016|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Special Populations, Toxicology|Tags: benzodiazepine, Bjug Borgundvaag, CIWA, dexmeditomidine, Mel Kahan, phenobarbital, Sara Gray, SHOT, thiamine|9 Comments