round table discussions on emergency medicine cases

Episode 27: Drugs of Abuse – Stimulants and Opiates

Dr. Margaret Thompson & Dr. Lisa Thurgur Canada's toxicologist gurus discuss several cases of stimulant drugs of abuse such as cocaine, MDMA & bath salts, as well as the pearls and pitfalls of managing opiates toxicity. We discuss: The management of the intoxicated patient including seizures, dysrhythmias, cardiac ischemia and hypertensive emergencies related to cocaine toxicity, the recognition and management of necrotizing vasculitis caused by cocaine cut with Levamisole, the differential diagnosis and management of the "hot and crazy" patient, including the role of dantrolene and cyproheptidine, pearls and pitfalls of naloxone, the utility of urine drug screens and much more....

By Anton Helman|2021-03-31T13:05:16-04:00October 15th, 2012|Categories: EM Cases, Emergency Medicine, Episodes, Toxicology|Tags: acute coronary syndrome, bath salts, cocaine, dantrolene, drug screen, dysrhthmia, ecstacy, hypertensive emergency, levamisole, Lisa Thurgur, Margaret Thompson, naloxone, opiate, seizure, sympathomimetic, vasculitis|0 Comments

Episode 26: Low Back Pain Emergencies

In this episode we go through seven cases that display the breadth of presentations of limb or life threatening causes of low back pain emergencies with my huge mentors, Dr. Walter Himmel and Dr. Brian Steinhart. We cover everything from spinal epidural abscess to cauda equina syndrome to retroperitoneal bleeds, elucidating the key historical, physical exam, lab, imaging and treatment pearls for all of these diagnoses. We then go on to review the best management for the most common cause of back pain presentation, lumbosacral strain and debate the various medication options.

By Anton Helman|2022-01-05T23:26:07-05:00September 12th, 2012|Categories: EM Cases, Emergency Medicine, Episodes, Neurology, Oncology, Orthopaedics|Tags: Brian Steinhart, cauda equina syndrome, disc herniation, inflammatory markers, lumbosacral sprain, mechanical low back pain, metastatic cancer, pain managment, retroperitoneal bleed, siatica, spinal cord compression, spinal epidural hematoma, Walter HImmel|2 Comments

Episode 25: Pediatric Syncope and Adult Syncope

In this episode on Pediatric Syncope & Adult Syncope, Dr. Eric Letovksy & Dr. Anna Jarvis run through the key clinical pearls of the history, the physical, interpretation of the ECG and the value of clinical decision rules such as the ROSE rule and the San Francisco Syncope Rule in working up these patients. We discuss how to differentiate syncope from seizure, cardiac causes of syncope such as Arrhthmogenic Right Ventricular Cardiomyopthy & Prolonged QT Syndrome, and the indications for Holter monitoring, Echocardiograms and stress testing in patients with Syncope. Dr. Letvosky & Dr. Jarvis answer such questions as: How can we diagnose Hypertrophic Cardiomyopathy in the ED? What is the value of Troponin and BNP in the work-up of syncope? In what ways are patients with Down Syndrome at high risk for serious causes of syncope? In what ways are patients with alcohol dependence at risk for serious causes of syncope? Why is 'Benign' early repolarization not a benign condition in patients with syncope? Which children with syncope should be admitted? and many more....

By Anton Helman|2025-06-01T13:04:33-04:00July 16th, 2012|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Pediatrics|Tags: Anna Jarvis, benign early repolarization, BNP, clinical decsion rules, echocardiogram, Eric Letovsky, holter, hypertrophic cardiomyopathy, prolonged QT, troponin|0 Comments

Episode 24: COPD and Pneumonia

In this episode we have the continuation of our discussion on Respiratory Emergencies with Dr. Anil Chopra and Dr. John Foote. We discuss key clinical decisions in COPD assessment and management - how to assess for impending respiratory failure, how best to oxygenate the COPD patient, medication pearls and how best to approach intubating the COPD patient. We then review an approach to hemoptysis as well as tricks of the trade for managing massive hemoptysis. Many pearls of pneumonia work-up and management are detailed as well as how to make important disposition decisions.

By Anton Helman|2022-10-26T21:52:48-04:00June 14th, 2012|Categories: EM Cases, Emergency Medicine, Episodes, Respirology, Resuscitation|Tags: Anil Chopra, BIPAP, blood gas, hemoptysis, John Foote, pneumothorax, tension pneumothorax|0 Comments

Episode 23: Vaginal Bleeding in Early Pregnancy

In this episode on Vaginal Bleeding in Early Pregnancy Dr. David Dushenski & Dr. Ross Claybo run through the key clinical pearls of the history, the physical, interpretation of the BhCG and the value of serum progesterone in working up these patients. The newest on bedside emergency department ultrasound is discussed in the patient with vaginal bleeding in early pregnancy. The various types of spontaneous abortion including septic abortion are reviewed as well as the management of the unstable patient with massive vaginal hemorrhage. Ectopic pregnancy, in all it's various presentations is reviewed with particular attention to the most common pitfalls and how to avoid them.

By Anton Helman|2021-03-31T13:08:01-04:00May 16th, 2012|Categories: EM Cases, Emergency Medicine, Episodes, Obstetrics & Gynecology|Tags: abortion, bedside ultrasound, David Dushenski, ectopic pregnancy, methotrexate, molar pregnancy, POCUS, Rhogam, Ross Claybo|0 Comments

Episode 22a: Whistler Update in Emergency Medicine Conference 2012

In this bonus episode, our second installment of the highlights from Whistler Update in Emergency Medicine Conference 2012, we have Dr. Eric Letovsky talking about complications of MI and the importance of listening for cardiac murmurs. Next, I moderate an expert panel on the current trends on imaging patients who present with renal colic and query appendicitis with Dr. Connie Leblanc, Dr. Joel Yaphe, Dr. David MacKinnon & Dr. Eric Letovsky. We then hear from Dr. Adam Cheng, Dr. Dennis Scolnick & Dr. Anna Jarvis in a pediatric expert panel about the newest on minor head injury, otitis media, mastoiditis and bronchiolitis. Dr. David Carr reviews one of the most important articles in 2011 regarding subarachnoid hemorrhage, and Dr. David MacKinnon gives us tonnes of clinical pearls when it comes to everyone's favourite subject, anorectal disorders.

By Anton Helman|2021-03-31T13:12:31-04:00April 3rd, 2012|Categories: Cardiology, Conference, Ears Nose & Throat, Emergency Medicine, Episodes, Gastroenterology, Genitourinary, Pediatrics, Trauma, Whistler Update in EM|Tags: acute otitis media, Anna Jarvis, Appendicitis, clinical decsion rules, Dave MacKinnon, Dennis Scolnik, Eric Letovsky, minor head injury, myocardial infarction, subarachnoid hemorrhage, testicular torsion, urinary tract infection|0 Comments

Episode 21: Pulmonary Embolism

In this episode on Pulmonary Embolsim we have the triumphant return of Dr. Anil Chopra, the Head of the Divisions of Emergency Medicine at University of Toronto, and Dr. John Foote the CCFP(EM) residency program director at the University of Toronto. We kick it off with Dr. Foote's approach to undifferentiated dyspnea and explanation of Medically Unexplained Dyspea ('MUD') and go on to discuss how best to develop a clinical pre-test probability for the diagnosis of pulmonary embolism using risk factors, the value of the PERC rule, Well's criteria and how clinical gestalt plays into pre-test probability. Dr. Chopra tells about the appropriate use of D-dimer to improve our diagnostic accuracy without leading to over-investigation and unwarranted anticoagulation. We then discuss the value of V/Q scan in the workup of PE, and the pitfalls of CT angiography. A discussion of anticoagulation choices follows and the controversies around thrombolysis for submassive PE are reviewed.

By Anton Helman|2023-02-06T12:49:35-05:00March 14th, 2012|Categories: EM Cases, Emergency Medicine, Episodes, Respirology|Tags: Anil Chopra, clinical decision rules, CT angiogram, D-dimer, John Foote, massive pulmonary embolism, medically unexplained dyspnea, PERC rule, submassive pulmonary embolism, VQ scan, Well's Criteria|0 Comments

Episode 20: Atrial Fibrillation

In this episode Dr. Clare Atzema, Dr. Nazanin Meshkat and Dr. Bryan Au discuss the presentation, etiology, precipitants, management and disposition of Atrial Fibrillation in the Emergency Department. The pros and cons of rate and rhythm control are debated, what you need to know about rate and rhythm control medications reviewed, and the strength of the Ottawa Aggressive Protocol discussed. The importance of appropriate anticoagulation is detailed, with a review of the CHADS-VASc score and whether to use Warfarin, Dabigatran or ASA for stroke prevention for patient with Atrial Fibrillation. We end off with a discussion on how to recognize and treat Wolff-Parkinson-White syndrome in the setting of Atrial Fibrillation.

By Anton Helman|2021-09-23T18:05:58-04:00February 9th, 2012|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Resuscitation|Tags: anticoagulants, anticoagulation, CHADS Score, Clare Atzema, clinical decision rule, dabigitran, Warfarin|1 Comment

Episode 19 Part 2: Pediatric Gastroenteritis, Constipation and Bowel Obstruction

In Part 2 of this pediatric abdominal pain Episode - Pediatric Gastroenteritis, Constipation & Bowel Obstruction, Dr. Anna Jarvis, Canada's "mother of pediatric emergency medicine" and Dr. Stephen Freedman, one of Canada's pre-eminent researchers in pediatric GI emergencies, discuss the assessment, work-up and treatment of pediatric gastroenteritis, with particular attention to gastroenteritis & acute abdomen mimics, how best to assess hydration status, the nuances of the use of ondansetron and the prose and cons of various rehydration methods. A detailed discussion of the most common and lethal causes of acute abdomen bowel obstruction in pediatrics follows, including intussesception and midgut volvulus. Finally, the differential diagnosis and best management of the most common cause of pediatric abdominal pain, constipation, is reviewed.

By Anton Helman|2026-01-26T00:42:18-05:00January 6th, 2012|Categories: EM Cases, Emergency Medicine, Episodes, Gastroenterology, Pediatrics|Tags: Anna Jarvis, constipation, gastroenteritis, Hemolytic Uremic Syndrome, intussesception, ondansetron, ultrasound, volvulus|0 Comments

Episode 19 Part 1: Pediatric Abdominal Pain and Appendicitis

In Part 1 of this Episode on Pediatric Abdominal Pain, Dr. Anna Jarvis, "the mother of pediatric emergency medicine" & Dr. Stephen Freedman, one of the world's pre-eminent pediatric EM researchers, discuss the nuances of the history, physical and work up of Pediatric Abdominal Pain & Appendicitis and key pearls on how to distinguish serious surgical causes from the very common diagnosis of gastroenteritis. An in-depth discussion on the pearls of the history, physical exam, lab tests, imaging including serial ultrasounds vs CT abdomen, clinical decision rules such as the Alvarado Score, best analgesics and antibiotics in pediatric appendicitis follows.

By Anton Helman|2025-06-01T13:05:52-04:00December 8th, 2011|Categories: EM Cases, Emergency Medicine, Episodes, Gastroenterology, Pediatrics|Tags: abdominal pain, Alvarado Score, Anna Jarvis, Appendicitis, clinical decision rules, computed tomography, gastroentritis, pain management, Stephen Freedman, ultrasound|2 Comments