round table discussions on emergency medicine cases

Episode 18 Part 2: More Point of Care Ultrasound

In Part 2 of this Episode on Emergency Ultrasound or Point of Care Ultrasound (POCUS) Dr. Fischer, Dr. Hannam, Dr. Chenkin & Dr. Hall, Canada's EM ultrasound gurus discuss how POCUS can help our decision-making in the pediatric patient with a limp, in the patient with necrotizing fasciitis, in the pregnant patient with vaginal bleeding and in the common and challenging elderly patient with undifferentiated abdominal pain. They cover POCUS indications from urinary retention to appendicitis and debate the utility of these indications. This is followed by a debate on how best to educate ourselves and the EM community in POCUS and how best to designs quality assurance programs so that point of care ultrasound (POCUS) becomes an accepted tool across the entire medical community.

By Anton Helman|2024-08-18T18:48:59-04:00November 8th, 2011|Categories: Clinical Practice, EM Cases, Emergency Medicine, Episodes, Obstetrics & Gynecology|Tags: abdominal pain, cauda equina syndrome, cholycystitis, deep vein thrombosis, emergency procedures, FAST, foreign body, Greg Hall, Jordan Chenkin, necrotizing faciitis, nerve block, POCUS, pulmonary embolism, quality assurance, septic arthritis, ultrasound, urinary retention, vaginal bleeding|1 Comment

Episode 18 Part 1: Point of Care Ultrasound Pearls, Pitfalls and Controversies

In this first installment of this Episode, Point of Care Ultrasound Pearls, Pitfalls & Controversies we have a panel of POCUS gurus, Dr. Greg Hall, Dr. Jordan Chenkin, Dr. Paul Hannam & Dr. Jason Fischer. They review the basic criteria for commonly used, practical Point of Care Ultrasound indications at the bedside and then dive into heated debate about specific pearls and pitfalls in Point of Care Ultrasound assessment of the patient with undifferentiated shortness of breath, undifferentiated shock, cardiac arrest and swollen leg. They discuss how best to interpret the massive body of literature for POCUS and when we can hang our hats on our Point of Care Ultrasound findings.

By Anton Helman|2024-08-18T18:49:10-04:00October 13th, 2011|Categories: EM Cases, Emergency Medicine, Episodes, Resuscitation, Ultrasound|Tags: deep vein thrombosis, Greg Hall, Jason Fischer, Jordan Chenkin, pericardial effusion, pericardial tamponade, pneumothorax, pulmonary embolism, quality assurance|0 Comments

Episode 17 Part 2: Stroke, Dabigatran and Intracranial Hemorrhage

In the 2nd part of this episode on Stroke, Dabigitran & Intracranial Hemorrhage Dr. Walter Himmel & Dr. Dan Selchen tell us everything the ED doc needs to know about the oral direct thrombin inhibitor Dabigatran and how to reverse a Dabigatran ICH. The ED treatment of stroke is reviewed including best medications and a simple way to remember BP goals. They review the management of ICH including BP goals, indications for neurosurgery, the role of recombinant Factor Vlla, and how best to reverse Warfarin-associated and platelet-associated ICH.

By Anton Helman|2024-08-18T18:51:11-04:00September 7th, 2011|Categories: EM Cases, Emergency Medicine, Episodes, Neurology|Tags: anticoagulants, dabigitran, intracranial hemorrhage, recombinant factor 7, stroke, Walter HImmel, Warfarin|0 Comments

Episode 17 Part 1: Emergency Stroke Controversies

Ep17 P1 StrokeDr. Walter Himmel, "the walking encyclopedia of Emergency Medicine" & Dr. Dan Selchen, the head of the stroke program at St. Micheal's Hospital in Toronto with 30+ years of experience as a stroke neurologist, update us on the literature regarding Emergency Stroke Controversies including the ABCD2 Score to predict Stroke after TIA, as well as the current thinking around the best carotid imaging for patients who have had a TIA. They then review the important findings of the key thrombolysis stroke trials & how we could incorporate these findings into our daily practice. Dr. Selchen reviews the key CT findings we should look for in stroke, & Dr. Himmel takes us through how to manage the dreaded complication of ICH post thrombolysis. This episode is super controversial - so please 'speak your mind' at the bottom of the page.

By Anton Helman|2024-08-18T18:51:10-04:00September 7th, 2011|Categories: EM Cases, Emergency Medicine, Episodes, Neurology|Tags: ABCD2 Score, anti-platelet, atrial fibrillation, clinical decision rules, clopidogrel, CT head, intracranial hemorrhage, ischemic stroke, thrombolysis, TIA, transient ishemic attack, Walter HImmel|1 Comment

Episode 16: Acute Monoarthritis

Ep16 MonoarthritisDr. Joel Yaphe, University of Toronto's Emergency Medicine Residency Program Director and Dr. Indy Ghosh discuss the difficult diagnostic dilemmas when faced with a patient with acute monoarthritis. They review how to distinguish clinically between septic arthritis and gout and which aspects of the presentation and work-up are the most reliable in risk stratifying patients. The key differential diagnosis of Acute Polyarthritis can be even more of a challenge, but fear not: by then end of this podcast and post you will be able to recognize the key diagnoses, how to work them up, and who needs consultation.

By Anton Helman|2022-09-05T17:58:33-04:00July 24th, 2011|Categories: EM Cases, Emergency Medicine, Episodes, Orthopaedics|Tags: arthrocentesis, colchicine, gout, Joel Yaphe, NSAIDs, reactive arthritis, septic arthritis, synovial fluid analysis|0 Comments

Episode 15 Part 2: Acute Coronary Syndromes Management

In Part 2 of this Episode on Acute Coronary Syndromes Risk Stratification & Management, the evidence for various medications for ACS, from supplemental oxygen to thrombolytics are debated, and decision making around reperfusion therapy for STEMI as well as NSTEMI are discussed. Finally, there is a discussion on risk stratification of low risk chest pain patients and all it's attendant challenges as well as disposition and follow-up decisions. Dr. Eric Letovsky, the Head of the CCFP(EM) Program at the University of Toronto, Dr. Mark Mensour & Dr. Neil Fam, an interventional cardiologist answer questions like: What is the danger of high flow oxygen in the setting of ACS? When, if ever, should we be using IV B-blockers in AMI patients? How can you predict, in the ED, who might go on to have an urgent CABG, in which case Clopidogrel is contra-indicated? Which anticoagulant is best for unstable angina, NSTEMI and STEMI - unfractionated heparin (UFH), low molecular weight heparin (LMWH), or fonduparinux? Is there currenly any role for Glycoprotein 2b3a Inhibitors in ACS in the ED? When is thrombolysis better than PCI for STEMI? When should we consider facilitated angioplasty and rescue angioplasty? Which low risk chest pain patients require an early stress test? CT coronary angiography? Stress Echo? Admission to a Coronary Decision Unit (CDU)? and many more.......

By Anton Helman|2024-08-18T18:52:19-04:00June 21st, 2011|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Resuscitation|Tags: ACS, anticoagulants, biomarkers, clopidogrel, cocaine, Eric Letovsky, NSTEMI, PCI, STEMI, troponin|0 Comments

Episode 15 Part 1: Acute Coronary Syndromes Risk Stratification

In Part 1 of this Episode on Acute Coronary Syndromes Risk Stratification Dr. Eric Letovksy, Dr. Mark Mensour and Dr. Neil Fam discuss common pearls and pitfalls in assessing the patient who presents to the ED with chest pain. They review atypical presentations to look out for, what the literature says about the value of traditional and non-traditional cardiac risk factors, the diagnostic utility of recent cardiac testing, and which patients in the ED should have a cardiac work-up. Finally, in the ED work up of Acute Coronary Syndromes Risk Stratification, they highlight some valuable key points in ECG interpretation and how best to use and interpret cardiac biomarkers like troponin. Drs. Letovksy, Mensour & Fam address questions like: How useful are the traditional cardiac risk factors in predicting ACS in the ED? How does a negative recent treadmill stress test, nuclear stress test or angiogram effect the pre-test probability of ACS in the ED? What does recent evidence tell us about the assumption that patients presenting with chest pain and a presumed new LBBB will rule in for MI and require re-perfusion therapy? How can we diagnose MI in the patient with a ventricular pacemaker? What is the difference between Troponin I and Troponin T from a practical clinical perspective? Is one Troponin ever good enough to rule out MI in the patient with a normal ECG? Should we be using a 2hr delta troponin protocol? How will the new ultra-sensitive Troponins change our practice? and many more.....

By Anton Helman|2024-08-18T18:52:18-04:00June 21st, 2011|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Medical Specialty|Tags: ACS, ECG interpretation, Eric Letovsky, LBBB, NSTEMI, risk stratification, STEMI, troponin|1 Comment

Episode 14 Part 2: Thunderclap Headache – Cerebral Venous Thrombosis and Cervical Artery Dissection

emergency headacheIn Part 2 of this episode on Thunderclap Headache - Cerebral Venous Thrombosis & Cervical Artery Dissction, Dr. Stella Yiu and Dr. Anil Chopra review the presentation, work-up and management of some of the less common but very serious causes of headache including Cervical Artery Dissection (CAD), Cerebral Venous Thrombosis (CVT) and Idopathic Intracranial Hypertension (IIH). They tell us the most effective ways in which we can minimize the chance of the common Post-LP Headache. They answer questions such as: How does a carotid artery dissection present compared to a vertebral artery dissection? What is the evidence for chiropractic neck manipulation as a cause for Cervical Artery Dissection? How do antiplatelets compare to heparin for the treatment of Cervical Artery Dissection? What is Spontaneous Intracranial Hypotension? What is the differential diagnosis for headache in the peri-partum patient? Does D-dimer have a role in ruling out Cerebral Venous Thrombosis in the low risk patient? What is the imaging modality of choice for suspected Cerebral Venous Thrombosis? What is the value of opening pressure when performing an LP? What are the key headache diagnoses that can be missed on plain CT of the head and would warrant further investigation? and many more.....

By Anton Helman|2024-08-18T18:53:59-04:00May 9th, 2011|Categories: EM Cases, Emergency Medicine, Episodes, Neurology|Tags: Anil Chopra, CVT, D-dimer, IIH, opening pressure, post-LP headache, pseudotumor cerebri, spontaneous intracrnial hypotension, Stella Yiu|4 Comments

Episode 14 Part 1: Migraine Headache and Subarachnoid Hemorrhage

In Part 1 of this episode on Headache Pearls & Pitfalls - Migraine Headache & Subarachnoid Hemorrhage, Dr. Anil Chopra and Dr. Stella Yiu discuss the best evidenced-based management of migraine headache in the ED including the use of dexamethasone, dopamine antagonists, the problems with narcotics and the efficacy of 'triptans'. An easy way to remember the worrisome symptoms of headache indicating a serious cause is reviewed followed by a detailed discussion of the pearls, pitfalls and controversies around the work-up of Subarachnoid Hemorrhage (SAH) in light of some exciting recent literature, including the basis for a new Canadian decision rule for SAH.

By Anton Helman|2024-08-18T18:53:57-04:00May 9th, 2011|Categories: EM Cases, Emergency Medicine, Episodes, Neurology|Tags: Anil Chopra, clinical decision rules, lumbar puncture, migraine, Stella Yiu, subarchnoid hemorrhage|1 Comment

Episode 13 Part 2: Killer Coma Cases – The Intoxicated Patient

In part 2 of this episode Dr. Helman presents two more cases to Dr. Carr and Dr. Steinhart, who give us their insights into the common conundrums when it comes to the intoxicated ED patient, and some key clues to the not-so-common life threatening toxicological emergencies that we need to be on the look out for.

By Anton Helman|2021-03-31T13:28:03-04:00April 12th, 2011|Categories: EM Cases, Emergency Medicine, Episodes, Neurology, Toxicology|Tags: altered mental status, Brian Steinhart, coma cocktail, David Carr, naloxone|2 Comments