round table discussions on emergency medicine cases

Ep 122 Sepsis and Septic Shock – What Matters from EM Cases Course

In this podcast Dr. Sara Gray, intensivist and emergency physician, co-author of The CAEP Sepsis Guidelines, answers questions such as: How does one best recognize occult septic shock? How does SIRS, qSOFA and NEWS compare in predicting poor outcomes in septic patients? Which fluid and how much fluid is best for resuscitation of the septic shock patients? What are the indications for norepinephrine, and when in the resuscitation should it be given, in light of the CENSER trial? What are the goals of resuscitation in the patient with sepsis or septic shock? When should antibiotics administered, given that the latest Surviving Sepsis Campaign Guidelines recommend that antibiotics be administered within one hour of arrival for all patients suspected of sepsis or septic shock? What are the indications for a second vasopressor after norepinephrine? Given the conflicting evidence for steroids in sepsis, what are the indications for steroids? Should we be considering steroids with Vitamin C and thiamine for patients in septic shock? What are the pitfalls of lactate interpretation, and how do serial lactates compare to capillary refill in predicting poor outcomes in light of the ANDROMEDA trial? Is procalcitonin a valuable prognostic indicator in septic patients? and many more...

By Anton Helman|2023-02-06T13:11:10-05:00March 26th, 2019|Categories: Conference, EM Cases, EM Cases Course, Emergency Medicine, Episodes, Medical Specialty, Resuscitation|Tags: ANDROMENA, CENSER, Dr. Sara Gray, EM Cases Course, Lactate, NEWS, norepinephrine, procalcitonin, qSOFA, Ringer's Lactate, sepsis, septic shock, SIRS, vasopressin|7 Comments

Ep 121 Elbow Injuries – Ten Pitfalls in Diagnosis and Management

In this main episode podcast we discuss the pitfalls in the diagnosis and management of elbow injuries and answer questions such as: What is an easy way to remember the surgical indications for radial head fractures? What is the significance of a coronoid process fracture and how does it change management when seen with a radial head fracture? What is the best way to assess for pronation and supination of the forearm? Why is it so important to assess for the extensor mechanism on physical exam for patients with olecranon fractures? What is a quick easy way to test the peripheral nerves of the upper extremities? Which often missed soft tissue injuries of the elbow require urgent operative management? and many more...

By Anton Helman|2022-10-11T13:35:36-04:00February 26th, 2019|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Orthopaedics|Tags: coronoid process fracture, Dr. Arun Sayal, Dr. Dale Dantzer, elbow dislocation, olecranon fracture, radial head fracture, radiocapitellar line, terrible triad|3 Comments

Ep 120 ED Stroke Management in the Age of Endovascular Therapy

In this EM Cases main episode podcast, a follow up to our episode on TIA released in November 2018 with Walter Himmel and David Dushenski, we’ll try to simplify the confusing time-based and brain tissue-based options for stroke management. We’ll answer the questions that have been plaguing us for a while now: Which patients are eligible for endovascular therapies? Which patients are the ones who’ll benefit from these therapies and how do we make that happen in our different practice environments? Which patients should be considered for lytic therapy? Which patients should be considered for both lytic and endovascular therapy? and many more...

By Anton Helman|2024-08-19T19:34:40-04:00January 29th, 2019|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Neurology|Tags: Dr. David Dushenski, Dr. Walter Himmel, endovascular therapy, NIHSS, thrombolytics, tPA, VAN tool|2 Comments

Ep 119 Trauma – The First and Last 15 Minutes Part 2

What should your resuscitation targets be in the first 15 minutes for trauma patients with hemorrhagic shock, neurogenic shock, severe head injury? When is a pelvic binder indicated? Is a bedsheet good enough? What are the most common pitfalls in binding the pelvis? What are the best ways to maintain team situational awareness during a trauma resuscitation? Should we rethink patient positioning for the trauma patient? What are the indications for transport to a trauma center? What is the minimal data set required before transfer? Which patients require a pelvic x-ray prior to transfer to a trauma center? What are the key elements of a transport checklist? What does the future hold for trauma care and many more...

By Anton Helman|2024-08-02T17:11:44-04:00January 1st, 2019|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Trauma|Tags: Dr. Andrew Petrosoniak, Dr. Chris Hicks, Dr. Kylie Bosman, pelvic binder, resuscitation targets, transport checklist, trauma transfer|5 Comments

Ep 118 Trauma – The First and Last 15 Minutes Part 1

In this part 1 of Trauma - The First and Last 15 Minutes, we answer questions such as: how should we best prepare our team, our gear and ourselves for the trauma patient? How does resequencing the initial trauma resuscitation save lives? How can we most readily identify occult shock, the silent killer in trauma? What are 7 actions to consider in the first 15 minutes of resuscitation? How can the concepts of "controlled resuscitation" and "resuscitation intensity" help us decide resuscitation targets and when to activate a massive transfusion protocol? and many more...

By Anton Helman|2024-08-02T17:12:12-04:00December 18th, 2018|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Trauma|Tags: ABC score, controleed resuscitation, delta shock index, Dr. Andrew Petrosoniak, Dr. Chris Hicks, massive transfusion, resequenced trauma resuscitation, resuscitation intensity, shock index|5 Comments

Ep 117 TIA Update – Risk Stratification, Workup and Dual Antiplatelet Therapy

Much has changed in recent years when it comes to TIA risk stratification, workup and antiplatelet therapy. In this podcast we use the overarching theme of timing to elucidate how to distinguish true TIA from the common TIA mimics, the importance of timing in the workup of TIA, why the duration of therapy with dual antiplatelet therapy and timing of starting anticoagulation in patient with atrial fibrillation, contributes to the difference between preventing catastrophic strokes and causing intracranial hemorrhage...

By Anton Helman|2024-08-19T19:34:39-04:00November 20th, 2018|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Neurology|Tags: ABCD2, DAPT, David Dushenski, dual antiplatelet therapy, endarterectomy, tia mimics, Walter HImmel|5 Comments

Ep 116 Emergency Management of Opioid Misuse, Overdose and Withdrawal

In this episode Dr. Kathryn Dong, Dr. Michelle Klaiman and Dr. Aaron Orkin discuss the latest in naloxone in opioid overdose cardiac arrest and altered LOA, a 5-step approach to ED opioid withdrawal management and how we can improve mortality and morbidity in patients with opioid use disorder in the era of the opioid epidemic...

By Anton Helman|2022-10-16T08:03:58-04:00October 23rd, 2018|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Resuscitation, Special Populations, Toxicology|Tags: buprenorphine, COWS Score, naloxone, naltrexone, opioid use disorder, precipitated withdrawal, readiness ruler, SBIRT, suboxone|3 Comments

Ep 115 Emergency Management of the Agitated Patient

Managing acutely agitated patients can cause anxiety in even the most seasoned emergency doctor. These are high risk patients and they are high risk to you and your ED staff. It’s important to understand that agitation or agitated delirium is a cardinal presentation – not a diagnosis. There is pathology lurking beneath - psychiatric, medical, traumatic and toxicological diagnoses driving these patients and we just won’t know which until we can safely calm them down...

By Anton Helman|2022-10-16T10:48:01-04:00September 25th, 2018|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Psychiatry, Resuscitation, Toxicology|Tags: excited delirium, haloperidol, ketamine, Margaret Thompson, midazolam, physical restraints, Reuben Strayer|6 Comments

Ep 114 Pulmonary Embolism Challenges in Diagnosis 2 – Imaging, Pregnancy, Subsegmental PE

In Part 1 of Pulmonary Embolism Challenges in Diagnosis Drs. Helman, Lang and DeWit discussed a workup algorithm using PERC and Wells score, the bleeding risk of treated pulmonary embolism, pearls in decision making on whether or not to work up a patient for pulmonary embolism, how risk factors contribute to pretest probability, the YEARS criteria and age-adjusted D-dimer. In this Part 2 we answer questions such as: what are the important test characteristics of CTPA we need to understand? Which patients with subsegmental pulmonary embolism should we treat? When should we consider VQ SPECT? What is the best algorithm for the work up of pulmonary embolism in pregnant patients? How best should we implement pulmonary embolism diagnostic decision tools in your ED? and many more…

By Anton Helman|2022-10-16T11:15:02-04:00August 28th, 2018|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Respirology|Tags: CTPA, Dr. Eddy Lang, Dr. Kerstin DeWit, subsegmental PE, VQ spect|0 Comments

Ep 113 Pulmonary Embolism Challenges in Diagnosis Part 1

Dr. Kerstin DeWit and Dr. Eddy Lang answer the questions that plague us on almost every shift: Which patients require any work-up at all for PE? What’s the utility of PERC and Well’s scores? Should the newer YEARS decision tool supplant Well’s? When should we order a D-dimer? What’s the diagnostic role of CXR, ECG, POCUS, CTA and VQ? How should we work up pregnant patients for PE? How can we use shared decision making strategies for PE to help us do what’s best for our patients, and many more...

By Anton Helman|2024-08-02T17:22:20-04:00August 14th, 2018|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Respirology|Tags: age adjusted d-dimer, D-dimer, Dr. Eddy Lang, Dr. Kerstin DeWit, PERC, Well's Criteria, YEARS criteria|9 Comments