emergency medicine cardiology

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 86 – Emergency Management of Hyperkalemia

This is 'A Nuanced Approach to Emergency Management of Hyperkalemia' on EM Cases. Of all the electrolyte emergencies, hyperkalemia is the one that has the greatest potential to lead to cardiac arrest. And so, early in my EM training I learned to get the patient on a monitor, ensure IV access, order up an ECG, bombard the patient with a cocktail of kayexalate, calcium, insulin, B-agonists, bicarb, fluids and furosemide, and get the patient admitted, maybe with some dialysis to boot. Little did I know that some of these therapies were based on theory alone while others were based on a few small poorly done studies. It turns out that some of these therapies may cause more harm than good, and that precisely when and how to give these therapies to optimize patient outcomes is still not really known...

By Anton Helman|2022-02-17T13:42:30-05:00September 27th, 2016|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Medical Specialty, Resuscitation|Tags: calcium chloride, digoxin toxicity, Ed Etchells, kayexelate, Melanie Baimel|13 Comments

Best Case Ever 49 – Post-Arrest Hyperkalemia

Melanie Baimel's Best Case Ever on Post-Arrest Hyperkalemia on EM Cases. Post arrest patients can sometimes be challenging. We need to think of a variety of underlying causes of the arrest, antiarrhythmics, possible cath lab activation, targeted temperature management, sedation and more. To add to this, many post arrest patients do not have ideal vital signs that require attention. In this Best Case Ever, in anticipation of our upcoming episode on A Rational Approach to Hyperkalemia Dr. Melanie Baimel describes a post arrest patient who remains bradycardic and hypotensive despite multiple pressors....

By Anton Helman|2017-02-03T11:57:58-05:00September 13th, 2016|Categories: Best Case Ever, Cardiology, EM Cases, Emergency Medicine, Medical Specialty, Resuscitation|Tags: bradycardia, calcium chloride, Melanie Baimel, post arrest care|1 Comment

Episode 84 – Congenital Heart Disease Emergencies

Congenital Heart Disease Emergencies on EM cases with Gary Joubert and Ashley Strobel. You might be surprised to learn that the prevalence of critical cardiac disease in infants is almost as high as the prevalence of infant sepsis. And if you’re like me, you don’t feel quite as confident managing sick infants with critical heart disease as you do managing sepsis. Critical congenital heart defects are often missed in the ED. For a variety of reasons, there are currently more children with congenital heart disease presenting to the ED than ever before and these numbers will continue to grow in the future. When I was in medical school I vaguely remember learning the complex physiology and long lists of congenital heart diseases, which I’ve now all but forgotten. What we really need to know about congenital heart disease emergencies is what actions to take in the ED when we have a cyanotic or shocky baby in front of us in the resuscitation room. So with the goal of learning a practical approach to congenital heart disease emergencies using the child’s age, colour and few simple tests, Dr. Strobel and Dr. Joubert will discuss some key actions, pearls and pitfalls so that the next time you’re faced with that crashing baby in the resuscitation room, you’ll know exactly what to do.

By Anton Helman|2021-03-30T14:45:22-04:00August 10th, 2016|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Medical Specialty, Pediatrics, Resuscitation|Tags: Ashley Strobel, BNP, CHF, congestive heart failure, cyanosis, cyanotic infant, etomidate, Gary Joubert, hypoxia test, prostaglandins|3 Comments

Journal Jam 7 – Amiodarone vs Lidocaine vs Placebo in Cardiac Arrest: The ALPS Trial

Journal Jam 7 - Amiodarone vs Lidocaine vs Placebo in Cardiac Arrest: The ALPS Trial. In our most popular EM Cases episode to date - ACLS Guidelines Cardiac Arrest Controversies, we boldly stated, that there has never been an antiarrhythmic medication that has shown any long term survival benefit in cardiac arrest. The use of medications in cardiac arrest has been one of those things that we all do, but that we know the evidence isn’t great for. Yet Amiodarone is still in the newest AHA adult cardiac arrest algorithm for ventricular fibrillation or pulseless ventricular tachycarida – 300mg IV after the 3rd shock with the option to give it again at 150mg after that. Anti-arrhythmics have been shown in previous RCTs to increase the rate of return of spontaneous circulation and even increased survival to hospital admission, however none of them have been able to show a decrease in mortality or a favourable neurological outcome at hospital discharge. In other words, there has never been shown a long term survival or functional benefit - which is a bit disconcerting. But now, we have a recent large randomized, controlled trial that shines some new light on the role of anti-arrythmics in cardiac arrest - The ALPS trial: Amiodarone vs Lidocaine vs placebo in out of hospital cardiac arrest. In this Journal Jam podcast, Justin Morgenstern and Anton Helman interview two authors of the ALPS trial, Dr. Laurie Morrison a world-renowned researcher in cardiac arrest and Dr. Paul Dorian, a cardiac electrophysiologist and one of Canada's leading authorities on arrhythmias about what we should take away from the ALPS trial. It turns out, it's not so simple. We also discuss the value of dual shock therapy for shock resistant ventricular fibrillation and the future of cardiac arrest care.

By Justin Morgenstern|2020-05-31T23:25:17-04:00July 26th, 2016|Categories: Cardiology, EM Cases, Emergency Medicine, Journal Jam, Medical Specialty, Resuscitation|Tags: ALPS trial, amiodarone, cardiac arrest, Laurie Morrison, lidocaine, Paul Dorian|2 Comments

Best Case Ever 47 – Cyanotic Infant

In anticipation of EM Cases' upcoming episode, Congenital Heart Disease Emergencies we have Dr. Gary Joubert a double certified Pediatric EM and Pediatric Cardiology expert telling his Best Case Ever of a four month old infant who presents with intermittent cyanosis. The Cyanotic Infant can present a significant challenge to the EM provider as the differential is wide, ranging from benign causes such as GERD to life threatening heart disease that may present atypically in a well-appearing child. Dr. Joubert gives us some simple sweet clinical pearls to help us along the way...

By Anton Helman|2016-10-17T11:41:01-04:00July 26th, 2016|Categories: Best Case Ever, Cardiology, EM Cases, Emergency Medicine, Medical Specialty, Pediatrics, Resuscitation|Tags: congenital heart disease, cyanosis, Gary Joubert, Tet spell|0 Comments

Best Case Ever 45 – Mike Winters on Cardiac Arrest

I had the great pleasure of meeting Dr. Mike Winters on his first ever visit to Canada at North York General's Emergency Medicine Update Conference, where he gave two fantastic presentations. His credentials are impressive: He is the Medical Director of the Emergency Department, Associate Professor in both EM and IM, EM-IM-Critical Care Program co-director and Residency Program Director of EM-IM at the University of Maryland in Baltimore. Sometimes we are so caught up with the job we need to get done during cardiac arrest that we forget about the important and profound effect that this event has on patients' families. On this Best Case Ever Dr. Winters tells the story of witnessing his grandfather's cardiac arrest, being present in the ED during the resuscitation attempts, and how that experience has coloured his practice. We discuss some pearls on communication with patients' families after death, colour-coded cardiac arrest teams and how to integrate POCUS into cardiac arrest care while minimizing chest compressions.

By Anton Helman|2020-05-31T23:22:52-04:00May 10th, 2016|Categories: Best Case Ever, Cardiology, Clinical Practice, Emergency Medicine, Medical Specialty, NYGH EM Update, Resuscitation, Ultrasound|Tags: cardiac arrest, Mike Winters, patient centered care, patient communication, POCUS|1 Comment

CritCases 2 – Is this Septic Shock with Pneumonia?

Welcome to EM Cases' CritCases blog, a collaboration between Mike Betzner, the STARS air ambulance service and EM Cases’ Michael Misch and Anton Helman! These are educational cases with multiple decision points where there is no strong evidence to guide us. Various strategies and opinions from providers around the world are coalesced and presented to you in an engaging format. Enjoy!

By Anton Helman|2020-05-31T23:22:46-04:00March 15th, 2016|Categories: Cardiology, CritCases, Emergency Medicine, Medical Specialty, Respirology, Resuscitation|Tags: adenosine, endocarditis, Lewis Leads, Michael Misch, Mike Betzner|2 Comments

Best Case Ever 43 Ruptured AAA

I caught up with Dr. Anand Swaminathan, otherwise known as EM Swami, at The Teaching Course in NYC where he told his Best Case Ever from Janus General of his heroic and collaborative attempts at saving the life of a gentleman who presented to the ED with a classic story for a ruptured AAA. As William Olser famously said, "There is no disease more conducive to clinical humility than aneurysm of the aorta."

By Anton Helman|2020-05-31T23:20:32-04:00January 26th, 2016|Categories: Best Case Ever, Cardiology, Emergency Medicine, Medical Specialty, Resuscitation|Tags: AAA, Anand Swaminathan, thoracotomy|2 Comments

Journal Jam 5 One Hour Troponin to Rule Out and In MI

Traditionally we've run at least 2 troponins 6 or 8 hours apart to help rule out MI and recently in algorithms like the HEART score we've combined clinical data with a 2 or 3 hour delta troponin to help rule out MI. The paper we'll be discussing here is a multicentre/multinantional study from the Canadian Medical Association Journal from this year out of Switzerland entitled "Prospective validation of a 1 hour algorithm to rule out and rule in acute myocardial infarction using a high sensitivity cardian troponin T assay" with lead author Tobias Reichlin. It not only looks at whether or not we can rule out MI using a delta troponin at only 1 hour but whether or not we can expedite the ruling in of MI using this protocol.

By Anton Helman|2020-05-31T23:22:44-04:00December 22nd, 2015|Categories: Cardiology, EM Cases, Emergency Medicine, Journal Jam, Medical Specialty|Tags: Andrew Worster, Justin Morgenstern, myocardial infarction, troponin|1 Comment