emergency medicine education

Best Case Ever 36 Tracheo-innominate Fistula

In this Best Case Ever with Dr. Scott Weingart, the brains behind EMcrit.org, we hear the devastating story of a tracheostomy gone bad. Dr. Weingart shares with us what he has learned about how to manage massive hemoptysis in tracheostomy patients, and in particlar, a step-wise approach to managing a tracheo-innominate fistula. We discuss the balance between providing maximal aggrressive critical care while maintaining a deep respect for the risks associated with the procedures we perform. Recorded at North York General's EM Update Conference 2015.

By Anton Helman|2017-02-05T14:58:12-05:00June 2nd, 2015|Categories: Best Case Ever, Conference, Ears Nose & Throat, Emergency Medicine, Medical Specialty, NYGH EM Update, Resuscitation|Tags: EMU, hemoptysis, Scott Weingart, tracheostomy|0 Comments

Journal Jam 3 – Ultrasound vs CT for Renal Colic

In this Journal Jam we have Dr. Michelle Lin from Academic Life in EM interviewing two authors, Dr. Rebecca Smith‑Bindman, a radiologist, and Dr. Ralph Wang an EM physician both from USCF on their article “Ultrasonography versus Computed Tomography for suspected Nephrolithiasis” published in the New England Journal of Medicine in 2014. There is currently a wide practice variation in the imaging work-up of the patient who presents to the ED with a high suspicion for renal colic. On the one extreme, some EM physicians use CT to screen all patients who present with renal colic, while on the other extreme, other EM physicians do not use any imaging on any patient who has had previous imaging. The role of POCUS and radiology department ultrasound as an alternative to CT in the work up of renal colic has not been clearly defined in the ED setting. This study was a pragmatic multi-centre randomized control trial of patients in whom the primary diagnostic concern was renal colic, that tried to answer the question: is there a significant difference in the serious missed diagnosis rate, serious adverse events rate, pain, return visits, admissions to hospital, radiation dose and diagnostic accuracy if the EM provider chose POCUS, radiology department ultrasound or CT for their initial imaging modality of choice. This Journal Jam is peer review by EMNerd's Rory Spiegel. [wpfilebase tag=file id=618 tpl=emc-play /] [wpfilebase tag=file id=619 tpl=emc-mp3 /]

By Anton Helman|2020-05-15T09:16:44-04:00May 20th, 2015|Categories: Emergency Medicine, Genitourinary, Journal Jam, Medical Specialty, Ultrasound|Tags: computed tomography, POCUS, renal colic, ultrasound|4 Comments

Episode 64 Highlights from Whistler’s Update in EM Conference 2015 Part 2

In this Part 2 of EM Cases' Highlights from Whistler's Update in EM Conference 2015 Dr. David Carr gives you his top 5 pearls and pitfalls on ED antibiotic use including when patients with sinusitis really require antibiotics, when oral antibiotics can replace IV antibiotics, how we should be dosing Vancomycin in the ED, the newest antibiotic regimens for gonorrhea and the mortality benefit associated with antibiotic use in patients with upper GI bleeds. Dr. Chris Hicks gives you his take on immediate PCI in post-cardiac arrest patients with a presumed cardiac cause and The Modified HEART Score to safely discharge patients with low risk chest pain.

By Anton Helman|2024-08-09T21:15:19-04:00May 13th, 2015|Categories: Cardiology, Conference, Ears Nose & Throat, EM Cases, Emergency Medicine, Episodes, Medical Specialty, Resuscitation, Whistler Update in EM|Tags: cardiac arrest, chest pain, Chris Hicks, David Carr, gonorrhea, HEART score, McIasaac score, PCI, pharyngitis, PROCAT, sinusitis, vancomycin|0 Comments

Episode 62 Diagnostic Decision Making in Emergency Medicine

This is Part 1 of EM Cases' series on Diagnostic Decision Making with Walter Himmel, Chris Hicks and David Dushenski discussing the intersection of evidence-based medicine, cognitive bias and systems issues to effect our diagnostic decision making in Emergency Medicine. In this episode we first discuss 5 strategies to help you master evidence-based diagnostic decision making to minimize diagnostic error, avoid over-testing and improve patient care including: 1. The incorporation of patients' values and clinical expertise into evidence-based decisions 2. Critically appraising diagnostic studies 3. Understanding that diagnostic tests are not perfect 4. Using the concept of test threshold to guide work-ups 5. Understanding that the predictive value of a test depends on the prevalence of disease We then go on to review some of the factors that play into the clinician’s and patient’s risk tolerance in a given clinical encounter, how this plays into shared decision making and the need to adjust our risk tolerance in critical situations. Finally, we present some strategies to prevent over-testing while improving patient care, patient flow and ethical practice.

By Anton Helman|2024-08-07T19:58:37-04:00April 14th, 2015|Categories: Clinical Practice, EM Cases, Emergency Medicine, Episodes, Medical Specialty|Tags: choosing wisdely, Chris Hicks, cognitive bias, David Dushenski, EBM, evidence based medicine, likelihood ratio, LR, predictive value, risk tolerance, shared decision making, Walter HImmel|4 Comments

Best Case Ever 35: Taking Action in Emergency Medicine

In anticipation of our series of podcasts on Diagnostic Decision Making with Dr. Walter Himmel, Dr. Chris Hicks and Dr. David Dushenski we have Dr. Hicks presenting his Best Case Ever. Taking action in Emergency Medicine requires not only careful consideration of the best evidence, the experience of the clinician, the patient's values and the system that you work in, but also the will to act. Dr. Hicks describes a case of a patient who suffers a cardiac arrest, where the diagnosis is quite obvious to everyone in the room (and the required action is as well), yet a delay in treatment occurs nonetheless.

By Anton Helman|2017-02-03T11:50:08-05:00April 7th, 2015|Categories: Best Case Ever, Clinical Practice, Emergency Medicine, Medical Specialty, Resuscitation|Tags: Chris Hicks, cognitive bias, cognitive error, pulmonary embolism, thrombolysis|2 Comments

Episode 61 Whistler’s Update in EM Conference 2015 Highlights Part 1

This EM Cases episode is Part 1 of The Highlights of The University of Toronto, Divisions of Emergency Medicine, Update in EM Conference from Whistler 2015 with Paul Hannam on Pearls and Pitfalls of Intraosseus Line Placement, Anil Chopra on who is at risk and how to prevent Contrast Induced Nephropathy, and Joel Yaphe on the Best of EM Literature from 2014, including reduction of TMJ dislocations, the TRISS trial (on transfusion threshold in sepsis), PEITHO study for thrombolysis in submassive PE, Co-trimoxazole and Sudden Death in Patients Receiving ACE inhibitors or ARBs, the effectiveness and safety of outpatient Tetracaine for corneal abraisons, chronic effects of shift work on cognition and much more...

By Anton Helman|2024-08-09T21:15:57-04:00March 26th, 2015|Categories: Conference, EM Cases, Emergency Medicine, Episodes, Medical Specialty, Orthopaedics, Resuscitation, Whistler Update in EM|Tags: Anil Chopra, CIN, Contrast Nephropathy, corneal abrasion, intraosseous, IO, Joel Yaphe, Paul Hannam, PEITHO, pulmonary embolism, TMJ dislocation, TRISS trial, Update in EM Conference, VISAT|1 Comment

Best Case Ever 34: Inferior MI Presenting with Abdominal Pain

In a previous Best Case Ever, 'Thinking Outside the Abdominal Box', Dr. Brian Steinhart reviewed some important can't-miss-diagnoses that can present elusively with abdominal pain. In this Carr's Cases Series on Inferior MI Presenting with Abdominal Pain, we continue in the theme of 'Thinking Outside the Abdominal Box' with David Carr explaining how he figured out that a man presenting with classic biliary colic was diagnosed with an inferior MI with right ventricular extension.

By Anton Helman|2019-11-11T17:12:13-05:00March 19th, 2015|Categories: Best Case Ever, Cardiology, EM Cases, Emergency Medicine, Medical Specialty|Tags: cardiac biomarkers, David Carr, STEMI|1 Comment

Episode 60: Emergency Management of Hyponatremia

In this EM Cases episode Dr. Melanie Baimel and Dr. Ed Etchells discuss a simple and practical step-wise approach to the emergency management of hyponatremia: 1. Assess and treat neurologic emergencies related to hyponatremia with hypertonic saline 2. Defend the intravascular volume 3. Prevent further exacerbation of hyponatremia 4. Prevent rapid overcorrection 5. Ascertain a cause Dr. Etchells and Dr. Baimel answer questions such as: What are the indications for giving DDAVP in the emergency management of hyponatremia? What is a simple and practical approach to determining the cause of hyponatremia in the ED? How fast should we aim to correct hyponatremia? What is the best fluid for resuscitating the patient in shock who has a low serum sodium? Why is the management of the marathon runner with hyponatremia counter-intuitive? What strategies can we employ to minimize the risk of Osmotic Demyelination Syndrome (OSD) and cerebral edema in the emergency management of hyponatremia? and many more...

By Anton Helman|2021-04-13T13:02:17-04:00March 3rd, 2015|Categories: Emergency Medicine, Episodes, Medical Specialty|Tags: cerebral edema, DDAVP, EAH, Ed Etchells, hypertonic saline, Melanie Baimel, ODS, osmotic demyelination syndrome, SIADH|18 Comments

Best Case Ever 33: Over-correction of Hyponatremia

Rapid over-correction of Hyponatremia can have devastating consequences: for one, osmotic demyelination syndrome (ODS) can result in destruction of the pons and a locked-in state. We don't see ODS very much as it's onset is delayed and usually sets in after the patient is admitted to hospital (or worse, sent home). Nonetheless, we need to know how to manage Hyponatremia in the ED so that we prevent ODS from ever happening. In this Best Case Ever, Dr. Melanie Baimel describes the case of a young woman who came in to the ED after drinking alcohol and taking Ecstasy, wanted to leave AMA after her Hyponatremia had inadvertently been corrected too rapidly, and the conundrum that ensues. In the upcoming episode, Dr. Baimel and the first ever Internal Medicine specialist on EM Cases, Dr. Ed Etchels, discuss a rational step-wise approach to managing Hyponatremia, tailored for the EM practitioner; when you might consider giving DDAVP in the ED, the best way to correct Hyponatremia, how to manage the patient who's Hyponatremia has been corrected too quickly, and an easy approach to the differential diagnosis. Get a sneak peak at the algorithm that will be explained and reviewed in the upcoming episode...... [wpfilebase tag=file id=577 tpl=emc-play /] [wpfilebase tag=file id=578 tpl=emc-mp3 /]

By Anton Helman|2019-11-11T17:21:15-05:00February 26th, 2015|Categories: Best Case Ever, Emergency Medicine, Medical Specialty, Toxicology|Tags: DDAVP, ecstasy, MDMA, Melanie Baimel, ODS, osmotic demyelination syndrome|3 Comments

Episode 57: The Stiell Sessions 2 – Update in Atrial Fibrillation 2014

In this bonus EM Cases podcast, The Stiell Sessions 2, we have Dr. Ian Stiell discussing an update in Atrial Fibrillation 2014 management including the age-old question of rate control vs rhythm control, the new CHADS-65 algorithm for oral anticogulant therapy, the need to initiate anticoagulant therapy in the ED, the more aggressive use of the Ottawa Aggressive Protocol, the dangers of attempting to cardiovert unstable patients who are in permanent Atrial Fibrillation, the new 150 rule to help determine the likelihood of successful cardioversion and much more. Thanks to all the listeners who did the survey on clinical decision rules and the post-listen survey.

By Anton Helman|2021-03-30T16:56:19-04:00December 31st, 2014|Categories: Cardiology, Emergency Medicine, Episodes, Medical Specialty|Tags: anticoagulants, atrial fibrillation, cardioversion, CHADS Score, dabigitran, Ian Stiell, NOACS, Warfarin|3 Comments