emergency medicine gastroentrology

Episode 89 – DOACs Part 2: Bleeding and Reversal Agents

In this Part 2, DOACs Bleeding and Reversal we discuss the management of bleeding in patients taking DOACs with minor risk bleeds, like epistaxis where local control is easy to access, moderate risk bleeds, like stable GI bleeds and high risk bleeds, like intracranial hemorrhage. We answer questions such as: How do we weigh the risks and benefits of stopping the DOAC? When is reversal of the DOAC is advised? How best do we accomplish the reversal of DOACs? Is there any good evidence for the newest reversal agent? When should we stop DOACs for different procedures, and when should we delay the procedure?

By Anton Helman|2021-03-30T14:38:50-04:00December 6th, 2016|Categories: EM Cases, Emergency Medicine, Episodes, Gastroenterology, Hematology, Medical Specialty, Neurology|Tags: abixiban, Andexanet Alfa, dabigitran, epistaxis, GI bleed, ICH, Idarucizumab, Jim Douketis, PCCs, rivaroxiban, Walter HImmel|4 Comments

Journal Jam 8 – Dilute Apple Juice for Pediatric Gastroenteritis

This is EM Cases Journal Jam podcast on a randomized control trial of dilute apple juice vs PediaLyte for mild pediatric gastroenteritis. While IV rehydration is required in cases of severe gastroenteritis (which we rarely see in North America) and oral rehydration with electrolyte maintenance solutions is still the mainstay in treating moderate gastroenteritis, could better-tasting, more cost-effective fluids such as diluted apple juice be just as effective as traditional electrolyte solutions in milder cases? Listen to Dr. Justin Morgenstern (@First10EM) interviewing Dr. Stephen Freedman, the world-renowned pediatric EM researcher who put ondansetron for pediatric gastroenteritis on the map and who was one of our guest experts on our main episode on Pediatric Gastroenteritis, Constipation and Bowel Obstruction, about this practice-changing paper. This is followed by a hilarious rant on the topic from Dr. Anthony Crocco ("Ranthony"), the Division head and medical director of pediatric EM at Hamilton Health Sciences.

By Anton Helman|2018-12-21T19:20:46-05:00November 8th, 2016|Categories: EM Cases, Emergency Medicine, Gastroenterology, Journal Jam, Medical Specialty, Pediatrics|Tags: Anthony Crocco, dehydration, gastroenteritis, Justin Morgenstern, pediatlyte, Stephen Freedman|1 Comment

Best Case Ever 51 – Anticoagulants and GI Bleed with Walter Himmel

In anticipation of Episode 88 and 89: DOACs Use, Misuse and Reversal with the president of Thrombosis Canada and world renowned thrombosis researcher Dr. Jim Douketis, internist and thrombosis expert Dr. Benjamin Bell and 'The Walking Encyclopedia of EM' Dr. Walter Himmel, we have Dr. Himmel telling us the story of his Best Case Ever on anticoagulants and GI bleed. He discusses the most important contraindication to DOACs, the importance of not only attempting to reverse the effects of anticoagulants in a bleeding patient but managing the bleed itself as well as more great pearls. In the upcoming episodes we'll run through 6 cases and cover the clinical use of DOACs, how they work, safety, indications, contraindications, management of minor, moderate and severe bleeding, the new DOAC reversal agents, management of DVT with DOAC anticoagulants, stroke prevention in atrial fibrillation with DOACs and much more...

By Anton Helman|2017-02-05T14:59:19-05:00November 8th, 2016|Categories: Best Case Ever, EM Cases, Emergency Medicine, Gastroenterology, Hematology, Medical Specialty, Resuscitation|Tags: dabigitran, DOACs, massive GI bleed, upper GI bleed, Walter HImmel|0 Comments

Episode 47: Evidence Based Medicine from NYGH EMU Conference 2014

Dr. Walter Himmel (the 'walking encyclopedia of EM') gave a fantastic talk from North York General's Emergency Medicine Update Conference in Toronto, which have edited into a podcast with key commentary and summaries. Dr. Himmel eloquently shows us, through absolutely stunning personal cases, how evidence based medicine can be appropriately or inappropriately applied in real practice, resulting in major outcome differences for your patients. He elucidates the importance of clinical experience, patient values and ED resources in helping apply the medical literature to your practice. He reviews the essence of critical appraisal, the hierarchy of evidence and how to keep up with the emergency medicine literature. The famous NINDS thrombolysis for stroke trial is distilled down to a few key considerations and the NEJM transfusion for upper GI bleed trial from last year is dissected, analyzed and then applied to Dr. Himmel's personal cases, to help us understand exactly how to apply the literature to our daily practice. Blog post and written summary prepared by Keerat Grewal, edited by Anton Helman July 2014

By Anton Helman|2021-03-30T17:06:00-04:00July 8th, 2014|Categories: Clinical Practice, Conference, EM Cases, Emergency Medicine, Episodes, Gastroenterology, Neurology, NYGH EM Update|Tags: critical apprraisal, EBM, evidence based medicine, GI bleed, NINDS, thrombolysis, Walter HImmel|4 Comments

Episode 43 – Appendicitis Controversies

In this episode on Appendicitis Controversies, we have the continuation of our discussion on abdominal pain emergencies with Dr. Brian Steinhart & Dr. David Dushenski. We kick off the discussion with key clinical pearls and pitfalls in the history and physical exam with their respective liklihood ratios when assessing patients with abdominal pain for appendicitis - a diagnosis that is still sometimes missed despite its prevalence. Dr. Dushenski hacks apart the Alvarado and Appendicitis Inflammatory Response Scores and we discuss the value of WBC, CRP and urinalysis in the work-up of appendicitis. Next up are the controversies of imaging algorithms using ultrasound and CT abdomen, as well as the factors affecting which imaging algorithm you might pursue. We wrap up the discussion on Appendicitis Controversies with a critical look at the value of antibiotics in the ED for appendicitis and which patients might be appropriate for non-surgical management.

By Anton Helman|2022-01-05T23:15:48-05:00April 22nd, 2014|Categories: EM Cases, Emergency Medicine, Episodes, Gastroenterology|Tags: Alvarado Score, Brian Steinhart, clinical decision rules, CT Abdomen, David Dushenski, ultrasound|2 Comments

Episode 42: Mesenteric Ischemia and Pancreatitis

In this episode Dr. Steinhart, (one of my biggest mentors – the doc that everyone turns to when no one can figure out what’s going on with a patient in the ED), & Dr. Dave Dushenski, (a master of quality assurance and data analysis, who would give David Newman a run for his money), discuss the 4 diagnoses that make up the deadly & difficult diagnosis of Mesenteric Ischemia, it’s key historical and physical exam features, the value of serum lactate, D-dimer & blood gas, when CT can be misleading, ED management of Mesenteric Ischemia, the difficult post-ERCP abdominal pain patient, the pitfalls in management of Pancreatitis, the BISAP score for Pancreatitis compared to the APACHE ll & Ranson Score, the comparative value of amylase and lipase, ultrasound vs CT for pancreatitis and much more…

By Anton Helman|2021-03-30T17:11:05-04:00March 29th, 2014|Categories: EM Cases, Emergency Medicine, Episodes, Gastroenterology|Tags: Amylase, BISAP score, Brian Steinhart, clinical decision rules, D-dimer, David Dushenski, Lactate, Lipase, Mesenteric Ischemia, pancreatitis, post-ERCP|1 Comment

Best Case Ever 21 Abdominal Pain – Thinking Outside the Box

As a bonus to Episode 42 on Mesenteric Ischemia & Pancreatitis, Dr. Brian Steinhart presents his Best Case Ever of Abodominal Pain – Thinking Outside the Box. While about 10% of abdominal pain presentations to the ED are surgical, there are a variety of abdominal pain presentations that have diagnoses outside the abdomen – so one needs to be thinking outside the box. In the related episode, Dr. Steinhart, (one of my biggest mentors – the doc that everyone turns to when no one can figure out what’s going on with a patient in the ED), & Dr. Dave Dushenski, (a master of quality assurance and data analysis, who would give David Newman a run for his money), discuss the 4 diagnoses that make up the deadly & difficult diagnosis of Mesenteric Ischemia, it’s key historical and physical exam features, the value of serum lactate, D-dimer & blood gas, when CT can be misleading, ED management of Mesenteric Ischemia, the difficult post-ERCP abdominal pain patient, the pitfalls in management of Pancreatitis, the BISAP score for Pancreatitis compared to the APACHE ll & Ranson Score, the comparative value of amylase and lipase, ultrasound vs CT for pancreatitis and much more…

By Anton Helman|2017-02-03T11:40:37-05:00March 26th, 2014|Categories: Best Case Ever, EM Cases, Emergency Medicine, Gastroenterology|Tags: abdominal pain, APACHE, BISAP, Brian Steinhart, D-dimer, Lactate, Mesenteric Ischemia, pancreatitis, Ranson|0 Comments

Episode 34: Geriatric Emergency Medicine

In this episode Dr. Don Melady, Canada's leading educator in Geriatric Emergency Medicine (Geri-EM) & Dr. Jaques Lee, one of Canada's leading researchers in Geri-EM, discuss the common yet challenging Geriatric Emergencies: a practical approach to geriatric Delirium, best practice for managing agitation and pain in the older patient, management of recurrent falls, pearls in the assessment of the 'Weak & Dizzy' geriatric patient, atypical presentations of common life threatening emergencies including ACS and surgical abdomen, key drug interactions in the geriatric patient and more..

By Anton Helman|2021-03-31T12:58:46-04:00July 8th, 2013|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Gastroenterology, Neurology, Trauma|Tags: delirium, Don Melady, drug interactions, falls, Geri-EM, Jaques Lee, Warfarin, weak and dizzy|1 Comment

Episode 32: Whistler Update in Emergency Medicine Conference 2013

Whistler's Update in Emergency Medicine Conference 2013 in Whistler, British Columbia is U of Toronto's case-based interactive small group EM conference. There were so may great talks with amazing clinical pearls that I decided to wade through the 18 hours of audio recordings and packaged some of the key highlights for you here......EM Literature Review 2012 by Dr. Joel Yaphe, Neonatal Resuscitation Pearls by Dr. Nicole Kester-Greene, Fever of Unknown Origin by Dr. Shirley Lee, Improving Cosmesis in Wound Management by Dr. Maria Ivankovic, Hepato-biliary Disease by Dr. Sara Gray, & Pediatric Cardiac & Respiratory Cases by Dr. Donna Goldenberg.

By Anton Helman|2022-09-05T18:03:34-04:00April 10th, 2013|Categories: Cardiology, Conference, Emergency Medicine, Episodes, Gastroenterology, Pediatrics, Respirology, Whistler Update in EM|Tags: anticoagulants, azithromycin, cholangitis, cholycystitis, FUO, gonorrhea, hepatic encephalopathy, intubation, Joel Yaphe, laceration, Maria Ivankovic, pain managment, peritonsillar abscess, pneumothorax, Sara Grey, Shirley Lee, sinusitis, tissue adhesive, wound managment|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