emergency medicine neurology

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...

CritCases 10 Hyponatremia Associated Seizures

In this EM Cases CritCases blog - a collaboration between STARS Air Ambulance Service, Mike Betzner and EM Cases, a middle aged woman presents to a rural ED with headache and vomiting, normal vital signs with subsequent status epilepticus and serum sodium of 110 mmol/L. What management recommendations would you make to the rural ED physician, the transport team and in your ED with regards to treatment of seizures, safe correction of hyponatremia, airway management, search for underlying cause and prevention of Osmotic Demyelenation Syndrome?

POCUS Cases 3 Idiopathic Intracranial Hypertension and Ocular POCUS

In this POCUS Cases 3 - Idiopathic Intracranial Hypertension & Ocular POCUS, Dr. Simard explains the limitations of CT head in the diagnosis of idiopathic intracranial hypertension, how to identify papilledema on ocular POCUS, how to measure Optic Nerve Sheath Diameter (ONSD) on POCUS and the limitations of ONSD on ocular POCUS.

Ep 104 Emergency Management of Intracerebral Hemorrhage – The Golden Hour

There exists a kind of self-fulfilling prognostic pessimism when it comes to ICH. And this pessimism sometimes leads to less than optimal care in patients who otherwise might have had a reasonably good outcome if they were managed aggressively. Despite the poor prognosis of these patients overall, there is some evidence to suggest that early aggressive medical management may improve outcomes. As such, the skill with which you manage your patient with ICH in those first few hours could be the most important determinant of their outcome. In this Golden Hour you have a chance to prevent hematoma expansion, stabilize intracerebral perfusion and give your patient the best chance of survival with neurologic recovery.

Episode 99 Highlights from EMU 2017

North York General Hospital's 30th Annual Emergency Medicine Update (EMU) Conference 2017 featured some of the best talks I've ever heard from the likes of Sara Gray, Amal Mattu, David Carr and many more. I had a hard time choosing which talks to feature on this EM Cases podcast. I settled on a potpourri of clinical topics and practice tips: Leeor Sommer on Lyme disease, Chris Hicks on signover, Matt Poyner on patient complaints and Walter Himmel on acute vestibular syndrome...

New Rapid Reviews Videos on TIA

The EM Cases Rapid Reviews Videos library is growing! You might have had trouble remembering all the details of Episode 6 on TIA from a few years back with Walter Himmel and Daniel Selchen. But don't fret! In these short videos Eileen Cheung reviews the differential diagnosis of a TIA and its key features, the 4 types of TIA, the 4 key ED investigations for a TIA, the acute ED management of a TIA, risk-stratification and disposition decision in TIA and lastly as a special bonus, an approach to vertigo...

CritCases 8 Management of Elevated ICP

In this CritCases blog - a collaboration between STARS Air Ambulance Service, Mike Betzner and EM Cases, we take you through a not uncommon stroke presentation which then develops into a challenge with regard to management of elevated ICP, hypertension and the airway...

Journal Jam 10 Part 2 Endovascular Therapy for Stroke

In this part 2 of EM Cases Journal Jam podcast on Thrombolysis and Endovascular Therapy for Stroke Justin Morgenstern, Rory Spiegel and Anton Helman do a deep dive into the world's literature on endovascular therapy for stroke. While the evidence for endovascular therapy is stronger than that for IV systemic thrombolysis for stroke outcomes at 90 days, a closer look at the literature reveals that a very small minority of patients are eligible for endovascular therapy and we still don't know which patients benefit most from endovascular therapy...

Journal Jam 10 Thrombolysis & Endovascular Therapy for Stroke Part 1

In this two part EM Cases Journal Jam podcast Justin Morgenstern, Rory Spiegel and Anton Helman do a deep dive into the world's literature on systemic thrombolysis for ischemic stroke followed by an analysis of endovascular therapy for stroke. We elucidate the important issues related to p-values, ordinal analysis, fragility index, heterogeneity of studies, stopping trials early and conflicts of interest related to this body of evidence. While "calling a code stroke" is now considered standard for most stroke patients and tPA for stroke is considered a class 1A drug, a close look at the literature tells us that the evidence is not as strong as our stroke protocols suggest...