BCE 65 Intimate Partner Violence – A Silent Epidemic

I was taken aback when I came across the statistic that approximately every 6 days a woman in Canada is killed by her intimate partner. Victims of intimate partner violence and domestic violence that we see in the ED typically involve an abuse story of repeated escalating violence over time that ends up in a crisis situation. The woman is often financially dependent on her abuser and has no one to turn to for help. In one of her worst cases ever from Janus General, Dr. Meeta Patel and I discuss the notions that Emergency providers have a unique opportunity to identify patients who are victims of intimate partner violence; that we should begin by thinking of how we can screen every woman of childbearing age about intimate partner violence in a private, safe and respectful way. We describe the quick Partner Violence Screen and finally how to offer supportive, empowering statements and connect your patients with resources like assaulted women’s helpline and shelters in your community...

Ep 105 Commonly Missed Ankle Injuries

You probably can't remember the last time you worked a shift in the ED and didn’t see at least one patient with an ankle injury. While almost all of these patients are relatively straightforward to diagnose and manage a small but significant minority of these patients will have a more elusive diagnosis, that if not identified early, could lead to significant morbidity...

EM Cases Best of 2017 Top 10

Based on a blend of the number of podcast downloads, webpage views, social media engagement, number of positive emails and comments that I received, and my own favs, I'm pleased to bring you the EM Cases Best of 2017 Top 10. Many huge thanks to the entire EM Cases team, Advisory Board, SREMI, the amazing guest experts and you, the listeners of the podcasts, readers of the blogs, viewers of the videos and participants in the course, for making 2017 another successful year for EM Cases! And here they are...

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.

BCE 64 Salicylate Poisoning

In this EM Cases Best Case Ever Hans Rosenberg and Rajiv Thavanathan discuss recognition and management pearls and pitfalls in salicylate poisoning. They answer question such as: What are the most important diagnostic clues of salicylate poisoning in the patient who presents with undifferentiated fever and altered level of awareness? What is the best timing and ventilation strategy for intubation? Which electrolyte abnormalities do you need to be on the lookout for? and many more...

Journal Jam 11 Post Contrast Acute Kidney Injury – PCAKI

Lauren Westafer joins Justin Morgenstern, Rory Spiegel and Anton Helman in a deep dive discussion on the world's literature on Post Contrast Acute Kidney Injury (PCAKI) in this Journal Jam podcast. Hospitals continue to insist on time consuming, and potentially dangerous protocols for administration of fluids to patients with renal dysfunction prior to CT IV contrast despite the lack of evidence that Contrast Induced Nephropathy (CIN) even exists. Would you choose a different imaging modality if your radiologist suggested that a patient with renal dysfunction who required a CT with IV contrast should forgo the contrast risking a missed diagnosis?

Ep 103 Preventing Burnout and Promoting Wellness in Emergency Medicine

Burnout – it’s the elephant in the room that we all know about but prefer not to discuss. Yet according to a 2013 Medscape survey, 40% of physicians reported burnout in U.S. In this episode, Sara Gray and Chris Trevelyan present an honest approach to preventing burnout and promoting wellness, outlining strategies both at the individual and systems levels. They explain why wellness matters, how you can strive to achieve it and how to recognize when you or a colleague are unwell so that you can get the help you need...

BCE 63 Failing Up after Medical Error

Dr. Sarah Gray tells us the story of her worst case ever and what she learned from it. About 50% of North American physicians involved in a serious medical error report increased anxiety for future errors, decreased confidence in their job, decreased job satisfaction, insomnia, PTSD, panic disorder – the list goes on. Dr. Gray shares how and why many of us react to medical error - the embarrassment, the shame, the guilt and sense of failure. She then explains the notion of acceptance that we all fail, that perfection is a myth, and how she learned that "failing up" after of the most difficult case of her career is the best choice after making a medical error...

Episode 102 GI Bleed Emergencies Part 2

In Part 2 of our two part podcast on GI Bleed Emergencies Anand Swaminathan and Salim Rezaie kick off with a discussion on the evidence for benefit of various medications in ED patients with upper GI bleed. PPIs, somatostatin analogues such as Octreotide, antibiotic prophylaxis and prokinetics have varying degrees of benefit, and we should know which ones to prioritize. We then discuss the usefulness of the Glasgow-Blatchford and Rockall scores for risk stratification and disposition of patient with upper GI bleeds and hit it home with putting it all together in a practical algorithm. Enjoy!

Episode 101 GI Bleed Emergencies Part 1

In this Part 1 of our two part podcast on GI bleed emergencies we answer questions such as: How do you distinguish between an upper vs lower GI bleed when it's not so obvious clinically? What alterations to airway management are necessary for the GI bleed patient? What do we need to know about the value of fecal occult blood in determining whether or not a patient has a GI bleed? Which patients require red cell transfusions? Massive transfusion? Why is it important to get a fibrinogen level in the sick GI bleed patient? What are the goals of resuscitation in a massive GI bleed? What's the evidence for using an NG tube for diagnosis and management of upper GI bleeds?  In which patients should we give tranexamic acid and which patients should we avoid it in? How are the indications for massive transfusion in GI bleed different to the trauma patient? What are your options if the bleeding can't be stopped on endoscopy? and many more...

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