Medical Specialty Archives - Page 44 of 56

BEEM Cases 1 – Pediatric Minor Head Injury

Dr. Andrew Worster and the BEEM (Best Evidence in Emergency Medicine) group from McMaster University has teamed up with EM Cases, Justin Morgenstern (@First10EM) and Rory Spiegel (@EMNerd_) to bring you a blog that blends the BEEM critical appraisals in a case-based, interactive, practice-changing format. In each post we choose the most important literature on a given topic and run through a case, learning how to apply evidence based medicine to our practice. Welcome to BEEM Cases! And here's BEEM Cases 1 - Pediatric Minor Head Injury... Written by Justin Morgenstern (@First10EM), edited by Anton Helman (@EMCases), adapted from the BEEM Course, Jan 2016 Pediatric Minor Head Injury - Decision Rules, Isolated LOC & Strict Rest The Case... With seconds left in the game, Melissa, an 11 year old girl, drives hard to the basket for a layup. She gets knocked to the ground, and doesn’t see the winning shot pass through the net, because it appeared as though she briefly lost consciousness. She quickly gets back up and celebrates with her friends, but after the celebrations, her parents bring her to your community emergency department to get checked. You confirm that she did indeed [...]

By Justin Morgenstern|2025-06-01T13:10:31-04:00January 12th, 2016|Categories: BEEM Cases, Emergency Medicine, Medical Specialty, Pediatrics, Trauma|Tags: CDR, clincical decision rules, Justin Morgenstern, minor head injury, PECARN, return to play|1 Comment

EM Cases Best of 2015 Top Ten

2015 was the most productive year in the entire 6 year history of EM Cases with a total of 33 podcast releases, the introduction of the Waiting to Be Seen Blog, the first EM Cases Digest ebook and the planning of the first ever EM Cases Course. The website racked up 393,616 page views, and podcast downloads totaled a whopping 1,027,744 downloads in 2015. Based on a blend of the number of podcast downloads, webpage views, social media engagement, scores on the questionnaires at the bottom of each post, number of positive emails and comments that I received, and my own favs, I'm pleased to bring you the EM Cases Best of 2015 top 10 picks of 2015. Many huge thanks to the entire EM Cases team, Advisory Board, SREMI, the amazing guest experts and you, the listeners, for making 2015 the most successful year for EM Cases! And here they are.....

By Anton Helman|2016-12-06T22:12:43-05:00January 4th, 2016|Categories: Emergency Medicine, Medical Specialty, News|Tags: 2015, ACLS gudielines, hyponatremia, IV Iron, pediatric DKA|0 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

Episode 74 Opioid Misuse in Emergency Medicine

Pain leads to suffering. Opioid misuse leads to suffering. We strive to avoid both for our patients. On the one hand, treating pain is one of the most important things we do in emergency medicine to help our patients and we need to be aggressive in getting our patients' pain under control in a timely, effective, sustained and safe fashion. This was the emphasis 10-20 years ago after studies showed that we were poor at managing pain and our patients were suffering. On the other hand, opioid dependence, addiction, abuse and misuse are an enormous public health issue. Opioid misuse in Emergency Medicine has become a major problem in North America over the past 10 years at least partly as a reaction to the years that we were being told that we were failing at pain management. As Dr. Reuben Strayer said in his SMACC talk on the topic: “Opioid misuse explodes in our face on nearly every shift, splattering the entire department with pain and suffering, and addiction and malingering and cursing and threats and hospital security, and miosis and apnea and naloxone and cardiac arrest.” So how do we strike a balance between managing [...]

By Anton Helman|2021-03-30T14:59:01-04:00December 15th, 2015|Categories: Clinical Practice, Emergency Medicine, Episodes, Medical Specialty, Psychiatry, Special Populations, Toxicology|Tags: analgesia, David Juurlink, drug abuse, ketamine, malingerer, opiates, pain management, Reuben Strayer|7 Comments

Episode 73 Emergency Management of Pediatric Seizures

Pediatric seizures are common. So common that about 5% of all children will have a seizure by the time they’re 16 years old. If any of you have been parents of a child who suddenly starts seizing, you’ll know intimately how terrifying it can be. While most of the kids who present to the ED with a seizure will end up being diagnosed with a benign simple febrile seizure, some kids will suffer from complex febrile seizures, requiring some more thought, work-up and management, while others will have afebrile seizures which are a whole other kettle of fish. We need to know how to differentiate these entities, how to work-them up and how to manage them in the ED. At the other end of the spectrum of disease there is status epilepticus – a true emergency with a scary mortality rate - where you need to act fast and know your algorithms like the back of your hand. This topic was chosen based on a nation-wide needs assessment study conducted by TREKK (Translating Emergency Knowledge for Kids), a collaborator with EM Cases. With the help of two of Canada’s Pediatric Emergency Medicine seizure experts hand picked by TREKK, Dr. Lawrence Richer and Dr. Angelo Mikrogianakis, we’ll give you the all the tools you need to approach the child who presents to the ED with seizure with the utmost confidence.

By Anton Helman|2025-06-01T13:11:15-04:00December 1st, 2015|Categories: EM Cases, Episodes, Medical Specialty, Neurology, Pediatrics|Tags: Angelo Mikrogianakis, benzodiazepine, febrile seizure, status epilepticus|3 Comments

WTBS 5 Emergency Physician Speed Part 2 – Solutions to Physician Productivity

In Emergency Physician Speed How Fast is Fast Enough – Part I, Dr. David Petrie addressed the issue of physician productivity (patients per hour, or PPH), the many factors that influence how quickly emergency physicians can process patients, and some of the tradeoffs between speed and quality. He also discussed the processing rate of the entire ED and introduced the concepts of surge capacity and the effect of crowding on safety if the ED can’t keep up. In this follow-up blog, Dr. Petrie expands on the departmental aspects of throughput and safety, and calls on policy-makers to recognize the need to include surge capacity in planning efforts. He also makes some powerful arguments about the related issues of so-called 'inappropriate visits' and the changing role of the ED. In this post - Emergency Physician Speed Part 2 - Solutions to Physician Productivity , he also brilliantly dismantles some common myths about ED visits — and drivers of costs.

By Anton Helman|2020-05-31T23:20:58-04:00November 17th, 2015|Categories: Clinical Practice, Emergency Medicine, Medical Specialty, Waiting to be Seen|Tags: David Petrie, patient safety, physician productivity, physician scheduling|6 Comments

Best Case Ever 42 Pediatric Cardiac Arrest

When was the last time you saw ventricular fibrillation in a 4 month old? Dr. Simard tells his Best Case Ever of a Pediatric Cardiac Arrest in which meticulous preparation, sticking to his guns, early activation of the transportation service, and clever use of point of care ultrasound helped save the life of a child. He explains the importance of debriefing your team after an emotionally charged case.

By Anton Helman|2025-06-01T13:00:07-04:00November 17th, 2015|Categories: Best Case Ever, Cardiology, Emergency Medicine, Medical Specialty, Pediatrics, Resuscitation|Tags: epinephrine, pediatric arrest, POCUS, Rob Simard|1 Comment

Episode 72 ACLS Guidelines 2015 Post Arrest Care

Once we've achieved ROSC our job is not over. Good post-arrest care involves maintaining blood pressure and cerebral perfusion, adequate sedation, cooling and preventing hyperthermia, considering antiarrhythmic medications, optimization of tissue oxygen delivery while avoiding hyperoxia, getting patients to PCI who need it, and looking for and treating the underlying cause. Dr. Lin and Dr. Morrison offer us their opinion on the new simplified approach to diagnosing the underlying cause of PEA arrests. We'll also discuss when it's time to terminate resuscitation or 'call the code' as well as some fascinating research on gender differences in cardiac arrest care. These co-authors of the guidelines will give us their vision of the future of cardiac arrest care and we'll wrap up the episode with a third opinion, so to speak: Dr. Weingart's take on the whole thing....

By Anton Helman|2024-08-07T20:02:12-04:00November 3rd, 2015|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Medical Specialty, Resuscitation|Tags: CCR, epinephrine, Laurie Morrison, lidocaine, PCI, PEA arrest, Scott Weingart, TTM|1 Comment

Episode 71 ACLS Guidelines 2015 – Cardiac Arrest Controversies Part 1

A lot has changed over the years when it comes to managing the adult in cardiac arrest. As a result, survival rates after cardiac arrest have risen steadily over the last decade. With the release of the 2015 American Heart Association ACLS Guidelines 2015 online on Oct 16th, while there aren’t a lot a big changes, there are many small but important changes we need to be aware of, and there still remains a lot of controversy. In light of knowing how to provide optimal cardio-cerebral resuscitation and improving patient outcomes, in this episode we’ll ask two Canadian co-authors of The Guidelines, Dr. Laurie Morrison and Dr. Steve Lin some of the most practice-changing and controversial questions.

By Anton Helman|2024-08-07T20:02:39-04:00October 21st, 2015|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Medical Specialty, Resuscitation|Tags: amiodarone, cardiac arrest, CCR, chest compressions, dual shock therapy, end tidal CO2, ITD, Laurie Morrison, lidocaine, Steve Lin, ventricular fibrillation|12 Comments

Best Case Ever 41 Opiate Misuse and Physician Compassion

Opiate misuse is everywhere. Approximately 15-20% of ED patients in the US are prescribed outpatient opiates upon discharge. In Ontario, about 10 people die accidentally from prescription opiates every week. Between 1990 and 2010, drug overdose deaths in the US increased by almost four fold, eclipsing the rate of death from motor vehicle collisions in 2009. This was driven by deaths related to prescription opiates, which now kill more people than heroin and cocaine combined. Opiates are the most prescribed class of medication in the US. In 2010, one out of every eight deaths among persons aged 25 to 34 years was opiate-related. Four out of 5 new heroin users report that their initial drug was a prescription opiate. In Ontario, three times the people died from opiate overdose than from HIV in 2011. Yet, we are expected to treat pain aggressively in the ED. Dr. Reuben Strayer, the brains behind the fantastic blog EM Updates tells his Best Case Ever, in which he realizes the importance of physician compassion in approaching the challenging drug seekers and malingerers that we manage in the ED on a regular basis. This Best Case Ever is in anticipation of an upcoming main episode in which Dr. Strayer and toxicologist Dr. David Juurlink discuss how to strike a balance between managing pain effectively and providing the seed for perpetuating a drug addiction or feeding a pre-existing drug addiction, and how we best take care of our patients who we suspect might have a drug misuse problem.

By Anton Helman|2020-11-29T14:55:07-05:00October 13th, 2015|Categories: Best Case Ever, Clinical Practice, Emergency Medicine, Psychiatry, Special Populations, Toxicology|Tags: drug seekers, malingerer, opiates, opiod abuse, opiod addiction, pain management, physician compassion, Reuben Strayer|3 Comments