This past May in Toronto, the largest and, in my opinion, best Canadian EM conference, North York General Hospital’s Emergency Medicine Update Conference, attracted ‘Captain Cortex’ himself, Stuart Swadron, a Toronto native to talk about his approach to vertigo, which highlights how not to miss a posterior circulation stroke. For the  seventh year running the EMU conference was proud to have one of the worlds most well known EM educators, Amal Mattu who presented the most important Cardiology Literature from the past year. This podcast includes edited versions of their talks with commentary and summaries.

Blogpost & Summary Prepared by Dr. Keerat Grewal, June 2014

Cite this podcast as: Swadron, S, Mattu, A, Helman, A. NYGH EM Update Conference 2014. Emergency Medicine Cases. June, 2014. https://emergencymedicinecases.com/episode-45-swadron-vertigo-mattu-cardiology-literature-em-update-2014/. Accessed [date].

Chapter 1 – Dr. Stuart Swadron – An Approach to Vertigo

From North York General’s Emergency Medicine Update Conference, May 2014

VIDEO LINK for HINTS exam: http://emcrit.org/misc/posterior-stroke-video/

Go here to see a video Scott Weingart explaining how to use an iphone to help interpret the Head Impulse Test for your HINTS exam.

Paucis Verbis: Acute vestibular syndrome and HINTS exam.  Academic Life in Emergency Medicine

An excellent review of the HINTS exam by Andrew Petrosoniak on Boring EM

GET STUART SWADRON’S BEST CASE EVER

Update 2015: Should HINTS be used on all patients with vertigo in the ED? Check out this critical appraisal of the HINTS exam on SOCMOB.

Chapter 2 – Dr. Amal Mattu – Cardiology Literature

From North York General’s Emergency Medicine Update Conference, May 2014

Dr. Amal Mattu’s screencast on Sgarbossa Criteria at Emergency ECG Video of the Week: Episode 114

GET AMAL MATTU’S BEST CASE EVER

Summary of Full Episode

lbbb-algorithm

Fig 1: LBBB Algorithm (Cai et al., 2013) (4)

ST-S-ratio-Sgarbosa

 

 

 

 

 

 

 

 

 

 

Fig 2: ST/S Ratio (Cai et al., 2014) (4)

Quote of the Month

“Everything should be made as simple as possible, but not simpler” – Albert Einstein

 

Dr. Helman, Dr. Mattu and Dr. Swadron have no conflicts of interest to declare.

KEY REFERENCES

1. Clinical practice guideline: Benign paroxysmal positional vertigo. Bhattacharyya, n et al. Otolaryngology-Head and Neck Surgery 2008; 139: 47-81. Abstract

2. Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. Tarnutzer, MD et al. CMAJ 2011; 183(9):571-592. Free Full Text

3. HINTS to diagnose stroke in the Acute Vestibular Syndrome: Three-step beside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Kattah, JC et al. Stroke 2009; 40: 3504-3510. Free Full Text

4. The left bundle-branch block puzzle in the 2013 ST-elevation myocardial infarction guideline: From falsely declaring emergency to denying reperfusion in a high risk population. Are the Sgarbossa Criteria ready for prime Time? Cai Q et al. American Heart Journal 2013; 166(3): 409-413. Free Full Text

5. 2013 ACCF/AHA Guideline for the management of ST-elevation myocardial infarction. O’Gara PT et al. Journal of the American College of Cardiology 2013; 61(4): 78-140. Free Full Text

6. Diagnostic time course, treatment, and in-hospital outcomes for patients with ST-segment elevation myocardial infarction presenting with nondiagnostic initial electrocardiogram. Riley RF et al. American Heart Journal 2013; 165(1): 50-56. Free Full Text

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