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Episode 93 – PALS Guidelines

I remember when I started practicing emergency medicine a decade and a half ago it seemed that any kid who came to our ED in cardiac arrest died. I know, depressing thought. But, over the past 15 years, survival to discharge from pediatric cardiac arrest has markedly improved, at least for in-hospital arrests. This is probably mostly due to an emphasis on high-quality CPR and advances in post-resuscitation care; nonetheless the more comfortable, knowledgeable and prepared we are for the always scary critically ill pediatric patient, the more likely we will be able to resuscitate them successfully - which is always a huge save.

By Anton Helman|2022-12-06T07:28:41-05:00March 14th, 2017|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Medical Specialty, Pediatrics, Resuscitation|Tags: amiodarone, atropine, cardiac arrest, chest compressions, CPR, ECMO, fluid management, lidocaine, septic shock, TTM|3 Comments

Episode 92 – Aortic Dissection Live from The EM Cases Course

While missing aortic dissection was considered "the standard" in the late 20th century, our understanding of the clinical diagnoses has improved considerably since the landmark International Registry of Aortic Dissection (IRAD) study in 2000. Nonetheless, aortic dissection remains difficult to diagnosis with 1 in 6 being missed at the initial ED visit. With the help of Dr. David Carr we’ll discuss how to pick up atypical presentations of aortic dissection without over-imaging as well as manage them like pros by reviewing: 1. The 5 Pain Pearls, 2. The concepts of CP +1 and 1+ CP, 3. Physical exam pearls, 4. CXR pearls and blood test pitfalls, and 5. The importance of the correct order and aggressive use of IV medications. So with these objectives in mind…

By Anton Helman|2021-03-30T14:35:40-04:00February 21st, 2017|Categories: Cardiology, Conference, EM Cases, Emergency Medicine, Episodes, Medical Specialty|Tags: David Carr, EM Cases Course, esmolol, labetolol, troponin|0 Comments

Episode 91 Occult Knee Injuries Pearls and Pitfalls

There are a whole slew of very important occult knee injuries - those that have a normal or near normal x-ray – that can cause serious morbidity if you miss them, and for the catchall soft tissue injuries there are some subtleties in diagnosis and management that will make a real difference to our patients. Arun Sayal and Hossein Mehdian answer questions such as: When should we suspect a spontaneously reduced knee dislocation? Do all patients suspected of a spontaneous knee dislocation require a CT angiogram to rule out vascular injury? Which patients with a low energy mechanism are at risk for knee dislocation and vascular complications? How can you increase the accuracy of the active straight leg raise in assessing for quadriceps and patella tendon rupture? What is an easy way to identify patella baja and patella alta on a knee x-ray? What are the indications for ultrasound of the knee? What are the true indications for a knee immobilizer and how can knee immobilizers kill our patients? and many more...

By Anton Helman|2021-04-02T13:30:58-04:00January 24th, 2017|Categories: EM Cases, Emergency Medicine, Episodes, Orthopaedics, Trauma|Tags: Arun Sayal, Hossein Mehdian, knee dislocation, tibial plateau fracture|1 Comment

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

Episode 87 – Alcohol Withdrawal and Delirium Tremens: Diagnosis and Management

Alcohol withdrawal is everywhere. We see over half a million patients in U.S. EDs for alcohol withdrawal every year. Despite these huge volumes of patients and the diagnosis of alcohol withdrawal seeming relatively straightforward, it’s actually missed more often than we’d like to admit, being confused with things like drug intoxication or sepsis. Or it’s not even on our radar when an older patient presents with delirium. What’s even more surprising is that even if we do nail the diagnosis, observational studies show that in general, alcohol withdrawal is poorly treated. So, to help you become masters of alcohol withdrawal management, our guest experts on this podcast are Dr. Bjug Borgundvaag, an ED doc and researcher with a special interest in emergency alcohol related illness and the director of Schwartz-Reismann Emergency Medicine Institute, Dr. Mel Kahan, an addictions specialist for more than 20 years who’s written hundreds of papers and books on alcohol related illness, and the medical director of the substance use service at Women’s College Hospital in Toronto, and Dr. Sara Gray, ED-intensivist at St. Michael's Hospital...

By Anton Helman|2021-03-30T14:41:11-04:00October 25th, 2016|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Special Populations, Toxicology|Tags: benzodiazepine, Bjug Borgundvaag, CIWA, dexmeditomidine, Mel Kahan, phenobarbital, Sara Gray, SHOT, thiamine|9 Comments

Episode 86 – Emergency Management of Hyperkalemia

This is 'A Nuanced Approach to Emergency Management of Hyperkalemia' on EM Cases. Of all the electrolyte emergencies, hyperkalemia is the one that has the greatest potential to lead to cardiac arrest. And so, early in my EM training I learned to get the patient on a monitor, ensure IV access, order up an ECG, bombard the patient with a cocktail of kayexalate, calcium, insulin, B-agonists, bicarb, fluids and furosemide, and get the patient admitted, maybe with some dialysis to boot. Little did I know that some of these therapies were based on theory alone while others were based on a few small poorly done studies. It turns out that some of these therapies may cause more harm than good, and that precisely when and how to give these therapies to optimize patient outcomes is still not really known...

By Anton Helman|2022-02-17T13:42:30-05:00September 27th, 2016|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Medical Specialty, Resuscitation|Tags: calcium chloride, digoxin toxicity, Ed Etchells, kayexelate, Melanie Baimel|13 Comments

Episode 85 – Medical Clearance of the Psychiatric Patient

Psychiatric chief complaints comprise about 6 or 7% of all ED visits, with the numbers of psychiatric patients we see increasing every year. The ED serves as both the lifeline and the gateway to psychiatric care for millions of patients suffering from acute behavioural or psychiatric emergencies. As ED docs, besides assessing the risk of suicide and homicide, one of the most important jobs we have is to determine whether the patient’s psychiatric or behavioral emergency is the result of an organic disease process, as opposed to a psychological one. There is no standard process for this. With the main objective in mind of picking up and appropriately managing organic disease while improving flow, decreasing cost and maintaining good relationships with our psychiatry colleagues, we have Dr. Howard Ovens, Dr. Brian Steinhart and Dr. Ian Dawe discuss this controversial topic...

By Anton Helman|2021-03-30T14:44:30-04:00August 29th, 2016|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Neurology, Psychiatry, Special Populations, Toxicology|Tags: Brian Steinhart, CT head, Howard Ovens, Ian Dawe, urine drug screen|1 Comment

Episode 84 – Congenital Heart Disease Emergencies

Congenital Heart Disease Emergencies on EM cases with Gary Joubert and Ashley Strobel. You might be surprised to learn that the prevalence of critical cardiac disease in infants is almost as high as the prevalence of infant sepsis. And if you’re like me, you don’t feel quite as confident managing sick infants with critical heart disease as you do managing sepsis. Critical congenital heart defects are often missed in the ED. For a variety of reasons, there are currently more children with congenital heart disease presenting to the ED than ever before and these numbers will continue to grow in the future. When I was in medical school I vaguely remember learning the complex physiology and long lists of congenital heart diseases, which I’ve now all but forgotten. What we really need to know about congenital heart disease emergencies is what actions to take in the ED when we have a cyanotic or shocky baby in front of us in the resuscitation room. So with the goal of learning a practical approach to congenital heart disease emergencies using the child’s age, colour and few simple tests, Dr. Strobel and Dr. Joubert will discuss some key actions, pearls and pitfalls so that the next time you’re faced with that crashing baby in the resuscitation room, you’ll know exactly what to do.

By Anton Helman|2021-03-30T14:45:22-04:00August 10th, 2016|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Medical Specialty, Pediatrics, Resuscitation|Tags: Ashley Strobel, BNP, CHF, congestive heart failure, cyanosis, cyanotic infant, etomidate, Gary Joubert, hypoxia test, prostaglandins|3 Comments

Episode 82 – Emergency Radiology Controversies

EM Cases Episode 82 Emergency Radiology Controversies, pearls and pitfalls: Which patients with chest pain suspected of ACS require a CXR? What CXR findings do ED docs tend to miss? How should we workup solitary pulmonary nodules found on CXR or CT? Is the abdominal x-ray dead or are there still indications for it's use? Which x-ray views are preferred for detecting pneumoperitoneum? When should we consider ultrasound as a screening test instead of, or before, CT? What are the indications for contrast in abdominal and head CT? How should we manage the patient who has had a previous CT contrast reaction who really needs a CT with contrast? What is the truth about CT radiation for shared decision making? And much more...

By Anton Helman|2021-03-30T14:48:26-04:00June 7th, 2016|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Ultrasound|Tags: computed tomography, contrast reaction, CT contrast, CT radiation, CXR, Fleischner Criteria, pneumoperitoneum, ultrasound, Walter HImmel|6 Comments

Episode 81 – A Balanced View on Recent EM Literature with Joel Yaphe

EM Cases - A Balanced View on recent EM Literature with Joel Yaphe Being an optimist, I'm constantly searching for EM literature that will change my practice in a positive way and ultimately improve the care that I deliver. The past year was filled with promising papers, some of which received a lot of attention. I'm not the only one who is biased towards craving a positive paper - so are the researchers, the journal editors and the public. We all want our field to mightily move forward! Enter Dr. Joel Yaphe. An EM Residency Program Director at University of Toronto and an ED doc who I admire for his balanced, sensible and practical approach to appraising the literature. In this episode Dr. Yaphe, at University of Toronto's Update in EM Conference - Whistler, leads us through a few key articles from the past year including the REVERT trial to convert SVT, medical expulsive therapy for urolithiasis, steroids in anaphylaxis, and analgesics for low back pain, and discusses whether they should (or rather, should not) change our practice. He challenges authors' conclusions and questions whether the findings are relevant to our patients....

By Anton Helman|2021-03-30T14:51:38-04:00May 23rd, 2016|Categories: Emergency Medicine, Episodes, Genitourinary, Medical Specialty, Whistler Update in EM|Tags: Joel Yaphe, low back pain, medical expulsive therapy, nephrolithiasis, renal colic, REVERT trial, SVT, tamsulosin, Whistler|0 Comments

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