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Seven patients with ischemic symptoms, none meeting STEMI criteria but all identified by a specific pattern of first diagonal branch occlusion are explored in this ECG Cases blog with Jesse MacLaren who also explains The South African Flag Sign...
In this ECG Cases blog we look at seven patients with cardiac syncope, and a systematic approach to ECG interpretation...
While community acquired pneumonia (CAP) is 'bread and butter' emergency medicine, and the diagnosis is often a 'slam dunk', it turns out that up one third of the time, we are wrong about the diagnosis; that x-rays are not perfect; that blood work is seldom helpful; that not all antibiotics are created equal and that deciding who can go home and who needs to go to the ICU isn’t always so clear cut. With this in mind we are taking a deep dive into CAP, from diagnosis to disposition so that we can better achieve our EM goals of stabilizing sick patients, getting the right diagnosis, initiating the best treatment with the information at hand, prognosticating/appropriately deciding on disposition of patients, and being healthcare and antimicrobial stewards...
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...
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?
Welcome to EM Cases' CritCases blog, a collaboration between Mike Betzner, the STARS air ambulance service and EM Cases’ Michael Misch and Anton Helman! These are educational cases with multiple decision points where there is no strong evidence to guide us. Various strategies and opinions from providers around the world are coalesced and presented to you in an engaging format. Enjoy!
The EM Cases Summaries are succinct, written, easily navigable, key point reports of each main episode podcast, authored by Our Team that you can download to your smartphone or tablet to reference and read at the bedside or at your leisure with 2 easy automatic download options: Evernote or Dropbox. Or you can download individual summary pdfs below. Download individual pdf EM Cases Summaries by clicking on the episode title below Episode 174 Traumatic Pneumothorax - Is Less More? with Mathieu Toulouse Episode 173 Febrile Infant with Brett Burstein & Gary Joubert Episode 172 Syncope Simplified with David Carr Episode 170 Cardiac Arrest Controversies Part 2 - PoCUS, Communication, ECPR, Termination with Bourke Tillmann, Scott Weingart, Sara Gray & Rob Simard Episode 169 Cardiac Arrest Controversies Part 1 with Bourke Tillmann, Scott Weingart, Sara Gray & Rob Simard Episode 167 Myocarditis with Paul Dorian & Walter Himmel Episode 166 Pericarditis & Cardiac Tamponade with Paul Dorian & Walter Himmel Episode 164 Cardiogenic Shock Simplified with Tarlan Hedayati & Bourke Tillmann Episode 163 Acute Heart Failure Part 1 with Tarlan Hedayati & Bourke Tillmann Episode 161 Red Flag [...]
Dr. Margaret Thompson & Dr. Lisa Thurgur Canada's toxicologist gurus discuss several cases of stimulant drugs of abuse such as cocaine, MDMA & bath salts, as well as the pearls and pitfalls of managing opiates toxicity. We discuss: The management of the intoxicated patient including seizures, dysrhythmias, cardiac ischemia and hypertensive emergencies related to cocaine toxicity, the recognition and management of necrotizing vasculitis caused by cocaine cut with Levamisole, the differential diagnosis and management of the "hot and crazy" patient, including the role of dantrolene and cyproheptidine, pearls and pitfalls of naloxone, the utility of urine drug screens and much more....
In Part 1 of this Episode on Acute Coronary Syndromes Risk Stratification Dr. Eric Letovksy, Dr. Mark Mensour and Dr. Neil Fam discuss common pearls and pitfalls in assessing the patient who presents to the ED with chest pain. They review atypical presentations to look out for, what the literature says about the value of traditional and non-traditional cardiac risk factors, the diagnostic utility of recent cardiac testing, and which patients in the ED should have a cardiac work-up. Finally, in the ED work up of Acute Coronary Syndromes Risk Stratification, they highlight some valuable key points in ECG interpretation and how best to use and interpret cardiac biomarkers like troponin. Drs. Letovksy, Mensour & Fam address questions like: How useful are the traditional cardiac risk factors in predicting ACS in the ED? How does a negative recent treadmill stress test, nuclear stress test or angiogram effect the pre-test probability of ACS in the ED? What does recent evidence tell us about the assumption that patients presenting with chest pain and a presumed new LBBB will rule in for MI and require re-perfusion therapy? How can we diagnose MI in the patient with a ventricular pacemaker? What is the difference between Troponin I and Troponin T from a practical clinical perspective? Is one Troponin ever good enough to rule out MI in the patient with a normal ECG? Should we be using a 2hr delta troponin protocol? How will the new ultra-sensitive Troponins change our practice? and many more.....
In this episode on Cognitive Decision Making & Medical Error, Dr. Doug Sinclair, CMO of St. Michael's Hospital and Dr. Chris Hicks show us that, while the ED physician's knowledge base may play a small part in predicting medical error, more important might be how we understand and reflect upon our decision-making processes, how we communicate with our staff and patients, and how we cope with the ED environment and shift work. Medical error is the 6th leading cause of death in North America, and despite huge advances in imaging technology and lab testing as well as an explosion of EM literature in recent years, the misdiagnosis rate detected through autopsy studies has not changed significantly over the past century. Studies on diagnostic error in emergency medicine have shown error rates between 1 and 12%, and it's been suggested that cognitive error, or some flaw in the decision making process (as apposed to a lack of knowledge), is present in about 95% of these cases. Dr. Sinclair and Dr. Hicks elucidate for us how to identify and understand cognitive decision making and medical error, and how we can improve our decision making, reduce medical error and optimize the care of our patients.