Most Recent
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...
WTBS 9 – EM Quality Assurance Part One: Improving Follow up from the ED
This is Waiting to Be Seen 9 on EM Cases - Improving Follow up From the ED, Quality Assurance Part 1. We all face the challenge of how to manage final reports that arrive after the patient has been admitted or discharged, but some EDs are more organized and diligent than others in systematically addressing their obligations in this area. In this two-part guest blog, Dr. Lucas Chartier, an emergency physician in Toronto, will discuss best practices in departmental organization in part one and the obligations of the individual physician in part two. No ED will ever be perfect, but there are some positive lessons to share and we likely all can do better in reducing risks related to test result follow-up.
BEEM Cases 3 – Acute Respiratory Failure: NIPPV & POCUS
Shortness of breath is a very common chief complaint in the emergency department, but despite our familiarity with this symptom, management is not always straightforward. The differential diagnosis is extensive, including the common cardiorespiratory conditions, but extending to toxicologic, hematologic, neuromuscular, metabolic, and psychiatric causes. Over the past decade, we have seen the widespread adoption of new technologies to help us manage these patients. This post will look at some new evidence on two of those technologies: noninvasive positive pressure ventilation (NIPPV) and ultrasound (POCUS). We will answer 3 questions based on 3 systematic reviews using the BEEM critical appraisal framework...
Best Case Ever 49 – Post-Arrest Hyperkalemia
Melanie Baimel's Best Case Ever on Post-Arrest Hyperkalemia on EM Cases. Post arrest patients can sometimes be challenging. We need to think of a variety of underlying causes of the arrest, antiarrhythmics, possible cath lab activation, targeted temperature management, sedation and more. To add to this, many post arrest patients do not have ideal vital signs that require attention. In this Best Case Ever, in anticipation of our upcoming episode on A Rational Approach to Hyperkalemia Dr. Melanie Baimel describes a post arrest patient who remains bradycardic and hypotensive despite multiple pressors....
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...
CritCases 4 – Uterine Inversion and Postpartum Hemorrhage
In this CritCases blog - a collaboration between STARS Air Ambulance Service, Mike Betzner and EM Cases, Dr. James Brokenshire presents a case of acute unstable Uterine Inversion and discusses key therapeutic maneuvers including the Johnson Maneuver, tocolytics and resuscitation of postpartum hemorrhage.
