Most Recent
Episode 16: Acute Monoarthritis
Ep16 MonoarthritisDr. Joel Yaphe, University of Toronto's Emergency Medicine Residency Program Director and Dr. Indy Ghosh discuss the difficult diagnostic dilemmas when faced with a patient with acute monoarthritis. They review how to distinguish clinically between septic arthritis and gout and which aspects of the presentation and work-up are the most reliable in risk stratifying patients. The key differential diagnosis of Acute Polyarthritis can be even more of a challenge, but fear not: by then end of this podcast and post you will be able to recognize the key diagnoses, how to work them up, and who needs consultation.
Best Case Ever 5 Septic Arthritis
Septic Arthritis is often at the top of our differential for acute monoarthritis. Dr. Joel Yaphe tells his Best Case Ever of a patient with septic arthritis as a bonus to Episode 16: Acute Monoarthritis. In the related episode Dr. Yaphe and Dr. Indy Ghosh discuss such questions as: What are the most important risk factors for septic arthritis? What are the most predictive signs and symptoms of septic arthritis? How does serum WBC, ESR and CRP contribute to the probability of septic arthritis? Should we still be performing arthrocenteses on patient's with overlying cellulitis? with an INR of 6? How can you tell the difference between septic bursitis and septic arthritis and how are they managed differently? What does the literature tell us about how useful the synovial fluid tests are in ruling in or ruling out septic arthritis? What is the role of bedside ultrasound in septic arthritis? Is there a role for steroid therapy in septic arthritis? When would you consider oral NSAIDs vs oral prednisone vs intra-articular methylprednisolone for the treatment of Gout? Is there a role for colchicine in the ED treatment of Gout? What is acute calcific arthritis of hydroxyapatite disease and why is it important for ED docs to know about? What is the most common cause of dermatitis-arthritis? How can one distinguish Reactive Arthritis from Septic Arthritis clinically, and how do their work-ups differ? Is there a role for antibiotics in Reactive Arthritis? How does gonococcal arthritis present compared with nongonococcal septic arthritis? and many more..... [wpfilebase tag=file id=378 tpl=emc-play /] [wpfilebase tag=file id=379 tpl=emc-mp3 /]
Episode 15 Part 2: Acute Coronary Syndromes Management
In Part 2 of this Episode on Acute Coronary Syndromes Risk Stratification & Management, the evidence for various medications for ACS, from supplemental oxygen to thrombolytics are debated, and decision making around reperfusion therapy for STEMI as well as NSTEMI are discussed. Finally, there is a discussion on risk stratification of low risk chest pain patients and all it's attendant challenges as well as disposition and follow-up decisions. Dr. Eric Letovsky, the Head of the CCFP(EM) Program at the University of Toronto, Dr. Mark Mensour & Dr. Neil Fam, an interventional cardiologist answer questions like: What is the danger of high flow oxygen in the setting of ACS? When, if ever, should we be using IV B-blockers in AMI patients? How can you predict, in the ED, who might go on to have an urgent CABG, in which case Clopidogrel is contra-indicated? Which anticoagulant is best for unstable angina, NSTEMI and STEMI - unfractionated heparin (UFH), low molecular weight heparin (LMWH), or fonduparinux? Is there currenly any role for Glycoprotein 2b3a Inhibitors in ACS in the ED? When is thrombolysis better than PCI for STEMI? When should we consider facilitated angioplasty and rescue angioplasty? Which low risk chest pain patients require an early stress test? CT coronary angiography? Stress Echo? Admission to a Coronary Decision Unit (CDU)? and many more.......
Episode 15 Part 1: Acute Coronary Syndromes Risk Stratification
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.....
Best Case Ever 4 Acute Coronary Syndrome From Venous Source
In anticipation of Episode 15, 'Acute Coronary Syndromes' with Dr. Eric Letovsky, Dr. Mark Mensour and Dr. Neil Fam, we present here, Dr. Helman's 'Best Case Ever' of an ACS patient. In Episode 15: 'Acute Coronary Syndromes', Drs. Fam, Mensour , Letovsky and Helman discuss questions like: How does a recent negative 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 reperfusion therapy? [wpfilebase tag=file id=376 tpl=emc-play /] [wpfilebase tag=file id=377 tpl=emc-mp3 /]
Best Case Ever 3: Emergency Headache – Importance of Opening Pressure
In association with Episode 14, 'Headache Pearls & Pitfalls' with Dr. Anil Chopra and Dr. Stella Yiu, we present here, the third of our new 5 minute 'Best Case Ever' series. In Episode 14: Headache Pearls & Pitfalls, which has just been released, Dr. Chopra and Dr. Yiu answer questions like: With the ever improving resolution of CT, should we still be doing LP after negative plain CT head for all our thunderclap headache patients? How can we best minimize the chance of post-LP headache? What evidenced-based treatments can we initiate in the ED for our SAH patients that will improve outcomes? [wpfilebase tag=file id=375 tpl=emc-play /] [wpfilebase tag=file id=374 tpl=emc-mp3 /]
