Best Case Ever is a 5-20 minute podcast where an Emergency Medicine Cases guest expert describes a practice changing case, what they learned from it, and clinical pearls and pitfalls you can use on your next shift. Tacit knowledge sharing at it’s best.
Best Case Ever 9 Vaginal Bleeding in Early Pregnancy
As a bonus to Episode 23 on 'Vaginal Bleeding in Early Pregnancy' with Dr. Ross Claybo and Dr. David Dushenski, we have here, Dr. Claybo's Best Case Ever. While vaginal bleeding in early pregnancy is rarely life threatening, there are a significant percentage of woman who will require emergency resuscitation and surgical intervention. We don't have mountains of RCTs on this topic; still Dr. David Dushenski & Dr. Ross Claybo run through the key clinical pearls of the history, the physical, interpretation of the BhCG and the value of serum progesterone in working up these patients. The newest on point of care ultrasound is discussed in the patient with vaginal bleeding in early pregnancy. The various types of spontaneous abortion including septic abortion are reviewed as well as the management of the unstable patient with massive vaginal hemorrhage. Ectopic pregnancy, in all it’s various presentations is reviewed with particular attention to the most common pitfalls and how to avoid them. [wpfilebase tag=file id=388 tpl=emc-play /] [wpfilebase tag=file id=389 tpl=emc-mp3 /]
Best Case Ever 8: Acute Dyspnea
Acute Dyspnea has a wide differential diagnosis from Metabolic Acidosis to Medically Unexplained Dyspnea. As a bonus to Episode 21 on Pulmonary Embolism and Acute Dyspnea, Dr. John Foote the CCFP(EM) residency program director at the University of Toronto presents his Best Case Ever related to an Acute Dyspnea presentation. In the related episode on Pulmonary Embolism we havet, with Dr. Foote, the triumphant return of Dr. Anil Chopra, the Head of the Divisions of Emergency Medicine at University of Toronto . We kick it off with Dr. Foote’s approach to undifferentiated acute dyspnea and explanation of Medically Unexplained Dyspea (‘MUD’) and go on to discuss how best to develop a clinical pretest probability for the diagnosis of pulmonary embolism using risk factors, the value of the PERC rule, Well’s criteria and how clinical gestalt plays into pretest probability. Dr. Chopra tells about the appropriate use of D-dimer to improve our diagnostic accuracy without leading to over-investigation and unwarranted anticoagulation. We then discuss the value of V/Q scan in the workup of PE, and the pitfalls of CT angiography. A discussion of anticoagulation choices follows and the controversies around thrombolysis for submassive PE closes the podcast. [wpfilebase tag=file id=384 tpl=emc-play /] [wpfilebase tag=file id=385 tpl=emc-mp3 /]
Best Case Ever 7: Atrial Fibrillation
As a bonus to Episode 20 on Atrial Fibrillation, we present here, Dr. Clare Atzema, a leading EM researcher in Atrial Fibrillation, telling her Best Case Ever related to Afib. What would you do if you needed to cardiovert a patient who was too obese to fit on an ED stretcher? Dr. Atzema, along with Dr. Nazanin Meshkat and Dr. Bryan Au, discuss the presentation, etiology, precipitants, management and disposition of Atrial Fibrillation in the Emergency Department. The pros and cons of rate vs rhythm control are debated, what you need to know about Afib medications, and the value of the Ottawa Aggressive Protocol discussed. The importance of appropriate anticoagulation is detailed, with a review of the CHADS-VASc score and whether to use anticogulants or ASA for stroke prevention for patients with Afib. We end off with a discussion on how to recognize and treat Wolff-Parkinson-White syndrome in the setting of Atrial Fibrillation. [wpfilebase tag=file id=382 tpl=emc-play /] [wpfilebase tag=file id=383 tpl=emc-mp3 /]
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 /]
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 /]
