Best Case Ever 45 – Mike Winters on Cardiac Arrest

I had the great pleasure of meeting Dr. Mike Winters on his first ever visit to Canada at North York General's Emergency Medicine Update Conference, where he gave two fantastic presentations. His credentials are impressive: He is the Medical Director of the Emergency Department, Associate Professor in both EM and IM, EM-IM-Critical Care Program co-director and Residency Program Director of EM-IM at the University of Maryland in Baltimore. Sometimes we are so caught up with the job we need to get done during cardiac arrest that we forget about the important and profound effect that this event has on patients' families. On this Best Case Ever Dr. Winters tells the story of witnessing his grandfather's cardiac arrest, being present in the ED during the resuscitation attempts, and how that experience has coloured his practice. We discuss some pearls on communication with patients' families after death, colour-coded cardiac arrest teams and how to integrate POCUS into cardiac arrest care while minimizing chest compressions.

Episode 71 ACLS Guidelines 2015 – Cardiac Arrest Controversies Part 1

A lot has changed over the years when it comes to managing the adult in cardiac arrest. As a result, survival rates after cardiac arrest have risen steadily over the last decade. With the release of the 2015 American Heart Association ACLS Guidelines 2015 online on Oct 16th, while there aren’t a lot a big changes, there are many small but important changes we need to be aware of, and there still remains a lot of controversy. In light of knowing how to provide optimal cardio-cerebral resuscitation and improving patient outcomes, in this episode we’ll ask two Canadian co-authors of The Guidelines, Dr. Laurie Morrison and Dr. Steve Lin some of the most practice-changing and controversial questions.

Episode 64 Highlights from Whistler’s Update in EM Conference 2015 Part 2

In this Part 2 of EM Cases' Highlights from Whistler's Update in EM Conference 2015 Dr. David Carr gives you his top 5 pearls and pitfalls on ED antibiotic use including when patients with sinusitis really require antibiotics, when oral antibiotics can replace IV antibiotics, how we should be dosing Vancomycin in the ED, the newest antibiotic regimens for gonorrhea and the mortality benefit associated with antibiotic use in patients with upper GI bleeds. Dr. Chris Hicks gives you his take on immediate PCI in post-cardiac arrest patients with a presumed cardiac cause and The Modified HEART Score to safely discharge patients with low risk chest pain.

Best Case Ever 26: Chloral Hydrate Poisoning and Cardiac Arrest

I met up with Mike Betzner at North York General's Update in EM Conference in Toronto. He is the medical director of Air Transport STARS air ambulance out of Calgary and an amazing speaker on the national lecturing circuit. His Best Case Ever on Chloral Hydrate poisoning & cardiac arrest describes a young man in cardiac arrest with resistant Ventricular Fibrillation and Torsades de Pointes. There is only one class of drugs that can get him back into normal sinus rhythm. Dr. Betzner describes how he recognized that this patient was suffering from Chloral Hydrate poisoning and how he saved his life with one simple intervention.

Episode 44 – Whistler Update in Emergency Medicine Conference 2014

In this episode on Whistler's Update in Emergency Medicine Conference 2014 Highlights we have... Chapter 1 with David Carr on his approach to Shock, including the RUSH protocol, followed by a discussion on Thrombolysis for Submassive Pulmonary Embolism.... Then in Chapter 2 Lisa Thurgur presents a series of Toxicology Cases packed with pearls, pitfalls and surprises and reviews the use of Lipid Emulsion Therapy in toxicology....Finally in Chapter 3 Joel Yaphe reviews the most important articles from 2013 including the Targeted Temperature Managment post-arrest paper, the use of Tranexamic Acid for epistaxis, return to play concussion guidelines and clinical decision rules for subarachnoid hemorrhage. Another Whistler's Update in Emergency Medicine Conference to remember.......

Best Case Ever 20: CPR in Trauma

BEST CASE EVER 20: CPR in Trauma?!?! Closed Chest Compressions in Traumatic Arrest?!?! Is CPR ever successful in the trauma patient? Dr. Dave MacKinnon, Trauma Team Leader at St. Michael's Hospital in Toronto, gives you his Best Case Ever in the cardiac arrest trauma patient. The literature is full of case series of zero survival in trauma patients requiring CPR. For example, this report in CJEM. Normally, we should not be thinking of CPR in traumatic arrests, but instead, ED thoracotomy as Scott Weingart of emcrit describes in his podast 36 - Traumatic Arrest. But just wait until you here Dave's Best Case Ever..........

Best Case Ever 6 Can Point of Care Ultrasound Save Lives?

As a bonus to Episode 18: Point of Care Ultrasound Controversies with the gurus of POCUS, Dr. Greg Hall, Dr. Jordan Chenkin, Dr. Paul Hannam and Dr. Jason Fischer, we present here, Dr. Hall's Best Case Ever. In the related episode our panel of experts answer questions such as: How does 2-point compression Point of Care Ultrasound of the leg compare to radiology department ultrasound for DVT? How does POCUS for pneumothorax compare to CXR and CT? In what situations does cardiac standstill on POCUS not suggest futile resuscitation? Can evaluation of RV function on Point of Care Ultrasound help us decide whether or not to thrombolyse a patient with submassive pulmonary embolism? How can POCUS help in diagnosing CHF? What is the best anatomical approach for pericardiocentesis? How can Point of Care Ultrasound help us in the crashing pediatric patient? and many more…… [wpfilebase tag=file id=380 tpl=emc-play /] [wpfilebase tag=file id=381 tpl=emc-mp3 /]

Episode 12 Part 2: ACLS Guidelines – Atropine, Adenosine & Therapeutic Hypothermia

In Part 2 of this episode on ACLS Guidelines - Atropine, Adenosine & Therapeutic Hypothermia, Dr. Steven Brooks and Dr. Michael Feldman discuss the removal of Atropine from the PEA/Asystole algorithm, the indications and dangers of Adenosine in wide-complex tachycardias, pressors as a bridge to transvenous pacing in unstable bradycardias, and the key elements of post cardiac arrest care including therapeutic hypothermia and PCI. They answer questions such as: In which arrhythmias can Amiodarone cause more harm than good? Is there any role for transcutaneous pacing for asystole? When should Bicarb be given in the arrest situation? In what situations is Atropine contra-indicated or the dosage need to be adjusted? How has the widespread use of therapeutic hypothermia currently effected our ability to prognosticate post-arrest patients? What are the indications for PCI and thrombolysis in the cardiac arrest patient? Should we be using therapeutic hypothermia in the non-Vfib arrest patient? What is the best method for achieving the target temperature for the patient undergoing therapeutic hypothermia? and many more......

Best Case Ever 1 Is Thrombolysis Better Than PCI for STEMI?

Our first Best Case Ever is from Dr. Steven Brooks, a co-author of the 2010 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. This Best Case Ever is a bonus to Episode 12 ACLS Guidelines - What's New & Controversial, in which we discuss the frameworks of Cardiocerebral Rescusitation and the 3 phase model of rescucitation (electrical, circulatory and metabolic), the importance of high quality CPR, the de-emphasis on early ventilation and the utility of continuous quantitative waveform capnography. Dr. Brooks and Dr. Michael Feldman answer questions such as: of all the therapeutic manoeuvres we do for the cardiac arrest patient, which ones have been shown to improve survival to hospital discharge? What is the evidence for chest compression machines? What is the utility of point of care ultrasound (POCUS) in the cardiac arrest patient? Why is cardiac arrest survival to discharge in Seattle the best in the world? Should we be performing 'hands-on defibrillation'? and many more..... [wpfilebase tag=file id=368 tpl=emc-play /] [wpfilebase tag=file id=369 tpl=emc-mp3 /]

Episode 2: Excited Delirium

Dr. Margaret Thompson, Canada's toxicology guru and Dr. Dan Cass review the clinical presentation, precipitating factors and important do's and don'ts in managing patients with Excited Delirium Syndrome to prevent sudden death. They update us on the most current guidelines for Excited Delirium Syndrome and discuss the prevalent theories to explain why many of these patients have cardiac arrests. Excited Delirium Syndrome has recently been recognized by the American College of Emergency Physicians as a true medical emergency in which, typically, a young obese male, often under the influence of sympathomimetic drugs, becomes acutely delirious and displays super-human strength, tachypnea, profuse sweating and severe agitation. Usually, there is a prolonged and continued struggle with law enforcement despite physical restraints . Severe acidosis, rhabdomyolysis and hyperkalemia ensue, often leading to a sudden bradyasystolic cardiac arrest. Listen to this fascinating episode to find out how you can recognize and treat this important syndrome.

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