Best Case Ever 48 – Organic vs Psychiatric Illness

Sometimes what initially appears to be a psychiatric illness turns out to be an organic illness, and vise versa. In our assessment of the patient with altered behaviour, it is critical to drill down and dissect apart the type of hallucinations a patient might be displaying, whether the demented patient is simply suffering from worsening dementia or alternatively has acute delirium (which carries a high mortality rate), and whether their somatic complaints might be due to depression or a psychotic psychiatric illness. In anticipation of our upcoming episode on Medical Clearance of the Psychiatric Patient Dr. Brian Steinhart tells the story of his Best Case Ever, reminding us of some of the clinical clues that can help us in our approach to the patient with altered behaviour, so that we avoid misdiagnosing a psychiatric illness with an organic one, or even worse, an organic illness with a psychiatric one...

Episode 34: Geriatric Emergency Medicine

In this episode Dr. Don Melady, Canada's leading educator in Geriatric Emergency Medicine (Geri-EM) & Dr. Jaques Lee, one of Canada's leading researchers in Geri-EM, discuss the common yet challenging Geriatric Emergencies: a practical approach to geriatric Delirium, best practice for managing agitation and pain in the older patient, management of recurrent falls, pearls in the assessment of the 'Weak & Dizzy' geriatric patient, atypical presentations of common life threatening emergencies including ACS and surgical abdomen, key drug interactions in the geriatric patient and more..

Best Case Ever 17: Geriatric Emergency Medicine

As a bonus to Episode 34 on Geriatric Emergency Medicine, Dr. Don Melady, one of Canada's leading educators in Geriatric EM, tells us about his Best Case Ever in which a simple fall turns out to be a multi-facited complicated case with a simple solution. In the related Episode 34 on Geriatric Emergency Medicine Dr. Melady and Dr. Jacques Lee cover an approach to geriatric Delirium, managing agitation, indications for CT head in the delirious older person, management of recurrent falls, pearls in the assessment of the 'Weak & Dizzy' geriatric patient, key drug interactions, pain management, atypical ACS and pearls in Geriatric abdominal pain presentations.

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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