I caught up with airway educator, innovator and self-described enthusiast Dr. Richard Levitan at SMACC in Chicago this past June. In this Best Case Ever on Airway Strategy and Mental Preparedness in EM Procedures, Dr. Levitan uses a great save of his in a penetrating trauma case as a basis for discussion on mental preparedness and how we've been thinking about our general approach to emergency procedures the wrong way. Rather than fixating on the final goal of a procedure, which can often be daunting and lead us astray, he suggests a methodical incrementalized and compartmentalized approach to EM procedures that reduces stress and fear, improves confidence and enhances success. He runs through several examples including intubation, cricothyrotomy and initial approach to hypoxia to explain his Simple Incremental Approach to EM Procedures. Could this be a paradigm shift in the way we think about procedures in EM?....
Dr. Leeor Sommer,who runs annual ENT workshops in Toronto give us his Best Case Ever involving an Extubation in the ED gone bad. In the related Episode 38 - ENT Emergencies - Pearls & Pitfalls, Tips & Tricks, Dr. Leeor Sommer and Dr. Maria Ivankovic, lecturer extrodinaire on ENT emergencies discuss: Dr. Ivankovic's stepwise approach to managing epistaxis, Tips for nasal and ear foreign body removal, How to pick up and work up the dreaded Malignant Otitis Externa, Sudden sensorineural hearing loss ('The Bells' Palsy of the Ear'), Epiglottitis work-up and management, Pharyngitis work-up and treatment - Does anyone with phayrngitis need antibiotics?, Tips and Tricks for peritonsillar abscess drainage, Hereditary and ACE-inhibitor associated Angioedema presentations and management.
Whistler's Update in Emergency Medicine Conference 2013 in Whistler, British Columbia is U of Toronto's case-based interactive small group EM conference. There were so may great talks with amazing clinical pearls that I decided to wade through the 18 hours of audio recordings and packaged some of the key highlights for you here......EM Literature Review 2012 by Dr. Joel Yaphe, Neonatal Resuscitation Pearls by Dr. Nicole Kester-Greene, Fever of Unknown Origin by Dr. Shirley Lee, Improving Cosmesis in Wound Management by Dr. Maria Ivankovic, Hepato-biliary Disease by Dr. Sara Gray, & Pediatric Cardiac & Respiratory Cases by Dr. Donna Goldenberg.
There are so many emergency airway controversies in emergency medicine! Dr. Jonathan Sherbino, Dr. Andrew Healy and Dr. Mark Mensour debate dozens of these controversies surrounding emergency airway management. A case of a patient presenting with decreased level of awareness provides the basis for a review of the importance, indications for, and best technique of bag-valve-mask (BVM) ventilation, as well as a discussion of how best to oxygenate patients. This is followed by a discussion of what factors to consider in deciding when to intubate and some of the myths of when to intubate. The next case, of a patient with severe head injury who presents with a seizure, is the fodder for a detailed discussion of Rapid Sequence Intubation (RSI). Tips on preparation, pre-oxygenation and positioning are discussed, and some great debates over pre-treatment medications, induction agents and paralytic agents ensues. The new concept of Delayed Sequence Intubation is explained and critiqued. They review how to identify a difficult airway, how best to confirm tube placement and how to avoid post-intubation hypotension. In the last case of a morbidly obese asthmatic they debate the merits of awake intubation vs RSI vs sedation alone in a difficult airway situation and explain the best strategies of ventilation to avoid the dreaded bradysystlolic arrest in the pre-code asthmatic. Finally, some key strategies to help manage the morbidly obese patient's airway effectively are reviewed.