Emergency Medicine has undergone many changes over the last couple of decades and especially during the COVID pandemic. Most of these changes have been very positive, but increasing volumes, staff shortages, aging populations, increasing breadth of responsibilities and better access to more imaging have made some of us question how we should define the scope of our practices. In this main episode podcast, highlights from CAEP 2022 conference, Anton discusses the article 'Saving EM: Is Less More?' with Dr. Paul Atkinson and Dr. Grant Innes and offer some solutions to this current state of affairs in EM. In another CAEP highlight, trauma team leader Dr. Mathieu Toulouse delivers the latest on management of traumatic pneumothorax. He answers such questions as: Do all patients with a traumatic pneumothorax require tube thoracostomy? How do CXR and CT differ in determining which patients require a chest tube? Do all patients receiving positive pressure ventilation require a chest tube for their traumatic pneumothorax? Does the presence of hemothorax necessitate placement of a chest tube? Are 14Fr pigtail catheters adequate for all traumatic pneumothoraces? and many more...
EM Quick Hits 18 Conservative Management Pneumothorax, Microdosing Buprenorphine, Practical Use of CRITOE, Canadian TIA Score, Pediatric Surviving Sepsis Guidelines, Safety of Peripheral Vasopressors
Justin Morgenstern on watchful waiting for large spontaneous pneumothoraces, Michelle Klaiman on mirco-dosing buprenorphine for opiate use disorder, Arun Sayal on the practical application of CRITOE in pediatric elbow fractures, Jeff Perry on The Canadian TIA Score, Sarah Reid on updated pediatric surviving sepsis guidelines, Salim Rezaie (Best of REBELEM) on safety of vasopressor administration through peripheral IVs...
In this POCUS Cases 2 - Pneumothorax, Dr. Simard explains the limitations of supine chest x-rays for ruling out pneumothorax in trauma patients, how to recognize lung sliding and/or comet tails on POCUS and how to understand that they rule out pneumothorax in supine trauma patients, how to recognize the lung point in pneumothorax and distinguishing it from physiologic lung points, how to understand the limitations and false positives of pneumothorax POCUS and much more...
It makes sense that the treatment of primary spnontaneous pneumothorax would lend itself well to outpatient management, since patients are usually young and otherwise healthy, and the mortality and morbidity from these air leaks are really very low. Most patients would rather be managed as an outpatient rather than admitted to hospital and sending these patients home would probably end up saving the system resources and money. In this month's Journal Jam Podcast on small bore chest tube and outpatient management of pneumothorax, the highlighted article that Anton Helman and Teresa Chan discuss is Voison et al. on the “Ambulatory Management of Large Spontaneous Pneumothorax With Pigtail Catheters.” We hear from Michelle Lin, Seth Trueger, Heather Murray and the lead author himself, Stephan Jouneau. Questions posed include: In what ways is the use of small bore catheters with Heimlich valves for spontaneous pneumothorax better than needle aspiration? Is it necessary to repeat a CXR after placement of the catheter? Who should follow up these patients after they are discharged from the hospital? How can we minimize kinking and dislodgement of the catheter? and many more..... [wpfilebase tag=file id=523 tpl=emc-play /] [wpfilebase tag=file id=524 tpl=emc-mp3 /]
In anticipation of the Highlights from North York General's Emergency Medicine Update Conference 2014 we have the master educator himself, Dr. Amal Mattu's Best Case ever of a patient who presented with a COPD exacerbation, that we recorded at the conference in Toronto just a couple of weeks ago. Dr. Mattu gives you a string of pearls and pitfalls when it comes to management of COPD, bagging & vent settings that you will never forget. In the upcoming episode Dr. Mattu will review his favorite papers from the cardiology literature of the past year and Dr. Stuart Swadron will give you his approach to the challenges of the patient with vertigo. This will the first of two parts of the highlights from the conference - the largest and best EM conference in Canada.
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.
In this episode we have the continuation of our discussion on Respiratory Emergencies with Dr. Anil Chopra and Dr. John Foote. We discuss key clinical decisions in COPD assessment and management - how to assess for impending respiratory failure, how best to oxygenate the COPD patient, medication pearls and how best to approach intubating the COPD patient. We then review an approach to hemoptysis as well as tricks of the trade for managing massive hemoptysis. Many pearls of pneumonia work-up and management are detailed as well as how to make important disposition decisions.
In this first installment of this Episode, Point of Care Ultrasound Pearls, Pitfalls & Controversies we have a panel of POCUS gurus, Dr. Greg Hall, Dr. Jordan Chenkin, Dr. Paul Hannam & Dr. Jason Fischer. They review the basic criteria for commonly used, practical Point of Care Ultrasound indications at the bedside and then dive into heated debate about specific pearls and pitfalls in Point of Care Ultrasound assessment of the patient with undifferentiated shortness of breath, undifferentiated shock, cardiac arrest and swollen leg. They discuss how best to interpret the massive body of literature for POCUS and when we can hang our hats on our Point of Care Ultrasound findings.
In Part 2 of this episode on Trauma Pearls & Pitfalls Dr. Dave MacKinnon and Dr. Mike Brzozowski go through key management strategies and controversies surrounding head, neck, chest, abdominal, pelvic and extremity trauma, followed by a discussion on how best to prepare the trauma patient for transfer to a trauma centre.