David Carr discusses his top 10 pearls on endocarditis and blood culture interpretation in this Carr's Cases Best Case Ever on EM Cases - Endocarditis and Blood Culture Interpretation. [wpfilebase tag=file id=560 tpl=emc-play /] [wpfilebase tag=file id=561 tpl=emc-mp3 /]
On this EM Cases Best Case Ever, Andrew Sloas, the brains behinds the fabulous PEM-ED podcast tells the tale of a pericardiocentesis gone bad and what he learned from it. Emergency pericardicentesis can be life saving, but it also carries risks. Dr. Sloas reviews the steps to take to ensure that the pericardiocentesis needle is the the correct place to minimize the risk of intubating the right ventricle of the heart. A discussion of errors of omission and ones of commission follows.... [wpfilebase tag=file id=540 tpl=emc-play /] [wpfilebase tag=file id=541 tpl=emc-mp3 /]
In this Episode, a follow up to Episode 18 Point of Care Ultrasound Pearls and Pitfalls, which covered pericardial effusion, pneumothorax, undifferentiated shock, cardiac arrest & DVT, we bring you 4 of North America’s Pediatric Point of Care Ultrasound gurus recorded live from Toronto during the first ever P2 Conference (PEM POCUS) - Pediatric Emergency Medicine Point of Care Ultrasound. The format will be a bit different for this episode. I’ve asked each our P2 gurus to describe a case that illustrates their favorite point of care ultrasound application, why they think it is useful, how it improves patient care, a step by step description of how to perform the application, the pearls and pitfalls of the application, and bit about what the literature says about the application. Dr. Jason Fischer on ultrasound-guided nerve blocks, Dr. Alyssa Abo on pediatric lung POCUS, Dr. Adam Sivitz on pediatric appendicitis POCUS and Dr. Alex Arroyo on intussesception.
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.......
In this episode, Dr. Jordan Chenkin & Dr. Jamie Blicker discuss positioning, landmarking, and best technique for lumbar puncture, how to minimize post-LP headache and traumatic taps, as well as when CT head is not required prior to LP. They discuss the indications, contraindications, trouble-shooting and pros and cons of needle aspiration, small bore pleural catheter with Heimlich valve and large bore chest tube for the treatment of spontaneous pneumothorax. Dr. Chenkin presents an intriguing argument for why he uses ultrasound-guided fracture reduction routinely in the ED, and we end with a few tips and tricks using skin adhesive for some unorthodox indications.
In this episode on Vaginal Bleeding in Early Pregnancy 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 bedside emergency department 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.
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 /]
In Part 2 of this Episode on Emergency Ultrasound or Point of Care Ultrasound (POCUS) Dr. Fischer, Dr. Hannam, Dr. Chenkin & Dr. Hall, Canada's EM ultrasound gurus discuss how POCUS can help our decision-making in the pediatric patient with a limp, in the patient with necrotizing fasciitis, in the pregnant patient with vaginal bleeding and in the common and challenging elderly patient with undifferentiated abdominal pain. They cover POCUS indications from urinary retention to appendicitis and debate the utility of these indications. This is followed by a debate on how best to educate ourselves and the EM community in POCUS and how best to designs quality assurance programs so that point of care ultrasound (POCUS) becomes an accepted tool across the entire medical community.
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 /]
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 /]