EM Cases Best of 2016 Top Ten

The year 2016 was one of the most productive one in the entire 7 year history of EM Cases with a total of 29 podcast releases, the introduction of the CritCases blog, the Q & A Pearl of the Week, Just The Nuggets emails, BEEM Cases, the expansion of the Waiting to Be Seen blog, the second EM Cases Digest ebook and the first ever EM Cases Course. The website was viewed by 227,200 visitors, and podcast downloads totaled a whopping 1,626,190 downloads in 2016, bringing us to over 3.5 million podcast downloads since inception. Based on a blend of the number of podcast downloads, webpage views, social media engagement, scores on the questionnaires at the bottom of each post, number of positive emails and comments that I received, and my own favs, I'm pleased to bring you the EM Cases Best of 2016 Top 10 picks of 2016...

Episode 81 – A Balanced View on Recent EM Literature with Joel Yaphe

EM Cases - A Balanced View on recent EM Literature with Joel Yaphe Being an optimist, I'm constantly searching for EM literature that will change my practice in a positive way and ultimately improve the care that I deliver. The past year was filled with promising papers, some of which received a lot of attention. I'm not the only one who is biased towards craving a positive paper - so are the researchers, the journal editors and the public. We all want our field to mightily move forward! Enter Dr. Joel Yaphe. An EM Residency Program Director at University of Toronto and an ED doc who I admire for his balanced, sensible and practical approach to appraising the literature. In this episode Dr. Yaphe, at University of Toronto's Update in EM Conference - Whistler, leads us through a few key articles from the past year including the REVERT trial to convert SVT, medical expulsive therapy for urolithiasis, steroids in anaphylaxis, and analgesics for low back pain, and discusses whether they should (or rather, should not) change our practice. He challenges authors' conclusions and questions whether the findings are relevant to our patients....

BEEM Cases 2 – Renal Colic Imaging, Analgesia, Fluids & Medical Expulsive Therapy

Urolithiasis is one of the more frequent diagnoses we are faced with in the Emergency Department, with an estimated 1 million ED visits due to renal colic. As such we are tasked with its diagnosis, prognosis and treatment. The following is a brief summation of the evidence regarding some of the most frequent questions encountered when diagnosing and managing urolithiasis. Four questions are answered by Rory Spiegel on this BEEM Cases. What is the optimal initial imaging modality for the diagnostic work-up of urolithiasis? Once the diagnosis of renal colic has been made what is the most efficacious analgesic strategy? Is there clinical utility to IV fluid administration in the management of renal colic? What is the use of medical expulsion therapy in the management of urolithiasis?

Journal Jam 3 – Ultrasound vs CT for Renal Colic

In this Journal Jam we have Dr. Michelle Lin from Academic Life in EM interviewing two authors, Dr. Rebecca Smith‑Bindman, a radiologist, and Dr. Ralph Wang an EM physician both from USCF on their article “Ultrasonography versus Computed Tomography for suspected Nephrolithiasis” published in the New England Journal of Medicine in 2014. There is currently a wide practice variation in the imaging work-up of the patient who presents to the ED with a high suspicion for renal colic. On the one extreme, some EM physicians use CT to screen all patients who present with renal colic, while on the other extreme, other EM physicians do not use any imaging on any patient who has had previous imaging. The role of POCUS and radiology department ultrasound as an alternative to CT in the work up of renal colic has not been clearly defined in the ED setting. This study was a pragmatic multi-centre randomized control trial of patients in whom the primary diagnostic concern was renal colic, that tried to answer the question: is there a significant difference in the serious missed diagnosis rate, serious adverse events rate, pain, return visits, admissions to hospital, radiation dose and diagnostic accuracy if the EM provider chose POCUS, radiology department ultrasound or CT for their initial imaging modality of choice. This Journal Jam is peer review by EMNerd's Rory Spiegel. [wpfilebase tag=file id=618 tpl=emc-play /] [wpfilebase tag=file id=619 tpl=emc-mp3 /]

Episode 5: Renal Colic, Toxicology Update & Body Packers

This Episode is a potpourri of topics - Renal Colic, Toxicology Update & Body Packers. Dr. Lisa Thurgur and Dr. Paul Rosenberg discuss the common presentation of Renal Colic, with perspectives on the mixed evidence for medical expulsive therapy, the overuse of imaging studies and when we need to worry about the patient who presents with excruciating flank pain. Next, Dr. Thurgur gives us an update on the three most important recent advances in Toxicology for emergency physicians - Lipid Emulsion Therapy, Hydroxocobalamin and Insulin therapy for Calcium Channel Blocker toxicity. Finally, Dr. Rosenberg and Dr. Thurgur discuss the 'ins and outs' of body packers. They review the management of both asymptomatic and symptomatic body backers, highlighting common errors and key therapeutic moves to prevent death.