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Emergency Medicine Cases

Emergency Medicine Cases – Where the Experts Keep You in the Know. For complete episodes please visit emergencymedicinecases.com

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JJ 16 Heparin for ACS and STEMI

Does heparin - LMWH or unfractionated heparin - benefit the patient with a pretty good story for angina with a bump in their troponin and some ST depression in the lateral leads? We’re expected to routinely give heparin for all these NSTEMI and unstable angina patients with any ischemic changes seen on the ECG, right? And for STEMI too. But should we?.... The post JJ 16 Heparin for ACS and STEMI appeared first on Emergency Medicine Cases.

1hr 1min

28 Jan 2020

Rank #1

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Episode 71 ACLS Guidelines 2015 – Cardiac Arrest Controversies Part 1

A lot has changed over the years when it comes to managing the adult in cardiac arrest. As a result, survival rates after cardiac arrest have risen steadily over the last decade. With the release of the 2015 American Heart Association ACLS Guidelines 2015 online on Oct 16th, while there aren’t a lot a big changes, there are many small but important changes we need to be aware of, and there still remains a lot of controversy. In light of knowing how to provide optimal cardio-cerebral resuscitation and improving patient outcomes, in this episode we’ll ask two Canadian co-authors of The Guidelines, Dr. Laurie Morrison and Dr. Steve Lin some of the most practice-changing and controversial questions. The post Episode 71 ACLS Guidelines 2015 – Cardiac Arrest Controversies Part 1 appeared first on Emergency Medicine Cases.

1hr 7mins

21 Oct 2015

Rank #2

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Episode 101 GI Bleed Emergencies Part 1

In this Part 1 of our two part podcast on GI bleed emergencies we answer questions such as: How do you distinguish between an upper vs lower GI bleed when it's not so obvious clinically? What alterations to airway management are necessary for the GI bleed patient? What do we need to know about the value of fecal occult blood in determining whether or not a patient has a GI bleed? Which patients require red cell transfusions? Massive transfusion? Why is it important to get a fibrinogen level in the sick GI bleed patient? What are the goals of resuscitation in a massive GI bleed? What's the evidence for using an NG tube for diagnosis and management of upper GI bleeds?  In which patients should we give tranexamic acid and which patients should we avoid it in? How are the indications for massive transfusion in GI bleed different to the trauma patient? What are your options if the bleeding can't be stopped on endoscopy? and many more... The post Episode 101 GI Bleed Emergencies Part 1 appeared first on Emergency Medicine Cases.

1hr 35mins

10 Oct 2017

Rank #3

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Episode 95 Pediatric Trauma

Management of the pediatric trauma patient is challenging regardless of where you work. In this EM Cases episode, with the help of two leading pediatric trauma experts, Dr. Sue Beno from Hospital for Sick Children in Toronto and Dr. Faud Alnaji from Children's Hospital of Eastern Ontario in Ottawa we answer such questions as: what are the most important physiologic and anatomic differences between children and adults that are key to managing the trauma patient? How much fluid should be given prior to blood products? What is the role of POCUS in abdominal trauma? Which patients require abdominal CT? How do you clear the pediatric c-spine? Are atropine and fentanyl recommended as pre-induction agents in the pediatric trauma patient? How can the BIG score help us prognosticate? Is tranexamic acid recommended in early pediatric trauma like it is in adults? Is the Pediatric Trauma Score helpful in deciding which patients should be transferred to a trauma center? and many more... The post Episode 95 Pediatric Trauma appeared first on Emergency Medicine Cases.

1hr 40mins

9 May 2017

Rank #4

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Ep 109 Skin and Soft Tissue Infections – Cellulitis, Skin Abscesses and Necrotizing Fasciitis

How do you distinguish cellulitis from the myriad of cellulitis mimics? At what point do we consider treatment failure for cellulitis? What is the best antibiotic choice for patients who are allergic to cephalosporins? Which patients with cellulitis or skin abscess require IV antibiotics? Coverage for MRSA? What is the best and most resource wise method for analgesia before I&D of a skin abscess? What is the best method for drainage of a skin abscess? Which patients with skin abscess require a swab? Irrigation? Packing? Antibiotics? With the goal of sharpening your diagnostic skills when it comes to skin and soft tissue infections – there are lots of cellulitis mimics - and choosing wisely when it comes to treatment, we’ll be discussing best practices for management of cellulitis and skin abscesses, when to cover for MRSA, how to pick up nec fasc before it’s too late and a lot more… The post Ep 109 Skin and Soft Tissue Infections – Cellulitis, Skin Abscesses and Necrotizing Fasciitis appeared first on Emergency Medicine Cases.

1hr 21mins

24 Apr 2018

Rank #5

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Episode 41: Hypertensive Emergencies

In this episode on Hypertensive Emergencies, Dr. Joel Yaphe, EM residency program director at the University of Toronto & Dr. Clare Atzema, one of Canada's leading cardiovascular EM researchers will discuss the controversies of how to manage patients who present to the ED with high blood pressure and evidence of end organ damage related to the high blood pressure. Hypertensive emergencies are a grab bag of diagnoses that all need to be treated differently. Hypertensive Encephalopathy, Aortic Dissection, Acute Pulmonary Edema, Pre-eclampsia & Eclampsia, Acute Renal Failure, Subarachnoid Hemorrhage and Intracranial Hemorrhage all need individualized blood pressure management. The post Episode 41: Hypertensive Emergencies appeared first on Emergency Medicine Cases.

1hr 8mins

24 Mar 2014

Rank #6

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Best Case Ever 56 Anion Gap Metabolic Acidosis

In this month's Best Case Ever on EM Cases Dr. Ross Claybo and Dr. Keerat Grewal tell the story of a patient with a complicated anion gap metabolic acidosis. We discuss how to sort through the differential diagnosis with a better mnemonic than MUDPILES, the controversy around administering sodium bicarbonate for metabolic acidosis, the indications for fomepizole and the value of taking time to to build a therapeutic relationship with your ED patients... The post Best Case Ever 56 Anion Gap Metabolic Acidosis appeared first on Emergency Medicine Cases.

20mins

28 Mar 2017

Rank #7

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Best Case Ever 45 – Mike Winters on Cardiac Arrest

I had the great pleasure of meeting Dr. Mike Winters on his first ever visit to Canada at North York General's Emergency Medicine Update Conference, where he gave two fantastic presentations. His credentials are impressive: He is the Medical Director of the Emergency Department, Associate Professor in both EM and IM, EM-IM-Critical Care Program co-director and Residency Program Director of EM-IM at the University of Maryland in Baltimore. Sometimes we are so caught up with the job we need to get done during cardiac arrest that we forget about the important and profound effect that this event has on patients' families. On this Best Case Ever Dr. Winters tells the story of witnessing his grandfather's cardiac arrest, being present in the ED during the resuscitation attempts, and how that experience has coloured his practice. We discuss some pearls on communication with patients' families after death, colour-coded cardiac arrest teams and how to integrate POCUS into cardiac arrest care while minimizing chest compressions. The post Best Case Ever 45 – Mike Winters on Cardiac Arrest appeared first on Emergency Medicine Cases.

24mins

10 May 2016

Rank #8

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Ep 104 Emergency Management of Intracerebral Hemorrhage – The Golden Hour

There exists a kind of self-fulfilling prognostic pessimism when it comes to ICH. And this pessimism sometimes leads to less than optimal care in patients who otherwise might have had a reasonably good outcome if they were managed aggressively. Despite the poor prognosis of these patients overall, there is some evidence to suggest that early aggressive medical management may improve outcomes. As such, the skill with which you manage your patient with ICH in those first few hours could be the most important determinant of their outcome. In this Golden Hour you have a chance to prevent hematoma expansion, stabilize intracerebral perfusion and give your patient the best chance of survival with neurologic recovery. The post Ep 104 Emergency Management of Intracerebral Hemorrhage – The Golden Hour appeared first on Emergency Medicine Cases.

1hr 38mins

19 Dec 2017

Rank #9

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Best Case Ever 59 Management of Acute Renal Failure with Volume Overload

Sometimes our renal failure patients present short of breath with volume overload and we don't have immediate access to dialysis. What then? Dr. Mike Betzner, EM doc and medical director of STARS air ambulance service and collaborator on EM Cases CritCases blog tells his Best Case Ever and his approach to this challenging clinical situation. He offers two commonly used solutions: nitroglycerin and BiPAP as well as two not so common solutions: phlebotomy and rotating BP cuffs blown to above SBP... The post Best Case Ever 59 Management of Acute Renal Failure with Volume Overload appeared first on Emergency Medicine Cases.

14mins

28 Jun 2017

Rank #10

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Episode 80 – Presentation Skills

Whether you’re a first year resident or a veteran of EM, you’ve probably given, or will be giving at least one presentation at some point in your career. On the one hand, presentations can be intimidating, time consuming to prepare for and frightening to perform, but on the other hand, if you’re well-prepared and know the tricks of the trade, they can be fun, educational and hugely rewarding. Giving a memorable and educational talk requires skill. It requires serious thoughtful planning, dedicated practice and creativity. The good news is that these skills can be easily taught. What we know about giving great talks comes from non-medical fields. We can learn about how to use our voices, eyes and body language effectively during a presentation from stage actors. We can learn how to build great slides from experts in design. We can learn how to use stories to help engage an audience and improve their retention of the material from writers, broadcasters and storytellers. We can learn how to inspire people from professional speech writers, and we can employ strategies to help improve retention of the material from cognitive neuroscientists and educators. As EM providers, we’re much too busy to read dozens of books on effective presenting, so with the help of two EM physicians and master educators, Dr. Eric Letovsky who has studied the art of public speaking and has been giving presentations for more than 30 years, and Dr. Rick Penciner who has been scouring the world’s literature on this topic for 20 years, we’ll distill down for you the key secrets, tips and tricks, theories and approaches, pearls and pitfalls of presentation skills so that the next time you get up in front of your colleagues to give a talk, you’ll blow their minds... The post Episode 80 – Presentation Skills appeared first on Emergency Medicine Cases.

1hr 7mins

26 Apr 2016

Rank #11

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Ep 112 Tachydysrhythmias with Amal Mattu and Paul Dorion

In this EM Cases main Episode 112 Tachydysrhythmias with Amal Mattu and Paul Dorion we discuss a potpurri of clinical goodies for the recognition and management of both wide and narrow complex tachydysrhythmias and answer questions such as: Which patients with stable Ventricular Tachycardia (VT) require immediate electrical cardioversion, chemical cardioversion or no cardioversion at all? Are there any algorithms that can reliably distinguish VT from SVT with aberrancy? What is the "verapamil death test"?  While procainamide may be the first line medication for stable VT based on the PROCAMIO study, what are the indications for IV amiodarone for VT? How should we best manage patients with VT who have an ICD? How can the Bix Rule help distinguish Atrial Flutter from SVT? What is the preferred medication for conversion of SVT to sinus rhythm, Adenosine or Calcium Channel Blockers (CCBs)? Why is amiodarone contraindicated in patients with WPW associated with atrial fibrillation? What are the important differences in the approach and treatment of atrial fibrillation vs. atrial flutter? How can we safely curb the high bounce-back rate of patients with atrial fibrillation who present to the ED? and many more... The post Ep 112 Tachydysrhythmias with Amal Mattu and Paul Dorion appeared first on Emergency Medicine Cases.

1hr 29mins

17 Jul 2018

Rank #12

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Episode 20: Atrial Fibrillation

In this episode Dr. Clare Atzema, Dr. Nazanin Meshkat and Dr. Bryan Au discuss the presentation, etiology, precipitants, management and disposition of Atrial Fibrillation in the Emergency Department. The pros and cons of rate and rhythm control are debated, what you need to know about rate and rhythm control medications reviewed, and the strength of the Ottawa Aggressive Protocol discussed. The importance of appropriate anticoagulation is detailed, with a review of the CHADS-VASc score and whether to use Warfarin, Dabigatran or ASA for stroke prevention for patient with Atrial Fibrillation. We end off with a discussion on how to recognize and treat Wolff-Parkinson-White syndrome in the setting of Atrial Fibrillation. The post Episode 20: Atrial Fibrillation appeared first on Emergency Medicine Cases.

1hr 29mins

10 Feb 2012

Rank #13

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Episode 60: Emergency Management of Hyponatremia

In this EM Cases episode Dr. Melanie Baimel and Dr. Ed Etchells discuss a simple and practical step-wise approach to the emergency management of hyponatremia: 1. Assess and treat neurologic emergencies related to hyponatremia with hypertonic saline 2. Defend the intravascular volume 3. Prevent further exacerbation of hyponatremia 4. Prevent rapid overcorrection 5. Ascertain a cause Dr. Etchells and Dr. Baimel answer questions such as: What are the indications for giving DDAVP in the emergency management of hyponatremia? What is a simple and practical approach to determining the cause of hyponatremia in the ED? How fast should we aim to correct hyponatremia? What is the best fluid for resuscitating the patient in shock who has a low serum sodium? Why is the management of the marathon runner with hyponatremia counter-intuitive? What strategies can we employ to minimize the risk of Osmotic Demyelination Syndrome (OSD) and cerebral edema in the emergency management of hyponatremia? and many more... The post Episode 60: Emergency Management of Hyponatremia appeared first on Emergency Medicine Cases.

1hr 5mins

3 Mar 2015

Rank #14

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Ep 122 Sepsis and Septic Shock – What Matters from EM Cases Course

In this podcast Dr. Sara Gray, intensivist and emergency physician, co-author of The CAEP Sepsis Guidelines, answers questions such as: How does one best recognize occult septic shock? How does SIRS, qSOFA and NEWS compare in predicting poor outcomes in septic patients? Which fluid and how much fluid is best for resuscitation of the septic shock patients? What are the indications for norepinephrine, and when in the resuscitation should it be given, in light of the CENSER trial? What are the goals of resuscitation in the patient with sepsis or septic shock? When should antibiotics administered, given that the latest Surviving Sepsis Campaign Guidelines recommend that antibiotics be administered within one hour of arrival for all patients suspected of sepsis or septic shock? What are the indications for a second vasopressor after norepinephrine? Given the conflicting evidence for steroids in sepsis, what are the indications for steroids? Should we be considering steroids with Vitamin C and thiamine for patients in septic shock? What are the pitfalls of lactate interpretation, and how do serial lactates compare to capillary refill in predicting poor outcomes in light of the ANDROMEDA trial? Is procalcitonin a valuable prognostic indicator in septic patients? and many more... The post Ep 122 Sepsis and Septic Shock – What Matters from EM Cases Course appeared first on Emergency Medicine Cases.

1hr 6mins

26 Mar 2019

Rank #15

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Episode 93 – PALS Guidelines

I remember when I started practicing emergency medicine a decade and a half ago it seemed that any kid who came to our ED in cardiac arrest died. I know, depressing thought. But, over the past 15 years, survival to discharge from pediatric cardiac arrest has markedly improved, at least for in-hospital arrests. This is probably mostly due to an emphasis on high-quality CPR and advances in post-resuscitation care; nonetheless the more comfortable, knowledgeable and prepared we are for the always scary critically ill pediatric patient, the more likely we will be able to resuscitate them successfully - which is always a huge save. The post Episode 93 – PALS Guidelines appeared first on Emergency Medicine Cases.

1hr 24mins

14 Mar 2017

Rank #16

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Episode 48 – Pediatric Fever Without A Source

Have you ever seen a child in your emergency department with a fever - he asks sarcastically? At the ginormous community hospital where I work, we see about 25,000 kids each year in our ED and about half of them present with fever. Yes, there still exists fever phobia in our society, which brings hoards of worried parents into the ED with their febrile kids. For most of these kids it's relatively straight forward: Most kids with fever have clinical evidence of an identifiable source of infection – a viral respiratory infection, acute otitis media, gastro, or a viral exanthem. However, about 20% have Fever Without a Source despite your thorough history and physical exam. A small but significant number of this 20% without an identifiable source of fever will have an occult bacterial infection - UTI, bacteremia, pneumonia, or even the dreaded early bacterial meningitis. These are all defined as Serious Bacterial Infections (SBI), with occult UTI being the most common SBI especially in children under the age of 2 years. In the old days we used to do a full septic work-up including LP for all infants under the age of 3 months, but thankfully, times have changed in the post-Hib and pneumoccocal vaccine age, and we aren’t quite so aggressive any more with our work-ups. Nonetheless, it's still controversial as to which kids need a full septic workup, which kids need a partial septic workup, which kids need just a urine dip and which kids need little except to reassure the parents. In this episode, with the help of Dr. Sarah Reid and Dr. Gina Neto from the Children's Hospital of Eastern Ontario, we will elucidate how to deal with fever phobia, when a rectal temp is necessary, how to pick out the kids with fever that we need to worry about, how to work up kids with fever depending on their age, risk factors and clinical picture, who needs a urinalysis, who needs a CXR, who needs blood cultures and who needs an LP, and much more.... The post Episode 48 – Pediatric Fever Without A Source appeared first on Emergency Medicine Cases.

1hr 14mins

23 Jul 2014

Rank #17

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Episode 26: Low Back Pain Emergencies

In this episode we go through seven cases that display the breadth of presentations of limb or life threatening causes of low back pain emergencies with my huge mentors, Dr. Walter Himmel and Dr. Brian Steinhart. We cover everything from spinal epidural abscess to cauda equina syndrome to retroperitoneal bleeds, elucidating the key historical, physical exam, lab, imaging and treatment pearls for all of these diagnoses. We then go on to review the best management for the most common cause of back pain presentation, lumbosacral strain and debate the various medication options. The post Episode 26: Low Back Pain Emergencies appeared first on Emergency Medicine Cases.

2hr 28mins

12 Sep 2012

Rank #18