Ultrasound Archives - Emergency Medicine Cases: Recent Episodes
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In this month's EM Quick Hits: Heather Cary on the use and misuse of abdominal FAST in pediatric trauma, Hans Rosenberg and Arleigh McCurdy on the diagnosis and management of Multiple Myeloma in the ED, David Jerome on practice tips for managing the drowning patient, Brit Long and Michael Gottlieb on the diagnosis and management of Alcohol-Induced Ketoacidosis, Navpreet Sahsi on his journey to becoming a humanitarian and global EM doctor...
The post EM Quick Hits 48 – FAST in Pediatric Trauma, Multiple Myeloma, Drowning, AKA, Global EM appeared first on Emergency Medicine Cases.
In this part 2 of our 2-part podcast series on Cardiac Arrest - The When, Why & How, we discuss some of the finer art of cardiac arrest care and answer questions such as: how should we best communicate to EMS, the ED team and the family of the patient to keep the team focused, garner the most important info and keep the flow of the code going? How should we integrate PoCUS into cardiac arrest care so we do not interrupt the core components, yet we gain valuable data? What are the indications for consideration of ECPR/ECMO in cardiac arrest? What factors need to be taken into consideration to decide on when to terminate resuscitation of the cardiac arrest patient - when to call the code? and many more...
The post Ep 170 Cardiac Arrest – PoCUS Integration, Communication Strategies, E-CPR, Calling the Code appeared first on Emergency Medicine Cases.
What is the preferred order of vasopressors and ionotropes in the management of cardiogenic shock? In which patients would dobutamine be preferred over milrinone and vice versa? How can we best pick up occult cardiogenic shock before it floured shock kicks in? What are the best strategies to efficiently get the patient in cardiogenic shock to definitive care, whether that be the cath lab or the operating room? What is the evidence for intra-aortic balloon pumps, percutaneous ventricular assist devices and ECMO in the patient with cardiogenic shock? Which patients with acute heart are safe to send home in general? How useful is the Ottawa Heart Failure Risk Score in aiding in disposition decisions?...
The post Ep 164 Cardiogenic Shock Simplified appeared first on Emergency Medicine Cases.
In this month's EM Quick Hits podcast, Anand Swaminathan on tips and tricks in polytrauma, Rohit Mohindra on diagnosis and management of toxic megacolon, Jesse McLaren on ECG in pulmonary embolism, Victoria Myers on approach to the patch call for cardiac arrest, Brit Long on when to do a CT head before LP, Salim Rezaie on nebulized ketamine - the ketaBAN study...
The post EM Quick Hits 33 Polytrauma Tips & Tricks, Toxic Megacolon, ECG in PE, Patch Calls, CT Before LP, Nebulized Ketamine appeared first on Emergency Medicine Cases.
In this main episode podcast we discuss the conservative management of large spontaneous pneumothorax, when a pigtail chest tube with Heimlich valve is indicated, detection of persistent air leak, removal of chest tube, surgical indications for spontaneous pneumothorax, management pitfalls and more...
The post Ep 158 Management of Primary Spontaneous Pneumothorax appeared first on Emergency Medicine Cases.
In this month's EM Quick Hits podcast: Anand Swaminathan on the approach to cardiogenic shock, Hania Bielawska on the myths of radiation dose in pregnant patients, Hans Rosenberg & Michael Gottlieb on PoCUS in airway management, Menaka Pai on VIPIT following AstraZeneca COVID-19 vaccination, Brit Long & Michael Gottlieb on Angiotensin II for emergency clinicians, Michael Schull on tips on the safety of short-term steroid use....
The post EM Quick Hits 28 Cardiogenic Shock, Radiation Dose in Pregnancy, PoCUS in Airway Management, VIPIT, Angiotensin II, Short-Term Steroid Safety appeared first on Emergency Medicine Cases.
Dr. Rob Simard discusses one of the most important uses of POCUS in the ED, and that is for AAA. He reviews the literature on the accuracy of POCUS for AAA as well as demonstrates the limitations and the common pitfalls in this POCUS Cases video....
The post POCUS Cases 10 Limitations, Pitfalls and Accuracy of POCUS for Ruptured AAA appeared first on Emergency Medicine Cases.
Rob Simard explains how to incorporate abdominal POCUS into your assessment of the trauma patient, he reviews the literature on accuracy of POCUS for assessment of abdominal free fluid, reviews the key POCUS steps and cautions us about interpretation of your findings in trauma patients who have sustained an injury to their abdomen...
The post POCUS Cases 9 Abdominal Free Fluid in Trauma appeared first on Emergency Medicine Cases.
Justin Morgenstern on imaging choices in renal colic, Hanni Stoklosa on recognition and management of human trafficking, Rohit Mohindra on management of atrial fibrillation during COVID-19, Anand Swaminathan on transvenous pacemaker placement, Rob Simard on COVID-19 lung POCUS, Brit Long on COVID-19 dermatology and Sarah Foohey & Paul Koblic on virtual simulation...
The post EM Quick Hits 20 Imaging Renal Colic, Human Trafficking, Atrial Fibrillation During COVID, Transvenous Pacemaker Placement, COVID Lung POCUS, COVID Derm, Virtual Simulation appeared first on Emergency Medicine Cases.
Tension hydrothorax is a massive pleural effusion presenting with hemodynamic abnormalities secondary to mediastinal compression. Dr. Allan Shefrin tells his Best Case Ever of a child who presents in shock and discusses the causes of tension hydrothorax, indications for tube thoracostomy for hydrothorax and integration of POCUS into pediatric resuscitation.
The post BCE 81 Tension Hydrothorax appeared first on Emergency Medicine Cases.
In this EM Quick Hits podcast we have Emily Austin on physostigmine for anticholinergic toxidrome, Walter Himmel on understanding nystagmus to differentiate central vs peripheral causes of vertigo, Rob Devins on the role of transesophageal echocardiogram in cardiac arrest, Jesse MacLaren on nuances in inferior MI ECG changes and aVL, Andrew Petrosoniak on a practical approach to blunt cerebrovascular injury and Reuben Strayer on choicebo...
The post EM Quick Hits 11 Blunt Cerebrovascular Injury, Physostigmine, TEE in Cardiac Arrest, Understanding Nystagmus, Subtle Inferior MI, Choicebo appeared first on Emergency Medicine Cases.
In this POCUS Cases video Dr. Rob Simard reviews the literature on accuracy of identifying LV dysfunction on POCUS by non-radiologists, the steps in assessing LV dysfunction, and cautions us when it comes to patients with chronic LV dysfunction...
The post POCUS Cases 8 – LV Dysfunction appeared first on Emergency Medicine Cases.
In this POCUS Cases Dr. Simard reviews the literature on accuracy of POCUS for pericardial effusion diagnosis, compares and contrasts the two cardiac views for determining a pericardial effusion, explains how to distinguish between pericardial fluid vs epicardial fat and pericardial fluid vs pleural effusion, explains the findings of cardiac tamponade and electrical alternans, and reviews the false positives of pericardial effusion on POCUS...
The post POCUS Cases 6 Pericardial Effusion POCUS appeared first on Emergency Medicine Cases.
In this POCUS Cases 5 - Small Bowel Obstruction, Dr. Simard explains the limitations of x-rays for small bowel obstruction, the three signs of small bowel obstruction on POCUS including the "keyboard sign", the most important literature on the topic and the limitations of using POCUS for the diagnosis of small bowel obstruction...
The post POCUS Cases 5 – Small Bowel Obstruction appeared first on Emergency Medicine Cases.
In this month's POCUS Cases Dr. Rob Simard explains the role of POCUS in distal radius fracture diagnosis and reduction, how to troubleshoot finding the echogenic line that represents the shaft of the radius, and the limitations of using POCUS for distal radius fractures...
The post POCUS Cases 4 – Distal Radius Fracture Diagnosis and Reduction appeared first on Emergency Medicine Cases.
While first trimester bleeding isn't a particularly challenging presenting complaint we do miss more ectopic pregnancies than we might think. In this series of Rapid Reviews Videos Dr. Nick Clarridge discusses important features of the history and physical in vaginal bleeding in early pregnancy, reviews types and treatment of spontaneous abortions, points out the salient features of molar pregnancies, discusses the value of risk factors and physical exam findings associated with ectopic pregnancy, talks about the myths of beta-HCG cut-offs, the role of ultrasound and ED treatment of ectopic pregnancy and much more...
The post Rapid Reviews Videos on First Trimester Bleeding and Ectopic Pregnancy appeared first on Emergency Medicine Cases.
This month's EM Cases Best Case Ever podcast features Dr. Catherine Varner, Emergency Physician at Sinai Health System and researcher at Schwartz-Reisman Emergency Medicine Institute (SREMI) discussing the key pitfalls in the diagnosis of ectopic pregnancy and ruptured ectopic pregnancy. It turns out that we're missing the diagnosis more than we'd like to admit. Dr. Varner debunks much of the traditional teaching around ectopic pregnancy so that we can improve our diagnostic skills for this potentially life threatening diagnosis...
The post BCE 68 Ectopic Pregnancy Pitfalls in Diagnosis appeared first on Emergency Medicine Cases.
The long wait has been well worth it. The EM Cases POCUS Cases Video Series has officially been launched!
POCUS Cases is an original EM Cases video series led by Dr. Robert Simard, an Emergency Physician at North York General Hospital and Sunnybrook Health Sciences Centre in Toronto. Rob always wished he had x-ray vision…but since he possesses no special powers…using Point-of-Care Ultrasound (POCUS) is the next closest thing. He completed a POCUS fellowship at NOSM and teaches POCUS nationally and internationally. He is the creator POCUS Cases, an original EM cases screencast that provides POCUS clinical pearls in an engaging and fun way that will help you provide stellar care to your patients...
The post POCUS Cases Video Series has Launched! appeared first on Emergency Medicine Cases.
This is the first ever video podcast on EM Cases with Jordan Chenkin from EMU Conference 2017 discussing how to optimize three aspects of cardiac arrest care: persistent ventricular fibrillation, optimizing pulse checks and PEA arrest, with code team videos contrasting the ACLS approach to an optimized approach...
The post Episode 96 Beyond ACLS Cardiac Arrest – Live from EMU Conference 2017 appeared first on Emergency Medicine Cases.
EM Cases Episode 82 Emergency Radiology Controversies, pearls and pitfalls: Which patients with chest pain suspected of ACS require a CXR? What CXR findings do ED docs tend to miss? How should we workup solitary pulmonary nodules found on CXR or CT? Is the abdominal x-ray dead or are there still indications for it's use? Which x-ray views are preferred for detecting pneumoperitoneum? When should we consider ultrasound as a screening test instead of, or before, CT? What are the indications for contrast in abdominal and head CT? How should we manage the patient who has had a previous CT contrast reaction who really needs a CT with contrast? What is the truth about CT radiation for shared decision making? And much more...
The post Episode 82 – Emergency Radiology Controversies appeared first on Emergency Medicine Cases.
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?
The post BEEM Cases 2 – Renal Colic Imaging, Analgesia, Fluids & Medical Expulsive Therapy appeared first on Emergency Medicine Cases.
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.
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.
The post Journal Jam 3 – Ultrasound vs CT for Renal Colic appeared first on Emergency Medicine Cases.
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....
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The post Best Case Ever 31: Emergency Pericardiocentesis appeared first on Emergency Medicine Cases.
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.
The post Episode 53 Pediatric POCUS appeared first on Emergency Medicine Cases.
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.
The post Episode 18 Part 1: Point of Care Ultrasound Pearls, Pitfalls and Controversies appeared first on Emergency Medicine Cases.