respiratory emergency medicine: Recent Episodes
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In this part 2 of our 2-part podcast on asthma with Dr. Sameer Mal and Dr. Leeor Sommer, we dig into the recognition and management of life-threatening asthma. We answer such questions as: what are the key elements in recognition of threatening asthma? What are the most time-sensitive interventions required to break the vicious cycle of asthma? What are the best options for dosing and administering magnesium sulphate, epinephrine, fentanyl and ketamine in the management of the crashing asthmatic? What is the role of NIPPV in the management of life-threatening asthma? What are the factors we should consider when it comes to indications for endotracheal intubation of the crashing asthmatic? What role do blood gases play in the decision to intubate? What are the most appropriate ventilation strategies in the intubated asthma patient? and many more...
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The post Ep 193 The Crashing Asthmatic – Recognition and Management of Life Threatening Asthma appeared first on Emergency Medicine Cases.
In this part 1 of our 2-part podcast series on Asthma Management we explore a systematic approach to managing patients presenting to the ED with asthma exacerbations. Our discussion will emphasize the critical role of a thorough history and physical examination in effectively stratifying patient risk and guiding treatment/disposition decisions. Additionally, we'll examine the importance of providing comprehensive discharge medications and instructions to mitigate both mortality and morbidity associated with asthma exacerbations. We answer questions such as: which patients, if any, require peak expiratory flow measurements in the ED? Why is it so important to add steroid MDI therapy to oral steroid therapy in patients being discharged from the ED after an asthma exacerbation? What are the most predictive variables to risk stratify patients with asthma exacerbations to help guide treatment and disposition? and many more. Stay tuned for Part 2, where we'll delve deep into the management of the crashing asthmatic.
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The post Ep 192 ED Adult Asthma Management Strategies For Improved Prognosis – A Stepwise Approach appeared first on Emergency Medicine Cases.
Key principles and approach to management of both non-massive and massive hemoptysis with Dr. Scott Weingart and Dr. Bourke Tillmann, who answer questions such as: What are the factors to consider in the decision to intubate patients with massive hemoptysis? How can one reliably distinguish hemoptysis from pseudohemoptysis? What is the evidence for tranexamic acid in patients with hemoptysis? What are the best strategies for suctioning blood from the airway to improve visualization during endotracheal intubation in crashing hemoptysis patients? What is the role of bronchoscopy and how should it be integrated into the hemoptysis management algorithm? How does one's hemorrhage control strategy change when pulmonary embolism is the underlying diagnosis? and many more...
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The post Ep 188 Hemoptysis – ED Approach and Management appeared first on Emergency Medicine Cases.
I had the enormous honour of interviewing Dr. Ben McKenzie, EM physician and a PhD candidate at the University of Melbourne studying the topic of resuscitation algorithms in anaphylaxis and asthma. The tragic death of his son Ben McKenzie at the age 15 from hypoxic respiratory arrest as a result of anaphylaxis and asthma in 2021 has led Dr. McKenzie on a mission to prevent deaths from anaphylaxis and asthma by educating emergency providers around the world using his AMAX4 algorithm as a framework...
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The post Ep 187 Crashing Anaphylaxis – AMAX4 Algorithm and The Max McKenzie Case appeared first on Emergency Medicine Cases.
On this month's EM Quick Hits podcast: Anand Swaminathan on the role of methylene blue in septic shock, Nour Khatib on jaw dislocation reduction techniques, Hans Rosenberg on a phenotypic approach to Crohn's disease emergencies, Gil Yehudaiff on evidence based analgesics in renal colic, Brit Long on the importance of inhaled steroids for asthma, and Andrew Petrosoniak on the "lethal diamond" in polytrauma patients and the current state of hypocalcemia in bleeding trauma patients...
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The post EM Quick Hits 51 – Methylene Blue in Septic Shock, TMJ Dislocation, Crohn’s Disease, Analgesia for Renal Colic, Inhaled Steroids for Asthma, Hypocalcemia in Bleeding Trauma Patients appeared first on Emergency Medicine Cases.
On this month's EM Quick Hits podcast David Carr on differential diagnosis of normal unenhanced CT renal colic, Leeor Sommer on recognition and management of perichondritis and auricular abscess, Suzanne Schuh on IV magnesium sulphate for pediatric asthma, Jess McLaren on Occlusion MI ECG interpretation requiring cath lab activation and Justin Morgenstern on update on steroids for pneumonia...
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The post EM Quick Hits 50 Normal Unenhanced CT Renal Colic DDx, Perichondritis, Magnesium in Pediatric Asthma, Steroids for Pneumonia, OMI Cath Lab Activation appeared first on Emergency Medicine Cases.
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 month's EM Quick Hits podcast: Anand Swaminathan on 3-pronged approach to aortic dissection management, Jonathan Wallace on rural practice tips for glue removal and ESP block for renal colic, Sara Gray on everything you need to know about High Flow Nasal Cannula but were afraid to ask, Maria Ivankovic on reducing the duration of antibiotic therapy for uncomplicated common bacterial infections, Tahara Bhate on handover and learner oversight on QI corner and Kerstin De Wit on the ADJUST-UNLIKELY tool for pulmonary embolism...
The post EM Quick Hits 47 HFNC, Dissection Drugs, ADJUST-UNLIKELY for PE, Antibiotic Course Duration, Skin Glue Hacks, ESP Block, Learner Oversight appeared first on Emergency Medicine Cases.
In this month's EM Quick Hits podcast Justin Morgenstern & Eddy Lang discuss the problem of overdiagnosis in EM, Anand Swaminathan's approach to indications and dosing of thrombolytics for submassive (intermediate risk) pulmonary embolism, Tahara Bhate's QI Corner on a patient with unexplained shortness of breath, Brit Long on emergency treatment of the bleeding hemophilia patient...
The post EM Quick Hits 39 Overdiagnosis, Lytics for Submassive PE, Pericardial Effusion, Hemophilia Treatment appeared first on Emergency Medicine Cases.
In this months EM Quick Hits podcast: Ken Milne expertly walks us through the 10 biggest EM papers of 2021, Brit Long on a careful structured approach to Febrile Neutropenia to improve outcomes, Catherine Varner on how not to miss Peripartum Cardiomyopathy, Joe Nemeth on Anaphylaxis update and Anand Swaminathan gives us his approach to the Crashing Asthmatic...
The post EM Quick Hits 35 – 10 Best Papers of 2021, Peripartum Cardiomyopathy, Crashing Asthmatic, Febrile Neutropenia, Anaphylaxis update 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 month's ECG Cases Dr. Jesse McLaren runs through 10 cases and explains how the ECG can be integral in the diagnosis and management of pulmonary embolism, even though it is not incorporated into any of the commonly used decision tools for diagnosis of pulmonary embolism...
The post ECG Cases 26: Pulmonary Embolism and Acute RV Strain 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.
What are the indications for steroids in patients with pneumonia besides those with concurrent COPD exacerbations, ARDS or adrenal shock? What is the evidence for benefit for steroids in CAP, the flu and COVID pneumonia? And if there is benefit, do those benefits outweigh the potential harms? To help us sort this out, Justin and Anton have the mighty return of a special guest - Dr. Andrew Morris in this Journal Jam podcast...
The post Journal Jam 17 – Steroids for CAP and COVID Pneumonia appeared first on Emergency Medicine Cases.
In this month's EM Quick Hits podcast we have Salim Rezaie on clinical probability adjusted D-dimer for pulmonary embolism, Bourke Tillmann on ARDS for the ED Part 2, Brit Long & Michael Gottlieb on pharyngitis mimics, Justin Hensley on the many faces of barotrauma, Hans Rosenberg & Peter Johns on assessment of continuous vertigo and Justin Morgenstern & Jeannette Wolfe on gender-based differences in CPR...
The post EM Quick Hits 23 – Clinical Probability Adjusted D-dimer, ARDS Part 2, Pharyngitis Mimics, Barotrauma, Vertigo, CPR Gender-Based Differences appeared first on Emergency Medicine Cases.
Salim Rezaie on HALT-IT trial for TXA in unstable GI bleed, Sarah Reid on pediatric DKA update in fluid management and cerebral edema, Hans Rosenberg on POCUS in shoulder dislocations via CJEM, Arun Sayal on Lisfranc injury pearls and pitfalls, Justin Morgenstern on RECOVERY Trial for Dexamethasone in COVID pneumonia, Walter Himmel on getting what you need from consultants...
The post EM Quick Hits 21 TXA in GI Bleed, Pediatric DKA, POCUS for Shoulder Dislocations, Lisfranc Injuries, Dexamethasone for COVID Pneumonia, Consultation Tips 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.
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...
The post EM Quick Hits 18 Conservative Management Pneumothorax, Microdosing Buprenorphine, Practical Use of CRITOE, Canadian TIA Score, Pediatric Surviving Sepsis Guidelines, Safety of Peripheral Vasopressors appeared first on Emergency Medicine Cases.
Anand Swaminathan on oxygenation strategies for COVID-19 learned from the New York experience, Andrew Petrosoniak on trauma care modifications in the COVID-19 era, Michelle Klaiman on addiction medicine considerations, Brit Long & Michael Gottlieb on cardiac complications of COVID-19 and Leeor Sommer on physician compassion and preserving patients' humanity...
The post EM Quick Hits 16 COVID-19 Oxygenation Strategies, Trauma Care, Addictions Considerations, Cardiovascular Complications and Compassionate Care appeared first on Emergency Medicine Cases.
The single most important thing we can do as ED providers in this COVID pandemic is to protect ourselves, our colleagues, our patients, our families and our friends against transmission of the virus; and there is no higher risk of transmission that during the resuscitation of a sick COVID patient. In this podcast we speak with a world expert on PPE, Dr. Laurie Mazurik about protecting against transmission of the virus before, during and after your shift. Not only do we discuss the details of all PPE from head protection to footwear, but we give tips on the equally important non-PPE protection as well. We touch on PPE conservation strategies as we struggle with supplies, give you the bottom line on donning/doffing sequencing, and discuss the core principles of the protected code blue...
The post Ep 139 COVID-19 Part 3 – PPE: What We Know, Conservation Strategies and Protected Code Blue appeared first on Emergency Medicine Cases.
In this special edition EM Quick Hits podcast, Drs. Eddy Lang, Salim Rezaie, Anand Swaminathan, Jonathan Sherbino and Reuben Strayer share their experience with the COVID-19 pandemic and offer some practical tips...
The post EM Quick Hits 14 – COVID-19 Your Colleagues’ Experiences and Practical Tips appeared first on Emergency Medicine Cases.
No matter where you practice emergency medicine there will be, or has been, capacity problems in the COVID-19 crisis. Even if we "flatten the COVID-19 curve" there will be a load on the systems that exceeds our capacity. Dr. Daniel Kollek, emergency physician, chair of the CAEP Disaster Medicine committee and Director of the Centre for Excellence in Emergency Preparedness, answers questions...
The post Ep 138 COVID-19 Part 2 – ED Surge Capacity Strategies in the COVID-19 Pandemic appeared first on Emergency Medicine Cases.
In this early release first podcast in a series of main episodes on COVID-19, Infectious Diseases specialist at Mount Sinai Health Systems and University Health Network and Professor at the University of Toronto Andrew Morris joins Anton on the latest on emergency screening, diagnosis and management of COVID-19, with some tips on managing yourself and your team by Howard Ovens...
The post Ep 137 COVID-19 Part 1 – Screening, Diagnosis and Management 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.
The current outbreak of the novel respiratory pathogen Coronavirus is an opportunity to remind ourselves of how to properly and adequately prepare for an emergency outbreak in our EDs. Although the mortality rate in patients with Coronavirus in this outbreak is less than 1% (which pales in comparison to Ebola or SARS), historically these types of outbreaks have occured every 5-6 years (SARS 2003, HINI 2009, Ebola 2014, Coronavirus 2020), so they are somewhat predictable and we should know how to prepare for them in our EDs. In this special edition EM Cases podcast Dr. Megan Landes, a Global Health expert, researcher and EM educator runs us through how to best practically prepare our EDs for an outbreak like Coronavirus...
The post Preparation for Emergency Infectious Outbreak in your ED – Coronavirus appeared first on Emergency Medicine Cases.
Dr. Mike Misch guides us through this part 2 of a blunt chest trauma case with a presumed bronchopulmonary fistula requiring 3 chest tubes and describes options to optimize one-lung ventilation for safe transport...
The post Crit Cases 14 Bronchopleural Fistula Management appeared first on Emergency Medicine Cases.
In this CritCases blog, Shock and Hypoxia in Blunt Chest Trauma, a collaboration between STARS Air Ambulance Service, Mike Betzner and EM Cases, Mike Misch guides us through a hairy thoracic trauma case, reviewing principles of trauma resuscitation, airway considerations, tension pneumothorax management and a rare and challenging trauma diagnosis...
The post CritCases 13 Shock and Hypoxia in Blunt Chest Trauma appeared first on Emergency Medicine Cases.
This EMU365 Video features Dr. Sarah Reid, PEM educator extraordinaire presenting her top 5 common pitfalls made in pediatric asthma diagnosis and management in the ED. She explains the importance of risk stratification using the PRAM score, early diagnosis of preschool asthma and initiating maintenance inhaled corticosteroid therapy upon discharge. ...
The post EMU365 Sarah Reid on Top 5 Pediatric Asthma Pitfalls appeared first on Emergency Medicine Cases.
Justin Morgenstern on the lack of evidence for burn debridement, Jesse MacLaren on ECG Cases - missed ischemia and pitfalls of "normal" computer ECG interpretations, Arun Sayal on clinical diagnosis pitfalls of compartment syndrome, Sarah Reid on pediatric asthma pitfalls and myths, Andrew Petrosoniak on T-spine and L-spine fracture work-up, Michelle Klaiman & Taryn Lloyd on motivational interviewing part 2...
The post EM Quick Hits 9 Burn Blister Debridement, ECG Cases, Compartment Syndrome, Pediatric Asthma, Spinal Trauma, Motivational Interviewing P2 appeared first on Emergency Medicine Cases.
While community acquired pneumonia (CAP) is 'bread and butter' emergency medicine, and the diagnosis is often a 'slam dunk', it turns out that up one third of the time, we are wrong about the diagnosis; that x-rays are not perfect; that blood work is seldom helpful; that not all antibiotics are created equal and that deciding who can go home and who needs to go to the ICU isn’t always so clear cut. With this in mind we are taking a deep dive into CAP, from diagnosis to disposition so that we can better achieve our EM goals of stabilizing sick patients, getting the right diagnosis, initiating the best treatment with the information at hand, prognosticating/appropriately deciding on disposition of patients, and being healthcare and antimicrobial stewards...
The post Ep 130 Community Acquired Pneumonia: Emergency Management appeared first on Emergency Medicine Cases.
In this EM Cases Best Case Ever podcast Rajiv interviews Dr. Eric Russell, Assistant Professor of Pediatrics at the Baylor College of Medicine, Pediatric Emergency Medicine attending physician at the Texas Children's Hospital, and editor at the Human Diagnosis Project. They discuss a challenging case of a pediatric patient who presents with what at first appears to be bronchiolitis...
The post BCE 80 Pediatric Respiratory Failure appeared first on Emergency Medicine Cases.
In this EM Quick Hits Podcast: Ludwig's Angina Emergency Management - Approach, Airway, Imaging, Transient Monocular Vision Loss (TMVL), D-dimer in the Work-up of Pulmonary Embolism in Pregnancy, Management of Pediatric Nasal Foreign Bodies: Tips and Tricks, Sulfamethoxazole-Trimethoprim Drug Interactions and Airway Options in Cardiac Arrest - LMA for all?...
The post EM Quick Hits 5 Ludwig’s Angina, Transient Monocular Vision Loss, D-dimer for PE Workup in Pregnancy, Pediatric Nasal Foreign Bodies, Trimethoprim Drug Interactions, Airway Management in Cardiac Arrest appeared first on Emergency Medicine Cases.
The final EMU365 video from EMU2018 features Dr. Amit Shah who discusses decision making and dosing around the use of thrombolytics in PE in the context of cardiac arrest, massive PE and submassive PE; the controversy around using half dose alteplase, and nuanced decision making around which patients with submassive PEs should have thrombolysis...
The post EMU 365 Thrombolysis in Pulmonary Embolism with Amit Shah appeared first on Emergency Medicine Cases.
This Best Case Ever elucidates the practical challenges of working up pregnant patients in the ED with a suspicion of pulmonary embolism. Since this recording, the first ever multi-center prospective outcome study looking at the pulmonary embolism workup in pregnancy was published in the Annals of Internal Medicine. A suggested algorithm and analysis of the study by Lauren Westafer are provided in these show notes....
The post BCE 77 Pulmonary Embolism Workup in Pregnancy appeared first on Emergency Medicine Cases.
In Part 1 of Pulmonary Embolism Challenges in Diagnosis Drs. Helman, Lang and DeWit discussed a workup algorithm using PERC and Wells score, the bleeding risk of treated pulmonary embolism, pearls in decision making on whether or not to work up a patient for pulmonary embolism, how risk factors contribute to pretest probability, the YEARS criteria and age-adjusted D-dimer. In this Part 2 we answer questions such as: what are the important test characteristics of CTPA we need to understand? Which patients with subsegmental pulmonary embolism should we treat? When should we consider VQ SPECT? What is the best algorithm for the work up of pulmonary embolism in pregnant patients? How best should we implement pulmonary embolism diagnostic decision tools in your ED? and many more…
The post Ep 114 Pulmonary Embolism Challenges in Diagnosis 2 – Imaging, Pregnancy, Subsegmental PE appeared first on Emergency Medicine Cases.
Dr. Kerstin DeWit and Dr. Eddy Lang answer the questions that plague us on almost every shift: Which patients require any work-up at all for PE? What’s the utility of PERC and Well’s scores? Should the newer YEARS decision tool supplant Well’s? When should we order a D-dimer? What’s the diagnostic role of CXR, ECG, POCUS, CTA and VQ? How should we work up pregnant patients for PE? How can we use shared decision making strategies for PE to help us do what’s best for our patients, and many more...
The post Ep 113 Pulmonary Embolism Challenges in Diagnosis Part 1 appeared first on Emergency Medicine Cases.
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...
The post POCUS Cases 2 Pneumothorax appeared first on Emergency Medicine Cases.
In this CritCases blog - a collaboration between STARS Air Ambulance Service, Mike Betzner and EM Cases we discuss a challenging case of pulmonary hypertension where a fine balance in volume resuscitation, oxygenation and ventilation is critical.
The post CritCases 7 Pulmonary Hypertension – A Fine Balance appeared first on Emergency Medicine Cases.
Shortness of breath is a very common chief complaint in the emergency department, but despite our familiarity with this symptom, management is not always straightforward. The differential diagnosis is extensive, including the common cardiorespiratory conditions, but extending to toxicologic, hematologic, neuromuscular, metabolic, and psychiatric causes. Over the past decade, we have seen the widespread adoption of new technologies to help us manage these patients. This post will look at some new evidence on two of those technologies: noninvasive positive pressure ventilation (NIPPV) and ultrasound (POCUS). We will answer 3 questions based on 3 systematic reviews using the BEEM critical appraisal framework...
The post BEEM Cases 3 – Acute Respiratory Failure: NIPPV & POCUS appeared first on Emergency Medicine Cases.
In this EM Cases episode on Pediatric Asthma we discuss risk stratification (including the PASS and PRAM scores), indications for CXR, the value of blood gases, MDIs with spacer vs nebulizers for salbutamol and ipatropium bromide, the best way to give corticosteroids, the value of inhaled steroids, the importance of early administration of magnesium sulphate in the sickest kids, and the controversies around the use of ketamine, heliox, high flow nasal cannuala oxygen, NIPPV, epinephrine and IV salbutamol in severe asthma exacerbations. So, with the multinational and extensive experience of Dr. Dennis Scolnik, the clinical fellowship Program Director at The Hospital for Sick Children in Toronto and Dr. Sanjay Mehta, multiple award winning educator who you might remember from his fantastic work on our Pediatric Orthopedics episode, we'll help you become more comfortable the next time you are faced with a child with asthma who is crashing in your ED...
The post Episode 79 – Management of Acute Pediatric Asthma Exacerbations appeared first on Emergency Medicine Cases.
Welcome to EM Cases' CritCases blog, a collaboration between Mike Betzner, the STARS air ambulance service and EM Cases’ Michael Misch and Anton Helman! These are educational cases with multiple decision points where there is no strong evidence to guide us. Various strategies and opinions from providers around the world are coalesced and presented to you in an engaging format. Enjoy!
The post CritCases 2 – Is this Septic Shock with Pneumonia? appeared first on Emergency Medicine Cases.
Dr. Salim Rezaie of R.E.B.E.L. EM tells his Best Case Ever of a Low Risk Pulmonary Embolism that begs us to consider a work-up and management plan that we might not otherwise consider. With new guidelines suggesting that subsegmental pulmonary embolism need not be treated with anticoagulants, exceptions to Well's Score and PERC rule to help guide work-ups, the adaptation of outpatient management of pulmonary embolism, and the option of NOACs for treatment, the management of pulmonary embolism in 2016 has evolved considerably. In which situations would you treat subsegmental pulmonary embolism? How comfortable are you sending patients home with pulmonary embolism? How does the patient's values play into these decisions? Listen to Dr. Rezaie provide an insightlful perspective on these important issues and much more...
The post Best Case Ever 44 Low Risk Pulmonary Embolism appeared first on Emergency Medicine Cases.
In response to Episode 59 with Dr. Sanjay Mehta and Dr. Dennis Scolnik on the emergency department diagnosis and management of Bronchiolitis, Dr. Amy Plint, one of Canada's most prominent researchers in Bronchiolitis and the Chair of Pediatric Emergency Research Canada, tells her practical approach to choosing medications in the emergency department, the take home message from her landmark 2009 NEJM study on the use of nebulized epinephrine and dexamethasone for treating Bronchiolitis, and the future of Bronchiolitis research.
The post Episode 59b: Amy Plint on the Management of Bronchiolitis appeared first on Emergency Medicine Cases.
This EM Cases episode is on the diagnosis and management of Bronchiolitis. Bronchiolitis is one of the most common diagnoses we make in both general and pediatric EDs, and like many pediatric illnesses, there’s a wide spectrum of severity of illness as well as a huge variation in practice in treating these children. Bronchiolitis rarely requires any work up yet a lot of resources are used unnecessarily. We need to know when to worry about these kids, as most of them will improve with simple interventions and can be discharged home, while a few will require complex care. Sometimes it’s difficult to predict which kids will do well and which kids won’t. Not only is it difficult to predict the course of illness in some of these children but the evidence for different treatment modalities for Bronchiolitis is all over the place, and I for one, find it very confusing. Then there’s the sphincter tightening really sick kid in severe respiratory distress who’s tiring with altered LOC. We need to be confident in managing these kids with severe disease.
So, with the help of Dr. Dennis Scolnik, the clinical fellowship program director at Toronto’s only pediatric emergency department and Dr. Sanjay Mehta, an amazing educator who you might remember from his fantastic work on our Pediatric Ortho episode, we’ll sort through how to assess the child with respiratory illness, how to predict which kids might run into trouble, and what the best evidence-based management of these kids is.
The post Episode 59: Bronchiolitis appeared first on Emergency Medicine Cases.
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.....
The post Journal Jam 2: Small Bore Chest Tube and Outpatient Management of Pneumothorax appeared first on Emergency Medicine Cases.
In this first ever episode of the Journal Jam podcast, a collaboration between EM Cases, Academic Life in EM and The Annals of Emergency Medicine's Global Emergency Medicine Journal Club, Teresa Chan and I, along with Jeff Kline, Jonathan Kirschner, Anand Swaminathan, Salim Rezaie and Sam Shaikh from ALiEM, discuss the potential for Age Adjusted D-dimer to rule out pulmonary embolism in low risk patients over the age of 50.
We discuss 4 key questions about the ADJUST-PE Study from JAMA in March 2014 including: Would you order a CTPA on a 60 year old woman with an age adjusted D-dimer of 590 ng/L?
The problem until now has been that the older the patient, the more likely the D-dimer is to be positive whether they have a PE or not, so many of us have thrown the D-dimer out the window in older patients and go straight to CTPA, even in low risk patients. If you are a risk averse doc, this strategy will lead to over-utilization of resources, huge costs, length of stay, radiation effects etc; and if you’re not so risk averse, then you might decide not to work up the low risk older patient at all and miss clinically important PEs.
expert peer reviewFor all the questions discussed on this podcast, the original Google Hangout interview from which this podcast was based, and the crowd sourced opinions from around world, visit the ALiEM website. Many thanks to all the talented people who made this podcast possible. Together, we're smarter!
The post Journal Jam 1: Age Adjusted D-dimer with Jeff Kline and Jonathan Kirschner appeared first on Emergency Medicine Cases.
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.
The post Best Case Ever 24: COPD, Baggging and Vent Settings appeared first on Emergency Medicine Cases.
Dr. Leeor Sommer who runs ENT hands-on workshops and Dr. Maria Ivankovic, lecturer extraordinaire on ENT emergencies discuss ENT Emergencies Pearls, Pitfalls, Tips & Tricks:
Dr. Ivankovic's stepwise approach to managing epistaxis including the best local anesthetics, the use of ice to decrease nasal flow, who requires antibiotics, the management of hypertension in epistaxis, tranexamic acid for nose bleeds and managing posterior bleeds, tips for nasal and ear foreign body removal including the use of tissue adhesive, how to pick up and work up the dreaded Malignant Otitis Externa including key diagnostic pearls the best tests, sudden sensorineural hearing loss ('The Bells' Palsy of the Ear') including how to save a patient from losing their hearing, Epiglottitis including diagnostic clues and imaging findings, Pharyngitis work-up and treatment: Do we need to work-up and treat with antibiotics at all? & The Toronto Throat Score, Tips and Tricks for peritonsillar abscess drainage, Hereditary and ACE-inhibitor associated Angioedema presentations and management including the use of C1 Esterase inhibitors.
The post Episode 38: ENT Emergencies Pearls, Pitfalls, Tips and Tricks appeared first on Emergency Medicine Cases.
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.
The post Episode 32: Whistler Update in Emergency Medicine Conference 2013 appeared first on Emergency Medicine Cases.
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.
The post Episode 31: LP, Spontaneous Pneumothorax and Ultrasound Guided Fracture Reduction appeared first on Emergency Medicine Cases.
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.
The post Episode 24: COPD and Pneumonia appeared first on Emergency Medicine Cases.
In this episode on Pulmonary Embolsim we have the triumphant return of Dr. Anil Chopra, the Head of the Divisions of Emergency Medicine at University of Toronto, and Dr. John Foote the CCFP(EM) residency program director at the University of Toronto. We kick it off with Dr. Foote's approach to undifferentiated dyspnea and explanation of Medically Unexplained Dyspea ('MUD') and go on to discuss how best to develop a clinical pre-test probability for the diagnosis of pulmonary embolism using risk factors, the value of the PERC rule, Well's criteria and how clinical gestalt plays into pre-test probability. Dr. Chopra tells about the appropriate use of D-dimer to improve our diagnostic accuracy without leading to over-investigation and unwarranted anticoagulation. We then discuss the value of V/Q scan in the workup of PE, and the pitfalls of CT angiography. A discussion of anticoagulation choices follows and the controversies around thrombolysis for submassive PE are reviewed.
The post Episode 21: Pulmonary Embolism appeared first on Emergency Medicine Cases.
Acute Dyspnea has a wide differential diagnosis from Metabolic Acidosis to Medically Unexplained Dyspnea. As a bonus to Episode 21 on Pulmonary Embolism and Acute Dyspnea, Dr. John Foote the CCFP(EM) residency program director at the University of Toronto presents his Best Case Ever related to an Acute Dyspnea presentation. In the related episode on Pulmonary Embolism we havet, with Dr. Foote, the triumphant return of Dr. Anil Chopra, the Head of the Divisions of Emergency Medicine at University of Toronto . We kick it off with Dr. Foote’s approach to undifferentiated acute dyspnea and explanation of Medically Unexplained Dyspea (‘MUD’) and go on to discuss how best to develop a clinical pretest probability for the diagnosis of pulmonary embolism using risk factors, the value of the PERC rule, Well’s criteria and how clinical gestalt plays into pretest probability. Dr. Chopra tells about the appropriate use of D-dimer to improve our diagnostic accuracy without leading to over-investigation and unwarranted anticoagulation. We then discuss the value of V/Q scan in the workup of PE, and the pitfalls of CT angiography. A discussion of anticoagulation choices follows and the controversies around thrombolysis for submassive PE closes the podcast.
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The whole playing field changes with pregnant patients in the emergency department. When you're faced with one of the Medical and Surgical Emergencies in Pregnancy that we'll cover in this episode, there are added challenges and considerations. Dr. Shirley Lee and Dr. Dominick Shelton discuss a challenging case of a pregnant patient presenting to the emergency department with shortness of breath and chest pain. They review those diagnoses that the pregnant patient is at risk for and discuss the challenges of lab test interpretation and imaging algorithms in the pregnant patient. Next, they walk us through the management of cardiac arrest in the pregnant patient. In another case of a pregnant patient who presents with abdominal pain and fever, they discuss strategies to minimize delays in diagnosis to prevent serious morbidity and mortality. The pros and cons of abdominal ultrasound, CT and MRI are reviewed as well as the management of appendicitis, pyelonephritis and septic abortion in pregnant patients.
The post Episode 7: Medical and Surgical Emergencies in Pregnancy appeared first on Emergency Medicine Cases.