BNP is currently in use in many EDs across North America and Europe. In this Journal Jam podcast we discuss the clinical utility of BNP and pro-NT-BNP in the work-up of the dyspneic ED patient. We ask the questions: does BNP add much beyond physician gestalt? Which patients might BNP be useful for? Should we abandon BNP as a dichotomous rule-in/rule-out variable and instead use it as a continuous variable? Does using BNP effect patient oriented outcomes? Is lung POCUS a better test? Are predicti...
Mar 13, 2018•50 min
In anticipation of EM Cases Episode 107 on Pediatric Physical Abuse with Dr. Carmen Coombs and Dr. Alyson Holland, Dr. Coombs tells her Best Case Ever (actually worst case ever) that inspired her to pursue expertise in pediatric physical abuse...
Mar 13, 2018•11 min
In this live podcast on Blunt Ocular Trauma from The EM Cases Course 2018 with Anna MacDonald we discuss the most important diagnoses to consider, describe how physical exam in queen while CT can misguide you, explain a simple approach to orbital compartment syndrome with retrobulbar hematoma, give you tips on lateral canthotomy, how to pick up subtle hyphemas, why sickle cell patients are high risk, describe the key clinical clues to subtle globe rupture, the role of tranexamic acid in eye blee...
Feb 27, 2018•59 min
When patients with known congenital heart disease present to the ED with common illnesses we need to consider how their physiology might alter our approach to those common illnesses. Max Ben-Yakov guides us through his Best Case Ever of a CHD patient who presents with bronchiolitis and gives us some tips on how best to approach these fragile patients in a crisis situation...
Feb 13, 2018•16 min
We see patients with toxic alcohol poisoning most commonly in three clinical scenarios. One, after an intentional suicide attempt where they tell you exactly what they took; two, when they come in agitated and won’t give you a history and the three, the inebriated patient found down. Alcohol is everywhere, and inevitably inebriated people show up at your ED with a myriad of medical and psychiatric problems. It’s our job as ED professionals, not only to identify traumatic, medical and psychiatric...
Jan 30, 2018•1 hr 18 min
I was taken aback when I came across the statistic that approximately every 6 days a woman in Canada is killed by her intimate partner. Victims of intimate partner violence and domestic violence that we see in the ED typically involve an abuse story of repeated escalating violence over time that ends up in a crisis situation. The woman is often financially dependent on her abuser and has no one to turn to for help. In one of her worst cases ever from Janus General, Dr. Meeta Patel and I discuss ...
Jan 23, 2018•13 min
You probably can't remember the last time you worked a shift in the ED and didn’t see at least one patient with an ankle injury. While almost all of these patients are relatively straightforward to diagnose and manage a small but significant minority of these patients will have a more elusive diagnosis, that if not identified early, could lead to significant morbidity...
Jan 09, 2018•1 hr 20 min
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 mos...
Dec 19, 2017•1 hr 39 min
In this EM Cases Best Case Ever Hans Rosenberg and Rajiv Thavanathan discuss recognition and management pearls and pitfalls in salicylate poisoning. They answer question such as: What are the most important diagnostic clues of salicylate poisoning in the patient who presents with undifferentiated fever and altered level of awareness? What is the best timing and ventilation strategy for intubation? Which electrolyte abnormalities do you need to be on the lookout for? and many more...
Dec 05, 2017•20 min
Lauren Westafer joins Justin Morgenstern, Rory Spiegel and Anton Helman in a deep dive discussion on the world's literature on Post Contrast Acute Kidney Injury (PCAKI) in this Journal Jam podcast. Hospitals continue to insist on time consuming, and potentially dangerous protocols for administration of fluids to patients with renal dysfunction prior to CT IV contrast despite the lack of evidence that Contrast Induced Nephropathy (CIN) even exists. Would you choose a different imaging modality if...
Nov 21, 2017•1 hr 10 min
Burnout – it’s the elephant in the room that we all know about but prefer not to discuss. Yet according to a 2013 Medscape survey, 40% of physicians reported burnout in U.S. In this episode, Sara Gray and Chris Trevelyan present an honest approach to preventing burnout and promoting wellness, outlining strategies both at the individual and systems levels. They explain why wellness matters, how you can strive to achieve it and how to recognize when you or a colleague are unwell so that you can ge...
Nov 07, 2017•1 hr 38 min
Dr. Sarah Gray tells us the story of her worst case ever and what she learned from it. About 50% of North American physicians involved in a serious medical error report increased anxiety for future errors, decreased confidence in their job, decreased job satisfaction, insomnia, PTSD, panic disorder – the list goes on. Dr. Gray shares how and why many of us react to medical error - the embarrassment, the shame, the guilt and sense of failure. She then explains the notion of acceptance that we all...
Oct 31, 2017•13 min
In Part 2 of our two part podcast on GI Bleed Emergencies Anand Swaminathan and Salim Rezaie kick off with a discussion on the evidence for benefit of various medications in ED patients with upper GI bleed. PPIs, somatostatin analogues such as Octreotide, antibiotic prophylaxis and prokinetics have varying degrees of benefit, and we should know which ones to prioritize. We then discuss the usefulness of the Glasgow-Blatchford and Rockall scores for risk stratification and disposition of patient ...
Oct 17, 2017•30 min
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 t...
Oct 10, 2017•1 hr 36 min
If you were faced with stab wound to the neck and had to act fast, would you have a well-thought out plan that you are comfortable with? In this EM Cases Best Case Ever podcast we discuss the do's and don'ts of penetrating upper airway injury awake intubation with airway expert George Kovacs....
Sep 26, 2017•27 min
As ED docs we’re particularly well suited to take a lead in disaster medicine. We own this. In this EM Cases podcast, with the help of Laurie Mazurik, Daniel Kollek and Joshua Bezanson we will help you become familiar with a general approach to mass casualties, how to handle critical infrastructure disruption in your ED, management of biohazards including airway management, chemical hazards including decontamination and finally evacuation principles in the case of a natural disaster...
Sep 12, 2017•1 hr 33 min
In anticipation of EM Cases Main Episode 100 on Disaster Medicine with Laurie Mazurik, David Kollek and Joshua Bezanson, Dr. Mazurik tells of her experience as a disaster medicine leader with keeping health care workers safe during the SARS era. If you were faced with a patient with suspected Ebola or drug resistant TB or any other biohazard patient who required intubation, would you know how to handle the situation so that you and your colleagues were safe...
Aug 28, 2017•12 min
North York General Hospital's 30th Annual Emergency Medicine Update (EMU) Conference 2017 featured some of the best talks I've ever heard from the likes of Sara Gray, Amal Mattu, David Carr and many more. I had a hard time choosing which talks to feature on this EM Cases podcast. I settled on a potpourri of clinical topics and practice tips: Leeor Sommer on Lyme disease, Chris Hicks on signover, Matt Poyner on patient complaints and Walter Himmel on acute vestibular syndrome...
Aug 15, 2017•1 hr 8 min
In this EM Cases podcast Dr. Joel Lockwood tells his Best Case Ever of a prehospital trauma resuscitation, bringing to light the challenges faced by EMS with the complicated trauma patient. He discusses the importance of checklists, practice and simulation to help streamline the process, offloading some cognitive burden, prepare the team, reduce the change of errors, improve efficiency and etch actions into each team member's muscle memory.
Aug 01, 2017•13 min
We discuss some quick, easy tips on how you can take your educating skills to the next level, from orienting the learner and establishing expectations at the start of the shift, to key questioning techniques to use in case presentations, to the lost art of active observation, to the One Minute Preceptor model, to giving effective end-of-shift feedback, medicine’s white whale. We end with a surprise appearance by another master educator who gives his top pearls on teaching on shift. This podcast ...
Jul 18, 2017•1 hr 18 min
In this part 2 of EM Cases Journal Jam podcast on Thrombolysis and Endovascular Therapy for Stroke Justin Morgenstern, Rory Spiegel and Anton Helman do a deep dive into the world's literature on endovascular therapy for stroke. While the evidence for endovascular therapy is stronger than that for IV systemic thrombolysis for stroke outcomes at 90 days, a closer look at the literature reveals that a very small minority of patients are eligible for endovascular therapy and we still don't know whic...
Jul 04, 2017•40 min
In this two part EM Cases Journal Jam podcast Justin Morgenstern, Rory Spiegel and Anton Helman do a deep dive into the world's literature on systemic thrombolysis for ischemic stroke followed by an analysis of endovascular therapy for stroke. We elucidate the important issues related to p-values, ordinal analysis, fragility index, heterogeneity of studies, stopping trials early and conflicts of interest related to this body of evidence. While "calling a code stroke" is now considered standard f...
Jul 04, 2017•1 hr 29 min
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.....
Jun 28, 2017•14 min
Quick and insightful reviews of 17 important adult and pediatric emergency medicine studies from 2016: The PROCAMIO study for stable VT, platelets for head bleeds (PATCH), BP lowering in ICH (ATACH II), antibiotics for abscesses, work up of subarachnoid hemorrhage, dosing IV ketorolac, the PESIT trial, ketamine dosage for sedation in pediatrics, instructions after minor head injury, Salter-Harris I fractures of the lateral malleolus, interpreting oxygen saturation for disposition making in child...
Jun 13, 2017•59 min
It's not only run of the mill DKA, starvation and alcoholic ketoacidosis that can cause a metabolic acidosis with elevated ketones. Euglycemic DKA can be caused by the newer diabetes medications sodium-glucose co-transporter 2 inhibitors like Canagliflozin; and it's important to recognize this tricky diagnosis early and initiate treatment for DKA despite a normal serum glucose level...
Jun 06, 2017•15 min
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...
May 23, 2017•21 min
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 pri...
May 09, 2017•1 hr 40 min
Airway management requires a lot things; it requires not only technical skills and specific considerations of anatomy and physiology but a co-ordinated team who can communicate clearly and react to a whole slew of potentially challenging situations. On this month's Best Case Ever podcast we use the framework of a new mnemonic PREPARE to discuss human factors, situational awareness and some airway tips and tricks with intensivist Peter Brindley, human factors expert Chris Hicks and EM-intensivist...
Apr 25, 2017•34 min
In 2014, the CDC reported that UTI antibiotic treatment was avoidable at least 39% of the time. Why? Over-diagnosis and treatment results from the fact that asymptomatic bacteriuria is very common in all age groups, urine cultures are frequently ordered without an appropriate indication, and urinalysis results are often misinterpreted. Think of the last time you prescribed antibiotics to a patient for suspected UTI – what convinced you that they had a UTI? Was it their story? Their exam? Or was ...
Apr 12, 2017•1 hr 33 min
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...
Mar 28, 2017•21 min
