round table discussions on emergency medicine cases

Episode 90 – Low and Slow Poisoning

One of the things we need to think about whenever we see a patient who’s going low and slow with hypotension and bradycardia is an overdose. B-blockers, calcium channel blockers (CCB) and digoxin are some of the most frequently prescribed cardiovascular drugs. And inevitably we’re gonna be faced with both intentional and unintentional overdoses from these drugs in the ED. If we can recognize these overdoses early and manage them appropriately, well - we’ll save some lives...

By Anton Helman|2021-03-30T14:37:46-04:00January 3rd, 2017|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Toxicology|Tags: activated charcoal, b-blocker, CCB, digifab, digoxin, Emily Austin, gastric lavage, high dose insulin, intralipid, lipid emulsion, Margaret Thompson, whole bowel irrigation|4 Comments

Episode 89 – DOACs Part 2: Bleeding and Reversal Agents

In this Part 2, DOACs Bleeding and Reversal we discuss the management of bleeding in patients taking DOACs with minor risk bleeds, like epistaxis where local control is easy to access, moderate risk bleeds, like stable GI bleeds and high risk bleeds, like intracranial hemorrhage. We answer questions such as: How do we weigh the risks and benefits of stopping the DOAC? When is reversal of the DOAC is advised? How best do we accomplish the reversal of DOACs? Is there any good evidence for the newest reversal agent? When should we stop DOACs for different procedures, and when should we delay the procedure?

By Anton Helman|2021-03-30T14:38:50-04:00December 6th, 2016|Categories: EM Cases, Emergency Medicine, Episodes, Gastroenterology, Hematology, Medical Specialty, Neurology|Tags: abixiban, Andexanet Alfa, dabigitran, epistaxis, GI bleed, ICH, Idarucizumab, Jim Douketis, PCCs, rivaroxiban, Walter HImmel|4 Comments

Episode 88 – DOACs Part 1: Use and Misuse

As we get better at picking up thromboembolic disease, and the indications for Direct Oral Anticoagulants (DOACs) widen, we're faced with increasingly complex decisions about when to start these medications, how to start them, when to stop them and how to manage bleeding associated with them. There’s a lot that we need to know about these drugs to minimize the risk of thromboembolism in our patients while at the same time minimizing their risk of bleeding...

By Anton Helman|2024-08-06T22:19:17-04:00November 22nd, 2016|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Hematology, Medical Specialty|Tags: Abixaban, atrial fibrillation, CHADS65, dabigitran, DVT, Jim Douketis, rivaroxiban, Walter HImmel|1 Comment

Episode 87 – Alcohol Withdrawal and Delirium Tremens: Diagnosis and Management

Alcohol withdrawal is everywhere. We see over half a million patients in U.S. EDs for alcohol withdrawal every year. Despite these huge volumes of patients and the diagnosis of alcohol withdrawal seeming relatively straightforward, it’s actually missed more often than we’d like to admit, being confused with things like drug intoxication or sepsis. Or it’s not even on our radar when an older patient presents with delirium. What’s even more surprising is that even if we do nail the diagnosis, observational studies show that in general, alcohol withdrawal is poorly treated. So, to help you become masters of alcohol withdrawal management, our guest experts on this podcast are Dr. Bjug Borgundvaag, an ED doc and researcher with a special interest in emergency alcohol related illness and the director of Schwartz-Reismann Emergency Medicine Institute, Dr. Mel Kahan, an addictions specialist for more than 20 years who’s written hundreds of papers and books on alcohol related illness, and the medical director of the substance use service at Women’s College Hospital in Toronto, and Dr. Sara Gray, ED-intensivist at St. Michael's Hospital...

By Anton Helman|2024-05-21T02:01:40-04:00October 25th, 2016|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Special Populations, Toxicology|Tags: benzodiazepine, Bjug Borgundvaag, CIWA, dexmeditomidine, Mel Kahan, phenobarbital, Sara Gray, SHOT, thiamine|9 Comments

Episode 86 – Emergency Management of Hyperkalemia

This is 'A Nuanced Approach to Emergency Management of Hyperkalemia' on EM Cases. Of all the electrolyte emergencies, hyperkalemia is the one that has the greatest potential to lead to cardiac arrest. And so, early in my EM training I learned to get the patient on a monitor, ensure IV access, order up an ECG, bombard the patient with a cocktail of kayexalate, calcium, insulin, B-agonists, bicarb, fluids and furosemide, and get the patient admitted, maybe with some dialysis to boot. Little did I know that some of these therapies were based on theory alone while others were based on a few small poorly done studies. It turns out that some of these therapies may cause more harm than good, and that precisely when and how to give these therapies to optimize patient outcomes is still not really known...

By Anton Helman|2022-02-17T13:42:30-05:00September 27th, 2016|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Medical Specialty, Resuscitation|Tags: calcium chloride, digoxin toxicity, Ed Etchells, kayexelate, Melanie Baimel|13 Comments

Episode 85 – Medical Clearance of the Psychiatric Patient

Psychiatric chief complaints comprise about 6 or 7% of all ED visits, with the numbers of psychiatric patients we see increasing every year. The ED serves as both the lifeline and the gateway to psychiatric care for millions of patients suffering from acute behavioural or psychiatric emergencies. As ED docs, besides assessing the risk of suicide and homicide, one of the most important jobs we have is to determine whether the patient’s psychiatric or behavioral emergency is the result of an organic disease process, as opposed to a psychological one. There is no standard process for this. With the main objective in mind of picking up and appropriately managing organic disease while improving flow, decreasing cost and maintaining good relationships with our psychiatry colleagues, we have Dr. Howard Ovens, Dr. Brian Steinhart and Dr. Ian Dawe discuss this controversial topic...

By Anton Helman|2021-03-30T14:44:30-04:00August 29th, 2016|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Neurology, Psychiatry, Special Populations, Toxicology|Tags: Brian Steinhart, CT head, Howard Ovens, Ian Dawe, urine drug screen|1 Comment

Episode 84 – Congenital Heart Disease Emergencies

Congenital Heart Disease Emergencies on EM cases with Gary Joubert and Ashley Strobel. You might be surprised to learn that the prevalence of critical cardiac disease in infants is almost as high as the prevalence of infant sepsis. And if you’re like me, you don’t feel quite as confident managing sick infants with critical heart disease as you do managing sepsis. Critical congenital heart defects are often missed in the ED. For a variety of reasons, there are currently more children with congenital heart disease presenting to the ED than ever before and these numbers will continue to grow in the future. When I was in medical school I vaguely remember learning the complex physiology and long lists of congenital heart diseases, which I’ve now all but forgotten. What we really need to know about congenital heart disease emergencies is what actions to take in the ED when we have a cyanotic or shocky baby in front of us in the resuscitation room. So with the goal of learning a practical approach to congenital heart disease emergencies using the child’s age, colour and few simple tests, Dr. Strobel and Dr. Joubert will discuss some key actions, pearls and pitfalls so that the next time you’re faced with that crashing baby in the resuscitation room, you’ll know exactly what to do.

By Anton Helman|2021-03-30T14:45:22-04:00August 10th, 2016|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Medical Specialty, Pediatrics, Resuscitation|Tags: Ashley Strobel, BNP, CHF, congestive heart failure, cyanosis, cyanotic infant, etomidate, Gary Joubert, hypoxia test, prostaglandins|3 Comments

Episode 83 – 5 Critical Care Controversies from SMACC Dublin

EM Cases Episode 83 - 5 Critical Care Controversies from SMACC Dublin: I had the great opportunity to gather some of the brightest minds in Emergency Medicine and Critical Care from around the world (Mark Forrest from U.K., Chris Nickson from Australia, Chris Hicks from Canada and Scott Weingart from U.S.) at the SMACC Dublin Conference and ask them about 5 Critical Care Controversies and concepts: How to best prepare your team for a resuscitation Optimum fluid management in sepsis Direct vs. video laryngoscopy as first line tool for endotracheal intubation Early vs. late trauma intubation Whether or not to attempt a thoracotomy in non-trauma centres The discussion that ensued was enlightening...

By Anton Helman|2021-03-30T14:46:15-04:00July 5th, 2016|Categories: Conference, EM Cases, Emergency Medicine, Episodes, Medical Specialty, Resuscitation, Trauma|Tags: Chris Hicks, Chris Nickson, fluid responsiveness, fluid tolerance, Mark Forrest, rally point, Scott Weingart, team preparation, thoracotomy, trauma intubation, vasopressors|0 Comments

Episode 82 – Emergency Radiology Controversies

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...

By Anton Helman|2021-03-30T14:48:26-04:00June 7th, 2016|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Ultrasound|Tags: computed tomography, contrast reaction, CT contrast, CT radiation, CXR, Fleischner Criteria, pneumoperitoneum, ultrasound, Walter HImmel|6 Comments

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

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

By Anton Helman|2021-03-30T14:51:38-04:00May 23rd, 2016|Categories: Emergency Medicine, Episodes, Genitourinary, Medical Specialty, Whistler Update in EM|Tags: Joel Yaphe, low back pain, medical expulsive therapy, nephrolithiasis, renal colic, REVERT trial, SVT, tamsulosin, Whistler|0 Comments