round table discussions on emergency medicine cases

Episode 43 – Appendicitis Controversies

In this episode on Appendicitis Controversies, we have the continuation of our discussion on abdominal pain emergencies with Dr. Brian Steinhart & Dr. David Dushenski. We kick off the discussion with key clinical pearls and pitfalls in the history and physical exam with their respective liklihood ratios when assessing patients with abdominal pain for appendicitis - a diagnosis that is still sometimes missed despite its prevalence. Dr. Dushenski hacks apart the Alvarado and Appendicitis Inflammatory Response Scores and we discuss the value of WBC, CRP and urinalysis in the work-up of appendicitis. Next up are the controversies of imaging algorithms using ultrasound and CT abdomen, as well as the factors affecting which imaging algorithm you might pursue. We wrap up the discussion on Appendicitis Controversies with a critical look at the value of antibiotics in the ED for appendicitis and which patients might be appropriate for non-surgical management.

By Anton Helman|2022-01-05T23:15:48-05:00April 22nd, 2014|Categories: EM Cases, Emergency Medicine, Episodes, Gastroenterology|Tags: Alvarado Score, Brian Steinhart, clinical decision rules, CT Abdomen, David Dushenski, ultrasound|2 Comments

Episode 42: Mesenteric Ischemia and Pancreatitis

In this episode Dr. Steinhart, (one of my biggest mentors – the doc that everyone turns to when no one can figure out what’s going on with a patient in the ED), & Dr. Dave Dushenski, (a master of quality assurance and data analysis, who would give David Newman a run for his money), discuss the 4 diagnoses that make up the deadly & difficult diagnosis of Mesenteric Ischemia, it’s key historical and physical exam features, the value of serum lactate, D-dimer & blood gas, when CT can be misleading, ED management of Mesenteric Ischemia, the difficult post-ERCP abdominal pain patient, the pitfalls in management of Pancreatitis, the BISAP score for Pancreatitis compared to the APACHE ll & Ranson Score, the comparative value of amylase and lipase, ultrasound vs CT for pancreatitis and much more…

By Anton Helman|2021-03-30T17:11:05-04:00March 29th, 2014|Categories: EM Cases, Emergency Medicine, Episodes, Gastroenterology|Tags: Amylase, BISAP score, Brian Steinhart, clinical decision rules, D-dimer, David Dushenski, Lactate, Lipase, Mesenteric Ischemia, pancreatitis, post-ERCP|1 Comment

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.

By Anton Helman|2024-08-10T19:20:03-04:00March 24th, 2014|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Resuscitation|Tags: acute renal failure, aortic dissection, Clare Atzema, congestive heart failure, eclampsia, hypertensive encephalopathy, intractranial hemorrhage, Joel Yaphe, labetolol, nicardipine, nitroprusside, subarachnoid hemorrhage|18 Comments

Episode 40: Asymptomatic Hypertension

University of Toronto EM Residency program director, Joel Yaphe and cardiovascular EM researcher, Clare Atzema discuss the guidelines, controversies, pearls & pitfalls of Asymptomatic Hypertension in the ED. The literature is thin in this area, and there are many controversies: Does an elevated BP measured in the ED represent true essential hypertension? Do these patients need to be worked up? Are they at risk of serious morbidity and mortality? Should we treat these patients in the ED with antihypertensives? Should we send them home on antihypertensives? and many more......

By Anton Helman|2024-08-10T19:18:54-04:00February 20th, 2014|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes|Tags: ACE Inhibitor, acep guidelines, antihypertensive, b-blocker, calcium channel blocker, Clare Atzema, feature, hydralazine, hydrocholorthiazide, hypertensive emergency, Joel Yaphe|2 Comments

Episode 39: Update in Trauma Literature

Dr. Dave MacKinnon & Dr. Mike Brzozowski return for an Update in Trauma Literature since the epic Episode 10: Trauma Pearls & Pitfalls. In this episode we discuss predicting the sick trauma patient, videolaryngoscopy vs traditional laryngoscopy, Damage Control Resuscitation, Occult Hemothorax, Blunt Thoracic Aorta and Cardiac Injury, Sternal Fractures, Tranexamic Acid, Communication in the trauma bay and much more......

By Anton Helman|2021-03-30T17:13:06-04:00February 4th, 2014|Categories: EM Cases, Emergency Medicine, Episodes, Hematology, Resuscitation, Trauma|Tags: aortic injury, blunt cardiac injury, damage control resuscitation, Dave MacKinnon, hemothorax, laryngoscopy, Mike Brzozowski, occult hemothorax, sternal fracture, tranexamic acid, video laryngoscopy|0 Comments

Episode 38: ENT Emergencies Pearls, Pitfalls, Tips and Tricks

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.

By Anton Helman|2021-04-02T13:17:21-04:00November 19th, 2013|Categories: Ears Nose & Throat, EM Cases, Emergency Medicine, Episodes, Respirology, Resuscitation|Tags: angioedema, epiglottitis, epistaxis, Leeor Sommer, malignant otitis externa, Maria Ivankovic, nasal foreign body, peritonsillar abscess, pharyngigits, pharyngitis, sudden sensorineural hearing loss, tranexamic|1 Comment

Episode 37: Anticoagulants, PCCs and Platelets

In the second part of this epic 2-part authoritative episode, Anticoagulants, PCCs & Platelets, we have Dr. Walter Himmel (also known as 'The walking encyclopedia of EM') along with Dr. Katerina Pavenski (Head of Transfusion Medicine at St. Michael's Hospital) & Dr. Jeannie Callum (Head of Transfusion Medicine at Sunnybrook Hospital) who will discuss the latest on comparative efficacy and reversal of Warfarin vs Dabigatran vs Rivaroxiban vs Abixaban, the use of prothrombin complex concentrates (PCCs), the ins and outs of thrombocytopenia & platelet transfusions, ITP, TTP, anti-platelet associated intracranial bleeds, indications for Tranexamic Acid & more...

By Anton Helman|2024-08-10T19:22:17-04:00October 7th, 2013|Categories: EM Cases, Emergency Medicine, Episodes, Genitourinary, Hematology, Neurology, Resuscitation|Tags: Abixaban, anticoagulants, dabigitran, ICH, intracranial hemorrhage, ITP, Jeannie Callum, Katerina Pavenski, Octaplex, PCCs, Recombinant Factor 7a, rivaroxiban, tranexamic acid, transfusions, TTP, Walter HImmel, Warfarin|1 Comment

Episode 36: Transfusions, Anticoagulants and Bleeding

In the first part of this epic 2 part must-hear episode, Transfusions, Anticoagulants & Bleeding, we have the triumphant return of Dr. Walter Himmel (also known as 'The walking encyclopedia of EM') along with Dr. Katerina Pavenski (Head of Transfusion Medicine at St. Michael's Hospital) & Dr. Jeannie Callum (Head of Transfusion Medicine at Sunnybrook Hospital) who will update you on the latest in transfusion indications & risks, managing INRs and how Wararin compares to Dabigatran, Rivaroxiban & Apixaban. They give you the authoritative low down on: Indications for red cell transfusions in different clinical scenarios (GI bleed, cardiac disease, vaginal bleeding etc) and how to give them, Risks of red cell transfusions including Host vs Graft Disease, TRALI & TACO and how to manage them, IV Iron as an alternative to red cell transfusions, Managing INRs: indications for Vit K, Prothrombin Complex Concentrates (Octaplex & Beriplex), adjusting Warfarin Dose, liver patients, and much much more.........

By Anton Helman|2024-08-10T19:22:28-04:00September 20th, 2013|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Hematology, Resuscitation|Tags: Apixiban, dabigitran, IV Iron, PCCs, Red Cell Transfusion, rivaroxiban, TACO, TRALI, Walter HImmel, Warfain|2 Comments

Episode 35: Pediatric Orthopedics Pearls and Pitfalls

Dr. Sanjay Mehta & Dr. Jonathan Pirie, two experienced Pediatric EM docs from The Hospital for Sick Children in Toronto discuss their approach to a variety of common, occult, challenging and easy to miss pediatric orthopedics diagnoses including: differentiating Septic Arthritis from Transient Synovitis of the hip, Toddler's Fracture, Tillaux Fracture, Suprachondylar Fracture, ACL tear, tibial spine & Segond fractures. They also debate the value of the Ottawa Knee Rules in kids, non-accidental trauma, pediatric orthopedic pain management, the evidence for the best management of Buckle, Greenstick, Salter 1 and 2 distal radius fractures and lateral malleolus fractures.

By Anton Helman|2021-03-31T12:58:00-04:00August 9th, 2013|Categories: EM Cases, Emergency Medicine, Episodes, Orthopaedics, Pediatrics, Trauma|Tags: ACL, Buckle Fracture, Distal Radius Fracture, Greenstick Fracture, Jonathan Pirie, Ottawa Knee Rules, Sanjay Mehta, Segond fracture, septic arthritis, suprachondylar fracture, tillaux fracture, toddler's fracture, transient synovitis|1 Comment

Episode 34: Geriatric Emergency Medicine

In this episode Dr. Don Melady, Canada's leading educator in Geriatric Emergency Medicine (Geri-EM) & Dr. Jaques Lee, one of Canada's leading researchers in Geri-EM, discuss the common yet challenging Geriatric Emergencies: a practical approach to geriatric Delirium, best practice for managing agitation and pain in the older patient, management of recurrent falls, pearls in the assessment of the 'Weak & Dizzy' geriatric patient, atypical presentations of common life threatening emergencies including ACS and surgical abdomen, key drug interactions in the geriatric patient and more..

By Anton Helman|2021-03-31T12:58:46-04:00July 8th, 2013|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Gastroenterology, Neurology, Trauma|Tags: delirium, Don Melady, drug interactions, falls, Geri-EM, Jaques Lee, Warfarin, weak and dizzy|1 Comment