round table discussions on emergency medicine cases

Episode 33: Oncologic Emergencies

In this episode on Oncologic Emergencies Dr. John Foote (University of Toronto's CCFP(EM) residency program director) and Dr. Joel Yaphe (the director of the University of Toronto’s Annual Update in Emergency Medicine conference in Whistler), review 5 important presentations in the patient with cancer: fever, shortness of breath, altered mental status, back pain and acute renal failure; with specific attention to key cancer-related emergencies such as febrile neutropenia, hypercalcemia, superior vena cava syndrome, hyperviscosity syndrome and tumor lysis syndrome.

By Anton Helman|2021-03-31T12:59:54-04:00May 21st, 2013|Categories: EM Cases, Emergency Medicine, Episodes, Hematology, Oncology|Tags: Appendicitis, brain herniation, febrile neutropenia, Hypercalcemia, Hyperviscosity Syndrome, ICP, Joel Yaphe, John Foote, multiple myeloma, SVC Syndrome, tumor lysis syndrome, Typhlitis|2 Comments

Episode 32: Whistler Update in Emergency Medicine Conference 2013

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.

By Anton Helman|2022-09-05T18:03:34-04:00April 10th, 2013|Categories: Cardiology, Conference, Emergency Medicine, Episodes, Gastroenterology, Pediatrics, Respirology, Whistler Update in EM|Tags: anticoagulants, azithromycin, cholangitis, cholycystitis, FUO, gonorrhea, hepatic encephalopathy, intubation, Joel Yaphe, laceration, Maria Ivankovic, pain managment, peritonsillar abscess, pneumothorax, Sara Grey, Shirley Lee, sinusitis, tissue adhesive, wound managment|0 Comments

Episode 31: LP, Spontaneous Pneumothorax and Ultrasound Guided Fracture Reduction

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.

By Anton Helman|2021-03-31T13:02:17-04:00March 11th, 2013|Categories: EM Cases, Emergency Medicine, Episodes, Neurology, Orthopaedics, Respirology|Tags: fracture managment, Heimlich valve, Jamie Blicker, Jordan Chenkin, lumbar puncture, pigtail cathether, POCUS, post-LP headache, spontaneous pneumothorax, ultrasound|2 Comments

Episode 30: Central Lines, Surgical Airways and Pericardiocentesis

In this episode dedicated to emergency procedures pearls and pitfalls, tips and tricks, Dr. Jordan Chenkin & Dr. Jamie Blicker take us step by step through how best to perform surgical airways and pericardiocentesis, as well as place central lines and intraosseous lines. They explain the various methods for surgical airways including the bougie-assisted surgical airway. They review the indications, contraindications, and complications for all of these life saving procedures, and give us some amazing tips and tricks on what to do when things aren't going as expected.

By Anton Helman|2021-03-31T13:03:23-04:00February 11th, 2013|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Resuscitation|Tags: bougie, central line, Cricothyrotomy, intraosseus line, Jamie Blicker, Jordan Chenkin, pericardiocentesis, surgical airway|0 Comments

Episode 29: Hand Emergencies

Dr. Andrew Arcand & Dr. Laura Tate discuss the key clinical pearls and pitfalls in the recognition and management of many apparently benign hand emergencies that have serious morbidity, including high pressure injection injuries, flexor tenosynovitis, gamekeeper's thumb, fight bites, hook of the hammate fractures and many more important hand emergencies. Dr. Tate & Arcand answer such questions as: which lacerations require prophylactic antibiotics? Which hand lacerations do not require sutures? How is rotational deformity best tested for metacarpal fractures? What are the pearls of tendon repair? How do you test for instability when you suspect a Gamekeeper's thumb? How is compartment syndrome of the hand different to compartment syndrome in the leg? What are Kanavel's signs of tenosynovitis? How should felons be managed in the ED? What are the most common errors that plastic surgeons see ED docs make?

By Anton Helman|2021-03-31T13:04:02-04:00January 15th, 2013|Categories: EM Cases, Emergency Medicine, Episodes, Orthopaedics, Trauma|Tags: Andrew Arcand, fight bite, flexor tenosynovitis, gamekeeper's thumb, high pressure injection injuries, hook of the hammate fracture, Laura Tate|4 Comments

Episode 27: Drugs of Abuse – Stimulants and Opiates

Dr. Margaret Thompson & Dr. Lisa Thurgur Canada's toxicologist gurus discuss several cases of stimulant drugs of abuse such as cocaine, MDMA & bath salts, as well as the pearls and pitfalls of managing opiates toxicity. We discuss: The management of the intoxicated patient including seizures, dysrhythmias, cardiac ischemia and hypertensive emergencies related to cocaine toxicity, the recognition and management of necrotizing vasculitis caused by cocaine cut with Levamisole, the differential diagnosis and management of the "hot and crazy" patient, including the role of dantrolene and cyproheptidine, pearls and pitfalls of naloxone, the utility of urine drug screens and much more....

By Anton Helman|2021-03-31T13:05:16-04:00October 15th, 2012|Categories: EM Cases, Emergency Medicine, Episodes, Toxicology|Tags: acute coronary syndrome, bath salts, cocaine, dantrolene, drug screen, dysrhthmia, ecstacy, hypertensive emergency, levamisole, Lisa Thurgur, Margaret Thompson, naloxone, opiate, seizure, sympathomimetic, vasculitis|0 Comments

Episode 26: Low Back Pain Emergencies

In this episode we go through seven cases that display the breadth of presentations of limb or life threatening causes of low back pain emergencies with my huge mentors, Dr. Walter Himmel and Dr. Brian Steinhart. We cover everything from spinal epidural abscess to cauda equina syndrome to retroperitoneal bleeds, elucidating the key historical, physical exam, lab, imaging and treatment pearls for all of these diagnoses. We then go on to review the best management for the most common cause of back pain presentation, lumbosacral strain and debate the various medication options.

By Anton Helman|2022-01-05T23:26:07-05:00September 12th, 2012|Categories: EM Cases, Emergency Medicine, Episodes, Neurology, Oncology, Orthopaedics|Tags: Brian Steinhart, cauda equina syndrome, disc herniation, inflammatory markers, lumbosacral sprain, mechanical low back pain, metastatic cancer, pain managment, retroperitoneal bleed, siatica, spinal cord compression, spinal epidural hematoma, Walter HImmel|2 Comments

Episode 25: Pediatric Syncope and Adult Syncope

In this episode on Pediatric Syncope & Adult Syncope, Dr. Eric Letovksy & Dr. Anna Jarvis run through the key clinical pearls of the history, the physical, interpretation of the ECG and the value of clinical decision rules such as the ROSE rule and the San Francisco Syncope Rule in working up these patients. We discuss how to differentiate syncope from seizure, cardiac causes of syncope such as Arrhthmogenic Right Ventricular Cardiomyopthy & Prolonged QT Syndrome, and the indications for Holter monitoring, Echocardiograms and stress testing in patients with Syncope. Dr. Letvosky & Dr. Jarvis answer such questions as: How can we diagnose Hypertrophic Cardiomyopathy in the ED? What is the value of Troponin and BNP in the work-up of syncope? In what ways are patients with Down Syndrome at high risk for serious causes of syncope? In what ways are patients with alcohol dependence at risk for serious causes of syncope? Why is 'Benign' early repolarization not a benign condition in patients with syncope? Which children with syncope should be admitted? and many more....

By Anton Helman|2022-05-03T20:35:42-04:00July 16th, 2012|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Pediatrics|Tags: Anna Jarvis, benign early repolarization, BNP, clinical decsion rules, echocardiogram, Eric Letovsky, holter, hypertrophic cardiomyopathy, prolonged QT, troponin|0 Comments

Episode 24: COPD and Pneumonia

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.

By Anton Helman|2022-10-26T21:52:48-04:00June 14th, 2012|Categories: EM Cases, Emergency Medicine, Episodes, Respirology, Resuscitation|Tags: Anil Chopra, BIPAP, blood gas, hemoptysis, John Foote, pneumothorax, tension pneumothorax|0 Comments

Episode 23: Vaginal Bleeding in Early Pregnancy

In this episode on Vaginal Bleeding in Early Pregnancy Dr. David Dushenski & Dr. Ross Claybo run through the key clinical pearls of the history, the physical, interpretation of the BhCG and the value of serum progesterone in working up these patients. The newest on bedside emergency department ultrasound is discussed in the patient with vaginal bleeding in early pregnancy. The various types of spontaneous abortion including septic abortion are reviewed as well as the management of the unstable patient with massive vaginal hemorrhage. Ectopic pregnancy, in all it's various presentations is reviewed with particular attention to the most common pitfalls and how to avoid them.

By Anton Helman|2021-03-31T13:08:01-04:00May 16th, 2012|Categories: EM Cases, Emergency Medicine, Episodes, Obstetrics & Gynecology|Tags: abortion, bedside ultrasound, David Dushenski, ectopic pregnancy, methotrexate, molar pregnancy, POCUS, Rhogam, Ross Claybo|0 Comments