Best Case Ever | Emergency Medicine Cases

Best Case Ever 29: Drug Induced Aseptic Meningitis

Dr. David Carr presents his third of EM Cases' Carr's Cases. This series features potentially debilitating diagnoses that may be thought of as 'zebras', but actually have a higher incidence then we might think - and if diagnosed early, can significantly effect patient outcomes. Dr. Carr tells the story of young woman with an MRSA supra pateller abscess who was put on trimethoprim sulfamethoxazole and presents looking very ill with a severe headache. Not only has trimethoprim sulfamethoxazole been implicated in aseptic meningitis, but NSAIDS, immunomodulators and antibiotics have also been implicated. The reason this is so important for ED practitioners to know, is that case reports of drug-induced aseptic meningitis have shown that symptoms will resolve completely within 24 hours, once the offending drug has been stopped. Not only that, but if the patient receives the drug again in the future, they are at risk for a more severe case of drug induced aseptic meningitis.

By Anton Helman|2020-05-31T23:22:27-04:00September 23rd, 2014|Categories: Best Case Ever, EM Cases, Emergency Medicine, Neurology|Tags: altered mental status, Carr's Cases, David Carr, meningtitis, seizure|0 Comments

Best Case Ever 28: Anti-NMDA Receptor Encephalitis

Dr. David Carr presents his second of Carr's Cases. This series features some potentially life-threatening diagnoses that may be perceived as zebras, but actually have a higher incidence then we might think - and if diagnosed early, can significantly effect patient outcomes. This Best Case Ever is about Anti-NMDA Receptor Encephalitis, a diagnosis that was only discovered in 2005, and has only recently been recognized by the Emergency Medicine community. Anti-NMDA Receptor Encephalitis may mimic a first presentation of schizophrenia or Neuraleptic Malignant Syndrome. It may present with seizure, altered mental status, autonomic instability or movement disorder in the absence of drug exposure. When you are faced with any of these presentations and no other diagnosis seems to fit, do an LP and send the CSF for anti-NMDA receptor antibodies. The time-sensitive treatment is IVIG and steroids. Anti-NMDA receptor Encephalitis is a must know diagnosis for all emergency medicine practitioners. Learn how to pick up this important diagnosis by listening to Dr. Carr's Best Case Ever and following the links to further resources.

By Anton Helman|2020-05-31T23:22:02-04:00August 6th, 2014|Categories: Best Case Ever, EM Cases, Emergency Medicine, Neurology|Tags: altered mental status, David Carr, encephalitis|4 Comments

Best Case Ever 27: Pediatric Shock

Ottawa this year, I had the pleasure of discussing pediatric shock and sepsis with Dr. Sarah Reid, a good medical school friend of mine from the Gretzky Year ('99) graduating class. I knew back then that she was heading for PEM educator stardom. Lo and behold, she is the now the director of CME at the Children's Hospital of Eastern Ontario and a national PEM speaker extraordinaire. After recording an eye-opening session on Pediatric Fever Without a Source and Pediatric Sepsis, she told me the story of her Best Case Ever where the initial presumptive diagnosis was sepsis. Maximize your learning and submit your questions on 'Pediatric Fever Without a Source' on the Next Time on EM Cases page.

By Anton Helman|2020-05-15T09:15:57-04:00July 16th, 2014|Categories: Best Case Ever, EM Cases, Emergency Medicine, Pediatrics, Resuscitation|Tags: Addison's disease, adrenal insufficiency, Sarah Reid, sepsis, septic shock, steroids|0 Comments

Best Case Ever 26: Chloral Hydrate Poisoning and Cardiac Arrest

I met up with Mike Betzner at North York General's Update in EM Conference in Toronto. He is the medical director of Air Transport STARS air ambulance out of Calgary and an amazing speaker on the national lecturing circuit. His Best Case Ever on Chloral Hydrate poisoning & cardiac arrest describes a young man in cardiac arrest with resistant Ventricular Fibrillation and Torsades de Pointes. There is only one class of drugs that can get him back into normal sinus rhythm. Dr. Betzner describes how he recognized that this patient was suffering from Chloral Hydrate poisoning and how he saved his life with one simple intervention.

By Anton Helman|2017-02-03T13:59:54-05:00July 3rd, 2014|Categories: Best Case Ever, EM Cases, Emergency Medicine, Resuscitation, Toxicology|Tags: b-blocker, cardiac arrest, chloral hydrate, Mike Betzner, Torsades de Pointes|1 Comment

Best Case Ever 24: COPD, Baggging and Vent Settings

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.

By Anton Helman|2017-02-03T11:42:29-05:00May 27th, 2014|Categories: Best Case Ever, Cardiology, EM Cases, Emergency Medicine, Respirology, Resuscitation|Tags: Amal Mattu, COPD, Emergency Medicine Update, EMU, pneumothorax, tension pneumothorax|2 Comments

Best Case Ever 22: Nonconvulsive Status Epilepticus (NCSE)

In the first of our series on Best Case Ever of 'Carr's Cases' we have, the legend himself, Dr. David Carr. This series will run on the theme of interesting diagnoses that we don't think of too often, but that are not as rare as we might think and can make a significant difference to your patient's outcome if you pick up on them early - and maybe even make you look as smart as David! Dr. Carr will be highlighted in our upcoming episode on Whistler's Update in EM Conference highlights 2014 when he will be speaking about his approach to the shocky patient as well as the controversial management of submassive pulmonary embolism. He will be featured along with Dr. Lisa Thurgur speaking about lipid emulsion therapy and other toxicologic goodies and Joel Yaphe will give us his take on the best of the EM literature from 2013 including the TTM trial, tranexamic acid for epistaxis, return to sport after concussion guidelines and more. Please go to the 'Next Time on EM Cases' page to submit your question about these topics.

By Anton Helman|2017-02-05T14:30:29-05:00May 5th, 2014|Categories: Best Case Ever, EM Cases, Emergency Medicine, Neurology, Resuscitation|Tags: benzodiazepine, David Carr, epilepsy, found down, seizure, Whistler|0 Comments

Best Case Ever 21 Abdominal Pain – Thinking Outside the Box

As a bonus to Episode 42 on Mesenteric Ischemia & Pancreatitis, Dr. Brian Steinhart presents his Best Case Ever of Abodominal Pain – Thinking Outside the Box. While about 10% of abdominal pain presentations to the ED are surgical, there are a variety of abdominal pain presentations that have diagnoses outside the abdomen – so one needs to be thinking outside the box. In the related 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|2017-02-03T11:40:37-05:00March 26th, 2014|Categories: Best Case Ever, EM Cases, Emergency Medicine, Gastroenterology|Tags: abdominal pain, APACHE, BISAP, Brian Steinhart, D-dimer, Lactate, Mesenteric Ischemia, pancreatitis, Ranson|0 Comments

Best Case Ever 20: CPR in Trauma

BEST CASE EVER 20: CPR in Trauma?!?! Closed Chest Compressions in Traumatic Arrest?!?! Is CPR ever successful in the trauma patient? Dr. Dave MacKinnon, Trauma Team Leader at St. Michael's Hospital in Toronto, gives you his Best Case Ever in the cardiac arrest trauma patient. The literature is full of case series of zero survival in trauma patients requiring CPR. For example, this report in CJEM. Normally, we should not be thinking of CPR in traumatic arrests, but instead, ED thoracotomy as Scott Weingart of emcrit describes in his podast 36 - Traumatic Arrest. But just wait until you here Dave's Best Case Ever..........

By Anton Helman|2020-05-31T23:22:21-04:00December 3rd, 2013|Categories: Best Case Ever, EM Cases, Emergency Medicine, Resuscitation, Trauma|Tags: best, cardiac arrest, CPR, Dave MacKinnon, penetrating trauma, trauma resuscitation, traumatic arrest|0 Comments

Best Case Ever 18: Anticoagulant Reversal in Trauma

Dr. Katerina Pavenski, on Anticoagulant Reversal in Trauma. A leader in Transfusion Medicine from St. Michael's Hospital, Dr. Pavenski tells us about her Best Case Ever in which a straight forward trauma case turns into a 'bloody disaster', after Prothrombin Complex Concentrates (PCCs) were given in an anticoagulant reversal attempt. In the related two-part epic episode on Antiocagulants, Transfusions & Bleeding, Drs. Pavenski, Dr. Jeannie Callum (Head of Transfusion Medicine at Sunnybrook Hospital & Dr. Walter Himmel (also known as 'The walking encyclopedia of EM') cover: Indications for red cell transfusion in different clinical scenarios (GI bleed, cardiac disease, vaginal bleeding etc), Risks of transfusion including Host vs Graft Disease, TRALI & TACO, Indications for Platelet transfusion in different scenarios (hyporoliferative patients vs ITP, invasive procedures with thrombocytopenia), Managing INRs - indications for Vit K, PCC, adjusting Warfarin Dose, liver patients, Apixaban vs Rivaroxiban vs Dabigatran vs Warfarin and reversal of them, Anti-platelet medication-associated intracranial hemorrhage management, Indications for Tranexamic Acid, and much more........

By Anton Helman|2017-02-03T12:52:29-05:00September 4th, 2013|Categories: Best Case Ever, EM Cases, Emergency Medicine, Hematology, Resuscitation, Trauma|Tags: Apixaban, best, dabigitran, INR, Katerina Pavenski, PCCs, rivaroxiban, Warfarin|0 Comments

Best Case Ever 17: Geriatric Emergency Medicine

As a bonus to Episode 34 on Geriatric Emergency Medicine, Dr. Don Melady, one of Canada's leading educators in Geriatric EM, tells us about his Best Case Ever in which a simple fall turns out to be a multi-facited complicated case with a simple solution. In the related Episode 34 on Geriatric Emergency Medicine Dr. Melady and Dr. Jacques Lee cover an approach to geriatric Delirium, managing agitation, indications for CT head in the delirious older person, management of recurrent falls, pearls in the assessment of the 'Weak & Dizzy' geriatric patient, key drug interactions, pain management, atypical ACS and pearls in Geriatric abdominal pain presentations.

By Anton Helman|2017-02-03T12:54:32-05:00July 2nd, 2013|Categories: Best Case Ever, EM Cases, Emergency Medicine, Neurology, Trauma|Tags: acute coronary syndrome, delirium, Don Melady, drug interactions, falls, Geri-EM, pain management|0 Comments