resuscitation and critical care medicine

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

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

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

Best Case Ever 12: Drugs of Abuse

As a bonus to Episode 27 on Drugs of Abuse -Stimulants & Opiates, Dr. Margaret Thompson, one of Canada's leading Toxicologists and the medical director of the Ontario Poison Control Centre tells us 2 of her Best Cases Ever about stimulant overdose surprises. In the related Episode, 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.... [wpfilebase tag=file id=396 tpl=emc-play /] [wpfilebase tag=file id=397 tpl=emc-mp3 /]

By Anton Helman|2019-11-11T21:38:55-05:00October 7th, 2012|Categories: Best Case Ever, EM Cases, Emergency Medicine, Resuscitation, 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 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 20: Atrial Fibrillation

In this episode Dr. Clare Atzema, Dr. Nazanin Meshkat and Dr. Bryan Au discuss the presentation, etiology, precipitants, management and disposition of Atrial Fibrillation in the Emergency Department. The pros and cons of rate and rhythm control are debated, what you need to know about rate and rhythm control medications reviewed, and the strength of the Ottawa Aggressive Protocol discussed. The importance of appropriate anticoagulation is detailed, with a review of the CHADS-VASc score and whether to use Warfarin, Dabigatran or ASA for stroke prevention for patient with Atrial Fibrillation. We end off with a discussion on how to recognize and treat Wolff-Parkinson-White syndrome in the setting of Atrial Fibrillation.

By Anton Helman|2021-09-23T18:05:58-04:00February 9th, 2012|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Resuscitation|Tags: anticoagulants, anticoagulation, CHADS Score, Clare Atzema, clinical decision rule, dabigitran, Warfarin|1 Comment

Best Case Ever 7: Atrial Fibrillation

As a bonus to Episode 20 on Atrial Fibrillation, we present here, Dr. Clare Atzema, a leading EM researcher in Atrial Fibrillation, telling her Best Case Ever related to Afib. What would you do if you needed to cardiovert a patient who was too obese to fit on an ED stretcher? Dr. Atzema, along with Dr. Nazanin Meshkat and Dr. Bryan Au, discuss the presentation, etiology, precipitants, management and disposition of Atrial Fibrillation in the Emergency Department. The pros and cons of rate vs rhythm control are debated, what you need to know about Afib medications, and the value of the Ottawa Aggressive Protocol discussed. The importance of appropriate anticoagulation is detailed, with a review of the CHADS-VASc score and whether to use anticogulants or ASA for stroke prevention for patients with Afib. We end off with a discussion on how to recognize and treat Wolff-Parkinson-White syndrome in the setting of Atrial Fibrillation. [wpfilebase tag=file id=382 tpl=emc-play /] [wpfilebase tag=file id=383 tpl=emc-mp3 /]

By Anton Helman|2016-10-20T13:24:00-04:00February 2nd, 2012|Categories: Best Case Ever, Cardiology, EM Cases, Emergency Medicine, Resuscitation|Tags: anticoagulation, cardioversion, Clare Atzema, clinical decision rules, dabigitran, ottawa aggressive protocol, Warfarin, wolff-parkinson-white|1 Comment

Episode 18 Part 1: Point of Care Ultrasound Pearls, Pitfalls and Controversies

In this first installment of this Episode, Point of Care Ultrasound Pearls, Pitfalls & Controversies we have a panel of POCUS gurus, Dr. Greg Hall, Dr. Jordan Chenkin, Dr. Paul Hannam & Dr. Jason Fischer. They review the basic criteria for commonly used, practical Point of Care Ultrasound indications at the bedside and then dive into heated debate about specific pearls and pitfalls in Point of Care Ultrasound assessment of the patient with undifferentiated shortness of breath, undifferentiated shock, cardiac arrest and swollen leg. They discuss how best to interpret the massive body of literature for POCUS and when we can hang our hats on our Point of Care Ultrasound findings.

By Anton Helman|2024-08-18T18:49:10-04:00October 13th, 2011|Categories: EM Cases, Emergency Medicine, Episodes, Resuscitation, Ultrasound|Tags: deep vein thrombosis, Greg Hall, Jason Fischer, Jordan Chenkin, pericardial effusion, pericardial tamponade, pneumothorax, pulmonary embolism, quality assurance|0 Comments

Episode 15 Part 2: Acute Coronary Syndromes Management

In Part 2 of this Episode on Acute Coronary Syndromes Risk Stratification & Management, the evidence for various medications for ACS, from supplemental oxygen to thrombolytics are debated, and decision making around reperfusion therapy for STEMI as well as NSTEMI are discussed. Finally, there is a discussion on risk stratification of low risk chest pain patients and all it's attendant challenges as well as disposition and follow-up decisions. Dr. Eric Letovsky, the Head of the CCFP(EM) Program at the University of Toronto, Dr. Mark Mensour & Dr. Neil Fam, an interventional cardiologist answer questions like: What is the danger of high flow oxygen in the setting of ACS? When, if ever, should we be using IV B-blockers in AMI patients? How can you predict, in the ED, who might go on to have an urgent CABG, in which case Clopidogrel is contra-indicated? Which anticoagulant is best for unstable angina, NSTEMI and STEMI - unfractionated heparin (UFH), low molecular weight heparin (LMWH), or fonduparinux? Is there currenly any role for Glycoprotein 2b3a Inhibitors in ACS in the ED? When is thrombolysis better than PCI for STEMI? When should we consider facilitated angioplasty and rescue angioplasty? Which low risk chest pain patients require an early stress test? CT coronary angiography? Stress Echo? Admission to a Coronary Decision Unit (CDU)? and many more.......

By Anton Helman|2024-08-18T18:52:19-04:00June 21st, 2011|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Resuscitation|Tags: ACS, anticoagulants, biomarkers, clopidogrel, cocaine, Eric Letovsky, NSTEMI, PCI, STEMI, troponin|0 Comments

Episode 12 Part 2: ACLS Guidelines – Atropine, Adenosine & Therapeutic Hypothermia

In Part 2 of this episode on ACLS Guidelines - Atropine, Adenosine & Therapeutic Hypothermia, Dr. Steven Brooks and Dr. Michael Feldman discuss the removal of Atropine from the PEA/Asystole algorithm, the indications and dangers of Adenosine in wide-complex tachycardias, pressors as a bridge to transvenous pacing in unstable bradycardias, and the key elements of post cardiac arrest care including therapeutic hypothermia and PCI. They answer questions such as: In which arrhythmias can Amiodarone cause more harm than good? Is there any role for transcutaneous pacing for asystole? When should Bicarb be given in the arrest situation? In what situations is Atropine contra-indicated or the dosage need to be adjusted? How has the widespread use of therapeutic hypothermia currently effected our ability to prognosticate post-arrest patients? What are the indications for PCI and thrombolysis in the cardiac arrest patient? Should we be using therapeutic hypothermia in the non-Vfib arrest patient? What is the best method for achieving the target temperature for the patient undergoing therapeutic hypothermia? and many more......

By Anton Helman|2024-08-19T19:27:44-04:00March 9th, 2011|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Resuscitation|Tags: adenosine, atropine, capnography, cardiac arrest, cardiocerebral resuscitation, CPR, Michael Fledman, post arrest care, Steven Brooks|0 Comments