Emergency Medicine Cases

Ep 115 Emergency Management of the Agitated Patient

Managing acutely agitated patients can cause anxiety in even the most seasoned emergency doctor. These are high risk patients and they are high risk to you and your ED staff. It’s important to understand that agitation or agitated delirium is a cardinal presentation – not a diagnosis. There is pathology lurking beneath - psychiatric, medical, traumatic and toxicological diagnoses driving these patients and we just won’t know which until we can safely calm them down...

By Anton Helman|2022-10-16T10:48:01-04:00September 25th, 2018|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Psychiatry, Resuscitation, Toxicology|Tags: excited delirium, haloperidol, ketamine, Margaret Thompson, midazolam, physical restraints, Reuben Strayer|6 Comments

BCE 74 Coding in the Scanner

In anticipation of EM Cases Episode 113 Diagnosis an Workup of Pulmonary Embolism with Dr. Kerstin DeWit and Dr. Eddy Lang, we have Dr. Peter Reardon telling us his Best Case Ever (Coding in the Scanner) of a young woman who presents with a seizure followed by hemodynamic instability, who codes while in the CT scanner...

By Anton Helman|2023-05-14T17:53:39-04:00August 1st, 2018|Categories: Best Case Ever, EM Cases, Emergency Medicine, Medical Specialty, Resuscitation|Tags: alteplase, massive pulmonary embolism, tenectaplase, TNK, tPA|2 Comments

Ep 112 Tachydysrhythmias with Amal Mattu and Paul Dorian

In this EM Cases main Episode 112 Tachydysrhythmias with Amal Mattu and Paul Dorion we discuss a potpurri of clinical goodies for the recognition and management of both wide and narrow complex tachydysrhythmias and answer questions such as: Which patients with stable Ventricular Tachycardia (VT) require immediate electrical cardioversion, chemical cardioversion or no cardioversion at all? Are there any algorithms that can reliably distinguish VT from SVT with aberrancy? What is the "verapamil death test"? While procainamide may be the first line medication for stable VT based on the PROCAMIO study, what are the indications for IV amiodarone for VT? How should we best manage patients with VT who have an ICD? How can the Bix Rule help distinguish Atrial Flutter from SVT? What is the preferred medication for conversion of SVT to sinus rhythm, Adenosine or Calcium Channel Blockers (CCBs)? Why is amiodarone contraindicated in patients with WPW associated with atrial fibrillation? What are the important differences in the approach and treatment of atrial fibrillation vs. atrial flutter? How can we safely curb the high bounce-back rate of patients with atrial fibrillation who present to the ED? and many more...

By Anton Helman|2022-10-16T12:53:36-04:00July 17th, 2018|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Medical Specialty, Resuscitation|Tags: Amal Mattu, amiodarone, atrial fibirillation, atrial flutter, diltiazem, electrical cardioversion, ICD, Paul Dorion, procainamide, SVT, ventricular tachycardia, WPW|9 Comments

$esmolol for refractory ventricular vibrillation$

BCE 73 Esmolol in Refractory Ventricular Fibrillation

In anticipation of EM Cases Episode 112 on Tachydysrhthmias with Amal Mattu and Paul Dorion, Melanie Baimel tells her Best Case Ever of a previously healthy young man who presents in refractory ventricular fibrillation after receiving multiple single shocks, ongoing chest compressions, several rounds of epinephrine, amiodarone and dual sequence defibrillation without ROSC...

By Anton Helman|2023-05-14T17:54:52-04:00July 3rd, 2018|Categories: Best Case Ever, Cardiology, EM Cases, Emergency Medicine, Medical Specialty, Resuscitation|Tags: Melanie Baimel, ventricular fibrillation, ventricular storm, VF|3 Comments

CritCases 10 Hyponatremia Associated Seizures

In this EM Cases CritCases blog - a collaboration between STARS Air Ambulance Service, Mike Betzner and EM Cases, a middle aged woman presents to a rural ED with headache and vomiting, normal vital signs with subsequent status epilepticus and serum sodium of 110 mmol/L. What management recommendations would you make to the rural ED physician, the transport team and in your ED with regards to treatment of seizures, safe correction of hyponatremia, airway management, search for underlying cause and prevention of Osmotic Demyelenation Syndrome?

By Anton Helman|2018-06-18T22:47:15-04:00June 19th, 2018|Categories: CritCases, EM Cases, Emergency Medicine, Medical Specialty, Neurology, Resuscitation|Tags: hypertonic saline, ODS, status epilepticus|2 Comments

Ep 110 Airway Pitfalls – Live from EMU 2018

The last decade has seen a torrent of literature and expert opinion on emergency airway management. It is challenging to integrate all this new information into a seamless flow when faced with a challenging airway situation. In this live podcast recorded at North York General's Emergency Medicine Update Conference 2018, Scott Weingart and Anton Helman put together the latest in emergency airway management by outlining 6 common airway pitfalls: Failure to prepare for failure, failure to position the patient properly, failure to optimize oxygenation, failure to optimize hemodynamics, failure to consider an awake intubation and failure to prepare for a cricothyrotomy...

By Anton Helman|2024-05-05T14:41:02-04:00May 22nd, 2018|Categories: Conference, EM Cases, Emergency Medicine, Episodes, Medical Specialty, NYGH EM Update, Resuscitation|Tags: Cricothyrotomy, ear to sternal notch, EMU, preoxygenation, Scott Weingart, stress management, triple 15 rule|1 Comment

BCE 71 Cricothyrotomy and the Value of Simulation Training

In anticipation of EM Cases Episode 110 Airway Pitfalls Live from EMU 2018 with Scott Weingart, we have Dr. Shira Brown tell her Best Case Ever of a pediatric trauma patient who required a cricothyrotomy. She explains how, despite working in a non-trauma center with limited resources, her team was well prepared because of the robust simulation program specifically designed for practicing emergency physicians that she had developed in her region. We also discuss the advantages and disadvantages of the scalpel-Bougie vs scalpel-finger-Bougie cricothyrotomy techniques and to maintain an optimistic attitude in seemingly futile cases...

By Anton Helman|2024-05-05T14:38:24-04:00May 15th, 2018|Categories: Best Case Ever, EM Cases, Emergency Medicine, Medical Specialty, Resuscitation, Trauma|Tags: Bougie cric, cric kit, Dr. Shira Brown, scalpel Bougie, simulation training|0 Comments

BCE 66 CHD with Bronchiolitis: A Delicate Balance

When patients with known congenital heart disease present to the ED with common illnesses we need to consider how their physiology might alter our approach to those common illnesses. Max Ben-Yakov guides us through his Best Case Ever of a CHD patient who presents with bronchiolitis and gives us some tips on how best to approach these fragile patients in a crisis situation...

By Anton Helman|2018-06-08T12:09:04-04:00February 13th, 2018|Categories: Best Case Ever, Cardiology, EM Cases, Emergency Medicine, Medical Specialty, Pediatrics, Resuscitation|Tags: bronchiolitis, CHD, cogenital heart disease, cyanosis, cyanotic infant, Tet spell|1 Comment

CritCases 9 Pre-Eclampsia and Preterm Labor – Time Sensitive Management

In this CritCases blog we present a case of a 30 week gestational age pregnant woman with high blood pressure, headache, blurry vision and pelvic cramping. We discuss the management challenges of transporting a patient with severe pre-eclampsia and preterm labor, with special attention to dosing of magnesium, antihypertensive agents choice, and indications for steroids, tocolytics and antibiotics.

By Anton Helman|2020-09-18T15:23:20-04:00February 12th, 2018|Categories: CritCases, EM Cases, Medical Specialty, Obstetrics & Gynecology, Resuscitation|Tags: fetal lung maturity, HELLP, latetolol, MgSO4, nifedipine, tocolytic|5 Comments

Ep 104 Emergency Management of Intracerebral Hemorrhage – The Golden Hour

There exists a kind of self-fulfilling prognostic pessimism when it comes to ICH. And this pessimism sometimes leads to less than optimal care in patients who otherwise might have had a reasonably good outcome if they were managed aggressively. Despite the poor prognosis of these patients overall, there is some evidence to suggest that early aggressive medical management may improve outcomes. As such, the skill with which you manage your patient with ICH in those first few hours could be the most important determinant of their outcome. In this Golden Hour you have a chance to prevent hematoma expansion, stabilize intracerebral perfusion and give your patient the best chance of survival with neurologic recovery.

By Anton Helman|2022-12-06T07:54:06-05:00December 19th, 2017|Categories: EM Cases, Emergency Medicine, Episodes, Medical Specialty, Neurology, Resuscitation|Tags: anticoagulant reversal, hypertonic saline, ICH, ICH score, ICP, optic nerve sheath, Scott Weingart, Walter HImmel|4 Comments