resuscitation and critical care medicine

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

Episode 102 GI Bleed Emergencies Part 2

In Part 2 of our two part podcast on GI Bleed Emergencies Anand Swaminathan and Salim Rezaie kick off with a discussion on the evidence for benefit of various medications in ED patients with upper GI bleed. PPIs, somatostatin analogues such as Octreotide, antibiotic prophylaxis and prokinetics have varying degrees of benefit, and we should know which ones to prioritize. We then discuss the usefulness of the Glasgow-Blatchford and Rockall scores for risk stratification and disposition of patient with upper GI bleeds and hit it home with putting it all together in a practical algorithm. Enjoy!

By Anton Helman|2024-08-06T22:16:46-04:00October 17th, 2017|Categories: EM Cases, Episodes, Gastroenterology, Medical Specialty, Resuscitation|Tags: Anand Swaminathan, Glasgow-Blatchford, Lactate, octreotide, PPI, Salim Rezaie, UGIB|2 Comments

Episode 101 GI Bleed Emergencies Part 1

In this Part 1 of our two part podcast on GI bleed emergencies we answer questions such as: How do you distinguish between an upper vs lower GI bleed when it's not so obvious clinically? What alterations to airway management are necessary for the GI bleed patient? What do we need to know about the value of fecal occult blood in determining whether or not a patient has a GI bleed? Which patients require red cell transfusions? Massive transfusion? Why is it important to get a fibrinogen level in the sick GI bleed patient? What are the goals of resuscitation in a massive GI bleed? What's the evidence for using an NG tube for diagnosis and management of upper GI bleeds? In which patients should we give tranexamic acid and which patients should we avoid it in? How are the indications for massive transfusion in GI bleed different to the trauma patient? What are your options if the bleeding can't be stopped on endoscopy? and many more...

By Anton Helman|2024-08-06T22:17:06-04:00October 10th, 2017|Categories: EM Cases, Emergency Medicine, Episodes, Gastroenterology, Medical Specialty, Resuscitation|Tags: Anand Swaminathan, balloon tamponade, Blakemore, endoscopy, FOBT, Jeannie Callum, LGIB, massive transfusion, NG tube, Salim Rezaie, tranexamic acid, TXA, UGIB|2 Comments