trauma emergency medicine

Episode 95 Pediatric Trauma

Management of the pediatric trauma patient is challenging regardless of where you work. In this EM Cases episode, with the help of two leading pediatric trauma experts, Dr. Sue Beno from Hospital for Sick Children in Toronto and Dr. Faud Alnaji from Children's Hospital of Eastern Ontario in Ottawa we answer such questions as: what are the most important physiologic and anatomic differences between children and adults that are key to managing the trauma patient? How much fluid should be given prior to blood products? What is the role of POCUS in abdominal trauma? Which patients require abdominal CT? How do you clear the pediatric c-spine? Are atropine and fentanyl recommended as pre-induction agents in the pediatric trauma patient? How can the BIG score help us prognosticate? Is tranexamic acid recommended in early pediatric trauma like it is in adults? Is the Pediatric Trauma Score helpful in deciding which patients should be transferred to a trauma center? and many more...

By Anton Helman|2022-12-06T07:32:02-05:00May 9th, 2017|Categories: EM Cases, Emergency Medicine, Episodes, Pediatrics, Resuscitation, Trauma|Tags: abdominal trauma, airway, BIG score, c-cpine, chest trauma, head injury, pediatric tauma score, Sue Beno, tranexamic acid|2 Comments

Best Case Ever 55 Pediatric Cerebral Herniation

In anticipation of the upcoming EM Cases main episode on Pediatric Polytrauma Dr. Suzanne Beno, Co-director of the Trauma Program at the Hospital for Sick Children in Toronto, tells her Best Case Ever of a child who suffers a severe traumatic head injury with signs of raised intracranial pressure and cerebral herniation. She discusses the importance of being vigilant when presented with classic patterns of injury, the use of hypertonic saline, crisis resource management and shared decision making with consultants...

By Anton Helman|2020-05-15T09:16:04-04:00March 7th, 2017|Categories: Best Case Ever, EM Cases, Emergency Medicine, Medical Specialty, Neurology, Pediatrics, Trauma|Tags: cerebral herniation, epidural hematoma, hypertonic saline, major head injury, raised ICP, Suzanne Beno|0 Comments

Episode 91 Occult Knee Injuries Pearls and Pitfalls

There are a whole slew of very important occult knee injuries - those that have a normal or near normal x-ray – that can cause serious morbidity if you miss them, and for the catchall soft tissue injuries there are some subtleties in diagnosis and management that will make a real difference to our patients. Arun Sayal and Hossein Mehdian answer questions such as: When should we suspect a spontaneously reduced knee dislocation? Do all patients suspected of a spontaneous knee dislocation require a CT angiogram to rule out vascular injury? Which patients with a low energy mechanism are at risk for knee dislocation and vascular complications? How can you increase the accuracy of the active straight leg raise in assessing for quadriceps and patella tendon rupture? What is an easy way to identify patella baja and patella alta on a knee x-ray? What are the indications for ultrasound of the knee? What are the true indications for a knee immobilizer and how can knee immobilizers kill our patients? and many more...

By Anton Helman|2021-04-02T13:30:58-04:00January 24th, 2017|Categories: EM Cases, Emergency Medicine, Episodes, Orthopaedics, Trauma|Tags: Arun Sayal, Hossein Mehdian, knee dislocation, tibial plateau fracture|1 Comment

Episode 83 – 5 Critical Care Controversies from SMACC Dublin

EM Cases Episode 83 - 5 Critical Care Controversies from SMACC Dublin: I had the great opportunity to gather some of the brightest minds in Emergency Medicine and Critical Care from around the world (Mark Forrest from U.K., Chris Nickson from Australia, Chris Hicks from Canada and Scott Weingart from U.S.) at the SMACC Dublin Conference and ask them about 5 Critical Care Controversies and concepts: How to best prepare your team for a resuscitation Optimum fluid management in sepsis Direct vs. video laryngoscopy as first line tool for endotracheal intubation Early vs. late trauma intubation Whether or not to attempt a thoracotomy in non-trauma centres The discussion that ensued was enlightening...

By Anton Helman|2021-03-30T14:46:15-04:00July 5th, 2016|Categories: Conference, EM Cases, Emergency Medicine, Episodes, Medical Specialty, Resuscitation, Trauma|Tags: Chris Hicks, Chris Nickson, fluid responsiveness, fluid tolerance, Mark Forrest, rally point, Scott Weingart, team preparation, thoracotomy, trauma intubation, vasopressors|0 Comments

CritCases 3 – GSW to the Chest

EM Cases CritCases 3 - GSW to the chest in a rural setting. In this CritCases we discuss preparation for penetrating trauma in a rural setting, the ABC score, massive transfusion protocol, clamshell thoracotomy, trauma intubation and more. The Case... You are the transport physician on call. A 50-year old male with a history of depression allegedly shot himself in the chest with a rifle. A bystander called 911. The local paramedics are en route and the air transport team is activated with a plan to rendezvous at the nearest hospital, Janus General, which is 90 minutes by ground from the nearest tertiary care centre. You contact the rural hospital for a status update but all they can tell you is that his GCS is 14 and he has a GSW to the central chest.

By Anton Helman|2020-05-31T23:22:55-04:00June 6th, 2016|Categories: CritCases, Emergency Medicine, Medical Specialty, Resuscitation, Trauma|Tags: ABC score, Dave MacKinnon, massive transfusion, Michael Misch, penetrating trauma, permissive hypotension, thoracostomy, thoracotomy, trauma intubation|0 Comments

BEEM Cases 1 – Pediatric Minor Head Injury

Dr. Andrew Worster and the BEEM (Best Evidence in Emergency Medicine) group from McMaster University has teamed up with EM Cases, Justin Morgenstern (@First10EM) and Rory Spiegel (@EMNerd_) to bring you a blog that blends the BEEM critical appraisals in a case-based, interactive, practice-changing format. In each post we choose the most important literature on a given topic and run through a case, learning how to apply evidence based medicine to our practice. Welcome to BEEM Cases! And here's BEEM Cases 1 - Pediatric Minor Head Injury... Written by Justin Morgenstern (@First10EM), edited by Anton Helman (@EMCases), adapted from the BEEM Course, Jan 2016 Pediatric Minor Head Injury - Decision Rules, Isolated LOC & Strict Rest The Case... With seconds left in the game, Melissa, an 11 year old girl, drives hard to the basket for a layup. She gets knocked to the ground, and doesn’t see the winning shot pass through the net, because it appeared as though she briefly lost consciousness. She quickly gets back up and celebrates with her friends, but after the celebrations, her parents bring her to your community emergency department to get checked. You confirm that she [...]

By Justin Morgenstern|2019-11-11T16:14:06-05:00January 12th, 2016|Categories: BEEM Cases, Emergency Medicine, Medical Specialty, Pediatrics, Trauma|Tags: CDR, clincical decision rules, Justin Morgenstern, minor head injury, PECARN, return to play|1 Comment

Episode 69 Obesity Emergency Management

Current estimates of the prevalence of obesity are that a quarter of adult Canadians and one third of Americans are considered obese with approximately 3% being morbidly obese. With the proportion of patients with a BMI>30 growing every year, you’re likely to manage at least one obese patient on every ED shift. Obese patients are at high risk of developing a host of medical complications including diabetes, hypertension, coronary artery disease, peripheral vascular disease, biliary disease, sleep apnea, cardiomyopathy, pulmonary embolism and depression, and are less likely compared to non-obese adults to receive timely care in the ED. Not only are these patients at higher risk for morbidity and mortality, but obesity emergency management is complicated by the patient’s altered cardiopulmonary physiology and drug metabolism. This can make their acute management much more challenging and dangerous. To help us gain a deeper understanding of the challenges of managing obese patients and elucidate a number of important differences as well as practical approaches to obesity emergency management, we welcome Dr. Andrew Sloas, the founder and creator of the fantastic pediatric EM podcast PEM ED, Dr. Richard Levitan, a world-famous airway management educator and innovator and Dr. David Barbic a prominent Canadian researcher in obesity in emergency medicine from University of British Columbia....

By Anton Helman|2021-03-30T16:40:10-04:00September 8th, 2015|Categories: Emergency Medicine, Episodes, Medical Specialty, Resuscitation, Special Populations, Trauma|Tags: airway, Andrew Sloas, Cricothyrotomy, David Barbic, ramped, Richard Levitan, surgical airway, vapors|1 Comment

Best Case Ever 39 – Airway Strategy & Mental Preparedness in EM Procedures with Richard Levitan

I caught up with airway educator, innovator and self-described enthusiast Dr. Richard Levitan at SMACC in Chicago this past June. In this Best Case Ever on Airway Strategy and Mental Preparedness in EM Procedures, Dr. Levitan uses a great save of his in a penetrating trauma case as a basis for discussion on mental preparedness and how we've been thinking about our general approach to emergency procedures the wrong way. Rather than fixating on the final goal of a procedure, which can often be daunting and lead us astray, he suggests a methodical incrementalized and compartmentalized approach to EM procedures that reduces stress and fear, improves confidence and enhances success. He runs through several examples including intubation, cricothyrotomy and initial approach to hypoxia to explain his Simple Incremental Approach to EM Procedures. Could this be a paradigm shift in the way we think about procedures in EM?....

By Anton Helman|2017-10-26T13:56:43-04:00September 1st, 2015|Categories: Best Case Ever, Resuscitation, Trauma|Tags: Cricothyrotomy, hypoxia, intubation, mental preparedness, Richard Levitan|1 Comment

Episode 66 Backboard and Collar Nightmares from Emergency Medicine Update Conference

In the first of our series on Highlights from North York General's Emergency Medicine Update Conference, Dr. Kylie Boothdiscusses Backboard and Collar Nightmares. The idea that backboards and c-spine collars prevent spinal cord injuries came from level 3 evidence in the 1960's and there has never been an RCT to prove this theory. In fact a Cochrane review on the topic in 2007 concluded that "the effect of pre-hospital spinal immobilisation on mortality, neurological injury, spinal stability and adverse effects in trauma patients remains uncertain" and that "the possibility that immobilisation may increase mortality and morbidity cannot be excluded". There have subsequently been several observational studies that describe increased morbidity and mortality associated with backboard and collars in a subset of patients. Dr. Booth argues that the time has long past that a major paradigm shift needs to occur toward a safer more rational use of backboards and collars in our trauma patients.