trauma emergency medicine

Episode 56 The Stiell Sessions: Clinical Decision Rules and Risk Scales

There are hundreds of clinical decision rules and risk scales published in the medical literature, some more widely adopted than others. Ian Stiell, the father of clinical decision rules, shares with us his views and experiences gained from co-creating some of the most influential CDRs and risk scales to date. He explains the criteria for developing a CDR, the steps to developing a valid CDR, how best to apply CDRs and risk scales to clinical practice, and the hot-off the-press new Ottawa COPD Risk Score and Ottawa Heart Failure Risk Score for helping you with disposition decisions. It turns out that in Canada, we discharge about two thirds of the acute decompensated heart failure patients that we see in the ED, while the US almost all patients with decompensated heart failure are admitted to hospital. Dr. Stiell's new risk scores may help physicians in Canada make safer disposition decisions while help physicians in the US avoid unnecessary admissions.

Episode 52: Commonly Missed Uncommon Orthopedic Injuries

We rarely discuss medico-legal issues on EM Cases because it misguides us a bit from good patient centered care – which is what emergency medicine is really all about. Nonetheless, missed orthopedic injuries are the most common reason for an emergency doc to be sued in Canada. This is partly because missed orthopedic injuries are far more common than missed MIs for example, but it’s also because it’s easy to miss certain orthopedic injuries – especially the ones that aren’t super common. And orthopedics is difficult to learn and remember for the EM practitioner as there are so many injuries to remember. And so, you guessed it – on this episode we’re going to run through some key not-so-common, easy to miss orthopedic injuries, some of which I, personally had to learn about the hard way, if you know what I mean. After listening to this episode, try some cognitive forcing strategies – for every patient with a FOOSH that you see, look for and document a DRUJ injury. Wait, hold on….I don’t wanna give it all away at the top of the post. Let’s hear what EM doc and sports medicine guru Ivy Cheng, and the orthopedic surgeon who everyone at North York General turns to when they need help with a difficult ortho case, Hossein Medhian, have to say about Commonly Missed Uncommon Orthopedic Injuries.

Episode 39: Update in Trauma Literature

Dr. Dave MacKinnon & Dr. Mike Brzozowski return for an Update in Trauma Literature since the epic Episode 10: Trauma Pearls & Pitfalls. In this episode we discuss predicting the sick trauma patient, videolaryngoscopy vs traditional laryngoscopy, Damage Control Resuscitation, Occult Hemothorax, Blunt Thoracic Aorta and Cardiac Injury, Sternal Fractures, Tranexamic Acid, Communication in the trauma bay and much more......

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..........

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........

Episode 35: Pediatric Orthopedics Pearls and Pitfalls

Dr. Sanjay Mehta & Dr. Jonathan Pirie, two experienced Pediatric EM docs from The Hospital for Sick Children in Toronto discuss their approach to a variety of common, occult, challenging and easy to miss pediatric orthopedics diagnoses including: differentiating Septic Arthritis from Transient Synovitis of the hip, Toddler's Fracture, Tillaux Fracture, Suprachondylar Fracture, ACL tear, tibial spine & Segond fractures. They also debate the value of the Ottawa Knee Rules in kids, non-accidental trauma, pediatric orthopedic pain management, the evidence for the best management of Buckle, Greenstick, Salter 1 and 2 distal radius fractures and lateral malleolus fractures.

Episode 34: Geriatric Emergency Medicine

In this episode Dr. Don Melady, Canada's leading educator in Geriatric Emergency Medicine (Geri-EM) & Dr. Jaques Lee, one of Canada's leading researchers in Geri-EM, discuss the common yet challenging Geriatric Emergencies: a practical approach to geriatric Delirium, best practice for managing agitation and pain in the older patient, management of recurrent falls, pearls in the assessment of the 'Weak & Dizzy' geriatric patient, atypical presentations of common life threatening emergencies including ACS and surgical abdomen, key drug interactions in the geriatric patient and more..

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.

Episode 29: Hand Emergencies

Dr. Andrew Arcand & Dr. Laura Tate discuss the key clinical pearls and pitfalls in the recognition and management of many apparently benign hand emergencies that have serious morbidity, including high pressure injection injuries, flexor tenosynovitis, gamekeeper's thumb, fight bites, hook of the hammate fractures and many more important hand emergencies. Dr. Tate & Arcand answer such questions as: which lacerations require prophylactic antibiotics? Which hand lacerations do not require sutures? How is rotational deformity best tested for metacarpal fractures? What are the pearls of tendon repair? How do you test for instability when you suspect a Gamekeeper's thumb? How is compartment syndrome of the hand different to compartment syndrome in the leg? What are Kanavel's signs of tenosynovitis? How should felons be managed in the ED? What are the most common errors that plastic surgeons see ED docs make?

Best Case Ever 14: High Pressure Injection Injury

Dr. Laura Tate, plastic surgeon extraordinaire, presents her best hand emergency case. In the upcoming episode, she and Dr. Andrew Arcand will discuss key pearls and pitfalls in the recognition and management of flexor tenosynovitis, high pressure injection injuries, fight bites, hook of the hammate fractures, gamekeeper's thumb and many more potentially devastating hand emergencies.

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