Emergency Medicine Cases

In the first of our series on Best Case Ever of 'Carr's Cases' we have, the legend himself, Dr. David Carr. This series will run on the theme of interesting diagnoses that we don't think of too often, but that are not as rare as we might think and can make a significant difference to your patient's outcome if you pick up on them early - and maybe even make you look as smart as David! Dr. Carr will be highlighted in our upcoming episode on Whistler's Update in EM Conference highlights 2014 when he will be speaking about his approach to the shocky patient as well as the controversial management of submassive pulmonary embolism. He will be featured along with Dr. Lisa Thurgur speaking about lipid emulsion therapy and other toxicologic goodies and Joel Yaphe will give us his take on the best of the EM literature from 2013 including the TTM trial, tranexamic acid for epistaxis, return to sport after concussion guidelines and more. Please go to the 'Next Time on EM Cases' page to submit your question about these topics.

Dr. Brian Steinhart, an expert in emergency medicine focused on abdominal emergencies, and Dr. David Dushenski, known for his work in abdominal pain assessment, dive into the controversies surrounding appendicitis. They discuss the nuances of atypical symptoms, the reliability of clinical decision rules like Alvarado and AIR, and the limitations of imaging techniques such as ultrasound versus CT. Controversies around antibiotic use versus surgical intervention for uncomplicated appendicitis are also explored, making for a thought-provoking listen for medical professionals.

In this episode Dr. Steinhart, (one of my biggest mentors – the doc that everyone turns to when no one can figure out what’s going on with a patient in the ED), & Dr. Dave Dushenski, (a master of quality assurance and data analysis, who would give David Newman a run for his money), discuss the 4 diagnoses that make up the deadly & difficult diagnosis of Mesenteric Ischemia, it’s key historical and physical exam features, the value of serum lactate, D-dimer & blood gas, when CT can be misleading, ED management of Mesenteric Ischemia, the difficult post-ERCP abdominal pain patient, the pitfalls in management of Pancreatitis, the BISAP score for Pancreatitis compared to the APACHE ll & Ranson Score, the comparative value of amylase and lipase, ultrasound vs CT for pancreatitis and much more…

As a bonus to Episode 42 on Mesenteric Ischemia & Pancreatitis, Dr. Brian Steinhart presents his Best Case Ever of Abodominal Pain – Thinking Outside the Box. While about 10% of abdominal pain presentations to the ED are surgical, there are a variety of abdominal pain presentations that have diagnoses outside the abdomen – so one needs to be thinking outside the box. In the related episode, Dr. Steinhart, (one of my biggest mentors – the doc that everyone turns to when no one can figure out what’s going on with a patient in the ED), & Dr. Dave Dushenski, (a master of quality assurance and data analysis, who would give David Newman a run for his money), discuss the 4 diagnoses that make up the deadly & difficult diagnosis of Mesenteric Ischemia, it’s key historical and physical exam features, the value of serum lactate, D-dimer & blood gas, when CT can be misleading, ED management of Mesenteric Ischemia, the difficult post-ERCP abdominal pain patient, the pitfalls in management of Pancreatitis, the BISAP score for Pancreatitis compared to the APACHE ll & Ranson Score, the comparative value of amylase and lipase, ultrasound vs CT for pancreatitis and much more…

Dr. Joel Yaphe, an EM residency program director and expert in hypertensive emergencies, joins Dr. Clare Atzema, a leading cardiovascular EM researcher. They delve into the complexities of managing hypertensive emergencies like aortic dissection and hypertensive encephalopathy. The discussion highlights the urgency of individualized care strategies and the importance of careful blood pressure management. They also cover the latest treatment protocols for conditions such as preeclampsia and emphasize the critical evaluation of diagnostic approaches in emergency settings.

University of Toronto EM Residency program director, Joel Yaphe and cardiovascular EM researcher, Clare Atzema discuss the guidelines, controversies, pearls & pitfalls of Asymptomatic Hypertension in the ED. The literature is thin in this area, and there are many controversies: Does an elevated BP measured in the ED represent true essential hypertension? Do these patients need to be worked up? Are they at risk of serious morbidity and mortality? Should we treat these patients in the ED with antihypertensives? Should we send them home on antihypertensives? and many more......

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?!?! 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..........

Dr. Maria Ivankovic, an emergency physician and lecturer at the University of Toronto, teams up with Dr. Leeor Sommer, an expert in ENT skills and hands-on workshops. They dive into the intricacies of managing epistaxis, offering a four-step approach and tips for foreign body removal. Key discussions include the urgent treatment of sudden sensorineural hearing loss and the critical signs of epiglottitis. They also explain the nuances of diagnosing and managing angioedema, stressing the importance of airway assessment and effective treatment strategies.

In the second part of this epic 2-part authoritative episode, Anticoagulants, PCCs & Platelets, we have 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 discuss the latest on comparative efficacy and reversal of Warfarin vs Dabigatran vs Rivaroxiban vs Abixaban, the use of prothrombin complex concentrates (PCCs), the ins and outs of thrombocytopenia & platelet transfusions, ITP, TTP, anti-platelet associated intracranial bleeds, indications for Tranexamic Acid & more...