Emergency Medicine Cases

There are so many emergency airway controversies in emergency medicine! Dr. Jonathan Sherbino, Dr. Andrew Healy and Dr. Mark Mensour debate dozens of these controversies surrounding emergency airway management. A case of a patient presenting with decreased level of awareness provides the basis for a review of the importance, indications for, and best technique of bag-valve-mask (BVM) ventilation, as well as a discussion of how best to oxygenate patients. This is followed by a discussion of what factors to consider in deciding when to intubate and some of the myths of when to intubate. The next case, of a patient with severe head injury who presents with a seizure, is the fodder for a detailed discussion of Rapid Sequence Intubation (RSI). Tips on preparation, pre-oxygenation and positioning are discussed, and some great debates over pre-treatment medications, induction agents and paralytic agents ensues. The new concept of Delayed Sequence Intubation is explained and critiqued. They review how to identify a difficult airway, how best to confirm tube placement and how to avoid post-intubation hypotension. In the last case of a morbidly obese asthmatic they debate the merits of awake intubation vs RSI vs sedation alone in a difficult airway situation and explain the best strategies of ventilation to avoid the dreaded bradysystlolic arrest in the pre-code asthmatic. Finally, some key strategies to help manage the morbidly obese patient's airway effectively are reviewed.

The whole playing field changes with pregnant patients in the emergency department. When you're faced with one of the Medical and Surgical Emergencies in Pregnancy that we'll cover in this episode, there are added challenges and considerations. Dr. Shirley Lee and Dr. Dominick Shelton discuss a challenging case of a pregnant patient presenting to the emergency department with shortness of breath and chest pain. They review those diagnoses that the pregnant patient is at risk for and discuss the challenges of lab test interpretation and imaging algorithms in the pregnant patient. Next, they walk us through the management of cardiac arrest in the pregnant patient. In another case of a pregnant patient who presents with abdominal pain and fever, they discuss strategies to minimize delays in diagnosis to prevent serious morbidity and mortality. The pros and cons of abdominal ultrasound, CT and MRI are reviewed as well as the management of appendicitis, pyelonephritis and septic abortion in pregnant patients.

Daniel Selchen, neurologist and TIA researcher, and Walter Himmel, emergency physician and educator, break down how to spot true TIA versus mimics. They cover top risk scores, when to image carotids or heart, acute medication choices, and a practical approach to dizzy patients with red flags for posterior circulation disease.

This Episode is a potpourri of topics - Renal Colic, Toxicology Update & Body Packers. Dr. Lisa Thurgur and Dr. Paul Rosenberg discuss the common presentation of Renal Colic, with perspectives on the mixed evidence for medical expulsive therapy, the overuse of imaging studies and when we need to worry about the patient who presents with excruciating flank pain. Next, Dr. Thurgur gives us an update on the three most important recent advances in Toxicology for emergency physicians - Lipid Emulsion Therapy, Hydroxocobalamin and Insulin therapy for Calcium Channel Blocker toxicity. Finally, Dr. Rosenberg and Dr. Thurgur discuss the 'ins and outs' of body packers. They review the management of both asymptomatic and symptomatic body backers, highlighting common errors and key therapeutic moves to prevent death.

Dr. Eric Letovsky, an expert in ECG and acute heart failure from Valley Credit Hospital, teams up with Dr. Brian Steinhart, a researcher in cardiac biomarkers at St. Michael's Hospital, to explore the complexities of diagnosing and managing acute congestive heart failure in emergency settings. They discuss practical diagnostic strategies, including the use of BNP and Troponin, as well as the role of ultrasound. The duo emphasizes the challenges in treatment, especially concerning drug considerations and immediate management tactics like BiPAP.

Dr. Rahim Valani, an emergency physician with extensive training in pediatric care, and Dr. Jennifer Riley, an assistant professor in medicine and pediatrics, tackle the complexities of pediatric head injuries. They dive into landmark studies that guide when to use CT scans for minor injuries and share vital tips for parents on post-discharge care. The duo also discusses managing serious head traumas, including innovative approaches to control intracranial pressure, ensuring that healthcare providers continue collaboration for optimal recovery.

Dr. Margaret Thompson, a double-certified emergency physician and toxicology expert, joins Dr. Dan Cass, a regional supervising coroner, to discuss Excited Delirium Syndrome, a critical medical emergency often seen in young, drug-intoxicated males. They delve into its symptoms, such as acute agitation and super-human strength, and the dangers of cardiac dysrhythmias. The conversation emphasizes the importance of collaboration between law enforcement and medical staff in managing these cases and updating treatment protocols for improved outcomes.

Dr. Arun Sayal, an emergency physician at North York General Hospital, and Dr. Natalie Maumann, a sports medicine-trained emergency physician, dive into the often-overlooked world of occult fractures and dislocations. They discuss the critical signs of scaphoid fractures and the diagnostic challenges in elderly patients. Interesting case studies highlight the need for advanced imaging to avoid misdiagnosis. Listeners gain insights into ankle injuries from snowboarding, and the nuances of managing calcaneus fractures, emphasizing timely intervention.