Emergency Medicine Cases

The hand is anatomically complex. Having an anatomical-based approach to the assessment of patients who present to the Emergency Department is important to preserve quality of life following a hand injury. Hand injuries are the second most common injury leading to days without work. It is no surprise then that open finger injuries land in the top 10 most common diagnoses that end up in court. In this first part of our two-part series on hand injuries Dr. Matt Distefano and Dr. Arun Sayal guide us through the principles and pitfalls of assessment and management of hand injuries and answer questions such as: what is the differential diagnosis of a globally swollen hand? What is the intrinsic minus hand position? When should we suspect compartment syndrome of the hand? How should we best locate retracted lacerated tendons of the hand? What are the best ways to control bleeding of a finger tip amputation? What are the best analgesic choices? How large of a skin avulsion hand injury should we let heal by secondary intention rather than recommend a flap/skin graft? and many more...

In this Part 2 of our 3-part Journal Jam series on Laceration Management we dive into the evidence for the choice of material to close lacerations. Which is best for which kind of laceration? Surgical skin glue? Wound adhesive strips? Surgical staples? Absorbable sutures? Nonabsorbable sutures?...

Understanding why ETCO2 is recommended in cardiac arrest with Swami, practical steps to organ donation in the ED with Dr. Andrew Healy, using your hospital food court to treat paraphimosis, rectal prolapse and food bolus obstruction with Dr. Sarah Foohey, QI Corner with Dr. Tahara Bhate, 4 Medicolegal Myths with Dr. Jennifer C. Tang on this month's EM Quick Hits podcast...

In this main episode podcast Anton discusses with world expert and bronchiolitis researcher Dr. Suzanne Schuh, the challenges of the diagnosis and management of bronchiolitis during a time of crisis in pediatric emergency medicine and offers some evidence-based solutions to improving outcomes while minimizing valuable resources, as part of our 'Best of University of Toronto EM' series...

In this Journal Jam podcast Anton and Justin welcome special guest Dr. Haley Cochrane. We dive deep into the evidence for timing of closure and infection rate, fluid choice, volume and pressure of irrigation of lacerations, glove type and infection rate, how eversion of wound edges effects cosmetic outcomes and much more. You might be surprised to discover that the evidence for many things we do for lacerations that are considered "standard of care", is either weak or non-existent. But do not fret - we deliver practical bottom line practical recommendations to help improve outcomes, save time and decrease resource utilization...

In this EM Quick Hits podcast: Justin Morgenstern on fluids in pancreatitis, Leeor Sommer on nasal fractures, Christina Shenvi on delirium, Sheldon Cheskes and Rohit Mohindra on Dose VF, and Noor Khatib and Kari Sampsel on intimate partner violence...

Do not let a negative X-ray rule the day! Like almost all medical tests X-rays are far from perfect and should be ordered and interpreted only in the context of a thorough history and physical exam. In this 2nd part of our 2-part series on orthopedic x-rays with Dr. Arun Sayal and Dr. Yatin Chadha we discuss the pitfalls of obtaining and interpreting orthopedic X-rays, when orthopedic X-ray decision tools lead us astray, how understanding the concept of central ray helps dictate how we should order X-rays and interpret them, how the ring structure concept of the forearm and lower leg can remind us where to look for a second injury, when we need 3 views vs 2 views, when extra views like the clenched fist view and weight bearing views are indicated, why we should always look at the lateral view first, the limitations of ultrasound and CT in long bone and joint injuries and more... Please support EM Cases by giving a donation: https://emergencymedicinecases.com/donation/

In this main episode podcast, Dr. Arun Sayal creator of the CASTED course and Dr. Yatin Chadha a radiologist with a fellowship in MSK radiology, join Anton for Part 1 of 2 podcasts on Emergency Orthopedic Injuries. This episode focuses on a differential diagnosis of MSK injuries that are occult to X-ray with the help of the SCARED OF mnemonic. It ensures we pick up all the “can’t miss” diagnoses that can be easily overlooked when we do not integrate a pointed history and physical exam with the X-ray in front of us. Essentially, we discuss ‘when X-rays lie’ and offer up a variety of clinical pearls and pitfalls in assessing patients in the ED with MSK presentations…

On this month's EM Quick Hits podcast: Best of University of Toronto EM with Yaron Finkelstein on pediatric cannabis poisoning pitfalls, Brit Long on recognition and management of esophageal perforation, Jesse McLaren on 3 questions to diagnose Brugada Syndrome, Tahara Bhate on QI Corner, Constance Leblanc on maintaining wellness in career transitions from CAEP 2022...

Emergency Medicine has undergone many changes over the last couple of decades and especially during the COVID pandemic. Most of these changes have been very positive, but increasing volumes, staff shortages, aging populations, increasing breadth of responsibilities and better access to more imaging have made some of us question how we should define the scope of our practices. In this main episode podcast, highlights from CAEP 2022 conference, Anton discusses the article 'Saving EM: Is Less More?' with Dr. Paul Atkinson and Dr. Grant Innes and offer some solutions to this current state of affairs in EM. In another CAEP highlight, trauma team leader Dr. Mathieu Toulouse delivers the latest on management of traumatic pneumothorax. He answers such questions as: Do all patients with a traumatic pneumothorax require tube thoracostomy? How do CXR and CT differ in determining which patients require a chest tube? Do all patients receiving positive pressure ventilation require a chest tube for their traumatic pneumothorax? Does the presence of hemothorax necessitate placement of a chest tube? Are 14Fr pigtail catheters adequate for all traumatic pneumothoraces? and many more...