Taking action in Emergency Medicine requires not only careful consideration of the best evidence, the expertise of the clinician, the patient’s values and the system that you work in, but also the will to act. Dr. Chris Hicks describes a case of a patient who suffers a cardiac arrest, where the diagnosis is quite obvious to everyone in the room...

Taking Action in Emergency Medicine 2015

Emergency Department end of life care and consultant communication is discussed in Dr. Paul Miller's Best Case Ever on EM Cases

End of Life Care & Consultant Communication

1. How to best prepare your team for a resuscitation
2. Optimum fluid management in sepsis
3. Direct vs. video laryngoscopy as first line tool for endotracheal intubation
4. Early vs. late trauma intubation
5. Whether or not to attempt a thoracotomy in non-trauma centres

EM Cases

5 Critical Care Controversies from SMACC

In anticipation of EM Cases' upcoming episode, Congenital Heart Disease Emergencies we have Dr. Gary Joubert a double certified Pediatric EM and Pediatric Cardiology expert telling his Best Case Ever of a four month old infant who presents with intermittent cyanosis. The Cyanotic Infant can present a significant challenge to the EM provider as the differential is wide, ranging from benign causes such as GERD to life threatening heart disease that may present atypically in a well-appearing child. Dr. Joubert gives us some simple sweet clinical pearls to help us along the way...

BCE-048-Cyanotic-Infant

Sometimes what initially appears to be a psychiatric illness turns out to be an organic illness, and visa versa. In our assessment of the patient with altered behaviour, it is critical to drill down and dissect apart the type of hallucinations a patient might be displaying, whether the demented patient is simply suffering from worsening dementia or alternatively has acute delirium (which carries a high mortality rate), and whether their somatic complaints might be due to depression or a psychotic psychiatric illness. In anticipation of our upcoming episode on Medical Clearance of the Psychiatric Patient Dr. Brian Steinhart tells the story of his Best Case Ever, reminding us of some of the clinical clues that can help us in our approach to the patient with altered behaviour, so that we avoid misdiagnosing a psychiatric illness with an organic one, or even worse, an organic illness with a psychiatric one…

Organic-vs-Psychiatric-illness

Post arrest patients can sometimes be challenging. We need to think of a variety of underlying causes of the arrest, antiarrhythmics, possible cath lab activation, targeted temperature management, sedation and more. To add to this, many post arrest patients do not have ideal vital signs that require attention. In this Best Case Ever, in anticipation of our upcoming episode on A Rational Approach to Hyperkalemia Dr. Melanie Baimel describes a post arrest patient who remains bradycardic and hypotensive despite multiple pressors…. 

Post Arrest Bradycardia

Dr. Melanie Baimel & Dr. Ed Etchells discuss a nuanced approach to the Emergency Management of Hyperkalemia, ECG pearls, insuslin/glucose, calcium, dialysis, cardiac arrest and more...

Emergency Management of Hyperkalemia

In anticipation of EM Cases Episode 87 on Alcohol Withdrawal Dr. Sara Gray describes her Best Case Ever of severe alcohol withdrawal and Delirium Tremens from Janus General.

Also on this podcast Dr. Anand Swaminathan reacts to Episode 86 Emergency Management of Hyperkalemia and gives us his take on the use of calcium in the setting of digoxin toxicity.

Early recognition and treatment of Delirium Tremens – a rapid onset of severe alcohol withdrawal accompanied by delirium and autonomic instability about 3-10 days after the appearance of withdrawal symptoms –  is key to preventing long term morbidity and mortality. This is sometimes easier said than done as some patients will deny alcohol use all together and the differential diagnosis for delirium is lengthy to say the least. It’s helpful to know the predictors of Delirium Tremens (listed below) to anticipate and help with early recognition. It is also important to understand that the CIWA score is not a diagnostic test for alcohol withdrawal or delirium tremens. It is a scale to determine severity of withdrawal and guide treatment and should not be used for delirium tremens. Sometimes these patients require the kind of dosages of benzodiazepines that would render most of us comatose, and being comfortable with the use of high dose benzodiazepines as well as second line agents is important in management of these patients. All this and more will be discussed in Episode 87…

Delirium Tremens

In anticipation of Episode 88 and 89: DOACs Use, Misuse and Reversal with the president of Thrombosis Canada and world renowned thrombosis researcher Dr. Jim Douketis, internist and thrombosis expert Dr. Benjamin Bell and ‘The Walking Encyclopedia of EM’ Dr. Walter Himmel, we have Dr. Himmel telling us the story of his Best Case Ever on anticoagulants and GI bleed. He discusses the most important contraindication to DOACs, the importance of not only attempting to reverse the effects of anticoagulants in a bleeding patient but managing the bleed itself and more great pearls. In the upcoming episodes we’ll run through 6 cases and cover the clinical use of DOACs, how they work, safety, indications, contraindications, management of minor, moderate and severe bleeding, the new DOAC reversal agents, management of DVT with DOAC anticoagulants, stroke prevention in atrial fibrillation with DOACs and much more…

Anticoagulants & GI Bleed

Emergency Medicine Cases (EM Cases) is a free online medical education podcast & medical blog dedicated to providing online emergency medicine education & CME for physicians, residents, students, nurses & paramedics. We are Canada's most listened to emergency medicine podcast with thousands of listeners. In each episode 2 or more experts in a particular emergency medicine topic join Dr. Helman in a round-table, case-based discussion on key practice changing clinical emergency medicine topics, which are then carefully edited to maximize your learning. We are 'The emergency medicine CME audio program where the experts keep you in the know'.

Our Team, is headed by EM Cases founder and host Dr. Anton Helman. Our Advisory Board includes prominent leaders in the faculty of the University of Toronto Divisions of Emergency Medicine. Our Guest Experts, Canada's brightest minds in emergency medicine, are carefully chosen for each episode topic.

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