Emergency Medicine Cases
By Emergency Medicine Cases
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Podcast Description
The free Podcast portion of the CME audio program where the experts keep you in the know. Go to www.emergencymedicinecases.com for the full subscription version and to access the complete audio library. Emergency Medicine Cases (EMC) is Canada’s premier educational website dedicated to keeping staff physicians and emergency medicine residents up to date on the most current topics in emergency medicine. In ten episodes each year we present cases to two of Canada’s leading experts in emergency medicine, and discuss clinical pearls, important management issues and current clinical literature around the cases. We highlight key practical learning points that you can use in your every day practice. The discussions are skillfully edited so that the monthly program that is available for immediate listening or for download to your computer, handheld or ipod, is packed with relevant information. Learning with case examples has proven to be a very effective method of building one’s knowledge base of medicine. The cases you will hear on this program have been specifically designed to enhance learning.
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Best Case Ever 9: Ross Claybo on Vaginal Bleeding in Early Pregnancy | In anticipation of Episode 23 on 'Vaginal Bleeding in the First Half of Pregnancy' with Dr. Ross Claybo and Dr. David Dushenski, we have Dr. Claybo's Best Case Ever. In the upcoming episode we will....... run through the key clinical pearls of the history, the physical, interpretation of the BhCG and the value of serum progesterone in working up these patients. The newest on bedside emergency department ultrasound is discussed and the key pitfalls of interpreting transvaginal ultrasound. The various types of spontaneous abortion including septic abortion are reviewed as well as the management of the unstable patient with massive vaginal hemorrhage. Ectopic pregnancy, in all it's various presentations is reviewed with particular attention to the most common pitfalls and how to avoid them, and much more. [filebase:file:file=154:tpl=mp3_file] [filebase:file:file=154:tpl=mp3_dl] | 5/8/12 | Free | View In iTunes |
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Best Case Ever 8: John Foote on Dyspnea | In anticipation of Episode 21 on Respiratory Emergencies, Dr. John Foote the CCFP(EM) residency program director at the University of Toronto presents his Best Case Ever related to the dyspeic patient. In the upcoming episde, Dr. Foote and Dr. Anil Chopra, the author of past Tintinalli chapters on thromboembolic and arterial disease discuss how to approach the patient with dyspnea and the pearls and controversies of pulmonary embolism. They discuss how best to develop a clinical pre-test probability for the diagnosis of pulmonary embolism using risk factors, some new evidence about the PERC rule, Well's criteria and how clinical gestalt plays into pre-test probability. Dr. Chopra tells about the appropriate use of D-dimer to improve our diagnostic accuracy without leading to over-investigation and unwarranted anticoagulation, and how it can be used in pregnancy and in the elderly. We then discuss the value of V/Q scan in the workup of PE, and the pitfalls of CT angiography. A discussion of anticoagulation choices follows and the controvesies around thrombolysis for submassive PE are reviewed. [filebase:file:file=144:tpl=mp3_file] [filebase:file:file=144:tpl=mp3_dl] | 3/2/12 | Free | View In iTunes |
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Best Case Ever 7: Dr. Clare Aztema on Afib | In anticipation of Episode 20 on Atrial Fibrillation, we present here, Dr. Clare Atzema's Best Case Ever related to Afib. In the upcoming Episode 20 on Afib, Drs. Nazanin Meshkat, Clare Atzema and BryanAu answer such questions as: What factors should you take into account when deciding whether to use rate control or rhythm control? How is Aflutter treated differently to Afib in the ED? When should Troponins be ordered for our patients in Afib? What are the indications for admission for Afib and who can be safely sent home? How does the CHADS-VASc score compare to the CHADS2 score for determining who needs anticoagulation for stroke prevention? In which patients is electrical cardioversion contra-indicated? What is the best anti-arrhythmic medication for WPW in the setting of Afib? Why should you consider using an initial energy level of 200J biphasic for all your patients with Afib or Aflutter for electrical cardioversion despite the ACLS guidelines suggesting lower levels? and many many more...... [filebase:file:file=142:tpl=mp3_file] [filebase:file:file=142:tpl=mp3_dl] | 2/2/12 | Free | View In iTunes |
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Best Case Ever 6: Dr. Greg Hall on ED Ultrasound | In anticipation of Episode 18, 'Emergency Ultrasound - Pearls, Pitfalls & Controversies' with Dr. Greg Hall, Dr. Jordan Chenkin, Dr. Paul Hannam and Dr. Jason Fischer, we present here, the sixth of our 'Best Case Ever' series.In the upcoming episode we review the basic criteria for commonly used, practical Emergency Ultrasound (eUS) indications at the bedside and then dive into heated debate about specific pearls and pitfalls in eUS assessment of the patient with undifferentiated shortness of breath, undifferentiated shock, cardiac arrest and swollen leg. We discuss how best to interpret the massive body of literature for eUS and when we can hang our hats on our eUS findings.[filebase:file:file=119:tpl=mp3_file][filebase:file:file=119:tpl=mp3_dl] | 10/4/11 | Free | View In iTunes |
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Episode 17 Part 1: Stroke Controversies (FREE!) | Dr. Walter Himmel & Dr. Dan Selchen update us on the recent literature regarding the ABCD2 Score to predict Stroke after TIA, as well as the current thinking around the best carotid imaging protocols for patients who have had a TIA. They then review the important findings of the key thrombolysis in stroke trials and how we should incorporate these findings into our daily practice. Dr. Selchen reviews the key CT findings we should be looking for in stroke patients and Dr. Himmel takes us through how to manage the dreaded complication of ICH after thrombolysis. Dr. Himmel and Dr. Selchen answer questions such as: Should we be ordering CT angiograms of the neck in the ED for our patients with TIA or stroke? Should elderly patients be excluded from lytic protocols? Should community hospitals be using lytic for stroke or only stroke centres? Is there a role for intra-arterial thrombolysis? Are rapidly resolving or fluctuating symptoms a contra-indication to lysis for stroke? What are the key early signs of stroke on CT that ED docs should know about and why? What CT findings are contraindications to lytic? What are the most important supportive measures that we can do to improve our patients' outcomes? [filebase:file:file=116:tpl=mp3_file] [filebase:file:file=116:tpl=mp3_dl] [filebase:file:file=118:tpl=m4a_file] [filebase:file:file=112:tpl=pdf_file] | 9/7/11 | Free | View In iTunes |
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Episode 17 Part 2: Stroke, Dabigatran & ICH (FREE!) | In the 2nd part of this episode Dr. Himmel & Dr. Selchen tell us everything the ED doc needs to know about the oral direct thrombin inhibitor Dabigatran and how to reverse a Dabigatran ICH. The ED treatment of stroke is reviewed including best medications and a simple way to remember BP goals. They review the management of ICH including BP goals, indications for neurosurgery, the role of recombinant Factor Vlla, and how best to reverse Warfarin-associated and platelet-associated ICH. Dr. Himmel & Dr. Selchen answer questions such as: When should we use heparin in the setting of stroke? Is Dabigatran any better than Warfarin in preventing stroke in patients with Atrial Fibrillation? What is only medication worth trying in the setting of a Dabigatran-associated ICH? How does the ED management of spontaneous ICH differ to that of ischemic stroke? Which ICHs are more likely to benefit from neurosurgical intervention? Is there a role for Recombinant Factor Vlla for the treatment of ICH? What is the best way to reverse a Warfarin-associated ICH? An ASA-associated ICH? and many more...... [filebase:file:file=115:tpl=mp3_file] [filebase:file:file=115:tpl=mp3_dl] [filebase:file:file=117:tpl=m4a_file] [filebase:file:file=112:tpl=pdf_file] | 9/7/11 | Free | View In iTunes |
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Best Case Ever 5: Dr. Joel Yaphe on Septic Arthritis | In anticipation of Episode 16, 'Hot Joints - What to Do' with Dr. Joel Yaphe and Dr. Indy Ghosh, we present here, the fifth of our 'Best Case Ever' series.In Episode 16: 'Hot Joints - What to Do' Dr. Yaphe and Dr. Ghosh discuss such questions as: What are the most important risk factors for septic arthritis? What are the most predictive signs and symptoms of septic arthritis? How does serum WBC, ESR and CRP contribute to the probability of septic arthritis? Should we still be performing arthrocenteses on patient's with overlying cellulitis? with an INR of 6? How can you tell the difference between septic bursitis and septic arthritis and how are they managed differently? What does the literature tell us about how useful the synovial fluid tests are in ruling in or ruling out septic arthritis? What is the role of bedside ultrasound in septic arthritis? Is there a role for steroid therapy in septic arthritis? When would you consider oral NSAIDs vs oral prednisone vs intra-articular methylprednisolone for the treatment of Gout? Is there a role for colchicine in the ED treatment of Gout? What is acute calcific arthritis of hydroxyapatite disease and why is it important for ED docs to know about? What is the most common cause of dermatitis-arthritis? How can one distinguish Reactive Arthritis from Septic Arthritis clinically, and how do their work-ups differ? Is there a role for antibiotics in Reactive Arthritis? How does gonococcal arthritis present compared with non-gonococcal septic arthritis? and many more.....[filebase:file:file=97:tpl=mp3_file][filebase:file:file=97:tpl=mp3_dl] | 7/19/11 | Free | View In iTunes |
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Best Case Ever 4: Dr. Anton Helman on ACS | In anticipation of Episode 15, 'Acute Coronary Syndromes' with Dr. Eric Letovsky, Dr. Mark Mensour and Dr. Neil Fam, we present here, Dr. Helman's 'Best Case Ever' of an ACS patient.In Episode 15: 'Acute Coronary Syndromes', Drs. Fam, Mensour , Letovsky and Helman discuss questions like: How does a recent negative stress test or angiogram effect the pre-test probability of ACS in the ED? What does recent evidence tell us about the assumption that patients presenting with chest pain and a presumed new LBBB will rule in for MI and require reperfusion therapy? How will the new ultra-sensitive Troponins change our practice? When, if ever, should we be using IV B-blockers in AMI patients in the ED? How can we predict, in the ED, who might go on to have an urgent CABG, in which case Clopidogrel is contra-indicated? How should we choose between UFH, LMWH or Fondaparinux for unstable angina, NSTEMI and STEMI? In what situations is thrombolysis better than PCI for STEMI? Which low risk chest pain patients require an early stress test? CT coronary angiography? and many many more......[filebase:file:file=91:tpl=mp3_file][filebase:file:file=91:tpl=mp3_dl] | 6/5/11 | Free | View In iTunes |
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Best Case Ever 3: Dr. Anil Chopra on Headache | In association with Episode 14, 'Headache Pearls & Pitfalls' with Dr. Anil Chopra and Dr. Stella Yiu, we present here, the third of our new 5 minute 'Best Case Ever' series.In Episode 14: Headache Pearls & Pitfalls, which has just been released, Dr. Chopra and Dr. Yiu answer questions like: With the ever improving resolution of CT, should we still be doing LP after negative plain CT head for all our thunderclap headache patients? How can we best minimize the chance of post-LP headache? What evidenced-based treatments can we initiate in the ED for our SAH patients that will improve outcomes? What are the best evidenced-based medications for migraine in the ED? What is the evidence for chiropractic neck manipulation as a cause for Cervical Artery Dissection? How do antiplatelets compare to heparin for the treatment of Cervical Artery Dissection? What is Spontaneous Intracranial Hypotension? What is the differential diagnosis for headache in the peri-partum patient? Does D-dimer have a role in ruling out Cerebral Venous Thrombosis in the low risk patient? and many many more......[filebase:file:file=89:tpl=mp3_file][filebase:file:file=89:tpl=mp3_dl] | 5/10/11 | Free | View In iTunes |
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Best Case Ever 2: Dr. Brian Steinhart on Coma | In anticipation of Episode 13, 'Killer Coma Cases' with Dr. Brian Steinhart and Dr. David Carr, we present here, the second of our new 5 minute 'Best Case Ever' series.Dr. Steinhart's "found down" coma patient.In Episode 13: Killer Coma Cases, Dr. Helman presents 4 challenging cases of patients who present with altered mental status to Dr. Carr and Dr. Steinhart, who give us loads of key pearls and intriguing controversy in the evaluation and treatment of these difficult patients.[filebase:file:file=78:tpl=mp3_file][filebase:file:file=78:tpl=mp3_dl] | 3/31/11 | Free | View In iTunes |
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Best Case Ever 1: Dr. Steven Brooks | For the first time, EMC will be posting a new series of 5 minute audio bites called 'Best Case Ever' on our Facebook page , on iTunes and here on the sidebar of our home page, in which one of the guest experts for the upcoming unreleased EMC episode will be featured telling us the story of a memorable case and what they learned from it. The case will be related in subject matter to the soon-to-be-posted episode. Please let us know what you think with a comment or by emailing anton@emergencymedicinecases.com. If you like it we will aim to post one for every future episode. Our first 'Best Case Ever' is from Dr. Steven Brooks, a co-author of the 2010 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. For this one, as it is the first one, we will post it here as well. Just click on the title of this posting to listen. [filebase:file:file=72:tpl=mp3_file] [filebase:file:file=72:tpl=mp3_dl] | 2/16/11 | Free | View In iTunes |
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FREE Episode 11: Diagnostic Decision Making & Medical Error | In this episode Dr. Doug Sinclair and Dr. Chris Hicks show us that, while the ED physician's knowledge base may play a small part in predicting medical error, more important might be how we understand and reflect upon our decision-making processes, how we communicate with our staff and patients, and how we cope with the ED environment and shift work. Medical error is the 6th leading cause of death in North America, and despite huge advances in imaging technology and lab testing as well as an explosion of EM literature in recent years, the misdiagnosis rate detected through autopsy studies has not changed significantly over the past century. Studies on diagnostic error in emergency medicine have shown error rates between 1 and 12%, and it's been suggested that cognitive error, or some flaw in the decision making process (as apposed to a lack of knowledge), is present in about 95% of these cases. Dr. Sinclair and Dr. Hicks elucidate for us how to identify and understand cognitive error, and how we can improve our decision making, reduce medical error and optimize the care of our patients. They answer questions like: What is heuristics training and how does it allow us to develop insight and awareness into our own thinking so that we minimize error? How does one's affective state effect how we make decisions in the ED? How can we counter our natural tendency toward confirmation bias and premature closure in the ED? How can authourity gradients effect patient outcomes? What tools can we use to help us recognize high risk situations? How can we best minimize medical error related to handover or transfer of care? How does our decicision making ability change over the course of a typical shift and how can we prepare for this? How does shift work and sleep deprivation effect us in terms of our health and cognitive abilities, and what can do to minimize the negative effects of shift work? What can we do to help facilitate feedback for emergency physicians in order to improve quality of care and learn from our triumphs and our mistakes? What are some easy ways that we can minimize errors when communicating with our nurses, housestaff and patients? When you have made an error, what is the best way to disclose that error? and many more...... [filebase:file:file=67:tpl=mp3_file] [filebase:file:file=67:tpl=mp3_dl] [filebase:file:file=68:tpl=m4a_file] [filebase:file:file=70:tpl=pdf_file] | 2/4/11 | Free | View In iTunes |
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FREE Episode 10: Trauma Pearls & Pitfalls Part 1 | Dr. Dave MacKinnon and Dr. Mike Brzozowski discuss the latest in trauma controversies. In Part 1 of this episode they give us some key pearls and pitfalls on airway management, C-spine collar use, clearing the C-spine, vascular access, 'Damage Control Rescuscitation', the best resuscitation fluids to use including hypertonic saline, hemostatic drugs such as Tranexamic Acid, Recombinant Factor 7a, and Prothrombin Complex Concentrates. In this episode Dr. MacKinnon and Dr. Brzozowski debate questions like: Is Ketamine safe in head injured patients? Why should we minimize the use of C-spine collars? What type of central line is best in the trauma patient? What is the evidence for a 1:1:1 ratio of RBCs:FFP:Plts in the resuscitation of the sick trauma patient? Should we be practising permissive hypotension in the multi-trauma patient? What is the evidence for the use of hypertonic saline in the trauma patient? for therapeutic hypothermia in the head-injured patient? What is the utility of blood work in the trauma patient? How useful are the ABC score and the TASH score in assessing the need for massive transfusion? Is there any role for vasopressors in trauma? Should we consider using Recombinant Factor 7a in the trauma patient? How good is the evidence for the use of Tranexamic Acid in the bleeding patient? How good is the evidence for Prothrombin Complex Concentrates like Octaplex for trauma patients taking Warfarin? and many many more..... [filebase:file:file=62:tpl=mp3_file] [filebase:file:file=62:tpl=mp3_dl] [filebase:file:file=65:tpl=m4a_file] [filebase:file:file=66:tpl=pdf_file] | 1/11/11 | Free | View In iTunes |
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FREE Episode 10: Trauma Pearls & Pitfalls Part 2 | In Part 2 of this episode on Trauma Pearls & Pitfalls Dr. Dave MacKinnon and Dr. Mike Brzozowski go through key management strategies and controversies surrounding head, neck, chest, abdominal, pelvic and extremity trauma, followed by a discussion on how best to prepare the trauma patient for transfer to a trauma centre. They end with a great rant about 'pan-scanning' the multi-trauma patient. In this episode Dr. MacKinnon & Dr. Brzozowski debate questions like: How should we work-up a 'Neck Seat Belt Sign'? When should we be using X-ray vs CT to clear the T-spine? How good is bedside ED ultrasound at diagnosing pneumothorax compared to CXR? How should we treat an occult pneumothorax seen only on CT? What are some of the key injuries that FAST ultrasound misses? that CT misses? What are the indications for angiography in patients with pelvic fractures? How good is handheld doppler at ruling out vascular injury in patients with penetrating extremity trauma? What are the priorities of management for the severely traumatized patient at a non-trauma centre? Which trauma patients should be 'pan-scanned'? and many many more.... [filebase:file:file=63:tpl=mp3_file] [filebase:file:file=63:tpl=mp3_dl] [filebase:file:file=64:tpl=m4a_file] [filebase:file:file=66:tpl=pdf_file] | 1/11/11 | Free | View In iTunes |
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FREE Episode 9: Non-traumatic Eye Emergencies | Dr. George Porfiris and Dr. Simon Kingsley discuss four non-traumatic eye emergency presentations. The painful red eye, the painless red eye, acute painful loss of vision and acute painless loss of vision. Several cases are discussed in which an accurate diagnosis and timely ED management are of critical importance in order to prevent permanent vision loss and significant morbidity. A systematic approach to the eye examination is described with particular attention to important maneuvers such as the swinging flashlight test. The utility of ED ultrasound of the eye is debated, and a discussion around systemic diseases that cause eye problems provides fodder for many clinical pearls. In this episode, Dr. Porfiris and Dr. Kingsley provide answers to questions like: When is it okay for EM physicians to be using topical steroids for eye emergencies? How can one distinguish conjunctivitis from Episcleritis and Scleritis? Which systemic diseases do we need to know about that present with eye complaints? What is the best emergency management of acute painless loss of vision due to central retinal artery occlusion? What is the evidence for thrombolysis of central retinal artery occlusion? What is the role of ED ultrasound in non-traumatic eye emergencies? What is the sensitivity of ESR for temporal arteritis? What is the roll of Doppler ultrasound in the diagnosis of temporal arteritis? How is temporal arteritis with ocular manifestations treated differently to temporal arteritis without ocular manifestations? What is the role of MRI in the diagnosis and management of optic neuritis? What is the evidence for IV steroid therapy in optic neuritis? What funduscopic finding is pathagnomonic of subarachnoid hemorrhage? [filebase:file:file=60:tpl=mp3_file] [filebase:file:file=60:tpl=mp3_dl] [filebase:file:file=59:tpl=m4a_file] [filebase:file:file=61:tpl=pdf_file] | 11/22/10 | Free | View In iTunes |
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FREE Episode 8: Airway Controversies | Dr. Jonathan Sherbino, Dr. Andrew Healy and Dr. Mark Mensour debate dozens of 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. In this episode on Airway Controversies, Dr. Sherbino, Dr. Healy and Dr. Mensour answer questions like: Does Delayed Sequence Intubation have a role in airway management? Which is the best induction agent for patients with head injury? Asthma? What are the pros and cons of Roccuronium vs Succinylcholine? What is the evidence for pre-treatment using lidocaine and fentanyl and head injured patients? Is the new drug Suggamadex useful? Should we be using Video Laryngoscopy (eg: Glidescope) as the primary tool for endotracheal intubation? What is the newest evidence for what constitutes a difficult airway? What are the best methods for confirming Endotracheal Tube placement? How can we best prevent and treat post-intubation hypotension? What is the best positioning for obese patients for intubation? What are the best ventilator settings for patients in status asthmaticus? and many more..... [filebase:file:file=57:tpl=mp3_file] [filebase:file:file=57:tpl=mp3_dl] [filebase:file:file=56:tpl=m4a_file] [filebase:file:file=58:tpl=pdf_file] | 10/6/10 | Free | View In iTunes |
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FREE Episode 7: Medical & Surgical Emergencies in Pregnancy | 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. Pregnant patients who present to the emergency department with non-obstetrical complaints are very challenging. Their symptoms can be misleading or confused with normal pregnancy, their vital signs are normally altered, the physical exam can often be more difficult, their lab values are harder to interpret and imaging algorithms for pregnant patients are very complicated. In addition, they generally have worse outcomes than non-pregnant patients. In this episode, Dr. Lee and Dr. Shelton answer questions such as: how is the pregnant patient with suspected pulmonary embolism worked up and treated? How are ACLS protocols different for pregnant patients? How and when should emergency physicians perform emergency C-sections? How is the presentation of appendicitis different in pregnant patients? What are the risks to the fetus of CT pulmonary angiogram vs. VQ scan? What is the role of MRI for diagnosing appendicitis in pregnant patients? Is gadolinium contrast contraindicated in pregnancy? How can we minimize radiation exposure to our pregnant patients? Which pregnant patients with UTI should be admitted to hospital? What are the best antibiotic choices for asymptomatic bacteruria, cystitis and pyelonephritis in pregnant patients? Do we need to do a BhCG on every woman of childbearing age who presents to the ED? How is septic abortion diagnosed and best managed? and many, many more...... [filebase:file:file=53:tpl=mp3_file] [filebase:file:file=53:tpl=mp3_dl] [filebase:file:file=52:tpl=m4a_file] [filebase:file:file=54:tpl=pdf_file] | 7/31/10 | Free | View In iTunes |
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FREE Episode 6: Transient Ischemic Attack | Dr. Walter Himmel and Dr. Daniel Selchen discuss the key historical and physical examination maneuvers to determine whether patients with neurologic complaints have had a TIA or whether they have had a TIA mimic. They review the 3 best risk stratification rules including the ABCD2 Score to help us determine who needs to be admitted and who needs timely investigations to reduce vascular morbidity and mortality. The reasoning behind which patients require urgent carotid imaging, echocardiograms and advanced imaging such as CT Angiogram is explained, and the best medication choices are reviewed, as well as the indications for Clopidogrel, Aggrenox, Warfarin, Heparin and carotid endarterectomy in the managment of TIAs. In the second part of the episode, a simple and practical approach to the patient with dizziness is presented, and a discussion on which patients with dizziness need urgent work-up and treatment for vertebrobasilar TIA. In this episode Dr. Himmel and Dr. Selchen answer questions like: What simple things can we do in the ED for our TIA patients to improve cerebral blood flow? How do we manage blood pressure in the ED after a TIA? What are the limitations of the best stroke risk prediction rules after TIA? How can we differentiate the common TIA and stroke mimics from a true TIA or stroke in the ED? When is IV Heparin indicated for TIA? Why is carotid doppler imaging such an important test? Which patients need an urgent CT Angiogram or MR Angiogram? Which patients with TIA require admission? Which medication is better for stroke prevention after TIA, Clopidogrel or Aggrenox? How good is Warfarin at reducing the risk of stroke in patients with Atrial Fibrillation and TIA? Should we be prescribing antihypertensives for our patients who have had a TIA? When should we suspect carotid or vertebral artery dissection as a cause for TIA? How should we interpret the Dix-Hallpike manoeuvre and the Head-thrust test? How can we differentiate peripheral vs. central causes of vertigo at the bedside? What are the best medications for patients with vertigo? and many many more..... [filebase:file:file=50:tpl=mp3_file] [filebase:file:file=50:tpl=mp3_dl] [filebase:file:file=49:tpl=m4a_file] [filebase:file:file=51:tpl=pdf_file] | 7/1/10 | Free | View In iTunes |
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FREE Episode 5: Renal Colic, Tox 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. There are widely varying practices when it comes to managing patients who present to the emergency department with Renal Colic. What is the best practice? How far do we need to go with our workups for renal colic patients? How good are we at diagnosing renal colic clinically? Who requires blood work? Who requires which imaging? Who needs consultation and admission? What determines the probability of a stone passing spontaneously? Who should receive medical expulsive therapy and is their good evidence for it's use? What's new in Toxicology? Lipid emulsion therapy as a last ditch attempt to save the life of certain crashing poisoned patients has had a lot of attention from the Toxicology community recently. For patients who present to the ED with smoke inhalation injuries, many of them will also suffer from cyanide poisoning. Hydroxocobalamin is a new antidote for cyanide poisoning and may be the preferred choice over traditional cyanide antidote kits. Finally, to close our Tox Update, while high dose insulin therapy has been used for many years in patients with calcium channel blocker poisoning, it's use requires finesse. Here, Dr. Thurgur gives us the low down on how to use high dose insulin therapy in CCB poisoning effectively. With an increase in the number of body packers seen in Emergency Departments in recent years, we need to know how to recognize when these patients can potentially die and how to manage them. Dr. Rosenberg and Dr. Thurgur answer questions like what is the best method of GI decontamination? Is there a role for sending a urine tox screen? How do we know when all the packets are passed? What is the best way to manage seizures, severe hypertension and ventricular dysrhythmias in cocaine overdose? What are the indications for surgery in body packers? and many many more... [filebase:file:file=47:tpl=mp3_file] [filebase:file:file=47:tpl=mp3_dl] [filebase:file:file=46:tpl=m4a_file] [filebase:file:file=48:tpl=pdf_file] | 5/31/10 | Free | View In iTunes |
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FREE Episode 4: Acute Heart Failure | Dr. Eric Letovsky and Dr. Brian Steinhart describe a practical way to approach patients with undifferentiated SOB and acute heart failure (AHF), the utility of various symptoms and signs in the diagnosis of AHF, as well as the controversies surrounding the best use of BNP and Troponin in the ED. A discussion of the use of ultrasound for patients with SOB as well as the indications for formal Echo are reviewed. In the second part of the episode they discuss the management of AHF based on a practical EM model, as well as the difficulties surrounding disposition of patients with AHF. Despite recent advances in the management of acute heart failure, the one year mortality remains unchanged in the last 30 years. Emergency physcians are only about 80% accurate in their diagnoses of patients with acute heart failure. Dr. Steinhart and Dr. Letovsky have a combined clinical experience of 60 years. They discuss the best clinical predictors for the diagnosis of acute heart failure, how we can use BNP to improve our diagnostic accuracy, and key clinical pearls in management. They answer questions like: How can we differentiate patients with COPD exacerbations from patients with acute heart failure? Which physical examination findings have the best likelihood ratios for acute heart failure? How can the ECG help us discover the cause of acute heart failure? What are the indications for an urgent Echo in the ED? Should we be using BNP in Canadian emergency departments? Why does NIPPV work so well for patients with acute pulmonary edema? What is the evidence for furosemide, nitroglycerine, ACE Inhibitors, milrinone and dobutamine in the treatment of acute heart failure? When should we suspect peripartum cardiomyopathy? Which patients are safe to send home? And many many more..... [filebase:file:file=43:tpl=mp3_file] [filebase:file:file=43:tpl=mp3_dl] [filebase:file:file=45:tpl=m4a_file] [filebase:file:file=44:tpl=pdf_file] | 4/30/10 | Free | View In iTunes |
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21 |
FREE Episode 3: Pediatric Head Trauma | Dr. Rahim Valani and Dr. Jennifer Riley discuss their approach to the workup and management of both minor and major head injury in children. They review two recent landmark studies describing decision rules for performing CT head in minor pediatric head trauma, as well as practical tips on instructing parents regarding back to sport activities after discharge. In major pediatric head injury, they discuss key clinical pearls on managing blood pressure, the use of hypertonic saline and managing raised intracranial pressure in the treatment of major head injury. [filebase:file:file=36:tpl=mp3_file] [filebase:file:file=36:tpl=mp3_dl] [filebase:file:file=31:tpl=m4a_file] [filebase:file:file=32:tpl=pdf_file] | 3/14/10 | Free | View In iTunes |
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22 |
FREE Episode 2: Excited Delirium & Sudden Death | Dr. Margaret Thompson and Dr. Dan Cass review the clinical presentation, precipitating factors and important do's and don'ts in managing patients with Excited Delirium Syndrome to prevent sudden death. They update us on the most current guidelines for Excited Delirium Syndrome and discuss the prevalent theories to explain why many of these patients have cardiac arrests. Excited Delirium Syndrome has recently been recognized by the American College of Emergency Physicians as a true medical emergency in which, typically, a young obese male, often under the influence of sympathomimetic drugs, becomes acutely delirious and displays super-human strength, tachypnea, profuse sweating and severe agitation. Usually, there is a prolonged and continued struggle with law enforcement despite physical restraints . Severe acidosis, rhabdomyolysis and hyperkalemia ensue, often leading to a sudden bradyasystolic cardiac arrest. Listen to this fascinating episode to find out how you can recognize and treat this important syndrome, and save lives. [filebase:file:file=34:tpl=mp3_file] [filebase:file:file=34:tpl=mp3_dl] [filebase:file:file=37:tpl=m4a_file] [filebase:file:file=33:tpl=pdf_file] | 3/9/10 | Free | View In iTunes |
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23 |
FREE Episode 1: Occult Fractures & Dislocations | Dr. Arun Sayal and Dr. Natalie Mamen discuss the key diagnostic considerations in commonly missed occult fractures and dislocations. They review the indications and controversies for the use of Bone Scan, CT and MRI in occult fractures and dislocations and give you some great clinical pearls to use on your next shift. Missed occult fractures and dislocations are the basis of much morbidity and many law suites in emergency medicine. Six cases are presented in this episode, ranging from common scaphoid fractures to rarer dislocations. These experts answer questions like: Which fractures can mimic ankle sprains and how do you avoid missing them? What are the most reliable signs of scaphoid fracture? In which occult orthopaedic injuries should we anticipate limb threatening ischemia? Which is better to diagnose occult fractures - MRI or CT? Which calcaneus fractures require surgery? and many many more...... [filebase:file:file=29:tpl=mp3_file] [filebase:file:file=29:tpl=mp3_dl] [filebase:file:file=35:tpl=m4a_file] [filebase:file:file=30:tpl=pdf_file] | 3/8/10 | Free | View In iTunes |
| Total: 23 Episodes |
Customer Reviews
Fantastic podcast
It's actually hard to describe how informative and educational this podcast is. Highly interesting topics, extremely educated panel members, and great discussion. This is a must for anyone in Emergency Medicine. I was hooked after listening to the first episode; a great way to pass the time while commuting.
Great job putting this podcast together. Thanks and keep it up!
Excellent ED Resource
A great set of informative talks on critically important ED topics. Dr Helman does a fantastic job recapping and summarizing the key points of both evidence-based medicine and expert opinion. Very useful discussions that are easy to apply to practice.
Extraordinarily informative
It's a shame that those involved in this Podcast decided to monitize the recordings. If you want to make money, create an LMS with high quality screencasts that contain objectives and tests for CME points. Keep the audio Podcasts free and then they become the teaser for your for-profit high-end e-learning material. Shame, shame, shame.
Rob Theriault
paramedic educator
e-learning entheusiast
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