Emergency Medicine is relevant to every primary care clinician. I am a primary care office physician [Internal Medicine, Pediatrics, and Office Gynecology] but I find the most useful primary care CME is almost always from the emergency medicine bloggers and podcasters.
And of all the many outstanding EM blogs and podcasts, my personal favorite is Emergency Medicine Cases.
Here are a list recent posts, podcasts, vidcasts and more that I will be reviewing over the next few weeks from Emergency Medicine Cases.
This month’s EM Cases Best Case Ever podcast features Dr. Catherine Varner, Emergency Physician at Sinai Health System and researcher at Schwartz-Reisman Emergency Medicine Institute (SREMI) discussing the key pitfalls in the diagnosis of ectopic pregnancy and ruptured ectopic pregnancy. It turns out that we’re missing the diagnosis more than we’d like to admit. Dr. Varner debunks much of the traditional teaching around ectopic pregnancy so that we can improve our diagnostic skills for this potentially life threatening diagnosis…
The EM Cases Rapid Reviews Videos library is growing! This month we have a special guest production team bring you a whiteboard video on Pediatric Trauma. You might have had trouble remembering all the details of Episode 95 Pediatric Trauma with Dr. Sue Beno and Dr. Fuad Alnaji. But don’t fret! In this short video Dr. Beno and Dr. Alun Ackery review the most important elements of both pediatric and adult multitrauma management for the community Emergency Physician. They discuss common pitfalls leading to bad pediatric trauma outcomes, airway management, hemodynamics, preparation for transfer to a trauma center and much more…
This special Rapid Reviews video on Pediatric Multitrauma Management in the community was sponsored by the University of Toronto Trauma Program, Hospital for Sick Children, Sunnybrook Health Sciences Centre and St. Michael’s Hospital. With Dr. Alun Ackery, Dr. Suzanne Beno. Production by Mike Heinrich with assistance by Dr. Kealin Wong
The long wait has been well worth it. The EM Cases POCUS Cases Video Series has officially been launched!
POCUS Cases is an original EM Cases video series led by Dr. Robert Simard, an Emergency Physician at North York General Hospital and Sunnybrook Health Sciences Centre in Toronto. Rob always wished he had x-ray vision…but since he possesses no special powers…using Point-of-Care Ultrasound (POCUS) is the next closest thing. He completed a POCUS fellowship at NOSM and teaches POCUS nationally and internationally. He is the creator POCUS Cases, an original EM cases screencast that provides POCUS clinical pearls in an engaging and fun way that will help you provide stellar care to your patients.
In this POCUS Cases 1 – Pulmonary Embolism, Dr. Simard shows us how to recognize right ventricular heart strain on POCUS, how to appreciate that right ventricular strain has a differential diagnosis that is much more comprehensive than just pulmonary embolism, how to differentiate the specific findings of pulmonary embolism from chronic findings of right ventricular heart strain on POCUS and finally, how to understand the limitations of POCUS in the diagnosis of pulmonary embolism.
Keep your eyes open for a new POCUS Cases each month! POCUS Cases 1 – Pulmonary Embolism
This is EM Cases main episode podcast on Pediatric Physical Abuse Recognition and Management
Just one case of missed pediatric physical abuse I consider a travesty. The sad state of affairs is that thousands of cases of pediatric physical abuse are missed on initial presentation to EDs across North America. And a small but significant minority of these children die. In fact, 20-30% of children who died from abuse and neglect had previously been evaluated by medical providers for abusive injuries that were not recognized as abuse. Every child that presents to the ED with a suspicious injury gives the treating physician an opportunity to intervene. We have to get better at identifying these kids when there’s still something we can do to protect them, before it’s too late. In this EM Cases main episode podcast on Pediatric Physical Abuse Recognition and Management Dr. Carmen Coombs and Dr. Alyson Holland discuss the 6 B’s of child abuse, the TEN-4 FACE decision rule, the Pittsburgh Infant Brain Injury Score, disclosure tips, screening tests, reporting responsibilities and more…
ED physicians are only about 80% accurate in their diagnosis of acute CHF. Why? There is no single element of past medical history, presenting symptoms or physical exam findings that can reliably rule in or rule out acute CHF in the ED. Orthopnea, PND and weight gain are not especially helpful in making the diagnosis and even the lauded S3 gallop which most of us cannot identify on the best of ED shifts is not that helpful. The classic signs of CHF are often absent on CXR and interobserver agreement (whether you are an ED doc or a radiologist) on the diagnosis of CHF by CXR is enormous. Nonetheless, when all of these elements are put together, ED physician clinical gestalt is not bad at diagnosing CHF. But we could do better.
Enter BNP. BNP is currently in use in many EDs across North America and Europe. In this Journal Jam podcast we discuss the clinical utility of BNP and pro-NT-BNP in the work-up of the dyspneic ED patient. We ask the questions: does BNP add much beyond physician gestalt? Which patients might BNP be useful for? Should we abandon BNP as a dichotomous rule-in/rule-out variable and instead use it as a continuous variable? Does using BNP effect patient oriented outcomes? Is lung POCUS a better test? Are prediction models that include BNP useful? and many more….
In anticipation of EM Cases Episode 107 on Pediatric Physical Abuse with Dr. Carmen Coombs and Dr. Alyson Holland, Dr. Coombs tells her Best Case Ever (actually worst case ever) that inspired her to pursue expertise in pediatric physical abuse…
It’s been another trying flu season in the northern hemisphere—for patients and for emergency department (ED) providers. EDs that are crowded at the best of times come close to a tipping point, waits to be seen and for beds climb, and hospitals struggle to handle the load, sometimes coping by putting patients in hallways or lounges. Even well-written surge plans fall apart in the face of staff illness or unit outbreaks. Too often when trying to help the system cope, a hospital, health region, or government puts out a call for the public to stay away from crowded EDs unless absolutely necessary—but are such warnings ethical or effective?
In this live podcast on Blunt Ocular Trauma from The EM Cases Course 2018 with Anna MacDonald we discuss the most important diagnoses to consider, describe how physical exam in queen while CT can misguide you, explain a simple approach to orbital compartment syndrome with retrobulbar hematoma, give you tips on lateral canthotomy, how to pick up subtle hyphemas, why sickle cell patients are high risk, describe the key clinical clues to subtle globe rupture, the role of tranexamic acid in eye bleeds and much more…
We include special guest appearances by POCUS gurus Jordan Chenkin and Rob Simard to give us tips on using POCUS in a patient who presents with their eye swollen shut as well as a bonus excerpt from the Expert Panel Discussion at The EM Cases Course on how to deal with obstructive consultants with Walter Himmel.
When patients with known congenital heart disease present to the ED with common illnesses we need to consider how their physiology might alter our approach to those common illnesses. Max Ben-Yakov guides us through his Best Case Ever of a CHD patient who presents with bronchiolitis and gives us some tips on how best to approach these fragile patients in a crisis situation…
In this CritCases blog – a collaboration between STARS Air Ambulance Service, Mike Betzner, ORNGE Air Ambulance and EM Cases – we present a case of a 30 week gestational age pregnant woman with high blood pressure, headache, blurry vision and pelvic cramping. We discuss the management challenges of transporting a patient with severe pre-eclampsia and preterm labor, with special attention to dosing of magnesium, antihypertensive agents choice, and indications for steroids, tocolytics and antibiotics.
We see patients with toxic alcohol poisoning most commonly in three clinical scenarios. One, which is usually relatively straightforward, after an intentional suicide attempt where they tell you exactly what they took; the next scenario is a bit more challenging – when they come in agitated and won’t give you a history and the third – also very challenging – the inebriated patient found down. Alcohol is everywhere, and inevitably inebriated people show up at your ED with a myriad of medical and psychiatric problems – we’re all familiar with these patients. Or they are simply very drunk. And most of them just need to sober up and can be sent home. But, it’s our job as ED professionals, not only to identify traumatic, medical and psychiatric catastrophes in these patients but also to identify and manage the relatively rare but potentially life and sight threatening toxicologic diagnoses in the inebriated or agitated patient. And that isn’t so easy – especially when it comes to toxic alcohols.
So, in this Episode #106 Toxic Alcohols – Minding the Gaps – Recognition and Emergency Management, we’ve got the mighty return of two of my favorite brilliant Toronto based toxicologists –Margaret Thompson, the medical director of the Ontario Poison Control Centre, and the blossoming toxicology educator extraordinaire Emily Austin to help give you the knowledge of toxic alcohol poisoning recognition, clinical and lab clues, limitations of the osmolar gap, goals of management, time sensitive treatments and more…
This is EM Cases’ BCE 65 – Intimate Partner Violence – A Silent Epidemic
I was taken aback when I came across the statistic that approximately every 6 days a woman in Canada is killed by her intimate partner. Every 6 days a woman is killed at the hands of her partner. Victims of intimate partner violence and domestic violence that we see in the ED typically involve an abuse story of repeated escalating violence over time that ends up in a crisis situation. The woman is often financially dependent on her abuser and has no one to turn to for help. In one of her worst cases ever from Janus General, Dr. Meeta Patel and I discuss the notions that Emergency providers have a unique opportunity to identify patients who are victims of intimate partner violence; that we should begin by thinking of how we can screen every woman of childbearing age about intimate partner violence in a private, safe and respectful way. We describe the quick Partner Violence Screen and finally how to offer supportive, empowering statements and connect your patients with resources like assaulted women’s helpline and shelters in your community…
This is EM Cases Episode 105 Commonly Missed Ankle Injuries.
You probably can’t remember the last time you worked a shift in the ED and didn’t see at least one patient with an ankle injury. While almost all of these patients are relatively straightforward to diagnose and manage a small but significant minority of these patients will have a more elusive diagnosis, that if not identified early, could lead to significant morbidity. On the flip side, if we’re super conservative and defensive and we immobilize everyone with an ankle injury no matter how minor we’re not doing our patients or our consultants any favors either.
With the help of Canada’s leading ED-ortho educator Arun Sayal, the brains behind The CASTED Course, and Hossein Mehdian, an Orthopedic surgeon at North York General, we cover a general way of thinking about ankle injuries, the limitations of the Ottawa Ankle Rules, a simplified approach to the ankle x-ray, the importance of identifying an external rotation mechanism of injury and much more…
The EM Cases Rapid Reviews Videos library is growing! You might have had trouble remembering all the details of Episode 78 Anaphylaxis & Anaphylactic Shock live from the EM Cases Course with David Carr. But don’t fret! In these short videos Patrick Gilbride reviews the ED recognition and management nuances of anaphylaxis and anaphylactic shock including when to give epinephrine, steroids and H1 blockers, epinephrine resistant shock, Kounis Syndrome and more…
The year 2017 was the most successful year in EM Cases 8 year history with more than 200,000 podcast downloads per month reaching a total download count of nearly 6 million to date, as well as nearly 1 million webpage views. We introduced the Rapid Reviews Videos series as part of our soon to be released EM Cases Learning System that will include a Q & A databank to round out our multimodal resources (podcasts, shownotes, blogs, emails, videos, courses and ebooks). 2017 also saw the growth of the CritCases blog, the Q & A Pearl of the Week, Just The Nuggets emails, the Waiting to Be Seen blog, and the 2nd annual EM Cases Course.
Based on a blend of the number of podcast downloads, webpage views, social media engagement, number of positive emails and comments that I received, and my own favs, I’m pleased to bring you the EM Cases Best of 2017 Top 10. Many huge thanks to the entire EM Cases team, Advisory Board, SREMI, the amazing guest experts and you, the listeners of the podcasts, readers of the blogs, viewers of the videos and participants in the course, for making 2017 another successful year for EM Cases!
And here they are…
EM Cases Best of 2017 Top 10
#10 GI bleed Emergencies Part 1 & 2 with Salim Rezaie & Anand Swaminathan Link
#9 Best Case Ever 64 – Salicylate Poisoning with Hans Rosenberg Link
#8 Episode 104 Intracerebral Hemorrhage – The Golden Hour With Walter Himmel & Scott Weingart Link
#7 Episode 92 Aortic Dissection Live from the EM Cases Course 2017 with David Carr Link
#6 Rapid Reviews Videos – Lyme Disease from EMU Conference 2017 with Leeor Sommer Link
#5 CritCases 7 – Pulmonary Hypertension with expert peer review by Susan Wilcox Link
#4 Journal Jam 11 – Post Contrast Acute Kidney Injury with guest Lauren Westafer Link
#3 Episode 91 – Occult Knee Injuries Pearls & Pitfalls with Arun Sayal & Hossein Mehdian Link
#2 Episode 94 – UTI Myths & Misconceptions with Justin Morgenstern & Andrew Morris Link
#1 Best Case Ever 63 – Failing Up with Sara Gray Link