Emergency Medicine Cases

Episode 23: Vaginal Bleeding in Early Pregnancy

ahelman — Thu, 17 May 2012 02:00:52 +0000

In this episode Dr. David Dushenski & Dr. Ross Claybo discuss the very common presentation of vaginal bleeding in the first half of pregancy. They 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. We wrap it up with a mind-blowing case of Dr. Dushenski’s.

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Best Case Ever 9: Ross Claybo on Vaginal Bleeding in Early Pregnancy

ahelman — Wed, 09 May 2012 00:41:38 +0000

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.

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Episode 22b: Whistler Conference Highlights Part 2

ahelman — Wed, 25 Apr 2012 16:02:41 +0000

In this bonus episode, our second instalment of the highlights from the 25th Annual Update in Emergency Medicine from Whistler B.C., we have Dr. David Carr updating us on infectious diseases, Dr. Dennis Scolnick giving us the low down on pediatric urological emergencies, Dr. Anil Chopra reviewing the pearls and pitfalls of managing shock states, and much more. In these conference highlights our experts answer such questions as: Which oral antibiotics can replace IV antibiotics in the majority of bacterial infections? What are the most recent recommendations for pelvic inflammatory disease management? Which patients with mammalian bites require antibiotics? How can we best counsel our patients with potential exposure to HIV? Does every child with a painful scrotum require an ultrasound? What is the role of treatment with Bicarb in shock? What are the best antibiotic choices in patients suspected of septic shock? When are steroids indicated for patients in shock? How should you decide between the different vasopressors for shock? and many more…….

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Episode 22a: Whistler Update in EM Conference Highlights

ahelman — Wed, 04 Apr 2012 02:13:50 +0000

This past February I helped organize, and lectured at, the Univeristy of Toronto’s 25th Annual Update in EM Conference in Whistler, British Columbia, and there were so may great talks with amazing clinical pearls that we decided to wade through the 18 hours of audio recordings and packaged the key highlights for you here – for free!

In this first installment we cover Dr. Eric Letovsky talking about complications of MI and the importance of listening for cardiac murmurs. Next, I moderate an expert panel on the current trends on imaging patients who present with renal colic and query appendicitis with Dr. Connie Leblanc, Dr. Joel Yaphe, Dr. David MacKinnon & Dr. Eric Letovsky. We then hear from Dr. Adam Cheng, Dr. Dennis Scolnick & Dr. Anna Jarvis in a pediatric expert panel about the newest on minor head injury, child with a limp, otitis media, mastoiditis and bronchiolitis. Dr. David Carr reviews one of the most important articles in 2011 regarding subarachnoid hemorrhage, and Dr. David MacKinnon gives us tonnes of clinical pearls when it comes to everyone’s favourite subject, anorectal disorders.

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Episode 21: Respiratory Emergencies 1 – Pulmonary Embolism

ahelman — Wed, 14 Mar 2012 17:04:18 +0000

In this episode we have the triumphant return of Dr. Anil Chopra the author of past Tintinalli chapters on thromboembolic and arterial disease, and with him Dr. John Foote the CCFP(EM) residency program director at the University of Toronto. We kick it off with Dr. Foote’s key pearls in his approach to undifferentiated dyspnea and go on to discuss how best to develop a clinical pre-test probability for the diagnosis of pulmonary embolism using risk factors, the value of 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. 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.

Dr. Chopra & Dr. Foote answer such questions as: What are the most important under-recognized risk factors for pulmonary embolism, and how does the absence of risk factors change the pre-test probability of PE? Should we be using D-dimer in pregnant patients? How does the D-dimer value change with age and how can we incorporate this into our work-up? How does an experienced doctor’s clinical gestalt compare to clinical desicion rules in working up PE? In what situations is V/Q scan preferred over CT angiogram for the diagnosis of PE? How should we manage patients with subsegmental PE found on CTA? What is the danger of aggressive fluid resuscitation in patients with massive PE? Which patients can be sent home from the ED with PE? Should we thrombolyse patients with submassive PE? What is Medically Unexplained Dyspnea (MUD) and how can we identify these patients and avoid lengthy work-ups?

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Best Case Ever 8: John Foote on Dyspnea

ahelman — Fri, 02 Mar 2012 20:56:05 +0000

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.

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