In this post, we will review the anatomy, essential history, and common presentations of tracheostomy patients in the ED, including obstruction, decannulation, bleeding, tracheal stenosis, and infection. Anatomy of a tracheostomy tube Outer cannula Sits directly in the tracheal stoma Proximal end designed to allow tube to be easily securedRead More →
Methodology: 3.5/5 Usefulness: 4/5 Albers GW, et al. N Engl J Med. 2018 Jan 24. Journal Club Bottom Line Question/Methods: This was a multicentre, prospective, randomized, open label, blinded outcome trial comparing thrombectomy + medical therapy vs medical therapy alone in patients with delayed presentation (6-16 hours) of proximal MCARead More →
Urgent care presents a specific set of challenging clinical questions for the emergency physician. Often, seemingly mundane presentations will leave us questioning whether or not we have managed a case appropriately. Our decision-making can be highly influenced by the long lasting effects of dogma, clinical anecdotes, or historical studies ofRead More →
Sickle Cell Disease (SCD) is a complex medical entity, associated with significant morbidity and mortality. Patients with SCD suffer from acute and chronic pain, along with a seemingly endless list of additional complications (from hemolysis and sequestration, to aplastic crises and acute chest syndrome). The associated morbidity of SCD isRead More →
In this post, we will explore the current literature regarding common EM controversies, covering the nature and prevalence of penicillin allergies, the management of skin and soft tissue infections, and the role of NSAIDs for acute pain. Penicillin allergies in the ED Penicillin (PCN) is a Beta-lactam antibiotic discovered in 1928.Read More →
Traumatic injuries are amongst the most common presentations for all emergency departments (ED). In 2010, there were over 1 million patients in Canada who visited the ED for trauma, result in an cost of almost 9 billion dollars.1 Yet, in spite of their frequency, there remains a great deal ofRead More →
In this post, we will discuss the use of neuromuscular blocking agents (NMBAs) for intubation in the Emergency Department; we will focus on considerations in predicted difficult airways (RSI vs. awake intubation), Rocuronium vs. Succinylcholine, and the indications for Sugammadex. This post will not cover laryngoscopy; although this was previouslyRead More →
In this post, we will discuss updates and controversies surrounding rate control in Afib, specifically we will: Review the new 2017 CAEP Afib best practices guidelines Review Tachycardia Induced Cardiomyopathy Review Afib and Type 2 ACS Discuss the identification and management of secondary Afib 2017 CAEP AAF Best Practices GuidelineRead More →
Necrotising soft tissue infections are an significant cause of morbidity and mortality, so an timely diagnosis is critical for the Emergency Physician. Here we discuss the publication of a new systematic review and meta-analysis on this challenging diagnostic entity, and include an helpful infographic to help interpret the findings [1]. Background NecrotizingRead More →
The management of traumatic cardiac arrest differs significantly from the management of medical cardiac arrest, however the management is often lumped together. In this weeks Grand Rounds summary Dr. Nicholas Costain takes us through some controversies in the management of these difficult cases. Objectives: Review updated literature regarding indications toRead More →