What a headache: Updates on Migraine Management

Migraine headaches are not a benign disease – they have a significant impact on quality of life, ability to function, and pose a considerable economic and societal burden. Prevalence tends to peak during peoples’ period of highest productivity.  According to the World Health Organization’s (WHO) update on Global Burden of Disease (2004), a severe migraine is considered to be as disabling […]

Pulmonary Embolism in Pregnancy: Diagnostic Dilemmas

Epidemiology of pulmonary embolism in pregnancy The rate of pulmonary embolism (PE) in pregnancy is 5.4 per 10 000 pregnancies. This is 5x the risk of the general non-pregnant female population The rates of venous thromboembolism change throughout pregnancy: Antepartum: 5.4 per 10 000 Peripartum: 7.2 per 10 000 Postpartum: 4.3 per 10 000 This leads to 0.96 deaths per 100 […]

Sepsis and Septic Shock

The Surviving Sepsis Guidelines define sepsis as a “life-threatening organ dysfunction caused by a dysregulated host response to an infection”. Septic shock is further defined as sepsis with hypotension (MAP ≤65) and/or lactate ≥2.0 despite adequate fluid resuscitation(1,2). This definition of septic shock highlights the importance of factoring in both macrocirculatory (blood pressure) and microcirculatory markers (lactate) when treating patients. […]

Part II: COVID-19, making sense of the numbers

In the current age of the COVID pandemic, we find ourselves inundated with headlines and millions of daily social media posts on COVID-19. For the frontline healthcare worker, the massive amount of online information can be overwhelming, and for the general public, it often feels as though they are being plunged into anxiety and panic. The goal of these articles […]

An open letter to Canadians from the frontlines

Your friendly neighborhood Emergency doctor here with a message for Canadians. Hey Canada, sitting here on the frontlines – we see you. Staying home, helping to gather PPE, supporting us, and feeding us, you’re helping us to do our jobs. When we see you helping to support frontline workers, it really helps morale. Although, I can’t say I’m surprised, it […]

Guidelines for Emergency Airway Management of COVID-19

Guiding Principles Suspected SARS-COV-2 patients showing signs of hypoxemic respiratory failure should be intubated proactively, as early as possible. Signs may include FiO2 requirement > 50%, clinical signs of respiratory fatigue despite supplemental oxygen, or hemodynamic instability. Do not wait for rapid deterioration to act! Such unstable respiratory failure patients in the ED – whether under the care of Emergency […]

Bupropion – Picking our Poisons

What is Bupropion? Bupropion is an anti-depressant commonly prescribed for seasonal affective disorder, as a smoking cessation aid, and off-label in the management of major depressive disorder. You may know it by the trade names Wellbutrin, Zyban or Champix. While frequently compared to SSRIs, it has a unique mechanism of action – it is a norepinephrine-dopamine reuptake inhibitor, with barely […]