The Status on Status: Management of Status Epilepticus

Status epilepticus (SE) is considered one of the most common neurological emergencies with an estimated incidence of 20 cases/100,000 people worldwide. Just the facts The distribution is bimodal, peaking in patients <1 and >60 years old.  In children, the cause is predominantly from febrile illnesses, with or without infection, and in adults it is largely secondary to acute damage from […]

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 […]

Braving the Electrical Storm in the ED

This post takes a deep dive into the pathophysiology, presentation and management of electrical storm in the emergency department. The management focuses on patients with implantable cardioverter-defibrillators receiving multiple shocks, patients with polymorphic ventricular tachycardia and refractory ventricular fibrillation. Electrical storm (ES) has varying definitions in the literature depending on whether or not the patient has an ICD (an implantable […]

Solid Organ Donation from the Emergency Department – Missed Donor Opportunities

In this post, we aim to highlight the perspectives of family, physicians, the emergency department and pre-hospital medicine in regards to organ donation. Types of Organ Tissue Donation There are 2 main types of deceased organ donation including neurologic determination of death and donation after circulatory determination of death. Neurologic determination of death includes a very strict set of criteria […]

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 […]

Pneumonia: Getting In-Sync with the Guidelines

Community-acquired pneumonia is the leading infectious cause of death in Canada, and combined with influenza is the 7th most common cause of death overall. Diagnosis The 3 main pillars leading to the diagnosis of pneumonia are as follow: Evidence of infection (fever, chills, leukocytosis) Signs and symptoms localized to the respiratory system (cough, SOB, sputum, chest pain, crackles on auscultation, elevated RR, low […]

Community Paramedicine: Behind the Scenes

What is Community Paramedicine? The international round table on community paramedicine provides the following definition: “…a model of care whereby paramedics apply their training and skills in non-traditional community-based environments outside of the usual emergency response/transport model. The community paramedic practices in an expanded role; working in non-traditional roles using existing skills.”(1) Models of Care in Community Paramedicine The CSA group describes 3 models […]

Management of PEA: in need of resuscitation?

What is pulseless electric activity (PEA)? Pulseless electrical activity is diagnosed based on a patient having an organized, non-shockable rhythm and no palpable pulse.  However, PEA is not always a cardiac arrest state.  In many cases, patients with PEA have underlying cardiac activity and detectable arterial blood pressure.1 PEA is a spectrum of disease Imagine a spectrum, where on one […]

Borderline Personality Disorder – Part 2

This post is a continuation of Borderline Personality Disorder – Part 1. In this second post, Dr. Beamish discusses the management of BPD in the emergency department and shares some valuable resources. Borderline Personality Disorder – Part 2 Case 2 A 22 year old female with chronic suicidal ideation is brought to the ED by police after her roommates called […]

Borderline Personality Disorder – Part 1

Borderline Personality Disorder (BPD) is a personality disorder that describes the emotional dysregulation, impulsivity, recurrent self-harm and suicidal behaviour experienced by many individuals. People suffering from this personality disorder frequently live chaotic lives characterized by extreme stress, interpersonal conflict and maladaptive behaviours – leading them to frequent emergency department visits. BPD prevalence varies between 1.6  to 5.9% of the general population, […]