Remember how it felt when you saw that really difficult patient and knew exactly what to do? What if you had the knowledge to do that with all of your patients? What would that look like? What would it sound like? How would you feel? We take care of people. They come to us because they need our expertise. The EM SHOW is about the latest evidence and deconstructing the performance of the best clinical specialists, to bring you knowledge that can take you to the level of 'Outstanding'. "The Knowledge you take into Your Shift, DOES Matter".
A patient walks into the Emergency Department with a complaint of Diplopia. "I'm seeing Double".
How do you approach this situation?
What are the causes?
How do we tell the difference between Monocular and Binocular?
Here are 5 things I do.
23 Feb 2024
Episode 12: Guillain Barre Syndrome
This is a low frequency High stakes Disease we cannot miss.
15 Feb 2024
Episode 11: Do steroids decrease mortality in severe community acquired pneumonia
Here is a controversial paper with mortality findings very different to what has been published before.
The Community-Acquired Pneumonia: Evaluation of Corticosteroids (CAPE COD) Trial, was a double-blind, randomised, controlled, superiority trial, conducted in 31 French ICUs.
Intravenous hydrocortisone, 200mg, was given within 24 hours of onset of severity criteria (median time < 15 hours). The results were very different to the previous study conducted in 42 ICU centres.
15 Feb 2024
Episode 10: Does using a small volume BVM affect ROSC?
Airway in Cardiac Arrest is still a bit of a mystery. We don't really know if we should intubate early. Contrary to prior studies showing no benefit of intubation over BVM or SGA, new evidence may be pointing in a different direction. We don't know the correct rate of breaths or volume of breaths or FiO2. Small animal studies and 'expert' opinion restrict our delivery of breaths to a maximum of 10 per minute and the volume of each breath to about 500 mL.
This has resulted in some centres now using paediatric BVMs for adult resuscitation. Do these work? Previous studies may have shown no inferiority, but here is a new study, that suggests that traditional BVMs may be better.
5 Jan 2024
Episode 9: The EM Show Podcast: What it's all about.
The Clinical Cases Podcast, also called The EM Show. Coming to EM Mastery Soon
6 Dec 2023
Episode 8: Atrial Flutter with a High degree Block
A patient presents feeling dizzy when standing. His ECG shows he is in Atrial Flutter with a variable block. The block is significant. In some places it is 8:1. His blood pressure is 130 mmHg systolic. He is normally on Diltiazem. What should we do?
29 Nov 2023
Episode 7: Cases in Shock: Choosing Inotropes and vasopressors.
How do you approach the patient in shock? Septic shock, Cardiogenic Shock, shock due to a massive pulmonary embolism?
There is no perfect drug, however Noradrenaline may be as perfect as it gets.
21 Nov 2023
Episode 6: Hypertensive Emergencies
Is there such an entity as a Hypertensive Urgency? Probably not. Hypertensive Emergencies are a Clinical Diagnosis as they involve end-organ damage.
Apart from Aortic Dissection and preeclampsia, we shouldn't decrease systolic Blood pressure by more than 20-25% in the first hour. What STEMI, or ICH, or stroke?What is the best medication to use? We look at that in this episode, taken from a lecture I gave in 2023.
14 Nov 2023
Episode 5: A Case of Electrical VT Storm
Electrical Storm can be difficult to manage. Repeated episodes of Ventricular tachycardia, with haemodynamic compromise, that do not respond to defibrillation and potentially to medication, are a significant challenge. We discuss a recent case of just this scenario and it was approached as well as an approach to the Electrical VT Storm Patient.
8 Nov 2023
Episode 4: Oxygen Targets in Post Cardiac Arrest Patients with ROSC
We look at the unknown variables of ventilation and oxygenation both during cardiac arrest and post ROSC. We mention the EXACT Trial and the BOX Trial.
2 Nov 2023
Episode 3: Pericarditis
Pericarditis requires 2 of 4 criteria to make the diagnosis. It can however be difficult to do so, because criteria such as a pericardial rub are difficult to hear, the ECG changes may not be present and the chest pain may not be as typical as we think. In this episode, we look at a patient with an atypical presentation who was still diagnosed with the condition.
1 Nov 2023
Episode 2: Shocking the Patient in Asystole
The patient in asystole during cardiac arrest, has a very poor prognosis. But is it really asystole? Is there benefit in giving one shock to the patient? Surely we need to look at all the leads and increase the amplitude, to see of this is low amplitude VF. Even if we find low amplitude VF, will we be able to successfully defibrillate them? Aren't we supposed to perform CPR to increase the amplitude of the VF waveform?....we've been doing this, with no success. Delivering one shock may be very appropriate.
1 Nov 2023
Episode 1: Spontaneous Coronary Artery Disease
SCAD is a separation of layers of the coronary artery wall, resulting in intramural haemorrhage and haematoma formation. Coronary insufficiency results due to the narrowing of the coronary artery lumen, from an expanding intramural hameatoma. SCAD may or may not involve an intimal layer tear.
SCAD plays a prominent role in myocardial infarction in women. In total the disease accounts for approximately 1% of all acute myocardial infarctions. However 90% of cases of SCAD occurs in female patients between the ages of 47 and 53. It accounts for up to 20% of myocardial infarctions during pregnancy and is now increasingly being reported in older women.
Although the condition does occur in males, its prevalence is very low.
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