Generated by All in One SEO v5.0.1.1, this is an llms.txt file, used by LLMs to index the site. # CanadiEM An online community of practice for Canadian EM physicians ## Sitemaps - [XML Sitemap](https://canadiem.org/sitemap.xml): Contains all public & indexable URLs for this website. ## Posts - [HiQuiPs (Quality Improvement)](https://canadiem.org/hiquips/) - Quality Improvement Quality of Care and the ED Preparation Part 1 - General Considerations for a QI Project in the ED Preparation Part 2 - Stakeholder Engagement and Behaviour Change Preparation Part 3 - Root Cause Analysis QI in the ED - Implementation Part 1. QI Implementation Methodologies QI in the ED - Implementation - [HiQuiPs Patient Safety Fundamentals: Reducing Central Line-Associated Bloodstream Infections](https://canadiem.org/hiquips-patient-safety-fundamentals-reducing-central-line-associated-bloodstream-infections/) - You are a resident rotating through the ICU. One of your patients is a 75-year-old female who was admitted for urosepsis (sepsis originating from the urinary tract). She required vasopressor support and had an internal jugular vein central venous catheter placed in the ED. Since admission, the patient has been improving with broad-spectrum antibiotics. However, - [An Approach to Undifferentiated Shock and Hypotension](https://canadiem.org/approach-to-undifferentiated-shock-and-hypotension/) - Background Shock is a state of cellular and tissue hypoxia caused by reduced oxygen delivery or increased oxygen consumption. We tend to use the patients systolic blood pressure (SBP) as our main diagnostic test for shock as it is readily available and simple to assess. Therefore, patients with a SBP of 90 mmHg or less are considered to be in shock - [See (N)one, Do One, Teach One: Barriers in Teaching Cricothyrotomy](https://canadiem.org/see-none-do-one-teach-one-barriers-in-teaching-cricothyrotomy/) - 👨‍⚕️💊👩‍⚕️ See (N)one, Do One, Teach One: Barriers in Teaching Cricothyrotomy - CanadiEM - George Gainham & Doctor Grace Bravo 🥼💉🏥 - [How can artificial intelligence advance emergency medicine? A look at the current state](https://canadiem.org/artificial-intelligence-emergency-medicine/) - Nearly two years have passed since OpenAI unveiled ChatGPT, propelling artificial intelligence's (AI) capabilities into the public spotlight and sparking a technological race to incorporate AI into virtually every field - from computer operating systems, to film writing, to ordering food at the drive-through. Beyond the excitement, large AI models have important pitfalls to pay - [FIRE SAFE: What are the indications for intubation in inhalational injuries?](https://canadiem.org/tiny-tips-fire-safe/) - Inhalational injuries occur as a complication of approximately one-third of burns and may lead to significant morbidity and mortality if not correctly managed.​1​ Inhalational injury to the upper airway can occur as a result of direct thermal injury, leading to airway swelling and necessitating the need for early intubation for airway protection.​2​ Inhalational injuries can - [Recognizing and Managing Liver Failure in the ED](https://canadiem.org/recognizing-and-managing-liver-failure-in-the-ed/) - Donna is a 48-year-old female brought by EMS to your community ED after her roommates noticed her behaving erratically at home. They report she has been vomiting and become increasingly confused over the past 24 hours, now complaining of right upper quadrant discomfort. She was recently discharged from the hospital a week ago following an - [Is IO (intraosseous) cannulation an underutilized method of emergency vascular access?](https://canadiem.org/intraosseous-cannulation-emergency-vascular-access/) - A 40-year-old gentleman is brought into your Emergency Department by EMS in Pulseless Electrical Activity (PEA) arrest. With CPR in progress, monitors being placed, and epineprine being prepared, both nurses on either side of the patient report they couldn’t get IV access. A third nurse tries. Then a fourth. What should be done next? What - [Money Heist Crush Injuries](https://canadiem.org/money-heist-crush-injuries/) - Patient Presentation Helsinki, or Mirko Dragic, is a Serbian mercenary who is a member of the highly specialized team assembled by The Professor for the complex Bank of Spain heist. Before the heist could be completed, an elite military unit was sent in to put an end to the elaborate operation. The unit detonates explosives - [Renal Trauma in Professional Boxing: A Case Study of Adonis Johnson Creed](https://canadiem.org/renal-trauma-in-professional-boxing-a-case-study-of-adonis-johnson-creed/) - Presentation: In their first bout for the World Heavyweight Boxing Championship, Adonis Creed, the reigning champion, and son of the late Apollo Creed, faces Viktor Drago. Ivan, the father of Viktor Drago, holds a notorious legacy as the man behind Apollo Creed's fatal defeat in the ring years ago. Adonis, at the peak of his - [Common ED Presentations: Clerk Flashcards](https://canadiem.org/clerk-flashcards/) - Are you a medical student ready to excel in your first ever emergency medicine shift and impress your mentors in the ED? We introduce to you a set of flashcards with common differential diagnoses so you can confidently tackle common ED presentations! This post was reviewed by Daniel Ting and copy-edited by @aafia-maqsood - [HiQuiPs: Test Result Follow-up in the Emergency Department](https://canadiem.org/hiquips-test-result-follow-up-in-the-emergency-department/) - Introduction Test result follow-up can be especially challenging in the Emergency Department (ED) due to its multiplicity of moving parts. ED physicians are under increasing pressure when treating patients due to the challenges of high volumes of patients, pressure for quick discharges in the face of space constraints, and complexities surrounding patient handover. Test result - [Predicting Occult Scaphoid Fractures in the ED Using Clinical Features](https://canadiem.org/occult-scaphoid-fractures-in-the-ed/) - A 27F presents to the ED with wrist pain after a fall. The X-Rays are normal. What clinical features can be used to predict occult scaphoid fractures in the ED? - [HiQuiPs: Patient Safety Fundamentals - Patient Fall Prevention](https://canadiem.org/hiquips-patient-safety-fundamentals-patient-fall-prevention/) - An 85-year-old woman who lives independently at home was hospitalized three days ago for pneumonia. She has multiple comorbidities, including dementia, hypertension and diabetic neuropathy. While in hospital, the patient’s care team noticed her losing balance, and it was determined that the patient was at high risk of falling. One evening, the patient attempted to - [HiQuiPs: Patient Safety Fundamentals - Reducing Pressure Injuries](https://canadiem.org/hiquips-patient-safety-fundamentals-reducing-pressure-injuries/) - Hilary Weatherby is a Registered Nurse working as a Patient Safety & Quality Improvement (QI) Specialist. Hilary helps teams apply QI methodology to organization-wide projects and reviews patient safety events for the purposes of continuous quality improvement across a large, downtown Toronto, hospital system. You are a medical student seeing patients on a medicine unit - [HiQuiPs: Using In Situ Stress Testing to Address Latent Safety Threats](https://canadiem.org/hiquips-using-in-situ-stress-testing-to-address-latent-safety-threats/) - It’s a night shift, quieter than usual, though you wouldn’t say so out loud. As if the thought is enough to tempt fate, EMS rolls by. You got no patch, no heads up. “Car accident, just outside the hospital,” a paramedic calls as the patient is transferred onto the trauma stretcher. All you hear are - [HiQuiPs: Dashboards Demystified Part 2 - Designing Your Dashboard](https://canadiem.org/hiquips-dashboards-demystified-part-2-designing-your-dashboard/) - This post covers functional and non-functional requirements as well as design principles of effective dashboards. - [HiQuiPs: Dashboards Demystified Part 1 - Problem Identification](https://canadiem.org/hiquips-dashboards-demystified-part-1-problem-identification/) - In today’s post, we’ll go over the first part of a multi-step process in designing and developing dashboards to solve a real-world clinical and QI challenge. - [HiQuiPs: Using dashboards to supercharge clinical care and quality improvement](https://canadiem.org/hiquips-using-dashboards-to-supercharge-clinical-care-and-quality-improvement/) - Dashboards are not limited to sci-fi! Many organizations across sectors make daily use of dashboards to run smoothly and work towards their goals. - [What is the role of systemic thrombolysis in the management of pulmonary embolism?](https://canadiem.org/systemic-thrombolysis-in-pulmonary-embolism/) - A previously well 41-year-old woman on OCP presents to the emergency department with acute-onset tachycardia, dyspnea, and leg swelling. While awaiting imaging, she rapidly deteriorates and BP drops to 86/60 (triage BP 134/78). CT shows bilateral pulmonary emboli. Risk Stratification Pulmonary embolism (PE) is a cardiovascular emergency which can result in significant morbidity and mortality - [HiQuiPs: Engaging Residents in QIPS – Current and Future Perspectives](https://canadiem.org/hiquips-engaging-residents-in-qips-current-and-future-perspectives/) - Welcome to this HiQuiPs post on Quality Improvement in Residency Education where we will review the current status of Quality Improvement and Patient Safety (QIPS) education in postgraduate medical education and strategies to effectively engage trainees in QIPS. CanMEDS and QIPS In 2015, the updated CanMEDs framework broadened accreditation standards for residency programs across Canada.​1​ - [HiQuiPs: Managing Crises - What’s going on behind the scenes?](https://canadiem.org/hiquips-managing-crises-whats-going-on-behind-the-scenes/) - You are on-call - covering medicine and ICU admissions - while overseeing 20 admitted patients. Your wards are at capacity. You receive 3 new admissions from the ED, but you still have to move 2 sick patients to the ICU. You also have to prepare 3 discharges for the next morning. You wonder how you - [HiQuiPs: Design Thinking in Quality Improvement](https://canadiem.org/design-thinking-in-quality-improvement/) - Is your team about to embark on a new Quality Improvement (QI) project that involves patients but you’re not sure how to structure it? Are you looking for a meaningful and empathetic approach that champions the user perspective from start to finish and complements traditional QI methods? Design thinking has been gaining attention across a - [Dress for Success: A Guide to Dressing Choices for Common Wounds in the Emergency Department](https://canadiem.org/dressing-choices-common-wounds/) - During your Emergency Medicine (EM) rotation, you've encountered numerous lacerations and have honed your suturing skills. Following the primary closure of your most recent laceration, your supervising physician has requested that you apply an appropriate dressing and provide wound care instructions, as the nursing staff are preoccupied with attending to other patients. You look at - [HiQuiPs: How do we evaluate virtual care?](https://canadiem.org/hiquips-how-do-we-evaluate-virtual-care/) - Would the virtual care provided be appropriate for the type of care the patient needs? How would one determine what quality virtual visits mean to patients? - [HiQuiPs: Root Cause Analysis in the Time of COVID-19](https://canadiem.org/hiquips-root-cause-analysis-in-the-time-of-covid-19/) - You are midway through a busy rapid response shift where you have noticed an increased response time of the hospital’s intubating teams to decompensating patients. Over the last few months, the COVID-19 pandemic has prompted a restructuring of the use of many spaces to accommodate the influx of patients. You understand that the system is - [Next Generation Improvement Part 2: QI Frameworks - Quality Improvement vs. Systems Thinking](https://canadiem.org/next-generation-improvement-part-2-qi-frameworks-quality-improvement-vs-systems-thinking/) - You are the nurse manager of an emergency department at a small community hospital in rural Ontario. You recently helped facilitate the creation of a group of healthcare professionals to focus on improving patient flow within the emergency department, something that your hospital has noted to be a longstanding issue. The team is meeting for - [Next Generation Improvement Part 1: A Call for the Strategic Deployment of Improvement Modalities](https://canadiem.org/next-generation-improvement-part-1-a-call-for-the-strategic-deployment-of-improvement-modalities/) - Quality Improvement (QI) is in the middle of a “market surge”. Over the last few years, we have seen QI move from being a fad to having an established presence in academia, hospital operations, and science. A plot of Pubmed articles with the search criteria “quality improvement” OR “QI” yield a very flat slope between - [HiQuiPs: Building Quality & Safety Infrastructure](https://canadiem.org/hiquips-building-quality-safety-infrastructure/) - You’ve completed a Quality Improvement (QI) project and you’re thinking about how you might align your efforts with those of your colleagues to build a community of practice that can prioritize, support, and deliver a comprehensive program of high-quality Q&S work. But where to start? What are the crucial steps and antecedents for success in - [HiQuiPs: Resource Issues in the Emergency Department](https://canadiem.org/hiquips-resource-issues-in-the-emergency-department/) - Emergency departments are busy and are getting busier1, 2. Emergency physicians are faced with issues of overcrowding, departmental closures, and insufficient staffing. These issues are exacerbated by both the Covid pandemic3 and pressures found in the post-Covid “return to normal”4. Physicians are still expected to provide safe medical care in the face of these challenges. - [HiQuiPs: Optimizing your diagnostic reasoning – themes from CMPA medico-legal cases](https://canadiem.org/hiquips-optimizing-your-diagnostic-reasoning-themes-from-cmpa-medico-legal-cases/) - A 49-year-old male presents to the emergency department with shortness of breath on exertion and left lower chest discomfort for the past 3 days. His past medical history is significant for hypertension and he has a family history of heart disease. At triage he is noted to have a pulse of 117 and normal blood - [Quality Improvement in Nephrology Part 1 - Examining Patient Follow-up Practices](https://canadiem.org/quality-improvement-in-nephrology-examining-patient-follow-up-practices/) - The Quality Improvement paradigm has been applied to a wide spectrum of settings and patient populations. There has been an exponential rise in QI publications over the recent decades.1​ In this new HiQuiPs Series we explore the QI paradigm applied to different medical specialties and settings. We start with an example of an outpatient nephrology - [Initiation of Congestive Heart Failure Action Plan in the Emergency Department](https://canadiem.org/patient-directed-furosemide-protocol/) - A 72-year-old English-speaking male with a history of congestive heart failure (CHF) withreduced ejection fraction (EF) presented to the emergency department (ED) with acutedecompensated CHF. He had a two-year history of progressive dyspnea and exercise intolerance.Other comorbidities included coronary artery disease, hypertension, dyslipidemia, cardioembolicstroke, and gastroesophageal reflux disease. His medications included furosemide, apixaban,atorvastatin, carvedilol, and - [Opioid Use Disorder Treatment: Opioid Agonist Therapy Induction](https://canadiem.org/oud-treatment-in-the-ed/) - Explore treating OUD in the ED. Gain insight into withdrawal management, OAT induction, and improving patient outcomes - [An Approach to Adult Burns in the Emergency Department](https://canadiem.org/an-approach-to-adult-burns-in-the-emergency-department/) - Case: You are working as a 3rd year clerk in the ED and your staff has asked you to see Kathy, a 24 year old female caught in a house fire presenting with burns in multiple areas and difficulties breathing. Burn injuries result in the partial or complete destruction of the skin and can affect - [Clinical Question: How do I measure frailty in the Emergency Department?](https://canadiem.org/frailty-in-the-emergency-department/) - With increased length times in the Emergency Department it is imperative that we identify ways to optimize care of our older patients experiencing frailty. - [CJEM Visual Abstract - Hypotension and respiratory events related to electrical cardioversion for atrial fibrillation or atrial flutter in the emergency department](https://canadiem.org/cjem-visual-abstract-hypotension-and-respiratory-events-related-to-electrical-cardioversion-for-atrial-fibrillation-or-atrial-flutter-in-the-emergency-department/) - Welcome back to the 2024 CJEM year! In this issue, we collaborated with the CJEM team to present "Hypotension and respiratory events related to electrical cardioversion for atrial fibrillation or atrial flutter in the emergency department" in a visual abstract format​1​. Electrical cardioversion (ECV) is extremely common in the emergency department for paroxysmal atrial rhythms. - [Images in Emergency Medicine Competition: A Showcase of Diversity and Representation](https://canadiem.org/images-in-emergency-medicine-competition-a-showcase-of-diversity-and-representation/) - 📸Calling all photography enthusiasts and advocates for diverse representation in healthcare!📸 What it is: A first-ever CAEP photography competition designed to promote equity, representation, and inclusivity in emergency medicine education by showcasing images that reflect the diversity of healthcare providers and patients in Canada. Accepted photographs will be showcased in CAEP’s new open access Images - [2023 CanadiEM Year in Review and Editor's Choice Awards](https://canadiem.org/2023-canadiem-year-in-review/) - In our 2023 year in review, CanadiEM celebrates its 8th birthday! Does CanadiEM continue to serve an important role in the medical education community? This year is an opportunity for those who value this virtual community of practice to get involved, especially for those who are interested in a leadership role. If that interests you, - [Improving Emergency Care For Individuals Experiencing Homelessness](https://canadiem.org/improving-care-for-homelessness/) - How can we best provide healthcare to individuals experiencing homelessness? A novel program in Ottawa, Ontario is tackling this problem. - [Approach to Unhoused Patients Presenting to the Emergency Department with a History of Opioid Use Disorder](https://canadiem.org/approach-to-unhoused-patients-with-opioid-use-disorder/) - Editor's Note: This is part 2 of a 2-part series on homelessness. Check out Part I about the Ottawa Inner City Health Initiative. ‘Ken’ is a 47-year-old unhoused man presenting to the Emergency Department (ED) with severe opioid withdrawal symptoms. After taking his history, you learn that he has been unhoused for the past 2 - [Tiny Tips: Hematuria: IS THIS PP RED?](https://canadiem.org/tiny-tips-hematuria-is-this-pp-red/) - Mnemonics to remember differential diagnoses are usually cumbersome, difficult to remember, and unnecessary. However, sometimes one stands above the crowd. Sometimes, one is so perfect that the world around you seems brighter… the greens greener… the sky bluer… your lunch tastier… Feel your mental status exam improve as I present to you “IS THIS PP - [CJEM Visual Abstract - Machine learning for the diagnosis of acute coronary syndrome using a 12-lead ECG: a systematic review](https://canadiem.org/cjem-visual-abstract-machine-learning-for-the-diagnosis-of-acute-coronary-syndrome-using-a-12-lead-ecg-a-systematic-review/) - For the October 2023 issue of CJEM, we collaborated with their team to present “Machine learning for the diagnosis of acute coronary syndrome using a 12-lead ECG: a systematic review"​1​​ in a visually simplified format. Many of us see the interpretation that is included on the top or side of each ECG, with common practice - [Clinical Question: Which ultrasound-guided nerve block is best for acute pain management of rib fractures in the ED?](https://canadiem.org/clinical-question-nerve-block-rib-fractures/) - A 72-year-old male presents to the emergency department (ED) with severe chest pain and difficulty breathing after an MVC. Physical examination reveals tenderness and localized swelling over the left lateral chest wall, with X-ray confirming multiple rib fractures. The patient's vital signs are stable, but he is visibly distressed and struggling to find a comfortable - [Tiny Tips: Infective Endocarditis FROM JANE](https://canadiem.org/tiny-tips-infective-endocarditis-from-jane/) - Infective endocarditis refers to an infection (i.e., bacteria such as Strep, Staph or fungal) that seeds onto the endocardial surface of valves.​1​ The mortality rate of endocarditis is 25%.​2​ Systemic complications include septic embolization and can result in end-organ damage. Although native heart valves are the most commonly affected, prosthetic heart valves, heart valve disease, - [Call for Junior Editors, Class of 2023-24](https://canadiem.org/call-for-junior-editors-class-of-2023-24/) - We are pleased to announce that CanadiEM is now accepting applications for our Junior Editor program! If you are interested in learning more about Free Open Access Medical Education (FOAM) or becoming part of our virtual community of practice,​​​1​ this program is for you. The application deadline is October 31, 2023. We are currently looking - [CJEM Visual Abstract - Just the facts: traumatic cardiac arrest](https://canadiem.org/cjem-visual-abstract-just-the-facts-traumatic-cardiac-arrest/) - CJEM Visual Abstract for September 2023: Just the facts: traumatic cardiac arrest - [CJEM Visual Abstract - Machine learning to identify attributes that predict patients who LWBS in a pediatric ED](https://canadiem.org/cjem-visual-abstract-machine-learning-models-for-lwbs-in-pediatric-ed/) - For August 2023, we collaborated with CJEM to create a visual abstract looking at machine learning models to predict LWBS in pediatric Emergency Departments - [Can diltiazem replace adenosine as part of the initial management of stable supraventricular tachycardia?](https://canadiem.org/can-diltiazem-replace-adenosine-initial-management-of-stable-supraventricular-tachycardia/) - A 50-year-old female presents to your ER with a chief complaint of palpitations. A 12-lead ECG shows supraventricular tachycardia at a rate of 165 bpm, and she is put on telemetry. She is clinically stable. You attempt the modified Valsalva maneuver with no effect. You explain that you will have to give her medication to - [CJEM Visual Abstract - Buprenorphine/naloxone initiation and referral as a quality improvements intervention for patients who live with opiate use disorder](https://canadiem.org/cjem-visual-abstract-buprenorphine-naloxone-initiation/) - For this issue of CJEM, we collaborated with their team to present “Buprenorphine/naloxone initiation and referral as a quality improvements intervention for patients who live with opiate use disorder”​1​ in a visual abstract format. Opioid use disorder is a major public health concern that accounts for a high number of potential years of life lost. - [HiQuiPs: Handover Issues in the Emergency Department](https://canadiem.org/hiquips-handover-issues-in-the-emergency-department/) - Introduction Transitions in care are a crucial part of safe medical care. Effective handovers transfer not just information, but clinical responsibility and situational awareness.(1) The emergency department (ED) presents unique challenges for handover due to its fast-paced environment, high frequency of transitions, time pressures, and the complexity of undifferentiated and often unstable patients.(2) Common barriers to effective - [HIQUIPS: Quality Metrics in Anesthesia Part 1 - The Basics](https://canadiem.org/hiquips-quality-metrics-in-anesthesia-part-1-the-basics/) - Introduction to Quality Improvement and Applicability to Patient Care in Anesthesia Continued medical advancement involves refining clinical practices to maximize patient well-being, with Quality Improvement (QI) being a critical method to systematically identify and address care deficits. As integral members of the perioperative care team, anesthesiologists anticipate potential complications and mitigate them through patient optimization. - [HIQUIPS - Quality Metrics in Anesthesia Part 2 - Applications of Tracking](https://canadiem.org/hiquips-quality-metrics-in-anesthesia-part-2-applications-of-tracking/) - In a previous post, we delved deep into the theoretical underpinnings of Quality Improvement (QI) and its criticality in anesthesiology. We explored how this discipline intertwines with patient care, emphasizing its role in enhancing clinical practices for optimal patient well-being. As we transition from theoretical constructs to practical implementations, we venture into the realm of local - [The Virtual Emergency Physician: Reducing Medico-Legal Risk and Improving Patient Safety - CMPA](https://canadiem.org/the-virtual-emergency-physician-reducing-medico-legal-risk-and-improving-patient-safety-cmpa/) - While virtual care has been used in several provinces for decades (1), during the COVID pandemic the use of these models of care increased. Virtual care may be structured in different ways, with differing access points and staffing structures (2). In this article, we focus on the model of the in-person emergency department staffed with nurses with a - [Navigating CAEP: A medical student's guide to success](https://canadiem.org/navigating-caep-a-medical-students-guide-to-success/) - Every year, thousands of emergency medicine enthusiasts from across thecountry gather for the Canadian Association of Emergency Physicians (CAEP) annualconference. This five day event is a hub for medical students, residents and physiciansto connect, collaborate and share cutting-edge practices and research. For first-timeattendees or junior learners, the bustling atmosphere and packed agenda might seemoverwhelming. To - [Tiny Tips: The 6 S's Mnemonic for Mitigating Cognitive Bias in the Emergency Department](https://canadiem.org/6s-mnemonic-for-cognitive-bias-in-ed/) - The chaos and rapidity associated with the ED make it an environment much more prone to diagnostic error.1 96% of these incidents involving missed diagnoses can be attributed to various cognitive biases/factors.2 The consequence of these biases ultimately lead to incomplete H/P’s (20-42% of errors),2,3 failure to consider competing diagnoses (32% of errors),3 or failure - [CAEP Capsule 23: Day 3 (May 30th-The Finale)](https://canadiem.org/caep-capsule-23-day-3-may-30th-the-finale/) - Hi Folks! The third day of the CAEP 2023 Conference was marked by an atmosphere of enthusiastic engagement, as attendees continued their quest for knowledge, networking, and collaboration. It was filled with some extremely insightful sessions, including a panel featuring powerful leaders in Medicine hosted by Dr. Kevin Wasko. The panel discussion fostered thought-provoking conversations - [CAEP Capsule 23: Day 2 (May 29th)](https://canadiem.org/caep-capsule-23-day-2-may-29th/) - Hi Folks! The second day of CAEP truly embodied the essence of phrase "Work Hard, Play Hard." It was a jam-packed day filled with remarkable talks, enlightening presentations, and a thought-provoking plenary by Dr. Heather Patterson on using photography to cope with burnout. To wrap up the day on a high note, we were treated - [CAEP Capsule 23: Day 1 (May 28th)](https://canadiem.org/caep-capsule-23-day-1-may-28th/) - Hi Folks! The atmosphere at the Canadian Association of Emergency Physicians (CAEP) conference was electric as attendees gathered for the first day of an event that promised to be both informative and transformative. From the heartwarming reunions of old friends and colleagues to the forging of new friendships, the day was already off to an - [Introducing CAEP Capsule 23: CanadiEM's Newest Podcast Series](https://canadiem.org/introducing-caep-capsule-23-canadiems-newest-podcast-series/) - Hi folks! As the highly anticipated annual CAEP conference approaches, we are thrilled to announce our partnership with CanadiEM to bring you "The CAEP Capsule," a dynamic podcast series that will give you a brief overview of each conference day. Get ready for insightful interviews, succinct summaries, and thought-provoking discussions, all designed to capture the - [When do you use X-ray vs CT for pediatric head injuries?](https://canadiem.org/x-ray-vs-ct-for-pediatric-head-injuries/) - A 3-year-old boy is brought to the ED by his anxious parents following a head injury he sustained while playing in the playground. He was running when he tripped and bumped his head against the metal steps. As you observe him calmly playing on his tablet in the waiting room, his parents are inquiring about - [CJEM Visual Abstract - Emergency department crowding negatively influences outcomes for adults presenting with COPD](https://canadiem.org/cjem-visual-abstract-may-2023/) - In this issue, we collaborated with CJEM team to present “Emergency department crowding negatively influences outcomes for adults presenting with chronic obstructive pulmonary disease”​1​ in a visual abstract format. In the ED, patients with respiratory pathology present on a shiftly basis. A majority of these patients are affected by chronic obstructive pulmonary disease (COPD). The - [CJEM Visual Abstract - Just the facts: POCUS assessment for deep vein thrombosis](https://canadiem.org/cjem-visual-abstract-just-the-facts-pocus-assessment-for-deep-vein-thrombosis/) - In this issue, we collaborated with the CJEM team to present "Just the facts: POCUS assessment for deep vein thrombosis"​1​ in a visual abstract format. Deep vein thrombosis is a diagnosis that can be notoriously difficult to risk stratify and diagnose in a timely manner in the ED. There are multiple contributing factors, including variability - [CanadiEM Deputy Editor-in-Chief: Call for Applications!](https://canadiem.org/canadiem-deputy-editor-in-chief-2023/) - Are you a medical education expert looking to take your career to the next level? Are you passionate about open educational resources and want to make a difference in the Free Open-Access Medical Education (FOAMed) community? If so, we have the opportunity for you! Apply to be CanadiEM's next Deputy Editor-in-Chief. The application deadline is - [Sharing Patient Information with Police: The Do’s and Don’ts](https://canadiem.org/sharing-patient-information-with-police/) - Police are a common presence in emergency departments. Sharing patient information between healthcare providers and the police can be essential for safety purposes. However, it can also erode the trust patients have in healthcare and pose a barrier to accessing care they need. Police presence can be distressing for many patients, especially considering that policing - [The Climate Crisis and Emergency Medicine: Part 2 of 2](https://canadiem.org/the-climate-crisis-and-emergency-medicine-part-2/) - This article is the second in a two-part series discussing the reciprocal relationship between climate change and emergency medicine (EM). Part one addressed how the effects of climate change disproportionately impact vulnerable populations. It explored how heat waves, atmospheric pollution, and natural disasters are directly related to climate change and how they affect people’s health. - [CJEM Visual Abstract: The efficacy of prehospital IV fluid management in severely injury trauma patients: a systematic review and meta-analysis](https://canadiem.org/cjem-visual-abstract-the-efficacy-of-prehospital-iv-fluid-management-in-severely-injury-trauma-patients-a-systematic-review-and-meta-analysis/) - We’re back again with another edition of the CJEM: Visual Abstract series. In this collaboration with the Canadian Journal of Emergency Medicine, we select one abstract monthly to highlight with a visual abstract. For March 2023, we selected: “The efficacy of prehospital IV fluid management in severely injured trauma patients: a systematic review and meta-analysis”.​1​ - [CCEDRRN Infographic: Patient-reported health outcomes of SARS-CoV-2](https://canadiem.org/ccedrrn-infographic-patient-reported-health-outcomes/) - Although some COVID-19 survivors report persistent symptoms months after resolution of the acute infection, we do not know much about their long-term physical and psychological health outcomes. We sought to understand which patient factors are associated with poor patient-reported health outcomes to inform the development and prioritization of health interventions to improve the health of - [Applications Open! CanadiEM Digital Scholar Fellowship 2023 -2024](https://canadiem.org/digital-scholar-fellowship-2023/) - We’re now accepting applications for 2023-2024. Fellowships are 6-18 months long withflexible start time and pace. Applications are accepted throughout the year. The deadline is May 1, 2023 for a start date of July 1, 2023. WHY should you do it? Have you found that digital learning has helped you master knowledge and skill? Have - [CJEM Visual Abstract: Intra-articular lidocaine versus intravenous sedation for closed reduction of acute shoulder dislocation](https://canadiem.org/cjem-visual-abstract-intra-articular-lidocaine-versus-intravenous-sedation-for-closed-reduction-of-acute-shoulder-dislocation/) - In this issue, we collaborated with the CJEM team to create a visual abstract on the December 2022 article “Intra‐articular lidocaine versus intravenous sedation for closed reduction of acute anterior shoulder dislocation in the emergency department: a systematic review and meta‐analysis​1​”. Anterior shoulder dislocations often require analgesia for successful reduction in the emergency department (ED). Several - [CJEM Visual Abstract: Effect of specialist consultation on emergency department revisits with uncomplicated recent-onset atrial fibrillation or flutter](https://canadiem.org/cjem-visual-abstract-effect-of-specialist-consultation-on-emergency-department-revisits-with-uncomplicated-recent-onset-atrial-fibrillation-or-flutter/) - In this issue, we collaborated with the CJEM team to create a visual abstract on the November 2022 article “Effect of specialist consultation on emergency department revisits with uncomplicated recent-onset atrial fibrillation or flutter​1​”. Uncomplicated recent-onset atrial fibrillation or flutter (AF/AFL) is often managed in the emergency department (ED) without specialist consultation. Canadian guidelines recommend consultation - [Postpartum Hemorrhage in the House of the Dragons](https://canadiem.org/postpartum-hemorrhage-in-the-house-of-the-dragons/) - Main Points: Postpartum Hemorrhage (PPH) should be considered when there is any blood loss that has the potential to cause hemodynamic instability within the first 24 hours postpartum PPH is a life-threatening condition Management options depend on the etiology (think 4Ts!) Case presentation: Surrounded by her husband King Viserys, midwives and maesters, Queen Aemma was - [Tiny Tips: BRADIE for Differential Causes of Bradycardia](https://canadiem.org/tiny-tips-bradie-bradycardia/) - Bradycardia is a very common finding in patients presenting to the emergency department. In 2018, over 18,000 pacemakers were inserted in Canada alone for severe dysrhythmia management.​1​ However, there are many causes of bradycardia that exist. Knowing and identifying the underlying causes of bradycardias is critical to emergency department management and disposition. The following mnemonic, - [CJEM Visual Abstract: IV Prostaglandin to Reduce Digital Amputations in Frostbite](https://canadiem.org/cjem-visual-abstract-iv-prostaglandin-for-frostbite/) - In this issue, we collaborated with the CJEM team to create a visual abstract on the article "Effectiveness of intravenous prostaglandin to reduce digital amputations from frostbite: an observational study".​1​ When we are dealing with frostbite in the ED, traditionally, management is focused on re-warming (of both an extremity, or simply the entire patient!). Depending - [2022 CanadiEM Year in Review and Editor's Choice Awards](https://canadiem.org/2022-canadiem-year-in-review-and-editors-choice-awards/) - In this Year in Review, CanadiEM celebrates its seventh birthday, which is an occasion to reflect on this amazing virtual community of practice​​1​ that continues to grow! Read below for this year's awards and opportunities to get involved including a call for a Deputy Editor-in-Chief and Director of Multimedia. 2022 was another busy year for - [CAEP Daily 2022: Plenary Speakers](https://canadiem.org/caep-2022-plenary-speakers/) - In this series, we are collaborating with CAEP to break down everything you need to know about the CAEP Conference in Quebec City! We have teamed up with CAEP to bring you infographics summarizing the plenary talks for each day of the conference! Our first plenary is presented by Clare Atzema! In her presentation on - [CAEP Daily 2022: Plenary Speakers Day 2](https://canadiem.org/caep-2022-plenary-speakers-day-2/) - In this series, we are collaborating with CAEP to break down everything you need to know about the CAEP Conference in Quebec City! We have teamed up with CAEP to bring you infographics summarizing the plenary talks for each day of the conference! Our second plenary speech was a presentation titled " A Healthy Response - [CAEP Daily 2022: Plenary Speakers Day 3](https://canadiem.org/caep-2022-plenary-speakers-day-3/) - In this series, we are collaborating with CAEP to break down everything you need to know about the CAEP Conference in Quebec City! We have teamed up with CAEP to bring you infographics summarizing the plenary talks for each day of the conference! The plenaries for day 3 consist of the Top 4 research abstracts - [CAEP Daily 2022: Plenary Speakers Day 4](https://canadiem.org/caep-2022-plenary-speakers-day-4/) - In this series, we are collaborating with CAEP to break down everything you need to know about the CAEP Conference in Quebec City! We have teamed up with CAEP to bring you infographics summarizing the plenary talks for each day of the conference! Today's Plenary featured Daniel Kollek and Valerie Rzepka with "Vivre-esemble abroad: Lessons - [Clinical Question: How does the sensitivity/specificity of lung ultrasound compare to plain films in diagnosing acute decompensated heart failure?](https://canadiem.org/clinical-question-how-does-the-sensitivity-specificity-of-lung-ultrasound-compare-to-plain-films-in-diagnosing-acute-decompensated-heart-failure/) - A 64 year old woman presents to the emergency department with dyspnea. On exam she is mildly tachypneic, has an oxygen saturation of 94% on 2L nasal prongs, and bilateral crackles to auscultation. You suspect acute heart failure and wonder about the role of lung ultrasound as you await her chest x-ray. Clinical question: - [Clinical Question: Can stable patients presenting to the emergency department with blunt abdominal trauma be managed safely without a CT scan?](https://canadiem.org/blunt-abdominal-trauma-rural-management/) - You are working in a rural Emergency Department (ED). You assess a 25-year-old male patient who crashed his car into a tree. Vitals are normal and GCS is 15. Airway is patent and protected. There is bilateral chest rise, no abdominal tenderness or seatbelt sign. Pelvis is stable, and you notice some swelling over his - [Case Report: Hypothermia and Traumatic Arrest in the Game of Thrones](https://canadiem.org/case-report-hypothermia-and-traumatic-arrest-in-the-game-of-thrones/) - Be warned: this case report contains spoilers for Game of Thrones Season 5 and 6. Patient Presentation and History A 21-year-old man, by the name of Lord Commander Jon Snow, was discovered unconscious and unresponsive after receiving multiple stab wounds to the chest and abdomen. He was found lying supine in freezing temperature and presumed to - [Call for Junior Editors, Class of 2022-23!](https://canadiem.org/call-for-junior-editors-class-of-2022-23/) - We are pleased to announce that CanadiEM is now accepting applications for our Junior Editor program! If you are interested in learning more about Free Open Access Medical Education (FOAM) or becoming part of our virtual community of practice,​​​1​ this program is for you. The application deadline is October 31, 2022. We are currently looking - [The Many Paths to Emergency Medicine in Canada](https://canadiem.org/the-many-paths-to-emergency-medicine-in-canada/) - What is an emergency medicine doctor? The answer likely differs between a major academic centre and a rural hospital. Perhaps the simplest definition is any physician who staffs an emergency department (ED). When it comes to training, emergency medicine (EM) certainly holds the title of most heterogeneous specialty in Canada. While some physicians complete a - [ABCDE Approach](https://canadiem.org/abcde-approach/) - The ABCDE approach applies to the initial assessment of critically ill patients. For each step, appropriate treatment should be started regardless if there is a definitive diagnosis. Airway​1–3​ Fatal in minutes.Think of this separately from breathing!Consider what would you do if the airway became threatened, e.g. Have you assessed for predictors of difficult airway management? - [Preprints: What you need to know](https://canadiem.org/preprints-need-to-know/) - Introduction: the history of preprints Aashka is finally nearing the completion of her groundbreaking paper on an emerging influenza outbreak. She’s planning to submit it to a scientific journal when one of her team members asks her, “Why don’t we send it off to a preprint server first?” She doesn’t know much about this process - [Resuscitative Endovascular Balloon Occlusion Of The Aorta (REBOA): A Squid Game Case Report](https://canadiem.org/reboa-a-squid-game-case-report/) - Observations On exam, a penetrating anterior abdominal wound to the left suprapubic region is noted with an approximate 10 cm by 3 cm penetrating glass shard in situ. While difficult to assess, the wound width is estimated at approximately 3 cm with an unknown depth. A large amount of dried and fresh blood was seen - [Pediatric Damage Control Resuscitation in the Game of Thrones](https://canadiem.org/pediatric-damage-control-resuscitation-in-the-game-of-thrones/) - Bran Stark, a 10-year-old boy, was exploring Winterfell during King Robert Baratheon’s visit to Winterfell. This patient is the son of Ned Stark, Lord of the North, and heir of the powerful House Stark. As a curious young boy, he wanted to watch the festivities from the view of a tower. This was not unusual - [CJEM Visual Abstract: The cost of In- vs Out-patient antibiotic therapy](https://canadiem.org/cjem-visual-abstract-the-cost-of-in-vs-out-patient-antibiotic-therapy/) - In this issue, we collaborated with the CJEM team to create a visual abstract on the article “Outpatient parenteral antibiotic therapy (OPAT) and inpatient treatment strategies for emergency department patients with cellulitis: a cost analysis”.​1​ Skin and soft tissue infections in the ED almost always equals antibiotic prescription. Depending on severity and patient characteristics, the - [Managing Agitation in the ED: Part 2 - Restraints, Medical Approach, and Discharge](https://canadiem.org/managing-agitation-part-2/) - This post is part two of a two-part series. You may review the previous post here. In the last post, we followed Lucas, a 26 year old male who presented to the ED with bizarre behaviour and aggression. When we left off, he was becoming increasingly agitated and paranoid despite your best efforts in de-escalating - [Managing Agitation in the ED: Part 1 - Overview and Deescalation Strategies](https://canadiem.org/managing-agitation-part-1/) - Lucas is a 26 year old male who presents to the ED by his parents for bizarre behaviour and increasing aggression at home. He has a history of IV drug use but is not forthcoming about which drugs he has used and how recently he has used them. There are two hospital security employees behind - [How to Study Effectively: Powering Up Your Study Habits](https://canadiem.org/how-to-study-effectively/) - Kuldeep is a 29 yo medical student who has been studying daily but can’t seem to keep up with the content. His friends seem to be scoring higher than him on tests. How can Kuldeep add some new habits and learn how to study more effectively? When it comes to studying, we are often poor - [Social Justice EM Podcast E02: Metis Worldview and Emergency Medicine with Dr. Jill Roberge](https://canadiem.org/social-justice-em-podcast-e02-metis-worldview-and-emergency-medicine-with-dr-jill-roberge/) - Overview:In this episode, Amie speaks with Dr. Jill Roberge, a Métis physician about how she integrates the Métis Worldview into her practice. Dr. Roberge discusses her cultural background and why she chose to practice Emergency Medicine. Dr. Roberge discusses how the Métis worldview can be practiced every day through a compassionate lens. We also discuss - [Bimanual technique to reduce pediatric inguinal hernia ](https://canadiem.org/bimanual-technique-inguinal-hernia/) - A 7-week-old male infant named Johnny presents to the Emergency Department with a bulge in his right scrotum that the parents noticed today, worse when he is crying and upset. On exam you notice an inguinal hernia and try to reduce it but are unsuccessful. What technique could you try next? Incarcerated hernias can often - [Getting to "CT Safe and Fast"](https://canadiem.org/ct-safe-and-fast/) - A career in emergency medicine involves management of risk and uncertainty. We balance multiple competing priorities and make important trade-offs on a daily basis. None more so than the delicate balance between speed and safety. You may have heard the CT scanner being spoken about in a tongue in cheek fashion as “the doughnut of - [Tiny Tips: PETMAC as a mnemonic for the 6 deadly causes of chest pain](https://canadiem.org/tiny-tips-petmac-mnemonic-for-6-deadly-causes-of-chest-pain/) - An estimated 300,000-500,000 patients present to the emergency department (ED) every year inCanada with complaints of chest pain.​1​ In USA, the numbers are even more staggering at 8million per year.​2​ Given its prevalence, having a structured and rapid approach to chest pain isessential. Use the mnemonic PETMAC as an approach to these 6 cannot-miss causes - [We're hiring a website coordinator!](https://canadiem.org/were-hiring-a-website-coordinator/) - CanadiEM is a Canadian organization that aims to create a virtual community of practice for Canadian Emergency Medicine practitioners by producing and distributing high-quality, freely available educational resources. We put significant effort into fostering digital scholarship skills within medical students and emergency medicine trainees. We are seeking a part-time website coordinator to provide logistical and - [CJEM Visual Abstract: Diagnosis and management of wide complex tachycardia in the emergency department (ED)](https://canadiem.org/cjem-visual-abstract-diagnosis-and-management-of-wide-complex-tachycardia-in-the-emergency-department-ed/) - In this issue, we collaborated with the CJEM team to create a visual abstract on the article “Diagnosis and management of wide complex tachycardia in the emergency department”. 1 Seeing wide complex tachycardia in your patient should immediately trigger alarm bells. Despite having the potential to be lethal, the diagnosis and treatment of this arrhythmia - [PoCUS Previews 03: Intro to the FAST Scan](https://canadiem.org/pocus-previews-03-intro-to-the-fast-scan/) - Welcome back to PoCUS Previews, your illustrated guide to the world of Point of Care Ultrasound (PoCUS)! In the hands of a skilled sonographer, PoCUS can serve as a valuable tool while assessing a patient in trauma. PoCUS can quickly and fairly accurately detect blood loss and signal the presence of internal organ damage. Thus, - [A Study on Behalf of the CCEDRRN: Trends in COVID-19 ED management and outcomes, wave-by-wave.](https://canadiem.org/trends-in-covid-19-ed-management-and-outcomes/) - In 2020, coronavirus disease 2019 (COVID-19) presented the largest public health crisis inover a century. Healthcare workers had to learn how to treat and manage patients withCOVID-2019 without overwhelming health systems. They were faced with both evidence-based and non-evidence-based treatment recommendations. Simultaneously, public healthinterventions aimed to reduce transmission in the population and protect those mostvulnerable. - [CRACKCast E231- Genitourinary System](https://canadiem.org/crackcast-e231-genitourinary-system/) - This updated episode of CRACKCast covers Rosen’s Chapter 40 (9th Ed.) on genitourinary trauma. This episode will outline the approach and details of the diagnosis, classification and treatment of common traumatic genitourinary injuries. Shownotes PDF - Here [bg_faq_start] Rosen’s in Perspective We did it! We have reached the end of CRACKCast. In today’s episode, we - [FRCPC or CCFP-EM: What is best for you?](https://canadiem.org/frcpc-or-ccfp-em-what-is-best-for-you/) - FRCPC or CCFP-EM? This is a question that EM physicians spend a lot of time discussing with their mentees. Why are there two EM designations in Canada? What do the letters even mean? What’s the difference? Which route is right for you? These are great questions. Unfortunately, as with many important decisions, you’ll probably get - [Urinalysis Interpretation across specialties](https://canadiem.org/urinalysis-interpretation/) - I must have missed the class on urinalysis interpretation in medical school. When I hit the ward I didn't have a clue. Those first few weeks I nodded along knowingly when the residents talked confidently about how the patient did/did not have a UTI, initially being too embarrassed about not knowing something so simple to - [Development of the Canadian COVID-19 Emergency Department Rapid Response Network population-base registry: a methodology study](https://canadiem.org/canadian-covid-19-emergency-department-rapid-response-network/) - CanadiEM is excited to formally partner with the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN, pronounced "sedrin"), the third largest COVID-19 observational registry in the world according to the World Health Organization (WHO). Stay tuned for infographics, blog posts and other materials to disseminate high-quality Canadian research results on the COVID-19 Pandemic, and reduce - [Tiny Tips: The COWS Scale](https://canadiem.org/tiny-tips-the-cows-scale/) - As the opiate crisis continues to escalate, emergency departments are seeing higher numbers of patients with complaints and complications related to opiate use disorder. There is strong evidence for opiate agonist treatment in preventing opiate related deaths. Additionally, Suboxone (buprenorphine-naloxone) is the recommended first line treatment.​1​ Suboxone Treatment For a full Suboxone start, a patient - [Introducing the CanadiEM Junior Learner Primer App](https://canadiem.org/canadiem-junior-learner-app/) - We’ve developed the CanadiEM Junior Learner Primer App to help support junior medical learners during their emergency medicine rotations. In the fast-paced environment of emergency medicine, learners can often find themselves overwhelmed when faced with the acuity as well as the wide variety of cases. Communication and time management skills requirements can also be very - [HiQuiPs: Patient Safety Fundamentals - Introduction & Hospital Acquired Infections](https://canadiem.org/hiquips-patient-safety-fundamentals-introduction-hospital-acquired-infections/) - It’s another Friday morning on the ward, and you are looking forward to discharging one of your patients home to spend time in their garden over the weekend. Ms. Jones is an 83-year-old lady admitted a few days ago with what turned out to be a urinary tract infection. Initially weak and slightly confused, after - [Clinical Question: When should patients be allowed to eat in the Emergency Department?](https://canadiem.org/npo-emergency-department/) - You have just finished seeing a 12-year-old boy who fell off the monkey bars about an hour ago. He has an obvious deformity to his right elbow and you suspect a displaced fracture that will require reduction. You would like to use procedural sedation to facilitate the reduction, but an empty granola bar wrapper stops - [Tales From The Trenches 05: COVID Reflections – Two Years in a Pandemic](https://canadiem.org/tales-from-the-trenches-05-covid-reflections-two-years-in-a-pandemic/) - Overview: In this episode, Tiffany talks with Dr. Kevin Dong from Hamilton, Canada, and CanadiEM podcast extraordinaire! We reflect on two years of practicing medicine during the COVID pandemic and share our own unique challenges, lessons learned and motivation to continue to work in the department as we enter our third year of the pandemic. - [Journal Club by CanadiEM E05: The ARREST trial and ECMO programs](https://canadiem.org/journal-club-by-canadiem-e05-the-arrest-trial-and-ecmo-programs/) - Join us and our expert guest Dr. James Gould as we discuss ECMO and mature ECMO programs, appraise the ARREST trial and consider the future of cardiac arrest care. Today’s hosts are Jayneel Limbachia, Dakoda Herman, and Jake Domm. Expert Guest: Dr. James Gould is a father of 3, emergency medicine physician and assistant professor - [Social Justice EM Podcast E01: What's Nuclear Energy Got To Do With It: Emergency Medicine & Climate Change](https://canadiem.org/social-justice-em-podcast-e01-whats-nuclear-energy-got-to-do-with-it-emergency-medicine-climate-change/) - CanadiEM Podcast Series: Social Justice EM Podcast | Host: Amie Archibald-Varley RN, MN | Guest: Dr. Chris Keefer What is our role as healthcare providers when it comes to discussions on climate change? How can we reduce of carbon footprint? What changes can we make in the healthcare system to reduce carbon emissions? Is wind and solar - [The CCEDRRN COVID Mortality Score](https://canadiem.org/the-ccedrrn-covid-mortality-score/) - Emergency Departments see critically ill patients with COVID-19. Families and care providers often have to make immediate management decisions about whether or not to intubate hypoxic patients. That decision has substantial downstream implications for patients and the health system. For patients a course of mechanical ventilation is commonly prolonged (average 13 days), and fraught with - [Tox in 10: Anticholinergics](https://canadiem.org/toxin10-anticholinergics/) - Welcome to "Tox in 10," a new infographic series that exposes learners to medical toxicology topics that they can absorb in 10 minutes or less! This series is meant to introduce medical students and junior residents to the wonderful field of toxicology in an easy-to-reference-to manner! Each infographic covers the basics of the principles of - [HiQuiPs: Consent in Quality Improvement](https://canadiem.org/hiquips-consent-in-quality-improvement/) - You’re ready to start a quality improvement (QI) project aimed at improving the effectiveness of the communication surrounding patient prognosis by providers. Your Plan-Do-Study-Act (PDSA) cycles involve retrospective chart reviews, surveys with patients to understand their experiences, and 1:1 key informant interviews with inter-disciplinary staff members in your department. You’ve learned about navigating ethics in quality - [The CanadiEM Digital Scholar Fellowship application period is open for 2022-2023!](https://canadiem.org/digital-scholar-fellowship/) - We’re now accepting applications for 2022-2023. Fellowships are 6-18 months long with flexible start time and pace. The deadline is April 1, 2022. WHY should you do it? Have you found that digital learning has helped you master knowledge and skill? Have you developed friendships and role models by hanging out on social media? Have - [Diagnosing Acute Aortic Syndrome: A Canadian Clinical Practice Guideline Infographic](https://canadiem.org/acute-aortic-syndrome/) - Acute aortic syndrome (AAS) is a rare but time-dependent emergency, with a linear mortality increase of 2% per hour of diagnostic delay. It is also difficult to diagnose, with a miss rate of 25% and misdiagnosis rates up to 38%. The gold standard for AAS diagnosis is CT imaging. Although CT imaging is readily available - [PoCUS Previews 02: Intro to Image Generation](https://canadiem.org/pocus-previews-02-intro-to-image-generation/) - Welcome back to PoCUS Previews, your illustrated guide to the world of Point of Care Ultrasound (PoCUS)! This month's infographic will focus on image and probe orientation, different probe movements that can be used to generate these images, and some common artifacts (or abnormal alterations in ultrasound images). Ultrasound images can be challenging to interpret - [CJEM Visual Abstract: Barriers to buprenorphine/naloxone initiation in the emergency department (ED)](https://canadiem.org/cjem-visual-abstract-barriers-to-buprenorphine-naloxone-initiation-in-the-emergency-department/) - In this issue, we collaborated with the CJEM team to create a visual abstract on the article “Barriers and attitudes reported by Canadian emergency physicians regarding the initiation of buprenorphine/ naloxone in the emergency department for patients with opioid use disorder”1. Mortality as a result of opioid use has increased since the start of the - [Doctors Can’t Remember Everything: Calciphylaxis and a Diagnostic Aid](https://canadiem.org/calciphylaxis-and-a-diagnostic-aid/) - The general approach to the differential diagnosis has remained unchanged since the dawn of modern medicine. A doctor sees a patient, gets some initial information, and then creates a list of what they think are the most likely and dangerous possibilities. This list of possibilities is created by comparing the present patient to others that - [The Climate Crisis and Emergency Medicine: Part 1 of 2](https://canadiem.org/the-climate-crisis-and-emergency-medicine-part-1-of-2/) - This two-part series will address the bidirectional relationship between EM and climate change. Part 1 will explore heat waves, atmospheric pollution, and natural disasters as illustrative examples of the impact of climate change on the ED. Beyond these examples, climate change also impacts other health issues such as water quality, infectious disease and food security - [Miracles from Heaven Case Report: Small Bowel Obstruction](https://canadiem.org/miracles-from-heaven-case-report-small-bowel-obstruction/) - Earlier in the day, five-year-old Annabel had a regular morning and afternoon. She attended a birthday party and seemed to be herself, laughing with her friends and running around. At 0200 and Annabel calls for her mom, crying and clutching her stomach. Her mom rushes into her daughter’s room and finds Annabel in significant pain. - [Clinical Question – How Do I Approach Agitation and Aggression in Children with Autism Spectrum Disorder in the Emergency Department?](https://canadiem.org/autism-emergency-department/) - A 7-year-old boy with autism spectrum disorder presents to the emergency department (ED) with upper respiratory infection symptoms. He starts becoming agitated as you try to auscultate his lungs and aggressively comes towards you. You are unsure of the best method to approach this situation. Research has demonstrated that almost one third of children with - [PoCUS Previews 01: Intro to PoCUS](https://canadiem.org/pocus-previews-01-intro-to-pocus/) - Welcome to PoCUS Previews; CanadiEM’s newest infographic series! Ultrasound (US) is an imaging modality that uses high frequency soundwaves and their reflection to produce real time images of various structures within the human body. In Emergency Medicine, small portable US machines can be used to gain an abundance of clinical insight that can ultimately aid - [HiQuiPS: Virtual Care and Inequity Part 2 - Bridging the Digital Divide](https://canadiem.org/hiquips-virtual-care-and-inequity-part-2-bridging-the-digital-divide/) - You are a Nurse Practitioner who has educated yourself about Canada’s digital divide through personal research and interactions with your own patients. Now that you have a grasp on the source of the problem, you begin to search for solutions. You scour the internet for various services that will provide your patients with access to - [Hyperthermic Conditions in the Psychiatric Patient](https://canadiem.org/hyperthermic-conditions-in-the-psychiatric-patient/) - A 32 year-old female presents to your Emergency Department one afternoon with the presenting complaint of altered level of consciousness. On examination you find her to be agitated and confused, as well as tachycardic and febrile at 39.5o C. Collateral history from EMS is negative for any substance misuse. When reviewing her chart, you find - [2021 CanadiEM Year in Review and Editor's Choice Awards](https://canadiem.org/2021-canadiem-year-in-review-and-editors-choice-awards/) - Over the past year, healthcare workers in Emergency Departments across the world have continued to show incredible resiliency and grit during the COVID-19 pandemic. The Emergency Department is the safety net of the system, the place where the doors are always open and no patients are refused. During the pandemic, the Emergency Department has taken - [Zooming Through Medical School](https://canadiem.org/zooming-through-medical-school/) - We all know that medical school is a journey – but, honestly, during the pandemic it has felt more like a slog. In March of 2020, when the Covid-19 pandemic arrived, I was seven months into my medical training. After barely scratching the surface of medical school, I was nervous about what was to come. - [Case Report: Battlestar’s death in The Falcon and the Winter Soldier - a Review of Blunt Cardiac Injury](https://canadiem.org/case-report-battlestars-death-in-the-falcon-and-the-winter-soldier-a-review-of-blunt-cardiac-injury/) - History A 31 year old male, identified as Lamar “Battlestar” Hoskins was found dead by Emergency Medical Services (EMS) inside a refugee camp, slumped against a stone pillar. Reports indicate that he was a United States Army soldier working with the “New Captain America”. He was recently seen in armed combat with a terrorist organization - [Hyperthermia in Methamphetamine Toxicity](https://canadiem.org/hyperthermia-in-methamphetamine-toxicity/) - Paramedics roll in with an agitated young man, “John”. He is combative, rambling, sweaty and scared. The crew mention they found needles and a bag containing a crystalline white substance in his pockets: methamphetamine. Right away, you start thinking about your initial approach to a patient with excited delirium. In the room, four security guards - [The CCEDRRN COVID-19 Infection Score (CCIS) Infographic](https://canadiem.org/the-ccedrrn-covid-19-infection-score-ccis-infographic/) - In the Emergency Department, we often have to estimate a patient’s probability of having COVID-19 before test results come back. We may need to make decisions about isolation or cohorting of patients who are suspected positive, or triage low-risk patients to areas of the Emergency Department with shared patient spaces. If we are discharging patients - [Emergency Management of Frostbite](https://canadiem.org/emergency-management-of-frostbite/) - Frostbite often results in injury, with significant life altering effects. Amputations can range from tips of digits to whole hands and limbs. These guidelines provide an initial framework for the care of the patient with acute frostbite, and will hopefully help to reduce the dramatic consequences. - [PEM Pearls 01: Pediatric Airway Differences](https://canadiem.org/pem-pearls-01-pediatric-airway-differences/) - Welcome to PEM Pearls: a new CanadiEM Infographic Series focused on providing approaches and high-yield pearls for important pediatric EM topics! Today we will be discussing differences in pediatric airway anatomy and airway management considerations.​1​ Physiology Even in a healthy child, pediatric patients are incredibly prone to rapid oxygen desaturation during apnea. Furthermore, The rate - [CJEM Visual Abstract: Optimal management strategies for primary headache in the emergency department](https://canadiem.org/cjem-visual-abstract-optimal-management-strategies-for-primary-headache-in-the-emergency-department/) - In this issue, we collaborated with the CJEM team to create a visual abstract on the article “Optimal management strategies for primary headache in the emergency department.”​1​ Primary headaches, such as migraine or tension headache, are among some of the most frequently encountered conditions in the emergency department. Despite this, there are many variations in - [Clinical Question: What is the Role of Contrast in Abdominal CT for Adult Patients presenting with Acute Abdominal Pain?](https://canadiem.org/clinical-question-role-of-contrast-in-abdominal-ct-for-adult-patients-presenting-with-acute-abdominal-pain/) - Clinical Question: Role of Contrast in Abdominal CT for Adult Patients presenting with Acute Abdominal Pain A 73-year-old male presents to your Emergency Department with vague LLQ abdominal pain. Your differential includes stones/pyelonephritis, diverticulitis, obstruction, and neoplasm. You want a CT scan to assist in diagnosis. A colleague mentions you need oral contrast to diagnose - [Game of Thrones Case Report: Penetrating Renal Injury](https://canadiem.org/game-of-thrones-case-report-penetrating-renal-injury/) - Arya Stark, a 19-year-old young woman, was violently stabbed in her abdomen with a knife while walking through Braavos. Arya flees, tumbling into the river that flows through the town. She manages to crawl out of the river, but is too exhausted to move further and is clutching her abdomen, curled up on the bank - [CJEM Visual Abstract: Evaluating the diagnostic accuracy of point-of-care ultrasound for cholelithiasis and cholecystitis in a Canadian emergency department](https://canadiem.org/cjem-visual-abstract-evaluating-the-diagnostic-accuracy-of-point-of-care-ultrasound-for-cholelithiasis-and-cholecystitis-in-a-canadian-emergency-department/) - In this issue, we collaborated with the CJEM team to create a visual abstract on the article ‘Evaluating the diagnostic accuracy of point-of-care ultrasound for cholelithiasis”.​1​ Cholelithiasis and cholecystitis are conditions that are frequently encountered in the emergency department. The gold standard in their diagnosis is via comprehensive ultrasound by radiology. However, there are many - [HiQuiPs: Virtual Care and Equity Part 1- Introduction to Digital Inequity](https://canadiem.org/hiquips-virtual-care-and-equity-part-1-introduction-to-digital-inequity/) - You are a Nurse Practitioner with a practice in a COVID-19 hotspot. The pandemic has forced you to transition into providing virtual care. You are wrapping up your last telemedicine visit of the morning. Your patient is an 80-year-old Chinese female with a possible skin infection. Her granddaughter is with her and translates for you - [Tales From the Trenches E04: COVID Surge in India](https://canadiem.org/tales-from-the-trenches-e04-covid-surge-in-india/) - Overview: In this episode, Tiffany talks with Dr. Meenhas Oravil from Kerala India. They discuss the current COVID wave and at the time of this podcast recording, the Delta variant was just beginning to take hold. Take a listen! 0:00-1:01 – Introduction Host: Tiffany Proffitt DO, Staff Emergency Medicine Physician Honor Health Guest: Dr. Meenhas - [Introducing the 2021 CanadiEM Infographics Team](https://canadiem.org/introducing-the-2021-canadiem-infographics-team/) - The CanadiEM Infographics Team has recruited some new members! Our team now consists of 17 talented medical students, residents, and physicians. We strive to create helpful infographics that display EM knowledge in a digestible format. To showcase the talent of our new members, we tasked them with creating some team infographics! Over the last year, - [HiQuiPs: Expert’s Corner – Dr. Aikta Verma on Quality Improvement Leadership](https://canadiem.org/experts-corner-dr-aikta-verma-on-quality-improvement-leadership/) - HiQuiPs is back with another installment of Expert’s Corner! For this post, we had the opportunity to talk with Dr. Aikta Verma about quality improvement (QI) and quality culture in the Emergency Department (ED). Dr. Verma is the Chief of the Department of Emergency Services at Sunnybrook Health Sciences Centre. She completed a Masters of - [HiQuiPs: Introduction to Virtual Care – Virtual Processes](https://canadiem.org/hiquips-introduction-to-virtual-care-virtual-processes/) - As you begin envisioning virtual care in your hospital, you begin to wonder about the details of your program. How do you funnel patients to where they need to be, and how do you ensure that patients receive the care they need? Furthermore, how do you ensure that these processes are cohesive and well structured? - [Outlander Case Report: Penetrating Penile Trauma](https://canadiem.org/outlander-case-report-penetrating-penile-trauma/) - Case Presentation The year is 1743, and a complicated love story involving two passionate relationships with one woman, Claire, unravels. Her two lovers, Frank Randall and Jamie, find themselves in sword combat, fighting over their one true love. Unfortunately, despite putting up a good fight, Randall finds himself struck in his genitals during the duel. - [HiQuiPs: Introduction to Virtual Care – General Principles](https://canadiem.org/virtual-care-general-principles/) - In late 2020 and early 2021, several hospitals implemented “virtual ED” programs as COVID-19 cases increasingly strained and threatened to overwhelm the healthcare system. You may be wondering what virtual care really is, and why it is becoming so prevalent in Canada. You may also wonder if this is a program that can be of - [CJEM Visual Abstract: Observation time in the ED following anaphylaxis](https://canadiem.org/cjem-visual-abstract-observation-time-in-the-ed-following-anaphylaxis/) - In this issue, we collaborated with CJEM team to create a visual abstract on the article “Factors influencing emergency department observation time following anaphylaxis: a systematic review”.​1​ Anaphylaxis is a condition that warrants an observation period after symptom resolution to detect rare, but life-threatening, delayed complication. Simard et al. worked to identify factors that may - [First Seizure Discharge Instructions: Serving Up The Pizza SLICES!](https://canadiem.org/first-seizure-discharge-instructions-serving-up-the-pizza-slices/) - It’s a busy night in your emergency department when a 24-year-old confused female is brought in via EMS for a possible first seizure accompanied by her friend. Her friend reports calling 911 after witnessing the patient fall to the ground stiff and then convulsing for 30 seconds. The patient is confused and has difficulty answering - [Cannabinoid Hyperemesis Syndrome: Quarantine Tom's Twist](https://canadiem.org/cannabinoid-hyperemesis-syndrome-quarantine-toms-twist/) - Your next patient is Tom, an otherwise healthy 22-year-old male. He has returned for the fourth time within the last 3 months for intermittent generalized abdominal pain, nausea, and vomiting. A review of his previous visits reveals that he has been extensively worked up with a normal abdominal ultrasound, x-ray, and even a CT scan. - [Tiny Tip: WOBBLER as an approach to ECGs for syncope](https://canadiem.org/tiny-tip-wobbler-as-an-approach-to-ecgs-for-syncope/) - Syncope makes up approximately 1% of acute care visits in Canadian emergency departments and is a common symptom for a wide range of underlying etiologies.​1​ Identifying any serious underlying condition for syncope and disposition planning is the main area of focus in the emergency department. In addition to a comprehensive history and physical, the 12-lead - [CRACKCast E228 - Neck Trauma](https://canadiem.org/crackcast-e228-neck-trauma/) - Today's podcast review Chapter 37 in Rosen's 9th Edition and gives you the tools you will need to manage your next case of neck trauma in the ED. Find the show notes here: CRACKCast-E228-NeckDownload [bg_faq_start] Rosen's In Perspective Alright podcast listeners, let’s get into another episode of CRACKCast. Today we will start out with a - [Introducing: CRACKCast Visual Flashcards!](https://canadiem.org/introducing-crackcast-visual-flashcards/) - Check out the new CRACKCast Visual Flashcards: brought to you by the CanadiEM Infographics and CRACKCast teams! Our goal is to visually produce flashcards covering high-yield Wisecracks and Core Questions from CRACKCast episodes. The Infographics team has created a pilot deck, and we need YOUR feedback to improve the series. Click the link below, and - [MI Pretty Peaceful APE: Differentials for Sinister causes of chest pain](https://canadiem.org/mi-pretty-peaceful-ape-differentials-for-sinister-causes-of-chest-pain/) - About 1 in 10 cases seen in the Emergency department involve chest pain. While some of these causes are benign or subacute, there are six emergent and sinister causes of chest pain that one would want to consider first before exploring other diagnoses. The mnemonic “MI Pretty Peaceful APE” can be used to quickly recall - [CRACKCast E227 - Spinal Injuries](https://canadiem.org/crackcast-e227-spinal-injuries/) - This updated episode of CRACKCast covers Rosen’s Chapter 36 (9th Ed.) on spinal injuries. This episode will outline the approach and details of the diagnosis, classification and treatment of spinal trauma in the emergency department. Shownotes - PDF Here [bg_faq_start] Rosen’s in Perspective Alright, podcast listeners. We are back at it again with another episode - [Expert's Corner - Dr. Eddy Lang on Quality Improvement and Healthcare](https://canadiem.org/experts-corner-dr-eddy-lang-on-quality-improvement-and-healthcare/) - Welcome to another HiQuiPs Expert Corner. In this edition, we asked Dr. Eddy Lang three questions about Quality Improvement (QI) given his impressive track record of system improvements. Dr. Eddy Lang is the current Department Head of Emergency Medicine and a Professor at the Cumming School of Medicine, University of Calgary. In addition, he serves - [CRACKCast E224 - Multiple Trauma](https://canadiem.org/crackcast-e224-multiple-trauma/) - This review provides a framework for evaluation of the multi-trauma patient in the ED. - [CRACKCast E226 - Facial Trauma](https://canadiem.org/crackcast-e225-facial-trauma/) - This updated episode of CRACKCast covers Rosen’s Chapter 34 (9th Ed.) on facial trauma. This episode will outline the approach and details of the diagnosis, classification and treatment of common traumatic facial injuries. Shownotes – PDF Here [bg_faq_start] Rosen’s in Perspective Alright, podcast listeners. We are back at it again with another episode of CRACKCast. Today, - [HiQuiPs: Navigating Ethics in Quality Improvement](https://canadiem.org/hiquips-navigating-ethics-in-quality-improvement/) - You have decided to start a quality improvement (QI) project on improving access to fascia iliaca nerve blocks for hip fractures in your emergency department (ED). You have also gathered an interdisciplinary team of experts within your ED to help you identify structure, process, outcome and balance measures to use in your QI project. But - [Methoxyflurane- an alternative to opioid and NSAID analgesia in the Emergency Department?](https://canadiem.org/methoxyflurane-an-alternative-to-opioid-and-nsaid-analgesia-in-the-emergency-department/) - Introduction Methoxyflurane, also known as Penthrox, is an inhaled analgesic that was first used in the early 1960s for general anaesthesia.​1​ While initially popular, reports of serious side effects including hepatotoxicity and irreversible dose-dependent nephrotoxicity led to its reduced usage as a general anesthetic by the 1970s.​2​ Nevertheless, due to its non-opioid nature and short - [HiQuiPs: Sim to Win](https://canadiem.org/hiquips-sim-to-win/) - It’s a night shift, quieter than usual, though you wouldn’t say so out loud. As if the thought is enough to tempt fate, EMS rolls by. You got no patch, no heads up. “Car accident, just outside the hospital,” a paramedic calls as the patient is transferred onto the trauma stretcher. All you hear are - [HiQuiPs: Preparing a QI Manuscript – the SQUIRE 2.0 Guidelines](https://canadiem.org/preparing-a-qi-manuscript-squire-guidelines/) - You are planning to conduct a quality improvement project and your project supervisor has advocated that you download a copy of the SQUIRE 2.0 QI reporting guidelines before you begin. This is confusing, as it seemed to you that reporting guidelines governed how a manuscript should be drafted rather than how a project should be - [Journal Club by CanadiEM - E04 Approach to Systematic Reviews and Meta Analyses](https://canadiem.org/journal-club-by-canadiem-e04-approach-to-systematic-reviews-and-meta-analyses/) - Welcome back to Journal Club by CanadiEM! In this episode we go over an approach to systematic reviews and meta analyses based on Oxford centre of EBM, and learn about diagnosing pneumothorax with ultrasound vs X-ray Using the Oxford centre of EBM tool, we will ask:1. What question(s) did the systematic review address?2. Is it - [Carmscast Episode 04: Reflections](https://canadiem.org/carmscast-episode-04-reflections/) - Welcome to Carmscast, the podcast that aims to answer all the questions medical students have when creating a competitive CARMS application. In today’s episode, our co-hosts, Kara and Dakoda, mix up the podcast format and reflect on their CaRMS experience over the last year. Dr. Kara Tastad is now a graduate of the University of - [The CAEP Daily: Day 3 (June 17)](https://canadiem.org/the-caep-daily-day-3-june-17/) - This year, CanadiEM has partnered with the Canadian Association of Emergency Physicians, EMOttawa, and the Skeptic’s Guide to Emergency Medicine to help promote #CAEP21: CAEP at the Forks – Rising to the Challenge. From June 15-17, 2021 we will be publishing The CAEP Daily, a journalistic summary of highlights from the conference. Please join the discussion! [bg_faq_start] - [Case Report: The Hangover and the Lateral Canthotomy](https://canadiem.org/case-report-lateral-canthotomy/) - Alan Garner is a 38-year-old single, unemployed, Caucasian male, with a medical history of ADHD who has voluntarily arrived at the ED accompanied by friends Stu and Phil after being punched in the face while trespassing. Despite having a poor recollection of the night’s events, Alan and friends are certain that he received a sucker - [The CAEP Daily: Day 2 (June 16)](https://canadiem.org/the-caep-daily-day-2-june-16/) - This year, CanadiEM has partnered with the Canadian Association of Emergency Physicians, EMOttawa, and the Skeptic’s Guide to Emergency Medicine to help promote #CAEP21: CAEP at the Forks - Rising to the Challenge. From June 15-17, 2021 we will be publishing The CAEP Daily, a journalistic summary of highlights from the conference. Please join the - [New Results from the Targeted Temperature Management 2 (TTM2) Trial](https://canadiem.org/targeted-temperature-management-2/) - The Targeted Temperature Management (TTM) Trial was published in the New England Journal of Medicine in 2013 and had a significant impact on the care that we provide to patients following cardiac arrest. However, it also left questions unanswered. Today, in follow-up to this landmark trial, Dankiewicz et al published the second targeted temperature management - [The CAEP Daily: Day 1 (June 15)](https://canadiem.org/the-caep-daily-day-1-june-15/) - This year, CanadiEM has partnered with the Canadian Association of Emergency Physicians, EMOttawa, and the Skeptic’s Guide to Emergency Medicine to help promote #CAEP21: CAEP at the Forks - Rising to the Challenge. From June 15-17, 2021 we will be publishing The CAEP Daily, a journalistic summary of highlights from the conference. Please join the - [Call for Junior Editors, Class of 2021-22!](https://canadiem.org/call-for-junior-editors-class-of-2021-22/) - We are pleased to announce that CanadiEM is now accepting applications for our Junior Editor program! If you are interested in learning more about Free Open Access Medical Education (FOAM) or becoming part of our virtual community of practice,​1​ this program is for you. The application process deadline is June 30, 2021. What are Junior - [CAEP at the Forks: 2021 Promo Poster](https://canadiem.org/caep-at-the-forks-2021-promo-poster/) - CAEP at the Forks is this year's Canadian Association of Emergency Physicians annual conference! For the first time, #CAEP21 will be hosted on a virtual platform this year. CanadiEM and CAEP are working together to help promote this awesome event! With a spectacular lineup of national and international speakers as well as outside-the-box and fun - [CAEP 2021: Tracks and Plenary Speakers](https://canadiem.org/caep-2021-tracts-and-plenary-speakers/) - This is the third episode of our CanadiEM’s podcast series in collaboration with CAEP 2021, with our guest host Ken Milne. You may recognize Ken Milne’s voice from the popular podcast Skeptic’s Guide to Emergency Medicine. In this series, Ken breaks down will tell you everything you need to know about the upcoming CAEP 2021 - [Root Cause Analysis in the Time of COVID-19:](https://canadiem.org/root-cause-analysis-in-the-time-of-covid-19/) - You are midway through a busy rapid response shift where you have noticed an increased response time of the hospital’s intubating teams to decompensating patients. Over the last few months, the COVID-19 pandemic has prompted restructuring of the use of many spaces to accommodate the influx of patients. You understand that the system is overwhelmed - [CAEP 2021: Recent EM Literature and Global EM Tracks](https://canadiem.org/caep-2021-recent-em-literature-and-global-em-tracks/) - This is the third episode of our CanadiEM’s podcast series in collaboration with CAEP 2021. Today's episode is hosted by Dr. Hans Rosenberg, who is joined by two track chairs to discuss some of the awesome talks planned for CAEP 2021 conference, CAEP at the Forks: Rising to the Challenge! Tune in to learn all - [CAEP 2021: Pre-Conference Details](https://canadiem.org/caep-2021-pre-conference-details/) - This is the second episode of our CanadiEM’s podcast series in collaboration with CAEP 2021, with our guest host Ken Milne. You may recognize Ken Milne’s voice from the popular podcast Skeptic’s Guide to Emergency Medicine. In this series, Ken breaks down will tell you everything you need to know about the upcoming CAEP 2021 - [CAEP 2021: Goals of the Conference](https://canadiem.org/caep-2021-goals-of-the-conference/) - This is the first episode of our CanadiEM's podcast series in collaboration with CAEP 2021, with our guest host Ken Milne. You may recognize Ken Milne's voice from the popular podcast Skeptic's Guide to Emergency Medicine. In this series, Ken breaks down will tell you everything you need to know about the upcoming CAEP 2021 - [WildEM E11 - Drowning](https://canadiem.org/wildem-e11-drowning/) - So you have probably heard by now that kids aren't small adults. But ... could adults be over sized neonates ? Ok probably not but maybe we can learn from NRP to better understand the resuscitation of a drowning patient. Here si what we are going to cover on the podcast today : Drowning definitionType - [Tiny Tip: HOUSE as a discharge guide for marginalized patients that incorporates the social determinants of health](https://canadiem.org/tiny-tip-morph-as-a-discharge-guide-for-patients-with-substance-use-disorders/) - Emergency Departments are often the primary source of healthcare for marginalized patients with substance use disorders and precarious housing​1​. As such, we have unique opportunities to intervene and initiate change. While many screening tools exist to identify substance use disorders, the novel H.O.U.S.E. mnemonic is the first to cover high yield items to be discussed - [CAEP Conference + CanadiEM Special Podcast - Ep 2 - Introducing Track Chairs](https://canadiem.org/caep-conference-canadiem-special-podcast-ep-2-introducing-track-chairs/) - CAEP Conference + CanadiEM Promotions Team collaborate to bring you our second podcast episode! In this collaboration CAEP Conference promotions podcast episode #2 - We introduce some of our amazing track chairs from the conference. They discuss their guest speakers and some of the awesome content they will be hosting at their respective tracks! CAEP - [Tales From the Trenches E03: COVID and the Medical Student Dilemma with Dr. Jazmyn Shaw](https://canadiem.org/tales-from-the-trenches-e03-covid-and-the-medical-student-dilemma-with-dr-jazmyn-shaw/) - Overview: In this episode, Tiffany talks with Dr. Jazmyn Shaw, the current EMRA Medical Student Council Chair, about the unique challenges faced by medical students during the COVID pandemic. From being abruptly pulled from rotations, uncertainty over audition rotations, virtual interviews and match to the first doses of a COVID vaccine, we cover it all! - [CaRMS Guide](https://canadiem.org/carms-guide/) - The posts below have been arranged by the phase of medical school that they are most relevant to. Taken together, they form an organized "CaRMS Guide." While reading them in order would be best, they were all written independently and should be able to stand alone. As you read them, keep in mind that they - [CRACKCast E225 - Head Trauma](https://canadiem.org/crackcast-e225-head-trauma/) - This updated episode of CRACKCast covers Rosen’s Chapter 34 (9th Ed.) on head trauma. This episode will outline the approach and details of the diagnosis and treatment for patients with Traumatic Brain Injuries. We also cover return to play guidelines for athletes. Shownotes - PDF Here [bg_faq_start] Rosen's in Perspective: Head trauma is a relatively - [What is the role of POCUS to differentiate between cellulitis and abscess?](https://canadiem.org/role-of-pocus-to-differentiate-between-cellulitis-and-abscess/) - A 30-year-old male presents to the ER with right forearm redness, swelling and pain. On exam, you are unsure whether this infection represents cellulitis or abscess. You wonder if point-of-care ultrasound (POCUS) can be helpful. Superficial soft tissue infections are a common ED presentation. Cellulitis appears as an area of erythema, edema and tenderness. An - [Hosting More Effective Morbidity & Mortality Rounds](https://canadiem.org/how-to-host-more-effective-morbidity-mortality-rounds/) - LeBron was in the last few months of his emergency medicine (EM) residency and was tasked with presenting morbidity and mortality (M&M) rounds during an EM rotation. Between clinical shifts and incessant studying for his exam, he carved out time to prepare the rounds. Although he had been a participant in many M&M rounds, he - [Virtual Retreat 2020: The Future of CanadiEM](https://canadiem.org/virtual-retreat-2020-the-future-of-canadiem/) - On August 24, 2020 CanadiEM held its first ever virtual retreat. The goal was to conduct a formal needs assessment. In doing so, we can think about the direction of the organization and blog and to map out a vision for the future of CanadiEM. We also aimed to build connections with our members who - [CAEP + CanadiEM Collaboration - CAEP Conference 2021 - Podcast](https://canadiem.org/caep-canadiem-collaboration-caep-conference-2021-podcast/) - CAEP and CanadiEM are collaborating to help promote the Virtual CAEP Conference 2021! Did you know Canadian Association of Emergency Physicians (CAEP) is hosting a virtual CAEP Conference in 2021? CAEP at the Forks: Rising to the ChallengeWhen is it? June 15-17, 2021Where is it? It's virtual but its hosted by the organizers at University - [WildEM - E10 : IM TXA](https://canadiem.org/wildem-e10-im-txa/) - WildEM is a podcast about everything wilderness medicine. Our goal is bringing you better care out there. We are excited to partner up with CanadiEM and to publish an episode on the site for the first time ! Todays episode will be a review of the recent paper entitled "Pharmacokinetics of intramuscular tranexamic acid in - [Vicious Cycles: Management of the Tricyclic Antidepressant Overdose](https://canadiem.org/vicious-cycles-management-of-the-tricyclic-antidepressant-overdose/) - You’re on a night shift in the ED and receive a patch about a 75-year-old female with altered LOC. EMS reports an empty bottle of doxepin was found in her home. The patient is tachycardic and hypotensive, and on arrival has a GCS of around 12. You quickly look up the class of medication that - [When Guidelines Conflict: Managing Atrial Fibrillation in the ED](https://canadiem.org/when-guidelines-conflict-managing-atrial-fibrillation-in-the-ed/) - Atrial fibrillation (AF) is the most common arrhythmia with a prevalence of 1-2% in Canada.​1​ On an ECG, AF is recognized by an irregularly irregular rhythm lacking p waves (Figure 1). In addition to the clinical and pathophysiological pattern, AF can be categorized as "valvular AF" (VAF) or "nonvalvular AF" (NVAF). While there are varying - [Addiction Medicine in the Emergency Department: A Needs Assessment Survey of Emergency Medicine Providers](https://canadiem.org/addiction-medicine-in-the-emergency-department-a-needs-assessment-survey-of-emergency-medicine-providers/) - In the Emergency Department, we frequently care for patients with substance use disorders. With visits increasing and an opioid crisis, providing high quality care for patients struggling with substance use disorder has never been more important. As Emergency Medicine providers we have a unique opportunity for intervention, as many of our patients are faced with barriers - [Tiny Tips: Causes of Atrial Fibrillation](https://canadiem.org/tiny-tips-causes-of-atrial-fibrillation/) - Atrial fibrillation is the most common arrhythmia encountered and managed in the emergency department.​​1,2​ In addition to ensuring hemodynamic stability and subsequent management of the arrhythmia, the emergency physician must identify and treat potential underlying causes. Atrial fibrillation itself may be a sequela of an underlying life-threatening disease process such as pulmonary embolism or sepsis. - [5 Things You Should Know About Elder Abuse in the ED](https://canadiem.org/5-things-you-should-know-about-elder-abuse-in-the-ed/) - Studies suggest that the prevalence of elder abuse in high-income countries sits at around 7.6-10%.​1​ As individuals age, there can be a decline in social connections and even primary care visits. ED visits can be one of the only points of contact outside their immediate living environment, making this a crucial setting for identification of - [Grey's Anatomy Case Review: Don't Get Burned](https://canadiem.org/greys-anatomy-case-review-dont-get-burned/) - After a mass casualty incident involving a hotel fire, the Seattle Grace Hospital was in chaos. As in every episode, the emergency department was run entirely by surgeons. Patients were handed off between residents with little communication as they ran from one case to the next and additional casualties were wheeled in. Ultimately, one crucial - [Queen's Gambit Case Report: Pediatric Benzodiazepine Overdose](https://canadiem.org/queens-gambit-case-report-pediatric-benzodiazepine-overdose/) - Patient Presentation Beth Harmon is a 9-year-old female who presented to the ED from the Methuen Home, an orphanage, after a witnessed ingestion of “green pills” or Xanzolam. As reported by Headmistress Helen Deardorff, she swallowed at least a handful of the drug after stealing it from the orphanage’s pill jar. She then lost consciousness - [CRACKCast E223 - Back Pain](https://canadiem.org/crackcast-e223-back-pain/) - This review provides a framework for evaluation of back pain in the ED - [CarmsCast Episode 3: Preparing for Interviews](https://canadiem.org/carmscast-episode-3-preparing-for-interviews/) - In this week’s episode, we are covering how to best prepare for your all-important interviews! From what questions to expect to how to leave a positive impression, we cover it all! Helping break this all down for us is a panel of resident guests from diverse programs across Canada: Dr. Larissa Hattin, Dr. Dillan Radomske, - [FrontlineEM Primer: Human Trafficking](https://canadiem.org/frontlineem-primer-human-trafficking/) - Peds Cases https://pedscases.com/human-trafficking-pediatric-population-canada[bg_faq_end] Acknowledgments This document was additionally reviewed by individuals who were previously trafficked. To protect their safety, their names have not been included in the authors list. We are extremely grateful for their feedback in preparing this document so that we can improve our care of trafficked persons. Canadian Alliance of Medical Students - [KelownaKast E01: Musings, and strategies, for cultural sensitivity](https://canadiem.org/kelownakast-e01-musings-and-strategies-for-cultural-sensitivity/) - Hello everyone! This is the first episode of KelownaKast, a podcast made by myself, Hasan Abdullah, and Eric DeHaas. We are residents at the UBC Kelowna Family Medicine residency program hoping to share our interest and passion for teaching and social justice issues related to healthcare. In this first episode we talk about some interesting - [Tales From The Trenches E02: COVID and Critical Care Fellowship with Dr. Mark Ramzy](https://canadiem.org/tales-from-the-trenches-e02-covid-and-critical-care-fellowship-with-dr-mark-ramzy/) - Overview: In this episode, Tiffany talks with Dr. Mark Ramzy about finishing residency and starting his Critical Care fellowship in the hotspots of the COVID pandemic. They also discuss the unique challenges Dr. Ramzy faced when he became a father at the start of the pandemic. Dr. Ramzy shares how he rediscovered artistic talents and - [Journal Club by CanadiEM - E03: Randomized Controlled Trials (RCTs) - Part 2](https://canadiem.org/journal-club-by-canadiem-e03-randomized-controlled-trials-rcts-part-2/) - In this episode we: Learn the importance of treatment studies (Randomized Controlled Trials) in EBMUnderstand and interpret methods and results of treatment based studiesBecome familiar with critically appraising treatment based studies Part 1 examines the trial validityPart 2 covers the results Hosts: Dylan Collins Levi JohnstonDakoda HermanJayneel LimbachiaJake Domm Paper: Warren, Jaimee, et al. "Antacid Monotherapy - [Journal Club by CanadiEM - E02: Randomized Controlled Trials (RCTs) - Part 1](https://canadiem.org/journal-club-by-canadiem-e02-randomized-controlled-trials-rcts-part-1/) - In this episode we:1. Learn the importance of treatment studies (Randomized Controlled Trials) in EBM 2. Understand and interpret methods and results of treatment based studies 3. Become familiar with critically appraising treatment based studies Part 1 examines the trial validity Part 2 covers the results Hosts: Dylan Collins Levi JohnstonDakoda HermanJayneel LimbachiaJake Domm Paper: Warren, Jaimee, et - [Journal Club by CanadiEM E01: Meet the Team](https://canadiem.org/journal-club-by-canadiem-e01-meet-the-team/) - Journal Club by CanadiEM is a podcast designed to help medical learners at all stages of training develop the skills necessary to properly appraise, interpret, and apply medical research to the practice of Emergency Medicine, all in the spirit of evidence based medicine. Hosts From the West to the East coast: Dylan Collins – 4th - [Artificial intelligence in emergency medicine: beyond the hype](https://canadiem.org/artificial-intelligence-in-emergency-medicine-beyond-the-hype/) - During a busy night shift, you are reading a series of chest X-rays when you overhear a colleague remark, “This will all be replaced by computers soon, anyways”. You think back to a few Tweets on artificial intelligence in medicine and wonder if her comment has merit. There has been so much hype about the - [Checklists and the Hierarchy of Effectiveness](https://canadiem.org/checklists-and-the-hierarchy-of-effectiveness/) - You are working a particularly busy overnight solo coverage shift when a very sick 4-year old patient with respiratory distress begins desatting requiring urgent intubation. A team is quickly assembled and preparation is completed for the procedure. You begin attempting endotracheal tube insertion but after two failed attempts with direct laryngoscopy you ask for a - [Identifying a Trafficked Patient in the Emergency Room](https://canadiem.org/identifying-a-trafficked-patient-in-the-emergency-room/) - Editor's Note: February 22 is National Human Trafficking Awareness Day. Today, CanadiEM is featuring a pair of posts with important takes on this issue. A young woman presents to the emergency department with pelvic pain. She’s accompanied by her boyfriend who insists he come into the exam room and tries to provide the history for - [CRACKCast E222 – Vaginal Bleeding](https://canadiem.org/crackcast-e222-vaginal-bleeding/) - This updated episode of CRACKCast covers Rosen’s Chapter 31 (9th Ed.) on vaginal bleeding. With this review, we hope to provide you a systematic approach to this common complaint! Shownotes - PDF Here [bg_faq_start] Rosen’s in Perspective Alright CRACKCast listeners, we are back at it again with our podcast on Chapter 31 - Vaginal Bleeding - [PEM Pearls 02: Non-Accidental Trauma pt. 1](https://canadiem.org/pem-pearls-02-non-accidental-trauma-pt-1/) - Welcome back to PEM Pearls: the CanadiEM Infographic Series focused on providing approaches and high-yield pearls for important pediatric EM topics! This is part 1 of our 2 part Non-Accidental Trauma posts. Today we will be discussing the history, physical exam, and differential diagnosis considerations for potential non-accidental trauma cases.​1​ Physical child abuse is a - [The AHA 2020 "Top 10 Changes" Project: CPR & ECC Guidelines Infographic Series](https://canadiem.org/the-aha-2020-top-10-changes-project-cpr-ecc-guidelines-infographic-series/) - Cardiac Arrest: What Is It All About? "...After cardiac arrest, teacher wakes up in ICU four days later"“Elementary school’s first responder team saves teacher with CPR, AED”“AHA President’s heart stopped for several minutes. He’s now back at work, ready to share his story” Cardiac arrest is one of the most polarizing things we face in - ["CanadiEM Presents" Video Interview Series - Hot Wings with Dr. Brent Thoma](https://canadiem.org/canadiem-presents-video-interview-series-hot-wings-with-dr-brent-thoma/) - If you watch YouTube, you may have some familiarity with the idea of an "experiential interview." In this format, the participants take part in some sort of an activity. This serves to create an intermittent distraction, where the natural personalities of each person become apparent, and the viewer has a more intimate reaction to the - [Ten Fingers, Ten Problems: Creating a Brief Primer on Common Finger Pathologies](https://canadiem.org/ten-fingers-ten-problems-creating-a-brief-primer-on-common-finger-pathologies/) - A Note from the Editor:The Online Educational Resource (OER) detailed below was part of the University of Manitoba Emergency Medicine program’s “Research Day 2.0”. The academic flip to virtual learning prevented the program from hosting their usual in-person resident research day. Acknowledging the disruption COVID-19 caused with research projects, the residents instead set to work - [PEM Pearls 03: Non Accidental Trauma pt. 2](https://canadiem.org/pem-pearls-03-non-accidental-trauma-pt-2/) - Welcome back to PEM Pearls: the CanadiEM Infographic Series focused on providing approaches and high-yield pearls for important pediatric EM topics! This is part 2 of our 2 part Non-Accidental Trauma posts. Today we will be discussing the workup, investigations, and management for potential non-accidental trauma cases.​1​ There are a variety of goals of care - [Expert's Corner - Dr. Kaveh Shojania on Common QI Pitfalls](https://canadiem.org/experts-corner-dr-kaveh-shojania-on-common-qi-pitfalls/) - Welcome to another HiQuiPS post! Our series has aimed to present foundational topics in Health informatics, Quality Improvement and Patient Safety in a practical manner. In this new section - Expert’s Corner, we ask an expert some important questions to deepen our understanding of these sciences and improve our implementation. For our inaugural Expert’s Corner - [2020 American Heart Association Guidelines for Neonatal Resuscitation](https://canadiem.org/2020-american-heart-association-guidelines-for-neonatal-resuscitation/) - This year, the American Heart Association released the updated 2020 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care; the first update to the internationally recognized guideline in five years. The top ten things to know for Neonatal Guidelines are as follows: 1. Anticipation and Preparation: Newborn resuscitation depends heavily on proper planning and readiness of - [Tales from the Trenches E01: COVID Transitions with Dr. Andy Little](https://canadiem.org/tales-from-the-trenches-e01-covid-transitions-with-dr-andy-little/) - In this first episode of Tales from the Trenches, Dr. Tiffany Proffitt (host and EM physician at Honor Health in Arizona, USA) talks with guest Dr. Andy Little (Associate Program Director of Advent Health East Orlando Emergency Medicine Residency Program) about career and life transitions during the COVID pandemic. They discuss the unique challenges of - [Teaching That Counts: Crisis Resource Management in Medical Simulation](https://canadiem.org/teaching-that-counts-crisis-resource-management/) - This is part of the CanadiEM Teaching That Counts Infographic Series, where we take the current research and evidence on how to teach well in the emergency department, and distill it down into bite-sized chunks that are rapidly digestible and memorable. We all know that Crisis Resource Management (CRM) is an important skill. When done - [CRACKCast E221 – Acute Pelvic Pain](https://canadiem.org/crackcast-e221-acute-pelvic-pain/) - Summary of the evaluation and treatment of acute pelvic pain in the ED. - [How to make your CaRMS interviews sound and look spectacular](https://canadiem.org/how-to-make-your-carms-interviews-sound-and-look-spectacular/) - Introduction We are less than 3 months away from CaRMS interviews! Although you are likely working on personal and reference letters, now is a good time to start thinking about your interview. This year, for the first time, interviews will be entirely online from the comfort of your own home. This brings about a whole - [2020 American Heart Association Guidelines for Systems of Care](https://canadiem.org/2020-american-heart-association-guidelines-for-systems-of-care/) - This year, the American Heart Association (AHA) released the updated 2020 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care; the first major update to the internationally recognized guideline in five years. CanadiEM and the AHA came together to create an infographic which summarizes the new updates pertaining to the Systems of Care. Here are the - [2020 CanadiEM Year in Review and Editor’s Choice Awards](https://canadiem.org/2020-canadiem-year-in-review-and-editors-choice-awards/) - 2020 has transformed the idea of remote work across industries. As healthcare providers we are lifelong learners, and our education is a substantial part of our work. This year has reaffirmed the importance of Open Educational Resources, and Free Open Access Medical Education, within our communities. The changing nature of the COVID-19 Pandemic has required - [Reporting Patient Safety Events in the Emergency Department](https://canadiem.org/reporting-patient-safety-events-in-the-emergency-department/) - You are a physician caring for a 4-year-old patient in the Emergency Department (ED) presenting with a fever. Before ordering Acetaminophen for the patient, you check the patient's weight on the emergency record, which you read as 17kg. You then write an order based on this weight. The ED nurse checks the order to see - [Introducing 'Sirens to Scrubs'](https://canadiem.org/introducing-sirens-to-scrubs/) - Links to Sirens to Scrubs Posts Minor head injury (July 17, 2018) Esophageal foreign body obstructions (August 14, 2018) Acute coronary syndromes (part one) - Beyond door-to-balloon (September 27, 2018) Acute coronary syndromes (part two) - To the lab! (October 25, 2018) Acute coronary syndromes (part three) - Diagnosis and ED management (November 27, 2018) Acute - [Tiny Tips: Pediatric Airway Anatomy Considerations](https://canadiem.org/tiny-tips-pediatric-airway-anatomy-considerations/) - Intubation in children is an uncommon but high-risk procedure in the emergency department.​1​ The incidence of adverse events during intubation is high, particularly desaturation and hypotension.1 Thus, pediatric airway management is an important and lifesaving skill. The pediatric airway has significant anatomical differences from an adult. To remember these variations, consider the mnemonic “CHILD”. Because - [Case Report: Parkour aftermath - Andy’s fall from height in The Office](https://canadiem.org/case-report-parkour-aftermath-andys-fall-from-height-in-the-office/) - History A 36-year-old male with no medical conditions was brought to the ED by ambulance after a one-story fall in a workplace parkour incident at the Dunder-Mifflin Paper Company. While it’s debatable if the awkward leapfrogging preceding the incident could be considered parkour, Jim explains that the goal of parkour is “to get from point - [Teaching EBM? You can sim that!](https://canadiem.org/teaching-ebm-you-can-sim-that/) - If you’re in medicine, you’ve probably had to sit through at least one literature searching session. You were probably introduced to a long list of acronyms (most of which you’ve long forgotten) representing different literature databases. Perhaps you were asked to try out a search strategy in some of these databases, which you carefully assembled - [2020 American Heart Association Guidelines for Adult Basic and Advanced Life Support](https://canadiem.org/2020-american-heart-association-guidelines-for-adult-basic-and-advanced-life-support/) - This year, the American Heart Association (AHA) released the updated 2020 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care; the first major update to the internationally recognized guideline in five years. In collaboration with the AHA, the authors highlighted the "Top 10 Things to Know" regarding the guideline updates. As in previous years, the authors - [Carmscast Episode 02: Getting to know a program and some thoughts on personal letters](https://canadiem.org/carmscast-episode-02-getting-to-know-a-program-and-some-thoughts-on-personal-letters/) - What is CarmsCast? CarmsCast is a podcast dedicated to helping medical students navigate the confusing and often intimidating world of CaRMS. From electives to rank order lists and everything in between – our guests and us will try to help ease some of the stress we all experience around the match! Episode 02: On this - [CRACKCast E220 –Constipation](https://canadiem.org/constipation/) - Summary of the evaluation and treatment of constipation in the ED. - [Better Measurement in Quality Improvement](https://canadiem.org/better-measures-in-quality-improvement/) - You are getting handover at the beginning of a shift in the emergency department (ED) and hear about a 71 year old woman who presented with a hip fracture. You’ve read about the benefits of nerve blocks for hip fractures, but still don’t feel prepared or supported to perform one. You text message a couple - [Taking a Sexual History in the ED](https://canadiem.org/taking-a-sexual-history-in-the-ed/) - A complete sexual history is important in the investigation of several emergency department (ED) presentations. This is often challenging for students, as it can feel intimidating and uncomfortable to breach this topic with patients. Also, the setting of the ED is not inherently conducive to conversations like these, given the lack of established patient-staff rapport - [2020 American Heart Association Guidelines for Education Science](https://canadiem.org/2020-american-heart-association-guidelines-for-education-science/) - This year, the American Heart Association released the updated 2020 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care; the first major update to the internationally recognized guideline in five years. CanadiEM has worked alongside the AHA to produce infographics summarizing these updates. The “Top 10 Things to Know” for Education Science are as follows: Effective - [2020 AHA and Red Cross Focused Update on First Aid](https://canadiem.org/2020-aha-and-red-cross-focused-update-on-first-aid/) - This year, the American Heart Association released the updated 2020 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care; the first major update to the internationally recognized guideline in five years. CanadiEM has worked alongside the AHA to produce infographics summarizing these updates. Alongside the American Red Cross, the AHA developed a Focused Update for First - [ClerkCast Episode 5: Pediatric Fever](https://canadiem.org/clerkcast-episode-5-pediatric-fever/) - Welcome back to ClerkCast! Today we are sitting down with Dr Kaif Pardhan, FRCP EM assistant program director at the University of Toronto, staff emergency physician at Sunnybrook Health Sciences Centre, and staff emergency physician in the Pediatric Emergency Department at the McMaster Children’s Hospital. Key takeaways from this episode are: Every pediatric patient with - [HiQuips: Variation and Quality Improvement Processes](https://canadiem.org/hiquips-variation-and-quality-improvement-processes/) - Welcome to another HiQuiPs post, where we discuss the concept of variability and its relation to QI processes. You are finishing another busy shift in the ED, and you notice that wait times have increased, patient beds are now set up in the hallway, and extra team members have been called in to help. You - [HiQuiPs: Quality Improvement Projects and Patient Reported Measures](https://canadiem.org/hiquips-quality-improvement-projects-and-patient-reported-measures/) - You are about to start a Quality Improvement (QI) project in your ED. You have noted that clinicians are being interrupted frequently by patient questions about the ED process and non patient care related inquiries. You have read previously that emergency physicians were being interrupted an average of 9.7 times per hour and may result - [Special HiQuiPs Post - Choosing Wisely Canada and Quality Improvement](https://canadiem.org/hiquips-choosing-wisely-canada-1/) - Welcome to another HiQuiPs post! This is the first in a series of posts highlighting Choosing Wisely, an international movement that addresses unnecessary tests and treatments, which has spurred many local, national, and international QI initiatives. In our last post, we discussed variation in the efficiency of medical processes and how this can be attributed - [Special HiQuiPs Post - Choosing Wisely Canada and Quality Improvement Part 2](https://canadiem.org/special-hiquips-post-choosing-wisely-canada-and-quality-improvement-part-2/) - Welcome to our second HiQuiPs post highlighting Choosing Wisely, an international movement dedicated to reducing overuse in health care. Variation among providers and organizations in tests and procedures can help to identify areas of overuse and strategies to reduce it. In our first post we discussed sources of variation in healthcare and specifically how variation - [Special HiQuiPs Post: Ontario ED Return Visit Quality Program Part 1 - Program Overview](https://canadiem.org/special-post-ontario-ed-return-visit-quality-program-part-1/) - You are midway through a busy shift when a colleague approaches you and utters the dreaded “Remember that patient you saw…?!”. This time, it is about an elderly patient you saw the previous week with chest pain that you sent home. And now they are back! You finish the rest of your shift - a - [Special HiQuiPs Post: Ontario ED Return Visit Quality Program Part 2 - A Health Informatics Perspective](https://canadiem.org/hiquips-ontario-return-visit-quality-program-part-2-a-health-informatics-perspective/) - Welcome back to our second post on the Ontario Emergency Department (ED) Return Visit Quality Program (RVQP). In our first post we discussed the utility of return ED visits as triggers for potential quality improvement (QI) initiatives. We also discussed the scope of this program, which is a provincial-level program with many stakeholder organizations. The - [Special HiQuiPs Post: Ontario ED Return Visit Quality Program Part 3 - Program Accomplishments](https://canadiem.org/hiquips-ontario-return-visit-quality-program-part-3-program-accomplishments/) - You are working a busy shift in your busy emergency department (ED), when you are called by the microbiologist about a positive blood culture gram stain on a patient discharged home. You call the patient’s caregiver and they relay that the patient is doing well. You believe that the culture may be a contaminant from - [HiQuiPs: Quality Improvement in the time of COVID-19](https://canadiem.org/hiquips-quality-improvement-in-the-time-of-covid-19/) - You are attending your monthly ED staff meeting where the main topic of discussion is the COVID-19 pandemic. Recent events around the world have compelled your hospital to make changes to better prepare for the expected increase in local respiratory cases. The ED staff meeting has a debrief about some changes that will be happening - [Special HiQuiPs Post on Choosing Wisely Canada and Quality Improvement Part 3 - Patient Engagement](https://canadiem.org/special-hiquips-post-on-choosing-wisely-canada-and-quality-improvement-part-3-patient-engagement/) - Patient Engagement in Practice: Case of Minor Traumatic Brain Injury (mTBI)A 40-year-male presents to the ED after sustaining a closed head injury during a soccer game. There is a question of a brief loss of consciousness and he is now complaining of a mild headache. At the ED triage, it is suspected that he has suffered - [HiQuiPs Special Post: In Situ Simulation and High Reliability Organizations in the time of COVID-19](https://canadiem.org/in-situ-simulation-and-high-reliability-organizations-covid-19/) - It has been a slower than usual night shift, and you have just led a resuscitation for a COVID-19 patient in your ED. Your ED has experienced several policy changes in recent weeks, from new standards for the use of personal protective equipment to policies for mitigating risk during aerosol-generating medical procedures to guidelines on - [HiQuiPs: Computerized Physician Order Entry (CPOE ) - Using Health Informatics to Decrease Adverse Drug Events](https://canadiem.org/hiquips-computerized-physician-order-entry-cpoe-using-health-informatics-to-decrease-adverse-drug-events/) - Your emergency department (ED) recently switched over to an electronic health system (EHR). While you slowly adjust your clinical workflow, you find all the dictating, clicking and typing cumbersome and “slows you down”. You wonder how this innovative technology seemingly has become the foremost barrier to your clinical care and how this technology could ever - [HiQuiPs: Year in Review](https://canadiem.org/hiquips-year-in-review/) - It has already been one year since we launched the HiQuiPs (Health informatics, Quality Improvement, Patient Safety) series on CanadiEM. This year we had fifteen contributors from across the country, and over 15,000 page visits to our series. Over the past year, we have produced thirteen posts over the HiQuiPs interrelated fields: Quality Improvement: On - [HiQuiPs: Introduction to Biomedical and Health Informatics and its Role in the Emergency Department](https://canadiem.org/hiquips-introduction-to-biomedical-and-health-informatics-and-its-role-in-the-emergency-department/) - You are attending your departmental monthly team meeting where you are all discussing your emergency department’s (ED) plan to switch to an electronic healthcare record (EHR) system in the coming months. There is also a lot of discussion about utilizing more health informatics tools to improve patient care. The presenter discusses the emerging role of - [HiQuiPs: Patient Safety in the ED Part 5 – Patient Communication in the ED](https://canadiem.org/hiquips-patient-safety-in-the-ed-part-5-patient-communication-in-the-ed/) - You are working in the Emergency Department on a day when it is busy and bed blocked. You assess a patient presenting with chest pain in the EMS offload area. Standing next to the stretcher, stopping to move every time a porter comes by with another patient stretcher, you sense that your patient is frustrated. - [HiQuiPs: Patient Safety in the ED Part 4 – Patient Handovers and Transitions of Care](https://canadiem.org/hiquips-patient-safety-in-the-ed-part-4-patient-handovers-and-transitions-of-care/) - You are beginning a morning shift in the Emergency Department when the overnight physician comes up to you and asks “Hey, can I give you a few handovers?” Your colleague provides a brief verbal handover for three patients and then says “this fourth one is a slam dunk admit, I’ve called the hospitalist and they’ll - [HiQuiPs: Patient Safety in the ED Part 3 - The Role of Safety Culture in a Patient Safety Program](https://canadiem.org/hiquips-patient-safety-in-the-ed-part-3-the-role-of-safety-culture-in-a-patient-safety-program/) - You are attending a departmental event when you walk over to a group of your colleagues, and the conversation goes silent. You wonder if you had that effect on the conversation, but the awkward silence is reluctantly broken by the person who was speaking when they quietly continue their story. This veteran physician discusses a - [HiQuiPs: Patient Safety in the ED Part 2 - Key Concepts in the Systems-Based Patient Safety Paradigm](https://canadiem.org/hiquips-patient-safety-in-the-ed-part-2-key-concepts-in-the-systems-based-patient-safety-paradigm/) - You are working a busy shift in your local ED, which has a paper-based system for documentation and orders. You have seen two patients with the first name ‘Ben’, and two patients with the last name ‘Chen’. As you are reflecting on this, you realize that the last order you placed for one of the - [HiQuiPs: Patient Safety in the ED Part 1 - Introduction to the Systems Approach](https://canadiem.org/hiquips-patient-safety-in-the-ed-part-1-introduction-to-the-systems-approach/) - So far in our series we’ve explored several approaches, frameworks and tools that will help guide you through the process of quality improvement. You are probably eager to get started at this point (or you may have already!), but you may be wondering which areas to target first in your emergency department (ED). In a - [HiQuiPs: Implementation Part 2 - Which Strategy to Choose: PDSA, Lean, or Six Sigma?](https://canadiem.org/which-strategy-to-choose-pdsa-lean-or-six-sigma/) - PDSA, Lean, and Six Sigma are three different frameworks that can be part of your quality improvement armamentarium. Each of them can often be applied to the same quality issue. Deciding on which one to use requires an understanding of their inherent strengths and weaknesses. In our last post, we briefly introduced the theory behind - [HiQuiPs: Implementation Part 1 - QI Implementation Methodologies](https://canadiem.org/hiquips-implementation-part-1-qi-implementation-methodologies/) - In this two-part series, we will take a deeper dive into several QI conceptual frameworks, or ways to approach QI projects. In our previous posts, we discussed preparation strategies for QI projects; but when it comes to implementing a change, how would a team go about choosing an approach? We will start with a discussion - [HiQuiPs: Preparation Part 3 - Root Cause Analysis](https://canadiem.org/hiquips-root-cause-analysis/) - You have just finished a monthly business meeting with your emergency department (ED) team. One of your colleagues highlighted a recurring issue of the length of time it takes from ordering blood products to administering them in your ED. There is often a long delay in administration for patients who are in acute need. - [HiQuiPs: Preparation Part 2 – Stakeholder Engagement and Behavior Change](https://canadiem.org/hiquips-preparation-part-2-stakeholder-engagement-and-behaviour-change/) - You have recently finished a review of incidents that have been flagged in your ED. You have chosen a pertinent issue to tackle, formed a core group to work on the project, and formulated a SMART aim statement after reading our last HiQuiPs post. The median time for obtaining 12-lead ECGs is 13 minutes, while - [HiQuiPs: Preparation Part 1 - General Considerations for ED Quality Improvement Projects](https://canadiem.org/general-considerations-for-ed-quality-improvement-projects/) - You are in the middle of a busy night shift and you see a 73-year-old female with diffuse abdominal pain who is hemodynamically stable. You have a wide differential and order a CT scan to aid in the diagnosis as you begin empiric management. Three hours pass by and the CT has not been performed. - [How to Read and Make Statistical Process Charts - Part 1](https://canadiem.org/how-to-read-and-make-statistical-process-charts-part-1/) - You are attending your monthly ED business meeting. There has been a recent effort to decrease the time it takes a patient to be transferred to the imaging department for a STAT CT scan. The project team has concluded the first two PDSA cycles after wide stakeholder engagement, and a root cause analysis. Two interventions - [Designing a QI project - a Comparison of Quality Improvement and Traditional Research Paradigms](https://canadiem.org/designing-a-qi-project-a-comparison-of-quality-improvement-and-traditional-research-paradigms/) - You are attending your local ED monthly rounds where a journal club is being held discussing a Quality Improvement (QI) published paper. As the rounds progress, your presenter critiques the article and discusses perceived weaknesses including a small sample size, lack of randomization and blinding, and lists many different possible biases in this project. You - [Reporting QI Results Part 1 - Run Charts](https://canadiem.org/reporting-qi-results-run-charts/) - You are attending your first Quality Committee meeting in your ED. The team is discussing a project they have been working on to decrease unnecessary urine cultures at the urgent care centre associated with the ED. The team has already created a project charter with an appropriate aim statement​1​. They have engaged the appropriate stakeholders - [Reporting QI Results Part 2 - Run Charts](https://canadiem.org/reporting-qi-results-part-2-run-charts/) - You are working on a local quality improvement (QI) project aimed at improving emergency department (ED) lab test turnaround time. You started with a period of stakeholder engagement including the nursing staff, physicians, porters, administrators, clinical biochemists, lab technologists, and patients. Your team completed a root cause analysis and several potential interventions were highlighted. Your - [HiQuiPs: Quality of Care and the ED](https://canadiem.org/hiquips-quality-of-care-and-the-ed/) - You have just finished a busy ED shift on a warm summer evening and feel that you have been able to help a lot of people today. You plan to visit a patio and relax as you have earned it! On your way out you overhear a patient and their family members saying that they - [Human-Centered Design in Healthcare](https://canadiem.org/human-centered-design-in-healthcare/) - You are working a busy shift in the emergency department and are trying to quickly disposition patients. As the shift progresses and your feet hurt, you wonder why your work space is far removed from the patient care area, and different walls have bins that contain order sets, handover notes, and referral forms. Moreover, the - [Self-reported Anosmia and Dysgeusia as Key Symptoms of COVID-19](https://canadiem.org/anosmia-and-dysgeusia-as-key-symptoms-of-covid-19/) - This month CanadiEM is featuring an article from the Canadian Journal of Emergency Medicine that looks at the signs and symptoms of coronavirus disease 19 (COVID-19). Due to both the novelty of COVID-19, and its similarity with other viral infections, it can be difficult to distinguish for frontline physicians.​1​ This cross-sectional study​2​ was performed to - [2020 American Heart Association Guidelines for Pediatric Basic and Advanced Life Support](https://canadiem.org/2020-american-heart-association-guidelines-for-pediatric-basic-and-advanced-life-support/) - This year, the American Heart Association released the updated 2020 guidelines for cardiopulmonary resuscitation and emergency cardiovascular care; the first major update to the internationally recognized guideline in five years. The American Heart Association (AHA) has updated its Pediatric Basic and Advanced Life Support (PALS) guidelines since their last update in 2010. These new recommendations focus - [CRACKCast E219 – Diarrhea](https://canadiem.org/crackcast-e219-diarrhea/) - This updated episode of CRACKCast covers Rosen’s Chapter 28 (9th Ed.) on diarrhea. With this review, we hope to provide you a systematic approach to this explosive clinical presentation! Shownotes - PDF Here [bg_faq_start] Rosen’s in Perspective Alright, everyone. It is the episode you have all been waiting for. Today’s episode covers Chapter 28 in - [CarmsCast Episode 01: Preparing for your emergency medicine elective](https://canadiem.org/carmscast-episode-01-preparing-for-your-emergency-medicine-elective/) - What is CarmsCast? CarmsCast is a podcast dedicated to helping medical students navigate the confusing and often intimidating world of CaRMS. From electives to rank order lists and everything in between - our guests and us will try to help ease some of the stress we all experience around the match! Episode 01: In today’s - [What to Do in a Resuscitation as a Junior Learner](https://canadiem.org/what-to-do-in-a-resuscitation-as-a-junior-learner/) - Background If you’re a medical student interested in emergency medicine, it’s a pretty safe bet that you’re also interested in resuscitation medicine. It’s a defining aspect of the specialty -- how to take a sick, undifferentiated patient and simultaneously investigate and treat a potentially very broad differential diagnosis. The challenge is that, as a junior - [A Junior Learner’s Approach to Dealing with Difficult Situations during Patient Care](https://canadiem.org/a-junior-learners-approach-to-dealing-with-difficult-situations-during-patient-care/) - Why is this topic important? As a learner, you will inevitably experience “difficult” encounters during patient care. In fact, clerks and junior residents are more likely to label patient encounters as “difficult”.1 These encounters often involve patients that refuse to answer questions, use profanity, demand specific investigations or treatments, and express frustration with wait times. - [Abdominal Cutaneous Nerve Entrapment Syndrome (ACNES): A Not-So-Rare Cause of Abdominal Pain?](https://canadiem.org/acnes-abdominal-cutaneous-nerve-entrapment-syndrome/) - In this article, we will dive into the world of abdominal wall pain – specifically from a condition called Abdominal Cutaneous Nerve Entrapment Syndrome (ACNES) – a diagnosis rarely considered when seeing patients with abdominal pain in the ED. Case Your next patient is Ms. Amanda Cnes, a 34-year-old female with abdominal pain. Before seeing - [CRACKCast E218 - Gastrointestinal Bleeding](https://canadiem.org/crackcast-e218-gastrointestinal-bleeding/) - This updated episode of CRACKCast covers Rosen's Chapter 27 (9th Ed.) regarding gastrointestinal bleeding. With this review we hope to streamline your approach to patient's losing their circulatory volume from their GI tract to avoid the bloody mess. Thank you to Saskatoon EM residents Dr. Sey Shwetz and Dr. Josh Butcher for joining us for - [Tiny Tip: "WARM CREAM" as a diagnostic mnemonic for Kawasaki Disease](https://canadiem.org/tiny-tip-warm-cream-as-a-diagnostic-mnemonic-for-kawasaki-disease/) - Kawasaki Disease is typically a self-limiting, medium vessel vasculitis that predominantly affects Asian male children between the ages of 1 to 5.​1​ One of the major complications from Kawasaki Disease is the development of coronary artery aneurysms. If left untreated, 20-25% of the cases of Kawasaki Disease are associated with coronary artery aneurysms,​2​ but the - [Subungual Hematomas and Trephination](https://canadiem.org/subungual-hematomas-and-trephination/) - Case Presentation You are a clinical clerk on your rural family medicine rotation working in the local emergency department. Your preceptor asks you to see a 25-year-old male who presents shortly after having hit his left index finger with a hammer while building a new deck this afternoon. He is otherwise healthy, he is not - [CRACKCast E217 - Nausea and Vomiting](https://canadiem.org/crackcast-e217-nausea-and-vomiting/) - This updated episode covers the approach to a common, but icky complaint we will see often in the ED, nausea and vomiting. ShownotesPDF Here [bg_faq_start] Rosen’s in Perspective In the US, 4% of ED visits are for a chief complaint of nausea and vomiting. In this episode, we cover key aspects of this chief complaint, - [Time Management in the ED: Is there such a thing?](https://canadiem.org/time-management-in-the-ed-is-there-such-a-thing/) - Being efficient with your time during an ED shift is an important skill to develop. Not only will this help you (and your staff) keep up with the demands of a busy emergency department, but as a learner this will also provide you with the opportunity to see more cases and have more time for - [Blood & Clots Series: Subsegmental PE - To Treat or Not To Treat?](https://canadiem.org/blood-clots-series-subsegmental-pe/) - All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical expert, scholar Main Messages Improved technology has led to an increase in the detection of subsegmental PE (SSPE) An algorithmic approach can help identify patients who will benefit from anticoagulation: generally those with concomitant DVTs and patients with additional - [Blood & Clots Series: When is it safe to perform neuraxial procedures in an anticoagulated patient?](https://canadiem.org/blood-clots-series-when-is-it-safe-to-perform-neuraxial-procedures-in-an-anticoagulated-patient/) - All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical Expert, Collaborator Case Description You are assessing a 55-year-old male patient in the emergency room who is presenting with headache, fever, and neck stiffness. He needs a lumbar puncture to rule out bacterial meningitis. However, he is on - [Blood & Clots Series: How do I determine if my patient on a DOAC is still at increased risk of bleeding?](https://canadiem.org/blood-clots-series-how-do-i-determine-if-my-patient-on-a-doac-is-still-at-increased-risk-of-bleeding/) - CanMEDS Roles addressed: Expert Main Messages At standard doses DOACs are safe and effective for most patients and lab monitoring is not required for routine use. If the time of the last dose is known, an estimate of current anticoagulation effect can be obtained by measuring the number of half-lives that have elapsed in those - [Blood & Clots Series: What are the risks of reversing anticoagulation?](https://canadiem.org/what-are-the-risks-of-reversing-anticoagulation/) - All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical expert, Communicator Case Description You are working a shift in your local emergency department and an 89-year-old female is brought in with a 2-day history of melena stool. The patient has a history of atrial fibrillation and uncontrolled - [Blood & Clots Series: Is Fecal Occult Blood Testing helpful in deciding whether it’s safe to prescribe anticoagulants?](https://canadiem.org/is-fecal-occult-blood-testing-helpful-in-deciding-whether-its-safe-to-prescribe-anticoagulants/) - All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Expert, Leader Case Description You have just diagnosed a 55-year-old male with an acute proximal deep vein thrombosis in the emergency department. The event was unprovoked, and he has symptoms of leg swelling and pain. He is otherwise healthy - [Blood & Clots Series: When and how should I reverse anticoagulation with warfarin?](https://canadiem.org/when-and-how-should-i-reverse-anticoagulation-with-warfarin/) - All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical Expert Case Description You are in the emergency department seeing an 89-year-old female presenting with five episodes of coffee ground emesis over the last twenty-four hours. She has atrial fibrillation and is on long-term warfarin for stroke prevention. - [Blood & Clots Series: How do you stop warfarin for surgery?](https://canadiem.org/blood-clots-how-do-you-stop-warfarin-for-surgery/) - All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical Expert, Scholar Case Description You are assessing a 76 year old lady who takes warfarin for stroke prevention because she had a mechanical aortic valve replacement 4 years ago. She was at the preoperative clinic this morning because - [Blood&Clots Series: Performing non-neuraxial bedside procedures on patients taking anticoagulants](https://canadiem.org/bedside-procedures-on-patients-taking-anticoagulants/) - All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical expert Case Description You are assessing a patient in the emergency room who is presenting with a unilateral large pleural effusion that is causing hypoxia and shortness of breath. She needs a thoracentesis but her INR is 3.0 - [Blood&Clots Series: Anticoagulation for patients with moderate to severe renal dysfunction](https://canadiem.org/anticoagulation-for-patients-with-moderate-to-severe-renal-dysfunction/) - All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical expert, Manager Case Description You are called to assess an active and energetic 79 year old man who has come to the ER complaining of palpitations for three months. You do an EKG which shows atrial fibrillation. The - [Blood & Clots Series: How do you choose an anticoagulant for stroke prevention in atrial fibrillation?](https://canadiem.org/blood-clots-series-how-do-you-choose-an-anticoagulant-for-stroke-prevention-in-atrial-fibrillation/) - All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Expert, health advocate, communicator Case Description A 52 year old lady attends the emergency department with a several week history of palpitations. She is found to have atrial fibrillation. You have started a beta blocker and she is in - [Blood & Clots Series: How do I manage acute VTE in pregnancy?](https://canadiem.org/blood-clots-series-how-do-i-manage-acute-vte-in-pregnancy/) - All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical Expert, Collaborator Case Description You’re an EM resident seconded off-service on your internal medicine rotation, and it’s your night on call. The emergency physician asks you to see a pregnant patient with acute pulmonary embolism. Your patient is - [Blood and Clots Series: Diagnosing pulmonary embolism in pregnancy](https://canadiem.org/diagnosing-pulmonary-embolism-in-pregnancy/) - All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical Expert Case Description A pregnant 32 year old female presents to the ER with chest pain. She is 33 weeks gestational age, and this is her third pregnancy (two prior uneventful deliveries). Her pain started 3 hours ago - [Blood and Clots Series: What are the complications of transfusion? What symptoms/signs should I worry about?](https://canadiem.org/what-are-the-complications-of-transfusion-what-symptoms-signs-should-i-worry-about/) - All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical Expert, Communicator, Leader Case Description You are a resident physician rotating through the ICU. You’ve been taking care of a 32-year-old woman who sustained injuries in a high-speed motor vehicle collision two days ago. She is now stable - [Blood and Clots Series: Massive transfusion protocol: what is it, why does it exist, and when should I call one?](https://canadiem.org/massive-transfusion-protocol-what-is-it-why-does-it-exist-and-when-should-i-call-one/) - All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical Expert Case Description A 32-year old woman presents to the ED following a motor vehicle collision with lateral impact (T-bone collision) and is brought into the trauma bay. Significant bleeding was reported on scene and the patient arrives - [Blood and Clots Series: Does my complex patient have DIC?](https://canadiem.org/does-my-complex-patient-have-dic/) - All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Expert Case Description You are seeing a 56M in your critical care suite who has just arrived as a transfer from a peripheral hospital. The patient has had a recent diagnosis of acute leukemia and was given chemotherapy and - [Blood and Clots Series: When can patients on direct anticoagulants have surgery?](https://canadiem.org/when-can-patients-on-direct-anticoagulants-have-surgery/) - All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Professional, Collaborator, Medical expert As a Thrombosis specialist, I am often paged by emergency physicians and orthopedic surgeons requesting anticoagulation reversal in order to facilitate surgery. There are some simple and important points to remember when dealing with this - [Blood and Clots Series: My patient has a pulmonary embolism. Should I screen them for cancer?](https://canadiem.org/blood-and-clots-series-my-patient-has-a-pulmonary-embolism-should-i-screen-them-for-cancer/) - All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Expert, Leader Case Description An 83 year old female presents for follow-up after completing 3 months of oral anticoagulant therapy with Rivaroxaban for her unprovoked deep vein thrombosis. She did some research online and heard about a link between - [Blood and Clots Series: What are the risks of reversing DOAC-associated intracranial bleeding?](https://canadiem.org/blood-clots-series-risks-reversing-doac-associated-intracranial-bleeding/) - All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical Expert Case Description You are seeing a 54F in the emergency department after she sustained a mechanical fall. She struck her head on the pavement and is now confused. Her comorbidities include: hypertension, diabetes mellitus, and atrial fibrillation. - [Blood and Clots Series: How can I tell whether this patient has a deep vein thrombosis?](https://canadiem.org/blood-clots-series-can-tell-whether-patient-deep-vein-thrombosis/) - All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Communicator, Collaborator, Scholar, Professional, Medical expert Case Description A patient with increasing pain and edema in his left leg. In a recent hospital admission he was diagnosed with myeloma. This case reviews pretest probability of deep vein thrombosis, D-dimer - [Blood and Clots Series: Which antithrombotic therapy should I start for my patient with acute VTE?](https://canadiem.org/blood-clots-series-antithrombotic-therapy-start-patient-acute-vte/) - All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Expert Case Description You diagnose an 83 year old female patient with an acute DVT. Her comorbidities include hypertension, diabetes, mild chronic kidney disease (CrCL 55), osteoarthritis, and early mild cognitive impairment for which she is taking Ramipril 10 - [Identifying presentations of opioid poisoning as an opportunity for meaningful intervention](https://canadiem.org/presentations-of-opioid-poisoning/) - A 24-year-old woman is brought to the emergency department (ED) after being discovered with a decreased level of consciousness in a local mall bathroom. Two doses of intranasal naloxone were administered on-site by bystanders. After receiving naloxone, her LOC improved, though she was still mildly sedated upon arrival to the ED. After 1-2 hours in - [Case Report: Airway Management of Penetrating Neck Trauma in the Game of Thrones](https://canadiem.org/case-report-airway-management-of-penetrating-neck-trauma-in-the-game-of-thrones/) - Patient Presentation On a cold winter’s day in Winterfell, a middle-aged man by the name of Lord Baelish was stood in front of the Northern and Vale lords to answer for his crimes. His cunning and deceitful nature nature has finally led to his demise. After taking back the North from Lord Ramsay Bolton, Lady - [Danger Zone E001 - Surgical Airway](https://canadiem.org/danger-zone-surgical-airway/) - Episode 1 – Surgical Airway In this episode of Danger Zone, our hosts examine a relatively rare procedure performed in the ED - the Surgical Airway! They discuss indications, procedural considerations and important clinical pearls. [bg_faq_start] Key Concepts Cricothyrotomy is indicated for all patients who have deemed to be presenting with a C.I.C.O airway - can’t - [Teaching That Counts: Tips on Receiving Feedback](https://canadiem.org/teaching-that-counts-tips-on-receiving-feedback/) - This is part of the CanadiEM Teaching That Counts Infographic Series, where we take the current research and evidence on how to teach well in the emergency department and distill it down into bite-sized chunks that are rapidly digestible and memorable. Teaching That Counts: Tips on Receiving Feedback Do you ever have difficulty receiving feedback - [Priapism Case Report: Robert De Niro’s Hard Situation in “Little Fockers”.](https://canadiem.org/priapism-case-report-robert-de-niros-hard-situation-in-little-fockers/) - CASE PRESENTATION: Jack Byrnes, a 62-year-old Caucasian male, presented to the ER with a persistent, painful, 8-hour erection following the off-label use of Sustengo, a novel PDE5 inhibitor. Jack reports that he found a box of Sustengo samples among his son-in-law’s belongings and decided to try one. When his son-in-law discovered what had happened, he - [Spot the diagnosis! The case of woman lying in bed.](https://canadiem.org/spot-the-diagnosis-tuberculosis/) - This piece by Robert Tennant Cooper, commissioned in 1912, depicts a young woman lying in bed on a balcony. An ominous figure lurks by her bedside with an hourglass. Without the figure, the scene appears almost calm and peaceful with a beautiful landscape beyond the balcony. Observe the piece to come up with a potential - [Blood & Clots Series: When should I worry about a PE in a patient with COVID-19 and how do I make the diagnosis?](https://canadiem.org/blood-clots-series-when-should-i-worry-about-a-pe-in-a-patient-with-covid-19-and-how-do-i-make-the-diagnosis/) - All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical Expert, Health Advocate Case Description A patient is admitted to the internal medicine ward and after 5 days of clinical stability, she develops respiratory failure and is admitted to ICU. After 72 hours of mechanical ventilation her D-Dimer - [Regional Anesthesia in Canadian Emergency Departments](https://canadiem.org/regional-anesthesia-in-canadian-emergency-departments/) - This month CanadiEM is featuring an article from the Canadian Journal of Emergency Medicine that looks at the applications and opinions of regional anesthesia use in the emergency department (ED). Previous studies have shown that it can reduce general anesthetic dose, requirement for post-procedural opioids, and recovery time, highlighting the potential for increased use throughout - [Emergency Medicine as Social Emergency Medicine](https://canadiem.org/emergency-medicine-as-health-promotion/) - A conversation about social emergency medicine would have sounded incredibly dry before I became a medical student and a mother living through a global pandemic. Now, as I contemplate my own future, as well as the reality of Canadian families navigating complex challenges facing our health and livelihoods, the conversation feels deeply personal. I often - [How to Present a Case in the Emergency Department](https://canadiem.org/how-to-present-a-case-in-the-emergency-department/) - Presenting a case in the ED is important for a number of reasons. Not only does better communication result in better patient care, but it’s also a great learning opportunity and your chance as a clerk to impress your attending. Presenting a case well conveys your level of knowledge and understanding to an attending, which - [CRACKCast E216 – Jaundice](https://canadiem.org/crackcast-e216-jaundice/) - This episode of CRACKCast focuses on a slightly more uncommon ED presentation - jaundice. Grab a coffee and sit back as the CRACKCast crew (featuring Dr. Sey Shwetz, Saskatoon PGY-5 Emerg Resident/PEM fellow extraordinaire) go through the approach to your jaundiced patient. Shownotes - PDF Here [bg_faq_start] Rosen’s in Perspective Jaundice is one of those - [First Year Diaries E04: Dr. Daniel Ting & Dr. Jared Baylis - Transitioning to EM Practice](https://canadiem.org/first-year-diaries-e04-dr-daniel-ting-dr-jared-baylis-transitioning-to-em-practice/) - In this episode of First Year Diaries, I am joined by Dr. Daniel Ting and Dr. Jared Baylis. Dr. Daniel Ting is a first-year staff at UBC, who is currently working from the Vancouver General Hospital and BC Children’s Hospital. Dr. Jared Baylis is also a first-year staff, working at the Kelowna General Hospital. I - [Behind the scenes – Answering the call to action through “COVID-19 Made Simple”](https://canadiem.org/covid-19-made-simple/) - Zoom conversation between friends a few weeks into the COVID-19 pandemic: “Man, I barely check the news nowadays. There’s just so much going on, I cannot keep up! I have trouble keeping up with different media channels, news sources and my Twitter feed. Everyone is talking about COVID-19. I just want to know if we - [A 'Friends' Case Report - Concussion](https://canadiem.org/a-friends-case-report-concussion/) - Patient Presentation and History Joseph (Joey) F. Tribbiani is a 31-year-old man who presents with transient tinnitus following multiple hits to the head. Joey received 13 hits to the left and right temporal regions from his “friends” while wearing “protective equipment”. Collateral history from his friends, Chandler Bing and Ross Gellar, indicates that there was - [CanadiEM Frontline Primer - Intimate Partner Violence Screen](https://canadiem.org/canadiem-frontline-primer-intimate-partner-violence-screen/) - For a video that summarizes this post, check out this link! Points to Focus upon The emergency department (ED) is a safe haven for many. In the COVID-19 pandemic, many of those who might fall victim to violence at home are currently being asked to stay there in isolation with their potential abusers. During this - [The CanadiEM Junior Editor Program: Now Accepting Applications!](https://canadiem.org/the-canadiem-junior-editor-program-now-accepting-applications/) - We are pleased to announce that CanadiEM is now accepting applications for our Junior Editor program! If you are interested in learning more about Free Open Access Medical Education (FOAMed) or contributing to this medium, this program is for you. The application process deadline is July 31, 2020. What is a Junior Editor? The role - [Case Report: Johnny English’s Blunt Scrotal Trauma](https://canadiem.org/case-report-johnny-englishs-blunt-scrotal-trauma/) - CASE PRESENTATION Johnny English, a 42-year-old previously healthy male, presents to the ER with a 3-hour history of pain and swelling localized to the scrotum. He is systemically well and denies lower urinary tract or gastrointestinal symptoms. Upon further questioning, Johnny tells a bizarre story about saving the world by chasing a traitorous MI7 agent - [Hip Nerve Block Toolkit](https://canadiem.org/hip-nerve-block-toolkit/) - This post about how to perform a hip nerve block was created as part of the 2020 Manitoba Emergency Medicine Research Day 2.0 FOAMed competition. The authors have no disclosures of funding or conflicts of interest. Having a healthy understanding of regional anesthesia changes the game in Emergency Medicine. Whether you are relocating joints, fishing - [Urine Testing and UTIs in the Older ED Patient](https://canadiem.org/urine-testing-and-utis-in-the-older-ed-patient/) - 10 ED practice points based on current clinical practice guidelines 1. Focus on a change in urinary symptoms. Chronic urinary incontinence or dysuria can be common. 2. Watchful waiting is okay. For patients with non-localizing symptoms consider the alternative diagnosis before sending urine tests. If pyuria is present, consider a period of observation with hydration. - [First year Diaries E05: Dr. Mohamed Hagahmed - Preparing for Exams After Residency Graduation](https://canadiem.org/first-year-diaries-e05-dr-mohamed-hagahmed-preparing-for-exams-after-residency-graduation/) - In this episode, Kevin Dong (@kevinjdongMD) interviews Dr. Mohamed Hagahmed (@hagahmedMD) on his transition to practice and how to prepare for your board/licensing exams after you graduate from residency. Dr. Mohamed Hagahmed is an Assistant Clinical Professor in the Department of Emergency Medicine at UT Health San Antonio. Shownotes - PDF Here [bg_faq_start] Questions: Can - [Blood & Clots Series: What is the role of convalescent plasma for treating COVID-19?](https://canadiem.org/blood-clots-series-what-is-the-role-of-convalescent-plasma-for-treating-covid-19/) - All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical expert, scholar, advocate Case Description A 45-year-old patient is diagnosed with COVID-19 and is receiving supportive care on the inpatient medicine ward. It is early in her clinical course and she continues to require supplemental oxygen via nasal - [CRACKCast E215 - Abdominal Pain](https://canadiem.org/crackcast-e215-abdominal-pain/) - This updated episode of CRACKCast covers Rosen's Chapter 24 (9th Ed.), and while it may not be the most glamorous topic, abdominal pain is both common and potentially life-threatening. In this episode we hope to solidify an approach to your next patient's gut ache. Shownotes - PDF Here [bg_faq_start] Rosen’s in Perspective Alright, everyone. It - [Interpreting Critical Vital Signs](https://canadiem.org/interpreting-critical-vital-signs/) - Vital signs are amongst the first pieces of patient information available to you in the acute setting. They play a role in many of the decisions we make in emergency medicine. Unfortunately, vital signs can be influenced by a number of factors and there are many situations in which vital signs are less than reliable. - [Requesting Consults in the Emergency Department](https://canadiem.org/requesting-consults-in-the-ed/) - You are halfway through your very first Emergency Medicine shift. You have a 23 year old male patient who appears to be a slam dunk for acute appendicitis – he has symptoms that are consistent with the presentation, pain on palpation at McBurney’s point, a high white count, and CT findings of appendicitis. Your staff - [Is design thinking the way forward for physician innovation?](https://canadiem.org/is-design-thinking-the-way-forward-for-physician-innovation/) - In an attempt to better understand the inefficiencies in the emergency department, Kristian Simsarian, a renowned professor in the field of design, feigned a foot injury.​1​ With a video camera hidden, he documented his experience from start to finish.​1​ The insights he brought back to his team were both expected and sobering.​1​ The video tape - [How to Read Patient Monitors](https://canadiem.org/how-to-read-patient-monitors/) - It’s your first day as a clerk in the Emergency Department and your staff has asked you to see an 80 year old patient with known COPD presenting with increasing shortness of breath. He reminds you to check the patient monitor when you go in there to look for any abnormalities and to record a - [Using quality appraisal techniques to find trustworthy content in the FOAM universe](https://canadiem.org/using-quality-appraisal-techniques-in-foam/) - The COVID-19 Pandemic has highlighted the vast amount of information exchange that happens over the internet for healthcare providers. Learn to judge quality in Free Open Access Medical Education! - [Use of Anticoagulation in Patients with COVID-19 Infection](https://canadiem.org/use-of-anticoagulation-in-patients-with-covid-19-infection/) - Introduction The novel coronavirus, known as COVID-19, was originally reported in a cluster of pneumonia cases in Wuhan (China) near the end of 2019​1​. Over the next 6 months, COVID-19 has emerged as the world’s newest pandemic disease with over 7 million cases worldwide​1​. The clinical presentation of COVID-19 is broad and classically involves fever, - [COVID-19 Self-Management and Self-Isolation Patient Infographics](https://canadiem.org/covid-19-self-management-and-self-isolation-patient-infographics/) - A 55 year-old primarily Punjabi-speaking man presents to the Emergency Department (ED) and describes a three day history of fever, cough, with five days of myalgia and general fatigue. He is not in acute distress, his vital signs are within normal limits, and he does not meet testing criteria for COVID-19. You suspect he could - [Sirens to Scrubs: Thermal Burns](https://canadiem.org/sirens-to-scrubs-thermal-burns/) - You are dispatched to Jack, a 3-year-old with a burn. When you arrive, you’re told by Jack’s frantic mother that she turned her head for a second in the kitchen and Jack pulled a pot of boiling water off the counter, spilling hot water on his left arm and upper chest. Jack is crying in - [CRACKCast E214 - Chest Pain](https://canadiem.org/crackcast-e214-chest-pain/) - This updated episode of CRACKCast covers Rosen Chapter 23 (9th Ed.), one of the quintessential topics of Emergency Medicine, chest pain. Here the crew delivers an organized approach to ensure you're not missing any important pathology on your next shift. Shownotes - PDF here [bg_faq_start] Rosen’s in Perspective Chest pain is a very common ED - [Calling All Podcasters](https://canadiem.org/calling-all-podcasters/) - We are Recruiting! Are you wanting to get involved with the CanadiEM team? You’re in luck! We are looking for interested medical students, residents, and staff doctors for our Podcast team! We are recruiting for interested podcasters to help interview guests, create content, and edit podcasts related to clinical and medical education. This volunteer position - [A "Friends" Case Report - Joey's Urolithiasis](https://canadiem.org/a-friends-case-report-joeys-urolithiasis/) - Presentation Joey Tribbiani, a previously healthy 28-year-old male, presents to the ED with left-sided flank pain. In the past 12 hours, he has had four 20-minute episodes of sudden onset, severe left flank pain radiating to the groin. During these episodes he was unable to find a comfortable position. He felt nauseous and had one - [CanadiEM Frontline Primer - The Emergency Medicine Mindset](https://canadiem.org/canadiem-frontline-primer-the-emergency-medicine-mindset/) - Overview The following are three key steps that you can take to start "thinking like an emergency physician". Unlike other clinical services, the emergency department is often quite chaotic and requires a different mindset for organization of time and workflow. Check out this video made by the McMaster University Demystifying Medicine program alumni. Step 1: - [Behind CovidReview.ca - How McMaster Medical Students Created an Evidence-Based Medicine Database to Aid in the Fight against COVID-19](https://canadiem.org/behind-covidreview-ca/) - The Necessity For Knowledge The COVID-19 pandemic has drastically changed how physicians practice medicine worldwide and has created a wide information gap as clinicians struggle to integrate the immense volume of new research into their practice. Primary literature of varying quality is being published at an accelerated pace, and the lack of strong evidence for - [CPR Algorithm Adjustments when Caring for Suspected or Confirmed COVID Cases](https://canadiem.org/cpr-algorithm-adjustments-when-caring-for-suspected-or-confirmed-covid-cases/) - The infographic above was designed in collaboration with the American Heart Association (AHA) and highlights interim guidance for life support when caring for COVID-19 patients​1​. Check out their full list of COVID-19 resources for resuscitation here. Reduce Provider Exposure When caring for confirmed COVID-19 cases, it is essential for healthcare providers to protect themselves from - [ClerkCast Episode 4: Adult Fever](https://canadiem.org/clerkcast-episode-4-adult-fever/) - Welcome back to ClerkCast! Today we are sitting down with Dr Alim Pardhan, FRCP EM program director at McMaster University, Hamilton General Hospital site lead, and a passionate medical educator. Key takeaways from this episode are: Understanding the mechanisms behind fever and hyperthermiaThe causes of hyperthermia - think drugs, CNS infections, thyroid storm, and environmental - [Identification of Emergency Department Patients for Referral to Rapid-Access Addiction Services](https://canadiem.org/identification-of-emergency-department-patients-for-referral-to-rapid-access-addiction-services/) - This month, CanadiEM is featuring an article from the Canadian Journal of Emergency Medicine that looks at substance-related ED presentations and the need for direct referral to a rapid-access addiction services. Recent national data shows that substance-related emergency department visits are rapidly increasing.​1​ Despite this finding, previous studies show that many EDs do not have - [Must Not Miss Pediatric Fractures](https://canadiem.org/must-not-miss-pediatric-fractures/) - Andy is a 9-year-old male presenting to the emergency department after a left sided FOOSH injury. The initial survey indicates no other associated injuries or neurovascular compromise. However, Andy is holding his left arm and describes a poorly localized pain along his wrist and forearm preventing him from moving it. His immunizations are UTD and - [Introducing the 2020 CanadiEM Infographic Team](https://canadiem.org/introducing-the-2020-canadiem-infographic-team/) - We are happy to announce that our infographic team has grown yet again! Our group now consists of 16 members from across the country who contribute on a part time basis. This team of medical students and residents are committed to creating helpful infographics that healthcare professionals can use in their day-to-day practice. Currently, our - [How to Write a Procedure Note](https://canadiem.org/how-to-write-a-procedure-note/) - Emergency Medicine is known for being a relatively procedure-heavy specialty. Whether it be suturing up a forehead laceration, performing an incision and drainage of a forearm abscess, reducing and casting a Colles fracture, or performing a diagnostic lumbar puncture on a patient with altered mental status, it’s highly likely that you’ll have the chance to - [Approach to Caring for Homeless Patients in the ED during the COVID-19 Pandemic](https://canadiem.org/approach-to-caring-for-homeless-patients-in-the-ed-during-the-covid-19-pandemic/) - Introduction It’s a cliche that holds true now more than ever - the emergency department really is the front door to the medical system. Despite many health and social services shuttering or moving to virtual care during the COVID-19 pandemic, the emergency department remains open 24/7. Our EDs are still committed to seeing anyone who - [CRACKCast E213 – Dyspnea](https://canadiem.org/crackcast-e213-dyspnea/) - In this episode the CRACKCast team reviews the approach for patients presenting with "shortness of breath". Shownotes PDF hereDownload Core Questions [bg_faq_start] [1] Define the following terms: [bg_faq_end] [bg_faq_start] [2] What anatomical structures are responsible for controlling respiratory effort? The exact mechanisms that produce the sensation of breathlessness are not precisely known. However, we do - [COVID-19: Fast Facts on the Coronavirus Outbreak](https://canadiem.org/covid-19/) - A primer on the geography, epidemiology, clinical presentation, and infection control pearls needed to manage the COVID-19 disease outbreak! (Last Update: March 5, 2020) - ["Help us help you" - Soliciting Feedback in the ED](https://canadiem.org/help-us-help-you-soliciting-feedback-in-the-ed/) - We’ve all heard the adage that practice makes perfect and to become an expert you must complete 10 000 hours of deliberate practice​1​. This involves motivated, goal oriented, purposeful practice with periodic feedback. Feedback is critical to allow for growth from where you currently are as a clinical clerk to where you want to be - [Introducing the CanadiEM Newsletter](https://canadiem.org/introducing-the-canadiem-newsletter/) - The CanadiEM team is excited to bring you a newly minted newsletter! This regular feature will exhibit a handful of topical CanadiEM articles in a digestible format for your consumption. We will be curating posts and infographics both past and present to highlight excellent content that you might have missed. To subscribe, simply click - [Palliative Care and Advance Care Planning Resources for ED Physicians during the COVID-19 pandemic](https://canadiem.org/palliative-care-resources-for-ed-physicians-during-the-covid-19-pandemic/) - *All resources are from third parties that are Free Open Access. Please see the complete list of references below. The last few weeks have been a whirlwind of planning as Canada has prepared itself for an increasing number of COVID-19 cases to hit our hospitals. We’ve watched its devastating impact in China, Italy, and closer - [Infographie - Le leadership et l’aide en temps de crise](https://canadiem.org/le-leadership-et-laide-en-temps-de-crise/) - Looking for the English version of this post? Click here. Le dicton « ce sont des temps sans précédent » résonne dans les couloirs des établissements de santé et dans les réunions virtuelles ZOOM à travers le monde. Nous voyons nos équipes s’unir et les gens s'engager dans des rôles inconfortables qu'ils n'avaient jamais prévu d'assumer. Plusieurs - [CanadiEM Frontline Primer - Monitor Leads & ECGs](https://canadiem.org/canadiem-frontline-primer-monitor-leads-ecgs/) - ECG Illustrations adapted with permission from the LIFTL.com site Attaching Monitor Leads It's probably been a while since you attached cardiac monitor leads. Here is a quick rhyme to help you remember! White on right (Put the white lead on your patient's right arm [RA].)Smoke over fire (On left side of the patient's body, black - [CanadiEM Frontline Primer - ED Skills - ECG Interpretation](https://canadiem.org/canadiem-frontline-primer-ed-skills-ecg-interpretation/) - How to use this section? This is a quick refresher on ECGs commonly seen in the ED. We have provided one-liner introductions to each, and the answers are below the ECG. For those looking for a challenge, cover up the answer and quiz yourself. 1. ECG - Tachyarrhythmias ECG Cases Questions - What is the - [CanadiEM Frontline Primer - Clinical Debriefing ("Hot Debrief")](https://canadiem.org/canadiem-frontline-primer-clinical-debriefing-hot-debrief/) - Points to Focus upon "Hot Debriefs" are clinical debriefs that occur right after a high acuity situation. As a physician who has been redeployed to the ED there will be a vast amount of knowledge you will have to review and sift through. Running a debrief will allow you to review protocols and bounce ideas - [CanadiEM Frontline Primer - Consulting Other Physicians](https://canadiem.org/canadiem-frontline-primer-consulting-other-physicians/) - Points to Focus upon Consulting others in the outpatient or non-emergency setting may be quite different than the procedures we might use in the emergency department​1​. The following mnemonics can help you to scaffold your consultation requests so that you can quickly communicate with your consulting colleagues. As someone who has been redeployed in the - [CanadiEM Frontline Primer - ED Skills - Safe Handover](https://canadiem.org/canadiem-frontline-primer-ed-skills-safe-handover/) - Points to Focus upon Handover is when you transfer professional accountability and responsibility of at least one patient to another person, often within the same profession and within the same function. When there is a difference in skill set or practice (e.g. a community nurse practitioner asking an emergency physician to work-up a chest pain - [CanadiEM Frontline Primer - ED Skills - Safe Discharge](https://canadiem.org/canadiem-frontline-primer-ed-skills-safe-discharge/) - Points to Focus upon in Discussions Verbal discharge instructions are important to provide to your patient, but especially during the time of COVID-19, they may be especially challenging. Patients may be distracted, they may not have collateral visitors who can help them to remember things.Patients who are hard of hearing often use visual cues to - [CanadiEM Frontline Primer - Open-Access Medical Education](https://canadiem.org/canadiem-frontline-primer-open-access-medical-education/) - How to use this part of the Primer Continuous learning is something that we strive to encourage at the CanadiEM.org site. As one of the sites within the the Free Open Access Medical education (FOAM, or #FOAMed) movement, we are glad that you've enjoyed our Primer so far, but there's a lot more great Canadian - [CanadiEM Primer - Content Overview](https://canadiem.org/canadiem-primer-content-overview/) - Introduction to the Emergency Department Emergency Medicine MindsetEmergency Department Culture 101 Common Presentations Abdominal Pain Chest painDyspnea / Shortness of BreathBack painHeadacheIschemic StrokeVertigoFever and SepsisSkin and Soft Tissue InfectionsMusculoskeletal and Extremity IssuesJoint PainSoft Tissue PathologyCommon Fractures & SplintingLower Leg SwellingEarly Pregnancy Bleeds and complicationsEpistaxisPulmonary EmbolismTrauma - General ApproachTrauma - Isolated Head injury Emergency Department Skills - [Learning to fly in #PGWHY5: Five tips for survival in the exam year](https://canadiem.org/survival-tips-for-pgy5-exam/) - Five practical tips on surviving the Emergency Medicine Royal College Exam! - [Lessons Learned in Academic Scholarship](https://canadiem.org/lessons-learned-in-academic-scholarship/) - During my PGY-4 year, I had the opportunity to pursue a specialization in Academic Scholarship.1 My year had two primary components: (1) I was the inaugural Editorial Intern at the Canadian Journal of Emergency Medicine,2 and; (2) I was the Digital Scholars Fellow at CanadiEM.3 Over the course of the year, I learned many lessons - [CanadiEM Frontline Primer - Incision and Drainage](https://canadiem.org/canadiem-frontline-primer-incision-and-drainage/) - Indications Percutaneous abscess drainage. An abscess is an inflamed collection of pus, the area is usually tender, warm, firm, & fluctuant to palpation. Any abscess, however small, must be drained for complete resolution. Sometimes there is surrounding cellulitis or lymphangitis and, in the more serious case, fever. Possible Complications Risk of bleeding (damage to adjacent - [CanadiEM Frontline Primer - Suturing and Wound Closure](https://canadiem.org/canadiem-frontline-primer-suturing-and-wound-closure/) - Indications Wounds are closed or repaired to minimize risk of further bleeding and infection. Suture repair provides support and strength to hold the viable dermal edges together to facilitate appropriate healing. Good suturing techniques provide better approximation of tissues leading to an aesthetically pleasing result and preservation of function. Possible Complications Infection, bleeding, and possible - [CanadiEM Frontline Primer - ED Skills - Handling PPE](https://canadiem.org/canadiem-frontline-primer-ed-skills-handling-ppe/) - Points to focus upon Provider safety while caring for patients throughout the pandemic starts with donning appropriate personal protective equipment (PPE). There will be institutional variation with regards to available or required PPE, but the following section will help you with general principles and precautions, including when to use what PPE, and how to properly - [CanadiEM Frontline Primer - Advance Care Planning and Goals of Care Review](https://canadiem.org/canadiem-frontline-primer-advance-care-planning-and-goals-of-care-review/) - Points to focus upon Advance care planning (ACP) and Goals of care (GOC) discussions are extremely important for our patients to plan for their end of life care. ACP promotes conversation amongst patients, families, and their physicians on integral topics such as substitute decision making, end of life care, financial/health decisions, code status, and estate - [CanadiEM Frontline Primer - Breaking Bad News](https://canadiem.org/canadiem-frontline-primer-breaking-bad-news/) - This review is about how to break bad news in the emergency department. While this occurs in many areas of medicine, emergency medicine is unique in that the emergency department environment can be challenging and we generally do not have pre-existing relationships with our patients to draw upon. Points to Focus upon The SPIKES mnemonic - [CanadiEM Frontline Primer - Trauma - Isolated Head Injury](https://canadiem.org/canadiem-frontline-primer-trauma-isolated-head-injury/) - Can't Miss Diagnoses Epidural hematomaSubdural hematomaAcute on Chronic Subdural HematomaOther Intracranial Hemorrhage (ICH)Basilar Skull FractureLe fort Fractures of midface (I, II, III) Early COVID-19 may present with mild and subtle symptoms (headache, myalgias) make sure you consider this when receiving a trauma patient.See "Headache" section for more on other benign causes of headaches. History Trauma/head - [CanadiEM Frontline Primer - Trauma - Primary Survey](https://canadiem.org/canadiem-frontline-primer-trauma-primary-survey/) - Can't Miss Diagnoses Multisystem Trauma REMEMBER: Trauma violates the Occam's Razor approach to diagnosis. Unlike multiple-choice questions, multi-system trauma patients require a methodical approach from head to toe. A basic approach will be the classic Advanced Trauma Life Support (ATLS) approach. ALSO REMEMBER: Early COVID-19 may present with mild and subtle symptoms (headache, myalgia, etc.) - [CanadiEM Frontline Primer - MSK - Joint Pain](https://canadiem.org/canadiem-frontline-primer-msk-joint-pain/) - Can't Miss Diagnoses Septic ArthritisTraumaAlso, assess overlying soft tissues for infections which can also be very life-threatening (e.g. Necrotizing Fasciitis).Open JointProsthetic Joint Infection MIMICS GoutRheumatoid arthritisOsteoarthritisHemarthrosisDislocations DDx for Monoarticular Arthritis O - OsteoarthritisS - Septic arthritisT - Tumor in nearby bone / TraumaR - Rheumatic & autoimmune diseaseI - Intra-articular pathologyC - Crystal arthropathy (Gout, - [CanadiEM Frontline Primer - MSK - Common Fractures](https://canadiem.org/canadiem-frontline-primer-msk-common-fractures/) - Common Wrist & Forearm Fractures Radius Overview Colles Distal Radius FractureBarton Distal Radius FractureSmith Distal Radius Fracture (a.k.a. reverse Colles) Both Bones Overview Galeazzi Fracture+DislocationEssex Lopresti Fracture+DislocationRadial Head FractureRadial Neck Fracture Monteggia ("Nightstick") Fracture+Dislocation Ulna Ulna StyloidOlecranon Fracture Common Hand Fractures Carpal Bones Scaphoid FractureTrapezium FracturePerilunate Fracture+Dislocation Metacarpal Bones Bennet Fracture - ThumbPseudo-Bennet Fracture+Dislocation - - [CanadiEM Frontline Primer - MSK - Extremity Soft Tissue Abnormalities](https://canadiem.org/canadiem-frontline-primer-msk-extremity-soft-tissue-abnormalities/) - Can't Miss Diagnoses Necrotizing FasciitisToxic Shock SyndromeVenous Thromboembolism (e.g. DVT)Peripheral Arterial OcclusionAbscessTendon RuptureCellulitisBurns (including chemical) Common Diagnoses: SprainsStrainsNeuropathies IF CONSIDERING NEC. FASC. PLEASE USE PROPER PPE AND NOTIFY SURGICAL TEAMS EARLY. TIME IS TISSUE. Points to focus upon Hx To note and document; Tetanus status, anticoagulation, surgical manipulation if any.Ask about recent intercurrent febrile illnesses.May - [CanadiEM Frontline Primer - Musculoskeletal & Extremity Injuries](https://canadiem.org/canadiem-frontline-primer-musculoskeletal-extremity-injuries/) - Can't Miss Diagnoses Traumatic InfectiousInflammatory causesOpen joint/Open FractureCompartment Syndrome Also, assess for soft tissue injury and /or infections which can also be very life-threatening (e.g. Necrotizing Fasciitis). CAUTION:Make sure think about abuse, especially with inconsistent stories) - child abuse, domestic violence, or elder abuse. Points to focus upon Generally, the approach to MSK injuries will - [CanadiEM Frontline Primer - Pulmonary Embolism](https://canadiem.org/canadiem-frontline-primer-pulmonary-embolism/) - Points to focus upon How common is this:Pulmonary embolism is a relatively rare diagnosis (0.08%) in the emergency department, however, due to the potential for adverse outcomes, it is important to maintain a high degree of suspicion among vulnerable populations.​1​ Approximately half of the patients are admitted to hospital in Canada, although this proportion is - [CanadiEM Frontline Primer - Dyspnea or Shortness of Breath](https://canadiem.org/canadiem-frontline-primer-dyspnea/) - Can't Miss Diagnoses COVID-19 or other Viral Illnesses (Obviously)AnaphylaxisPneumonia (PNA)Congestive Heart Failure (CHF)Acute Coronary Syndrome (ACS)Acute exacerbation of AsthmaAcute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD)Pulmonary Embolism (PE)Aortic DissectionPneumothorax (PTx)Cardiac Tamponade Mimics due to high respiratory rate Diabetic KetoacidosisSepsis Points to focus upon Hx: Previous Seasonality / Patterns - to differentiate asthma from COVID-19, etc.Allergies - [CanadiEM Frontline Primer - Chest Pain](https://canadiem.org/canadiem-frontline-primer-chest-pain/) - Can't Miss Diagnoses Acute Coronary SyndromeAortic DissectionPericardial tamponadePulmonary EmbolismPericarditisPneumoniaTension pneumothoraxEsophageal rupture Points to focus upon Hx: Risk factors for Coronary Artery Disease and Pulmonary EmbolismFunctional Status - Exercise Tolerance, Recent Decline?Use of Medications - Nitro Spray effective? Adherent to anticoagulant prescriptions?Habits to inquire about - Smoking, Recent or recurrent cocaine useHemoptysis, Dyspnea (symptoms consistent with - [CanadiEM Frontline Primer - Abdominal Pain](https://canadiem.org/canadiem-frontline-primer-abdominal-pain/) - Can't Miss Diagnoses Acute MI or ACSAortic DissectionAppendicitisBowel obstruction, VolvulusCholangitis, Cholecystitis Ectopic pregnancy or Ovarian Torsion/ Ovarian cyst /TOA (FAST-US, Beta)Ischemic bowelGI Bleed, PancreatitisPerforated viscusRuptured AAA Testicular torsion Investigations CBC, BUN, Cr, Lytes, Glucose, VBG/LactateSerial Troponin and Chest x-ray where warranted ECG - Remember to compare an old ECGConsider telemetry Tips on tests hs-troponin T - [CanadiEM Frontline Primer - Emergency Department Culture 101](https://canadiem.org/canadiem-frontline-primer-emergency-department-culture-101/) - Introduction So, you have found yourself in an emergency department (ED). We are so happy you are here. Thank you for coming to lend us a hand – we won’t forget it. We can imagine that this place feels different than the wards or the operating theatre or clinic. Some of that difference has to - [CanadiEM Frontline Primer - Early Pregnancy - First Trimester Bleeding](https://canadiem.org/canadiem-frontline-primer-first-trimester-bleeding/) - Can't Miss Diagnoses First Trimester Bleeding: Miscarriage (formerly known as spontaneous abortion)Ectopic pregnancyInfectionCervical/vaginal lesionsTraumaCoagulopathy Points to focus upon Hx: Last Menstrual CycleDetermine if patient has been on fertility treatments, which will elevate their risk of heterotopic pregnancy (a concurrent intrauterine AND ectopic pregnancies) to roughly 1:200 (much more common than normal rates which are closer - [CanadiEM Frontline Primer - Epistaxis](https://canadiem.org/canadiem-frontline-primer-epistaxis/) - Background Epistaxis (“nose bleed”) is one of the most common ENT complaints seen in the ED. It occurs in up to 60% of the population, and one in ten people affected seek medical attention for the complaint(1). The condition can be classified as anterior or posterior, determined by the anatomic site of bleeding. Around 90% - [CanadiEM Frontline Primer - Lower Leg Swelling](https://canadiem.org/canadiem-frontline-primer-lower-leg-swelling/) - Can't Miss Diagnoses Unilateral Acute DVT (proximal, isolated distal)Arterial OcclusionCellulitisMSKSeptic JointBursitisFractureRuptured Baker’s CystCompartment SyndromeSuperficial ThrombophlebitisNecrotizing FasciitisHematomaMyositis Bilateral Acute Bilateral DVTCellulitisCHF ExacerbationConstrictive PericarditisAKINephrotic SyndromeIVC ThrombosisMedication Adverse EventPreeclampsia Considerations in the age of COVID-19 for your safety: Many individuals with COVID-19 can present entirely asymptomatically, without cough or fever. If the rate of COVID-19 is high in - [CanadiEM Frontline Primer - Skin and Soft Tissue Infections](https://canadiem.org/canadiem-frontline-primer-skin-and-soft-tissue-infections/) - Introduction Skin and soft tissue infections are a common chief complaint and continue to be an increasingly common chief complaint in the emergency department.​1–4​ Abscess and cellulitis are the two most common conditions encountered, but it is important to have a high clinical index of suspicion for some of the true cutaneous emergencies.Currently, there are - [CanadiEM Frontline Primer - Fever & Sepsis](https://canadiem.org/canadiem-frontline-primer-fever-sepsis/) - Can't Miss Diagnoses Sepsis (obviously) - but critically important to find the source and control it!Meningitis / Encephalitis (Not to miss since may need LP for full diagnosis)Febrile neutropenia (especially if recent chemotherapy)Alcohol Withdrawal (hyperthermia, tachycardia, diaphoresis)Benzodiazepine Withdrawal (hyperthermia, tachycardia, diaphoresis)Toxic ingestions - cocaine, methamphetamines, crystal methThyroid StormSerotonin SyndromeNeuroleptic malignant syndrome Points to focus upon - [CanadiEM Frontline Primer - Vertigo](https://canadiem.org/canadiem-frontline-primer-vertigo/) - Can't Miss Diagnoses Central Causes Cerebellar hemorrhageStroke (especially posterior circulation)Vertebrobasilar insufficiencyMultiple sclerosis TraumaInfections Peripheral Causes: Benign Paroxysmal Positional Vertigo (BPPV)Vestibular neuritis/ labyrinthitisMeniere’s DzInfection: Acute otitis mediaForeign body in the ear canal Vertigo Mimics: Syncope / Pre-syncopeHypoglycemiaDehydration Points to focus upon Hx: It is key to differentiate between peripheral (relatively benign, but extremely annoying) and central - [CanadiEM Frontline Primer - Ischemic Stroke](https://canadiem.org/canadiem-frontline-primer-ischemic-stroke/) - Can't Miss Diagnoses Proximal/Large Vessel Occlusion (LVO)Symptomatic carotid Artery StenosisEmbolic Stroke due to Atrial FibrillationIntracranial Hemorrhage Common Mimics SeizureMigraineBell’s PalsyVestibular Neuropathy Points to focus upon Hx: VERY IMPORTANT → Last known well time from patient if reliable or witness if not. Do not just go by what EMS says, may not accurate due to time - [CanadiEM Frontline Primer - Back Pain](https://canadiem.org/canadiem-frontline-primer-back-pain/) - Can't Miss Diagnoses Unstable vertebral fractureCord compression causing Cauda Equina SyndromeCES: Epidural abscess, hematomaSpinal AbscessesDiscitis Killer Mimics: VascularAortic dissection, Ruptured aortic aneurysmRenalPyelonephritis, renal colicPneumoniaPelvic conditionsProstatitis, PID Red Flags of Back Pain Important to assess in DM, History of malignancy, anti-coagulation, osteoporosis, IVDU, steroid and immunocompromised states, and associated alarm symptoms like fever, syncope (aortic dissection). - [CanadiEM Frontline Primer - Headache](https://canadiem.org/canadiem-frontline-primer-headache/) - Can't Miss Diagnoses Intracranial Hemorrhage (ICH) - subarachnoid hemorrhageTraumatic ICH - Subdural hematoma, Epidural hematomaIncreased ICP: Story of Shunt, malignancy, Cushing’s responseMeningitis, EncephalitisStatus MigrainosisEarly COVID-19 may present with headache, myalgias (early viral symptoms)Cerebral Venous sinus thrombosis (CVST)Vascular: Temporal arteritis/Giant-Cell Arteritis, Carotid artery dissectionEye: Acute angle-closure glaucomaCarbon Monoxide (CO) poisoning Mnemonic for Dangerous Headaches BITE ME: - [COVID-19 Guidance for Healthcare Providers](https://canadiem.org/covid-19-guidance-for-healthcare-providers/) - Healthcare providers are at increased risk of exposure to SARS-CoV-2. With the intent to help healthcare providers reduce the risk of SARS-CoV-2 transmission, interim guidance has been released by the AHA. We visually summarized this guidance with a focus on resuscitation care through our infographics. Key concepts in with regards to resuscitation care for COVID19 - [COVID-19 Guidance for EMS and First Responders](https://canadiem.org/covid-19-guidance-for-ems-and-first-responders/) - During the SARS-CoV-2 pandemic, people from around the country are stepping up to help in big ways! All of the physical distancing that Canadians have been doing has been a great way to give back to the front-line healthcare workers that have to face SARS-CoV-2 head-on. CanadiEM has prepared this infographic to help provide COVID-19 guidance - [Hydroxychloroquine & Chloroquine Toxicity Review](https://canadiem.org/hydroxychloroquine-chloroquine-toxicity-review/) - Infographics - Recommendations for Hydroxychloroquine & Chloroquine Toxicity During the COVID-19 pandemic, there have been many attempts to find treatments for the virus. One of the main medications proposed for treatment and very prominent in the media has been the use of chloroquine and hydroxychloroquine. As many research studies are under way to evaluate the - [Introducing...the CanadiEM Frontline Primer](https://canadiem.org/introducing-the-canadiem-frontline-primer/) - We've developed the CanadiEM Frontline Primer to help during this chaotic time. With the COVID-19 pandemic, many centres across the world have seen redeployment of physicians and other healthcare workers from their usual areas of work to acute care settings like the emergency department. For those of you who will be redeployed, we thank you - [McMaster COVID-19 Survival Guide](https://canadiem.org/mcmaster-covid-19-survival-guide/) - Editor's Note: In the vein of #FOAMed, a team at McMaster University has created a COVID-19 Survival Guide. We will be linking to it from our CanadiEM Frontline Primer. Please enjoy! - Teresa ChanThe COVID-19 McMaster Survival Guide is a concise, yet comprehensive, easy to read & navigate, practical manual relating to the clinical aspects, - [Sirens to Scrubs: COVID-19, an excuse to talk about infection control](https://canadiem.org/sirens-to-scrubs-covid-19-an-excuse-to-talk-about-infection-control/) - You and your partner are called to a private residence for Francesca, a 50-year-old woman who feels ‘generally unwell.’ Simple, right? [bg_faq_start] About Sirens to Scrubs Sirens to Scrubs was created with the goal of helping to bridge the disconnect between pre-hospital and in-hospital care of emergency patients. The series offers in-hospital providers a glimpse - [Chalk Talk #1: Acute Pain Control](https://canadiem.org/chalk-talk-1-acute-pain-control/) - BoringEM Chalk Talk's are short ( - [CJEM March 2020 Audio Summary Podcast - substance use disorder, ER resident selection, and more!](https://canadiem.org/cjem-march-2020-audio-summary-podcast-substance-use-disorder-er-resident-selection-and-more/) - The Canadian Journal of Emergency Medicine (CJEM) is very happy to collaborate with the amazing CanadiEM team to promote CJEM’s Audio Summary Podcast. Hosted by the Editor-in-Chief and Emergency Medicine research superstar, Ian Stiell, @EMO_Daddy, the CJEM Audio summaries provide a snippet into what the latest issue of CJEM has to offer. In this issue, we highlight - [Debrief while it’s HOT](https://canadiem.org/debrief-while-its-hot/) - A 72 year old male is brought into the resuscitation room with respiratory distress. He has had two days of fever, cough, fatigue and shortness of breath with a known COVID-19 positive case in his household. His past medical history includes well-controlled hypertension and diabetes. His oxygen saturation on 6L nasal prongs is 88% and - [Electronic Health Record Systems and the Emergency Department Part 1 - Introduction](https://canadiem.org/electronic-health-record-systems-and-the-emergency-department-part-1-introduction/) - You are working on a busy overnight shift in your local emergency department. You are comfortable with your flow, but feel that you are subject to some inefficiencies including finding the next patient’s chart, and different paper order sets, and having to write out lengthy discussions that you had with patients. You are often forced - [Spring is here! Differentiating COVID-19 from seasonal allergies](https://canadiem.org/spring-is-here-differentiating-covid-19-from-seasonal-allergies/) - Spring is finally in the air – but for many of our patients, that may mean the start of their allergy season. And if that is not enough, like many of us, they are more anxious than ever that they might have been exposed to or contracted SARS-CoV-2 / COVID-19. So when they develop a - [A Guide to Charting in the ED](https://canadiem.org/a-guide-to-charting-in-the-ed/) - It’s your first Emergency Medicine shift in clerkship. You’re asked to see a 25-year-old female with abdominal pain. What are things you want to make sure you ask about and examine, and how should you document your assessment without spending most of your shift on paperwork? Documenting patient encounters is a core skill in all - [Navigating Patient Handovers](https://canadiem.org/navigating-patient-handovers/) - 06:50AM: You are heading towards the tail end of your night shift, swamped with traumas, resuscitations, and overall high volumes of patients. You look forward to heading back to the warm embrace of your bed. However, before you can leave, you run your list again with your supervising physician and realize that there are still - [Disposition Decisions: What do we need to consider and why?](https://canadiem.org/disposition-decisions-what-do-we-need-to-consider-and-why/) - Being able to think patients through to their final disposition can be a challenging skill at the clerkship level. However, a good clinician should start thinking about a patient’s disposition as soon as they pick up the chart. Before you take a patient’s history, look at the triage note and start to think through your - [Teaching That Counts: Diagnosing Your Learner](https://canadiem.org/teaching-that-counts-diagnose-your-learner/) - This is part of the CanadiEM Teaching That Counts Infographic Series, where we take the current research and evidence on how to teach well in the emergency department, and distill it down into bite-sized chunks that are rapidly digestible and memorable. Gone are the days of a “one size fits all” model for assessing and - [Practice Essentials: Long Term Care Patients in the Emergency Department](https://canadiem.org/long-term-care-patients-in-the-emergency-department/) - The Case: An 86-year old female from a long-term care (LTC) facility is transferred to the Emergency Department (ED). She is primarily Russian speaking. The transfer note lists a history of hypertension, osteoporosis, osteoarthritis, and advanced dementia. She arrives alone by EMS to the ED with the transfer sheet saying, “chest pain”. She is wandering - [No beat and 'roids to treat? Corticosteroids in cardiac arrest outcomes](https://canadiem.org/corticosteroids-in-cardiac-arrest/) - SUMMARY: The addition of intravenous (IV) corticosteroids to the standard Advanced Cardiovascular Life Support (ACLS) algorithm in the resuscitation of adult patients experiencing non-traumatic cardiac arrest may improve the chances of achieving survival to hospital discharge. These findings are based on a small number of studies with diverse methodology, significant variability in patient population, and - [Apply for the CanadiEM Digital Scholar Fellowship!](https://canadiem.org/apply-for-the-canadiem-digital-scholar-fellowship/) - This post was copyedited by @alexsenger. - [CRACKCast](https://canadiem.org/crackcast/) - Welcome to the home of CRACKCast on CanadiEM! A podcast for those who have to satisfy their ADHD studying needs, the CRACK in CRACKCast is for Core Rosen’s and Clinical Knowledge. This is a podcast that truly gets down to the basics by covering each and every chapter of Rosen’s Emergency Medicine – in order. New episodes are published - [Infographic - Leadership & Helpership during a Crisis](https://canadiem.org/infographic-leadership-helpership-during-a-crisis/) - The saying “these are unprecedented times” rings through the hallways of healthcare institutions and ZOOM meetings across the world. We are seeing our teams bond and people stepping up into uncomfortable roles that they had never planned to assume before. Many are finding themselves reluctantly in leadership positions by the simple fact that their peers - [Breaking Bad News](https://canadiem.org/breaking-bad-news/) - Ruth, a 79 year old lady presents to the emergency department after a fall now unable to ambulate. Ruth is the sole care provider for her sick husband and is anxious to go home and look after him. Your x-rays show she has broken her right hip and will require admission and surgery. You wonder - [The RULES of Patient Reassessments](https://canadiem.org/the-4-rules-of-patient-reassessments/) - You have seen the patient, collected a thorough history of pertinent positives and negatives, completed a comprehensive physical, generated a differential diagnosis, presented the case to your attending and ordered all the appropriate investigations. The next step in providing the best care in the emergency department is reassessing, reassessing, and reassessing. The Emergency Department is - [Approach to Pain Management in the ED](https://canadiem.org/approach-to-pain-management-in-the-ed/) - Pain is one of the most common concerns of patients presenting to the ED. Achieving excellent analgesia while minimizing side effects is an important and nuanced skill to develop. The goal of emergency pain management is not to completely eradicate pain but rather, reduce pain to an acceptable level allowing for safe discharge/return to daily - [CRACKCast E212 – Hemoptysis](https://canadiem.org/crackcast-e212-hemoptysis/) - In this episode of CRACKCast, Dillan Radomske and Grayson Wilson outline an approach to hemoptysis in the ED. Shownotes: PDF Here [bg_faq_start] [1] Define "massive hemoptysis" Massive Hemoptysis (per Rosen’s 9th Edition) - 100 to 600 ml of blood loss in any 24-hour period, which can result in hemodynamic instability, shock, or impaired alveolar gas exchange - [CRACKCast E034 - Vaginal Bleeding](https://canadiem.org/crackcast-e034-vaginal-bleeding/) - This episode of CRACKCast covers Rosen's Chapter 34, Vaginal Bleeding. This chapter covers a complaint that ranges from mostly benign to life threatening, and covers causes and management. Also check out EM Cases Rapid Reviews Videos on Vaginal Bleeding Shownotes - PDF Here [bg_faq_start] 1) List 12 causes of vaginal bleeding, indicating at what age - [CRACKCast E019 - Dizziness and Vertigo](https://canadiem.org/crackcast-e019-dizziness-vertigo/) - This episode of CRACKCast covers Chapters 19 of Rosen’s Emergency Medicine, Dizziness and Vertigo. Dizziness is one of the most common presentations to the ED so we need to have an organized approach to these patients to discern the benign from the deadly. Shownotes - PDF Link [bg_faq_start] Rosen’s in Perspective: [bg_faq_start] Dizziness Very common - [CRACKCast E014 - Cyanosis](https://canadiem.org/crackcast-e014-cyanosis/) - This episode of CRACKCast covers Rosen’s Chapter 014, Cyanosis. Here are some tips for the next time someone comes in to the Emergency Department looking a little blue. Shownotes - PDF Link [bg_faq_start] Rosen’s in Perspective: Key terms: oxygenated vs. deoxygenated hemoglobin = saturated vs. desaturated hemoglobin SaO2 (arterial oxygen saturation measured/calculated by ABG) SpO2 - [CRACKCast E009 - Adult Resuscitation](https://canadiem.org/crackcast-e009-adult-resuscitation/) - This episode of CRACKCast cover’s Rosen’s Chapter 09, Adult Resuscitation. Here is some knowledge for the next time you are in the trauma bay with a patient with cardiac arrest. Shownotes - PDF Link [bg_faq_start] Rosen’s in Perspective: Cardiac Arrest out of hospital cardiac arrests: 3-16% survival rates - [Surviving Sepsis Campaign: COVID-19 Recommendations](https://canadiem.org/surviving-sepsis-campaign-covid-19-recommendations/) - The Surviving Sepsis Campaign (SSC) organized a 36-expert working group from 12 countries to create a set of guidelines released on March 20, 2020 for the management of critically ill adults with COVID-19. Currently, there is little direct evidence published about COVID-19 treatment, so guideline writers supplemented what is available with indirect evidence from the - [Call to Action – COVID-19 Healthcare Innovation Response](https://canadiem.org/call-to-action-covid-19-healthcare-innovation-response/) - The COVID-19 pandemic is creating era-defining strains on healthcare capacity and delivery. As a frontline healthcare provider, your innovative ideas could power change that eases this strain. Make your ideas heard and break down the silos of preparation and planning! The COVID-19 pandemic will be a career-defining window for most healthcare providers. Leadership teams for - [ClerkCast Episode 3: Abdominal Pain](https://canadiem.org/clerkcast-episode-3-abdominal-pain/) - Welcome back to ClerkCast! Episode 3 - Abdominal Pain ClerkCast Episode 3 is all about abdominal pain. Key takeaways from this episode include:1. Thinking outside the GI tract for patients with abdominal pain2. The importance of a good physical exam3. What type of imaging is best for your patient? Hint: it depends!4. How to consult - [The Simple Guide to Management of Non-Valvular Atrial Fibrillation in the ED](https://canadiem.org/the-simple-guide-to-management-of-non-valvular-atrial-fibrillation-in-the-ed/) - Case Presentation Mohammed is an otherwise healthy 58-year-old male presenting with a 24-hour history of palpitations and light-headedness following rigorous exercise. He denies chest pain, shortness of breath, diaphoresis, syncope, or focal neurological symptoms. He has no previous chronic conditions or hospitalizations. No alcohol or drug use. On exam, Mohammed appears somewhat anxious but is - [Recommendations for COVID-19 intubation: An Infographic](https://canadiem.org/recommendations-for-covid-19-intubation-an-infographic/) - Updated March 13, 2020 Intubation and the steps leading up to it are some of the highest-risk moments for COVID-19 spread to healthcare workers and other patients.​1,2​ In Wuhan, “intubation teams” were established to perform multiple intubations per hour while maintaining strict protocols to limit viral exposure. Who is going to be part of your - [Infographic - Giving Safe and Complete Discharge Instructions in the Emergency Department](https://canadiem.org/safe-and-complete-discharge-instructions-infographic/) - Providing patients with discharge instructions is one of the most important aspects of the ED encounter. Patients presenting to the ED are frequently anxious and physicians must convey clear explanations of their medical condition to reassure them. Even when given complete discharge instructions studies demonstrate that patients have poor retention of the information due to language - [CRACKCast E211 – Sore Throat](https://canadiem.org/crackcast-e211-sore-throat/) - This updated episode of CRACKCast covers Rosen’s Chapter 020, Sore Throat (9th Ed.). Sore throat is an extremely common ED presentation, that while can feel dry, is important to have a solid approach to due to uncommon, but severe infectious and airway sequelae. Shownotes - PDF Here [bg_faq_start] Rosen’s in Perspective We can hear all - [Busting Assumptions about the Suprapatellar Bursa](https://canadiem.org/busting-assumptions-about-the-suprapatellar-bursa/) - As a senior resident, I am continually humbled by the practical questions of junior residents that I cannot answer. While practicing ultrasound-guided knee aspiration last week, a resident asked for clarification about a conversation she had had with an Orthopedic surgeon about the suprapatellar bursa. A patient was seen in the Emergency Department with a - [CRACKCast E210 – Red and Painful Eye](https://canadiem.org/crackcast-e210-red-and-painful-eye/) - This updated episode of CRACKCast covers Rosen’s Chapter 019, Red and Painful Eye (9th Ed.). This podcast assists with the extensive differential and specific management plans to the inflamed, painful eye in the ED. Take it slow, this figure and box dense material can be an eye sore when read. Shownotes - PDF Here [bg_faq_start] - [CJEM January 2020 Audio Summary Podcast - defib in STEMI, #Tropandgo and more!](https://canadiem.org/cjem-january-2020-audio-summary-podcast-defib-in-stemi-tropandgo-and-more/) - The Canadian Journal of Emergency Medicine (CJEM) is very happy to collaborate with the amazing CanadiEM team to promote CJEM’s Audio Summary Podcast. Hosted by the Editor-in-Chief and Emergency Medicine research superstar, Ian Stiell, @EMO_Daddy, the CJEM Audio summaries provide a snippet into what the latest issue of CJEM has to offer. In this issue, we highlight - [An international survey of medical podcast use by emergency clinicians](https://canadiem.org/an-international-survey-of-medical-podcast-use-by-emergency-clinicians/) - This month CanadiEM is featuring one of our own studies that was recently published in the Canadian Journal of Emergency Medicine (CJEM). In this paper, we surveyed the podcast listening habits of an international cohort of emergency medicine and critical care clinicians1. This was done to determine their reasons for using medical podcasts and whether - [Teaching That Counts: 7 Tips for Filling Out EPA Assessments](https://canadiem.org/teaching-that-counts-7-tips-for-filling-out-epa-assessments/) - This is part of the CanadiEM Teaching That Counts Infographic Series, where we take the current research and evidence on how to teach well in the emergency department, and distill it down into bite-sized chunks that are rapidly digestible and memorable. Teaching That Counts: 7 Tips for Filling Out EPA Assessments With medical education programs - [Substance use in the ED: Alcohol Use Disorders and the Emergency Department](https://canadiem.org/substance-use-in-the-ed-alcohol-use-disorders-and-the-emergency-department/) - Think back to your last three shifts. Did you see an alcohol related condition? You might even notice a pattern— the same patient, the “regular” who returns time and time again with the same presentation. You may even find yourself writing “discharge home when ambulatory” as you’ve “reached your wits end” and don’t know what - [The FOAMed Quiz Website](https://canadiem.org/foamed-quiz-website/) - "Welcome to The FOAMed Quiz Website! Our little contribution to the FOAM (Free Open Access Medical education) world. Numerous very smart and motivated healthcare professionals work hard every day to take medical education to the next level and make people like us better Emergency Care providers. The goal of our website is to publish one - [CRACKCast E209 – Diplopia](https://canadiem.org/crackcast-e209-diplopia/) - This updated episode of CRACKCast covers Rosen’s Chapter 018, Diplopia (9th Ed.). This podcast will provide you with a simplified ED approach requiring half the thinking during the workup of double vision. Shownotes - PDF here [bg_faq_start] Rosen’s in Perspective Welcome back to another episode of CRACKCast. Today, we will spare you the typical introductory - [ClerkCast Episode 1: Introduction to the ED](https://canadiem.org/clerkcast-episode-1/) - Welcome to ClerkCast! ClerkCast is a new medical education podcast written by medical students for medical students, designed to help new learners excel in the ED. Each episode covers an approach to a common ED presentation, and walks you through a case the same way you would on shift. We’ve got 10 high-yield topics coming - [Resources to support competency-based medical education implementation in emergency medicine](https://canadiem.org/resources-to-support-competency-based-medical-education-implementation-in-emergency-medicine/) - The implementation of competency-based medical education (CBME) is challenging for both residents and staff observers. The shift to workplace-based assessments using entrustable professional activities (EPAs) can be very helpful for getting specific feedback; however, the number and diversity of EPAs can be overwhelming for new residents and those beginning a new rotation or stage of - [CAEP FEI | A Peer-Reviewed Instructional Video is as Effective as a Standard Recorded Didactic Lecture in Medical Trainees Performing Chest Tube Insertion: A Randomized Control Trial](https://canadiem.org/caep-fei-a-peer-reviewed-instructional-video-is-as-effective-as-a-standard-recorded-didactic-lecture-in-medical-trainees-performing-chest-tube-insertion-a-randomized-control-trial/) - Mark is a first year emergency medicine resident waiting in the trauma bay for an incoming thirty year old male with a penetrating stab wound to the chest. He wonders if he will have to insert a chest tube for this patient. It has been a long time since he did one in medical school - [CanadiEM year in review and 2020 preview](https://canadiem.org/canadiem-year-in-review-and-2020-preview/) - Since launching on January 1st, 2016, CanadiEM has experienced a lot of growth. In 2019 our site received >2.1 million pageviews, >300,000 podcast downloads from around the world, and was recognized of the top 10 sites tracked by the #FOAMed Social Media Index.​1,2​ While we have continued to focus on building a Canadian community of - [Teaching That Counts: Giving Feedback](https://canadiem.org/teaching-that-counts-giving-feedback/) - This is part of the CanadiEM Teaching That Counts Infographic Series, where we take the current research and evidence on how to teach well in the emergency department, and distill it down into bite-sized chunks that are rapidly digestible and memorable. Teaching That Counts: Giving Feedback Do you ever wonder if giving feedback is worth - [Approach to Corneal Disorders in the ED](https://canadiem.org/corneal-disorders-in-the-ed/) - Case: Tom is a 38-year-old male who presents to the ED with a red left eye. It started yesterday at work and has been getting more painful. He describes feeling like something is stuck in his eye, despite washing it multiple times. His vision is “a bit blurry” in the left eye. He wears contact - [ClerkCast Episode 2: Chest Pain](https://canadiem.org/clerkcast-episode-2-chest-pain/) - Welcome back to ClerkCast! [bg_faq_start] Episode 2 - Chest Pain In Episode 2 we break down a simple differential for deadly chest pain using the PETMAC mnemonic, covering common risk factors and concerning stories for each pathology. We also discuss the diagnosis of acute coronary syndrome and tips for chest pain investigations. The attending physician - [Sirens to Scrubs: Subarachnoid Hemorrhage](https://canadiem.org/sirens-to-scrubs-subarachnoid-hemorrhage/) - You are dispatched lights and sirens for Jennifer, a 52-year-old female complaining of “the worst headache of my life”. She recalls running on a treadmill then feeling like she had been struck in the back of the head by a clap of thunder. She then proceeded to have a witnessed two-minute episode of syncope. On - [Sirens to Scrubs: Acute Coronary Syndromes, Part Three - Diagnosis and ED Management](https://canadiem.org/sirens-to-scrubs-acute-coronary-syndromes-part-three-diagnosis-and-ed-management/) - In Part One of this series, we reviewed the pathophysiology of Acute Coronary Syndromes (ACS), as well as some of the important features that should be elucidated on history-taking. In Part Two we discussed the current evidence-based practices for the management and transportation considerations in patients identified by paramedics to be suffering from a STEMI. - [Sirens to Scrubs: Acute Coronary Syndromes, Part Four - Spot the Lesion!](https://canadiem.org/sirens-to-scrubs-acute-coronary-syndromes-part-four-spot-the-lesion/) - In Part One of this series, we reviewed the pathophysiology of Acute Coronary Syndromes (ACS), as well as some of the important features that should be elucidated on history-taking. In Part Two we discussed the current evidence-based practices for the management and transportation considerations in patients identified by paramedics to be suffering from a STEMI. - [Sirens to Scrubs: Acute Coronary Syndromes, Part One - Beyond Door-to-Balloon](https://canadiem.org/acute-coronary-syndrome-beyond-door-to-balloon/) - Emergency Medical Services receives a 9-1-1 call for a 52-year-old female suffering with chest pain. As Paramedics rush to the scene, they discuss the physiology of Acute Coronary Syndromes… [bg_faq_start] About Sirens to Scrubs Sirens to Scrubs was created with the goal of helping to bridge the disconnect between pre-hospital and in-hospital care of emergency - [Sirens to Scrubs: Esophageal Foreign Body Obstructions](https://canadiem.org/sirens-to-scrubs-esophageal-foreign-body-obstructions/) - You respond lights and sirens to a popular lunch spot near the provincial legislature for a man choking. You find 56-year-old Jeff clutching at his chest, struggling to breathe and looking very panicked. Around him are dozens of other patrons looking equally panicked, uncertain of what to do. After performing a primary survey on Jeff - [Sirens to Scrubs: Minor Head Injury](https://canadiem.org/sirens-to-scrubs-minor-head-injury/) - Paramedics are called to a skating rink, where a 45y/o female patient, Judy, has slipped on ice and struck her head. When they arrive, they find her sitting on a bench, alert and oriented with a GCS of 15. She is able to recall the events immediately leading up to the incident, and witnesses report - [Sirens to Scrubs: Do you think I need stitches?](https://canadiem.org/sirens-to-scrubs-sutures/) - You are dispatched to Sam, an 87-year-old who cut the base of his thumb while pitting an avocado approximately 30 minutes ago. The laceration is 3cm long and you can see fatty tissue in the wound. Sam’s wife asks whether you think he will need stitches. You think that he will, but you’ve been wrong - [2019 AHA Guidelines Update: Pediatric ALS](https://canadiem.org/2019-aha-guidelines-update-pediatric-als/) - The 2019 American Heart Association Update has arrived!​​1​ CanadiEM has partnered with the AHA to produce a three part infographic series highlighting new guideline changes. Our infographics visually summarize recommendations new to the 2019 update. Part two of our infographic series focuses on updates to the 2019 Pediatric ALS Guidelines. You can find the full article - [2019 AHA Guidelines Update: Systems of Care](https://canadiem.org/2019-aha-guidelines-update-systems-of-care/) - The 2019 American Heart Association Update has arrived!​​​1​ CanadiEM has partnered with the AHA to produce a three part infographic series highlighting new guideline changes. Our infographics visually summarize recommendations new to the 2019 update. Part three of our infographic series focuses on updates to the 2019 Systems of Care Guidelines. You can find the full - [2019 AHA Guidelines Update: Adult ACLS](https://canadiem.org/2019-aha-guidelines-update-adult-acls/) - The 2019 American Heart Association Update has arrived!​1​ CanadiEM has partnered with the AHA to produce a three part infographic series highlighting new guideline changes. Our infographics visually summarize recommendations new to the 2019 update. Part one of our infographic series focuses on updates to the 2019 Adult ACLS Guidelines. You can find the full - [The CanadiEM Infographic Team: Now Accepting Applications](https://canadiem.org/infographic-team-accepting-applications/) - Are you a medical student or resident with an interest in emergency medicine and/or infographics? Are you looking to gain some marketable skills in graphic design? If so, you’ll be happy to hear that CanadiEM is recruiting new members for the infographic team. How did it start? Our initial infographic team consisted of three members - [Pacemaker Essentials: Complications You Must Know](https://canadiem.org/pacemaker-essentials-complications/) - Like all good trilogies, this too, must end. After a long hiatus due to budget negotiations, studio restrictions, and transitioning into staff-hood, it is time we discuss some of the complications that you may see from our pesky pacemakers in the emergency department (ED). Before we begin, please review the prequels if you haven’t already. - [SHoC-ED2: Ultrasound and ECG findings as predictors of cardiac arrest outcomes in the emergency department](https://canadiem.org/ultrasound-ecg-cardiac-arrest/) - This month CanadiEM is featuring an article from the Canadian Journal of Emergency Medicine that looks at the use of point-of-care ultrasound (PoCUS) and ECG findings in emergency department (ED) cardiac arrest patients. While current Advanced Cardiac Life Support (ACLS) protocols do not mandate the use of echocardiography, cardiac PoCUS is increasingly being used in - [CRACKCast E208 – Headache](https://canadiem.org/crackcast-e208-headache/) - This updated episode of CRACKCast covers Rosen’s Chapter 017, Headache (9th Ed.). Headache is an exceedingly common ED presentation with a multitude of possible causes. This podcast will help you to keep your differentials broad by breaking down the not so bad, the bad and the ugly of headaches. Shownotes - PDF here [bg_faq_start] Rosen’s - [CRACKCast E207 – Dizziness and Vertigo](https://canadiem.org/crackcast-e207-dizziness-and-vertigo/) - This updated episode of CRACKCast covers Rosen’s Chapter 016, Dizziness and Vertigo (9th Ed.). Dizziness and Vertigo are terms that send shutters down the spines of most Emergency Physicians. This podcast will give you the tools to discern the difference between Vertigo and Lightheadedness and help guide your management of the underlying cause. Shownotes - - [CJEM Nov 2019 Audio Summary Podcast - US in cardiac arrest, concussions, domestic violence and more!](https://canadiem.org/cjem-nov-2019-audio-summary-podcast-us-in-cardiac-arrest-concussions-domestic-violence-and-more/) - The Canadian Journal of Emergency Medicine (CJEM) is very happy to collaborate with the amazing CanadiEM team to promote CJEM’s Audio Summary Podcast. Hosted by the Editor-in-Chief and Emergency Medicine research superstar, Ian Stiell, @EMO_Daddy, the CJEM Audio summaries provide a snippet into what the latest issue of CJEM has to offer. In this issue, we highlight - [Should Ketamine be Used for Trauma Analgesia?](https://canadiem.org/should-ketamine-be-used-for-trauma-analgesia/) - Case Description: A 21-year-old male presents to your emergency department via EMS after suffering a motorcycle accident. He was travelling at approximately 80 km/h when he lost control of his vehicle and slid into a median. He has an open fracture of his left tibia and fibula, but bleeding is controlled, and his left foot - [Teaching That Counts: Tailoring Your Teaching to the Individual Learner](https://canadiem.org/tailoring-your-teaching-to-the-individual-learner/) - This is part of the CanadiEM Teaching That Counts Infographic Series, where we take the current research and evidence on how to teach well in the emergency department, and distill it down into bite-sized chunks that are rapidly digestible and memorable. Teaching That Counts: Tailoring Your Teaching to the Individual Learner You wouldn’t treat a - [CanadiEM Advertisements: What do you think?](https://canadiem.org/canadiem-advertisements-what-do-you-think/) - Hello CanadiEM readers. You may have noticed some changes to the website this week. Specifically, the presence of advertisements on our pages. Since CanadiEM was founded at the beginning of 2016 we've largely resisted the urge to incorporate advertisements. However, as we've grown (we are now receiving >2,000,000 pageviews annually), so have our costs. This - [First Year Diaries E03 - Mike Kirlew - Rural ED](https://canadiem.org/first-year-diaries-e03-mike-kirlew-rural-ed/) - On this episode of First Year Diaries, I am joined by Dr. Mike Kirlew, a rural family and emergency medicine physician from Sioux Lookout in Northern Ontario. I asked him about how he ended up working in a rural area, and what it is like working with scarce medical resources. Later, we discussed how a - [The Problem with Mandatory Wellness](https://canadiem.org/the-problem-with-mandatory-wellness/) - Introduction “Medical School is bad for your health” – a direct quote from orientation on my very first day of classes. Along with this statement came a myriad of statistics highlighting the risk of burnout, depression, anxiety, and suicide for medical students, residents, and physicians. My excitement for my first day started to be replaced - [First Year Diaries E01 - Transition to EM Practice](https://canadiem.org/first-year-diaries-e01-transition-to-em-practice/) - Today’s episode is to aid new Emergency Medicine staff physicians to traverse through the first few months of their independent practice safely and effectively. As a new physician myself, I had the luxury of having many mentors and colleagues who were gracious enough to help me find my way in providing safe patient care. Additionally, - ["Rock Paper Scissors": A Mnemonic for Testing Peripheral Nerve Motor Functions of the Hand](https://canadiem.org/rock-paper-scissors-testing-peripheral-hand-nerve-motor-function/) - Upper extremity injuries are one of the common reasons for visits to the emergency department. A quick physical exam, including both motor and sensory exam of the hand, can help triage the severity and urgency for referral to upper extremity specialists. When assessing the distal peripheral nerve motor functions of the hand, try using this - [Is there a role for a single intravenous bolus dose of corticosteroid in reducing pain in Emergency Department patients with radicular back pain?](https://canadiem.org/corticosteroid-in-radicular-back-pain/) - Clinical vignette A 45-year-old healthy male, presents to the emergency department (ED) with a one-day history of back pain. The pain started while working out at the gym - he lifted a heavy weight above his head and felt a sudden lower back pain (LBP). The patient describes sharp, burning and stabbing pain in the low - [Spot the Diagnosis! The case of the sick artist with his physician](https://canadiem.org/spot-the-diagnosis-the-case-of-the-sick-artist-with-his-physician/) - As part of the Arts PRN series, we will intermittently be featuring pieces of historic art that hint at an underlying medical condition. They say a picture is worth 1000 words… can you Spot the Diagnosis after examining only a painting? Read on to learn not only about the art, but about these fascinating medical conditions. Who - [Meet our Digital Scholars Fellows for 2019-2020!](https://canadiem.org/digital-scholars-fellows-for-2019-2020/) - The three digital scholars fellows are incredible educators already but will receive further guidance to develop innovative educators and build a career of strong digital identity. Here is what they will be up to this year! Matthew J Douma MN RN ENC(C) CCN(C) CNCC(C) @matthewjdoumawww.RescueScience.org Matthew will be focusing his CanadiEM Digital Scholar Fellowship on - [Tiny Tips: OSTRICH as a differential for acute monoarthritis](https://canadiem.org/differential-for-acute-monoarthritis/) - Acute monoarthritis is a common complaint in the emergency department. The differential for acute monoarthritis is broad. A delay in proper diagnosis and treatment of certain etiologies can result in significant morbidity.​1,2​ The evaluation of a patient with acute monoarthritis should begin with a focused history and physical exam which will guide further laboratory and - [Testicular Torsion](https://canadiem.org/testicular-torsion/) - Case: 18-year-old Arthur comes to the emergency department complaining of sudden onset pain in his testicles that woke him up at 4 am. Arthur had noticed that part of his testicle appeared swollen when he awoke. This concerned him, since he didn’t remember an injury. He tried applying ice, but after a while of no - [Managing headaches in pregnancy](https://canadiem.org/managing-headaches-in-pregnancy/) - An approach to headache in pregnancy, including workup and treatment options! - [Stressed out about stress testing? The utility of stress testing after non-ACS chest pain](https://canadiem.org/stress-testing-for-non-acs-chest-pain/) - The Case Your next patient in the acute zone of the ED is Mr. Liu, a 53-year old man presenting with one hour of acute onset atypical chest pain. He has several risk factors for coronary artery disease, including Type II diabetes, dyslipidemia and an 18 pack-year smoking history. He is hemodynamically stable. After two - [Case Report: Penetrating Chest Trauma in the Game of Thrones](https://canadiem.org/game-of-thrones-penetrating-chest-trauma/) - This is the 4th episode of the Game of Thrones case series examining penetrating chest trauma. Be sure to review Hypothermia and Traumatic Arrest in Game of Thrones, Toxin-Induced Cardiac Arrest in Game of Thrones and Pregnancy and Trauma in Game of Thrones. This post contains spoilers from Game of Thrones Season 8! Patient Presentation - [Solid organ donation from the emergency department - a systematic review](https://canadiem.org/emergency-department-organ-donation/) - This month CanadiEM is featuring an article from the Canadian Journal of Emergency Medicine that looks at solid organ donation from the emergency department (ED). Given the shortage of transplant organs in Canada, the ED is one possible site for increased recruitment efforts, as previous studies have shown that patients referred from the ED are - [CRACKCast E206 – Seizures](https://canadiem.org/crackcast-e206-seizures/) - This updated episode of CRACKCast covers Rosen’s Chapter 015, Seizures (9th Ed.). This is a common presenting problems for patients frequenting the ED. This podcast will give you the tools to elucidate the potential cause for your patient's seizures and allow you to best steward their management afterwards. Shownotes - PDF Here [bg_faq_start] Rosen’s in - [CanadiEM MVP Infographic Series - CCR vs NLC in Patients with Trauma](https://canadiem.org/canadiem-mvp-infographic-series-ccr-vs-nlc-in-patients-with-trauma/) - In this issue of the MVP Infographic Series, we feature: "The Canadian C-Spine Rule versus the NEXUS Low-Risk Criteria in Patients with Trauma" published by Stiell I. et al.​1​ Emergency departments in the USA and Canada deal with 13 million trauma patients who are at risk for c-spine injury; a even smaller portion of these - [Teaching That Counts: Tagging Your Teachable Moment](https://canadiem.org/teaching-that-counts-tagging-your-teachable-moment/) - This is part of the CanadiEM Teaching That Counts Infographic Series, where we take the current research and evidence on how to teach well in the emergency department, and distill it down into bite-sized chunks that are rapidly digestible and memorable. You teach all the time, right? But how much of what you teach does - [Teaching That Counts: The One-Minute Preceptor Model](https://canadiem.org/teaching-that-counts-the-one-minute-preceptor-model/) - Introducing the Teaching That Counts Infographic Series Teaching in the Emergency Department is essential for developing budding learners that will eventually be treating our patients. Not only do we have a duty to teach, but teaching also allows even seasoned physicians to crystallize their own knowledge and reflect on their current practice. Physicians teach in - [CanadiEM MVP Infographic Series - The Canadian C-spine rule for radiography in alert and stable trauma patients](https://canadiem.org/canadian-cspine-rule/) - This issue of the MVP Infographic Series is focused on "The Canadian C-spine rule for radiography in alert and stable trauma patients" published by Stiell et al.1 Prior to the use of clinical decision rules, such as the Canadian C-spine Rule (CCR), clinicians varied up to 6-fold in how often they ordered C-spine X-rays. Although - [CanadiEM MVP Infographic Series - Comparison of PECARN, CATCH, and CHALICE Rules](https://canadiem.org/canadiem-mvp-series-pediatric-minor-head-trauma/) - Editor's Note – This post is one in a series of articles detailing “must know” papers in emergency medicine. Each post will summarize the findings of one study identified by the research of Bazak et al.1 [bg_faq_start] Introducing the CanadiEM MVP Series Evidence-based practice is critical for delivering quality emergency care, but with such a - [CanadiEM MVP Infographic Series - A Study to Develop Clinical Decision Rules for the Use of Radiography in Acute Ankle Injuries](https://canadiem.org/canadiem-mvp-infographic-series-ottawa-ankle/) - This post will highlight a study by Stiell et. al (1992) in which the authors successfully developed highly sensitive clinical decision rules to detect significant ankle and foot fractures on radiography.1 At the time of this study, the authors noted that there were no widely accepted guidelines for the use of radiography in ankle injuries.2,3 - [CanadiEM MVP Infographic Series - CRASH-2 Trial](https://canadiem.org/canadiem-mvp-infographic-series-crash-2-trial/) - CanadiEM MVP Infographic Series - CRASH-2 Trial As part of the MVP infographics series, this article features the CRASH-2 Trial that evaluated the use of tranexamic acid (TXA) in trauma patients with significant hemorrhage. Previous to this study, a significant amount of evidence existed in support of the use of TXA in patients undergoing elective - [CanadiEM MVP Infographic Series - Canadian CT Head Rule](https://canadiem.org/canadiem-mvp-infographic-series-canadian-ct-head-rule/) - The Canadian CT Head Rule for Patients with Minor Head Injuries As part of the CanadiEM MVP Infographic Series, this post reviews The Canadian CT Head Rule for Patients with Minor Head Injuries​1​. This article developed a highly sensitive algorithm to aid clinicians in deciding whether patients presenting with minor head injuries should undergo a - [CJEM Sept 2019 Audio Summary Podcast - organ donation, headaches and more!](https://canadiem.org/cjem-sept-2019-audio-summary-podcast-organ-donation-headaches-and-more/) - The Canadian Journal of Emergency Medicine (CJEM) is very happy to collaborate with the amazing CanadiEM team to promote CJEM’s Audio Summary Podcast. Hosted by the Editor-in-Chief and Emergency Medicine research superstar, Ian Stiell, @EMO_Daddy, the CJEM Audio summaries provide a snippet into what the latest issue of CJEM has to offer. In this issue, - [CanadiEM MVP Infographic Series - First Pass Success Without Hypoxemia is Increased With the Use of Apneic Oxygenation During Rapid Sequence Intubation in the Emergency Department](https://canadiem.org/canadiem-mvp-infographic-series-apox-rsi/) - Is first pass success without hypoxemia increased with the use of apneic oxygenation during rapid sequence intubation in the emergency department? As part of the MVP infographic series, this post reviews an article by Sakles et al. looking at apneic oxygenation in rapid sequence intubation (RSI). Previous studies have shown that multiple intubation attempts during - [ThromboPhonia E02, Re-starting Anti-Coagulation After Intracranial Hemorrhage](https://canadiem.org/thrombophonia-e02-re-starting-anti-coagulation-after-intracranial-hemorrhage/) - Blood & Clots Podcast, Thrombophonia: Episode 2 The same 65-year-old man who was seen earlier with an ICH has now recovered. For your reference, his past medical history is remarkable for hypertension, dyslipidemia, a mechanical aortic valve replacement, diabetes, and sleep apnea. His list of medications include ramipril, atorvastatin, aspirin, metformin, and warfarin. Should his anti-coagulation - [CanadiEM MVP Infographic Series](https://canadiem.org/canadiem-mvp-infographic-series/) - Introducing the CanadiEM MVP Infographic Series [bg_faq_start] Evidence-based practice is critical for delivering quality emergency care, but with such a broad specialty identifying and recalling high-yield studies can be challenging. This is especially true for new EM learners, who are tasked with becoming evidence-informed while transitioning to practice. To make this process easier, CJEM recently - [Flow Hacks 10 – An ED Model of Care©.](https://canadiem.org/flow-hacks-10-an-ed-model-of-care/) - To continue our FLOW Hacks series, Mary Van Osch (RN, MSN, ENC) discusses her team’s new Emergency Department Model of Care (ED MOC ©) at Fraser Health in British Columbia. Setting The model was implemented at Fraser Health in British Columbia, across 12 emergency departments (ED) with a total of 720,000 visits per year. Description - [CRACKCast E205 – Confusion](https://canadiem.org/crackcast-e205-confusion/) - This updated episode of CRACKCast covers Rosen’s Chapter 014, Confusion (9th Ed.). Confusion is a symptom experience by all at some point or another. Confusion has a spectrum of severity and in the Emergency Department it is associated with high rates of mortality. This podcast will give you the tools to identify the cause of - [Arts PRN Project](https://canadiem.org/arts-prn-project/) - Our vision Arts PRN strives to be a platform that showcases the experiences of healthcare providers through... the Arts! Each showcase cycle will have a call for submissions from anyone involved in the health care field. Submissions will be featured bi-weekly in the CanadiEM Arts PRN section. Educational posts outlining the benefits of art and - [First Year Diaries E02 - My Philosophy by Dr. David Carr](https://canadiem.org/first-year-diaries-e02-my-philosophy-by-dr-david-carr/) - On this episode of First Year Diaries, I am joined by Dr. David Carr, an Emergency Medicine Physician working in Toronto, who is a renowned medical education speaker and Toronto Blue Jays team physician. I asked him to impart his wisdom to new staff physicians like myself and share his approaches to a successful career in - [Flow Hacks 9 – OUCH! Timely analgesia administration for patients with MSK injuries in the ED.](https://canadiem.org/flow-hacks-9-ouch-timely-analgesia-administration-for-patients-with-msk-injuries-in-the-ed/) - To continue our FLOW Hacks series, Victoria Woolner (NP, MN, MSc QIPS) writes about another initiative her team has taken on, this time tackling timely analgesia administration for patients with MSK injuries in the ED. This innovation was also the winner of the Top QIPS Abstract Award at the Canadian Association of Emergency Physician’s Conference in - [Sirens to Scrubs: Fever-Phobia](https://canadiem.org/sirens-to-scrubs-fever-phobia/) - You’re transporting Milly, a 68y/o healthy woman to the hospital with a fever of 38.9C with a productive cough. As you offload her she asks for a blanket, so you ask your student to get her one while you start your paperwork. Your student, Vincent, later tells you that he was taught at school not - [CAEP FEI | ImageSim - An Online Image Interpreting Learning System](https://canadiem.org/caep-fei-imagesim/) - Lee is a second year pediatric emergency medicine fellow looking at a pediatric ankle x-ray. She is unsure if what she sees is a normal variant like a growth plate or ossification centre, or a fracture. Lee feels like her orthopedic knowledge is weak and wishes there was a tool to help her better learn - [#TipsforEMexams: The Psychological Science of Exams](https://canadiem.org/tipsforemexams-psychological-science-examinations/) - So, I ran into my friend Meghan McConnell the other day and we got chatting about how to make examinations less of a horrible experience. Dr. McConnell is a PhD researcher in the world renowned Program for Education Research & Development at McMaster University. Her research interests are in the area of how emotions influence training, - [CRACKCast E204 – Depressed Consciousness and Coma](https://canadiem.org/crackcast-e204-depressed-consciousness-and-coma/) - This updated episode of CRACKCast covers Rosen’s Chapter 013, Depressed Consciousness and Coma (9th Ed.). Obtaining a reliable history from an unresponsive patient is next to impossible, especially if the patient arrives to the ED alone. The podcast will give you the knowledge to rapidly identify the cause of your patient’s unresponsiveness and give you - [Exam Series: Guide to the Shoulder Exam](https://canadiem.org/exam-series-guide-to-the-shoulder-exam/) - A 58 year old right hand dominant painter presents to the emergency department with right shoulder pain. The pain started after he returned a particularly forceful serve during a tennis match earlier that afternoon. He states that it has a similar quality to the shoulder pain he typically feels at night, but more intense and - [CanadiEM MVP Infographic Series - PROPPR for Massive Transfusion in Trauma Patients](https://canadiem.org/canadiem-mvp-infographic-series-proppr/) - [bg_faq_start] Introducing the CanadiEM MVP Series Evidence-based practice is critical for delivering quality emergency care, but with such a broad specialty identifying and recalling high-yield studies can be challenging. This is especially true for new EM learners, who are tasked with becoming evidence-informed while transitioning to practice. To make this process easier, CJEM recently published - [CAEP FEI | GridlockED: An Emergency Medicine Game and Teaching Tool](https://canadiem.org/caep-fei-gridlocked-an-emergency-medicine-game-and-teaching-tool/) - Ken is a second year Emergency Medicine resident who just received the following feedback from his attending: "The shift went well, but as you continue in your training, it is important to think about the flow of the department". Ken acknowledges that managing the department is something he needs to learn, but he wishes there - [CRACKCast E203 – Syncope](https://canadiem.org/crackcast-e203-syncope/) - Syncope is one of the core presentations we see in the ED. While benign for many patients, there are several critical diagnoses we need to rule out in the syncopal patient. This episode features Chloe Labrie, a Family Medicine Resident with a keen interest in EM. Shownotes: PDF Here Core Questions: [bg_faq_start] Rosen’s in Perspective - [Tiny Tips: STEMI? Don't forget your PAILS!](https://canadiem.org/chest-pain-pails/) - Reading ECGs is a bread and butter emergency medicine skill. At busy centres a triage nurse may hand you tens of them to glance at per shift. It can be a mindless, monotonous task, but your brain needs to know where to look. So, when you identify legitimate ST elevation and you are concerned about - [CanadiEM MVP Infographic Series - Diagnostic Approach to Subarachnoid Hemorrhage](https://canadiem.org/subarachnoid-hemorrhage/) - Editor Note – This post is the first of a series of articles detailing “must know” papers in emergency medicine. Each post will summarize the findings of one study identified by the research of Bazak et al.1 [bg_faq_start] Introducing the CanadiEM MVP Infographic Series Evidence-based practice is critical for delivering quality emergency care, but with - [Sirens to Scrubs: Wolff-Parkinson-White Syndrome](https://canadiem.org/sirens-to-scrubs-wolff-parkinson-white-syndrome/) - You are dispatched to Jasmine, a 31yo patient, for palpitations. On arrival, you find her clinically stable in a narrow-complex, regular tachycardia at a rate of 180bpm. As you begin to coach her through vagal maneuvers and reach for your adenosine she advises you ‘I have something called Wolff-Parkinson-White – does that change anything?’ You - [CRACKcast E202 - Cyanosis](https://canadiem.org/crackcast-e202-cyanosis/) - This updated episode of CRACKCast covers Rosen's Chapter 011, Cyanosis (9th Ed.). Knowledge of this topic will allow you to more rapidly identify the cause of your patient's blue hue and give you the tools to intervene on your next shift. Shownotes - PDF Here [bg_faq_start] Rosen’s in Perspective Alright, here is the scenario for - [CAEPCast: The SIM Olympiad with Dr. Tamara McColl](https://canadiem.org/caepcast-the-sim-olympiad-with-dr-tamara-mccoll/) - From CAEP 2019 I always love the activities and experiences at CAEP, but year after year I’m drawn to the Simulation Olympiad. Every time I think it’s just incredible. This year, I decided to talk with some of the people who make the SIMOlympiad such a great experience for audiences and participants alike. In my first interview, I - [CanadiEM Digital Scholars Fellowship – Applications now open for 2019-2020](https://canadiem.org/canadiem-digital-scholars-fellowship-applications-now-open-for-2019-2020/) - Are you a RCPSC resident about to embark on your special interest time (ex. fellowship)? Are you a graduating CCFP-EM interested in medical education scholarship with a digital media focus? Are you finished your training in medicine (in any field) and you want to get into the digital medical education world? Are you an - [CanadiEM MVP Infographic Series – Thrombolysis with Alteplase 3 to 4.5 Hours After Acute Ischemic Stroke](https://canadiem.org/canadiem-mvp-infographic-series-thrombolysis-with-alteplase-3-to-4-5-hours-after-acute-ischemic-stroke/) - As part of the MVP Infographic Series this post explores “Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke” published by Hacke et al 2008.1 Alteplase is a tissue plasminogen activator used for intravenous thrombolysis treatment of acute ischemic strokes. Prior to this study, Alteplase was only approved until 3hrs following stroke symptom - [CRACKCast E201 - Weakness](https://canadiem.org/crackcast-e201-weakness/) - This updated episode of CRACKCast covers Rosen's Chapter 010, Weakness (9th Ed.). These topics are core knowledge that we use every day in the Emergency Department. Shownotes - PDF Here [bg_faq_start] Key Concepts This chapter in Rosen’s 9th Edition does not have any associated core concepts, but we have compiled a list of four key - [Tiny Tip: "STAB" as a Tool for Diagnosing Occipital Neuralgia](https://canadiem.org/tiny-tip-stab-as-a-tool-for-diagnosing-occipital-neuralgia/) - Approaching the complaint Occipital neuralgia is a headache disorder characterized by shooting neuropathic pain secondary to greater or lesser occipital nerve pathology. The diagnosis should be considered in a patient presenting with the following: Unilateral or bilateral pain originating at the skull base Sharp, shooting, lancinating, or burning pain that radiates forward along the dermatomes - [Describing a Rash](https://canadiem.org/describing-a-rash/) - When describing a rash there are many characteristics to make note of, including its primary morphology, secondary morphology, demarcation, colour, configuration, and distribution. The focus or this article will be on primary morphology. Reasoning through the first blush Within primary morphology you can stratify a lesion based on whether it is flat or elevated. If - [CRACKcast E200 - Fever in the Adult Patient](https://canadiem.org/crackcast-e200-fever-in-the-adult-patient/) - This updated episode of CRACKCast covers Rosen's Chapter 009, Fever in the Adult Patient (9th Ed.). These topics are core knowledge that we use every day in the Emergency Department. Shownotes - PDF Here [bg_faq_start] Rosen’s in Perspective You pick up a chart, look at the vitals, and you have a temp of 38.3ºC staring - [CRACKCast E197 - Shock](https://canadiem.org/crackcast-e197-shock/) - This updated episode of CRACKCast covers Rosen's Chapter 006, Shock (9th Ed.). These topics are core knowledge that we use every day in the Emergency Department. Shownotes - PDF Here [bg_faq_start] [bg_faq_start] Rosen’s in Perspective As you can probably guess, this introductory chapter is exceedingly important for practitioners of emergency medicine. Chapter 6 in Rosen’s - [CanadiEM MVP Infographic Series - Transfusion Strategies for Acute Upper GI Bleeding](https://canadiem.org/canadiem-mvp-infographic-series-transfusion-strategies-for-acute-upper-gi-bleeding/) - Approximately 20 million units of red blood cells, platelets and plasma are transfused annually in the United States1! Each transfusion carries an element of risk to the patient. Although numerous testing standards have been established to prevent the transmission of infectious diseases (i.e. HIV or Hepatitis C), immune reactions and alterations in homeostasis can still - [EM Approaches in Clerkship – ClerkCast wants to hear from you!](https://canadiem.org/em-approaches-in-clerkship-clerkcast/) - FOAMed resources are important tools for junior learners looking for accessible, quality information on topics of interest. Despite the large volume of resources available for EM staff and residents, there is a relative gap of information curated specifically for clinical clerks. To help address this gap and support a growing interest in EM as a - [Infographic: Disaster Triage Accuracy Following Screen-Based Simulation versus Immersive Simulation](https://canadiem.org/disaster-triage-accuracy-following-screen-based-simulation-versus-immersive-simulation/) - In this issue, we collaborated with the INSPIRE (International Network for Simulation-based Pediatric Innovation, Research, & Education) team to create an infographic on the article “Correlation Between Paramedic Disaster Triage Accuracy in Screen-Based Simulations and Immersive Simulations.” published by Cicero et al.1 Screen-based simulation (SBS) is an emerging alternative to traditional teaching methods which require - [CanadiEM MVP Infographic Series - Protocol-Based Care for Early Septic Shock](https://canadiem.org/process-trial/) - In this issue of the MVP Infographic Series, we feature: "A randomized trial of protocol-based care for early septic shock" published by the ProCESS Investigators.1 There are more than 750 000 cases of sepsis each year that occur in the United States annually. Rates of associated mortality were high, but a huge break through to - [CRACKCast E199 – Adult Resuscitation](https://canadiem.org/crackcast-e199-adult-resuscitation/) - This episode of CRACKCast focuses on adult resuscitation, reviewing core concepts from Chapter 8 of Rosen's 9th edition. Shownotes: PDF Here [bg_faq_start] [1] Describe your history and physical exam in the patient being actively resuscitated. History: Exact time of arrest Witnessed vs unwitnessed arrest Bystander CPR CPR duration – crucial ECG rhythm Prehospital interventions past - [CanadiEM MVP Infographic Series - Early Goal Directed Therapy in the Treatment of Sepsis](https://canadiem.org/early-goal-directed-therapy-in-sepsis/) - In this issue of the MVP Infographic Series, we feature: "Early-Goal Directed Therapy in the Treatment of Severe Sepsis and Septic Shock” by Rivers et al. This study demonstrated the importance of early recognition of septic patients and the use of early-goal directed therapy (EGDT) to decrease associated morbidity and mortality. At the time this - [Blood & Clots Series: What is the optimal antithrombotic strategy for atrial fibrillation post-PCI?](https://canadiem.org/what-is-the-optimal-antithrombotic-strategy-for-atrial-fibrillation-post-pci/) - All the content from the Blood & Clots series can be found here. CanMEDS Roles addressed: Medical Expert Main Messages P2Y12 inhibition is important for the first 1-6 months after PCI insertion, and may have ongoing benefits up to 12 months or longer. Addition of anticoagulant to antiplatelet therapy increases the risk of bleeding, but - [CanadiEM MVP Infographic Series – Targeted Temperature Management at 33°C vs 36°C](https://canadiem.org/canadiem-mvp-infographic-series-targeted-temperature-management-at-33c-vs-36c/) - In this issue of the MVP Infographic Series, we feature: "A randomized trial of protocol-based care for early septic shock" published by the ProCESS Investigators.1 This paper from the MVP series focuses on targeted temperature management post cardiac arrest. It was published by Neilson et al in The New England Journal of Medicine in 20131. - [CAEP FEI | The Global Health Emergency Medicine Organization](https://canadiem.org/caep-fei-the-global-health-emergency-medicine-organization/) - Natasha is a third year Emergency Medicine resident who has a passion for travel and tropical diseases. She has heard of other recent graduates of her training program pursuing additional training in global health. She has always felt drawn to a career in global health but is overwhelmed by the options available online. She wishes - [CanadiEM is on Instagram!](https://canadiem.org/canadiem-is-on-instagram/) - Do you love CanadiEM's visual content? Do you want a quick way to see old and new infographics? Lucky for you, CanadiEM has joined Instagram. We will be posting all our visual content from infographics to Tiny Tips to Arts PRN posts! Over the next several weeks we will be posting all our past visual - [CRACKCast E198 – Brain Resuscitation](https://canadiem.org/crackcast-e198-brain-resuscitation/) - Care of the brain injured patient (traumatic, increased ICP, or post-arrest) is something we need to know about in the ED. Sit back, grab a cup of coffee, and get ready for some brain resus pearls. This month, we have Sey Shwetz (@SeyShwetz), rockstar EM chief resident and incoming PEM fellow, as our very special - [The Agitated Patient in the ED: Moderate & Severe Agitation](https://canadiem.org/the-agitated-patient-in-the-ed-part-2/) - In my first post of a trilogy on the agitated patient in the ED I outlined BARS sedation score for defining levels of agitation, discussed how to risk stratify a potentially agitated patient and offered some tips on how to deal with the mildly agitated patient. This post will discuss what to do with moderately and severely - [Infographic: Implementation of a Simulation Curriculum](https://canadiem.org/infographic-implementation-of-simulation-curriculum/) - In this issue we have summarized the paper, "The Implementation of a Multi-institutional Multidisciplinary Simulation-based Resuscitation Skills Training Curriculum", a collaboration between the University of Saskatchewan and Queen's University.1 Post-graduate medical education is moving towards a competency-based design causing certain EPAs to become difficult to assess. Simulation presents as a good method to teach and - [CRACKCast E196 - Monitoring the Emergency Patient](https://canadiem.org/crackcast-e196-monitoring-the-emergency-patient/) - This updated episode of CRACKCast covers Rosen's Chapter 005, Monitoring the Emergency Patient (9th Ed.). These topics are core knowledge that we use every day in the Emergency Department. Shownotes - PDF here [bg_faq_start] Rosen’s in Perspective Monitoring is something we do often, but think about rarely. This basically provides us real-time information about various - [Steps to Success in Enhanced Training in Emergency Medicine: The CCFP-EM Year](https://canadiem.org/steps-to-success-in-enhanced-training-in-emergency-medicine-ccfp-em-year/) - This post is the first of a series of opinion pieces dedicated to resident physicians and medical students applying, experiencing, and studying for the Canadian College of Family Medicine – Enhanced Training in Emergency Medicine (CCFP-EM) year. Be sure to also listen to the companion podcast: Are you a Family Medicine resident about to graduate - [Sponsored Post: Work as an Emergency Physician for the Nova Scotia Health Authority](https://canadiem.org/sponsored-post-work-as-an-emergency-physician-for-the-nova-scotia-health-authority/) - The Nova Scotia Health Authority is currently seeking Emergency Physicians to join the Cape Breton team! The industrial area of Cape Breton ranges from the very eastern tip of Cape Breton to the west side of Sydney Harbour, including Sydney, Glace Bay, North Sydney, and a number of smaller communities. Cape Breton has been rated - [Murphy Mondays: An Emergency Department Therapy Dog Program](https://canadiem.org/murphy-mondays-an-emergency-department-therapy-dog-program/) - Nearly every Monday for the past 3 years the Royal University Hospital Emergency Department (ED) has been graced by the presence of Murphy and his handler, Jane Smith. A St. John Ambulance (SJA) Therapy Dog Team and part of the Royal University Hospital (RUH) Volunteer Pet Visitation Team, Jane and Murphy were the first SJA - [CRACKCast E175 – Neurologic Disorders](https://canadiem.org/crackcast-e175-neurologic-disorders/) - This episode of CRACKCast covers Chapter 174 in Rosen's 9th Edition. Today, we will go over common topics in paediatric neurology and emergency medicine that will help you on your next shift! Knowledge of neurologic disorders is essential for any practitioner of emergency medicine, so strap in for a high-yield post. Shownotes: PDF Here [bg_faq_start] - [CJEM Infographic: Effect of infographic promotion on research dissemination and readership](https://canadiem.org/the-effect-of-an-infographic-promotion-on-research-dissemination-and-readership/) - This month CanadiEM is featuring one of our own studies that was recently published in the Canadian Journal of Emergency Medicine (CJEM). In this randomized controlled trial, we studied the effect of a social media promotional strategy involving infographic abstracts and the CanadiEM.org website on CJEM article readership and dissemination.1 CJEM articles published between July - [CPR Update Series Part 5 - Avoiding excessive ventilation](https://canadiem.org/cpr-update-series-part-5-avoiding-excessive-ventilation/) - Editor’s note: This post marks the final in a series of posts outlining the evidence surrounding various aspects of CPR by Dr. Stu Netherton. Previously this series covered Rate of Compression, Depth of Compression, Chest Wall Recoil, and Minimizing Interruptions. Part 5 – Avoiding excessive ventilation There are many recommendations, for a wide variety of situations, on - [FLOW Hacks 8 - In & out of the ED for the ‘Treat & Release’ patient.](https://canadiem.org/flow-hacks-8-in-out-of-the-ed-for-the-treat-release-patient/) - To continue our FLOW Hacks series, Victoria Woolner (NP, MN, MSc QIPS) writes about her team's project tackling the 'Treat and Release' patient. Setting This intervention was carried out at Toronto General and Toronto Western Hospital (UHN) in Toronto, Ontario. Between the two sites, there are approximately 117, 000 visits per year. Description of the innovation - [Blood and Clots Quizlet 2: Trauma in a Patient on Warfarin](https://canadiem.org/trauma-in-a-patient-on-warfarin/) - Hello Blood & Clots/CanadiEM community! Before we post our blog series on thrombosis and bleeding, we encourage you to test your initial knowledge by going through a few brief case scenarios. These cases were originally posted as part of our needs assessment in Fall 2016, and you can find the answers after each question below. - [Infographic: Adherence To Pediatric Arrest Guidelines](https://canadiem.org/adherence-to-pediatric-arrest-guidelines/) - In this issue, we collaborated with the INSPIRE (International Network for Simulation-based Pediatric Innovation, Research, & Education) team to create an infographic on the article "Adherence to Pediatric Cardiac Arrest Guidelines Across a Spectrum of Fifty Emergency Departments: A Prospective, In Situ, Simulation-Based Study" published by Auerbach et al.1 Previous research has demonstrated an increase - [CPR Update Series Part 4 – Minimizing interruptions in chest compressions](https://canadiem.org/cpr-update-series-part-4-minimizing-interruptions-in-chest-compressions/) - Editor’s note: This post marks the fourth in a series of posts outlining the evidence surrounding various aspects of CPR by Dr. Stu Netherton. Follow along as he covers Rate of Compression, Depth of Compression, Chest Wall Recoil, Minimizing Interruptions, and Avoiding Excessive Ventilation. Part 4 – Minimizing interruptions in chest compressions As providers we - [CAEP FEI | The Nursing Shift: Inter-Professional Education for Medical Students](https://canadiem.org/caep-fei-the-nursing-shift-inter-professional-education-for-medical-students/) - Amy is a fourth year emergency medicine resident, who has recently started supervising medical students while on shift. She meets Jim, a third year medical student, who will be working with her for the shift. Over the course of the shift, it becomes apparent that Jim is struggling with understanding a charge nurse's role in - [CPR Update Series - Part 3 Chest Wall Recoil](https://canadiem.org/cpr-update-series-part-3-chest-wall-recoil/) - Editor’s note: This post marks the third in a series of posts outlining the evidence surrounding various aspects of CPR by Dr. Stu Netherton. Follow along as he covers Rate of Compression, Depth of Compression, Chest Wall Recoil, Minimizing Interruptions, and Avoiding Excessive Ventilation. Part 3 – Chest Wall Recoil The third component of high - [CRACKCast E195 - Procedural Sedation and Analgesia](https://canadiem.org/crackcast-e195-procedural-sedation-and-analgesia/) - This updated episode of CRACKCast cover’s Rosen’s Chapter 004, Procedural Sedation and Analgesia (9th Ed.). These topics are core knowledge that we use every day in the Emergency Department. Shownotes - PDF Here [bg_faq_start] Key Concepts Safe, effective procedural sedation requires high-level skills and information and sound protocols, including patient monitoring. Patients should be discharged - [Evidence Bite: Medical Education and caring for transgender patients](https://canadiem.org/medical-education-and-caring-for-transgender-patients/) - Transgender (trans) people make up 0.6% of the population1, yet are among the most underserved in health care.2–5 Barriers to accessing care have been linked to unsafe surgical practices, self-prescribed hormone therapy, and even in the high rate of suicidality among trans Ontarians.6–10 Just over half of trans people report having negative Emergency Department (ED) experiences specifically - [New Oncologic Therapies Mean New Oncologic Emergencies: An Approach to Immunotherapy-Related Adverse Events](https://canadiem.org/an-approach-to-immunotherapy-related-adverse-events/) - A 63-year-old man, Andrew, presents to the emergency department with a several-day history of worsening diarrhea. He has abdominal pain rated 6/10, has been having over 8 loose stools per day for 4 days, and tells you he has seen some blood and mucus in his stools. He denies any nausea, vomiting, fevers or chills, - [Sirens to Scrubs: Acute Coronary Syndromes, Part Two – To the Lab!](https://canadiem.org/acute-coronary-syndromes-part-two-to-the-lab/) - Disclaimer: The procedures and therapies discussed in this post are extrapolated from a number of ambulance services globally. This does not replace the direction of readers’ ambulance service clinical guidelines or protocols and should not be used in place of local guidelines or protocols. If you believe something in this post would benefit your ambulance - [CPR Update Series Part 2 – Depth of Compression](https://canadiem.org/depth-of-compression/) - Editor’s note: This post marks the second in a series of posts outlining the evidence surrounding various aspects of CPR by Dr. Stu Netherton. Follow along as he covers Rate of Compression, Depth of Compression, Chest Wall Recoil, Minimizing Interruptions, and Avoiding Excessive Ventilation. To guide the depth of our compressions during CPR, the 2015 - [FLOW Hacks 7 - Doc in the Box: Improving Physician Initial Assessment Time in the Emergency Department](https://canadiem.org/flow-hacks-7-doc-in-the-box-improving-physician-initial-assessment-time-in-the-emergency-department/) - To continue our FLOW Hacks series, Dr. Joanna Bostwick writes about her team's innovation aimed at improving physician initial assessment time in the ED. Setting This intervention was carried out at Hôpital Montfort, Ottawa, Ontario, an academic francophone community hospital with 56, 000 ED visits per year. Description of the innovation Our ED has applied an - [CRACKCast E194 – Pain Management](https://canadiem.org/crackcast-e194-pain-management/) - This episode of CRACKCast covers Chapter 3 in Rosen’s Emergency Medicine (9th Ed.) – Pain Management. This is an essential skill to master and applies to any field of medicine. This podcast will give you a solid approach to the basics pain management to use on your next shift! Shownotes - PDF HERE [bg_faq_start] Rosen’s in - [CPR Update Part 1 – Rate of Compression](https://canadiem.org/cpr-rate-of-compression/) - Editor's note: This post marks the first in a series of posts outlining the evidence surrounding various aspects of CPR by Dr. Stu Netherton Follow along over the next 5 weeks as he covers Rate of Compression, Depth of Compression, Chest Wall Recoil, Minimizing Interruptions, and Avoiding Excessive Ventilation. As early as 1892 Dr. Friedrich - [FLOW Hacks 6 - Improving Usage of Probenecid for Skin and Soft Tissue Infections](https://canadiem.org/probenecid-for-skin-and-soft-tissue-infections/) - To continue our FLOW Hacks series, Dr. Shawn Dowling writes about his team's innovation aimed at reducing the number of Emergency Department (ED) revisits for repeated IV antibiotic administration. Setting This intervention was carried out in all of the EDs in Calgary, Alberta. Across all four sites, there is an average of 320, 000 patient - [CJEM Visual Abstract: Use of Ottawa Ankle Rules by non-physician providers in a paediatric emergency department](https://canadiem.org/use-of-ottawa-ankle-rules-by-non-physician-providers-in-a-paediatric-emergency-department/) - In this issue, we collaborated with the CJEM team to create a visual abstract on the article: “Accuracy of the Ottawa Ankle Rules applied by non-physician providers in a pediatric emergency department.”1 The use of the Ottawa Ankle Rules by physicians has reduced radiography, time spent in the ED, healthcare expenditures, while not missing clinically - [CAEP FEI | Human Trafficking Awareness: A Learning Module](https://canadiem.org/caep-fei-human-trafficking-awareness-a-learning-module/) - Jeremy is a second year resident who is about to see a 25 year old female presenting with abdominal pain. During the history he notices the patient is remarkably quiet and that the patient's male friend is answering all the questions for her. When Jeremy asks the male friend to leave the room for a - [Spot the Diagnosis! The Case of the Dropsical Child](https://canadiem.org/the-case-of-the-dropsical-child/) - In this Spot the Diagnosis! post, we have the case of an ill looking child, brought in for healing by a worried mother. Through the symbolic ox, the haloed saint is identified as St Luke, a physician in the New Testament. (Note the book at his lap entitled "Hippocrates".) (Can you also see St. Luke's - [Blood & Clots Series: ThromboPhonia E01, Mechanical Valves and Intracranial Hemorrhage](https://canadiem.org/blood-clots-series-thrombophonia-e01-mechanical-valves-and-intracranial-hemorrhage/) - Blood & Clots Podcast, Thrombophonia: Episode 1 A 65-year-old man presents to the Emergency Department after suffering from an intracerebral hemorrhage (ICH). He has a past medical history of hypertension, dyslipidemia, a mechanical aortic valve replacement, diabetes, and sleep apnea. His medications include ramipril, atorvastatin, aspirin, metformin, and warfarin. How should this patient be managed? What - [The CPR Coach – A Paradigm Shift in Resuscitation Teams for Cardiac Arrest Management](https://canadiem.org/the-cpr-coach-a-paradigm-shift-in-resuscitation-teams-for-cardiac-arrest-management/) - Survival outcomes from cardiac arrest remain poor despite recent advancements in resuscitation science and education. The delivery of high quality cardiopulmonary resuscitation (CPR) during cardiac arrest is a key component of clinical care. The delivery of high quality CPR is associated with improved survival outcomes. Unfortunately, many studies have demonstrated that providers consistent struggle to - [Fighting Fire With Words: Journaling and Physician Wellness](https://canadiem.org/fighting-fire-with-words-journaling-and-physician-wellness/) - Burnout and physician wellness are two sides of the same coin. With the use of journaling, one can flip the coin with the odds in their favour. Burnout, a prevalent term in emergency medicine, is defined as a mix of emotional exhaustion, lack of control, and depersonalization.1 Importantly, studies demonstrate that 65% of emergency physicians may - [Introduction to Blood & Clots Series](https://canadiem.org/introduction-blood-clots-series/) - Welcome to the Blood & Clots series! This new set of blog posts will focus on some of the most difficult dilemmas we face in medicine today: how to manage patients who are bleeding, clotting, or both. You’ve seen these situations before - you’ve probably described them as something to the effect of: A pickle - [Tiny Tip: START Triage Protocol RPM – 30 – 2 – Can Do](https://canadiem.org/start-triage-protocol-rpm-30-2-can-do/) - If you’re like me, you appreciate the value of triage systems in emergency medicine and prehospital care but find it hard to remember the components of each. The START Triage (Simple Triage And Rapid Treatment) protocol was designed to quickly assess victims of mass casualty, categorising them into four colour-coded groups that communicate the urgency - [CRACKCast E193 - Mechanical Ventilation and Noninvasive Ventilatory Support](https://canadiem.org/crackcast-e193-mechanical-ventilation-and-noninvasive-ventilatory-support/) - This episode of CRACKCast covers Chapter 2 in Rosen’s Emergency Medicine (9th Ed.) – Mechanical Ventilation and Noninvasive Ventilatory Support. This is an essential skill to master for the care of critically ill patients. This podcast will give you a solid approach to the basics of mechanical ventilation and and non-invasive ventilation to use on your - [Flashcards](https://canadiem.org/boring-cards/) - This page is the home of CanadiEM Flashcards including both the CRACKCast and "Boring Cards" series. The CRACKCast set parallels the CRACKCast podcast, adding flashcards shortly after each new episode is released so that you can review the key concepts and memorize the relevant information that they presented. The "Boring Cards" series builds on the - [I heard a snap! Clay Shoveler’s Fracture](https://canadiem.org/clay-shovelers-fracture/) - Reginald, a 73-year-old man, presents to your Emergency Department with neck pain. He tells you that last night he was straining to lift a heavy box. He heard and felt a snap in his neck. This morning, he awoke with neck pain, dizziness, and mild confusion. You examine Reginald and find that he has pain - [CJEM Visual Abstract: Removing patient clothing in trauma](https://canadiem.org/removing-patient-clothing-in-trauma/) - This month we have created a visual abstract featuring our featured CJEM article is: “Cut and rip and cut alone techniques versus usual practice in the removal of trauma patient clothing”1 In trauma patients, rapid and adequate exposure is necessary for delivering timely and appropriate care.2 This can be achieved in multiple ways but there - [CRACKCast E192 - Airway](https://canadiem.org/crackcast-e192-airway-9th-edition/) - This Episode of CRACKCast covers Rosen's Chapter 1 - Airway. We are updating the first several episodes with 9th edition content. Enjoy! There's a reason that the first chapter of Rosen's is devoted to airway. These are some of the most critical skills we need to know as emergency clinicians. This episode provides an overview - [QI Series Part 3 | Differentiating Quality Improvement and Clinical Epidemiology](https://canadiem.org/qi-clinical-epidemiology/) - How do Quality Improvement methods differ from classical clinical research? This article is the last in a three-part series on Quality Improvement (QI) in health care. The first article, “What is Quality Improvement?”, defined this field of study and provided a brief history of its origins. The second article defined “quality” and briefly described tools - [Exam Series: Guide to the Back Exam](https://canadiem.org/exam-series-guide-to-the-back-exam/) - A 67-year-old male presents to your emergency room with back pain. He has a history of intermittent back pain that typically responds to NSAIDs, however this particular episode has been much more severe. He now feels sharp pain that radiates into this left foot with certain movements, which causes weakness when walking. His past medical - [CAEP FEI | The CanadiEM Digital Scholars Program](https://canadiem.org/caep-fei-the-canadiem-digital-scholars-program/) - Amy is a third year emergency medicine resident who loves listening to podcasts when she runs. She realizes that she loves using a variety of digital media to enhance her learning. Amy wonders if there is a fellowship opportunity where she can become a leader in digital scholarship. One of her supervisors asks her if - [A letter to my younger self](https://canadiem.org/a-letter-to-my-younger-self/) - I recently took an extended vacation at the end of residency, and had some time to reflect upon nearly an decade of medical training. I write this as an letter to my younger, naive self, in hopes that trainees may learn from my experiences. Dear PGY-1 Shahbaz, I have some big news for you: things are - [CRACKCast E177 - Acute Complications of Pregnancy](https://canadiem.org/crackcast-e177-acute-complications-of-pregnancy/) - This episode of CRACKCast covers Rosen’s Chapter 177, Acute Complications of Pregnancy. This chapter covers many acute issues that arise during the unique physiologic state that is pregnancy, from first trimester bleeding to diagnostic challenges and management of other conditions during pregnancy. Also check out EM Cases Rapid Reviews Videos on Ectopic Pregnancy Shownotes - - [CRACKCast E190 - Disaster Preparedness](https://canadiem.org/crackcast-e191-disaster-preparedness/) - This episode of CRACKCast covers Chapter 192 in Rosen's Emergency Medicine (9th Ed.) – Disaster Preparedness. Here we provide an overview of the systems and approach required to be ready for when the big one hits! Shownotes - PDF Here [bg_faq_start] Key Concepts: Comprehensive emergency management consists of four phases: mitigation, preparedness, response, and recovery. - [CRACKCast E191 – Weapons of Mass Destruction](https://canadiem.org/crackcast-e191-weapons-of-mass-destruction/) - This episode of CRACKCast covers Chapter 193 in Rosen's Emergency Medicine (9th Ed.) – Weapons of Mass Destruction. Although attacks involving WMD's are relatively uncommon, being thoroughly prepared for these events will prove invaluable for the community affected. Sit tight and listen in to make sure you are ready if the unthinkable should happen. Shownotes - [The Use of the Modified Valsalva Maneuver for Stable SVT](https://canadiem.org/modified-valsalva-maneuver-stable-svt/) - Please note that, while “supraventricular tachycardia (SVT)” is a term that can be used more broadly to refer to any tachyarrhythmia originating above the ventricles, I use its more conventional meaning here to describe AVnRT and AVRT. LITFL has a good summary of narrow-complex tachycardias. SVT is a narrow complex tachycardia commonly seen in the - [Highlights from the 2018 AHA Scientific Statement on Resuscitation Education](https://canadiem.org/aha-scientific-statement-on-resuscitation-education/) - Survival outcomes from cardiac arrest are poor. To date, much effort has been placed in gaining greater understanding related to medical science of cardiac arrest - the first element of the Formula for Survival.1 The American Heart Association’s Scientific Statement on Resuscitation Education Science2 was published on June 21, 2018. It draws attention to the other two - [CRACKCast E189 – Air Medical Transport](https://canadiem.org/crackcast-e189-air-medical-transport/) - This episode of CRACKCast covers Chapter 191 in Rosen's Emergency Medicine (9th Ed.) – Air Medical Transport. Including a review of clinically relevant physics! Fun stuff! Shownotes - PDF here [bg_faq_start] Key concepts Boyle’s law and Dalton’s law have the greatest impact and explain the development of hypoxia and most common altitude-related symptoms. Other stresses - [CRACKCast E188 – Emergency Medical Service: Overview and Ground Transport](https://canadiem.org/crackcast-e188-emergency-medical-service-overview-and-ground-transport/) - This episode of CRACKCast covers Chapter 190 of Rosen's Emergency Medicine(9th Ed.). After listening to this podcast, you will have a more comprehensive understanding of the intricacies of pre-hospital care and be better able to address issues in your community's out-of-hospital healthcare network. Shownotes - PDF HERE [bg_faq_start] Rosen’s In Perspective: If you like history, - [CRACKCast E187 – The Combative and Difficult Patient](https://canadiem.org/crackcast-e187-the-combative-and-difficult-patient/) - This episode of CRACKCast covers Chapter 189 in Rosen's Emergency Medicine (9th Ed.) – The Combative and Difficult Patient. Next time a severely agitated patient rolls into the department, you won't even break a sweat! Shownotes – PDF HERE [bg_faq_start] Rosen’s in Perspective Difficult encounters not only harm us, but also harm patients. Key priorities - [Spot the Diagnosis! The Case of the Bloody Man](https://canadiem.org/spot-the-diagnosis-the-case-of-the-bloody-man/) - As part of the Arts PRN series, we will intermittently be featuring pieces of historic art that hint at an underlying medical condition. They say a picture is worth 1000 words… can you Spot the Diagnosis after examining only a painting? Read on to learn not only about the art, but about these fascinating medical conditions. Who - [CRACKCast E186 - Substance Abuse](https://canadiem.org/crackcast-e186-substance-abuse/) - This episode of CRACKCast covers Rosen’s Chapter 140 (9th Edition), Substance Abuse. This chapter gives a brief overview regarding the burden of substance abuse from adolescent to elderly patients. An important consideration in the emergency department is self-awareness and advocacy for these patients that often are challenging to interact with and can provoke countertransference. Shownotes - [CRACKCast Episode 185 - Alcohol Related Disease](https://canadiem.org/crackcast-episode-185-alcohol-related-disease/) - This episode of CRACKCast covers Rosen’s Chapter 142 (9th Edition), Alcohol Related Disease. This chapter covers the spectrum of alcohol use, including effects of mild, moderate, and severe use disorders, including prevention, screening, diagnosis and management. We also examine the wide variety of complications associated with acute and chronic alcohol use. Shownotes - PDF Here - [Exam Series: Guide to the Knee Exam](https://canadiem.org/exam-series-guide-to-the-knee-exam/) - A 22 year old female comes to emergency department unable to walk. She was in the middle of a rugby game when she caught the ball while pivoting quickly, and was tackled shortly thereafter. She immediately heard a “pop” and says that the swelling in her right leg has increased substantially over the last hour. - [CRACKCast E184 - The Solid Organ Transplant Patient](https://canadiem.org/crackcast-e184-the-solid-organ-transplant-donor/) - This episode of CRACKCast covers Rosen's chapter 188, The Solid Organ Transplant patient. Although short in duration, this chapter has straightforward and useful information for emergency physicians in regards to complications possible with transplant recepients. Shownotes - PDF here [bg_faq_start] Key concepts The possibility of organ rejection, infection, or drug toxicity should be considered in - [CAEP FEI | Trauma Resuscitation Using In Situ Simulation Team Training (TRUST) Study](https://canadiem.org/caep-fei-trauma-resuscitation-using-in-situ-simulation-team-training-trust-study/) - Rob is a fourth year resident who is just walking out of the resuscitation bay after working with the team on a 45 year old man hit by a car. His attending staff asks him to think about areas where the resuscitation could have been improved. As Rob reflects on the experience, he wishes that - [CRACKCast E182 - Drug Therapy in the Geriatric Patient](https://canadiem.org/crackcast-e182-drug-therapy-in-the-geriatric-patient/) - This episode of CRACKCast covers Rosen's chapter 185, Drug Therapy in the Geriatric Patient. Although short, this post contains vital information that will help you optimize the care of yours elderly patients in the ED. Take some time to commit this information to memory, as it will no doubt help you on your next shift. - [CJEM Visual Abstract: Implementing an atrial fibrillation pathway](https://canadiem.org/implementing-an-atrial-fibrillation-pathway/) - In this issue, we collaborated with the CJEM team to create a visual abstract on the article: “Implementation of an emergency department atrial fibrillation and flutter pathway improves rates of appropriate anticoagulation, reduces length of stay and thirty-day revisit rates for congestive heart failure.”1 Atrial fibrillation and flutter are arrhythmias that come with significant morbidity - [CRACKCast Episode 183 - The Immunocompromised Patient](https://canadiem.org/crackcast-episode-182-the-immunocompromised-patient/) - This episode of CRACKCast covers Rosen’s Chapter 187, The Immunocompromised Patient. This chapter covers the unique population of immunocompromised patients, including management of febrile neutropenia, as well as common infections seen in these patients and how to treat them. Shownotes - PDF Here [bg_faq_start] Key Points Immunocompromised persons who present with acute infections, especially those - [The CanadiEM Junior Editor Program: Now Accepting Applications.. again!](https://canadiem.org/canadiem-junior-editor-program/) - We are currently celebrating emergency medicine at CAEP in Calgary and have been very excited about the number of people speaking to us about contributing to the website. To capitalize on this interest we are opening our annual recruitment to expand our team of Junior Editors! If you are a resident or medical student who - [CRACKCast E181 - Approach to the Geriatric Patient](https://canadiem.org/crackcast-e181-approach-to-the-geriatric-patient/) - This episode of CRACKCast covers Rosen's chapter 183, approach to the geriatric patient. Our geriatric patients can often mask serious diagnoses with vague presentations and multiple co-morbidities. Shownotes–PDF HERE [bg_faq_start] Rosen’s In Perspective Taking care of the elderly is hard! Given the Silver-Tsunami that is currently crashing down on us, we better get comfortable with - [When and how to treat hyponatremia in the ED](https://canadiem.org/hyponatremia-in-the-ed/) - Electrolyte imbalances like hyponatremia can be the cause of a variety of vague complaints. At the same time, patients may present with electrolyte abnormalities that are asymptomatic and are incidental findings on bloodwork. Here's an approach to deciding when and how to treat hyponatremia in the emergency department. We also thank Drs. Joel Topf (@kidney_boy) - [CRACKCast E180 - Labor & Delivery](https://canadiem.org/crackcast-e180-labor-delivery/) - This episode of CRACKCast covers Rosen’s Chapter 181, Labor and Delivery. This chapter covers the high risk realm of ED deliveries, including potential complications such as PROM, malpresentation and umbilical cord emergencies. Shownotes - PDF Here [bg_faq_start] Key Points All ED deliveries should be considered high risk. Antepartum hemorrhage, PROM, eclampsia, premature labor, precipitous - [What to do if your Patient is Poisoned by a Nerve Agent](https://canadiem.org/what-to-do-if-your-patient-is-poisoned-by-a-nerve-agent/) - While working in your emergency department, you receive news a number of patients have been found at a bus station unconscious. It is suspected that some sort of attack may have occurred. The first patient is brought to your ER, with obviously soiled clothing, vomiting and aggravated. As you make your way towards the bedside, - [CRACKCast E179 - Drug Therapy in Pregnancy](https://canadiem.org/crackcast-e179-drug-therapy-in-pregnancy/) - This episode of CRACKCast covers Rosen’s Chapter 179, Drug Therapy in Pregnancy. There is a lot of fear and anxiety often present within pharmacologic therapy in pregnancy, but having informed, shared decision making with patients can lead to safer outcomes and adherence when treating. Check out FOAMCast here Shownotes - PDF Here [bg_faq_start] Key Concepts - [CRACKCast E178 - Co-Morbird Medical Emergencies During Pregnancy](https://canadiem.org/crackcast-e178-co-morbird-medical-emergencies-during-pregnancy/) - This episode of CRACKCast covers Rosen’s Chapter 178, Co-Morbid Medical Emergencies during Pregnancy. This chapter covers many complicated issues that arise during the care of pregnant patients already suffering from concomitant medical illness, and how to manage these conditions balancing risks to both mother and fetus. Shownotes - PDF Here [bg_faq_start] Key Concepts The physiologic - [CRACKCast E176 – Pediatric Musculoskeletal Disorders](https://canadiem.org/crackcast-e176-pediatric-musculoskeletal-disorders/) - Children can injure themselves just like adults, but their growing anatomy can be quite different. Today, let's explore Rosen's chapter 175 on paediatric musculoskeletal disorders. Shownotes - PDF here Text in italics is from Rosen’s 9th edition, chapter 175 [bg_faq_start] Key concepts [podcasted items in bold] The growth plate is the weakest part of the - [CAEP FEI | The Nightmares Course at Queen's University](https://canadiem.org/caep-fei-the-nightmares-course-at-queens-university/) - Lilly is a first year resident who is called by the floor nurse about an elderly gentleman who is "feeling unwell". She walks into the room and notices he is wheezing and appears short of breath. Lilly starts feeling extremely anxious and is unsure of what she should do before rushing to find her staff. - [CRACKCast E174 – Genitourinary and Renal Tract Disorders](https://canadiem.org/crackcast-e174-genitourinary-and-renal-tract-disorders/) - This episode of CRACKCast covers Rosen's Chapter 173, Genitourinary and Renal Tract Disorders. Torsion, phimosis, UTIs, stones, and priapism are some of the high-yield topics covered here. Shownotes: PDF Here Core Questions [bg_faq_start] [1] List a DDx for priapism and describe treatment. Priapism is the engorgement of the dorsal corpora cavernosa, resulting in dorsal penile - [CRACKCast E173 - Infectious Diarrheal Disease and Dehydration](https://canadiem.org/crackcast-e173-infectious-diarrheal-disease-and-dehydration/) - This episode of CRACKCast covers Rosen's Chapter 173 (9th Ed.). Infectious diarrhea is a very common issue to deal with in the ER and resulting dehydration is especially important to recognize and treat appropriately. This episode will run you through the basics. Shownotes - PDF here [bg_faq_start] Key concepts: Identification of Pathogen Stool studies - [Blood and Clots Quizlet 3: Procedures on Warfarin](https://canadiem.org/procedures-on-warfarin/) - Hello Blood & Clots/CanadiEM community! Before we post our blog series on thrombosis and bleeding, we encourage you to test your initial knowledge by going through a few brief case scenarios. These cases were originally posted as part of our needs assessment in Fall 2016, and you can find the answers after each question below. - [Blood and Clots Quizlet 4: Antithrombotic Therapy for Atrial Fibrillation](https://canadiem.org/antithrombotic-therapy-for-atrial-fibrillation/) - Hello Blood & Clots/CanadiEM community! Before we post our blog series on thrombosis and bleeding, we encourage you to test your initial knowledge by going through a few brief case scenarios. These cases were originally posted as part of our needs assessment in Fall 2016, and you can find the answers after each question below. - [Blood and Clots Series Quizlet 5: Should I Screen my Patient for Occult Cancer After Unprovoked VTE?](https://canadiem.org/occult-cancer-after-unprovoked-vte/) - Hello Blood & Clots/CanadiEM community! Before we post our blog series on thrombosis and bleeding, we encourage you to test your initial knowledge by going through a few brief case scenarios. These cases were originally posted as part of our needs assessment in Fall 2016, and you can find the answers after each question below. - [Blood and Clots Quizlet 1: Oral Contraceptives and Pulmonary Embolism](https://canadiem.org/oral-contraceptives-and-pulmonary-embolism/) - Hello Blood & Clots/CanadiEM community! Before we post our blog series on thrombosis and bleeding, we encourage you to test your initial knowledge by going through a few brief case scenarios. These cases were originally posted as part of our needs assessment in Fall 2016, and you can find the answers after each question below. - [CRACKCast E172 - Pediatric Gastrointestinal Disorders](https://canadiem.org/crackcast-e172-pediatric-gastrointestinal-disorders/) - This episode of CRACKCast covers Rosen’s Chapter 172, Pediatric Gastrointestinal Disorders. This is a broad set of presentations with clinical topics covering pathology in infancy, childhood, and adolescence. While the lists of congenital abnormalities are comprehensive, recognition of the sick infant is the most important component to not missing the life-threatening diagnoses. Shownotes - PDF - [Case Report: Pregnancy and Trauma in the Game of Thrones](https://canadiem.org/pregnancy-and-trauma-in-the-game-of-thrones/) - This is the 3rd Episode of the Game of Thrones Case Series. Be sure to also review Hypothermia and Traumatic Arrest in the Game of Thrones and Toxin-Induced Cardiac Arrest in Game of Thrones. Patient Presentation and History During the wedding of Edmure and Roslin, a young pregnant woman of unknown gestational age was found unresponsive with - [CRACKCast E171 - Pediatric Cardiac Disorders](https://canadiem.org/crackcast-e171-pediatric-cardiac-disorders/) - This episode of CRACKCast covers Rosen’s Chapter 171, Pediatric Cardiac Disorders. This chapter covers specific diseases of the pediatric heart and blood vessels, including congenital heart disease, Kawasaki Disease, murmurs, Acute Rheumatic Fever, and dysrhythmias. Shownotes - PDF Here [bg_faq_start] KEY CONCEPTS The possibility of a congenital heart defect should be considered in an infant - [Dr. Google isn't the colleague you'd like it to be](https://canadiem.org/dr-google-isnt-the-colleague-youd-like-it-to-be/) - "Well, I looked up my symptoms on Google, and it said I was having a heart attack", we've all had this patient interaction before. We live in an era where information is so freely and easily accessible. The danger comes in determining the intrinsic accuracy of data. An recent study has suggested that researching symptoms online - [CRACKCast E170 - Paediatric Respiratory Emergencies: Disease of the Lungs](https://canadiem.org/crackcast-e170-pediatric-respiratory-emergencies-diseases-of-the-lungs/) - This episode of CRACKCast covers Rosen’s Chapter 170, Pediatric Respiratory Emergencies: Diseases of the Lungs. This chapter covers specific diseases of the pediatric lung, including pneumonia, pertussis and cystic fibrosis. Shownotes - PDF Here [bg_faq_start] Key Points Determining the causative agent of pneumonia by clinical presentation and radiographic findings is not reliable; empirical treatment is - [Shocked? Hands On Defibrillation](https://canadiem.org/hands-on-defibrillation/) - High quality chest compressions and defibrillation are two of the most meaningful interventions in a cardiac arrest1. If you have taken Advanced Cardiac Life Support (ACLS), you’ve heard the mantra “I’m clear, you’re clear, everybody’s clear.”1 During delivery of a shock, valuable seconds of chest compressions are lost. This pause in chest compression translates to a decrease - [Intracranial Bleeding in Seniors Who Fall](https://canadiem.org/intracranial-bleeding-in-seniors-who-fall/) - Intracranial bleeding in seniors who fall – a growing problem with no research evidence. The Falls Consortium researchers would like to capture the variation in approach to emergency department senior patients who present after a fall. Please take 5 minutes to complete our survey. Clinical Case: This morning, I reviewed Mr. Barker in the emergency - [CRACKCast E168 – Pediatric Respiratory Emergencies: Upper Airway Obstruction and Infections](https://canadiem.org/crackcast-e168-pediatric-respiratory-emergencies-upper-airway-obstruction-and-infections/) - This episode of CRACKCast Covers Rosen's Chapter 167, Pediatric Upper Airway Emergencies. Stridor is a very common presentation and this episode will help out with diagnosis and management. Shownotes – PDF HERE [bg_faq_start] Rosen's In Perspective: Big categories for upper airway obstruction: Infectious, congenital, foreign body (IN THE AIRWAY OR ESOPHAGUS!) Congenital causes: Think of - [CRACKCast E169 - Paediatric Respiratory Emergencies: Lower Airway Obstruction](https://canadiem.org/crackcast-169-pediatric-respiratory-emergencies-lower-airway-obstruction/) - This episode of CRACKCast covers Rosen's Chapter 168 (9th Ed.). Respiratory presentations are very common in kids, and you will be a pro at managing lower respiratory obstruction after listening to this episode. Shownotes - PDF here [bg_faq_start] Rosen’s In Perspective Asthma is on the rise (doubling in prevalence in the last 3 decades) “Because - [A lesson on blood and bullets for Rick Santorum](https://canadiem.org/a-lesson-on-blood-and-bullets-for-rick-santorum/) - Rick Santorum is clearly in need of a biology lesson following his puzzling assertion that the youth who filled Washington’s streets in protest of America’s infamously lax gun laws would have better spent their time learning cardiopulmonary resuscitation (CPR), in case a shooting were to occur in their high school. "How about kids instead of - [Medical History in Art: A brief history of one of the most symbolic tools in medicine](https://canadiem.org/medical-history-in-art-one-of-the-most-symbolic-tools-in-medicine/) - Yesterday (March 30th, 2018) was National Doctor's Day in the United States, and we thought it would be fitting to do a feature on arguably one of the most symbolic tools in medicine. What is the tool portrayed above? The painting above features Rene Theophile Hyacinthe Laennec using an early version of his invention - - [CRACKCast E167 – Pediatric Fever](https://canadiem.org/crackcast-e167-pediatric-fever/) - This episode of CRACKCast covers Rosen's Chapter 166 (9th Ed.), pediatric fever. You will have an excellent approach to this common presentation after listening to this episode. Shownotes: PDF Here [bg_faq_start] Rosen's In Perspective When it comes to dealing with pediatric fever, we usually break down kids into four age ranges: 0-28 days 1-3 months - [CRACKCast E166 – General approach to the paediatric patient](https://canadiem.org/crackcast-e166-general-approach-to-the-paediatric-patient/) - We're beginning the paediatric series. Here's a general approach to use as we focus on specific pathologies in the upcoming weeks! Shownotes - PDF here [bg_faq_start] Rosen’s In Perspective There are a few physiologic/anatomic considerations unique to kids that we should keep in mind: Temperature regulation: KEEP THEM COVERED AND WARM! Rapid heat loss (larger - [CAEP FEI | Advanced Performance in Medicine™: 12 Conversations](https://canadiem.org/caep-fei-advanced-performance-in-medicine-12-conversations/) - Zara is a third year resident who walks out of the trauma bay after running an unsuccessful pediatric resuscitation. As she reflects on the experience, she feels as though she struggled with effectively communicating during the post-resuscitation de-brief. Zara realizes that she struggles with balancing processing her own emotions while communicating with the team. She wishes - [CRACKCast E165 - Sedative Hypnotics](https://canadiem.org/crackcast-e165-sedative-hypnotics/) - This episode of CRACKCast covers Rosen’s 9th Edition Chapter 159, Sedative Hypnotics. While much of the care for overdose is supportive, certain withdrawal patterns can be life-threatening. Knowing how to manage the agitated and sedated patient concurrently are necessary for these presentations. Shownotes - PDF Here [bg_faq_start] Key Concepts Barbiturate intoxication is rare, and most - [CRACKCast E164 – Plants, Mushrooms, and Herbal Medications](https://canadiem.org/crackcast-e162-plants-mushrooms-and-herbal-medications/) - This episode of CRACKCast covers Rosen’s 9th Edition Chapter 158, Plants, Mushrooms, and Herbal Medications. Most of these ingestions occur in children, and much more commonly in the developing world. However, many of these species and herbals are available in North America, especially with out global trade industry, so we must be vigilant and aware - [CRACKCast E161 – Antipsychotics](https://canadiem.org/crackcast-e161-antipsychotics/) - This episode of CRACKCast covers Rosen’s 9th Edition Chapter 155, Antipsychotics. Continuing along the spectrum of toxicologic exposures, these agents account for a large number of presentations to emergency departments every year. Being equipped with the knowledge of how to deal with the side effects of these medications and their associated toxidromes is imperative and - [CRACKCast E160 – Lithium](https://canadiem.org/crackcast-e160-lithium/) - This episode of CRACKCast covers Rosen's Chapter 154, Lithium. You will have a solid approach to lithium overdose after listening to this episode! Shownotes – PDF HERE [bg_faq_start] Rosen’s In Perspective: Lithium was approved for the treatment of bipolar disorder in 1970, and it remains one of the most effective agents for both depressive and - [Wellness Criteria for P.E. (Practice Enjoyment)](https://canadiem.org/wellness-criteria-for-p-e-practice-enjoyment/) - Editors Note: As part of emergency medicine's annual wellness week (#iEMWell18), Dr. Gerhard Dashi riffed off of the well known Well's Criteria for Pulmonary Embolism to create the Wellness Criteria for Practice Enjoyment! Score yourself using our infographic to determine how likely it is that you are enjoying your practice! When to use the Wellness - [CRACKCast E163 – Pesticides](https://canadiem.org/crackcast-e163-pesticides/) - This episode of CRACKCast covers Rosen’s 9th Edition Chapter 163, Pesticides. These agents have unique presentations and management principles that this episode will go over. They are very important not to miss! Shownotes - PDF here [bg_faq_start] Key concepts: Organophosphates and carbamates cause symptoms by accumulation of acetylcholine. Treat cholinergic symptoms with atropine. Reverse the - [EM Wellness Week: Reflections of a wellness skeptic](https://canadiem.org/em-wellness-week-reflections-of-a-wellness-skeptic/) - This post describes how an EM resident’s perception of wellness takes a turn after he recognizes the symptoms of burnout in himself. It was submitted as part of EM Wellness Week. ​Honestly, I’m not really into this “wellness” stuff. I don’t get it. I like what I do - yes, it’s hard, but it’s worth it. All I hear - [Tiny Tips: ICH for ICH - Brain Herniation](https://canadiem.org/tiny-tips-ich-for-ich-brain-herniation/) - Brain herniation is a catastrophic sequela of increased intracranial pressure (ICP) or local mass effect from intracranial lesions. Different types of brain herniation can occur depending on the location of mass effect and how rapidly this mass effect develops.1 Any mass lesion, including hemorrhage, tumor, vasogenic or cytotoxic edema, trauma or infection can cause herniation. - [Narrative Medicine and Resilience in Emergency Medicine](https://canadiem.org/narrative-medicine-and-resilience-in-emergency-medicine/) - How do we treat suffering? It’s simple enough to trawl the depths of wisdom collected in Rosen’s. Journal clubs, podcasts, and blogs keep us abreast of the latest updates to evidence-based practice. There is no substitute for the experience gained on clinical shifts. Reading around cases we see in the Emergency Department helps. We may - [Tiny Tips: “KULT IMPACT” as a mnemonic for Anion Gap Metabolic Acidosis](https://canadiem.org/tiny-tips-kult-impact-as-a-mnemonic-for-anion-gap-metabolic-acidosis/) - Every medical student learns the differential diagnosis for an anion gap metabolic acidosis. The list is particularly crucial for emergency physicians, who often see this finding in sick, undifferentiated patients. Many people use the mnemonics “MUDPILES CAT” or “GOLDMARK” to help remember this list. An alternative mnemonic, “KULT IMPACT”, provides a practical and organized way - [CRACKCast E157 - Iron and Heavy Metals](https://canadiem.org/crackcast-e157-iron-heavy-metals/) - This episode of CRACKCast covers Rosen’s 9th Ed Chapter 151, Iron and Heavy Metals. While often not recognized in the acute care setting, chronic toxicity from heavy metals is common and has high morbidity, especially in pediatric populations and requires careful attention to risk factors and symptomatology. Shownotes - PDF Here [bg_faq_start] KEY CONCEPTS Asymptomatic - [Hidden Stories: The Fortune Teller](https://canadiem.org/hidden-stories-3/) - “Hidden stories” is a series that is part of Arts PRN that focuses on challenging and building observational skills. How many details can you notice? Can you weave together a story from this one still image? Don’t forget to check out more series featured on Arts PRN here. Test your visual intelligence by trying to decipher the - [CRACKCast E162 - Opioids](https://canadiem.org/crackcast-e162-opioids/) - This episode of CRACKCast covers Rosen’s Chapter 162, Opioids. This chapter covers a topic that has become a widespread epidemic in recent years, including an approach to the opioid toxidrome, presenting complications, management of long-acting agents, withdrawal symptoms and treatment. Shownotes - PDF Here [bg_faq_start] Key Points The opioid toxidrome includes three prominent findings - - [CRACKCast E155 – Toxic alcohols](https://canadiem.org/crackcast-e155-toxic-alcohols/) - In this 155th episode of Crackcast is focused on toxic alcohols. There will be a special emphasis on ethanol, ethylene glycol and isopropyl alcohol. Shownotes - PDF here Key concepts Serum osmolarity = 2 salt and a sticky BUN. is calculated by the following equation: Calculated osmolality = (2 x Na) + Glucose + BUN - [CRACKCast E159 - Inhaled Toxins](https://canadiem.org/crackcast-e159-inhaled-toxins/) - This episode of CRACKCast covers Rosen’s Chapter 153, Inhaled Toxins. This chapter covers exposure to various inhalation toxins including CO, hydrogen sulfide, etc. and includes their treatment and management for acute exposures. Shownotes - PDF Here [bg_faq_start] Key Points An asphyxiant is any gas that displaces sufficient oxygen from the breathable air. Treatment consists of - [Syncope: what (if any) investigations are required?](https://canadiem.org/syncope-what-if-any-investigations-are-required/) - Syncope is a common problem encountered in the Emergency Department, and yet despite this there are few strong consensus guidelines, and significant practice variation. Here we seek to explore some of the evidence regarding syncope care. The vast majority of literature and recommendations on syncope in this post, are based upon the well patient who - [CRACKCast E152 - Cardiovascular Drugs](https://canadiem.org/crackcast-e152-cardiovascular-drugs/) - This episode of CRACKCast covers Rosen’s 9th Ed Chapter 147, Cardiovascular Drugs. With increasingly common use of these medications for heart disease and an ever aging population, it is imperative to understand the prompt recognition and therapy for toxic exposures. Recognition of the more lethal agents and how to disposition these patients in the ED - [CRACKCast E154 – Cocaine and Other Sympathomimetics](https://canadiem.org/crackcast-e154-cocaine-sympathomimetics/) - This episode of CRACKCast covers Rosen’s 9th Edition Chapter 154, Cocaine and Other Sympathomimetics. Continuing along the spectrum of toxicologic exposures, these agents account for a large number of presentations to emergency departments every year. Having an in-dept understanding of their mechanism of action and a solid approach to the assessment and treatment of these - [CAEP FEI | Ice Cream Rounds](https://canadiem.org/caep-fei-ice-cream-rounds/) - Mike is a first year resident who just experienced his first case of child abuse. Due to the pressures of the emergency department, he was unable to debrief about the case while on shift. Mike frequently relies on his co-residents to help him process and deal with these difficult cases, but knows others who don't - [CRACKCast E158 - Hydrocarbons](https://canadiem.org/crackcast-e158-hydrocarbons/) - This episode of CRACKCast covers Rosen’s 9th Ed Chapter 152, Hydrocarbons. Continuing the spectrum of toxicologic exposures, these agents account for relatively few presentations. Recognition of the more lethal agents and how to disposition these patients in the ED are the cornerstones of this chapter. Shownotes - PDF Here [bg_faq_start] Key Concepts Aspiration is the - [Call for Applications for the 2018-19 CanadiEM Digital Scholars Fellowship!](https://canadiem.org/call-applications-2018-19-canadiem-digital-scholars-fellowship/) - Are you an RCPSC resident about to embark on your PGY4 special interest time? Are you a graduating CCFP-EM interested in medical education scholarship with an digital media focus? Then this is the fellowship for you! This year, Daniel Ting (@tingdan) has been the CanadiEM Digital Scholars Fellow. He writes about his experience below. When - [CRACKCast E154 - Hallucinogens](https://canadiem.org/crackcast-e154-hallucinogens/) - This episode of CRACKCast covers Rosen’s 9th Ed Chapter 150, Hallucinogens. This chapter covers exposure to several families of hallucinogenic toxins, their presentations, complications, and treatment. Shownotes - PDF Here [bg_faq_start] Key Concepts: Hallucinogens include many types of drugs and chemicals with different associated effects, including action at serotonin receptors, dopamine receptors, and NMDA receptors. - [CRACKCast E147 – General Approach to the Poisoned Patient](https://canadiem.org/crackcast-e147-general-approach-poisoned-patient/) - This episode of CRACKCast covers Rosen’s 9th Edition Chapter 139, General Approach to the Poisoned Patient. Poisonings are a staple presentation in any Emergency Department. Information gained from this episode will better prepare you to deal with the patient reporting acute ingestion and may just give you the tools to save a life on your - [TREKK Series | Bronchiolitis Guidelines](https://canadiem.org/trekk-series-bronchiolitis-guidelines/) - Editor's note: This post represents a first in a series led by Drs. Ashley Lubberdink and Kaif Pardhan translating the pediatric guidelines that have been developed by TREKK (TRanslating Emergency Knowledge for Kids). For more information and further pediatric emergency medicine guidelines, please visit the TREKK website. The Case: It is a cold January morning. - [Spot the Diagnosis! The Case of the Red Leg](https://canadiem.org/spot-diagnosis-case-red-leg/) - This week’s Spot the Diagnosis! looks at Miracle of Aurelia degli Angeli. Painted on canvas by Giovanni Battista Crespi in 1600, this piece pays homage to the life and miracles of Saint Aurelia degli Angeli. This woman looks to the Saint for aid, while doctors examine her red leg. While you're giving it some thought, - [CRACKCast E153 - Caustics](https://canadiem.org/crackcast-e153-caustic/) - This episode of CRACKCast covers Rosen’s Chapter 153, Caustics. This chapter covers oral exposure to caustic agents, including the ED management, complications and potential treatment. Shownotes - PDF Here [bg_faq_start] Key Points Health care workers caring for patients with caustic exposures should adhere to universal precautions to prevent additional exposure. All symptomatic patients should undergo - [CRACKCast E151 - Antidepressants](https://canadiem.org/crackcast-e151-antidepressants/) - This episode of CRACKCast covers Rosen’s 9th Edition Chapter 146, Antidepressants. Continuing the section on toxicology, antidepressants make up one of the most commonly prescribed medications in the general population. The use and misuse of antidepressants can have serious consequences and having a high suspicion of overdose in suicidal patients can lead to timely antidote - [CRACKCast Episode 150 – Anticholinergics](https://canadiem.org/crackcast-episode-150-anticholinergics/) - This episode of CRACKCast Covers Rosen's Chapter 145, Anticholinergics. You will learn everything you need to know for the next hot and bothered patient that rolls in to the ED! Shownotes: PDF HERE [bg_faq_start] Rosen's In Perspective Here we are usually talking about anticholinergic = antimuscarinic But in general Muscarinic receptors are on smooth muscle - [CRACKCast Episode 149 - Aspirin and Nonsteroidal Agents](https://canadiem.org/crackcast-episode-149-aspirin-nonsteroidal-agents/) - This episode of CRACKCast covers Rosen's Chapter 149, Aspirin and Nonsteroidal agents. You will become well-versed in the presentation of Salicylism and how to manage it. The episode also touches on NSAID overdose, with rare severe complications. Shownotes: PDF Here [bg_faq_start] Key concepts Salicylates: Salicylates are profoundly toxic and can be fatal. Salicylate overdose requires active - [Tide Pod Challenge: Managing caustic laundry pod ingestions](https://canadiem.org/tide-pod-challenge-managing-caustic-laundry-pod-ingestion/) - A Case of Laundry Pod Ingestion You are called to the low-acuity side of your department for a two year old child who was triaged three hours ago. The child was witnessed to eat a laundry pod at home, but was stable on arrival so sent to the back. Now, the child is wheezing, seems - [Anxiety: Why are we seeing so much of it?](https://canadiem.org/anxiety-seeing-much/) - Our early evolutionary ancestors relied on the fight or flight response to help ensure their survival and ability to propagate their genes. It was this successful trait that helped allow for the evolution and survival of our species to date. However, as we will discuss, the evolutionary and ecological history of this trait is perhaps - [Tramadol? Think of it more as 'Tramadont'](https://canadiem.org/tramadol-think-of-it-more-as-tramadont/) - Ok, I'll concede that title is pretty bad, but I felt my usual name for Tramadol (Tramacrap), just didn't seem as appropriate for a headline. Dad jokes aside, Tramadol is a synthetic opioid that entered the Canadian market in 2005, and has seen widespread uptake and use. Unfortunately, Tramadol has not been the miracle drug - [CRACKCast Episode 148 - Acetaminophen](https://canadiem.org/crackcast-episode-148-acetaminophen/) - This 148th episode of CRACKCast covers Rosen’s 9th edition, Chapter 143, acetaminophen. Also known as paracetamol and Tylenol, you need to know this overdose cold! Shownotes - PDF here [bg_faq_start] Rosen's In Perspective YOU NEED TO KNOW THIS OVERDOSE COLD!!! Acetaminophen (aka paracetamol aka APAP) is ubiquitous. It's hard to find a house these days - [Spot the Diagnosis! The Case of the Dutch Painter](https://canadiem.org/spot-diagnosis-case-dutch-painter/) - In 1665, Rembrandt painted an honest portrait of his younger colleague Gerard de Lairesse, unknowingly immortalizing this painter's unique physical appearance for contemporary speculation. Like Rembrandt, de Lairesse was a celebrated Dutch artist who was widely influential in his time for his French-style paintings. Today, many believe that he shows facial manifestations of this infectious disease. - [Amazing and Awesome Rounds](https://canadiem.org/amazing-awesome-rounds/) - Editor's note: This post was collaboratively written by the coordinators of Amazing & Awesome Rounds at Queen's. Eve Purdy, Chris Meyer, and Elizabeth Blackmore. You may have seen multiple postings on twitter and even an article in Annals of Emergency Medicine recently related to “Amazing and Awesome rounds."1 A number of Canadian and international institutions are - [Head Injury: minor, minimal or trivial. The difference matters!](https://canadiem.org/head-injuries-getting-it-right/) - The Canadian CT Head rule is a great rule. Really. Yet, time and time again we see it applied erroneously, or learners fail to appreciate the population for whom this decision rule was meant. Patients with head injury are often seriously over investigated, and this likely is secondary to a lack of appreciation regarding decision - [Choosing Wisely: Low Risk Pediatric Ankle Fractures](https://canadiem.org/choosing-wisely-low-risk-pediatric-ankle-fractures/) - This post has been co-written by Drs. Kathy Boutis and Maxim Ben Yakov. The dogmas of the past are now being challenged for the most common minor pediatric fractures, distal radius buckle fractures and minor distal fibular fractures. Since these fractures are stable and have an excellent prognosis, they do not need to be routinely - [Tiny Tips: “TREADMILLS” Peripheral Neuropathy mnemonic](https://canadiem.org/treadmills-peripheral-neuropathy-mnemonic/) - Peripheral neuropathy is prevalent in up to 2.4% of the general population1. It is often characterized by an asymmetric distribution with sensory symptoms following a dermatomal pattern. Initial investigations include a complete blood count (CBC), metabolic panel (electrolytes, glucose, urea, creatinine), and thyroid stimulating hormone (TSH)2. There are many causes for peripheral neuropathy, so when - [Tiny Tips: “C-3PO’s RIVAL” Acute Unilateral Painless Vision Loss mnemonic](https://canadiem.org/tiny-tips-c-3pos-rival-acute-unilateral-painless-vision-loss-mnemonic/) - Early diagnosis and treatment of acute, painless vision loss greatly increases the chances of vision restoration. Though treatment for most conditions involves an ophthalmology consult, it is important to consider and evaluate for the possible etiologies. A mnemonic to remember the list of causes for acute unilateral painless vision loss is “C-3PO’s RIVAL”.1 Central Retinal - [Choosing Wisely: Distal Radius Buckle Fractures](https://canadiem.org/choosing-wisely-distal-radius-buckle-fractures/) - This post has been co-written by Drs. Kathy Boutis and Maxim Ben Yakov. The dogmas of the past are now being challenged for the most common minor pediatric fractures, distal radius buckle fractures and minor distal fibular fractures. Since these fractures are stable and have an excellent prognosis, they do not need to be routinely - [CRACKCast E146 – Radiation Injuries](https://canadiem.org/crackcast-e146-radiation-injuries/) - This Episode of CRACKCast covers Rosen's Chapter 138, Radiation Injuries. While this is not a commonly seen presentation, we need to know how to diagnose and manage radiation injuries when they occur! Shownotes: PDF HERE [bg_faq_start] Rosens in Perspective: Don’t let this chapter give you PTSD - as you rack your brain to remember high - [ImageSim: Building Competency For Visually Diagnosed Tests in Emergency Medicine](https://canadiem.org/imagesim-building-competency-for-visually-diagnosed-tests-in-emergency-medicine/) - Visually diagnosed medical tests (e.g. radiographs, electrocardiograms) are the most commonly ordered tests in front-line medicine. As such, front-line health care professionals are faced with the task of learning the skill of interpreting these images to an expert performance level by the time they provide opinions that guide patient management decisions. However, discordant interpretations of - [CRACKCast E144 - High Altitude Medicine](https://canadiem.org/crackcast-e144-high-altitude-medicine/) - This episode of CRACKCast covers Rosen’s Chapter 144, High Altitude Medicine. The problems encountered can be mostly be prevented through slow ascent and generally treated with oxygen and descent. This summary of respiratory physiology will explain why people can find themselves quickly quite unwell at high altitudes. Shownotes - PDF Here [bg_faq_start] Key Concepts All - [Practicing emergency medicine in New Zealand: A Canadian's perspective](https://canadiem.org/practicing-emergency-medicine-in-new-zealand/) - Dr. Rob Woods is a well known Emergency Physician and program director for the FRCPC Emergency Medicine Program at the University of Saskatchewan, who recently practiced emergency medicine in New Zealand on a one-year sabbatical. Here, he provides us some with answers to many questions he has been getting, insights into the country, lifestyle and - [CRACKCast E145 - Drowning](https://canadiem.org/crackcast-e145-drowning/) - This episode of CRACKCast covers Rosen’s Chapter 145, Drowning. Shownotes - PDF Here [bg_faq_start] Key Points Drowning is a leading cause of death and loss of years of life with over 90% of cases occurring in lower- and middle-income countries. All significant drownings induce pulmonary injury and hypoxia by the amount of water aspirated and - [CRACKCast E126 - Diabetes Mellitus and Disorders of Glucose Homeostasis](https://canadiem.org/crackcast-e126-diabetes-mellitus-disorders-glucose-homeostasis/) - This episode of CRACKCast covers Rosen’s Chapter 118, Diabetes Mellitus and Disorders of Glucose Homeostasis. This chapter covers diabetes and its related complications. Having knowledge of these disease states and their related complications is essential in Emergency Medicine, as we often encounter patients afflicted with diabetes and related disorders of glucose homeostasis on shift. Shownotes - [CRACKCast E134 – Tickborne Illnesses](https://canadiem.org/crackcast-e134-tickborne-illnesses/) - This 134th episode of CRACKCast covers Rosen’s 9th edition, Chapter 126, tick-borne illnesses. Can't get all those crazy rare diseases straight in your head? We've got you covered. Shownotes - PDF here Also check out EMCases Rapid Review Video on Lyme Disease Core questions [bg_faq_start] [1] For each of the following illnesses, list the name - [CRACKCast E119 – Allergy, Hypersensitivity, Angioedema, and Anaphylaxis](https://canadiem.org/crackcast-e119-allergy-hypersensitivity-angioedema-anaphylaxis/) - This episode of CRACKCast covers Rosen’s Chapter 119 (109 in 9th), Allergy, Hypersensitivity, Angioedema, and Anaphylaxis. Patients suffering from acute allergic reactions, anaphylaxis, and angioedema are amongst the most unstable patients presenting to the ED. With proper management, however, these patients can be efficiently managed and discharged with relative ease. Shownotes - PDF Here [bg_faq_start] - [CRACKCast E123 - Selected Oncologic Emergencies](https://canadiem.org/crackcast-e123-selected-oncologic-emergencies/) - This 123rd episode of CRACKCast covers Rosen’s 9th edition, Chapter 115, Selected Oncologic Emergencies. With an ever aging population, cancer incidence continues to rise. Therapies continue to prolong life often with high risks of side effects, and emergency physicians need to be equipped to treat complications of this treatment and importantly cancer morbidity itself. Shownotes - - [CRACKCast E143 - Diving Injuries and Dysbarism](https://canadiem.org/crackcast-e143-diving-injuries-dysbarism/) - This episode of CRACKCast covers Rosen's Chapter 143, Diving Injuries and Dysbarism. While infrequently encountered except for those centers frequented by SCUBA enthusiasts, we must know the hard facts on the potentially life-threatening diving related injuries that may occur suddenly and need urgent attention. Shownotes - PDF Here [bg_faq_start] Key Concepts The majority of dive - [CRACKCast Episode 142 - Electrical and Lightning Injuries](https://canadiem.org/crackcast-episode-142-electrical-lightning-injuries/) - This episode of CRACKCast covers Rosen's Chapter 142, Electrical and Lightning Injuries. The episode will thoroughly differentiate the different types of electrical injuries in terms of recognition and management. Shownotes: PDF Here [bg_faq_start] Key concepts Electrical current follows the path of least resistance, often neurovascular bundles. Deep tissue and organ damage is often much more - [Post-game: The CaRMS Rank List](https://canadiem.org/post-game-the-carms-rank-list/) - Even after CaRMS interviews are over there is a lot of "stuff" to do. Should you send a thank you note to the programs that interviewed you? How is the program going about making their CaRMS rank list? How should you go about making your CaRMS rank list? Should this change if you're entering the couples match? And what really happens if the unthinkable occurs and you go unmatched? This post will cover these topics and more. - [Spot the Diagnosis! The Case of Mona Lisa](https://canadiem.org/spot-diagnosis-case-mona-lisa/) - This is one of the most famous paintings in the world. Various medical diagnoses float around regarding the subject of this painting; was she missing her teeth and that is what caused her tight lipped smile? Or was it a result of facial paralysis? However, there may be physical signs of one intriguing diagnosis. Can - [CAEP FEI | Preparing for High Acuity Events – Stress Inoculation Training](https://canadiem.org/caep-fei-stress-inoculation-training/) - Raj is a first year resident who overhears that a trauma patient is being brought into the resuscitation bay. He races over and sees several people moving urgently to set up the room. The paramedics bring the patient into the room and quickly start telling him the history. Raj can feel the stress building within him - [CRACKCast E141 – Heat Illness](https://canadiem.org/crackcast-e141-heat-illness/) - This 141st episode of CRACKCast covers Rosen’s 9th edition, Chapter 133, heat illness. Want to mentally escape from the throes of our gripping winter? Let's go straight into heat illnesses. Shownotes - PDF here [bg_faq_start] Rosen's In Perspective Heat illness usually occurs in two population groups: the athlete/military person or the elderly / destitute. Football - [Game Time: The CaRMS Interview](https://canadiem.org/game-time-the-carms-interview/) - This is part two of the CaRMS Trilogy and will focus on CaRMS interviews. See Pre-game: CaRMS Interview Preparation and Post-game: The CaRMS Rank List for discussion of other aspects of CaRMS and the full CaRMS Guide for the complete series of medical student mentorship posts. There are generally three parts to the CaRMS interview: the social, - [CRACKCast E140 – Accidental Hypothermia](https://canadiem.org/crackcast-e140-accidental-hypothermia/) - This episode of CRACKCast covers Rosen's Chapter 132, Accidental Hypothermia. Hypothermic patients will appear in the ED at any time and in any season. After listening to this podcast, you will be able to systematically approach these patients with ease. Shownotes: PDF Here [bg_faq_start] Rosen’s in Perspective Accidental hypothermia has been something that has plagued - [Happy 2nd Birthday CanadiEM! 2017 in Review](https://canadiem.org/happy-2nd-birthday-canadiem-2017-in-review/) - As 2017 comes to a close, we wanted to look back on the year that was for CanadiEM. From diagnosing artwork, dissecting Rosen's, and resuscitating the "King of the North" CanadiEM continues to grow faster than we thought possible. We were most honored to receive the 2017 ALiEM Award for 'Most Innovative Blog / Podcast' - [Arts PRN Gallery Recap: Moments](https://canadiem.org/arts-prn-gallery-recap-moments/) - We are thrilled to announce the wrap up of our first gallery: Moments. We have included a recap of each submission below, along with a brief accompanying commentary. Click on each image to find out more about the art and author. Nikki Our most diverse artist for this gallery, Nikki shared with - [CRACKCast E139 – Frostbite](https://canadiem.org/crackcast-e139-frostbite/) - This episode of CRACKCast covers Rosen's Chapter 131, Frostbite. You will be a pro at managing the spectrum of cold injury that can present to the ED! Shownotes: PDF Here Core Questions [bg_faq_start] Rosen’s in Perspective Humans are “physiologically tropical” - so we need to adapt our behaviour to survive in cold. What is frostbite? - [CRACKCast E138 - Sepsis Syndromes](https://canadiem.org/crackcast-e138-sepsis-syndromes/) - This episode of CRACKCast covers Rosen’s Chapter 138, Sepsis Syndromes. Sepsis is a topic that has undergone a lot of change in the last 15 years since the Rivers paper was published. This episode covers the original definitions of SIRS and sepsis, while also covering more recent evidence & the newest evidence-based treatment protocols. Shownotes - [CRACKCast E137 - Skin Infections](https://canadiem.org/crackcast-e137-skin-infections/) - This episode of CRACKCast covers Rosen’s Chapter 129, Skin Infections. These are common and rarely life threatening, but careful consideration should be given for those who may benefit from admission over outpatient treatment. This is a big episode covering the bugs, presentations, and useful tips when treating these infections in the ED. [bg_faq_start] Shownotes - - [Pre-Game: CaRMS Interview Preparation](https://canadiem.org/pre-game-carms-interview-preparation/) - It's that time of year again. The references are in, the applications are complete, interviews have been accepted, flights are booked and medical students across Canada are preparing themselves for the rigamarole known as CaRMS that will determine where they will be living for the next 2-5 years and what kind of medicine they will be practicing for the rest of their lives. All you can do now is some CaRMS interview preparation. - [CrackCAST E136 - Bone and Joint Infections](https://canadiem.org/crackcast-e136-bone-joint-infections/) - This episode of CRACKCast covers Rosen’s Chapter 128, Bone and Join Infections. This episode will look specifically at osteomyelitis and septic arthritis, infections can be subtle and difficult to diagnose, but with devastating consequences if missed. Shownotes - PDF Here [bg_faq_start] Key Concepts Skeletal infection should be considered in the differential diagnosis of all patients - [Could it be abuse? An approach to detecting physical abuse in pediatric patients](https://canadiem.org/abuse-approach-detecting-physical-abuse-pediatric-patients/) - Physicians have a responsibility to report any suspected child abuse. This is not easy. Identifying non-accidental trauma can be challenging, and is often guided by little more than a suspicion on the side of physician. It can be uncomfortable to think of the patient’s parents or caregivers as the cause of injury. Nevertheless, the physician - [Chapter 135 - Tuberculosis](https://canadiem.org/chapter-135-tuberculosis/) - Episode 135 of CRACKCast covers Rosen's 9th edition, Chapter 127, tuberculosis. TB, or not TB, that is the question. This episode will elucidate the early recognition, risk factors, therapy and precautions regarding this worldwide killer. Shownotes - PDF here [bg_faq_start] Key concepts Early recognition of patients with risk for TB should begin at ED triage. - [Case Report: Toxin-Induced Cardiac Arrest in Game of Thrones](https://canadiem.org/toxin-induced-cardiac-arrest-in-game-of-thrones/) - King Joffrey I Baratheon was found in respiratory distress by his mother, Cersei Lannister, and Jaime Lannister during his wedding to Margaery Tyrell. As this was the wedding for the King of the Seven Kingdoms, numerous guests and bystanders were present. The patient was eating a traditional pigeon pie and drinking from a glass of - [Interview Inducing Elective Behavior](https://canadiem.org/interview-inducing-elective-behavior/) - In response to my post on reference letters (The Reference Letter Triple Crown), one of my favorite bloggers Facebooked me the following request (note, she also plays the "Would you rather" game!): I would rather lick a public toilet seat than have to ask someone for a reference letter. I apparently went into the - [CRACKCast E133 – Parasitic Infections](https://canadiem.org/crackcast-e133-parasitic-infections/) - This episode of CRACKCast covers Rosen’s Chapter 125, Parasitic Infections. This episode will give you the tools to adequately investigate the peculiar parasitic infections that present in patients coming to the ED. In an age where physicians are increasingly exposed to international travelers and immigrant/refugee populations, knowing this content is absolutely essential. Shownotes - PDF - [CAEP FEI | Archives of Scholarship in Simulation and Educational Techniques (ASSET)](https://canadiem.org/caep-fei-simulation-asset/) - Heather is a fourth year resident asked to create and facilitate a simulation scenario for junior residents. She has always been interested in simulation based learning, but struggles with finding the time to create high-fidelity scenarios featuring important learning points. Heather wonders if there is a collection of simulation scenarios that she can use as educational tools. Emergency - [CRACKCast Episode 132 – HIV/AIDS](https://canadiem.org/crackcast-episode-132-hiv-aids/) - This episode of CRACKCast covers Rosen's Chapter 124 (9th Ed.), HIV/AIDS. Next time you look after an HIV/AIDS patient on shift, this episode will have you covered! Shownotes – PDF Here [bg_faq_start] Rosen’s In Perspective Box 124.2: Dermatologic and Mucocutaneous Manifestations of WHO Stage 4 HIV Disease Chronic herpes simplex virus ulcers Extrapulmonary tuberculosis Kaposi’s - [Hidden stories: What is happening to this man?](https://canadiem.org/hidden-stories-happening-man/) - "Hidden stories" is a new series for Arts PRN challenging your observation skills. How many details can you notice? Can you weave together a story from this one still image? Don't forget to check out more series featured on Arts PRN here. A big thank you to Dr. David Cisewski (@dhcisewski), an EM resident at - [Continuous Evidence Evaluation: HSFC/AHA Focused Update on the Role of Ventilation in Resuscitation](https://canadiem.org/ventilation-in-resuscitation/) - Did you know? ILCOR has shifted to a Continuous Evidence Evaluation (CEE) system What does this mean for you? You won’t get your giant q5year update anymore! Instead, experts and scientists will constantly scan the literature. When sufficient evidence requires a change in the guidelines, a FOCUSED update will then be released. When does this process - [CRACKCast E131 - Rabies](https://canadiem.org/crackcast-e131-rabies/) - This episode of CRACKCast covers Rosen’s Chapter 131, Rabies. This chapter covers all aspects of rabies, including top rabies carrying-animals in Canada and the world, as well as pathophysiology, treatment and post-exposure prophylaxis. Shownotes - PDF Here [bg_faq_start] Key Points Post-exposure prophylaxis (PEP) for rabies should be administered to individuals exposed to the secretions of - [CRACKCast E130 - Viruses](https://canadiem.org/crackcast-e130-viruses/) - This 130th episode of CRACKCast covers Rosen’s 9th edition, Chapter 122, Viruses. Viruses account for most infections and are typically self-limited illnesses. Recognition of specific viral illness patterns is important in the ED, where our intervention or withholding an ineffective treatment such as antibiotics can affect the health at a population level. Shownotes - PDF - [Routes to emergency medicine practice following a Family Medicine residency](https://canadiem.org/routes-to-emergency-medicine-practice-following-a-family-medicine-residency/) - Believe it or not, CCFP graduates provide the majority of emergency care in Canada. I don’t mean CCFP physicians with an emergency medicine (EM) designation - I’m referring to regular non-EM family physicians. From the very northern settlements of Canada to southern border cities, family physicians have been working in emergency departments since their earliest - [CrackCAST E129 - Bacteria](https://canadiem.org/crackcast-e129-bacteria/) - This 129th episode of CRACKCast covers Rosen’s 9th edition, Chapter 121, Bacteria. Bacterial infections represent a large proportion of presentations to the emergency department. Here we examine some of the most infrequently seen but extremely dangerous bacterial infections that you must be able to recognize. For more frequent infections, please see their individual chapters in - [Failing Up and Failing Better](https://canadiem.org/failing-failing-better/) - Do you have a case that haunts you? I do. The details aren’t relevant, but the case was terrible and stayed with me. Over the following days and weeks I stopped sleeping. I stopped going to the gym. I started dreading work. I swore more. I drank more. I started falling apart. Despite my years - [CRACKCast E128 – Thyroid and Adrenal Disorders](https://canadiem.org/crackcast-e128-thyroid-adrenal-disorders/) - This episode of CRACKCast covers Rosen's Chapter 120, Thyroid and Adrenal disorders. This episode is going to have a nice breakdown of how each of these major endocrine glands can go haywire and what to do when the storm approaches. The shownotes also have some additional material worth checking out! Shownotes - PDF Here [bg_faq_start] - [Spot the Diagnosis! The case of the Woman and the Flask](https://canadiem.org/spot-diagnosis-case-woman-flask/) - As part of the Arts PRN series, we will intermittently be featuring pieces of historic art that hint at an underlying medical condition. They say a picture is worth 1000 words… can you Spot the Diagnosis after examining only a painting? Read on to learn not only about the art, but about these fascinating medical conditions. Who - [Spot the Diagnosis! The case of the Man with the Red Hat](https://canadiem.org/case-of-the-man-with-the-red-hat/) - As part of the Arts PRN series, we will intermittently be featuring pieces of historic art that hint at an underlying medical condition. They say a picture is worth 1000 words… can you Spot the Diagnosis after examining only a painting? Read on to learn not only about the art, but about these fascinating medical conditions. Who - [Spot the Diagnosis! The case of the Jovial Man](https://canadiem.org/spot-the-diagnosis-the-case-of-the-jovial-man/) - As part of the Arts PRN series, we will intermittently be featuring pieces of historic art that hint at an underlying medical condition. They say a picture is worth 1000 words… can you Spot the Diagnosis after examining only a painting? Read on to learn not only about the art, but about these fascinating medical conditions. Who - [Spot the Diagnosis! The case of the Recluse](https://canadiem.org/case-of-the-recluse/) - As part of the Arts PRN series, we will intermittently be featuring pieces of historic art that hint at an underlying medical condition. They say a picture is worth 1000 words… can you Spot the Diagnosis after examining only a painting? Read on to learn not only about the art, but about these fascinating medical conditions. Who - [Spot the Diagnosis! The case of the Pale Woman](https://canadiem.org/spot-the-diagnosis-the-case-of-the-pale-woman/) - As part of the Arts PRN series, we will intermittently be featuring pieces of historic art that hint at an underlying medical condition. They say a picture is worth 1000 words... can you Spot the Diagnosis after examining only a painting? Read on to learn not only about the art, but about these fascinating medical - [Spot the Diagnosis! The Case of The Ugly Duchess](https://canadiem.org/spot-diagnosis-case-ugly-duchess/) - As part of the Arts PRN series, we will intermittently be featuring pieces of historic art that hint at an underlying medical condition. They say a picture is worth 1000 words... can you Spot the Diagnosis after examining only a painting? Read on to learn not only about the art, but about these fascinating medical - [CRACKCast E127 – Rhabdomyolysis](https://canadiem.org/crackcast-e127-rhabdomyolysis/) - This 127th episode of CRACKCast covers Rosen’s 9th edition, Chapter 119, Rhabdomyolysis. Although usually benign, rhabdomyolysis can have deadly complications. Acute kidney injury and hyperkalemia are accompanied by high mortality. At-risk patients (see the "MUSCLE Breakdown" mnemonic) may present with muscle pain or altered mentation. Shownotes - PDF here [bg_faq_start] Rosen's in perspective Rhabdomyolysis is - [CAEP GeMES | Rate of Milestone Attainment in Male Versus Female Emergency Medicine Residents](https://canadiem.org/caep-gemes-rate-milestone-attainment-male-versus-female-emergency-medicine-residents/) - Crystal is a 3rd year EM resident who is meeting with her program director at her mid-year feedback session to discuss her progress. After she finishes the meeting and is reassured that she is achieving all of her clinical milestones thus far, she grabs dinner with the other 3rd year EM residents in her program. - [CAEP FEI | ILearnEM](https://canadiem.org/caep-fei-ilearnem/) - Polly is a first year resident who has recently been introduced to free open access medical education (FOAM). She decides to use FOAM to learn tips and tricks to manage a lower GI bleed. However, she finds herself frustrated by spending lengthy periods of time navigating different sites to try to answer her questions. There are - [CRACKCast E125 – Electrolyte Disorders](https://canadiem.org/crackcast-e125-electrolyte-disorders/) - This episode of CRACKCast covers Rosen's Chapter 117, Electrolyte Disorders. This episode will help you manage those electrolyte disturbances like the slick medical professional you are! Check out the shownotes for a deeper dive into the material. Shownotes – PDF Here Core questions [bg_faq_start] [1] What are the five most common causes of hyperkalemia? Box - [CRACKCast E124 - Acid-Base Disorders](https://canadiem.org/crackcast-e124/) - This episode of CRACKCast covers Rosen’s Chapter 124, Acid Base Disorders. This chapter covers a simple approach to acid base disorders and ABG interpretation, including the differential diagnosis for the identified disorders & treatment options. Shownotes - PDF Here [bg_faq_start] Key Point Patients with an acute severe metabolic acidosis rely on a robust respiratory compensation; - [CRACKCAST E121 - Anemia, Polycythemia, and White Blood Cell Disorders](https://canadiem.org/crackcast-e121-anemia-polycythemia-white-blood-cell-disorders/) - This 121st episode of CRACKCast covers Rosen’s 9th edition, Chapter 112 and 113, Anemia, Polycythemia, and White Blood Cell Disorders. These blood disorders are numerous and this episode attempts to break their classification and approach down in a systematic manner. Shownotes - PDF Here [bg_faq_start] [1] Outline the important aspects of the history and physical for - [CRACKCast E122 - Disorders of Hemostasis](https://canadiem.org/crackcast-e122-disorders-hemostasis/) - This 122nd episode of CRACKCast covers Rosen’s 9th edition, Chapter 114, Disorders of Hemostasis. These blood disorders are numerous and this episode attempts to break their classification and approach down in a systematic manner. Shownotes - PDF Here [bg_faq_start] Key Concepts Although hemostatic disorders are confirmed by specific patterns of laboratory test results, a careful - ["Patient Satisfaction" - it's bad for everyone](https://canadiem.org/patient-satisfaction-its-bad-for-everyone/) - Higher patient satisfaction scores are linked to increased health care costs, and higher mortality1. Pause. Take a second, and re-read that last sentence. The follow up question is obvious - why would administrators push patient satisfaction if it results in worse outcomes? This post seeks to delve into the harms of targeting patient satisfaction, why - [CRACKCast E120 – Dermatologic presentations](https://canadiem.org/crackcast-e120-dermatologic-presentations/) - This 120th episode of CRACKCast covers Rosen's 9th edition, Chapter 110, Dermatologic presentations. The thought of a chief complaint with "rash" is enough to send shivers down some of our spines, yet so many systemic problems have cutaneous manifestations that are important to not miss. Shownotes - PDF here [bg_faq_start] Key concepts You have to - [One Emergency Medicine Resident. One Month of Palliative Care. Ten lessons.](https://canadiem.org/one-emergency-medicine-resident-one-month-of-palliative-care-ten-lessons/) - As emergency medicine residents, we work side-by-side with a wealth of specialities to gain clinical and diagnostic skills and to learn what happens to our patients when they leave the ED. We strive to distill the information we need to make ourselves better clinicians and improve the transition of patients from the ED to inpatient - [CRACKCast E118 - SLE and Vasculitides](https://canadiem.org/crackcast-e118-sle-vasculitides/) - This episode of CRACKCast covers Rosen’s Chapter 118 (108 in 9th), SLE and Vasculitides. These are complex patients with a constellation of seemingly unrelated symptoms that can be difficult to tie together. However, their presentation to the ED is often a more serious complication of their disease process and represents an opportunity to intervene and - [CRACKCast E111 – Mood Disorders](https://canadiem.org/crackcast-e111-mood-disorders/) - This episode of CRACKCast covers Rosen’s Chapter 101 (9th Ed.), mood disorders. The podcast will focus on the diagnosis and management of common mood disturbances. Shownotes - PDF Here [bg_faq_start] Rosens In Perspective: Mood = subjective emotional state. “A change in mood becomes a “mood disorder” when it significantly impairs functioning. In the emergency department, - [CRACKCast E113 – Somatoform Disorders](https://canadiem.org/crackcast-e113-somatoform-disorders/) - This 113th episode of CRACKCast covers Rosen’s 9th edition, Chapter 103, Somatoform Disorders. The diagnosis of SSD is made when there are persistent and clinically significant physical complaints that are accompanied by excessive and disproportionate health-related thoughts, feelings, and behaviors regarding these symptoms. Recent publications refer to “medically unexplained physical or somatic symptoms,” rather than - [CRACKCast E110 - Thought Disorders](https://canadiem.org/crackcast-e110-thought-disorders/) - This episode of CRACKCast covers Rosen’s Chapter 110, Thought Disorders. This is the first chapter in the psychiatric chapters of Rosens. Patients with mental illness present disproportionately to the emergency department as compared to the general population. Understanding these illnesses independently and how they affect the other presenting concerns is crucial to properly care for - [CRACKCast E114 - Factitious Disorders and Malingering](https://canadiem.org/crackcast-114-factitious-disorders-malingering/) - This episode of CRACKCast covers Rosen’s Chapter 114, Factitious Disorders and Malingering. These are difficult disorders to distinguish. This episode elucidates their specific characteristics. Shownotes - PDF Here [bg_faq_start] [1] What is a factitious disorder? What is malingering? These are disorders that occur in patients who are simulation experts! They simulate or intentionally produce symptoms. - [Lessons from NASA - How to Become an Expert Clinician](https://canadiem.org/lessons-nasa-become-expert-clinician/) - In medicine, we often draw some of our lessons on safety from the aviation industry (i.e.: preoperative checklists), here we will explore a host of pearls that medicine can learn from the brilliant minds at NASA to help augment one's practice as an expert clinician. Commander Chris Hadfield has previously discussed a riveting tale regarding - [CRACKCast E117 Tendinopathy & Bursitis](https://canadiem.org/crackcast-e117-tendinopathy-bursitis/) - This episode of CRACKCast covers Rosen’s Chapter 109, CNS Infections. This chapter covers a differential diagnosis for CNS infections, including necessary workup and approaches to treatment. Shownotes - PDF Here [bg_faq_start] Key Point Tendinopathy Mechanical overload and repetitive microtrauma are key underlying mechanisms in the development of tendinopathy. Patients most often present with a history - [CAEP GeMES | Residents' Perception of Direct Observation in a Clinical Setting](https://canadiem.org/caep-gemes-residents-perception-direct-observation-clinical-setting/) - Audrey is a 2nd year EM resident who is on her 3rd shift with Dr. Stewart, an EM staff physician. In the middle of the shift, Dr. Stewart tells Audrey that he would like to observe her as she assesses her next patient. Audrey is concerned that his decision to observe her is due to - [CRACKCast E116 – Arthritis](https://canadiem.org/crackcast-e116-arthritis/) - This episode of CRACKCast covers Rosen’s Ch 106, Arthritis. When a patient rolls in with an active joint, we need to know how to rule out those can't-miss diagnoses. Shownotes: PDF HERE [bg_faq_start] Rosens In Perspective: What are the types of joints? “As opposed to synarthrotic suture joints of the skull and amphiarthrotic fibrocartilage unions like - [Hidden stories: What happened to this woman?](https://canadiem.org/what-happened-to-this-woman/) - "Hidden stories" is a new series for Arts PRN challenging your observation skills. How many details can you notice? Can you weave together a story from this one still image? Don't forget to check out more series featured on Arts PRN here. [bg_faq_start] Is the woman asleep, unconscious or dead? The woman is lying on - [CRACKCast E115 - Suicide](https://canadiem.org/crackcast-e115-suicide/) - This episode of CRACKCast covers Rosen’s Chapter 115, Suicide (Chapter 105, 9th Edition). This is the last chapter in the psychiatric section of Rosen's. Dealing with patients with suicidal ideations, or who have attempted to commit suicide can be difficult, especially in terms of risk stratifying patients to determine whether they are safe to go - ["Allergies" - Sometimes they're real, but usually they're not](https://canadiem.org/allergies-sometimes-theyre-real-usually-theyre-not/) - How often have you seen a patient with more documented allergies than medications they're taking? Commonly; patient's will often suggest that they are allergic to medications like sulfa, penicillin, codeine and morphine in the Emergency Department. We often think for a moment, and prescribe something different - but I'd like to argue that this line - [Physicians as Humans Podcast E04: A break for parenthood](https://canadiem.org/physicians-humans-podcast-e04-break-parenthood/) - In the fourth episode of the Physicians as Humans project, I speak with Dr. Kevin Dueck, a family medicine resident at McMaster, about his decision to take parental leave during residency. Also check out the blog post that led to this podcast and his personal blog! This is an ongoing project, so if you or anyone you - [CAEP FEI | Hand Motion Analysis to Learn Ultrasound Guided Central Line](https://canadiem.org/caep-fei-hand-motion-analysis-to-learn-ultrasound-guided-central-line/) - Omar is a second year resident asked to place an ultrasound guided central line on a patient. He has always wanted to perform this procedure but struggles with finding the right hand positioning and can't thread the wire, forcing his senior resident to take over. Omar feels that he is performing the procedure awkwardly but is - [CAEP GeMES | Selection of an Appropriate Tool for Direct Observation of Trainees by Supervisors](https://canadiem.org/caep-gemes-selection-appropriate-tool-direct-observation-trainees-supervisors/) - Catherine is a 3rd year medical student who is finishing the last shift of her core emergency medicine rotation. She is interested in matching to neurology. During the shift, she asks her staff, Dr. Stewart, if he would be willing to observe her while she performs a neurological exam and provide feedback on her performance. - [CRACKCast E112 – Anxiety Disorders](https://canadiem.org/crackcast-e112-anxiety-disorders/) - This episode of CRACKCast covers Rosen’s Chapter 112, Anxiety Disorders. This is the third chapter in the psychiatric section of Rosen's. Although the diagnosis of these disorders in the ED seems intuitive, it is important to have a defined approach to the patient presenting with complaints of anxiety to ensure that alternative medical and psychiatric - [CRACKCast E053 - Shoulder](https://canadiem.org/crackcast-e053-shoulder/) - This episode of CRACKCast covers Rosen's Chapter 53, Shoulder. From the ski-hill to simple falls, shoulder injuries are common presentations to the emergency department and so properly assessing this important joint will be important for almost every shift. Shownotes - PDF Here [bg_faq_start] Rosen’s in Perspective: The shoulders inherent instability is what allows such great - [Infographic on the Proposed Canadian Tax Changes](https://canadiem.org/infographic-on-the-proposed-canadian-tax-changes/) - Two weeks ago CanadiEM published a primer on the proposed tax changes and their potential impact on physicians who are incorporated. To make the content even more easy to digest and share, our infographic team has put together the above image to describe the changes in a more visual medium. - [CRACKCast E109 - CNS Infections](https://canadiem.org/crackcast-e109-cns-infections/) - This episode of CRACKCast covers Rosen’s Chapter 109, CNS Infections. This chapter covers a differential diagnosis for CNS infections, including necessary workup and approaches to treatment. Shownotes - PDF Here [bg_faq_start] Key Points CNS infection should be considered in all patients with headache, neck stiffness, fever, altered sensorium, or diffuse or focal neurological findings. pneumoniae - [CRACKCast E108 - Neuromuscular Disorders](https://canadiem.org/crackcast-e108-neuromuscular-disorders/) - This episode of CRACKCast covers Rosen’s Chapter 108, Neuromuscular Disorders. These disorders have a wide range of presentations and etiologies. Shownotes - PDF Here [bg_faq_start] Key Concepts “In patients with acute neuromuscular weakness, complaints of difficulty in breathing or swallowing should heighten suspicion of bulbar involvement with possible airway compromise. In such patients, FVC of - [The Long and Short of Needleless IV Extension Sets](https://canadiem.org/needleless-iv-extension-sets/) - While working nights with an EMS crew, you arrive on scene to find a 24 year-old male who was thrown from his vehicle at highway speeds. You estimate that there was 1500 mLs of blood loss visible on the road, with active bleeding from his left femur and abdominal guarding. After applying a C-spine collar, - [Tiny Tips: “SNOOP MEETS Pregnancy” Headache mnemonic](https://canadiem.org/tiny-tips-snoop-meets-pregnancy-headache-mnemonic/) - Many must-not-miss diagnoses manifest as a secondary headache. Though the DDx list is quite large, the pertinent questions that must be asked on history can be remembered using the mnemonic “SNOOP MEETS Pregnancy”1,2 Below you’ll find the cues associated with each letter, the symptoms they are associated with, and the differential diagnosis for some of those symptoms. - [CRACKCast 107 - Peripheral Nerve Disorders](https://canadiem.org/crackcast-107-peripheral-nerve-disorders/) - This episode of CRACKCast covers Rosen’s Chapter 107, Peripheral Nerve Disorders. These disorders have a wide range of presentations and etiologies. This chapter includes a comprehensive classification system to help in the ED in recognizing the various disorders. Shownotes - PDF Here [bg_faq_start] Rosen’s In Perspective Nervous System = Central Nervous System + Peripheral Nervous - [Choose your own Adventure!](https://canadiem.org/choose-your-own-adventure/) - When I became a medical student, I was astounded by the number of opportunities available. The more I looked, the more awesome things I found. My interests in policy and leadership development led me into a number of roles with my medical student society and a summer working in the Canadian Medical Association Leadership in - [Tiny Tip: Back Pain Differential Mnemonic](https://canadiem.org/back-pain-differential/) - Back pain is a common presentation to the Emergency Department. It is associated with disability, health care expenses, and a loss of wages and productivity. When caring for a patient and developing a back pain differential diagnosis, remember to consider age, the history, physical exam findings, laboratory results, and imaging (if needed). Be sure to - [Proposed Canadian Tax Changes: A Primer](https://canadiem.org/proposed-canadian-tax-changes-whats-happening/) - There has been a lot of recent buzz and media attention around some proposed tax changes from the Canadian government. We’ve noticed that there is a lot of misconception and confusion regarding some of these changes, so we hope to provide some clarity into some of the issues as they affect small business and in - [CRACKCast E106 – Spinal Cord](https://canadiem.org/crackcast-e106-spinal-cord/) - This 106th episode of CRACKCast covers Rosen’s 9th edition, Chapter 96, Spinal Cord. Often presenting as vague or poorly localized symptoms, spinal cord pathology can be subtle but has dramatic impact on patient quality of life. Recognition of true neurological symptoms requires a high index of suspicion, and often the emergency department is the first place - [Tiny Tip: C BIG K DROP (Management of Hyperkalemia with ECG changes)](https://canadiem.org/tiny-tip-hyperkalemia-management/) - Editors Note: As you know, BoringEM has never shied away from controversy. In this Tiny Tip, we present to you a mnemonic for the management of hyperkalemia with ECG changes - wrought with several interesting suggestions with which MANY will avidly jump to post-publication peer review. We welcome the opportunity to engage with you and - [CAEP FEI | Mini-curriculum in Management](https://canadiem.org/caep-fei-mini-curriculum-management/) - Mitch is a fifth year resident who is excited by the prospect of entering practice. He has always wanted to play an important role in managing the emergency department and has aspirations of becoming a department head. Mitch recognizes that his career goals will require him to take up new responsibilities such as personnel management and - [CAEP GeMES | Impact of Rudeness on Overall Medical Team Performance](https://canadiem.org/caep-gemes-impact-rudeness-overall-medical-team-performance/) - Eric is a first year Emergency Medicine resident who just started his shift. The emergency department gets notified of an incoming patient with a history of liver cirrhosis who started to vomit frank blood. As the team is preparing the resuscitation room, the respiratory therapist asks Eric what intubation equipment he would like to use. - [CRACKCast E105 - Brain and Cranial Nerve Disorders](https://canadiem.org/crackcast-e105-brain-cranial-nerve-disorders/) - This episode of CRACKCast covers Rosen’s Chapter 105, Brain and Cranial Nerve Disorders. These can be the weird and wonderful in the ED, but subtle hints can clue us in that further investigation is needed for our patients. Having a high suspicion for these diagnoses can help you make an appropriate care plan and - [CAEP GeMES | Effects of Leadership Styles and Power Dynamics on Patient Safety](https://canadiem.org/caep-gemes-effects-leadership-styles-power-dynamics-patient-safety/) - Alyssa is a first year Emergency Medicine resident working on a late night shift with Dr. Howard, whom she has never worked with before. After diagnosing a patient with Sepsis NYD, Dr. Howard starts the patient on piperacillin-tazobactam at 4.5 g IV q6h, but forgets to take into account that the patient has a history - [Clinical Question: Can Ventolin improve wheeze in heart failure?](https://canadiem.org/can-ventolin-improve-wheeze-in-heart-failure/) - A 70-year-old male calls EMS with a 3-day history of shortness of breath. He sleeps in a chair because his breathlessness is made worse while lying on the flat of his back. He is working hard to breath and has difficulty speaking in full sentences. Physical examination reveals an elevated JVP, a third heart sound, - [CRACKCast E104 – Delirium and Dementia](https://canadiem.org/crackcast-e104-delirium-and-dementia/) - This episode of CRACKCast covers Rosen’s Chapter 94, Delirium and Dementia. These are common presentations in the emergency department, and this episode will focus on screening, diagnosis, and management. Shownotes - PDF here [bg_faq_start] Rosens in Perspective: “Delirium is characterized by a fluctuating neurobehavioral disturbance typically progressing over a short period. It is a direct - [I Kneed You - The Thessaly Test for Meniscal Injury](https://canadiem.org/medical-concepts-kneed-thessaly-test-meniscal-injury/) - The Case You are working a shift in the ambulatory zone of your emergency department. Your next patient is a 27 year old female with a chief complaint of “lower extremity injury”. On history, her right knee has been sore for the past 2 days, with swelling and worsening pain since last night, and she - [CRACKCast E103 - Headache Disorders](https://canadiem.org/crackcast-e103-headache-disorders/) - This episode of CRACKCast covers Rosen’s Chapter 103, Headache Disorders. This chapter covers an approach to headaches, including the red flags and key history questions to clinch the diagnosis. Shownotes - PDF Here [bg_faq_start] Rosen's in Perspective Hey! Check out https://canadiem.org/crackcast-e020-headaches/ For a basic approach to headaches, red flags, ddx and the fundamentals! [bg_faq_end][bg_faq_start] - [CRACKCast E001 - Airway](https://canadiem.org/crackcast-airway/) - As highlighted in Rosen's, the airway really is "the cornerstone of resuscitation and is a defining skill for the specialty of emergency medicine." One important piece of this skill set is knowing when we need to take the airway. Shownotes - PDF Here [bg_faq_start] 1. How do you make the decision to intubate? Failure to maintain or protect the airway - [Bouncebacks: Much ado about nothing?](https://canadiem.org/bouncebacks-much-ado-about-nothing/) - "Hey Doc, remember that patient you saw last night...?" That one phrase terrifies Emergency Room (ER) Physicians everywhere. There is such a strong negative connotation associated with "bounceback" visits to the ER. Historically, medicine has emphasized a culture of perfection, so a bounceback is often considered an significant failure, as it is unacceptable to miss - [CRACKCast E102 - Seizures](https://canadiem.org/crackcast-e102-seizures/) - This episode of CRACKCast covers Rosen’s Chapter 102, Seizures. This can be a challenging complaint to diagnose without collateral, but recognition and treatment is critical for patient and public safety. This chapter covers the various etiologies of seizure and their management - both acutely and in the community. Shownotes - PDF Here [bg_faq_start] Rosens in - [Tiny Tip: SCALP for the Layers of the Scalp](https://canadiem.org/tiny-tip-scalp-layers-scalp/) - At some point during clinical teaching in emergency medicine, someone is likely to ask you about the layers of the scalp, and Rosen’s provides a helpful mnemonic for remembering them1: S – skin C – connective tissue A – aponeurosis L - loose areolar tissue P - periosteum You may be asking yourself why you - [CRACKCast E101 - Stroke](https://canadiem.org/crackcast-e101-stroke/) - This episode of CRACKCast covers Rosen’s Chapter 101, Stroke. This chapter covers the common presentations of various types of stroke, keys to recognition, and key tenets of management in the ED including addressing the indications and contraindications for thrombolysis. Shownotes - PDF Here [bg_faq_start] Also check out EM Cases Rapid Review Video series on TIA - [CRACKCast E099 - Urological Disorders](https://canadiem.org/crackcast-e099-urological-disorders/) - This episode of CRACKCast covers Rosen’s Chapter 99, Urological Disorders. This episode will cover a selection of urological disorders commonly seen in the ED along with key steps in management. Shownotes - PDF Here Episode Overview UTI’s in Adults Prostatitis Renal Calculi Bladder (Vesical) Calculi Acute Scrotal Pain Acute Urinary Retention Hematuria [bg_faq_start] UTIs in - [My Heart Goes Boom… ß-Blockers in Cardiac Arrest](https://canadiem.org/beta-blockers-in-cardiac-arrest/) - A 52-year-old male presents with chest pain. He arrests upon arrival to the Emergency Department and is found to be in ventricular fibrillation. You provide good CPR and defibrillate the patient, and treat him with doses of epinephrine and amiodarone in keeping with the ACLS algorithms. The patient continues to be in ventricular fibrillation despite - [CRACKCast E100 - Gynecologic Disorders](https://canadiem.org/crackcast-e100-gynecologic-disorders/) - This (centennial!) episode of CRACKCast covers Rosen’s Chapter 100, Gynecologic Disorders. This chapter covers the common presentation of pelvic pain and vaginal bleeding in the emergency department, including can't miss life or organ diagnoses. Shownotes - PDF Here [bg_faq_start] Rosen's in Perspective Pelvic pain and Vaginal bleeding is a common presentation in our departments!!! - [Arts PRN: Why you need art](https://canadiem.org/healthcare-providers-need-art/) - Deliberate practice increases pattern recognition skills. Studies show that providing fine art education increases the number and sophistication of observations medical students make in both art and clinical reports.1–4 The participants were able to use more accurate terminology and noted more details surrounding a clinical case or fine arts piece compared to controls. We do - [Tiny Tips: How ready is this child?](https://canadiem.org/tiny-tips-ready-child/) - Not many neonates are delivered in the Emergency Department, but those rare babies who greet the world for the first time under the fluorescent lights of the resuscitation bay are precisely those who warrant urgent and concise communication about their clinical status to our obstetric, paediatric, and neonatologist colleagues. The Apgar score is an assessment - [CRACKCast E098 - Sexually Transmitted Infections](https://canadiem.org/crackcast-e098-sexually-transmitted-infections/) - This episode of CRACKCast covers Rosen’s Chapter 98, Sexually Transmitted Infections. This chapter covers an overview of the various sexually transmitted infections commonly seen in the ED, as well as their management. Shownotes - PDF Here [bg_faq_start] Question 1) List 6 causes of each of the following: See Table 88.1 Genital ulcers Genital herpes Primary - [Arts PRN: A new venue to share our experiences](https://canadiem.org/arts-prn-a-new-venue-to-share-our-experience/) - Welcome to “Arts PRN”, a new section of CanadiEM which showcases the stories and experiences of healthcare providers through word, vision, and sound. Since the beginning of human existence, we have been using abstract forms to share experiences that cannot be adequately expressed through concrete language. We have carved lines and curves in stone, danced - [CRACKCast E097 - Renal Failure](https://canadiem.org/crackcast-e097-renal-failure/) - This episode of CRACKCast covers Rosen’s Chapter 97, Renal Failure. This chapter covers an approach to acute and chronic kidney injuries, including causes, complications and treatments. Shownotes - PDF Here [bg_faq_start] Rosen's in Perspective So what’s the emergency about kidney disease? Well here’s the thought process: Identify renal failure (azotemia) Rule out life threats: hyperK, - [The Canadian Enhanced Competency Directory](https://canadiem.org/canadian-enhanced-competency-directory/) - Ever wondered how you might carve out a niche within emergency medicine? With well over 50 opportunities for fellowships and enhanced competency programs, you aren’t the only one! The journey to produce this resource began two years ago when the Canadian Association of Emergency Physicians (CAEP) Resident Section generated an initial Excel list of “fellowships” - [CRACKCast E096 - Anorectal Disorders](https://canadiem.org/crackcast-e096-anorectal-disorders/) - This episode of CRACKCast covers Rosen’s Chapter 96, Anorectal Disorders. These complaints are sensitive in nature and are not easily volunteered by patients. A sensitive and thorough history is necessary to help resolve these complaints that can be devastating to quality of life. Shownotes - PDF Here [bg_faq_start] Rosens in Perspective These conditions are extremely - [How useful is the physical examination in suspected cauda equina syndrome?](https://canadiem.org/how-useful-is-the-physical-examination-in-suspected-cauda-equina-syndrome/) - Background Cauda equina syndrome (CES) is a syndrome consisting of one or more of the following: (1) bladder and/or bowel dysfunction, (2) reduced sensation in the saddle area (i.e. the perineum and inner thighs), and (3) sexual dysfunction, with possible neurological deficit in the lower limb (motor/sensory loss or reflex change) [1]. The cauda equina - [Top 5 Things I've Learned About Geriatric Emergency Medicine](https://canadiem.org/top-5-geriatric-emergency-medicine/) - My medical school dean urged our class to “think not just about what interests you, but about who needs you.” Few patients I’ve encountered in healthcare have struck me as more in need than the frail elderly. As I’ve learned, the ED lies at the heart of the elder care ecosystem, a hub connecting seniors - [Do what you love, love what you do](https://canadiem.org/do-what-you-love-love-what-you-do/) - Junior medical students get a lot of information from senior medical students. They have just gone through the system so it makes sense that these students would seek out their advice on everything from how to study to how to prepare for residency match. Generally, that advice is good. However, there is one statement that - [CAEP FEI | EM Sim Cases](https://canadiem.org/caep-fei-em-sim-cases/) - Asad is a third year resident. This year, he will need to start running simulation scenarios with the junior residents in his program. He finds a few old sample cases in his sim lab, but they all strike him as low quality. He wonders, is there a FOAMed resource to help? This Feature Educational Innovation (FEI), - [CRACKCast E095 - Large Intestine](https://canadiem.org/crackcast-e095-large-intestine/) - This episode of CRACKCast covers Rosen’s Chapter 95, Large Intestine. This chapter covers a number of pathologies affecting the large colon, including their associated risk factors & complications. Shownotes - PDF Here [bg_faq_start] Rosen's in Perspective Rosen’s jumps right into the topics we're covering today! So let’s just give you the list of what we’ll - [CRACKCast E093 - Appendicitis](https://canadiem.org/crackcast-e093-appendicitis/) - This episode of CRACKCast covers Rosen’s Chapter 93, Appendicitis. This chapter covers some recent updates on the function of the appendix, diagnosis of appendicitis including the Alvarado score, as well as treatment of this relatively common condition. Shownotes - PDF Here [bg_faq_start] Rosen's in Perspective Once laughed at….now loved; yes it’s the appendix! No longer - [CRACKCast E094 - Gastroenteritis](https://canadiem.org/crackcast-e094-gastroenteritis/) - This episode of CRACKCast covers Rosen’s Chapter 94, Gastroenteritis. This diagnosis often makes its way onto charts at discharge, but this episode will cover when this presentation requires more than conservative management. Shownotes - PDF Here [bg_faq_start] Rosens in Perspective Here are some definitions! Diarrhea = three or more unformed liquid stools a day, stools - [Writer’s Guides to Education Scholarship: Important Papers for Junior #MedEd Scholars](https://canadiem.org/writers-guides-to-education-scholarship-important-papers/) - For education scholars, publication in peer-reviewed academic journals remains the gold standard for recognition and career advancement. Navigating the writing and peer-review process can be challenging as rejection rates are high, but many of the common reasons for manuscript rejection are preventable. Despite this, most physicians are never formally taught how to maximize their success - [The Google Hospital: What healthcare can learn from Google](https://canadiem.org/google-hospital/) - According to a Google spokesman, the company’s overarching philosophy aspires “to create the happiest, most productive workplace in the world”. After reading a little about their lofty goals, I thought to myself: boy, we should do that at the hospital. That would be awesome. A Google Hospital! Now, like all of you, I’ve had my fair - [CRACKCast E091 - Pancreas](https://canadiem.org/crackcast-e091-pancreas/) - This episode of CRACKCast covers Rosen’s Chapter 91 for the 8th Edition (Chapter 81 9th Edition), Pancreas. This chapter covers the various pathologies, diagnoses and treatments of the Pancreas. Shownotes - PDF Here [bg_faq_start] Rosen's in Perspective Pancreatitis is when the pancreas starts to auto-digest itself, usually because some spark (e.g. toxin) sets off an - [Approach to Asthma in the ED](https://canadiem.org/approach-asthma-ed/) - The Clinical Scenario A 35-year-old professor presents to the emergency department with marked dyspnea. He reports a history of asthma, for which he takes salbutamol, which is his only medication. Over the past 3 years, he has been coughing and wheezing with increasing severity. He has been using his inhaler every two hours with minimal - [CRACKCast E092 - Small Intestine](https://canadiem.org/crackcast-e092-small-intestine/) - This episode of CRACKCast covers Rosen’s Chapter 92 for the 8th Edition (Chapter 82 9th Edition), Small Intestine. This chapter covers the various pathologies, diagnoses and treatments of the Small Intestine. Shownotes - PDF Here [bg_faq_start] Rosen's in Perspective Mortality for small bowel obstruction used to be around 60%, but is now in the 8% - [Tiny Tips: HEADACHe Red Flags Mnemonic](https://canadiem.org/tiny-tips-headache-red-flags-mnemonic/) - Patients with complaints of acute headache comprise 4% of emergency department visits.1 Most headaches presenting to the ED are primary headaches such as migraines, however, important secondary causes, such as hemorrhage, cannot be missed.2. A recent CrackCast outlined an excellent approach to headache red flags. The HEADACHe mnemonic can help you remember these red flags3! History describing - [CRACKCast E090 - Liver and Biliary Tract](https://canadiem.org/crackcast-e090-liver-biliary-tract/) - This episode of CRACKCast covers Rosen’s Chapter 90, Liver and Biliary Tract. This chapter covers the various pathologies, diagnoses and treatments of the Liver and Biliary tract. Shownotes - PDF Here [bg_faq_start] 1) List 8 differential diagnoses for hepatitis The term hepatitis is general. Usually it refers to one of the TWO most common causes - [CRACKCast E088 - Pulmonary Embolism & Deep Venous Thrombosis](https://canadiem.org/crackcast-e088-dvt-pe/) - This episode of CRACKCast covers Rosen’s Chapter 88, DVT and PE. This episode covers the risk factors, diagnostic approach, treatment and management of PEs and DVTs. Shownotes - PDF Here [bg_faq_start] Rosen's in Perspective This chapter is all about VTE - venous thromboembolism - as it manifests in PE’s and DVT’s. VTE - formation depends - [CRACKCast E089 - Esophagus, Stomach & Duodenum](https://canadiem.org/crackcast-e089-esophagus-stomach-duodenum/) - This episode of CRACKCast covers Rosen’s Chapter 89, Esophagus, Stomach & Duodenum. This chapter covers the various pathologies, diagnoses and treatments of the GI tract. Shownotes - PDF Here [bg_faq_start] Rosen's in Perspective Join us for a journey through the upper GI tract....we’ll cover the tidbits of RIP as we move from section to section: - [Tiny Tips: Approach to Abnormal Uterine Bleeding](https://canadiem.org/tiny-tips-approach-abnormal-uterine-bleeding/) - Whether the patient is an expecting mother, a post-menopausal woman, or a young adolescent, abnormal uterine bleeding is distressing for the patient, and often overwhelming for learners. Consider the ‘CAUSES OF bLOOD’ to better tailor your investigations and management. Cancer Abruption Urogenital infections (PID, endometritis, salpingitis) Severe menorrhagia Ectopic pregnancy Spontaneous abortion Ovarian cyst rupture - [A Basic, Practical Approach to Toxicology](https://canadiem.org/approach-to-toxicology/) - A 16-year-old girl is found in her bedroom unresponsive by her mother. The patient had texted her friends earlier in the day, telling them that she was going to “go away forever.” The mother reports that her daughter has a history of depression and several episodes of self-harm but no previous overdose attempts. Her mother - [The PECARN Pediatric Head CT Rule Project | An Insider's Take!](https://canadiem.org/the-pecarn-pediatric-head-ct-rule-project/) - Editor's Note: Everyone loves a great super hero origin story! And so we bring you the backstory behind the joint PECARN-ALiEM-CanadiEM knowledge translation project. Hope you enjoy both the story and, more importantly, the infographics! - TC In the pediatric population, traumatic brain injury (TBI) is amongst the most common reason for presentation to an - [DOACs versus Warfarin: What is their impact on mortality?](https://canadiem.org/doacs-versus-warfarin-what-is-their-impact-on-mortality/) - A 68-year-old woman presents with palpitations, feeling generally unwell for three days. She denies any chest pain, shortness of breath, or lightheadedness. Past medical history includes hypertension, dyslipidemia, and osteoarthritis with no history of dysrhythmia. Her heart rate is 125 and her remaining vital signs are normal. Her pulse is irregular and her physical exam - [CRACKCast E087 - Peripheral Arteriovascular Disease](https://canadiem.org/crackcast-e087-peripheral-arteriovascular-disease/) - This episode of CRACKCast covers Rosen’s Chapter 87, Peripheral Arteriovascular Disease. This episode covers the diagnosis and management of acute and chronic arterial insufficiency, differentiating between thrombotic and embolic insufficiency, as well as aneurysms, AV fistulae, and thoracic outlet syndrome. Shownotes - PDF Here [bg_faq_start] Rosen's In Perspective This chapter covers the diseases that affect the - [IV Lipid emulsion for drug toxicity in the ED](https://canadiem.org/iv-lipid-emulsion-for-drug-toxicity-in-the-ed/) - What is the role of intravenous lipid emulsion in drug toxicity in the emergency department? A 32-year-old male with depression and chronic neuropathic pain presents to your ED after an intentional overdose of 50 x 75 mg tablets of amitriptyline one hour ago. On exam, his blood pressure is 92/54 mmHg and his heart rate - [CAEP GeMES | Workplace-Based Assessment Design Optimization](https://canadiem.org/caep-gemes-workplace-based-assessment-design-optimization/) - It's the end of another long Emergency Department shift, and Dr. Wu's resident approaches him to complete her shift evaluation form. She had a solid shift. Dr. Wu self-admittedly finds every post-shift debrief awkward and gives his usual bland assessment ("You are right on track") and cursory feedback ("Continue reading around cases"). Later that evening, - [CRACKCast E086 - Abdominal Aortic Aneurysm](https://canadiem.org/crackcast-e086-abdominal-aortic-aneurysm/) - This episode of CRACKCast covers Rosen’s Chapter 86, Abdominal Aortic Aneurysm. This episode covers the diagnosis of Abdominal Aortic Aneurysm including the risk factors, red flags to watch out for, as well as treatment and management. Shownotes - PDF Here [bg_faq_start] Rosen's in Perspective AAA = is a TRUE aneurysm in that it involves a localised - [Tiny Tips - Cauda Equina Syndrome](https://canadiem.org/tiny-tips-cauda-equina-syndrome/) - Cauda Equina Syndrome (CES) is a collection of signs and symptoms resulting from compression of neural elements at the cauda equina. Although CES has no universal definition, the most commonly cited clinical presentation involves severe lower back pain, bladder dysfunction, and sensory deficits in the sacral nerve root distribution. Associated symptoms can include radicular leg - [Tiny Tip: Is this a ‘CASE’ of an elbow fracture?](https://canadiem.org/tiny-tip-case-elbow-fracture/) - An elbow fracture is a common pediatric injury in emergency medicine. These fractures present challenges in diagnosis due to the maturing skeletal anatomy and the subtlety of these injuries.1 Plain radiographs are adequate to detect elbow fractures in most cases and a systematic approach can help learners diagnose these pathologies.2,3 An approach to reading elbow - [CRACKCast E085 - Aortic Dissection](https://canadiem.org/crackcast-e085-aortic-dissection/) - This episode of CRACKCast covers Rosen’s Chapter 85, Aortic Dissection. This episode covers diagnosis and management of a potentially lethal and can't miss diagnosis in the ED. Shownotes - PDF Here [bg_faq_start] Rosen's in Perspective As quoted in By Dr David Carr out of Toronto, “The aorta will %$#@ you up” Check out his SMACC Talk - [The CanadiEM Junior Editor Program: Now Accepting Applications!](https://canadiem.org/junior-editor-program/) - While Free Open Access Medical education (FOAMed) has established itself as a key tool for the dissemination of medical knowledge, especially in Emergency Medicine,1 most of the authors are senior residents or staff physicians. While most trainees are using it for educational purposes,2,3 they are rarely taught how to produce this type of content. We designed - [The Case of the Awake Intubation Kit, Episode 3](https://canadiem.org/case-awake-intubation-kit-episode-3/) - Thank you to all who have participated in the discussion to crowd-source an awake intubation kit in both previous installments of this series (Episode 1 and Episode 2). In this final installment, we discuss the implementation of our kit and the ongoing process involved in making this an effective and sustainable quality improvement intervention. Introduction - [CRACKCast E083 - Infective Endocarditis and Valvular Disease](https://canadiem.org/crackcast-e083-infective-endocarditis-valvular-disease/) - This episode of CRACKCast covers Rosen's chapter 83, Infective Endocarditis and Valvular Disease. In this exciting episode we dive deep into how to diagnose and manage IE, and also explores what every emergency physician needs to know about the spectrum of diseases involving the heart valves. Shownotes - PDF Here [bg_faq_start] Infective Endocarditis Principles of Disease - [CRACKCast E084 - Hypertension](https://canadiem.org/crackcast-e084-hypertension/) - This episode of CRACKCast covers Rosen’s chapter 84, Hypertension. Often thought to be a problem better handled by family physicians, hypertension is a frequent encounter in the ED where decision making between intervening and doing nothing is often the main hurdle. Shownotes - PDF Here [bg_faq_start] Rosen's in Perspective HTN is common, and is on - [CAEP 2017 Academic Symposium on Research: Knowledge Translation Recommendations](https://canadiem.org/knowledge-translation-recommendations/) - As part of the 2017 Canadian Association of Emergency Physicians (CAEP) Conference an Academic Symposium was held on research. One aspect of this symposium investigated best practices for knowledge translation in the emergency department. The 10 recommendations presented in the above infographic and following below were compiled using the preliminary results of a systematic review - [CRACKCast E082 - Pericardial & Myocardial Disease](https://canadiem.org/crackcast-e082-pericardial-myocardial-disease/) - This episode of CRACKCast covers Rosen’s Chapter 82, Pericardial & Myocardial Disease. This episode covers two diseases that can be challenging both in diagnosis and management and how to approach them in the ED. Shownotes - PDF Here [bg_faq_start] Rosen's in Perspective These are challenging diseases -- both in managing and diagnosing! They can present - [Shared decision making](https://canadiem.org/shared-decision-making/) - Resource utilization in medicine is becoming an increasingly critical issue (as also noted by the number of discussions we've had on it here at CanadiEM), and this acknowledgement is important. However, once we've accepted the harms (to the patient and system) with excessive over-utilization, we can begin to look at ways to address and optimize physician - [CRACKCast E081 - Heart Failure](https://canadiem.org/crackcast-e081-heart-failure/) - This episode of CRACKCast covers Rosen’s Chapter 81, Heart Failure. Heart failure is associated with high healthcare costs and high mortality. This episode covers the important aspects of pathophysiology, diagnosis and management of this common ED complaint. Shownotes - PDF Here [bg_faq_start] Rosen's in Perspective Heart failure (HF): a “debilitating cardiac syndrome - with - Dyspnea, exercise - [CAEP GeMES | Clinical Reasoning Problems Among EM Residents](https://canadiem.org/caep-gemes-clinical-reasoning-problems-among-em-residents/) - Jack is a first year Emergency Medicine resident. He pours over the content of each cardinal presentation (chest pain, shortness of breath, abdominal pain) after every shift and tries his best to remember all the various questions to ask patients. Being detail oriented, he spends at least one hour with each patient to make sure - [CRACKCast E069 - Elder Abuse](https://canadiem.org/crackcast-e069-elder-abuse/) - This episode of CRACKCast covers Rosen's Chapter 69, Elder Abuse. In the last of our series on vulnerable populations, this episode covers elder abuse. Unfortunately, this is all too common, but by staying vigilant and knowing clues on history and physical we as emergency practitioners have the ability to save and improve lives! Shownotes - - [CRACKCast E070 - Oral Medicine](https://canadiem.org/crackcast-e070-oral-medicine/) - This episode of CRACKCast covers Rosen’s Chapter 70, Oral Medicine. This chapter covers common tooth and mouth complaints that present to the ED and provides treatment and management tips to help with your next patient. Shownotes - PDF Here [bg_faq_start] Rosen's in Perspective The oral cavity and associated facial structures, AKA stomatognathic system, is made up - [CRACKCast E071 - Ophthalmology Part A](https://canadiem.org/crackcast-e071-ophthalmology-part/) - This episode of CRACKCast covers Rosen’s Chapter 71, Ophthalmology. Part A of this episode will open your eyes to the essentials of eye anatomy, diagnosis of pathology and approach to treatment of a wide variety of eye complaints. Shownotes - PDF Here [bg_faq_start] Rosen's in Perspective You gotta know eye anatomy You should review our - [CRACKCast E035 - Back Pain](https://canadiem.org/crackcast-e035-back-pain/) - This episode of CRACKCast covers Rosen’s Chapter 35, Back Pain. This chapter covers a diagnostic approach to a common ED complaint, with emphasis on the red flags you cannot miss, as well as an approach to treatment. Shownotes - PDF Here [bg_faq_start] 1) List 10 historical red flags for back pain Red flags on History and - [CRACKCast E077 - Pleural Disease](https://canadiem.org/crackcast-e077-pleural-disease/) - This episode of CRACKCast covers Rosen’s Chapter 77, Pleural Disease. This episode dives into the physiology and pathophysiology of pleural disease, as well as a step-wise approach to choosing appropriate therapy to treat pneumothoraces. Although not something we might encounter on every emergency shift, this is core information that every emergency practitioner needs to know - [CRACKCast E076 - Pneumonia](https://canadiem.org/crackcast-e076-pneumonia/) - This episode of CRACKCast covers Rosen’s Chapter 76, Pneumonia. This episode tackles high yield information on diagnosis and management of pneumonia, one of the most common emergency department presenting illnesses. Shownotes - PDF Here [bg_faq_start] Rosen's in Perspective This is a common disease - thankfully most cases can be managed as an outpatient, however, this - [#AnthroEve: An Intro to Anthropology and Medical Enculturation](https://canadiem.org/anthropology-and-medical-enculturation/) - I am becoming quite expert in navigating the look of confusion on my colleagues’ faces when I tell them that I am completing my master’s in anthropology. I can see behind their glazed eyes, in real time, the exotic mental images they are conjuring of the famous cultural anthropologist Margaret Mead or the comical similarities - [CRACKCast E078 - Acute Coronary Syndromes Part B](https://canadiem.org/crackcast-e078-acute-coronary-syndromes-part-b/) - This episode of CRACKCast covers Rosen’s Chapter 78, Acute Coronary Syndromes. Part B of this episode covers the essentials of Acute Coronary Syndromes, including DDx, pertinent ECG findings and the ever important STEMI in LBBB. Shownotes - PDF Here [bg_faq_start] Rosen's in Perspective For the RIP in this chapter let’s recap two things from last - [CRACKCast E079 - Dysrhythmias](https://canadiem.org/crackcast-e079-dysrhythmias/) - This episode of CRACKCast covers Rosen’s Chapter 79, Dysrhythmias. This encompasses a variety of pathologies with a spectrum of management from immediate intervention to watchful waiting. Learn the essentials of the conduction pathways, where things can go wrong, and what rhythms to watch for - here. Shownotes - PDF Here [bg_faq_start] Rosens in Perspective “In - [CRACKCast E080 - Implantable Cardiac Devices](https://canadiem.org/crackcast-e080-implantable-cardiac-devices/) - This episode of CRACKCast covers Rosen's Chapter 80, Implantable Cardiac Devices. These devices are becoming more and more prevalent in our aging population, and an understanding of some of the nuances with these devices is a must. Maybe you will be shocked by what you didn't know! Shownotes - PDF Here [bg_faq_start] Rosen’s in Perspective It is important - [CJEM Infographic: Device and Medication Preferences for Endotracheal Intubation in Critically Ill Patients](https://canadiem.org/cjem-infographic-device-medication-preferences-endotracheal-intubation-critically-ill-patients/) - The second article of the month featured on CanadiEM also comes from the Canadian Journal of Emergency Medicine (CJEM).1 This study aimed to examine the variation and diversity in practice of emergent endotracheal intubation (EETI) in practicing Canadian physicians. The authors surveyed a large number of emergency medicine (EM) and intensive care unit (ICU) physicians - [Clinical Question: Are ESR and CRP useful tests when evaluating an adult patient with potential septic arthritis?](https://canadiem.org/clinical-question-esr-and-crp-septic-arthritis/) - Monoarthropathies are common and carry a broad differential including infection, trauma, lupus, rheumatoid arthritis, or crystal arthropathies.1–3 Of these, the can’t miss diagnosis is septic arthritis, as delayed treatment can cause irreversible joint destruction with a fatality rate up to 11% if not treated.4 Yikes. The Patient You are working in minor treatment and a - [CJEM Infographics: Antimicrobial treatment decision for non-purulent skin and soft tissue infections in the ED](https://canadiem.org/antimicrobial-treatment-decision-for-non-purulent-skin-and-soft-tissue-infections/) - This month CanadiEM is featuring an article from the Canadian Journal of Emergency Medicine (CJEM) that looks at the treatment of non-purulent skin and soft tissue infections (SSTIs) in the emergency department.1 Current practice patterns are highly variable between emergency physicians, with differences in the choice of antibiotic, duration of therapy, route of administration (oral or - [CRACKCast E057 – Knee and Lower Leg](https://canadiem.org/crackcast-e057-knee-and-lower-leg/) - This episode of CRACKCast covers Chapter 57 of Rosen’s Emergency Medicine, Knee and Lower Leg. Continuing on with the orthopaedic chapters and objectives, this episode reviews the relevant approaches to knee and lower leg injuries that are actionable in the emergency department setting. Shownotes - PDF Here Also check out the EM Cases Rapid Review videos - [CAEP FEI | Beyond the PowerPoint Lecture](https://canadiem.org/caep-fei-beyond-powerpoint-lecture/) - Han is a third year Emergency Medicine resident who can't stand PowerPoint. Every Tuesday, he attends his full academic day from 0900-1700. Almost every lecture is a didactic PowerPoint presentation, and after a few minutes of each presentation his mind starts to wander and he finds the learning style tends to be passive, which tends to - [CRACKCast E078 - Acute Coronary Syndromes Part A](https://canadiem.org/crackcast-e078-acute-coronary-syndromes/) - This episode of CRACKCast covers Rosen’s Chapter 76, Acute Coronary Syndromes. Part A of this episode covers the essentials of Acute Coronary Syndromes, including DDx, pertinent ECG findings and the ever important STEMI equivalents. Shownotes - PDF Here [bg_faq_start] Rosen's in Perspective Ischemic heart disease and CAD are leading causes of death worldwide...and expected - [Congratulations to CrackCast on receiving the Herb Parkin Award!](https://canadiem.org/congratulations-crackcast-receiving-herb-parkin-award/) - CanadiEM is happy to announce that our partner podcast, CrackCast has recently been selected as the winner of Royal Columbian Herb Parkin Award. As outlined on the award page (which has yet to be updated to reflect the team's selection as this year's recipients), Dr. Herb Parkin was: "...a pioneer in Emergency Medicine. His efforts - [Clinical Ultrasonography 101: Where Right Upper Quadrant Scans Go Wrong](https://canadiem.org/right-upper-quadrant-scans-go-wrong/) - The FAST exam helped pave the way for Emergency point of care ultrasound. Compared to many emergency US applications still in their infancy, the FAST exam has been thoroughly studied, widely implemented, and has proven utility. … sorry transcranial US… The FAST has been around since the 1970’s and replaced DPL, it is very sensitive - [Want to be a (simulation) Olympian?](https://canadiem.org/want-simulation-olympian/) - A five year-old boy is brought into your resuscitation bay by EMS after falling out of a motor-boat in the frigid waters of the St Lawrence river. CPR was started at the scene and when he arrives he has regained a pulse but is hypotensive with a decreased level of consciousness. Your heart races as - [Tiny Tips: HEART Score - A Tool for Acute Coronary Syndrome](https://canadiem.org/tiny-tips-heart-score-a-tool-for-acute-coronary-syndrome/) - Chest Pain? Better check out the HEART (Score)! Chest pain suspected to be of cardiac origin is a common presentation in the first-world Emergency Department, but trying to decide the appropriate level of care of these patients can often be challenging. What if the chest pain is not a straight-forward STEMI that needs to be sent - [CAEP GeMES | POCUS Learning Curve](https://canadiem.org/caep-gemes-pocus-learning-curve/) - Geoff is a first year Emergency Medicine resident on his ultrasound rotation. Over the course of four weeks, he takes big steps in gaining competency in point-of-care ultrasound (POCUS). Most of the scans he finds quite easy. However, Geoff finds the obstetrical scans particularly tricky, especially given the high implications of misinterpreted scans when ruling out - [CRACKCast E075 - Upper Respiratory Tract Infections](https://canadiem.org/crackcast-e075-upper-respiratory-tract-infections/) - This episode of CRACKCast covers Rosen’s Chapter 75, Upper Respiratory Tract Infections (URTI). This spectrum of disease involves a range of management strategies, all the way from supportive care to life-saving interventions. Shownotes - PDF Here [bg_faq_start] Rosens in Perspective For these questions, see “CC E023 - Sore Throat” List 4 Centor criteria and how - [A Resident's Perspective on CBME](https://canadiem.org/a-residents-perspective-on-cbme/) - Editor's note: This is the second post in a series of posts related to CBME. Read the medical student perspective here. This post was written by a current Royal College EM trainee at Queen's University who has a keen interest in education and who has been extensively involved in the transition to CBME locally and nationally. - [TREKK Series | Procedural Sedation](https://canadiem.org/trekk-series-procedural-sedation/) - Cohen is an 8-year old boy (right hand dominant) who fell from the monkey bars and sustained a closed, angulated left distal radius fracture. He is neurovascularly intact and has normal vital signs for his age. He weighs 30kg. He is in a moderate amount of pain despite Tylenol and Advil which was administered in - [CRACKCast E074 - COPD](https://canadiem.org/crackcast-e074-copd/) - This episode of CRACKCast covers Rosen’s Chapter 74, COPD. This airway disease process is one of the most common causes of death worldwide. Approximately 20% of all hospital admissions for patients over age 65 are related to COPD, and so an approach to management will have nearly daily benefit for an emergency physician. Shownotes - - [CRACKCast E073 - Asthma](https://canadiem.org/crackcast-e073-asthma/) - This episode of CRACKCast covers Rosen’s Chapter 73, Asthma. Not just for kids! This disease process is satisfying to treat when patients respond well to therapy, but recognition of critically-ill patients is an important first step in management. Shownotes - PDF Here [bg_faq_start] Rosens in Perspective Basic Principles: Reverse Obstruction Treat Hypoxia Treat Inflammation Basic definition: - [CRACKCast E072 - Otolaryngology](https://canadiem.org/crackcast-e072-otolaryngology/) - This episode of CRACKCast covers Rosen’s Chapter 72, Otolaryngology. As a broad discipline, there are many common ENT presentations seen daily in the Emergency Department and a solid approach. Shownotes - PDF Here [bg_faq_start] Rosens in Perspective The Head and neck is home to some tres importante structures. Those painful ears are going to be a - [The Opioid Crisis: Centre for Excellence in Emergency Preparedness Review](https://canadiem.org/opioid-crisis-centre-emergency-preparedness-review/) - Editor's Note: Dr. Carl Jarvis is an Emergency Medicine Physician, and a director for the Centre for Excellence in Emergency Preparedness (CEEP). Nationally, CEEP's mandate is to support and inform structures and processes in ensuring an standard of excellence in health emergency preparedness. Most recently, the organization has taken to addressing the growing opioid crisis within our country, - [CRACKCast E071 - Ophthalmology Part B](https://canadiem.org/crackcast-e071-ophthalmology-part-b/) - This episode of CRACKCast covers Rosen’s Chapter 71, Ophthalmology. Part B of this episode covers ocular trauma, including indications for ophthalmology consult and surgical repair. Shownotes - PDF Here [bg_faq_start] Rosen's in Perspective If you haven’t listened to Episode 21 and 22, check them out! If you want to review how to do an eye exam... - [Sonography in Hypotension and Cardiac Arrest: The SHoC Consensus Statement](https://canadiem.org/sonography-hypotension-cardiac-arrest-shoc-consensus-statement/) - Cardiac arrest and hypotension are synonymous with emergency medicine. Over the years, point of care ultrasound (PoCUS) has become an extension of our stethoscope. The recently published consensus statement from the International Federation for Emergency Medicine (IFEM) aims to provide guidance for PoCUS use in these situations, and describes the Sonography in Hypotension and Cardiac - [CAEP FEI | Interdisciplinary Staff Simulation](https://canadiem.org/caep-fei-interdisciplinary-staff-simulation/) - Lynn heads the simulation lab at Milborough Hospital. One of the tenets she preaches to her learners is the "safe space" in a simulation lab, an environment in which learners can make mistakes without fear of judgment. Recently, she has read about in-situ simulation sessions happening across the country. These sessions take the simulation mannequins into the real-life - [CJEM Infographic: Predictors of repeat visits to a PEM crisis intervention program](https://canadiem.org/cjem-infographic-predictors-repeat-visits-pem-crisis-intervention-program/) - This month CanadiEM is featuring an article from the Canadian Journal of Emergency Medicine (CJEM) examines the characteristics of patients with the highest propensity for repeat visits to a pediatric emergency department (PED).1 The literature suggests that around a quarter of all mental health services are used by repeat users. Given that that PED and - [Key Clerkship Skills: Help us to identify them!](https://canadiem.org/key-clerkship-skills-needs-assessment/) - Editor's note: The CanadiEM team believes that it was import to consult stakeholders when developing new content. The bleeding and clotting needs assessment that we conducted previously has been completed and we will soon be publishing content directed at meeting the needs that we identified. This post contains a needs assessment directed at the most junior members of the - [QI Series Part 2 | What is “Quality” in health care and how do we achieve it?](https://canadiem.org/qi-serieswhat-is-quality-in-health-care/) - This article is the second in a three-part series on quality improvement in health care. The first article, “What is Quality Improvement?”, defined this field of study and provided a brief history of its origins. In this article, we will define “quality” and briefly describe tools often used to achieve improved quality in health-care delivery. - [CJEM Infographic: Use of POCUS in long bone fractures: a systematic review and meta-analysis](https://canadiem.org/pocus-in-long-bone-fractures/) - This month CanadiEM is featuring an article from the Canadian Journal of Emergency Medicine (CJEM) that looks at the use of point-of-care ultrasound (POCUS) in assessing long bone fractures (LBFs).1 The diagnosis and assessment of LBFs post-reduction is traditionally accomplished through plain radiographs taken at perpendicular angles to each other. However, some studies have suggested - [The (real) battle against strep throat](https://canadiem.org/real-battle-strep-throat/) - In the past week, there has been some national buzz around: “Why strep throat is causing serious complications, from amputations to death”. This is quite a headline, especially for those in the emergency medicine community who are moving more and more towards a practice of not routinely treating strep pharyngitis with antibiotics. I can already picture - [Case Series: Hindsight is always the sharpest - Penetrating trauma](https://canadiem.org/hindsight-is-always-the-sharpest-penetrating-trauma/) - The Case A 17-year-old female was transported to the Emergency Department (ED) by helicopter after a high speed, single vehicle motor vehicle collision. She was found unrestrained by paramedics, with an initial Glasgow Coma Scale of 14, but during extrication she became more agitated and confused. Subsequently she complained of dyspnea and became hypotensive. She - [CRACKCast E028 - Jaundice](https://canadiem.org/crackcast-e028-jaundice/) - This episode of CRACKCast covers Rosen's Chapter 28, Jaundice. Show Notes - Link HERE [bg_faq_start] 1) Describe heme metabolism Jaundice = elevated serum bilirubin Conjugated bilirubin = direct bilirubin Unconjugated bilirubin = indirect bilirubin (can cross blood brain barrier) – does not bind albumin unconjugated levels of bilirubin that is not bound to albumin is able - [CRACKCast E064 - Chemical Injuries](https://canadiem.org/crackcast-e064-chemical-injury/) - This episode of CRACKCast covers Rosen’s Chapter 64, Chemical Injuries. Whether from a workplace incident or chemical terrorism, these patients require urgent intervention in the ED to prevent progression of their injuries. This episode discusses the approach to a variety of chemical injuries and their management. Shownotes - PDF Here [bg_faq_start] Rosen's in Perspective - [CRACKCast E029 - Nausea and Vomiting](https://canadiem.org/crackcast-e029-nausea-vomiting/) - This episode of CRACKCast covers Rosen's Chapter 29, Nausea and Vomiting. This episode covers the pathophysiology of nausea and vomiting, as well as potential complications and antiemetic treatment in the ED. Shownotes - PDF HERE [bg_faq_start] Rosen's in Perspective Three phases of vomiting: - see Fig 29-1 1) Nausea May occur in isolation “Vague, extremely unpleasant - [CRACKCast E031 - Diarrhea](https://canadiem.org/crackcast-e031-diarrhea/) - This episode of CRACKCast covers Rosen’s Chapter 31, Diarrhea. This chapter covers a common ED complaint including the pathophysiology, risk factors for non-benign diarrhea, and the approach to treatment. Shownotes - PDF Here [bg_faq_start] Rosen's in Perspective Runny poo accounts for 5% of all ED visits… or about 6 patients a week for the average - [CRACKCast E066 - Child Maltreatment](https://canadiem.org/crackcast-e066-child-maltreatment/) - This episode of CRACKCast covers Rosen’s Chapter 66, Child Maltreatment. This episode covers an often overlooked but serious issue that presents to the ED and outlines the signs to look for when child injuries are suspicious for maltreatment. Thank you to Dr. Sampsel for her assistance with this episode! Shownotes - PDF Here [bg_faq_start] Rosen's in - [CRACKCast E30 - GI Bleeding](https://canadiem.org/crackcast-e30-gi-bleeding/) - This episode of CRACKCast covers Rosen’s Chapter 30, GI Bleeding. This episode gives us a solid approach to the workup and management for GI bleeds. Showntoes - PDF Here [bg_faq_start] Rosen’s in perspective: Large burden of disease More than 1 million admissions in US per year. Risk factors: Medication use: Aspirin NSAIDs Steroids Anticoagulants (warfarin, - [CRACKCAST E065 - Forensic Emergencies](https://canadiem.org/crackcast-e065-forensic-emergencies/) - This episode of CRACKCast covers Rosen’s Chapter 65, Forensic Emergencies. This episode gives us an important primer on Forensic Emergencies to help us gather and protect evidence and give victims the justice they deserve. Shownotes - PDF Here [bg_faq_start] Rosen’s In Perspective: Forensic EM: An area of specialty within EM originally spearheaded by the University - [CRACKCast E068 - Intimate Partner Violence](https://canadiem.org/crackcast-e068-intimate-partner-violence/) - This episode of CRACKCast covers Rosen’s Chapter 68, Intimate Partner Violence. This episode has a TON of pearls on how to recognize and manage Intimate Partner Violence (IPV). Tragically, abuse and violence is a daily nightmare for far too many people. Standardized approaches to screening for intimate partner violence saves lives. You owe it to - [CRACKCast E033 - Acute Pelvic Pain in Women](https://canadiem.org/crackcast-e033-acute-pelvic-pain-women/) - This episode of CRACKCast cover's Rosen's Chapter 33, Acute pelvic pain in women. This common presentation in the ED has a wide differential and having a solid approach will always keep you considering the life threatening causes. Link to the show notes - HERE [bg_faq_start] Rosen’s in Perspective A patient presenting with acute pain from - [CRACKCast E012 - Fever in the ER](https://canadiem.org/crackcast-e012-fever/) - This episode of CRACKCast covers Rosen's Chapter 012, Fever. Fever is a common presenting complaint with a variety of causes ranging from benign to terrifying and life threatening! 70-80% of febrile patients over the age of 65 are admitted to hospital, and have a 7-9% incidence of death within 1 month of admission. Also check out the EM Cases - [Clinical question: Is the Bier Block safe and effective analgesia in the ED?](https://canadiem.org/bier-block-safe-and-effective-analgesia/) - A 12-year-old healthy male fell while learning how to use his hoverboard. An X-ray done in the ER shows a displaced distal radius fracture, amenable to reduction and non-surgical management. While discussing the reduction technique, his parents request analgesia with as little sedation as possible because they don’t want him “put to sleep.” You recall - [CRACKCast E032 - Constipation](https://canadiem.org/crackcast-e032-constipation/) - This episode of CRACKCast cover's Rosen's Chapter 32, Constipation1. Constipation is a common presenting symptoms in the ER in our geriatric population, and a good approach can help prevent unnecessary testing. Shownotes - PDF Link [bg_faq_start] Rosen’s in Perspective Constipation as lots of different definitions: straining hard/infrequent stools pain during BMs, *Always have the patient define - [Isolated distal DVT - Diagnosis and Management](https://canadiem.org/isolated-distal-dvt-diagnostic-and-management/) - Case: [bg_faq_start] A 51-year-old woman presents to the ED with the chief complaint of left leg swelling. She recently underwent bunion correction surgery to her left foot 7 weeks ago, and her cast was removed one week ago. Over the last day or two she has had significantly increased leg swelling and more recently reports - [CRACKCast E067 - Sexual Assault](https://canadiem.org/crackcast-e067-sexual-assault/) - This episode of CRACKCast covers Rosen’s Chapter 067, Sexual Assault. Continuing Section Five of Rosen's - Violence and Abuse - this episode covers a safe, patient-centred approach to this area of forensic medicine. Thanks to Dr. Kari Sampsel for her help producing this episode! Shownotes - PDF Here [bg_faq_start] Rosen’s in Perspective Definition from the CDC: - [CAEP FEI | Teaching Rotation for Emergency Medicine Residents - MERIT](https://canadiem.org/teaching-rotation-emergency-medicine-residents-merit/) - Delaney is a first year Emergency Medicine resident. Over the course of her first few months, she works a number of shifts with Dr. Pan. Most of the ED staff really like whenever Dr. Pan works, because he treats a high volume of patients, "moves the meat," and keeps patient waiting times low. Conversely, Delaney - [FAQ About Medical Student Electives](https://canadiem.org/medical-student-electives-faq/) - This is a topic for which the “how to” seems to be passed down from senior to junior medical students and never written down. I remember being pretty clueless about this process when I went through it. I was a relative late-comer to the Royal College EM sweepstakes, having decided to pursue that program only during - [Mechanical Heart: a basic approach to LVADs in the ED](https://canadiem.org/lvads-approach-ed/) - You may be wondering; why do we need another post on left ventricular assist devices ( LVADs ) when there are already several phenomenal articles out there in the #FOAMed universe? There are two reasons for this. First, to my knowledge, there has not yet been a #FOAMed article regarding community emergency department (ED) management - [CAEP FEI | Competency-based Assessment of Resuscitation Skills](https://canadiem.org/caep-fei-competency-based-assessment-resuscitation-skills/) - Dougie, a junior Emergency Medicine resident, has just passed his LMCC Part II examination, where he was tasked to perform a series of standardized histories and physical exams with actors. Although he felt that not every scenario was particularly relevant to his future practice, he did find some benefit in the standardized assessment of competence. - [CAEP FEI | Tuckamore Innovation](https://canadiem.org/caep-fei-tuckamore-innovation/) - Miriam, the simulation lab nurse, has seen all sorts of healthcare teams rotate through the sim lab to practice patient cases. Often, the participants are all from a single discipline. Often, the patient cases are similar. This has always struck Miriam as strange, as from her experience working in the Emergency Department knows that real cases - [CAEP GeMES | Workplace based assessments in competency based education](https://canadiem.org/caep-gemes-workplace-based-assessments-competency-based-education/) - Aurora, a junior resident, is in a meeting with her residency training committee when the topic of competency-based education arises. Her institution will implement competency-based training starting next year and her program director has major reservations. Her program director says, "I can't see how we can have time to evaluate all of these tasks for learners while - [Invitation to the PAinED Study](https://canadiem.org/invitation-pained-study/) - Adequately treating patients who suffer from chronic pain can be a real problem in the emergency department. Studies have repeatedly shown that both clinicians and patients come away frustrated with the experience. We aim to find how your training as ED physicians, nurses, and other allied health professionals can impact your attitudes and opinions when dealing with patients suffering - [CAEP GeMES | Does integrating patient death within simulation favor better performance from residents?](https://canadiem.org/caep-gemes-integrating-patient-death-within-simulation-favor-better-performance-residents/) - "Success is a lousy teacher. It seduces smart people into thinking they can't lose" - Bill Gates One school of thought in simulation education is that the simulated patient should never die. Instead, learners should be "rescued" before ultimate failure to prevent students from having their confidence battered by a poor outcome in simulation, which - [CAEP GeMES | What affects a trainee's ability to generate self-directed learning goals](https://canadiem.org/caep-gemes-affects-trainees-ability-generate-self-directed-learning-goals/) - "So, how do you think the shift went?" Gregor reflects for a moment and recalls having difficulty diagnosing a sick elderly patient with abdominal pain. "I think I'll read about red flags in abdominal pain." "That's a great idea," says Dr. Tran, "Why don't you read about the sensitivity of serum lactate in acute mesenteric - [Announcing the new CanadiEM Digital Scholars Fellowship!](https://canadiem.org/announcing-new-canadiem-digital-scholars-fellowship/) - Are you an RCPSC resident about to embark on your PGY4 special interest time? Are you a graduating CCFP-EM interested in medical education scholarship with an digital media focus? Then this is the fellowship for you! What exactly is this fellowship? The Digital Scholars Fellowship is meant to provide residents with practical experiences in creating - [Injury Prevention - Dr Emily Sullivan](https://canadiem.org/injury-prevention-dr-emily-sullivan/) - "Find some reason that makes you want to advocate for injury prevention and start advocating!" Dr. Emily Sullivan A while back one of my senior residents gave us an engaging talk on injury prevention. I was so inspired that I asked her to guest blog on ERmentor - enjoy! Introduction Patients suffering from injuries are - [CAEP GeMES | Fostering and Retaining Female Academics in Emergency Medicine](https://canadiem.org/caep-gemes-fostering-retaining-female-academics-emergency-medicine/) - Catarina is a PGY-5 resident graduating this year. Throughout her residency, she has published more academic papers and presented at more conferences than any of her peers in her residency program. She has advanced training in clinical epidemiology and self-identifies the "nerd" of the program. At the same time, she has recently married and started a - [CAEP FEI | Critical Incident Stress Management](https://canadiem.org/caep-fei-critical-incident-stress-management/) - Glenn is an Emergency Department RN who has basically seen it all through his fifteen years of practice. One day, a teenager is rolled into the trauma bay in cardiac arrest after a horrific car crash. Despite the team's best efforts, the resuscitation fails and the teenager dies. Afterwards, Glenn is shaken and wants to talk. - [CAEP GeMES | Social Media Scholarship](https://canadiem.org/caep-gemes-social-media-scholarship/) - A medical student, Chandra, is interested in Emergency Medicine and wants to get involved in research to pad her resume and network. Unfortunately, at her site, there are few Emergency Physicians who are interested in research and the Emergency Department is not conducting any research studies. On the other hand, Chandra loves FOAMed and sees a - [Tiny Tips - Approach to Diabetic Ketoacidosis](https://canadiem.org/tiny-tips-diabetic-ketoacidosis/) - Don’t Know Anything about Diabetic Ketoacidosis (DKA)? In Canada, 5 000 - 10 000 patients are admitted to the hospital with diabetic ketoacidosis (DKA) each year.1 Most of these patients will initially present to the Emergency Department. The initial assessment and management of these patients in the ED is crucial, as 50% of DKA deaths occur in - [CAEP GeMES | Simulation Versus Case-Based Teaching](https://canadiem.org/caep-gemes-simulation-versus-case-based-teaching/) - Dr. Jonah is a self-identified "old school" Emergency Physician. He has been teaching learners for decades and has a great knack for collecting cases. Dr. Jonah's favorite way of teaching is taking these cases and discussing them with students in a small group setting. In recent years, he has seen many of his younger colleagues taking - [TREKK Series | Diabetic Ketoacidosis](https://canadiem.org/diabetic-ketoacidosis/) - Mark is a 7-year old boy who was brought into the ED by his mom who noticed he has been more fatigued than usual over the past day. Three days ago, he had rhinorrhea and a cough, and since then has been complaining of generalized abdominal pain, nausea, 2 episodes of nonbloody, nonbilious emesis today, - [CRACKCast E063 – Thermal Burns](https://canadiem.org/crackcast-e063-thermal-burns/) - This episode of CRACKCast covers Rosen’s Chapter 63, Thermal Burns. These patients are often the sickest in the department and many are on their way to the ICU. There are life-saving interventions that are begun in the emergency department with significant impacts on morbidity and mortality, and many are discussed in this episode. Shownotes - PDF - [CRACKCast E027 - Abdominal Pain](https://canadiem.org/crackcast-e027-abdominal-pain/) - This episode of CRACKCast cover's Rosen's Chapter 27, Abdominal Pain. Abdominal pain is one of the most common presenting symptoms in the ER and a good approach is vital for ER docs. Shownotes - PDF Link [bg_faq_start] Rosen’s in Perspective Common and challenging presentation: History and physical examination can be misleading Serious pain can be - [QI Series Part 1 | What is Quality Improvement?](https://canadiem.org/what-is-quality-improvement/) - As physicians involved in Quality Improvement (QI) work, we are often asked by colleagues and learners, “What is QI exactly?” And this makes sense, given that few resources exist for those unfamiliar with the concepts and goals of QI. Here, we hope to provide any health-care professional with the introductory knowledge to better understand how - [Volume Assessment: What's voodoo and what's vital?](https://canadiem.org/volume-assessment-whats-voodoo-whats-vital/) - Patient’s are often referred to as “wet” or “dry”. What do these terms actually mean? How do we tell if a patient will benefit from fluid administration or diuresis? Through a few clinical cases, this post will explore a practical approach to evaluating a patient’s volume status. - [CRACKCast E021 - Diplopia](https://canadiem.org/crackcast-e021-diplopia/) - This episode of CRACKCast covers Rosen's Emergency Medicine, Chapter 021 - Diplopia. Here the podcast reviews how to risk stratify diplopia and when to be most concerned for this uncommon chief complaint. Shownotes - PDF Here [bg_faq_start] Rosen's in Perspective Diplopia is uncommon presentation to the ED, representing 1.4% of eye emergencies; however, it can - [Congratulations to Sameer Sharif, 2017 Essentials of EM / CanadiEM Fellow!](https://canadiem.org/sameer-sharif-essentials-em/) - On behalf of the CanadiEM and Essentials of Emergency Medicine teams, we are pleased to announce that the winner of the 2017 Fellowship contest is Dr. Sameer Sharif! Sameer is a 3rd year resident in the FRCPC Emergency Medicine program at McMaster University. His submission, entitled ß-Blockers for Refractory Ventricular Fibrillation in Cardiac Arrest was rated - [CRACKCast E062 - Venomous Animal Injuries](https://canadiem.org/crackcast-episode-062-venomous-animal-injuries/) - This episode of CRACKCast covers Rosen’s Chapter 62, Venomous Animal Injuries. This presentation will be highly variable depending on where you practice, and this episode will equip you with tools to approach these cases as they arise. Shownotes - PDF here [bg_faq_start] Rosen's in Perspective Before we dive into Rosens, I just wanted to note for - [CRACKCast E026 - Chest Pain](https://canadiem.org/crackcast-e026-chest-pain/) - This episode of CRACKCast covers Rosen’s Chapter 26, Chest Pain. This chapter covers a broad approach to chest pain with emphasis on the 6 critical diagnoses you cannot miss in the ED. Shownotes - PDF Here [bg_faq_start] Rosen’s in Perspective Symptom caused by numerous diseases Afferent visceral fibers from the heart, lungs, great vessels, esophagus enter - [Tiny Tips - Taking a Social History](https://canadiem.org/tiny-tips-social-history/) - While often overlooked, a patient’s social history can help narrow the differential diagnosis as well as help guide their final disposition. A mnemonic to help with the essential parts of the social history is ETOH SHOTS: Education Level of education of the patient; are they able to understand discharge instructions. Treatment Coverage Does the patient - [CJEM Infographic | Prehospital application of CTAS by EMS](https://canadiem.org/prehospital-application-ctas-ems/) - This month CanadiEM is featuring an article from the Canadian Journal of Emergency Medicine (CJEM) that looks at prehospital triaging by Emergency Medical Services (EMS).1 In Canadian emergency departments (ED), this process is traditionally performed by the triage nurse using the Canadian Triage Acuity Scale (CTAS). However, observational evidence suggests that it may reliably be implemented - [CJEM Infographic | Analgesia for acute gingivostomatitis: a national survey of pediatric emergency physicians](https://canadiem.org/analgesia-acute-gingivostomatitis/) - This month CanadiEM is featuring an article from the Canadian Journal of Emergency Medicine (CJEM) that addresses the use of analgesia for acute gingivostomatitis in pediatric patients.1 Currently, there is little evidence regarding the best analgesic agent for this condition, however acetaminophen and ibuprofen are often used as first-line agents. As shown in this CanadiEM - [CRACKCast E061 - Mammalian Bites](https://canadiem.org/crackcast-e061-mammalian-bites/) - This episode of CRACKCast covers Rosen’s Chapter 61, Mammalian Bites. From dogs to seals, this episode covers a solid chunk of the pathogens, risk factors for infection and first line treatments for a number of different bites that you may encounter in your ED. Shownotes - PDF Here [bg_faq_start] Rosen’s in Perspective Can be a big - [CRACKCast E042 - Facial Trauma](https://canadiem.org/crackcast-e042-facial-trauma/) - This episode of CRACKCast covers Rosen's Chapter 042, Facial Trauma. Continuing in our series on all things trauma, this episode tackles the issue of facial trauma and explores some of the nuances in the diagnosis and management of these patients. Shownotes - PDF Link Rosen’s in Perspective mechanism of facial trauma varies significantly age highly - [CRACKCast E008 - Brain Resuscitation](https://canadiem.org/crackcast-e008-brain-resuscitation/) - This episode of CRACKCast cover's Rosen's Chapter 08, Brain Resuscitation. This complex topic is essential for critical care management in the ED. For the PDF version of this file click HERE [bg_faq_start] Rosen’s in Perspective – Why Cerebral Resuscitation? We frequently see post-cardiac arrest patients in the ED prognostic significance of immediate post-ROSC period is - [CRACKCast E044 - Neck Trauma](https://canadiem.org/crackcast-e044-neck-trauma/) - This episode of CRACKCast covers Rosen’s Chapter 044, Neck Trauma. Continuing in our trauma series, this episode tackles the challenging issue of neck trauma and injuries, and explores the anatomy and relevant considerations in the diagnosis and management of both blunt and penetrating neck injuries. Shownotes - PDF Link [bg_faq_start] Rosen’s in Perspective Wide range of - [CRACKCast E013 – Weakness](https://canadiem.org/crackcast-e013-weakness/) - This episode of CRACKCast cover's Rosen's Chapter 13, Weakness. Weakness is a very common presentation in the Emergency Room, and a good approach is vital. Link to the Show Notes - HERE [bg_faq_start] Rosen’s in Perspective: There is “true” (objective) weakness (loss of strength from a neurologic or muscular disease process) and then there is a host - [CJEM Infographic: Bystander Fatigue and CPR Quality by Older Adults](https://canadiem.org/cjem-infographic-bystander-fatigue-cpr-quality-older-adults/) - This month CanadiEM is featuring an article from the Canadian Journal of Emergency Medicine (CJEM) that compares the effectiveness of the continuous chest compression (CCC) and 30:2 compressions to ventilation (30:2) methods of CPR in an older bystander population. Considering that most cardiac arrests occur at home where both the victim and bystander (spouse) are - [CRACKCast E015 - Syncope](https://canadiem.org/crackcast-e015-syncope/) - This episode of CRACKCast covers Rosen’s Chapter 15, Syncope. This short but high yield chapter covers Syncope, a common reason for emergency visits that may be benign, but sometimes can have more sinister diagnoses lurking that cannot be missed! Shownotes - PDF Link [bg_faq_start] Rosen’s in Perspective: Syncope is defined as a sudden, transient, loss - [CRACKCast E018 - Seizures](https://canadiem.org/crackcast-e018-seizures/) - This episode of CRACKCast covers Rosen’s Chapter 18, Seizures. This topic covers the basics of seizures, and the management of status epilepticus. PDF Show Notes - Link Here [bg_faq_start] Rosen’s in Perspective: seizures are a pathologic excess of neuronal activity that disrupt normal cortical or deep limbic system functioning the term epilepsy refers specifically to recurrent - [CRACKCast E054 - Back Pain](https://canadiem.org/crackcast-e054-back-pain/) - This episode of CRACKCast covers Rosen’s Chapter 54, Back Pain. Back pain is one of the most common reasons for visits to the emergency department. Everyone will experience back pain at some point in their lives - having a solid approach to ruling out life threatening diagnoses is critical and will come in handy on - [CRACKCast E056 - Hip and Femur](https://canadiem.org/crackcast-e056-hip-femur/) - This episode of CRACKCast covers Chapter 56 of Rosen’s Emergency Medicine, Hip and Femur. This episode reviews the anatomy, pathophysiology, and management of both common and uncommon hip injuries that may present to the emergency department. As well, we would like to thank everyone who tunes in and supports our podcast. We wish you all - [CRACKCast E058 – Ankle and Foot](https://canadiem.org/crackcast-e058-ankle-foot/) - This episode of CRACKCast covers Chapter 58 of Rosen’s Emergency Medicine, Ankle and Foot. To finish off the orthopaedic chapters, this episode reviews the approach to the anatomy and pathophysiology of the ankle joint and foot to help you treat whatever walks (or limps) through the ED door. Shownotes - PDF Here [bg_faq_start] Rosen's in - [CRACKCast E023 - Sore Throat](https://canadiem.org/crackcast-e023-sore-throat/) - This episode of CRACKCast covers Rosen's Chapter 23, Sore Throat. While the sore throat may have some relatively benign causes, knowing the red flags for this common complaint will have you saying "ahhh" as you diagnose the more serious pathology in the ED. Shownotes - PDF Here [bg_faq_start] Rosen's in Perspective Relevant Anatomy One of - [CRACKCast E024 - Hemoptysis](https://canadiem.org/crackcast-e024-hemoptysis/) - This episode of CRACKCast covers Rosen’s Chapter 24, Hemoptysis. Hemoptysis has a host of causes ranging from benign to life threatening. This action packed episode covers it all, and will help you manage these potentially intimidating patients on your next shift. Shownotes - PDF here [bg_faq_start] Rosen’s in Perspective Expectoration of blood arising from the - [CRACKCast E060 - Foreign Bodies](https://canadiem.org/crackcast-e060-foreign-bodies/) - This episode of CRACKCast covers Rosen’s Chapter 60, Foreign Bodies. This episode covers an approach to foreign bodies, including location specific tips, complications and safe removal in the ED. Shownotes - PDF Here [bg_faq_start] Rosen’s in Perspective Tricky problem. Sometimes glaringly obvious: the arrow in the head, the electronic vibrating device in the rectum. However, - [CRACKCast E025 - Dyspnea](https://canadiem.org/crackcast-e025-dyspnea/) - This episode of CRACKCast covers Rosen’s Chapter 25, Dyspnea. Dyspnea has a broad differential; to list them all would leave you short of breath. This episode covers an approach to dyspnea and the critical diagnoses to remember for this cardinal presentation. Shownotes - PDF Here [bg_faq_start] Rosen’s in Perspective “Dyspnea”: uncomfortable sensation of breathlessness, “Air - [Physicians as Humans Podcast E03: Struggling with Depression](https://canadiem.org/struggling-with-depression/) - In the third episode of the Physicians as Humans project, I corresponded with a Canadian emergency physician who sent me her personal account of depression. The result is this beautiful, thoughtful story that she has graciously allowed me to read for the podcast. This is an ongoing project, so if you or anyone you know - [Emergency medicine autonomy is under siege](https://canadiem.org/emergency-medicine-autonomy-is-under-siege/) - The opposite of a motivated physician is a burnt-out physician. In healthcare, preventing physician burnout and promoting physician wellness is of increasing importance. Healthcare organizations are under tremendous pressure to retain quality physicians and push physicians to perform at the highest level possible. The key to getting these results is to truly understand what motivates - [Highlights from EM Wellness Week!!](https://canadiem.org/highlights-em-wellness-week/) - The first annual Emergency Wellness Week is coming to a close. This week we featured wellness initiatives that you can use to boost wellness in your emergency department, talked about the importance of debriefing, heard an amazing story of a Canadian Emergency physician and her personal account of depression, and shared ways to improve wellness - [“30 minutes? That’s enough to stay well” | Emergency Medicine Wellness Week](https://canadiem.org/30-minutes-emergency-medicine-wellness-week/) - A typical day in the life of an Emergency Medicine physician: You wake up without an alarm after eight hours of undisturbed sleep. You enjoy a fresh cup of french press coffee while reading the morning news on your smartphone - along with a freshly baked croissant of course! Then you go to an hour - [CRACKCast E059 - Wound Management Principles](https://canadiem.org/crackcast-e059-wound-management-principles/) - This episode of CRACKCast covers Rosen’s Chapter 59, Wound Management Principles. This episode covers the nitty-gritty details of wound management and what you need to know to get that perfect wound closure! Shownotes - PDF Here [bg_faq_start] Rosen’s in Perspective Infection risk is proportional to location, mechanism, host and care. Varies - [Emergency Medicine Wellness Week: An international collaboration & call to action!](https://canadiem.org/emergency-medicine-wellness-week-a/) - Calling ALL Emergency Medicine physicians - residents and attendings! It shouldn’t take tragedy for us to recognize the importance of wellness. Our specialty is known to be high risk and it is surprising that we are so late to the game to try and change that. We believe that, together, we can keep each other well. - [Tiny Tips: Modified Centor Score for Streptococcal Pharyngitis](https://canadiem.org/tiny-tips-modified-centor-score/) - Upper Respiratory Infection symptoms like cough or sore throat are still some of the top reasons for Canadian emergency department visits, and will likely be even higher in the upcoming months and in Urgent Care Centres.1 The most common organisms responsible for uncomplicated acute pharyngitis are viral agents at 50-80% and Streptococcal agents, specifically Group A - [Clinical Question: What is the best treatment for acute dyspepsia?](https://canadiem.org/clinical-question-best-treatment-acute-dyspepsia/) - The Case: Tummy Ache? Piece of Cake! A 26-year-old woman presents with epigastric pain after consuming a large piece of cake. She describes that she had previously been diagnosed with heartburn by her family doctor and was on a heartburn medication but stopped taking it when she went on vacation. She denies associated chest pain, shortness of - [CRACKCast E022 - Red and Painful Eye](https://canadiem.org/crackcast-e022-red-painful-eye/) - This episode of CRACKCast cover's Rosen's Chapter 22, Red and Painful Eye1. The red and painful eye can be a vision-threatening medical emergency and should be treated urgently to avoid long-term sequelae. Shownotes - PDF Link [bg_faq_start] Rosen’s in Perspective: [bg_faq_start] Review your eye anatomy in Rosen’s Recap the key components of the eye exam: - [Tips & Myths for Competency Based Assessment in a New Era of CBME](https://canadiem.org/tips-myths-competency-based-assessment-new-era-cbme/) - Competency Based Medical Education (CBME) curriculums are being launched across Canada for all Emergency Medicine Residency Programs in July 2018, although some programs have begun to make change as early as this year! - [Happy 1st Birthday, CanadiEM! Our Year in Review](https://canadiem.org/our-year-in-review/) - Well, it’s been a heck of a first year for the CanadiEM team! Thank you so much to the amazing FOAM community for welcoming us into the fold and continuing to engage with our team and our content. With your support, our new site has clocked over 600,000 pageviews from over 9000 cities/regions in - [CRACKCast E020 - Headaches](https://canadiem.org/crackcast-e020-headaches/) - This episode of CRACKCast covers Chapters 20 of Rosen’s Emergency Medicine, Headaches. This episode reviews the common and life threatening causes of headaches, and dives into red flags you cannot miss when assessing these patients on your next shift. Shownotes - PDF Here [bg_faq_start] Rosen’s in Perspective: Epidemiology 90% of people in the US have - [CRACKCast E055 - Pelvic Trauma](https://canadiem.org/crackcast-e055-pelvic-trauma/) - This episode of CRACKCast covers Rosen’s Chapter 55, Pelvic Trauma. These patients can decline quickly from blood loss, so recognition and determining injury severity early is important to stabilize them. Shownotes - PDF Link Here [bg_faq_start] Rosen's in Perspective Key message: be scared! Patients can easily exsanguinate into their pelvis from pelvic ring fractures Also requires - [A Medical Student's Perspective on CBME](https://canadiem.org/a-medical-students-perspective-on-cbme/) - As programs across the country transition to a form of competency-based medical education (CBME) we will be hosting a series of posts from the many people this transition will affect. Our first perspective is that of a medical student faced with a CBME filled future! Verdah Bismah is a medical student at Queen's University, which is transitioning all of it's postgraduate programs to CBME in 2017. If you are a medical student please feel free to share your thoughts in the comments below. If you are an educator we want to hear from you too! - [CRACKCast E017 - Confusion](https://canadiem.org/crackcast-e007-confusion/) - This episode of CRACKCast cover's Rosen's Chapter 017, Confusion. Confusion can mean many things, arise in a number of situations, from a variety of causes. Shownotes - PDF Link [bg_faq_start] Rosen's in Perspective Confusion means many different things, but we are particularly interested in processes impacting: Memory Attention Awareness Remember, confusion is a symptom, not a - [FLOW Hacks 5 - Bed Utilization in the ER](https://canadiem.org/flowhacks-bed-utilization-er/) - To continue our FLOW Hacks series, Dr. Lucas Chartier and nurse Barb McGovern write about their team's innovation called BED-UP: Bed in the Emergency Department Utilization Project. FLOW Hacks: The Concept The FLOW (Featured Leadership & Organizational Workplace) Hacks Series highlights innovative strategies for increasing patient flow in the emergency department (ED). This series is unique - [FLOW Hacks 2 - Reducing Coagulation Studies in the ED](https://canadiem.org/reducing-coagulation-studies-ed/) - To continue our FLOW Hacks series, Dr. Shawn Dowling of Calgary, AB writes about his team's innovation: Reducing Coagulation Studies in the Emergency Department. FLOW Hacks: The Concept The FLOW (Featured Leadership & Organizational Workplace) Hacks Series highlights innovative strategies for increasing patient flow in the emergency department (ED). This series is unique given its - [CRACKCast E052 - Orthopedics - Humerus and Elbow](https://canadiem.org/crackcast-e052-orthopedics-humerus-elbow/) - This episode of CRACKCast covers Rosen’s Chapter 52, Humerus and Elbow injuries. These injuries can be seen in patients of all ages, so this is a high yield chapter that may help you on your very next shift! PDF - Link Here [bg_faq_start] Rosen’s in Perspective The elbow allows for pronation, supination, flexion, extension Three - [CRACKCast E051 - Orthopedics - Wrist and Forearm Injuries](https://canadiem.org/crackcast-e051-wrist-forearm-injuries/) - This episode of CRACKCast covers Rosen’s Chapter 51, Wrist and Forearm Injuries. These common injuries have multiple eponyms, but this podcast helps deliver the fundamental approaches needed for management for these recurrent patterns of injury. Shownotes - Link to PDF Here [bg_faq_start] Rosen's in Perspective [bg_faq_start] What is the wrist? Distal radius/ulna → CMC junctions - [CRACKCast E016 - Depressed Consciousness and Coma](https://canadiem.org/crackcast-e016-depressed-consciousness-and-coma/) - This episode of CRACKCast covers Rosen’s Chapter 16, Depressed Consciousness and Coma. This presentation has a broad differential, but the systematic approach outlined here will guide your strategic work up for these altered patients. Shownotes - PDF Link Here [bg_faq_start] Rosen's in Perspective Depressed mental status represents an alteration in arousal stemming from a wide - [TREKK Series | Intussusception](https://canadiem.org/trekk-series-intussusception/) - An 18 month female named Ella presents to the ED with a 1-day history of multiple intermittent episodes of abdominal pain (lasting ~5-10 minutes each) where she pulls into a knee-chest position, in addition to episodes of non-bloody, non-bilious emesis after her last 3 meals. Her appetite has been poor. Her bowel movements have been - [Tiny Tips: Canadian CT Head Rule](https://canadiem.org/tiny-tips-canadian-ct-head-rule/) - "But Doc, I didn't hit my head THAT hard" Computed tomography (CT) scans are frequently performed after a head injury to rule out acute intracranial findings. However, most Emergency Department patients with a head injury have no acute CT findings. The Canadian CT Head Rule (CCHR) was developed to help clinicians determine when to order - [CRACKCast E050 - Orthopedics - Hand Injuries](https://canadiem.org/crackcast-e050-orthopedics-hands/) - This episode of CRACKCast covers Rosen’s Chapter 50, Hand Injuries. Hand injuries constitute 5-10 percent of all emergency room visits, and this high yield chapter will dive into the essential anatomy, examination, and management pearls for managing a whole host of hand injuries. Shownotes - PDF Link Check out this awesome videocast by Andy Neil - [CJEM Infographic: Adverse Events Following Pediatric Catheterization](https://canadiem.org/cjem-infographic-adverse-events-following-pediatric-catheterization/) - This month CanadiEM is featuring an article from the Canadian Journal of Emergency Medicine (CJEM) that focuses on the use of pediatric catheterization in the emergency department (ED). Currently, catheterization is used in the pediatric ED for diagnosing young children with a suspected urinary tract infection (UTI). However, there have been few studies that have looked at short-term - [Clinical Ultrasonography 101: Seeing Clearer with Ocular Ultrasound](https://canadiem.org/seeing-clearer-ocular-ultrasound/) - Ever feel frustrated with your eye exam? Confused by the slit lamp and even more distressed at the thought of doing funduscopy? Point-of-care ultrasound (POCUS) is taking over emergency medicine and can definitely help improve your eye evaluation. The eye is an ideal structure for viewing with ultrasound since it is a superficial structure that - [CRACKCast E049 - General Principles to Orthopedic Injuries](https://canadiem.org/crackcast-e049-general-principles-orthopedic-injuries/) - This episode of CRACKCast covers Rosen’s Chapter 049, General Principles to Orthopedic Injuries. This is a new section of Rosen's to cover and this episode lays a foundation for more a more in-depth look at specific injury patterns moving forward. Shownotes - PDF Here [bg_faq_start] Rosen's in Perspective [bg_faq_start] Management principles Reasons for urgent orthopedic consultation: - [CRACKCast E048 - Peripheral Vascular Trauma](https://canadiem.org/peripheral-vascular-trauma/) - This episode of CRACKCast covers Rosen’s Chapter 048, Peripheral Vascular Trauma. These injuries can still carry a high morbidity and mortality rating, though advances in our ability to intervene now make it even more important to identify the injury in the emergency department. Shownotes - PDF Here [bg_faq_start] Rosen's in Perspective Bottom Line Line: PVI comes - [Finding your niche in emergency medicine: The Canadian Fellowship Guide](https://canadiem.org/finding-niche-emergency-medicine-canadian-fellowship-guide/) - The Royal College of Physicians of Canada emergency medicine Specialty Training Requirements mandate: “…a minimum of six months, usually in PGY-4, be devoted to achieving particular expertise either in a scholarly activity or a clinical area, pertinent to the practice of the specialty of Emergency Medicine.”1 You may have found yourself pondering what it is - [CJEM Infographic: The PERIL Rule - Paramedics assessing Elders at Risk for Independence Loss](https://canadiem.org/peril-rule/) - This month's CJEM Infographic summarizes the PERIL Rule - a clinical decision instrument designed to help paramedics to identify patients who are at risk for adverse events [cite num="1"]. The summarized study was published in the most recent version of the Canadian Journal of Emergency Medicine. Featured in the latest CanadiEM infographic, this study by Lee - [Resource utilization: why do we overdo it?](https://canadiem.org/resource-utilization-overdo/) - There is a plethora of evidence that suggests, as physicians we over-diagnose, over-treat and over-investigate illness, often with little benefit to patients. The idea of rationale resource utilization is beginning to gain momentum, with campaigns such as Choosing Wisely, advocating for physicians to use the best evidence available in their practice. In order to appreciate - [CRACKCast E047 - Genitourinary Trauma](https://canadiem.org/crackcast-e047-genitourinary-trauma/) - This episode of CRACKCast covers Rosen’s Chapter 047, Genitourinary Trauma. These patient presentations can range from subtle injuries all the way to significant obvious deformity. This episode helps delineate what to look for and what not to miss when considering GU Trauma. Shownotes - PDF link [bg_faq_start] Rosen's in Perspective People rarely die from renal - [FLOW Hacks 4 - Emergency Department Paramedics](https://canadiem.org/emergency-department-paramedics/) - To continue our FLOW Hacks series, lead innovators Dr. Samuel Campbell and Patrick Froese write about their team's innovation, Using Advanced Care Paramedics as physician extenders in the management of lower acuity patients. Read on to learn how your institution could use emergency department paramedics. FLOW Hacks: The Concept The FLOW (Featured Leadership & Organizational Workplace) Hacks Series highlights - [CRACKCast E010 - Pediatric Resuscitation](https://canadiem.org/crackcast-e010-pediatric-resuscitation/) - This episode of CRACKCast covers Rosen’s Chapter 010, Pediatric Resuscitation. This episode covers what you NEED TO KNOW cold for the next time you are caring for a sick child. Shownotes – PDF Link [bg_faq_start] 1) Describe the CPR technique for an infant Rosen’s advocates for the “encircling” hands technique in infant CPR, which according to - [CRACKcast Flashcards!](https://canadiem.org/crackcast-flashcards/) - Much has been written about flashcards previously on CanadiEM (see here and here). For those of you wanting a study deck of cards to study the concepts from the podcast using spaced repetition - here it is! The CRACKCast team has been working on this project from day one and have up to episode 42 in CRACKCast - [CRACKCast E011 - Neonatal Resuscitation](https://canadiem.org/crackcast-e011-neonatal-resuscitation/) - This episode of CRACKCast covers Rosen’s Chapter 011, Neonatal Resuscitation. In these cases you hope you have help around you to care for these fragile patients, and this episode focuses on some of the key perinatal considerations. Shownotes - PDF Link [bg_faq_start] 1) List the equipment needed for neonatal resuscitation PPE equipment – gown, gloves, - [CRACKCast E046 - Abdominal Trauma](https://canadiem.org/crackcast-e046-abdominal-trauma/) - This episode of CRACKCast covers Chapters 46 of Rosen’s Emergency Medicine, Abdominal Trauma. This episode covers some of the diagnostic and management dilemmas in patients with blunt and penetrating abdominal trauma - a high yield action packed episode that can't be missed! Shownotes - PDF Link [bg_faq_start] Rosen’s in Perspective Principles to consider with any - [Essentials of Emergency Medicine Fellowship: Residents apply to win!](https://canadiem.org/residents-apply-to-win-a-trip-to-essentials-of-emergency-medicine/) - Essentials of Emergency Medicine is one of the largest live emergency medicine educational conferences in the world. Inspired by the contest operated by EMCrit and ALiEM, CanadiEM will be partnering with the Skeptic’s Guide to Emergency Medicine to offer one lucky Canadian emergency medicine resident the opportunity to attend EEM for free as an Essentials of Emergency Medicine Education Fellow. - [CRACKCast E045 - Thoracic Trauma](https://canadiem.org/crackcast-e045-thoracic-trauma/) - This episode of CRACKCast covers Rosen’s Chapter 045, Thoracic Trauma. This is a large topic, but these are often life-threatening presentations where effective management done quickly is essential for patient survival. Shownotes - PDF Link [bg_faq_start] Rosen's in Perspective Epidemiology Direct thoracic trauma leads to ¼ of all deaths from trauma This stuff kills! Usually caused - [CRACKCast E043 - Spinal Injuries](https://canadiem.org/crackcast-e043-spinal-injuries/) - This episode of CRACKCast covers Rosen’s Chapter 043, Spinal Injuries. Continuing in our series on all things trauma, this episode tackles the issue of spinal trauma focusing on mechanism of injuries, imaging guides, and management of various trauma patterns. Shownotes - PDF Link [bg_faq_start] Rosen's in Perspective MVC’s are 40% of spinal injuries Risk factors: speeding, ETOH - [Medical Concepts: Acute Angle Closure Glaucoma](https://canadiem.org/medical-concepts-acute-angle-closure-glaucoma/) - A 62 year old woman presents to your Emergency Department with a chief complaint of severe right eye pain. Upon further questioning, she reveals reduced vision in the affected eye and colored halos around lights. She reports a diffuse headache and two episodes of vomiting. A quick physical exam reveals significant conjunctival injection and a - [CRACKCast E007 - Blood and Blood Components](https://canadiem.org/crackcast-e007-blood-components/) - This episode of CRACKCast cover's Rosen's Chapter 07, Blood and Blood Components. A knowledge of blood and blood components is essential both for diagnosis and treatment. Shownotes - PDF Link [bg_faq_start] 1) Describe the 3 categories of blood antigens The whole goal of blood typing is to match ABO type, Rh antibodies, and over - [CAEP FEI | Emergency Training Efficiency](https://canadiem.org/caep-fei-emergency-training-efficiency/) - Marcel is a fourth year EM resident who is really coming into his own in the ED. For the most part, the medical aspects of being an emergency physician now come naturally to him. He quickly diagnoses complex patients, he knows what key investigations to order, and has a savvy know-how when speaking with consultants. - [CRACKCast E006 - Shock in the ER](https://canadiem.org/crackcast-e006-shock-er/) - This episode of CRACKCast cover's Rosen's Chapter 06, Shock. Shock is a common event in the ER and a good understanding of how to recognize and treat it is essential for ER docs. Shownotes - PDF Link [bg_faq_start] Rosen’s in Perspective: What is SHOCK? “a transition between life and death” mitochondria are first to be affected - [CJEM Infographic: Management of TIA in the Emergency Department](https://canadiem.org/management-of-tia-in-the-emergency-department/) - 1 This month CanadiEM is featuring an article from the Canadian Journal of Emergency Medicine (CJEM) that focuses on the treatment of transient ischemic attack (TIA) in the emergency department (ED). Current recommendations for these patients include brain imaging, noninvasive vascular imaging (carotids), ECG, initiating or modifying preventative medications (e.g. anticoagulants) and referral to a - [Physicians as Humans Podcast E02: An Illness Close to Home](https://canadiem.org/physicians-humans-podcast-e02-illness-close-home/) - In the second episode of the Physicians as Humans project, I speak with Dr. Rob Rogers (@EM_Educator), a leading educator in emergency medicine and director of The Teaching Course. He shares his experiences of dealing with a devastating illness in his own family and the effect it had on his career as an emergency physician. - [Bleeding and Clotting: A SoMe-based Needs Assessment](https://canadiem.org/bleeding-clotting-based-needs-assessment/) - This year Bob Stuntz published a study in Annals of EM1 which showed that, while Free Open Access Medical education (FOAM) content was doing a great job of covering certain ‘sexy’ topics, it has not covered less exciting areas as well. This is not surprising given FOAM’s crowd-sourced nature, but we wonder if there isn’t - [CAEP GeMES | Non-traditional learning methods by EM Residents](https://canadiem.org/caep-gemes-non-traditional-learning-methods-em-residents/) - Alexis, a first-year Emergency Medicine resident at Millborough Hospital, was studying with some of her senior residents, who could not stop talking about the various podcasts and blogs that they have been using to prepare for their rotations. Alexis, a self-proclaimed "old soul," has gotten by just fine so far with her traditional textbook and - [CRACKCast E041 - Head Injury](https://canadiem.org/crackcast-e041-head-injury/) - This episode of CRACKCast covers Rosen's Chapter 041, Head Injury. This episode covers a spectrum of head injuries seen in the emergency department along with appropriate management. Shownotes - PDF link [bg_faq_start] Rosen's in Perspective Most common causes of head injury: falls, MVC’s Leading cause of death for people < 25 yrs old There may be - [CJEM Infographic: Does Mode of Transport Confer a Mortality Benefit in Trauma Patients?](https://canadiem.org/mode-transport-confer-mortality-benefit-trauma-patients/) - This month CanadiEM is featuring an article from the Canadian Journal of Emergency Medicine (CJEM) that focuses on the mode of transport for trauma patients. This is primarily a choice between ground and air transport, for which there are no evidence-based guidelines. As shown in this CanadiEM infographic, this study by Buchanan et al.1 set out to determine - [CRACKCast E005 - Patient Monitoring](https://canadiem.org/crackcast-e005-patient-monitoring/) - This episode of CRACKCast covers Rosen’s Chapter 005, Patient Monitoring. Proper management of any acutely ill patient requires accurate monitoring. This involves understanding of the strengths and limitations to the monitoring modalities at the emergency physician's disposal. Shownotes - PDF Link [bg_faq_start] 1) List 6 situations when pulse oximetry is not useful Pulse oximetry basics: pulse oximetry uses - [CRACKCast E040 - Injury Prevention and Control](https://canadiem.org/crackcast-e040-injury-prevention-control/) - This episode of CRACKCast covers Rosen’s Chapter 040, Injury Prevention and Control. Although we typically think of the role of the emergency physician in the acute care management of patients, they can be crucial in identifying public health concerns and exacting broader system based changes necessary to save lives. Shownotes - PDF Link Rosen’s in Perspective: - [Beyond Medical Education: SoMe in Disasters](https://canadiem.org/beyond-medical-education-disasters/) - In the world of medicine, Social Media (SoMe) has arguably made the greatest impact in medical education. What started as scattered simple blog posts on random topics of interest by keen individuals, movements like FOAMed have evolved over the past few years with establishment of robust frameworks for dissemination and active discussion around medical topics - [FLOW Hacks 3 - Rapid Medical Evaluation Unit](https://canadiem.org/flow-hacks-3-rapid-medical-evaluation-unit/) - To continue our FLOW Hacks series, Dr. Lucas Chartier and Dr. Timothy Josephson write about their team's innovation called the Rapid Medical Evaluation Unit. FLOW Hacks: The Concept The FLOW (Featured Leadership & Organizational Workplace) Hacks Series highlights innovative strategies for increasing patient flow in the emergency department (ED). This series is unique given its focus on the - [CRACKCast E004 - Procedural Sedation and Analgesia](https://canadiem.org/crackcast-procedural-sedation-and-analgesia/) - This episode of CRACKCast cover’s Rosen’s Chapter 004, Procedural Sedation and Analgesia. These topics are core knowledge that we use every day in the Emergency Department. Shownotes - PDF link [bg_faq_start] 1. What are the various depths of procedural sedation? There are some key terms that we should be familiar with: anxiolysis: decreased apprehension about - [TREKK Series | Pediatric Multisystem Trauma](https://canadiem.org/trekk-series-pediatric-multisystem-trauma/) - Editor's note: This post represents the second in a series led by Drs. Ashley Lubberdink and Kaif Pardhan translating the pediatric guidelines that have been developed by TREKK (TRanslating Emergency Knowledge for Kids). For more information and further pediatric emergency medicine guidelines, please visit the TREKK website. The Case: It is a hot summer day in - [CRACKCast E039 - Geriatric Trauma](https://canadiem.org/crackcast-e039-geriatric-trauma/) - This episode of CRACKCast cover’s Rosen’s Chapter 039, Geriatric Trauma. We see more and more elderly patients in our trauma bay as our population ages, and there are important distinctions in the management of this growing population. Shownotes - PDF Link [bg_faq_start] Rosen's in Perspective GERIATRIC trauma is on the rise Have increased morbidity and mortality ATLS - [CAEP FEI | Emergency Department Ultrasound Simulator (edus2)](https://canadiem.org/caep-fei-emergency-department-ultrasound-simulator/) - Dr. Bowles is an avid simulation enthusiast. She enjoys adding an extra edge to her cases by adding an agitated family member or an unhelpful consultant, or by integrating images of chest radiographs and electrocardiograms. Recently, she has had the idea of integrating ultrasound images but has been limited by her presentation software to either use still - [Requesting Consultations using Kessler's 5-Cs](https://canadiem.org/requesting-consultations-dr-rob-woods/) - Bad consults are bad for patients. Consulting colleagues is a critical skill in Emergency Medicine. The success of a good consultation is more than simply getting the consultant to come see the patient. Rather, it's about getting the best out of your consultant so that ultimately the patient benefits. Poor consultations not only make you look - [CRACKCast E003 - Pain Management](https://canadiem.org/crackcast-e003-pain-management/) - This episode of CRACKCast cover’s Rosen’s Chapter 003, Pain Management. This is an essential toolset to master, as this is a key thing that emergency physicians deal with everyday, for more reading on the subject check out the Rosen’s chapter itself. Show Notes - PDF Link [bg_faq_start] 1. Describe the steps in the afferent pain pathway - [CRACKCast E037 - Trauma in Pregnancy](https://canadiem.org/crackcast-trauma-in-pregnancy/) - This episode of CRACKCast covers Rosen's Chapter 37, Trauma in Pregnancy. It's amazing how much a body can change throughout pregnancy, and these changes warrant careful consideration by emergency physicians when a pregnant woman is involved in trauma. Show Notes - PDF here With trauma in pregnancy we need to think about blunt vs. penetrating trauma. Many - [CRACKCast E038 - Pediatric Trauma](https://canadiem.org/crackcast-e038-pediatric-trauma/) - This episode of CRACKCast cover’s Rosen’s Chapter 038, Pediatric Trauma. Fortunately most emergency departments do not see major pediatric trauma frequently; however, it is important for the emergency physician to have the knowledge and skills to feel confident managing these high stakes, and at times high stress, situations. Shownotes - PDF Link [bg_faq_start] Rosen's in Perspective: Compared - [National Rounds | Diagnostic Reasoning: Should we trust our gut?](https://canadiem.org/national-rounds-diagnostic-reasoning/) - 5On May 24th, 2016, Dr. Jonathan Sherbino (@sherbino) of McMaster University was invited to speak at Grand Rounds at the University of Saskatchewan on the topic of diagnostic reasoning. His presentation explained how physicians think of a diagnosis and how we can teach learners cognitive strategies to improve their diagnostic reasoning. This blog post has taken that - [CRACKCast E002 - Mechanical Ventilation](https://canadiem.org/crackcast-mechanical-ventilation/) - This episode of CRACKCast cover's Rosen's Chapter 002, Mechanical Ventilation. This is an essential toolset to master for the care of critically ill patients and for more reading surrounding the principles and physiology of mechanical ventilation check out the Rosen's chapter itself. Shownotes - PDF Link For Principles of the Ventilator see the PDF Shownotes [bg_faq_start] 1. What - [Medical Coaching: Don Miguel Ruiz's "Four Agreements"](https://canadiem.org/medical-coaching-don-miguel-ruizs-four-agreements/) - In medicine and medical education, we're often hyper-focused on medical content, rather than the art of medicine. I recently finished reading Don Miguel Ruiz's book "The Four Agreements"1, and identified some excellent educational pearls for medical students, residents and practicing physicians; pertaining to self-awareness and belief systems. In his book (albeit with a rather religious theme) Ruiz - [CRACKCast E036 - Multiple Trauma](https://canadiem.org/crackcast-multiple-trauma/) - This episode of CRACKCast covers Chapters 36 of Rosen's Emergency Medicine - Multiple Trauma. Trauma is the leading cause of death in people aged 1-44 years and is therefore an essential aspect of emergency medicine. Show Notes - PDF Link Trauma Systems Regionalized trauma systems have been shown to decrease mortality by 15-25% General goal - [CRACKCast comes to CanadiEM](https://canadiem.org/crackcast-comes-canadiem/) - Those of you who are following the CanadiEM Podcast and RSS Feed may have noticed some suspicious activity this week. Overnight, every episode of the exceptional CRACKCast Podcast has joined the CanadiEM podcast library along with the stellar Physicians as Humans series. Today, the CanadiEM Editorial Team are proud to officially1 announce that the CRACKCast Boys are bringing - [Tiny Tips: History taking in a returning traveler](https://canadiem.org/tiny-tips-returning-traveler-history/) - Following a trip abroad, up to 8% of travelers will present for medical attention1. Many of these complaints are mild, but some are life-threatening. A detailed travel history and history of the presenting illness are essential in identifying serious illnesses and preventing over-investigation of more common non-dangerous infectious complaints (i.e. URTI’s). An easy mnemonic to help - [CAEP GeMES | The effectiveness of feedback by faculty to learners is often challenged by faculty factors](https://canadiem.org/caep-gemes-effectiveness-feedback-faculty-learners-often-challenged-faculty-factors/) - Dr. Hoag thoroughly enjoys working with Penelope, one of the senior residents at his hospital. He admires her knowledge, diligence on shifts and involvement in academic pursuits. Outside of the hospital, Dr. Hoag has become a mentor to Penelope, and often offers career advice. One day, Dr. Hoag observes Penelope treat a difficult psychiatric patient, - [CaRMS Rodeo - How to prepare for a crazy ride](https://canadiem.org/carms-rodeo/) - In the Canadian Residency Matching Service(CaRMS) applicants apply to all programs and, if selected for interview, rank these programs. The residency programs also rank all the interviewees [which is becoming increasingly difficult]. The computer spits out a match. In bull riding, the rider is matched to the bull randomly before the competition, however, since 2008 some - [Making the Most of Chart Reviews](https://canadiem.org/making-chart-reviews/) - A few months back Dr Eddy Lang (@EddyLang1) [Co-editor of the Royal College Research Guide] graced us with his kind and friendly personality and dropped some pearls on retrospective chart reviews. Medical Record Review [MRR] Research in General aka Chart Reviews "Chart reviews don't get the respect they may deserve" Dr Lang Dr Lang lamented the - [Email Etiquette: Thou Shalt Not CC Everybody](https://canadiem.org/email-etiquette-thou-shalt-not-cc/) - I was reflecting on a recent conversation with my sister-in-law about someone who sent a farewell email to her entire company. We debated the appropriateness of this, and email etiquette in general. It made me think of stupid things that I have done with email. I thought that I'd share. Ever hit "reply all" by - [Failure to Fail Part 3 - A Prescription for Better Evaluation in the ER](https://canadiem.org/failure-fail-part-3-better-evaluation/) - Introduction: In the last two posts (post 1, post 2) I introduced the fact that there exists a culture of 'failure to fail' in medicine. Faculty themselves have a large part to play and, apart from being too lenient, also unwittingly introduce bias during learner evaluations.In this final post I want to share my approach - [Emotional Intelligence and How It Can Make You a Selfish Altruist](https://canadiem.org/emotional-intelligence/) - I am a fan of Twitter. I use it to "keep my finger on the femoral pulse of Emergency medicine". Thanks to one of my Tweeps [twitter peeps] Dr Sam Ko [Twitter link] I came across this talk on Emotional Intelligence by author Chade-Meng Tan. You can see the talk yourself here. I have recently taken - [Acknowledging Death in the ER](https://canadiem.org/acknowledging-death-in-the-er/) - Picture the following: A resuscitation is in progress for an elderly gentleman. Health care providers try frantically to restore signs of life. Chest compressions are ongoing, a breathing tube is placed, large intravenous line inserted, electrical shocks and medications given. Eventually the team realizes that they have exhausted all possibilities. To do more would be - [Pearls of Evaluating Psych Patients in the ER](https://canadiem.org/pearls-of-evaluating-psych-patients-in-the-er/) - Psychiatry presentations comprise about 5-6% of total presentations,1,2 but account for way more work. It's a common mis-perception that psych patients require a one-hour intensive interview in order to ascertain what they need. Not true. We got an inservice from one of our psychiatry faculty today. He allowed me to share his pearls on evaluating - [The Social Media Index (SM-Index): A Pilot Project](https://canadiem.org/the-social-media-index-sm-index-a-pilot-project/) - As promised last week, I have put together a pilot Social Media Index (SM-Index) for free open-access medical education (FOAM) websites. There were 25 sites included within this analysis. They were selected from the sites that I frequent as well as anyone that volunteered their site when I asked on twitter. This article discusses the - [FOAM Is Good for You!](https://canadiem.org/foam-is-good-for-you/) - I recently gave a talk on FOAM (or FOAM-ED) – Free Open Access Medical Education- an acronym coined by Mike Cadogan at the Dublin ICEM 2012 conference. The legend will state that the idea of FOAM was borne over a pint of Guinness and, like Guinness - FOAM is good for you! The concept of FOAM came about because Mike felt that the term "social - [CAEP FEI | Teaching medico-legal issues by bringing the court to the classroom](https://canadiem.org/teaching-medico-legal-issues/) - When it comes to medico-legal issues, many residents can summarize their thoughts into a single word: "fear." It is a topic not often formally taught and rarely openly discussed. Concrete examples and practical advice are frequently in short supply, with the occasional whispers of the case that ended in court. Other difficult topics have had many - [FLOW Hacks 1: A Novel ED Surge Protocol](https://canadiem.org/a-novel-ed-surge-protocol/) - Starting off the FLOW Hacks series is Dr. Edmund Kwok of The Ottawa Hospital, speaking to us about his innovation: A Novel ED Surge Protocol Based on Input-Throughput-Output Model of ED Flow (link). [bg_faq_start] FLOW Hacks: The Concept The FLOW (Featured Leadership & Organizational Workplace) Hacks Series highlights innovative strategies for increasing patient flow in the emergency department - [CJEM Infographic: Comparison of Sacco vs START triage using a virtual reality scenario with paramedic students](https://canadiem.org/cjem-infographic-comparison-sacco-vs-start-triage-using-virtual-reality-scenario-paramedic-students/) - 1This month CanadiEM is features an article recently published in the Canadian Journal of Emergency Medicine (CJEM) that compares the Sacco and START triage methods.2 The START (Simple Triage and Rapid Treatment) triage method is the most commonly used triage method worldwide and sorts patients based on their vitals and ability to walk. By contrast, the - [CJEM Infographic: How accurate are instructors at assessing CPR quality?](https://canadiem.org/cjem-infographic-accurate-instructors-assessing-cpr-quality/) - This month CanadiEM features an article recently published in the Canadian Journal of Emergency Medicine (CJEM) that focuses on the assessment of CPR quality by instructors.1 Since instructors teaching CPR do not have access to objective measures of CPR quality (rate, depth, fraction), they must rely on subjective assessments.2 As outlined in this CanadiEM infographic, this study - [We welcome ERMentor, Nadim Lalani, to CanadiEM!](https://canadiem.org/welcome-ermentor-nadim-lalani-canadiem/) - Dr. Nadim Lalani has been a member of the FOAM (Free Open Access Medical education) movement longer than most. He was one of the folks around that bar table in Dublin when the term FOAM was coined and had one of the earlier websites, ERMentor.com. Back when I was a little 2nd year resident I recall - [Publish your Research: Insights from Dr. Brian Rowe](https://canadiem.org/publish-your-research/) - Dr Rowe is pound-for-pound one of the best EM researcher in Canada, especially considering he completed the majority of his research on a shoe-string budget while managing a formidable career. His prolific and high-quality research has resulted in the publication of one book, 28 book chapters, and over 385 peer-reviewed manuscripts. It goes without saying he - [Delivering a great presentation in medicine](https://canadiem.org/delivering-a-great-presentation-in-medicine/) - It's orientation week for our new residents in Saskatoon. As we pride ourselves on our presentation abilities at my institution, part of the transition to residency was a talk about creating a great presentation by my brilliant colleague Rob Woods. Read on to learn from his wisdom. Why do you need to give a great presentation? We've all gone to - [Failure to Fail Part 1- Why faculty evaluation may not identify a failing learner](https://canadiem.org/failure-to-fail-part-1/) - I recently gave a talk to fellow faculty on the phenomenon of "failure to fail" in emergency medicine. I am no expert, but I have tried to synthesize the details in a useful way. I have broken it down into three parts. Part 1 deals with the phenomenon of Failure to Fail. In two follow - [Failure to Fail Part 2: Types of Evaluation Bias](https://canadiem.org/failure-fail-part-2-evaluation-bias-opportunity-effective-evaluation/) - We know that the best way to evaluate learners is by directly observing what they do in the workplace. Unfortunately [for a variety of reasons] we do not do enough of this. In my last post I described some reasons why we sometimes fail at making appropriate judgments about failing learners. When it comes to - [Can We Reduce Lawsuits with Better Communication?](https://canadiem.org/reduce-lawsuits-with-better-communication/) - One concern when practicing in the world of Emergency Medicine is fear of litigation. This fear often leads to defensive medicine practices and over-testing of our patients.1 One of the main reasons patients seek legal recourse, however, is mis-communication, and not under-testing.2–4 In primary care research, better interpersonal communication and increased time spent with patients are shown - [My Approach to Clearing C-Spines](https://canadiem.org/clearing-the-c-spine/) - I gave a talk the other day on clearing C-Spines, with Prezi linked here. As a disclaimer, this is my approach based on my clinical experience and from reading the literature - you should discuss this amongst your colleagues and review the literature to see if you reach the same conclusions. I would appreciate some comments - [Coached Peer Review](https://canadiem.org/coached-peer-review/) - The CanadiEM team is pleased to announce that our novel Coached Peer Review process (the review process that we use to review and publish the articles on this blog) has been published as an Innovation Report in Academic Medicine! Coached Peer Review is a novel process we’ve developed which aims to provide a rigorous peer - [Medical Concepts: Acute Pancreatitis - A Pain in the Back](https://canadiem.org/medical-concepts-acute-pancreatitis-pain-back/) - The trauma bay is swamped, rooms are a scarce commodity and inpatient beds are in even more dubious supply. You set your coffee down and prepare to go see your newest patient, a 65-year-old male complaining of abdominal pain. Flipping through his chart, you note that he is tachycardic at 113 bpm and febrile with - [CAEP FEI | Using Clinical Grade Cadavers for High-Fidelity Simulation](https://canadiem.org/caep-fei-using-clinical-grade-cadavers-high-fidelity-simulation/) - It seems that every medical student does his or her first sutures on pig's feet. Although pragmatic, students quickly learn that there are many differences between the the texture and thickness in pig skin compared to live human tissue. For many procedures, especially those that are rare like the thoracotomy or surgical airway, these differences may - [Teaching Trainees at Different Levels in the ED](https://canadiem.org/teaching-trainees-at-different-levels-in-the-ed/) - Like many institutions, we have a mix of EM resident learners rotating through our departments. Expectations and competencies of junior learner differ greatly from that of a senior learner. For Example: PGY 1 - Focus on clinical skills e.g. Xray reading and procedures PGY2-4 - Focus on more challenging patient encounters e.g. medical and procedural - [#TipsForNewDocs | How to give a great Consult](https://canadiem.org/tipsfornewdocs-how-to-give-a-great-consult/) - There is nothing quite as daunting as dialing up a consultant service for the first time. As a clerk, I hated paging anyone because I worried that I would be interrupting them in the midst of something important or would get stumped by their questions. As a resident, I feel more relaxed because I’ve developed - [Medical Assistance in Dying (MAID) in the ED: Implications for EM Practice](https://canadiem.org/medical-assistance-dying-maid-ed-part-ii/) - After an excellent introduction to Medical Assistance in Dying, and its potential impact upon the Healthcare System, Dr. Francis Bakewell takes a further look at potential implications and ramifications within the Emergency Department (ED). Last week, after much review and attempts at amendment by the Senate, the federal government’s legislation on Medical Assistance in Dying - [Tiny Tip: BISAP for Pancreatitis](https://canadiem.org/tiny-tip-bisap-pancreatitis/) - EDITOR'S NOTE: I often struggle with determining whether the presentation is pancreatitis or whether it's PANCREATITIS. There are a number of scoring systems to help evaluate this question but one in particular is nicely suited to the Emergency Department. I like Doran's Tiny Tip that can help you remember some of the key features to consider. - EP - [How Can EM Faculty Be Better Evaluators?](https://canadiem.org/how-can-em-faculty-be-better/) - One of my colleagues - Dr Van De Kamp - gave us a talk on how we can improve on our evaluations of learners. [I have taken her talk and added some of my own reflections/literature].Duff et al in 2003 illustrate: "Giving the benefit of the doubt has consequences for future mentors, students and, may - [Physicians as Humans Podcast E01: An Addiction that Almost Killed Me](https://canadiem.org/addiction-almost-killed/) - On behalf of the Physicians as Humans project, I’m thrilled to present the first episode of the series: An Addiction that Almost Killed Me. If you are unfamiliar with the project, please read this post for more information on the origin of this podcast series. In this first episode I speak with a Canadian medical student about his personal battle with - [Tiny Tip: The Ottawa Ankle and Foot Rules - To Image or Not to Image](https://canadiem.org/tiny-tip-ottawa-ankle-foot-rules-image-not-image/) - Ankle and foot injuries are common presentations to the Emergency Department, and it can often be difficult to know whether imaging is required. In 1992, Dr. Ian Stiell and his colleagues developed The Ottawa Ankle Rules 12 to facilitate this decision. The Ottawa ankle and foot rules are highly sensitive and widely used as a tool to reduce unnecessary imaging in Emergency Departments. - [Medical Assistance in Dying (MAID)](https://canadiem.org/medical-assistance-dying/) - Very soon, the law against assisted suicide in Canada will cease to exist, but exactly what happens next remains to be seen. On April 14th, the federal government tabled Bill C-14 in an attempt to legalize the process of medical assistance in dying (MAID). The bill is currently making its way through Parliament, but may not be - [CAEP FEI | Neonatal Resuscitation Skills Training](https://canadiem.org/caep-fei-neonatal-resuscitation-skills-training/) - A seasoned emergency physician, Dr. Jensens has not practiced resuscitating an infant since he was a resident and hasn't actually participated in a neonatal resuscitation since he was a medical student. He notices a circulating departmental email asking for volunteers to help run an "in-situ" simulation session next week, with the topic of "Neonatal Emergencies." - [Courage to Make Lemonade](https://canadiem.org/courage-to-make-lemons/) - I just found out that a colleague and mentor [to whom I owe much] had a skiing accident in which he broke his neck. It's early days, but the outcome may not be so good. From what I hear he was joking around before going in for an 11-hour spine operation. He was joking about - [Elusive OMSS The Definitive Medical Explanation](https://canadiem.org/old-man-strength/) - After having seen several cases I thought that this was important enough to share. [Can't believe that this hasn't been published in a major journal]. Below I describe the pathophysiology and teleology and then finish up with two cases from recent memory. Introduction: "did you see grandpa pick up that keg of beer?" ..."Yeah he - [... --- ... LWBS ...---... ER inpatients ...---... EMS park ...---... Overcapacity](https://canadiem.org/lwbs-er-inpatients-ems-park-overcapacity/) - We had our inaugural residency retreat last month! Our guest speaker was Dr Paul Parks - a humble affable family man and Emergency Physician who was unwittingly thrust into the public eye after Emails were leaked documenting failures in the Alberta Health Care system resulting in ER "suboptimal outcomes". Dr Parks and colleagues documented - [Type and SCREAM STAT! Futility of ordering routine Blood Type and Screens in the ER](https://canadiem.org/type-and-scream-stat/) - My awesome hematology colleague Dr Karen Dallas was here again - giving us a learn-on on a recent audit of routine Type and Screen testing in our ER's Background: Our biggest ER routinely sends a STAT Type & Screen to the Transfusion Medicine Lab [TML]. These requests are often accompanied with a request for blood. - [Contagion - Pearls on Working Through a Pandemic](https://canadiem.org/contagion/) - Unlike my usual posts this one is more 'medical' so here's my disclaimer: the following is my opinion. You need to read around my post and make up your own mind. This one of the best products in the market with the added value that refrigeration is not necessary. Our Online Canadian Pharmacy is also accredited - [Reflections on Efficiency](https://canadiem.org/reflections-on-efficiency/) - I was at a great conference on Emergency Medicine in San Francisco. My wife and I went to a diner for breakfast. While there I was struck by how efficient the whole experience was. I think that things that made this experience really efficient were: Enough space so we didn't wait in line Menu's already - [Reflections on Stewardship](https://canadiem.org/reflections-on-stewardship/) - I came across this posting from one of my fav blogs [here's the original link]. It made me think about stewardship. What is stewardship and why is it important? So I did a quick lit search and came across an article from PubMed. The article talks about how to start good stewardship regarding antibiotics in - [Terrific T6 Talks - CanWHA?](https://canadiem.org/terrific-t6-talks-canwha/) - Thanks to Rob Woods for this: CanMEDS is a term unfamiliar for many current practicing physicians. The term stands for: Canadian Medical Education Directives for Specialists. It was born out of a concept called 'Outcome-Based Education'. The idea is that you should first decide what the product you want is, then design your assessment tools - [Terrific T6 talks - Teaching in a Busy ER](https://canadiem.org/terrific-t6-talks-teaching-in-a-busy-er/) - The Learning Context: Includes: Physical climate Emotional climate Intellectual climate Has definite effects on: Academic achievement Satisfaction Aspirations It's therefore important to foster a positive learning environment: Absence of hunger and sleep deprivation. Learning is perceived to be a priority. Safe environment. FUN environment. Individual needs and goals met. Learners are part of the team. - [Terrific T6 talks - Assessment](https://canadiem.org/terrific-t6-talks-assessment/) - Amazing product. One of the most affective products I have tried on the market. Generic cialis online. Online Canadian Pharmacy provides one of quickest and easiest ordering processes available oline today. Carleton University has a neat resource for TA's that is useful for all wanna-be educators. Here are tips for Clinicians regarding assessment of - [Terrific T6 talks - The Problem Learner](https://canadiem.org/terrific-t6-talks-the-problem-learner/) - Exercise: Reflect on the type of student that annoys/clashes with you. What type of student do you have no idea how to work with? Generally teachers avoid voicing negative feelings towards learners, but in truth there will always be a student that pushes your understanding, patience and goodwill to the limit. How do you deal? - [Terrific T6 talks - Giving Feedback](https://canadiem.org/terrific-t6-talks-giving-feedback/) - Most educators know how to give feedback using the "SH#T Sandwich Technique" [Good points followed by bad points followed by a "there's still hope for the future" statement]. Here's a great link by the Alberta Rural Physicians Action Plan that provides concise and high-quality teaching tools for clinicians including how to give effective feedback.[bookmark this - [Terrific T6 talks - Teaching Clinical Reasoning](https://canadiem.org/terrific-t6-talks-teaching-clinical-reasoning/) - The SNAPPS approach Unsatisfied with teaching historically "passive" learners in the outpatient context, Wopaw and co[ Link ] created this paradigm. They believed that it would allow more engagement during case presentations - linking learner initiation and preceptor facilitation in an "active learning conversation".SNAPPS stands for: (1) Summarize briefly the history and findings. (2) Narrow - [Terrific 'train the trainer to teach trainees' (T6) talks - Diagnosing the Learner](https://canadiem.org/terrific-train-the-trainer-to-teach-trainees-talks-diagnosing-the-learner/) - Recently participated in a Faculty Development workshop with some brilliant colleagues - Dr Rob Woods together with Sean Polreis and Deirdre Bonnycastle [see her work on my fav links page] . Below I will share the pearls that I gleaned. Some of the concepts derived from the ED STAT course put on by the Canadian - [This Just in! BIBEMS suppositorium stat! [LOL]](https://canadiem.org/this-just-in-bibem-suppositorium-stat-lol/) - My good friend and colleague Mark Wahba [read his brilliant ideas here]gave a talk at half day ... he referred to a patient as a "BIBEM". ... I am thinking " what's a BIBEM? [as in Justin Bieber]" - NO! ... turns out that this stands for Brought In By EMS. Later that night I - [Uphill both ways ... in my dad's pyjamas!](https://canadiem.org/uphill-both-ways-in-my-dads-pyjamas/) - Imagine being at a conference where 1 in 3 attendees are depressed and 1 in 5 wish they were somewhere else ... fun conference? I was reflecting on my residency when I wished that an attending would have stuck up for me just once when I was getting abused - three particular nurses, two residents - [Trust me! (no explanation required)](https://canadiem.org/trust-me-no-explanation-required/) - Two stories: ONE Yesterday I had a patient come to the ER because she didn't trust the family doctor she had just seen at the clinic who "gave me a prescription for puffers worth hundreds of dollars without even listening to her chest!"' I did my usual and diagnosed the child with reactive airways (likely - [Thou Shalt Not Oompa-Loompantasize Children](https://canadiem.org/thou-shalt-not-oompa-loompantasize-children/) - Got a letter of praise forwarded to the ER manager by the Patient Advocate Office the other day ... ZZZZZT! Wha? Did he just say "praise" or did he say "complaint" ... [re-read ... no it says "praise"]. Staggering! Furthermore it came from a patient encounter that I had in paeds ER. Hmm ... I - [Pacemaker Essentials: How to Interpret a Pacemaker ECG](https://canadiem.org/pacemaker-essentials-interpret-pacemaker-ecg/) - Is that pesky pacemaker still causing you trouble? It means well but sometimes it can rub emergency physicians the wrong way. Let’s shift our focus to the ECG, and hopefully we’ll discover some pearls to help us with these troublesome devices. - [Alcohol related diseases](https://canadiem.org/alcohol-related-diseases/) - The intoxicated patient is commonplace in the Emergency Department (ED), typically there is little clinical concern with these patients, and they are set up for the "breakfast plan"; to discharge them home once they are conversing and ambulating normally. These patients, however, have the potential to have significant alcohol related diseases are often under-diagnosed and under-recognized, and we - [Does that condition require investigation?](https://canadiem.org/does-that-condition-require-investigation/) - This post examines five commonly performed investigations (CT in minimal head injury, CXR in chest pain, investigations in Syncope/AFib/Renal Colic) in the Emergency Department (ED) to determine if the evidence exists to support current practice patterns. - [Tiny Tips: SALTR for Pediatric Growth-plate Fractures](https://canadiem.org/saltr/) - Up to one half of all children’s visits to the ED are orthopedic in nature [1]. Of these visits, approximately 35% are fractures that involve the growth plate, or physis, of a developing bone [2]. ED physicians must be familiar with the Salter-Harris classification system, which is the most commonly used system [3] for describing - [An open letter to ER nurses](https://canadiem.org/an-open-letter-to-er-nurses/) - I would like to think that we do a reasonable job recognizing and acknowledging nurses for all of the hard work that they do, compassion, caring nature and dedication to their work. We often talk about what nurses do for patients and their positive impact upon the healthcare system, but as we enter the busy holiday - [Defining a Specialty: What is an emergency physician?](https://canadiem.org/defining-a-specialty-what-is-an-emergency-physician/) - In January of this year, the Canadian Association of Emergency Medicine (CAEP) released a position statement on Emergency Medicine Definitions (go ahead, have a read). The statement provided explicit definitions of what the specialty of EM encompasses, as well as what should constitute an EM physician or specialist, and led to very strong and polarized - [CAEP GeMES | Those Who Can, Do and They Teach Too: Faculty Clinical Productivity and Teaching](https://canadiem.org/caep-gemes-can-teach-faculty-clinical-productivity-teaching/) - Valerie is always irked by the layman's expression, "Those who can't do, teach." In her experience, she has found that the great clinical teachers seem to be more engaged in the academic community and are invested in patient education. Indeed, Valerie finds that any additional time they spend with students or patients is well worth it. On - [Improving healthcare as a resident: Working on the system](https://canadiem.org/improving-healthcare-as-a-resident/) - I am currently at the midpoint of a five-year RCPSC residency specializing in emergency medicine. I’d like to briefly share my experience to date as a medical resident in Canada. The major focus encompasses gaining valuable experience providing high quality patient care, often by working long hours. The best learning typically comes in the clinical - [The real challenge with the #IceBucketChallenge.](https://canadiem.org/the-real-challenge-with-the-icebucketchallenge/) - Social media went a little bit nuts recently. Newsfeeds on multiple platforms were flooded with short video clips of individuals dunking ice-cold water onto themselves (or variations of), all in the name of raising awareness and funding for ALS, under the label of #IceBucketChallenge And like all viral trends, the skeptics and critics weren't far - [CAEP FEI | Daily Faculty Evaluations](https://canadiem.org/caep-fei-daily-faculty-evaluations/) - Dr. Rosenberg prides herself on the effort she places into teaching students on each shift, but she is not sure whether her teaching methods are effective. At the end of the academic year, she reviews her evaluations from students and is disappointed when she finds only a handful of generic evaluations, with the majority of her students not - [Tiny Tip: Ranson's Criteria in Pancreatitis](https://canadiem.org/tiny-tip-ransons-criteria-pancreatitis/) - Editor's Note: Last week we ran a tiny tip for the BISAP score which is an emergency department friendly way to evaluate the severity of disease. The more traditional RANSON criteria hasn't gone completely out of style though. It may be particularly helpful when coordinating admission and prognosticating in those who will become inpatients. Ranson’s Criteria - [Help wanted! CanadiEM Editorial Team is searching for 3 new members](https://canadiem.org/help-wanted-canadiem-editorial-team-searching-3-new-members/) - The CanadiEM Team is expanding! We have a lot of projects on the go and several more in the works. We are seeking 3 new members: one to help with a new pediatric emergency medicine series and two to assist with the behind-the-scenes management of the blog. - [Resource utilization: how we can help the healthcare system](https://canadiem.org/resource-utilization-how-can-we-help/) - The healthcare system in Canada is in trouble, and physicians have a significant role to play in order to address many of the shortcomings, particularly in regards to resource utilization. - [CAEP Consensus Conference | Review Papers](https://canadiem.org/caep-consensus-conference-review-papers/) - The Problem Medical education research is hard. However, many residents and junior staff take a shot at it. Review papers are some of the most valuable and challenging types of papers to write in medical education. It can be overwhelming for a resident or junior faculty to take them on. A Step In the Right Direction - [CAEP Consensus Conference | Quantitative Research](https://canadiem.org/caep-consensus-conference-quantitative-research/) - Medical education research is hard. However, many residents and junior staff take a shot at it. It starts out fun - with the implementation of an innovative new way to do something! The momentum continues when the early results come in and you are able to attend a conference like CAEP to present. Everyone is fascinated with what you've done and wants to learn about your work. And then you get home, and your mentor turns to you and asks: "How's the paper going? Have you written this up yet?" You sigh, and think: "If only there was a guide on how to get published in #MedEd..." - [Tragedy of the Commons: A Healthcare Perspective](https://canadiem.org/tragedy-commons-healthcare-perspective/) - The Tragedy of the Commons is by no means a new theory, nor it is an novel discussion point within the healthcare system. It is, however, quite alarming that despite our awareness of the phenomenon, we continue to exploit it with little consideration for the future of healthcare. Tragedy of the Commons The Tragedy of the Commons ## Pages - [Submissions](https://canadiem.org/submissions/) - Editor's Note: As of July 2024, we are no longer accepting new submissions to CanadiEM. -DT Do you want to contribute to CanadiEM? We are always looking for quality help! We accept submissions of content that is of national interest for Canadian emergency physicians, covers key medical concepts in emergency medicine, and/or addresses important healthcare issues. If you - [Editorial Board](https://canadiem.org/about/editorial-board/) - [Disclaimer](https://canadiem.org/about/disclaimer-copyright/) - While CanadiEM is many things, there are many things that it is not. This disclaimer outlines those things. Accuracy CanadiEM makes every effort to publish only correct information. We will double check our facts, but please realize that medicine is constantly changing and that one physician may interpret the available evidence differently from another. We are simply presenting our views on - [About](https://canadiem.org/about/) - [Blood & Clots](https://canadiem.org/bloodandclots/) - Welcome to the CanadiEM Blood & Clots series. This series of online educational resources focuses on some of the most difficult dilemmas we face in medicine today: how to manage patients who are bleeding, clotting, or both. Content Developed by the Blood & Clots Team Interactive Quizlets Quizlet 1: Oral Contraceptives and Pulmonary Embolism Quizlet 2: Trauma - [Privacy Policy](https://canadiem.org/privacy-policy/) - Cookie policyThis website will store some information about your preferences on your own computer inside a tiny file called a cookie. A cookie is a small piece of data that a website asks your browser to store on your computer or mobile device. The cookie allows the website to remember your actions or preferences over time. - [CanadiEM MVP Infographic Series](https://canadiem.org/mvp-infographic-series/) - Introducing the CanadiEM MVP Infographic Series [bg_faq_start] Evidence-based practice is critical for delivering quality emergency care, but with such a broad specialty identifying and recalling high-yield studies can be challenging. This is especially true for new EM learners, who are tasked with becoming evidence-informed while transitioning to practice. To make this process easier, CJEM recently - [Terms of Use Agreement](https://canadiem.org/about/terms-of-use-agreement/) - It is important that you read all the following terms and conditions carefully. This Terms of Use Agreement (“Agreement”) is a legal agreement between you, CanadiEM, and the owners and operators (“Owner”) of this Website (the “Website”). It states the terms and conditions under which you may access and use the Website and all written - [Arts PRN Gallery](https://canadiem.org/arts-prn-gallery/) - [#TipsforEMexams: Exam Tips and Tricks](https://canadiem.org/tipsforemexams/) - This group of articles is inspired by the ALiEM.com "How I work smarter series", we present to you the BoringEM "Tips for EM Exams" series. In an effort to share insights and tips about various EM board and certification exams, we are asking former grads to share their study tips for final year residents. We - [Life in Medicine](https://canadiem.org/life-in-medicine/) - Decidedly Un-Boring Insiders Guide to a Life in Medicine (#DearPreMed) These editorials were assembled originally in response to a Globe & Mail article that came out on July 15, 2014. Other very good responses emerged as well, but the BoringEM editorial team launch a 1 week event to aggregate reflections from all across the educational ## Portfolio - [Chinese Medicine](https://canadiem.org/portfolio/chinese-medicine/) - This piece was inspired from a trip I took to the Hong Kong Museum of Medical Sciences over the summer. The gallery displayed various aspects of Western medicine but also displayed the history of Traditional Chinese Medicine. As I walked through the gallery I was reminded of my identity as a Chinese Canadian. I reflected - [Moments: Remedy in Motion](https://canadiem.org/portfolio/moments-remedy-motion/) - Abstract Last year I had developed some problems in my right leg, which had hindered much of its mobility and had consequently led to cutting back the activities that brought me joy and kept me in good health. Sometimes within the field of health, there is not too much that can be done, and accommodating - [Moments: 7 wonderful works of Dr. Carl Abbott](https://canadiem.org/portfolio/moments-7-wonderful-works-dr-carl-abbott/) - Make sure to scroll through these amazing watercolour paintings! Use the left and right arrows overlaid on the images; there are 7 in total. [bg_faq_start] Comment on the lighthouses (Paintings 1-3): There are three: Point Amour (Labrador), Long Point (Twillingate) and George’s Island (Halifax harbor). “I love lighthouses. That’s why I paint them. Some are unfortunately - [Moments: Perception](https://canadiem.org/portfolio/moments-perception/) - It's all we see. It consumes us. It is our reality. But what is it really? Nothing but a mere image projected on to an intricate layer of highly specialized cells. Almost instantaneously capturing moments. Breakable, taint-able, albeit, powerful. It is worth noting how easily perceptions can be altered. All it takes is a single - [Moments: Harmony in Healing](https://canadiem.org/portfolio/moments-harmony-healing/) - the heart and the mind, two entities, often in conflict the mind pierces the heart with the sharp edges of its jagged thoughts, the heart retaliates, changing its vital rhythm, creating a fog of disarray and desolation and so they engage in a hasty tango, in an arms race, in a relentless competition, However, they - [Moments: Tell me what you see](https://canadiem.org/portfolio/moments-tell-see/) - “Tell me what you see” is a phrase that, for me, triggers the feeling of analysis and introspection. It makes me process in words what my eyes see. However, it is sometimes difficult to dissociate myself from what I perceive; often, I find that I unknowingly impose a mask of emotions and experiences onto whatever - [Moments: Grow](https://canadiem.org/portfolio/moments-grow/) - Abstract In medicine, we heal. We work relentlessly, administering medication, performing surgical interventions, and, literally, mending broken hearts. Often, the wards of a hospital can appear dreary, swarming with exhausted healthcare practitioners and suffering patients. However, there is so much beauty in it all - so much potential for growth for everyone involved. Finding a - [Moments: The Human Composition](https://canadiem.org/portfolio/moments-human-composition/) - Flesh and bones, is that the extent of the human composition? What about mind and soul, do those intangible entities merit more focused attention? Geographic location and cultural assimilation, does one feel their weight in the tongue as pronunciation is expressed in the form of a name that bears agnation? Yes, all those components add - [Spot the Diagnosis: The Case of the Recluse](https://canadiem.org/portfolio/the-case-of-the-recluse/) - A lover of self-portraits and still-lifes, Dick Ket is a Dutch painter who spent most of his life as a recluse, creating artwork in his parents' secluded home. Unfortunately, he died at just 37 years old as a result of deteriorating health from a life-long medical condition. What diagnosis do you think Ket may had - [Moments: Supporting Life](https://canadiem.org/portfolio/moments-supporting-life/) - There is fine balance in medicine like in nature. We gather strength from our roots, from our connections. We rely on our bodies, and spines, to keep us well supported and well grounded moment to moment. And with this balance, we can flourish into something beautiful and full of life. And when we flourish together, ## Categories - [Uncategorized](https://canadiem.org/category/all/uncategorized/) - [Knowledge Translation](https://canadiem.org/category/all/medical/knowledge-translation/) - [Medical Concepts](https://canadiem.org/category/all/medical/) - [Mentorship](https://canadiem.org/category/all/education-quality-improvement/mentorship/) - [Featured](https://canadiem.org/category/featured/) - [Tiny Tips](https://canadiem.org/category/all/medical/tiny-tip/) - [Chalk Talks](https://canadiem.org/category/all/medical/chalk-talks/) - [Counterpoint](https://canadiem.org/category/all/opinion/counterpoint/) - [Clinical Questions](https://canadiem.org/category/all/medical/clinical-questions/) - [TipsForEMExams](https://canadiem.org/category/all/education-quality-improvement/mentorship/tipsforemexams/) - [Infographics](https://canadiem.org/category/all/medical/infographics/) - [All Posts](https://canadiem.org/category/all/) - All posts on the CanadiEM website - [Opinion](https://canadiem.org/category/all/opinion/) - 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[Professional Development](https://canadiem.org/tag/professional-development/) - [Continuing Medical Education](https://canadiem.org/tag/continuing-medical-education/) - [CME](https://canadiem.org/tag/cme/) - [Twitterverse](https://canadiem.org/tag/twitterverse/) - [Bayesian Statistics](https://canadiem.org/tag/bayesian-statistics/) - [Bayes Theorem](https://canadiem.org/tag/bayes-theorem/) - [Likelihood Ratio](https://canadiem.org/tag/likelihood-ratio/) - [Pre-test Probability](https://canadiem.org/tag/pre-test-probability/) - [Post-test Probability](https://canadiem.org/tag/post-test-probability/) - [TheNNT](https://canadiem.org/tag/thennt/) - [Nate Silver](https://canadiem.org/tag/nate-silver/) - [The Signal and the Noise](https://canadiem.org/tag/the-signal-and-the-noise/) - [#EMConf](https://canadiem.org/tag/emconf/) - [Academic half-day](https://canadiem.org/tag/academic-half-day/) - [Didactics](https://canadiem.org/tag/didactics/) - [FOAMFeeds](https://canadiem.org/tag/foamfeeds/) - [Epilepsy](https://canadiem.org/tag/epilepsy/) - [status epilepsy](https://canadiem.org/tag/status-epilepsy/) - [CaRMS Applications](https://canadiem.org/tag/carms-applications/) - [CaRMS CV](https://canadiem.org/tag/carms-cv/) - [CV](https://canadiem.org/tag/cv/) - [Blog](https://canadiem.org/tag/blog/) - [Guest Blog](https://canadiem.org/tag/guest-blog/) - [Blogging](https://canadiem.org/tag/blogging/) - [Multi-site](https://canadiem.org/tag/multi-site/) - [New blogger](https://canadiem.org/tag/new-blogger/) - [Medical Blog](https://canadiem.org/tag/medical-blog/) - [Personal Letters](https://canadiem.org/tag/personal-letters/) - [Residency Match](https://canadiem.org/tag/residency-match/) - [CaRMS Application](https://canadiem.org/tag/carms-application/) - [Saskatchewan](https://canadiem.org/tag/saskatchewan/) - [Physician retention](https://canadiem.org/tag/physician-retention/) - [Return-of-service](https://canadiem.org/tag/return-of-service/) - [Obligatory return-of-service](https://canadiem.org/tag/obligatory-return-of-service/) - [Precordial thump](https://canadiem.org/tag/precordial-thump/) - [NNTLA](https://canadiem.org/tag/nntla/) - [NNT](https://canadiem.org/tag/nnt/) - [Acute Pain Control](https://canadiem.org/tag/acute-pain-control/) - [Opioids](https://canadiem.org/tag/opioids/) - [NSAIDs](https://canadiem.org/tag/nsaids/) - [Non-opioids](https://canadiem.org/tag/non-opioids/) - [Mnemonics](https://canadiem.org/tag/mnemonics/) - [Tips for new docs](https://canadiem.org/tag/tips-for-new-docs/) - [Letter](https://canadiem.org/tag/letter/) - [Invitation](https://canadiem.org/tag/invitation/) - [Ottawa SAH Rule](https://canadiem.org/tag/ottawa-sah-rule/) - [Pulmonary Edema](https://canadiem.org/tag/pulmonary-edema/) - [ARDS](https://canadiem.org/tag/ards/) - [nursing](https://canadiem.org/tag/nursing/) - [HELLP Syndrome](https://canadiem.org/tag/hellp-syndrome/) - [fibrinolysis](https://canadiem.org/tag/fibrinolysis/) - [KT Bite](https://canadiem.org/tag/kt-bite/) - [research](https://canadiem.org/tag/research/) - [teams](https://canadiem.org/tag/teams/) - [atrial fibrillation](https://canadiem.org/tag/atrial-fibrillation/) - [Aortic Dissection](https://canadiem.org/tag/aortic-dissection/) - [CT scan](https://canadiem.org/tag/ct-scan/) - [LHR](https://canadiem.org/tag/lhr/) - [pretest probability](https://canadiem.org/tag/pretest-probability/) - [Type A dissection](https://canadiem.org/tag/type-a-dissection/) - [Type B dissection](https://canadiem.org/tag/type-b-dissection/) - [CSF](https://canadiem.org/tag/csf/) - [Medical Concepts](https://canadiem.org/tag/medical/) - [Mentorship](https://canadiem.org/tag/mentorship/) - [Debrief](https://canadiem.org/tag/debrief/) - [Chalk Talks](https://canadiem.org/tag/chalk-talks/) - [weakness](https://canadiem.org/tag/weakness/) - [ECG](https://canadiem.org/tag/ecg/) - [hyphema](https://canadiem.org/tag/hyphema/) - [2014](https://canadiem.org/tag/2014/) - [Accountability](https://canadiem.org/tag/accountability/) - [alcohol](https://canadiem.org/tag/alcohol/) - [Analogy](https://canadiem.org/tag/analogy/) - [Bombing](https://canadiem.org/tag/bombing/) - [Boston Marathon](https://canadiem.org/tag/boston-marathon/) - [Canada](https://canadiem.org/tag/canada/) - [canada health act](https://canadiem.org/tag/canada-health-act/) - [canadian healthcare](https://canadiem.org/tag/canadian-healthcare/) - [cell phones](https://canadiem.org/tag/cell-phones/) - [confidentiality](https://canadiem.org/tag/confidentiality/) - [conservative party](https://canadiem.org/tag/conservative-party/) - [Costs](https://canadiem.org/tag/costs/) - [Disaster Planning](https://canadiem.org/tag/disaster-planning/) - [Disaster Preparedness](https://canadiem.org/tag/disaster-preparedness/) - [Doctors](https://canadiem.org/tag/doctors/) - [Economics](https://canadiem.org/tag/economics/) - [election](https://canadiem.org/tag/election/) - [ER](https://canadiem.org/tag/er/) - [federal election](https://canadiem.org/tag/federal-election/) - [flu shot](https://canadiem.org/tag/flu-shot/) - [Free healthcare](https://canadiem.org/tag/free-healthcare/) - [Health](https://canadiem.org/tag/health/) - [Health Accord](https://canadiem.org/tag/health-accord/) - [health care](https://canadiem.org/tag/health-care/) - [Health Council](https://canadiem.org/tag/health-council/) - [health tax](https://canadiem.org/tag/health-tax/) - [healthcare](https://canadiem.org/tag/healthcare/) - [healthcare costs](https://canadiem.org/tag/healthcare-costs/) - [high risk activity](https://canadiem.org/tag/high-risk-activity/) - [high risk behavior](https://canadiem.org/tag/high-risk-behavior/) - [hospitals](https://canadiem.org/tag/hospitals/) - [improvements](https://canadiem.org/tag/improvements/) - [infectious disease](https://canadiem.org/tag/infectious-disease/) - [Interprofessionals](https://canadiem.org/tag/interprofessionals/) - [liberal party](https://canadiem.org/tag/liberal-party/) - [Mass casualties](https://canadiem.org/tag/mass-casualties/) - [medical errors](https://canadiem.org/tag/medical-errors-2/) - [NDP](https://canadiem.org/tag/ndp/) - [neckties](https://canadiem.org/tag/neckties/) - [new year](https://canadiem.org/tag/new-year/) - [Nurse Practicioners](https://canadiem.org/tag/nurse-practicioners/) - [nurses](https://canadiem.org/tag/nurses/) - [Patient Safety](https://canadiem.org/tag/patient-safety/) - [Policy](https://canadiem.org/tag/policy/) - [politics](https://canadiem.org/tag/politics-2/) - [privacy](https://canadiem.org/tag/privacy/) - [private](https://canadiem.org/tag/private/) - [public](https://canadiem.org/tag/public/) - [Public healthcare](https://canadiem.org/tag/public-healthcare/) - [rankings](https://canadiem.org/tag/rankings/) - [recording](https://canadiem.org/tag/recording/) - [Scrubbing In](https://canadiem.org/tag/scrubbing-in/) - [smartphones](https://canadiem.org/tag/smartphones/) - [Socialized medicine](https://canadiem.org/tag/socialized-medicine/) - [suffering](https://canadiem.org/tag/suffering/) - [symptoms](https://canadiem.org/tag/symptoms/) - [Telemedicine](https://canadiem.org/tag/telemedicine/) - [Tough Mudder](https://canadiem.org/tag/tough-mudder/) - [TV](https://canadiem.org/tag/tv/) - [unhappy](https://canadiem.org/tag/unhappy/) - [United States](https://canadiem.org/tag/united-states/) - [vaccination](https://canadiem.org/tag/vaccination/) - [Virtual](https://canadiem.org/tag/virtual/) - [Wait times](https://canadiem.org/tag/wait-times-2/) - [War](https://canadiem.org/tag/war/) - [white coat](https://canadiem.org/tag/white-coat/) - [death](https://canadiem.org/tag/death/) - [resource utilization](https://canadiem.org/tag/resource-utilization/) - [healthcare spending](https://canadiem.org/tag/healthcare-spending/) - [Essentials of Emergency Medicine](https://canadiem.org/tag/essentials-of-emergency-medicine/) - [Essentials of EM](https://canadiem.org/tag/essentials-of-em/) - [EEM Fellowship](https://canadiem.org/tag/eem-fellowship/) - [Essentials of Emergency Medicine Fellowship](https://canadiem.org/tag/essentials-of-emergency-medicine-fellowship/) - [anecdotal evidence](https://canadiem.org/tag/anecdotal-evidence/) - [bias](https://canadiem.org/tag/bias/) - [reporting bias](https://canadiem.org/tag/reporting-bias/) - [confirmation bias](https://canadiem.org/tag/confirmation-bias/) - [regression to the mean](https://canadiem.org/tag/regression-to-the-mean/) - [thinking fast](https://canadiem.org/tag/thinking-fast/) - [heuristics](https://canadiem.org/tag/heuristics/) - [confounding](https://canadiem.org/tag/confounding/) - [availability bias](https://canadiem.org/tag/availability-bias/) - [anecdotes](https://canadiem.org/tag/anecdotes/) - [app](https://canadiem.org/tag/app/) - [winnipeg](https://canadiem.org/tag/winnipeg/) - [connected care](https://canadiem.org/tag/connected-care/) - [wait times app](https://canadiem.org/tag/wait-times-app/) - [CBME](https://canadiem.org/tag/cbme/) - [competency based medical education](https://canadiem.org/tag/competency-based-medical-education/) - [CBD](https://canadiem.org/tag/cbd/) - [competence by design](https://canadiem.org/tag/competence-by-design/) - [Royal college](https://canadiem.org/tag/royal-college/) - [counterpoint](https://canadiem.org/tag/counterpoint/) - [service and education](https://canadiem.org/tag/service-and-education/) - [tragedy of the commons](https://canadiem.org/tag/tragedy-of-the-commons/) - [canadian healthcare system](https://canadiem.org/tag/canadian-healthcare-system/) - [alcohol related diseases](https://canadiem.org/tag/alcohol-related-diseases/) - [wernicke's encephalopathy](https://canadiem.org/tag/wernickes-encephalopathy/) - [wernicke's](https://canadiem.org/tag/wernickes/) - [korsakoff's](https://canadiem.org/tag/korsakoffs/) - [alcohol ketoacidosis](https://canadiem.org/tag/alcohol-ketoacidosis/) - [B12 deficiency](https://canadiem.org/tag/b12-deficiency/) - [Folate deficiency](https://canadiem.org/tag/folate-deficiency/) - [CT Head](https://canadiem.org/tag/ct-head/) - [minor head injury](https://canadiem.org/tag/minor-head-injury/) - [minimal head injury](https://canadiem.org/tag/minimal-head-injury/) - [ED investigations](https://canadiem.org/tag/ed-investigations/) - [syncope workup](https://canadiem.org/tag/syncope-workup/) - [CXR](https://canadiem.org/tag/cxr/) - [chest pain](https://canadiem.org/tag/chest-pain/) - [renal colic](https://canadiem.org/tag/renal-colic/) - [FOAMe](https://canadiem.org/tag/foame/) - [MAID](https://canadiem.org/tag/maid/) - [Medical assistance in dying](https://canadiem.org/tag/medical-assistance-in-dying/) - [Bill C-14](https://canadiem.org/tag/bill-c-14/) - [Euthanasia](https://canadiem.org/tag/euthanasia/) - [assisted suicide](https://canadiem.org/tag/assisted-suicide/) - [failure to fail](https://canadiem.org/tag/failure-to-fail/) - [faculty evaluation](https://canadiem.org/tag/faculty-evaluation/) - [Authorship](https://canadiem.org/tag/authorship/) - [physician assisted suicide](https://canadiem.org/tag/physician-assisted-suicide/) - [Bill C14](https://canadiem.org/tag/bill-c14/) - [Canadian Syncope Risk Score](https://canadiem.org/tag/canadian-syncope-risk-score/) - [FLOW Hacks](https://canadiem.org/tag/flow-hacks/) - [four agreements](https://canadiem.org/tag/four-agreements/) - [medical coaching](https://canadiem.org/tag/medical-coaching/) - [self-awareness](https://canadiem.org/tag/self-awareness/) - [transformation](https://canadiem.org/tag/transformation/) - [intention](https://canadiem.org/tag/intention/) - [Red and painful eye](https://canadiem.org/tag/red-and-painful-eye/) - [SoMe](https://canadiem.org/tag/some/) - [disaster medicine](https://canadiem.org/tag/disaster-medicine/) - [CRACKcast](https://canadiem.org/tag/crackcast/) - [Quizlet](https://canadiem.org/tag/quizlet/) - [glaucoma](https://canadiem.org/tag/glaucoma/) - [choosing wisely](https://canadiem.org/tag/choosing-wisely/) - [Bed utilization](https://canadiem.org/tag/bed-utilization/) - [Emergency department](https://canadiem.org/tag/emergency-department/) - [Social history](https://canadiem.org/tag/social-history/) - [Centor Score](https://canadiem.org/tag/centor-score/) - [LVADs](https://canadiem.org/tag/lvads/) - [Community ED](https://canadiem.org/tag/community-ed/) - [Kelly Lien](https://canadiem.org/tag/kelly-lien/) - [opioids crisis](https://canadiem.org/tag/opioids-crisis/) - [fentanyl](https://canadiem.org/tag/fentanyl/) - [carfentanil](https://canadiem.org/tag/carfentanil/) - [narcan](https://canadiem.org/tag/narcan/) - [naloxone](https://canadiem.org/tag/naloxone/) - [simulation](https://canadiem.org/tag/simulation/) - [shared decision making](https://canadiem.org/tag/shared-decision-making/) - [SDM](https://canadiem.org/tag/sdm/) - [patient satisfcation](https://canadiem.org/tag/patient-satisfcation/) - [Cauda Equina Syndrome](https://canadiem.org/tag/cauda-equina-syndrome/) - [Lipid Emulsion](https://canadiem.org/tag/lipid-emulsion/) - [Drug Toxicity](https://canadiem.org/tag/drug-toxicity/) - [Asthma](https://canadiem.org/tag/asthma/) - [Infographic](https://canadiem.org/tag/infographic/) - [Small Intestine](https://canadiem.org/tag/small-intestine/) - [art](https://canadiem.org/tag/art/) - [humanities](https://canadiem.org/tag/humanities/) - [Geriatric Medicine](https://canadiem.org/tag/geriatric-medicine/) - [Top 5](https://canadiem.org/tag/top-5/) - [Sexually Transmitted Infections](https://canadiem.org/tag/sexually-transmitted-infections/) - [arts prn](https://canadiem.org/tag/arts-prn/) - [QI](https://canadiem.org/tag/qi/) - [bouncebacks](https://canadiem.org/tag/bouncebacks/) - [return visits](https://canadiem.org/tag/return-visits/) - [hypoxia](https://canadiem.org/tag/hypoxia/) - [clubbing](https://canadiem.org/tag/clubbing/) - [Ket](https://canadiem.org/tag/ket/) - [thyroid disorder](https://canadiem.org/tag/thyroid-disorder/) - [myxedema coma](https://canadiem.org/tag/myxedema-coma/) - [thyroid storm](https://canadiem.org/tag/thyroid-storm/) - [goiter](https://canadiem.org/tag/goiter/) - [Rubens](https://canadiem.org/tag/rubens/) - [spot the diagnosis](https://canadiem.org/tag/spot-the-diagnosis/) - [gallery](https://canadiem.org/tag/gallery/) - [tax changes](https://canadiem.org/tag/tax-changes/) - [federal government](https://canadiem.org/tag/federal-government/) - [incorporation](https://canadiem.org/tag/incorporation/) - [stigmata](https://canadiem.org/tag/stigmata/) - [liver disease](https://canadiem.org/tag/liver-disease/) - [jovial man](https://canadiem.org/tag/jovial-man/) - [drunk](https://canadiem.org/tag/drunk/) - [IV Extension Sets](https://canadiem.org/tag/iv-extension-sets/) - [fluid resuscitation](https://canadiem.org/tag/fluid-resuscitation/) - [allergies](https://canadiem.org/tag/allergies/) - [opinion](https://canadiem.org/tag/opinion/) - [antibiotics](https://canadiem.org/tag/antibiotics/) - [penicillin](https://canadiem.org/tag/penicillin/) - [antibiotic cycling](https://canadiem.org/tag/antibiotic-cycling/) - [decorticate posturing](https://canadiem.org/tag/decorticate-posturing/) - [brainstem injury](https://canadiem.org/tag/brainstem-injury/) - [erbs palsy](https://canadiem.org/tag/erbs-palsy/) - [gca](https://canadiem.org/tag/gca/) - [temporal arteritis](https://canadiem.org/tag/temporal-arteritis/) - [NASA](https://canadiem.org/tag/nasa/) - [stress inoculation](https://canadiem.org/tag/stress-inoculation/) - [patient experience](https://canadiem.org/tag/patient-experience/) - [patient satisfaction](https://canadiem.org/tag/patient-satisfaction/) - [glomerulonephritis](https://canadiem.org/tag/glomerulonephritis/) - [glomerular disease](https://canadiem.org/tag/glomerular-disease/) - [uremic syndrome](https://canadiem.org/tag/uremic-syndrome/) - [pagets](https://canadiem.org/tag/pagets/) - [CCFP(EM)](https://canadiem.org/tag/ccfpem/) - [CCFP](https://canadiem.org/tag/ccfp/) - [Family Medicine](https://canadiem.org/tag/family-medicine/) - [Socrates](https://canadiem.org/tag/socrates/) - [poison](https://canadiem.org/tag/poison/) - [hidden stories](https://canadiem.org/tag/hidden-stories/) - [Tramadol](https://canadiem.org/tag/tramadol/) - [serotonin syndrome](https://canadiem.org/tag/serotonin-syndrome/) - [opioid](https://canadiem.org/tag/opioid/) - [health canada](https://canadiem.org/tag/health-canada/) - [scheduled medications](https://canadiem.org/tag/scheduled-medications/) - [narcotics](https://canadiem.org/tag/narcotics/) - [moments](https://canadiem.org/tag/moments/) - [arts in medicine](https://canadiem.org/tag/arts-in-medicine/) - [mona lisa](https://canadiem.org/tag/mona-lisa/) - [CAD](https://canadiem.org/tag/cad/) - [sabbatical](https://canadiem.org/tag/sabbatical/) - [abroad](https://canadiem.org/tag/abroad/) - [travel](https://canadiem.org/tag/travel/) - [New Zealand](https://canadiem.org/tag/new-zealand/) - [syphilis](https://canadiem.org/tag/syphilis/) - [painter](https://canadiem.org/tag/painter/) - [STI](https://canadiem.org/tag/sti/) - [sexually transmitted infection](https://canadiem.org/tag/sexually-transmitted-infection/) - [red leg](https://canadiem.org/tag/red-leg/) - [skin infection](https://canadiem.org/tag/skin-infection/) - [erysipelas](https://canadiem.org/tag/erysipelas/) - [fortune teller](https://canadiem.org/tag/fortune-teller/) - [visual observation](https://canadiem.org/tag/visual-observation/) - [Laennec](https://canadiem.org/tag/laennec/) - [stethescope](https://canadiem.org/tag/stethescope/) - [art in medicine](https://canadiem.org/tag/art-in-medicine/) - [physical exam](https://canadiem.org/tag/physical-exam/) - [history of medicine](https://canadiem.org/tag/history-of-medicine/) - [history](https://canadiem.org/tag/history/) - [Rick Santorum](https://canadiem.org/tag/rick-santorum/) - [Santorum](https://canadiem.org/tag/santorum/) - [gun control](https://canadiem.org/tag/gun-control/) - [trauma](https://canadiem.org/tag/trauma/) - [Dr. Google](https://canadiem.org/tag/dr-google/) - [search engines](https://canadiem.org/tag/search-engines/) - [medicine and technology](https://canadiem.org/tag/medicine-and-technology/) - [suicide](https://canadiem.org/tag/suicide/) - [suicide assessment](https://canadiem.org/tag/suicide-assessment/) - [mental health](https://canadiem.org/tag/mental-health/) - [depression](https://canadiem.org/tag/depression/) - [spot the didagnosis](https://canadiem.org/tag/spot-the-didagnosis/) - [EMS](https://canadiem.org/tag/ems/) - [paramedic](https://canadiem.org/tag/paramedic/) - [interprofessional](https://canadiem.org/tag/interprofessional/) - [continuity of care](https://canadiem.org/tag/continuity-of-care/) - [Health Informatics](https://canadiem.org/tag/health-informatics/) - [Foreign body](https://canadiem.org/tag/foreign-body/) - [burnout](https://canadiem.org/tag/burnout/) - [physician wellness](https://canadiem.org/tag/physician-wellness/) - [Journaling](https://canadiem.org/tag/journaling/) - [Acute Coronary Syndromes](https://canadiem.org/tag/acute-coronary-syndromes/) - [STEMI](https://canadiem.org/tag/stemi/) - [brain resuscitation](https://canadiem.org/tag/brain-resuscitation/) - [Subarachnoid hemorrhage](https://canadiem.org/tag/subarachnoid-hemorrhage/) - [adult resuscitation](https://canadiem.org/tag/adult-resuscitation/) - [cardiac arrest](https://canadiem.org/tag/cardiac-arrest/) - [Supraventricular tachycardia](https://canadiem.org/tag/supraventricular-tachycardia/) - [Wolff-Parkinson-White (WPW)](https://canadiem.org/tag/wolff-parkinson-white-wpw/) - [Exam](https://canadiem.org/tag/exam/) - [Fever](https://canadiem.org/tag/fever/) - [Alcohol use disorder](https://canadiem.org/tag/alcohol-use-disorder/) - [Anticraving Medication](https://canadiem.org/tag/anticraving-medication/) - [Substance Use Disorders](https://canadiem.org/tag/substance-use-disorders/) - [Naltrexone](https://canadiem.org/tag/naltrexone/) - [Acamprosate](https://canadiem.org/tag/acamprosate/) - [Counselling](https://canadiem.org/tag/counselling/) - [Sutures](https://canadiem.org/tag/sutures/) - [COVID-19](https://canadiem.org/tag/covid-19/) - [Infection control](https://canadiem.org/tag/infection-control/) - [quality](https://canadiem.org/tag/quality/) - [homeless](https://canadiem.org/tag/homeless/) - [coronavirus](https://canadiem.org/tag/coronavirus/) - [newsletter](https://canadiem.org/tag/newsletter/) - [Friends](https://canadiem.org/tag/friends/) - [Kidney stone](https://canadiem.org/tag/kidney-stone/) - [urolithiasis](https://canadiem.org/tag/urolithiasis/) - [Dyspnea](https://canadiem.org/tag/dyspnea/) - [Burns](https://canadiem.org/tag/burns/) - [abdominal pain](https://canadiem.org/tag/abdominal-pain/) - [danger zone](https://canadiem.org/tag/danger-zone/) - [surgical airway](https://canadiem.org/tag/surgical-airway/) - [Regional anesthesia](https://canadiem.org/tag/regional-anesthesia/) - [GIB](https://canadiem.org/tag/gib/) - [Gastrointestinal bleed](https://canadiem.org/tag/gastrointestinal-bleed/) - [AHA](https://canadiem.org/tag/aha/) - [first aid](https://canadiem.org/tag/first-aid/) - [design](https://canadiem.org/tag/design/) - [Human-Centered Design](https://canadiem.org/tag/human-centered-design-2/) - [workarounds](https://canadiem.org/tag/workarounds-2/) - [design thinking](https://canadiem.org/tag/design-thinking-2/) - [Systems of Care](https://canadiem.org/tag/systems-of-care/) - [pelvic pain](https://canadiem.org/tag/pelvic-pain/) - [artificial intelligence](https://canadiem.org/tag/artificial-intelligence/) - [neural network](https://canadiem.org/tag/neural-network/) - [machine learning](https://canadiem.org/tag/machine-learning/) - [deep learning](https://canadiem.org/tag/deep-learning/) - [natural language processing](https://canadiem.org/tag/natural-language-processing/) - [RCT](https://canadiem.org/tag/rct/) - [Randomized Clinical Trial](https://canadiem.org/tag/randomized-clinical-trial/) - [Journal Club](https://canadiem.org/tag/journal-club/) - [randomized controlled trial](https://canadiem.org/tag/randomized-controlled-trial/) - [kelownakast](https://canadiem.org/tag/kelownakast/) - [Back Pain](https://canadiem.org/tag/back-pain/) - [podcast](https://canadiem.org/tag/podcast/) - [caepconference](https://canadiem.org/tag/caepconference/) - [Meta Analysis](https://canadiem.org/tag/meta-analysis-2/) - [Carmscast](https://canadiem.org/tag/carmscast/) - [Reflections](https://canadiem.org/tag/reflections/) - [Episode4](https://canadiem.org/tag/episode4/) - [4](https://canadiem.org/tag/4/) - [episode](https://canadiem.org/tag/episode/) - [canadiem](https://canadiem.org/tag/canadiem/) - [medical](https://canadiem.org/tag/medical-2/) - [toronto](https://canadiem.org/tag/toronto/) - [Highlights](https://canadiem.org/tag/highlights/) - [CJEM](https://canadiem.org/tag/cjem/) - [virtual care](https://canadiem.org/tag/virtual-care/) - [digital inequity](https://canadiem.org/tag/digital-inequity/) - [digital divide](https://canadiem.org/tag/digital-divide/) - [virtual inequity](https://canadiem.org/tag/virtual-inequity/) - [COVID](https://canadiem.org/tag/covid/) - [Virtual Learning](https://canadiem.org/tag/virtual-learning/) - [PoCUS Previews](https://canadiem.org/tag/pocus-previews/) - [Previews](https://canadiem.org/tag/previews/) - [Point of Care Ultrasound](https://canadiem.org/tag/point-of-care-ultrasound-2/) - [Image generation](https://canadiem.org/tag/image-generation/) - [Infographics](https://canadiem.org/tag/infographics/) - [Tox in 10](https://canadiem.org/tag/tox-in-10/) - [anticholinergics](https://canadiem.org/tag/anticholinergics/) - [ECMO](https://canadiem.org/tag/ecmo/) - [ECPR](https://canadiem.org/tag/ecpr/) - [psychiatry](https://canadiem.org/tag/psychiatry/) - [agitation](https://canadiem.org/tag/agitation/) - [emergency psychiatry](https://canadiem.org/tag/emergency-psychiatry/) - [Caep22](https://canadiem.org/tag/caep22/) - [Clare Atzema](https://canadiem.org/tag/clare-atzema/) - [Plenary Speakers](https://canadiem.org/tag/plenary-speakers/) - [Plenary](https://canadiem.org/tag/plenary/) - [Woman](https://canadiem.org/tag/woman/) - [Courtney Howard](https://canadiem.org/tag/courtney-howard/) - [Claudel Petrin-Desrosiers](https://canadiem.org/tag/claudel-petrin-desrosiers/) - [Nick Watts](https://canadiem.org/tag/nick-watts/) - [Climate Emergency](https://canadiem.org/tag/climate-emergency/) - [CAEP 2022](https://canadiem.org/tag/caep-2022/) - [2022](https://canadiem.org/tag/2022/) - [Ukraine](https://canadiem.org/tag/ukraine/) - [Daniel Kollek](https://canadiem.org/tag/daniel-kollek/) - [Valerie Rzepka](https://canadiem.org/tag/valerie-rzepka/) - [Quebec City](https://canadiem.org/tag/quebec-city/) - [damage control resuscitation](https://canadiem.org/tag/damage-control-resuscitation/) - [pediatric resuscitation](https://canadiem.org/tag/pediatric-resuscitation/) - [resuscitation](https://canadiem.org/tag/resuscitation/) - [Primary survey](https://canadiem.org/tag/primary-survey/) - [ABCDE approach](https://canadiem.org/tag/abcde-approach/) - [REBOA](https://canadiem.org/tag/reboa/) - [Medical Careers](https://canadiem.org/tag/medical-careers/) - [abdominal trauma](https://canadiem.org/tag/abdominal-trauma/) - [lung ultrasound](https://canadiem.org/tag/lung-ultrasound/) - [heart failure](https://canadiem.org/tag/heart-failure/) - [Postpartum Hemorrhage](https://canadiem.org/tag/postpartum-hemorrhage/) - [House of Dragons](https://canadiem.org/tag/house-of-dragons/) - [Case Series](https://canadiem.org/tag/case-series/) - [Patient Information](https://canadiem.org/tag/patient-information/) - [COPD](https://canadiem.org/tag/copd/) - [ED crowding](https://canadiem.org/tag/ed-crowding/) - [buprenorphine](https://canadiem.org/tag/buprenorphine/) - [QIPS](https://canadiem.org/tag/qips/) - [Diltiazem](https://canadiem.org/tag/diltiazem/) - [Adenosine](https://canadiem.org/tag/adenosine/) - [Management](https://canadiem.org/tag/management/) - [clinical question](https://canadiem.org/tag/clinical-question/) - [homelessness](https://canadiem.org/tag/homelessness/) - [opioid use disorder](https://canadiem.org/tag/opioid-use-disorder/) - [unhoused](https://canadiem.org/tag/unhoused/) - [approach](https://cana