Emergency Medicine Cases

Hip complaints are bread-and-butter emergency medicine—but every so often they are anything but straightforward. The obvious shortened, externally rotated leg after a fall is one thing; the patient with acute hip pain, a normal x-ray, unremarkable blood work, and no clear diagnosis is another. Hip fractures are also far from benign, carrying a 30-day mortality of 6–7% and a 1-year mortality of about 20%, often triggering a cascade of pain, immobility, delirium, deconditioning, and death. But hip fractures are only the tip of the iceberg. In this EM Cases episode, Dr. Arun Sayal and Dr. Matt DiStefano go beyond “get an x-ray and call ortho” to tackle hip fractures, occult injuries, atraumatic hip pain, and hip dislocations. We answer questions like: Why do so many patients never return to baseline after a hip fracture? What can we do in the ED to avoid delaying surgery? What are the best pain management and delirium prevention strategies? Which physical exam findings help diagnose an occult hip fracture? How do we distinguish hip from pelvic fractures clinically? When is a normal x-ray not enough, and when should we proceed to CT or MRI? What is POCUS useful for in the painful hip? How should hip fractures be classified to change ED management? How should we approach atraumatic hip pain? How do native and prosthetic hip dislocations differ? What clinical position suggests posterior versus anterior dislocation? Which reduction technique should we choose? What is the Whistler technique? What are the nuances of post-reduction management? And much more.

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Antibiotics for strep throat seem like a simple decision—but the evidence is anything but simple. In this Journal Jam podcast with Dr. Casey Parker and Dr. Justin Morgenstern, we critically appraise the literature behind one of the most common infections seen in emergency medicine. Do antibiotics meaningfully improve symptoms? Do they prevent peritonsillar abscess, post-streptococcal glomerulonephritis, or rheumatic fever? How reliable are the studies informing our practice? We explore publication bias, limitations of the Centor score, antibiotic harms, and the importance of local epidemiology, helping clinicians move beyond dogma toward more nuanced, evidence-based decision-making... Please consider a donation to EM Cases to ensure ongoing high quality free open access medical education here: https://emergencymedicinecases.com/donation/

Emergency physicians pride themselves on recognizing and treating life-threatening illness under pressure. Yet one of the most lethal, common, and treatable conditions presenting to our EDs still often receives fragmented, stigmatized care: substance use disorder. The opioid crisis has evolved into an era of increasingly toxic and unpredictable drug supplies, including ultra-potent synthetic opioids such as nitazenes. Between 2016 and 2021, more than 27,000 Canadians died from opioid toxicity, while opioid-related ED visits continue to rise sharply. Patients discharged with untreated opioid use disorder face mortality rates approaching 5% within 12 months. Despite this, substance use disorder is still not consistently approached with the same urgency and systems-based care as other chronic high-risk illnesses. In this episode, Dr. Bjug Borgundvaag, Tish Mizon and Kari Herbert discuss how stigma affects care in the ED and how trauma-informed communication, person-first language, compassionate care, peer navigators and Bridge-style addiction programs can improve outcomes for both patients and clinicians. Please support EM Cases ongoing Free Open Access Medical Education learning platform with a donation here: https://emergencymedicinecases.com/donation/

Pediatric agitation in the Emergency Department is one of those presentations that can escalate quickly and leave even experienced clinicians feeling on edge. It is high-risk, resource-intensive, and often unfolds in an already overstimulating environment where small missteps can make things worse. At the same time, agitation is not a diagnosis, it is a clinical presentation that may reflect anything from psychiatric illness to delirium, intoxication, trauma, or simply a child overwhelmed by the ED itself. So how do we approach these patients in a way that is safe, systematic, and effective? In this episode with guest experts, Dr. Susan Duffy and Dr. Thomas Chun, we tackle the questions that come up at the bedside: How do we rapidly distinguish mild, moderate, and severe agitation in a way that actually changes what we do next? Which patients are most likely to escalate, and how can we intervene early to prevent that? When should we be worried about a medical or toxicologic cause rather than assuming this is “behavioural”? What does effective verbal de-escalation actually look like in a busy ED, and why does it so often fail? When is a "code white" for emergency security measures truly indicated, and how do we avoid turning it into an escalation trigger? How should we be thinking about medications: what to choose, when to give them, and how to avoid over-sedation? And once the patient is finally calm, how do we make sure we aren't missing the underlying diagnosis? and many more... Please consider a donation to EM Cases to support ongoing high quality Free Open Access Medical Education https://emergencymedicinecases.com/donation/

In this Part 2 or our 2-part EM Cases podcast series on Cardiac Arrest Update, Dr. Sheldon Cheskes and Dr. Rob Simard take us beyond the algorithms and into the real-world decision-making of cardiac arrest care. We answer questions like: Do vasopressin and steroids improve survival or just ROSC? Should we be giving amiodarone earlier—and is lidocaine just as good? When should we use calcium, bicarbonate, or magnesium, and when should we avoid them? What role does ketamine play in CPR-induced consciousness? How should we choose between supraglottic airways and endotracheal intubation? What are the pitfalls of waveform capnography (ETCO2) to help guide CPR quality, detect ROSC, and inform prognosis? What is the role of PoCUS and TEE during cardiac arrest? When should we terminate resuscitation—and how do ETCO2 and POCUS factor into that decision? Should we widen the criteria to consider thrombolytics and who should go to the cath lab, and should we be ordering whole-body CT after ROSC for everyone who isn't going to the cath lab or getting ECMO? And finally, what are the key post-ROSC targets that actually impact neurologic outcomes in cardiac arrest patients? and many more...Please consider a donation to EM Cases to support ongoing high quality Free Open Access Medical Education https://emergencymedicinecases.com/donation/