CRACKCast & Physicians as Humans on CanadiEM

Core Questions   Outline the anatomic borders of the anterior and posterior triangles of the neck. Detail the borders and associated contents of the three zones of the neck.(Box 37.1) List 5 hard and 5 soft signs of penetrating neck trauma (Box 37.2) List 5 hard and 5 soft signs of vascular injury  Outline an approach to the management of a patient with a hemorrhaging penetrating neck wound. Describe the management of a patient with a suspected venous air embolism. Outline the steps in performing an awake intubation. Outline the indications for imaging to screen for blunt cerebrovascular injury.(Table 37.2) Detail the appropriate imaging studies to order in the patient at risk for or with suspected blunt cerebrovascular injury.   Wisecracks   What structure, if violated, should make you suspect injury to the deep tissues of the neck? What study or studies is/are indicated to evaluate a patient for suspected esophageal injury. List 4 mechanisms of morbidity and mortality that occur as the result of vascular injury in the neck. What is the most common mechanism of injury causing blunt cerebrovascular injury? List 3 mechanisms that cause pulmonary edema in a patient post-hanging.

Core Questions   Outline the Denis Classification system for determining the stability of spinal injuries List 5 flexion, 2 flexion-rotation, 3 extension, and 2 vertical compression spinal injuries (Table 36.1) Wedge Fracture  Flexion Teardrop Fracture Clay Shoveler's Fracture Spinal Subluxation Bilateral Facet Dislocation Altlanto-occipital Dislocation Anterior Atlanto-axial Dislocation Unilateral Facet Dislocation Posterior Neural Arch Fracture Hangman's Fracture Extension Tear Drop Fracture Burst Fracture Jefferson Fracture Outline the mechanisms and potential complications of the following injuries: How are odontoid fractures classified and what causes them? Organize the spinal motor, sensory, and reflex examinations based on spinal levels. (Tables 36.3, 36.4, 36.5) Central Cord Anterior Cord Brown-Sequard Detail the following cord syndromes:  List the components of the following imaging decision-making tools: Canadian C-Spine Rule, NEXUS C-Spine Rule.   Wisecracks   How do you calculate Power's Ratio and why is it important? What injuries is the open-mouth odontoid radiograph best at visualizing? How are whiplash-associated injuries classified? At what spinal level would you expect an injury to potentially cause Horner's Syndrome? What is spinal shock and what physical exam finding indicates its end?

CanadiEM Journal Club E04 Systematic reviews and meta analyses show notes 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: What question(s) did the systematic review address? Is it likely that important, relevant studies were missed? Were the criteria used to select articles for inclusion appropriate? Were the included studies sufficiently valid for the type of question asked? Were the results similar from study to study? What were the results? What is the clinical significance of the results? and then a clinical pearl on pneumothorax!! Hosts:  Dakoda Herman Jayneel Limbachia Jake Domm Paper: “Chest ultrasonography versus supine chest radiography for diagnosis of pneumothorax in trauma patients in the emergency department” Cochrane Database of Systematic Reviews by Chan KK, Joo DA, McRae AD, Takwoingi Y, Premji ZA, Lang E, Wakai A   What question(s) did the systematic review address? P: Trauma patients in the ER I: chest ultrasonography by non rad physicians C: Chest xray O: diagnosis of pneumothorax, improved patient safety  Secondary: investigate potential sources of hetero such as type of CUS operator, type of trauma, type of US probe on test accuracy T: inception to 10 April 2020   Is it unlikely that important, relevant studies were missed? This study included prospective, paired comparative  accuracy studies in which patients were suspected of having pneumothorax. Patients must have undergone both CUS by a frontline non-radiologist and CXR, as well as CT of the chest or tube thoracostomy as the reference standard. The authors carried out systematic searches in the following electronic databases: Cochrane Database of Systematic Reviews; Cochrane Central Register of Controlled Trials; MEDLINE; Embase; Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus; Database of Abstracts of Reviews of EIects; Web of Science core collection (which includes: Science Citation Index Expanded; Social Sciences Citation Index; Arts & Humanities Citation Index; Conference Proceedings Citation Index - Science; Conference Proceedings Citation Index - Social Sciences & Humanities; and Emerging Sources Citation Index; and Clinicaltrials.gov from database creation to April 2020. The authors also handsearched reference lists of included articles and reviews, retrieved via electronic searching, for potentially eligible studies. Additionally, they carried out forward citation searching of relevant articles in Google Scholar and looked at the “Related articles” on PubMed. They did not limit the search to Englsih language only and included articles published in all languages. Their search strategy in volved the use of MeSH terms such as Pneumothorax, Radiography, Ultrasonography, and focused assessment with ultrasonography for trauma. They also used many text words. Using this search strategy 3473 records were identified. 1180 duplicated records were removed, leaving 2293 records to be screened. These records were screened by two of the authors for their relevance, when there was a discrepancy a third author decided whether to include the record or not. 2268 records were excluded, leaving 25 full-text articles that were assessed for eligibility. 12 studies were excluded - 5 missing CUS/CXR/CT chest/chest tube, 4 CUS not performed by frontline non-radiologist physicians, 2 wrong patient population, 1 wrong study design. A total of 13 studies were included in qualitative and quantitative analysis. 9 studies using patients as units of analysis included in primary analysis. 4 studies using lung fields as units of analysis included in secondary analysis. Authors provide a nice figure depicting this. Authors did not contact experts for unpublished data but were very thorough and transparent in their search strategy. I think it is unlikely that important, relevant studies were missed.   Were the criteria used to select articles for inclusion appropriate? The authors of this study clearly outlined their study inclusion and exclusion criteria. They included prospective, comparative accuracy studies in which patients were suspected of having pneumothorax.  They included trauma patients in the emergency department setting. Patients must have undergone both CUS by frontline non-radiologist physicians and CXR as index tests, as well as CT of the chest or tube thoracostomy as the reference standard. The two main index tests were CUS completed by a frontline nonradiologist physician and CXR, both being performed in the supine position. If data on specific CUS findings (such as the absence of lung sliding, absence of B-lines or comet-tail artefact, presence of lung point, and absence of lung pulse) were available, they planned to assess the diagnostic accuracy of these individual CUS findings. The target condition was traumatic pneumothorax of any severity. They defined a pneumothorax identified on CT scan of the chest or via clinical findings of a rush of air or bubbling in a chest drain after tube thoracostomy as the reference standard. The authors excluded studies involving participants with already diagnosed pneumothorax (i.e. case-control studies); studies involving participants with nontraumatic pneumothorax; studies involving participants who had already been treated with tube thoracostomy; and studies in which a frontline non-radiologist physician did not perform CUS. These criteria were appropriate for inclusion. However, many studies did differ in their units of measurement - lung fields vs. patients, which could introduce significant bias into the results of individual studies.   Were the included studies sufficiently valid for the type of question asked? The authors used the QUADAS-2 tool to assess risk of bias and the applicability of each included study.  This tool assesses risk of bias in four domains: patient selection; index tests; reference standard; and flow and timing. In addition, they examined concerns about applicability in the first three domains. They tailored the tool to their review question - one of the signalling questions in the patient selection domain was not applicable because they excluded case-control studies; therefore they deleted this question from the tool.  Two review authors performed the assessments independently. They discussed and resolved any disagreements that arose through consultation with a third review author. They included a figure describing their assessments of study quality. Of the nine studies that we included in the primary analysis: One had a low risk of bias, two had an unclear risk, and six had high risk of bias in the patient selection domain, mostly due to convenience sampling or inappropriate exclusion criteria, such as excluding haemodynamically unstable patients, lack of access to CUS, chest wall injuries precluding CUS, or if CT was not indicated.  The risk of bias in the interpretation of CUS results was low in five studies, unclear in two studies, and high in two studies; this was related to unclear blinding methodology of outcome assessors interpreting CUS and CXR results.  The risk of bias in the interpretation of CXR results was low in two studies, unclear in six studies, and high in one study; this was largely due to unclear blinding methodology of outcome assessors interpreting CXR and CT results, as in some studies it was not clear whether radiologists had access to both imaging results or not.  The risk of bias introduced in interpretation of the reference standard results was low in three studies but unclear in the remainder for similar concerns regarding blinding methodology.  The risk of bias in the flow and timing domain was low in two studies, unclear in four studies, and high in three studies; this was due to the exclusion of patients based on missing CT data or unclear/inappropriate time intervals between CUS, CXR, and CT. They judged applicability concerns regarding patient selection as low for six studies but high for three studies; this was due to the exclusion of haemodynamically unstable patients or lack of access to CUS despite the study focusing on comparing CUS.  They judged one included study to have unclear concern regarding applicability of the reference standard used as there was insuIicient reporting of the method of assessment.  They deemed all other domains for applicability concerns as low risk for all studies. Studies that used lung fields as their unit of analysis had several limitations including missing CUS data for some lung fields and using two CUS tests (one for each lung field) compared to one CXR (for both lungs) on the same patient. Inherently, there would be an inability to blind the CUS operator during collection of CUS data while performing the two CUS tests (one on each side of the patient), as well as during the interpretation of the CXR and CT results between the two lung fields. By analysing lung fields separately, it is diIicult to ascertain whether patient characteristics, past medical history, or traumatic injury pattern could have affected one or both lungs and may have confounded the diagnostic accuracy. Out of the four studies included in the secondary analysis:  The risk of bias in the patient selection domain was low in one study, unclear in two studies, and high in one study; this was due to inappropriate exclusion criteria, such as excluding haemodynamically unstable patients or chest wall injuries precluding CUS, or due to unclear sampling technique. The risk of bias introduced in interpreting CUS results was low in two studies and unclear in two studies due to lack of clarity about blinding of the outcome assessors interpreting CUS and CXR results.  The risk of bias introduced in interpreting CXR and CT results to be low in one study, unclear in two studies, and high in one study; this was again due to definite unblinded interpretation of test results or unclear blinding methodology of outcome assessors interpreting CXR and CT results. The risk of bias in the flow and timing domain was low in two studies and high in two studies due to missing patient data. They judged applicability concerns in the patient selection domain as low for two studies, unclear for one study, and high for one study, due to unclear patient selection methods and exclusion of haemodynamically unstable patients or chest wall injuries precluding CUS.  They judged one study to have unclear concern regarding applicability of the reference standard, as blinding of the outcome assessor interpreting the results of CUS, CXR, and CT was unclear. We deemed all other domains as 'low concern' for all studies. The authors were thorough in their assessment of each study's quality and discussed how this may have impacted the results. The most common area of bias seemed to be in patient selection where 11/13 studies were judged to be at unclear or high risk of bias. Were the results similar from study to study? Substantial heterogeneity in sensitivity analysis of supine CXR Based on Figure 4, Forest plot:  Sensitivity ranged from 0.09 to 0.75 Wide and non overlapping confidence intervals are suggestive of high variability between studies  Limits the evidence  But they do not list the reasons for why such heterogeneity exists Some possibilities for the heterogeneity include the high or unclear risk of bias of included studies  There is no I squared statistic shown - a statistical measure that confirms the presence of significant heterogeneity in a meta-analysis   Results of the study:  Included 13 studies, 1271 trauma patients with 410 who had a pneumothorax 9 studies used patients as unit of analysis 4 studies used lung field as unit of analysis Most studies were high or unclear risk of bias - 11/13  CUS sensitivity and specificity: 0.91 (95% CI: 0.85 - 0.94) and 0.99 (95% CI: 0.97 - 1.00) CXR sensitivity and specificity: 0.47 (95% CI: 0.31 - 0.63) and 1.00 (95% CI: 0.97 - 1.00)  Difference in sensitivity: 0.44 (95% CI: 0.27 - 0.61)    Practise Changing? This is an excellently executed Systematic Review that makes the most of the limited evidence available and presents such in a transparent way. The results of this study suggest that CUS has better sensitivity in detecting pneumothorax in the emergency department than CXR, and comparable specificity. This publication adds to the body of research that is building in support of US in the primary care setting, and promotes a change in culture as US adoption rates grow.    Clinical pearl:  Pneumothorax, or, air in the pleural space, is a fairly common complication of thoracic traumas, occurring 15-50% of the time. History: If you're able to get a history, and often you won't be able to, you'll hear about a Sudden, severe, chest pain, sometimes referred to shoulder and maybe associated pleuritic pain or SOB. On Exam: Exam findings range from nothing to respiratory distress and shock. May have decreased chest wall motion, subcutaneous emphysema, or poprock skin, hyperresonance, or decreased or absent breath sounds on the affected side. Imaging: traditionally via x-ray or US depending on physician. On xray: Absence of lung markings beyond the edge of the lung. The edge of the scapula or upper ribs are often mistaken for a pneumothorax. On US: Scan over the most upright part of the patient's chest. if supine go right over the top of their chest (third or fourth intercostal space in the midclavicular line and is repeated on both sides) and if upright scan the apices. Looking for lung sliding and the classic “seashore sign” in M-mode in normal lungs, or absence of lung sliding and “barcode sign” seen in pneumothorax. There are tons of good videos online to take a look at.  CT is gold standard, but rarely necessary - Rush of air on thoracostomy is also diagnostic. - Treatment: varies based on severity, from no treatment if patient tolerating well, to drains and chest tubes, to needle or finger thoracostomy for immediate decompression if pneumothorax clinically indicated and hypotension.

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 Saskatchewan College of Medicine. She will soon be starting her first year of emergency medicine residency at the University of Toronto. Dr. Dakoda Herman just graduated from the Temerty Faculty of Medicine at the University of Toronto. He will be trading places with Kara as he begins residency in Family Medicine at the University of Saskatchewan in Saskatoon. For shownotes Click Here

08:17 no caep full Hans Rosenberg crackcast.org@gmail.com (CCteam)CanadiEM aims to improve emergency care in Canada by building an online community of practice for healthcare practitioners and providing them with high quality, freely available educational resources. Our podcasts are found on this channel and include: CRACKCast (Core Rosen's and Clinical Knowledge) helps residents to "Turn on their learn on" through podcasts that assist with exam prep by covering essential core content. ClerkCast: A podcast focused on clinical clerks and their time in emergency medicine. It provides an overview of key topics that help you to rock your EM rotations. First Year Diaries: A podcast focused on the first

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!

CanadiEM has partnered with the Canadian Association of Emergency Physicians, EMOttawa, and the Skeptic's Guide to Emergency Medicine to help promote 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!

Core Questions   Detail the nerve supply of the face. What bones form the borders of the orbit? Outline the LeFort fracture classification system. What is the tongue blade test and how is it performed? Outline the Ellis System for dental fracture classification. Outline an approach to the management of ingested/aspirated teeth. Describe three techniques for the reduction of anterior TMJ dislocations. List four indications for Panorex X-rays.   Wisecracks   At what age do the following sinuses become aerated: Mastoid Ethmoid Facial Maxillary Sphenoid What is the association between the presence of facial injuries and the presence of intracranial injuries/cervical spine injuries?  What facial lacerations require prophylactic antibiotics? List three solutions in which avulsed teeth can be placed to preserve them.

This is the third episode of our CanadiEM's podcast series in collaboration with CAEP 2021. In this episode, Dr. Hans Rosenberg is joined by two CAEP 2021 Track Chairs, who give a sneak peak about the great speakers lined up! First, we are joined by Dr. Ken Milne, who outlines the Recent Emergency Medicine Literature track. Afterwards, Dr. Caroline Kowal highlights the Global Emergency Medicine track. 

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 conference, CAEP at the Forks: Rising to the Challenge! In today's episode, Ken Milne meets with Dr. Tamara McColl to discuss everything you need to know about the upcoming CAEP conference tracks and plenary speakers. Dr. Tamara McColl breaks down why you should attend the CAEP conference, and what exciting tracks to look out for!

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 conference, CAEP at the Forks: Rising to the Challenge! In today’s episode, Ken Milne meets with Dr. Tamara McColl to discuss everything you need to know about the upcoming CAEP pre-conference. Dr. Tamara McColl breaks down the meaning behind CAEP at the Forks, why you should attend the CAEP pre-conference!

This episode covers drowning in the wilderness/prehospital setting.

This is the first episode of our CanadiEM's podcast series in collaboration with CAEP 2021, with our guest host Kevin Milne. You may recognize Kevin Milne's voice from the popular podcast Skeptic's Guide to Emergency Medicine. In this series, Kevin breaks down will tell you everything you need to know about the upcoming CAEP 2021 conference, CAEP at the Forks: Rising to the Challenge! In today's episode, Kevin Milne meets with Dr. Tamara McColl to discuss everything you need to about the upcoming CAEP Conference. Dr. Tamara McColl breaks down the meaning behind CAEP at the Forks, why you should attend the CAEP conference and all the details you need to know before attending!

In this collaboration CAEP Conference + CanadiEM promotions podcast episode - 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! Track Chairs - Tracks: Dr. Brandon Ritcey - Procedures Dr. Hasan Sheikh - Advocacy and Public Affairs: Leading System-Wide Change as an Emergency Physician Dr. Lisa Thurgur - CORE-EM Dr. Eddy Lang - Leadership and Admin (LeAd) and Flow Check out the podcast and register for the conference at CAEP Conference website at www.caepconference.ca

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! As we enter year 2 of the COVID pandemic, Dr. Shaw gives us a reminder to love ourselves more and fully appreciate all we have overcome in this past year. Take a listen!

Core Questions   Define mild, moderate, and severe TBI (including Box 34.1).  Explain the concepts of cerebral autoregulation and CPP. Why is this clinically relevant?  Primary and secondary brain injury.  direct and indirect brain injury.  Differentiate between:  Describe the 4 herniation syndromes  List the extra-axial brain injuries  List the intra-axial brain injuries  Outline your approach to the clinical assessment of the brain injured patient (including GCS and brainstem reflexes).  Describe key imaging findings in the main types of traumatic brain injury.  Inititial resuscitation  ICP management and hyperosmolar therapy Indications for seizure and antibiotic prophylaxis  Reversal of anticoagulation  Decompressive therapies  Outline your management priorities in TBI with respect to:  List the complications of TBI.  Wisecracks What are the layers of the scalp?  What is the Munro-Kellie doctrine?  What is Cushing’s reflex?  List the clinical features of basal skull fracture (Box 34.2)  Describe 3 clinical decision rules that apply to  neuroimaging in mild TBI.  Describe a graduated return to play protocol as per Rosen’s. 

This episode covers a recent article published : "Pharmacokinetics of intramuscular tranexamic acid in bleeding trauma patients"

Core Questions What are the injuries for the following blunt trauma mechanisms: Head-on collision Rear end collision Lateral (T-bone) collision Rollover Ejected from vehicle Windshield damage Steering wheel damage Dashboard involvement or damage Restraint or seat belt use Air bag deployment Low-speed pedestrian versus automobile High-speed pedestrian versus automobile Bicycle versus automobile Non-automobile-related Vertical impact falls Horizontal impact falls Outline an approach to the primary survey for the trauma patient. Describe the elements of the eFAST exam. Outline an approach to the secondary survey in the trauma patient. Detail relevant ancillary laboratory tests to order in the trauma patient. Canadian CT Head Rule Canadian C-Spine Rule NEXUS C-Spine Rule NEXUS Chest Rule List the components of the following imaging decision-making tool What are the indications for a CT abdomen/pelvis in the trauma patient? Wisecracks What are the mechanisms of injury for the following weapons: Knives Handgun rounds Shotgun rounds Rifle rounds What is the LD50 in feet for falls from a given height? What is permissive hypotension and what evidence does it have? 

Purpose:  Learn the importance of treatment studies (RCTs) in EBM  Understand and interpret methods and results of treatment based studies  Become familiar with critically appraising treatment based studies   Hosts:  Dylan Collins  Levi Johnston Dakoda Herman Jayneel Limbachia Jake Domm   Paper:  Warren, Jaimee, et al. "Antacid Monotherapy Is More Effective in Relieving Epigastric Pain Than in Combination With Lidocaine: A Randomized Double‐blind Clinical Trial." Academic Emergency Medicine 27.9 (2020): 905-909. https://onlinelibrary.wiley.com/doi/epdf/10.1111/acem.14069    EBM Checklist for therapy studies (University of Oxford: https://www.cebm.net/wp-content/uploads/2018/11/RCT.pdf    Episode takeaway  RCTs are considered gold standard in terms of evidence since the randomization process controls for both known and unknown confounding variables  Understanding how to quickly and efficiently appraise studies by assessing its methods is an important skill that can help you assess its utility to your practice and whether the authors adequately answered the question Use a validated critical appraisal tool. We used the CEBM tool, but there are others. The GATE from by Rod Jackson is another great method to learn. Know that sometimes people use publishing guidelines as critical appraisal tools, like the CONSORT for RCTs, but these are just work arounds.  Be skeptical and curious. If there is a published protocol, check it. Look at who funded the study. Read the COI and method to mitigate bias.

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 Challenge When is it? June 15-17, 2021 Where is it? It's virtual but its hosted by the organizers at University of Manitoba, Winnipeg in collaboration with educators from all over Canada. How can I register? caepconference.ca #CAEP2021 The CAEP Conference 2021 Social Media and Promotions team consists of many members of the CanadiEM Leadership as well as some of the most well-known educators in the country. Our goal is to help CAEP promote their amazing annual conference and bring awareness to some of the highlights from the upcoming event. Some of the promotional items coming at you: Pre and In-Conference Podcasts and Videocasts - highlighting our key plenaries, speakers, and providing quick summaries of each day's events. Social Media updates will come regularly, highlighting some of the best from the conference. Infographic summaries and reviews of the day's events and clinical, med-ed, research concepts/pearls. Newsletter updates using our various channels (CAEP Connects, CanadiEM Newsletter, etc.) More to come! If you have ideas, feel free to let us know! Introducing the CAEP Conference Social Media / Promotions Committee Members: Dr. Daniel Ting Dr. Kevin Junghwan Dong Dr. Ken Milne Dr. Hans Rosenberg Dr. Shahbaz Sayed Dr. Fareen Zaver Dr. Alkarim Velji Dr. Sonja Wakeling Dr. Patrick Boreskie Evan Formosa Follow @caepconference on Twitter and stay tuned for more content!

Purpose: 1. Learn the importance of treatment studies (RCTs) in EBM 2. Understand and interpret methods and results of treatment based studies 3. Become familiar with critically appraising treatment based studies Hosts: Dylan Collins Levi Johnston Dakoda Herman Jayneel Limbachia Jake Domm Paper: Warren, Jaimee, et al. "Antacid Monotherapy Is More Effective in Relieving Epigastric Pain Than in Combination With Lidocaine: A Randomized Double‐blind Clinical Trial." Academic Emergency Medicine 27.9 (2020): 905-909. https://onlinelibrary.wiley.com/doi/epdf/10.1111/acem.14069EBM Checklist for therapy studies (University of Oxford: https://www.cebm.net/wp-content/uploads/2018/11/RCT.pdf Episode takeaway 1. RCTs are considered gold standard in terms of evidence since the randomization process controls for both known and unknown confounding variables 2. Understanding how to quickly and efficiently appraise studies by assessing its methods is an important skill that can help you assess its utility to your practice and whether the authors adequately answered the question 3. Use a validated critical appraisal tool. We used the CEBM tool, but there are others. The GATE from by Rod Jackson is another great method to learn. Know that sometimes people use publishing guidelines as critical appraisal tools, like the CONSORT for RCTs, but these are just work arounds. 4. Be skeptical and curious. If there is a published protocol, check it. Look at who funded the study. Read the COI and method to mitigate bias.

In this episode host Dr. Tiffany Proffitt 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 reinforced old friendships and family bonds to help overcome the sense of isolation during quarantine. Take a listen, we will get through this together.

Core Questions List key historical red flags in a patient presenting with back pain. (Box 32.1)  List red flags on physical examination of a patient with back pain. (Box 32.1)  List key critical differential diagnoses for a patient presenting with acute back pain (Box 32.2) Describe an approach to the rapid assessment of a patient with acute lower back pain (Fig 32.1)  Describe an approach to ancillary testing and imaging for critical causes of acute back pain (table 32.1)  List the sensory, motor, and screening tests for the lumbar nerve roots L3-S1 (table 32.2)  Describe an overview of the management of acute low back pain (Fig 32.2)  Wisecracks What are 4 variables associated with serious outcomes in patients with back pain (p. 276)  Differentiate between conus medullaris syndrome and cauda equina syndrome.  What physical exam/ancillary findings are most predictive of cauda equina? (CJEM 2020;22(5):652–654)  How does Rosen’s differentiate between disc herniation and radiculopathy?

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. 

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, and  Dr. Ben Forestell.   Dr. Larissa Hattin is a 4th-year emergency medicine resident at UBC and co-chief resident of the Victoria site. She completed medical school at McMaster and quickly moved out to the island to escape the snow. This year she is completing her fellowship in Medical Education through Oxford University. Dr. Dillan Radomske went to medical school in Calgary at the Cumming School of Medicine and is now in his third year of emergency medicine resident at the University of Saskatchewan. He is interested in medical education, and some of our listeners may recognize his voice from the CanadiEM CrackCast series.  Dr. Ben Forestell is a graduate of McMaster medical school and he is now in his first year of emergency medicine residency, also at McMaster. He is passionate about medical education and has been lucky to be involved with projects like ClerkCast at CanadiEM. Click Here for more information about today's episode. 

This is the first episode of the KelownaKast podcast, hosted by Hasan Abdullah and Eric DeHaas, UBC Kelowna Family Medicine residents. We are residents who are interested in medical teaching, mentorship and minority issues in healthcare. We hope to share these interests with you, with a focus on tips/tools for clinical practice. In this first episode we are joined by Ashley Mikasko, a Master's of Social Work student, to share cases on challenging patient encounters due to cross-cultural communication as well as some tips to help in such situations.

Core Questions Define the following terms: Menorrhagia Metrorrhagia Menometrorrhagia  Oligomenorrhea  What points on history are important to elucidate in the patient with PV bleeding? Outline an approach to the physical examination in the patient with PV bleeding. Describe an approach to ancillary testing in the patient with PV bleeding. Outline the DDx of PV bleeding in the non-pregnant patient. Outline the DDx of PV bleeding in the pregnant patient. Detail an approach to the management of PV bleeding in nonpregnant patients in the ED. Wisecracks What is the average volume of blood lost during typical menstruation? What is the risk of spontaneous abortion in the patient who presents with vaginal bleeding in the first trimester?  List five risk factors for placental abruption. List five risk factors for PPH. List five risk factors for ectopic pregnancy. List five absolute contraindications to the use of oral contraceptive pills.

This episode goes over the basics of call and how to thrive in it as a medical student. 

This new CanadiEM series features Emergency Medicine figures from around Canada while they participate in some sort of ice-breaking activity. First up, how can Dr. Brent Thoma from the University of Saskatchewan manage increasingly spicy chicken wings while talking about his academic interests?   This podcast is the audio-only version of a video that you can watch on www.canadiem.org. 

In this episode, Dr. Tiffany Proffitt talks with Dr. Andy Little about career and life transitions during the COVID pandemic. They discuss the unique challenges of moving his family across the US from Ohio to Florida in the pursuit of the career for which they had planned and sacrificed. Dr. Little shares with us how the pandemic forced him to refocus on the things that matter most and helped him discover new adventures with his family. 

Core Questions Outline the anatomic contents of the female pelvis. Describe an approach to the history in a patient with acute pelvic pain. Describe an approach to the physical examination in the patient with acute pelvic pain. List 10 differential diagnoses for the patient presenting with acute pelvic pain. (Box 30.1) Outline an approach to ancillary testing for the patient presenting with acute pelvic pain. What must be seen on bedside ultrasound to confirm a definitive intrauterine pregnancy (IUP)? Wisecracks What is the incidence of domestic violence in patients presenting with pelvic pain?  What is the incidence of heterotopic pregnancy in the general population and in those that have conceived using reproductive technology? Under what circumstances can a pelvic examination be omitted in a patient presenting to the ED with acute pelvic pain? What is the classic triad of pelvic inflammatory disease (PID)?

In this week’s episode, we are covering how to get to know more about programs and give you some quick pointers on how to create your personal letters! Here to help us tackle this topic is our guest: Dr. Pardhan! Dr. Kaif Pardhan is an emergency medicine physician and Deputy Chief of the ED at Sunnybrook Health Sciences Centre in Toronto. He serves as the Assistant Program Director for the University of Toronto’s emergency medicine residency program. He also works as a pediatric emergency physician at McMaster Children’s Hospital in Hamilton. Click Here for more information about today's episode. 

In this episode of Clerkcast Lauren and Ben are teaming up with Dr. Kaif Pardhan to cover an approach to pediatric fever. 

Core Questions List risk factors for constipation . List 10 causes of constipation (Box 29.1). Describe an approach to the history and physical exam of the constipated patient.  What ancillary testing should and should not be ordered in constipation?  Describe an approach to management of constipation in the ED (figure 29.1) . Describe 5 classes of laxative agents. List the lifestyle changes that constipation patients should be counselled about.   Wisecracks List 5 medications that can cause constipation.  What agents can be considered in refractory opioid-induced constipation?  Describe the mechanism of action of PEG 3350.  Describe the mechanism of overflow incontinence.

This episode is the first of the Physician Passion Projects series, a podcast focused on highlighting Canadian EM physicians' work outside of clinical medicine. 

Core Questions Define diarrhea. Outline the pathophysiologic processes that result in diarrhea. List 10 infectious causes of diarrhea. - Box 28.1 List 10 non-infectious causes of diarrhea. - Box 28.2 Outline 5 important aspects of a patient’s history to elucidate in cases of diarrhea. Detail an approach to laboratory testing in the patient with diarrhea. When are empiric antibiotics indicated for the treatment of diarrheal illnesses? Wisecracks What antibiotics are most commonly implicated with precipitating C.difficile diarrhea? What factors increase the probability of non-benign diarrheal illness? Outline the constituent ingredients contained within the World Health Organization’s rehydration formula. What is the BRAT diet and why is it recommended in patients with acute diarrheal illnesses?

In today’s episode, we cover how to prepare for your upcoming emergency medicine elective and how best to ask for that coveted reference letter. Helping us navigate this subject is our expert guest Dr. Brent Thoma. Dr. Thoma works clinically as a trauma and emergency medicine physician. Academically, he studies technology-enhanced medical education and works for the Royal College of Physicians and Surgeons of Canada as a Clinician Educator. He is also the CEO of CanadiEM. Click here for resources mentioned in today's episode. 

Core Questions   Define upper gastrointestinal versus lower gastrointestinal bleeding and differentiate between the two based on anatomic location  Outline an approach to the history and physical examination for the patient with complaints consistent with GIB.- Box 27.3 List 5 causes of UGI bleeding and 5 causes of LGI bleeding- Table 27.1 Outline six alternative diagnoses or mimics of GI bleeding - Box 27.1 List five characteristics of patients with high-risk GI bleeds - Box 27.2 Describe an approach to ancillary testing in the patient with GI bleeding. List five substances that when ingested, can result in a falsely-positive stool guaiac study Outline an approach to the management of the patient with GI bleeding - Fig 27.3 Detail the Blatchford and Clinical Rockall Risk Scores - Tables 27.3/27.4   Wisecracks   Outline the three most common causes of UGIB in pediatric and adult patients. Outline the three most common causes of LGIB in pediatric and adult patients. What percentage of patients presenting with hematochezia actually have an UGIB? What volume of blood loss is needed to produce symptoms of anemia in the patient with an acute/subacute GI bleed?

Core Questions Define the following terms: Nausea Retching Vomiting Outline the neural pathway regulating nausea and vomiting. List 6 potential sequelae of vomiting. Outline an approach to the history in the patient complaining of nausea and vomiting. Outline an approach to the physical exam in the nauseated and/or vomiting patient. List 10 differential diagnoses for the vomiting patient. What ancillary tests are indicated in the patient with nausea and/or vomiting? List five antiemetics that can be used to treat the nauseous and vomiting patient. Wisecracks What are the three phases of vomiting?  What is Hamman’s Sign and what pathology does it point to? What medication is indicated in the patient with intractable chemotherapy-induced nausea and vomiting.

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.

Core Questions Explain broad causes of elevated bilirubin (obstructive, hepatocellular, and hemolysis) and the significance of direct vs. indirect hyperbilirubinemia (Fig 25.1) Explain your approach to the history and physical exam in patients with jaundice (Fig 25.2)  List 10 causes of jaundice (Table 25.2)  Explain your approach to ancillary testing in patients with jaundice.  Wisecracks What are the stages of hepatic encephalopathy?   What is the triad of acute hepatic failure?  What is Charcot’s triad and Reynold’s pentad?  What is the “1000s Club” and how do you become a member? 

In this episode, Kevin Dong interviews Dr. Mohamed Hagahmed 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.

Core Questions What are risk factors for serious underlying causes of abdominal pain? (Box 24.1)  Explain key symptoms and signs to look for in the evaluation of the patient with abdominal pain.  What diagnoses are associated with different patterns of abdominal pain? (Fig 24.1)  List 5 critical and 5 emergent causes of abdominal pain (Table 24.1, 24.2)  Explain an approach to ancillary testing in abdominal pain.  Outline a diagnostic algorithm for patients with abdominal pain (Fig 24.4)  Outline an empiric management algorithm for abdominal pain. (Fig 24.5)  Wisecracks What are the structures included in the foregut, midgut, and hindgut? More importantly, why do you care?  List indications for bedside US in the ED patient with abdominal pain (Table 24.3)  Explain how referred pain works in the setting of abdominal pain (Fig 24.2)    

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 asked them what it is like to transition from residency to working as staff physicians. Later, we discussed the challenges they face as staff physicians and how residency prepared them for life as Emergency Physicians. 

Core Questions Describe an approach to key history and physical exam for chest pain patients presenting to the ED. (Table 23.2 and 23.3)  List 5 critical diagnoses, 5 emergent, and 5 nonemergent diagnoses to consider in the patient presenting with chest pain. (Table 23.1) Describe an approach to the critically ill patient with undifferentiated chest pain. (Figure 23.1) Describe an approach to ancillary testing in chest pain. (Table 23.4 and 23.5) List the risk factors associated with each critical chest pain diagnosis (Box 23.1)  Explain the approach to risk stratification of ED chest pain patients.  Wisecracks What are the X-ray findings of aortic dissection?  What are your HR and BP targets in Aortic dissection?  List the components of the HEART score. 

Today we are sitting down with Dr Alim Pardhan. Dr Pardhan is the FRCP EM program director at McMaster University, Hamilton General Hospital ED side lead, and a passionate medical educator. Your key takeaways from this episode are: Understanding the mechanisms behind fever and hyperthermia The causes of hyperthermia - think drugs, CNS infections, thyroid storm, and environmental exposure Five big, bad, and deadly causes of fever in our patients in the ED - necrotizing fasciitis! Endocarditis! Meningitis! Ascending cholangitis! Sepsis! Identification and management of the patient with sepsis

Core Questions Define the following terms: Dyspnea Tachypnea Hyperpnea Hyperventilation Dyspnea on exertion Orthopnea Paroxysmal Nocturnal Dyspnea What anatomical structures are responsible for controlling respiratory effort? Outline an approach to the history for the dyspneic patient. Detail the physical examination for the dyspneic patient and highlight pivotal exam findings that point to specific pathologies. Outline the differential diagnosis for the patient presenting with dyspnea and highlight 5 critical, 5 emergent, and 5 non-emergent causes of shortness of breath. What ancillary tests are indicated for the dyspneic patient? Detail the utility of point-of-care ultrasound in the assessment of the dyspneic patient. Outline a management algorithm for the acutely dyspneic patient. Wisecracks List three findings on chest radiograph suggestive of pulmonary embolism. What is the utility of venous blood gas testing and how do its values correlate with that of an arterial blood gas?

Core Questions:    Define “massive hemoptysis”. Which vessels, when injured, are typically associated with small and massive hemoptysis, and how do the vessel characteristics influence the degree of bleeding? Outline an approach to the history and physical examination for a patient presenting with hemoptysis. Outline the differential diagnosis for hemoptysis and highlight five critical and five emergent diagnoses that cause hemoptysis. (Box 21.1 and 21.2) What ancillary tests are warranted in the patient with hemoptysis? Detail the utility of imaging studies in patients with hemoptysis. Detail the diagnostic approach to the patient with hemoptysis. (Figure 21.1) Outline an approach to managing the patient with hemoptysis. (Figure 21.2) What two maneuvers can be used to address massive hemoptysis from a suspected tracheo-innominate fistula (TIF)? What strategies can be used to improve oxygenation in the patient with massive hemoptysis? Wisecracks:  List one gynecologic cause of hemoptysis. List five causes of massive hemoptysis. What is the most lethal consequence of massive hemoptysis?

We are finally back with episode 3 of ClerkCast! Today we will be talking about ABDOMINAL PAIN with McMaster FRCP EM resident Dr Rakesh Gupta Key takeaways from this episode include: 1. Thinking outside the GI tract for patients with abdominal pain 2. The importance of a good physical exam 3. What type of imaging is best for your patient? Hint: it depends! 4. How to consult your inpatient colleagues! P-I-Q-U-E-D Thanks for the listen!

Core Questions:    What are the three anatomically-distinct zones of the pharynx, and what structures outline their borders? Ultrasound of the Neck Lateral neck radiograph Nasopharyngoscopy CT Soft Tissues Neck Describe the utility of the following imaging modalities in the patient with sore throat. Outline five viral, five bacterial, and five other potential aetiologies of sore throat in the ED patient? (Table 20.1) Outline the components of the Modified Centor Score and describe its application. Describe the diagnostic algorithm for the patient with sore throat. (Figure 20.4) Outline the approach to managing a patient with sore throat in the ED. (Figure 20.4) What antibiotics can be used in the  patient with suspected or confirmed streptococcal pharyngitis? (Box 20.2)   Wisecracks:    In what age groups is streptococcal pharyngitis rarely seen? What is Waldeyer’s Tonsillar Ring? What is the “thumb sign” and what pathology does it point to?

Core Questions:    Detail the pertinent points to review when taking the history of a patient presenting with a red and painful eye - Box 19.2 Outline an approach to the ocular physical examination - Box 19.3 Outline the components of the slit lamp examination - Box 19.4  What signs and symptoms, if present, likely indicate the presence of serious ocular pathologies - Box 19.1 What is a relative afferent pupillary defect and what conditions cause it? List ten causes of increase intraocular pressure List five causes for an absent red reflex - Box 19.5 Name three critical, emergent, urgent, and non-urgent causes of the red and painful eye? - Figure 19.8   Wisecracks:    What are the fundoscopic findings of a central retinal artery occlusion. What is the pinhole test and what visual disturbances does it correct? What are the three most common causes of an irregularly shaped pupil What is Seidel’s Test and what condition does it identify?