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CORE-EM Wednesday June 16

Ventilators

So you have intubated? Now what? A short practical guide to mechanical ventilation in the emergency department with clinical examples including the COVID patient and troubleshooting the ventilator.

Learning Objectives

Brief Practical Theory on Ventilation
Common Clinical Examples including COVID
Trouble Shooting the Ventilator

Pearls

Low Tidal Volume Ventilation
PEEP saves Lives
DOPE: Displaced, Obstructed, Pneumothorax, Equipment Failure

ENT Emergencies

In this short talk, we will get into the practical tips of managing soft tissue injuries to the ears and the nose. You will walk away with a more nuanced understanding of the anesthetic, aesthetic, and wound repair considerations of these sensitive organs.

Learning Objectives

At the end of the session, participants will be able to manage soft tissue ear injuries with specific care to hematomas and the cartilage.
At the end of the sessions, participants will be able to assess and manage nasal injuries including septal hematomas and nasal fracture.

Pearls

Ear hematomas should be drained and pressure-dressed.
Local anesthetic can be helpful in nasal fracture reduction.
Similar to the lip, nasal and ear injuries require cosmetic consideration.

Eye Emergencies

Eyes don’t have to be tricky. Improve your diagnostic confidence by learning some physical examination tips and tricks. This lecture will focus on corneal abrasions and ulcers, the “red eye” and “flashers and floaters”; letting you know who needs optho follow up and in what time frame. Learning Objectives • Provide “tips and tricks” to improve the accuracy of your physical examination of the eye. • Give an evidence based and practical approach to dealing with corneal abrasions and ulcers. • Review the diagnosis and management of patients presenting with “flashers and floaters”; who needs to be referred and who can just go home. Pearls • Consider using bandage contact lenses or take-home topical anaesthetics for low risk corneal abrasions. • Use the Van Herick technique to estimate anterior chamber depth so you can confidently dilate the pupil, and get a great look at the fundi. • POCUS has insufficient sensitivity to rule out retinal detachment.

Animal Bites

The talk will concentrate on typical animal bites that Emergency Medicine physicians in Canada may encounter.

Learning Objectives

Dog and cat bites
Rabies – what animals tend to carry rabies in Canada, and who needs rabies shots
Unusual animal bites – lab monkeys, Gila monsters, rattlesnakes

Pearls

Best not to get bitten

Chest Pain Risk Stratification in the ED

Chest pain is one of the most common presentations in the ED. This session will review evidenced-based clinical pathways for risk stratification of chest pain patients. Determine who can use an accelerated pathway for investigation and who is safe for discharge.

Learning Objectives
Recognize which low-risk chest pain patients can be evaluated with an accelerated pathway (1-2 hour repeat troponin)
Review which evidence-based pathways help determine which chest pain patients are safe for ED discharge

Pearls
High-sensitivity troponin with a validated risk stratification tool can identify which low-risk CP patients are safe for early discharge
Even with negative troponins, some CP patients require admission

Pediatric Orthopedics

Case discussions of common and potentially missable pediatric orthopedic injuries

Learning Objectives

Pediatric elbow alignment
Subtle x-ray findings that can assist in diagnosing uncommon injuries
Further investigations to undertake when uncertain

Pearls
Anterior humeral line and radiocapitellar line
Lipohemarthrosis (and interpretation)
When flecks matter

DOAC

This practical review will give you the pro tips a tricks for choosing the right anticoagulant for your patient with venous thrombosis and atrial fibrillation.

Learning Objectives

To review initiation of anticoagulation for stroke prevention in atrial fibrillation
To review initiation of anticoagulation for venous thrombosis
To learn easy-to-remember approaches to anticoagulation prescription

Pearls

Always review the hemoglobin, platelet count and creatinine before prescribing anticoagulation
Always check whether your patient has a recent history of serious bleeding before prescribing anticoagulation
Most patients with cancer can be prescribed a DOAC

Peripheral Nerves

Peripheral Nervous System Emergencies: We’re Neuron to Something

Afraid of the reflex hammer? Through this case-based talk we will develop a structured approach to radiculopathies, plexopathies, and neuropathies. There will be an emphasis on practical localization, key diagnostic entities, and evidence-based treatment.

Learning Objectives

Develop approach to localizing sensorimotor deficits in the peripheral nervous system
Understand the principles (presentation, findings, investigations, and management) of selected peripheral nervous system disorders
Improve your confidence and precision in tackling peripheral nervous system emergencies

Pearls

Elicit both UMN and LMN findings to avoid diagnostic momentum in patients with sensorimotor deficits
Incorporate bed-side reflexes to enhance your diagnostic precision in patients with neurological symptoms
Leverage your exam to increase the yield of imaging or ancillary investigations given likely localizations