Rapid Review: Ciguatera Poisoning

In the Rapid Review series, I briefly review the key points of a clinical review paper.

The topic: Ciguatera poisoning

The paper: Thompson CA, Jazuli F, Taggart LR, Boggild AK. Ciguatera fish poisoning after Caribbean travel. CMAJ Canadian Medical Association journal. 2016. PMID: 27160878 Continue reading “Rapid Review: Ciguatera Poisoning”

D-dimer for aortic dissection: the evidence

An overview of the evidence for D-dimer use in the diagnosis of aortic disection

I am really excited to announce that we are starting a new format on the EMCases Journal Jam podcast series. The plan is to take important questions about everyday clinical practice and do a deep dive into the literature to provide you with the most evidence based answer we can come up with. Most importantly, we are adding new (or, I suppose you might argue, our first ever) talent to the series: the brilliant @EMNerd_ himself, Dr. Rory Spiegel!

The first episode has just gone live. Our question: Is there a role for D-dimer testing in the workup of aortic dissection in the emergency department? I would suggest the podcast as the more entertaining and succinct way to get an answer, but because of time restraints and our desire not to bore you to death, we did not discuss every single study in the podcast. What follows are my notes for the podcast – a brief review of all the original literature I could find on the topic, arranged by year of publication. Continue reading “D-dimer for aortic dissection: the evidence”

Articles of the Month (January 2017)

Another month and another batch of articles to keep your practice informed. As always, I have no specific selection criteria. These are all just papers that I found interesting. I am always happy to receive suggestions if you encounter a paper that makes you think. And, of course, make sure to have a listen to me and Casey Parker making fools of ourselves as we try to come up with intelligent things to say about these papers on the BroomeDocs podcast. Continue reading “Articles of the Month (January 2017)”

At a loss for words (communicating with children after child abuse)

This is a guest post by Bruna Dessena, with edits by Justin Morgenstern. Bruna is an ALS paramedic from South Africa, with 26 years of clinical experience. She has worked for 17 years preparing children for court as a volunteer at the Teddy Bear clinic in Johannesburg. She has also published a book that acts as a guide to interacting with children after abuse.

You are seeing a 3 year old child with a femur fracture. You perform a rapid primary and secondary survey, confirming that there are no other life threatening injuries. The vital signs are stable. You provide rapid analgesia, starting with an intranasal dose of fentanyl as you set up for an IV. As you finish ticking off the clinical boxes in your head, a question pops into your mind: how exactly did this injury happen? Was this truly an accidental injury? And what should I say to this child? Continue reading “At a loss for words (communicating with children after child abuse)”

Rapid Review: anti-NMDA receptor encephalitis

In the Rapid Review series I briefly review the key points of a clinical review paper.

The topic: anti-NMDA receptor encephalitis

Continue reading “Rapid Review: anti-NMDA receptor encephalitis”

Torsades de Pointes

The first 10 minutes of emergency medicine resuscitation of torsades de pointes


A 46 year old female is referred into the emergency department after multiple syncopal episodes. Her family physician did blood work and found her to be hypokalemic. She is on venlafaxine for depression and amitriptyline for sciatica. She is currently on a course of moxifloxacin for her sinusitis and this morning took a dose of fluconazole for the resultant candidiasis. On arrival, she is alert and looks well. However, as the ECG is being performed, she slumps over and you see:


Continue reading “Torsades de Pointes”

Articles of the Month (December 2016)

Welcome to the year-end edition of the Articles of the Month (released well into the new year because of the craziness of emergency department holiday schedules). The podcast version of this post with Casey Parker is available through the BroomeDocs podcast.

Continue reading “Articles of the Month (December 2016)”