Emergency Medicine Cases

There are few things more frustrating for an Emergency Physician than caring for patient after patient who lands in the ED not because it’s necessarily the best place for their care, but because every other door in the health care system was closed, confusing or impossible to find. Emergency Medicine and Primary Care often operate in different worlds—one built around rapid diagnosis and uncertainty, the other around continuity and prevention—but our patients move constantly between the two. In this special EM Cases podcast, EM–Primary Care Health Systems Strategies, we step outside the usual ED lens with Dr. Tara Kiran (host of the Primary Focus podcast) and Dr. Danielle Martin to ask how we can deliver the right care, in the right place, at the right time. We challenge assumptions about what drives ED use and explore team-based primary care, after-hours cooperatives, call-first triage, virtual care, information sharing and warm handoffs. Drawing on models from Canada, the Netherlands, Denmark and elsewhere, we finish with practical strategies to reduce fragmentation, improve continuity and make the system work better for patients and providers. Please consider a donation to EM Cases to support our mission of providing high quality free open access medical education here: https://emergencymedicinecases.com/donation/. Disclaimer: This episode was recorded in October 2025, prior to Dr. Danielle Martin becoming a candidate for government office. The views and opinions expressed by Dr. Martin in this discussion were her own at the time of recording and do not represent or reflect the views, policies, or positions of the Government of Canada.

We are amidst a paradigm shift in the emergency management of acute ischemic stroke. The traditional way of categorizing ischemic strokes as 'minor' vs 'major' is no longer relevant to what we do in the ED. It's now about 'disabling' vs 'non-disabling' strokes. And this is no small change. This categorization dictates urgency of ED work-up and treatments, imaging choices, treatment decisions and goals of care. In this Part 1 or our 2-part main episodes EM Cases podcast series on management of ischemic stroke with Dr. Walter Himmel and Dr. Katie Lin, we answer questions like: How can we best rapidly determine if an ischemic stroke is disabling or non-disabling at the bedside? In what ways are 'wake up strokes' managed uniquely and what's the latest thinking on their pathophysiology? How should we best prioritize imaging depending on timing, geography and resources? How do we best predict large vessel occlusion amenable to endovascular therapy (EVT) at the bedside? How can we efficiently establish goals of care at the bedside to inform our emergency decision making around strokes? Which is better for thrombolysis in ischemic stroke - Tenecteplase or Alteplase? How have contraindications to IV thrombolysis changed over the last decade? When should we consider bridge therapy with EVT after IV thrombolysis? What are 4 key items the ED physician should have ready for the stroke neurologist on the first call? and many more... If you enjoy EM Cases content please consider a donation to help support ongoing FOAMed here: https://emergencymedicinecases.com/donation/

Discover evidence-based sleep strategies for shift workers. Optimize performance, recovery, and health with tips from sleep expert Dr. Michael Mak... If you find this beneficial please consider a donation to support EM Cases: https://emergencymedicinecases.com/donation/

In this update to the 7 T’s of Massive Hemorrhage Protocols with Dr. Jeannie Callum and Dr. Andrew Petrosoniak, we explore the most current, evidence-informed strategies for bleeding patients, from polytrauma to obstetrical, drawing on the latest clinical trial data and real-world experience. We answer the questions: What is the evidence based alternative to FFP in EDs where FFP is not readily available? How accurate are decision scores in helping decide the trigger for MHP activation? Why is testing fibrinogen levels and giving fibrinogen concentrates so important in massive hemorrhage? How should we tailor our MHP to the GI bleed patient? To the obstetrical patient? and many more... Please donate to EM Cases to ensure ongoing Free Open Access Medical Education at https://emergencymedicinecases.com/donation/.