EM Quick Hits 20 Imaging Renal Colic, Human Trafficking, Atrial Fibrillation During COVID, Transvenous Pacemaker Placement, COVID Lung POCUS, COVID Derm, Virtual Simulation

Topics in this EM Quick Hits podcast

Justin Morgenstern on imaging in renal colic patients (0:31)

Hanni Stoklosa on recognition and management of human trafficking (7:27)

Rohit Mohindra on management of atrial fibrillation in the COVID era (20:21)

Anand Swaminathan on transvenous pacemaker placement (24:48)

Rob Simard on COVID-19 lung POCUS (32:07)

Brit Long & Michael Gottlieb on COVID-19 dermatology (37:32)

Sarah Foohey & Paul Koblic on virtual simulation (44:29)



Podcast production and sound design by Anton Helman, voice editing by Sheza Qayyum

Podcast content, written summary & blog post by Graham Mazereeuw, edited by Anton Helman

Cite this podcast as: Helman, A. Swaminathan, A. Long, B. Gottlieb, M. Foohey, S. Koblic, P. Mohindra, R. Stoklosa, H. Simard, R. Morgenstern J. EM Quick Hits 20 - Imaging in Renal Colic, Human Trafficking, Atrial Fibrillation in COVID-19, Transvenous Pacemaker Placement, COVID-19 Lung POCUS, COVID-19 Dermatology, Virtual Simulation. Emergency Medicine Cases. June, 2020. https://emergencymedicinecases.com/em-quick-hits-20-june-2020/. Accessed [date].

Imaging in renal colic



* Most cases do not require imaging

* Clear-cut indications for imaging:



* Worried about alternative diagnosis

* Febrile or septic

* Uncontrolled pain or urgent surgical intervention anticipated





* CT renal colic is the gold standard. However, less than 5% detect a clinically important alternative diagnosis and most CT scans do not change management

* POCUS is helpful: sensitivity is only 70%, specificity is 75% for all stones but POCUS is unlikely to miss large stones requiring surgical management





Episode 5: Renal Colic, Toxicology Update & Body Packers

Expand to view reference list



* Moore CL, Carpenter CR, Heilbrun ME, et al. Imaging in Suspected Renal Colic: Systematic Review of the Literature and Multispecialty Consensus. Ann Emerg Med. 2019;74(3):391-399.

* Smith-Bindman R, Aubin C, Bailitz J, et al. Ultrasonography versus computed tomography for suspected nephrolithiasis. N Engl J Med. 2014;371(12):1100-10.



Human Trafficking



* The ED is the front line for human trafficking: most trafficked persons access healthcare while being trafficked and they most commonly present to the ED

* Definition: a crime involving the recruitment, transportation, harbouring and/ or exercising control, direction or influence over the movements of a person in order to exploit that person, typically through sexual exploitation or forced labour



* Means of control can be force, fraud and/or coercion (psychological, financial, threats to person or family)





* Trafficked persons present with a variety of chief complaints: suicidal ideation, substance use, and illnesses of poor living conditions are common

* You have the skills to suspect that a person may be trafficked



* Vulnerable groups



* Under-regulated, underpaid industries