Ep 171 Posterior Stroke, EP Lead, HEAR Score, Ketamine for Suicidal Ideation, Peer Support Workers – Highlights from Calgary EM Hodsman Lecture Day

This is a special edition EM Cases main episode podcast. In April 2022, I was honoured to be the guest professor for Calgary EM at their annual Hodsman Lecture day. The day was essentially a series of live podcasts highlighting some of the amazing work they do, capped off by a lecture on compassionate care dedicated to the memory of Dr. Barbara Tatham. We covered a wide range of topics: The challenges of posterior strokes with Dr. Katie Lin; improving your ED flow by having an Emergency Physician Lead on shift with Dr. Eddy Lang and Dr. Michael Betzner; when not to order a troponin and the HEAR score (this is not a typo; this is not HEART Score) with Dr. Andrew McRae; ketamine for suicidal ideation with Dr. Marshall Ross; EM Peer Support Workers for patients with substance use disorder with Dr. Stephanie VandenBerg, plus a closely related bonus cast on SREMI's incredible ED Pathway to Peers program for youth with mental health issues with Dr. Bjug Borgundvaag and Christine Bradshaw... Podcast production, sound design & editing by Anton Helman Written Summary and blog post by Anton Helman, Katie Lin and Marshall Ross July 2022 Cite this podcast as: Helman, A. Lang, E. Betzner, M. McRae, A. Lin, K. VandenBerg, S. Ross, M. Borgundvaag, B. Bradshaw, C. Posterior Stroke, EP Lead, HEAR Score, Ketamine for Suicidal Ideation, Peer Support Workers- Highlights from Calgary EM Hodsman Lecture Day. Emergency Medicine Cases. July, 2022. https://emergencymedicinecases.com/posterior-stroke-ep-lead-hear-score-ketamine-for-suicidal-ideation-peer-support-highlights-from-calgary-em-hodsman-lecture-day. Accessed December 6, 2024 The challenges of posterior circulation stroke (PCIS) Essential anatomy and corresponding deficits Posterior circulation ischemic stroke (PCIS)/TIA involves the vertebrobasilar artery system (vertebral arteries arising from the subclavian arteries, three paired cerebellar arteries – AICA/PICA/SCA, the basilar artery, and the posterior cerebral arteries). Collectively, the posterior circulation supplies blood to the brainstem, cerebellum, occipital lobes, and thalami. Posterior Circulation Anatomy (Source: GeekyMedics.com https://geekymedics.com/arterial-supply-of-the-brain/) Cerebellar signs: vertigo, truncal/limb ataxia, nystagmus Brainstem signs: limb weakness, sensory loss, cranial nerve palsies, altered LOC Occipital lobes: visual field deficits The anatomic and functional complexity of the posterior circulation territory (esp. brainstem) make localization more challenging Etiology of posterior circulation ischemic stroke (top 3) Etiology differs from that of leading anterior circulation causes. In posterior circulation stroke, the most common causes are: * Embolism (mostly cardiac eg. atrial fibrillation) * Atherosclerosis (causing arterial stenosis) * Arterial dissection (consider this etiology higher on the differential in younger patients who present with stroke symptoms) Key point: the most common etiology of posterior circulation ischemic strokes is cardio-embolic, such as from atrial fibrillation What are the key red flags to look for in the assessment for posterior circula...