Yes, we're back with another episode of EMK's Best Case Ever mini podcast series.

I'm your host, Dr. Rajiv Thavenathan.

We're here with a very special guest, and I always say they're special guests, but this one is totally, definitely a very special guest. His name is Dr. Shabaz Sayyed. He is a staff physician at the

Ottawa Hospital with a fellowship in digital scholarship and special interests in rational

resource utilization. He also manages the EM Ottawa blog, and you might know him as an editor and

contributor at CanadianM,

which is a great site with resources for learners at all levels. That includes not just residents,

but medical students and staff physicians, too. There's tons of great foam med and editorial content

on there. Shabas, thanks for being with us today. Oh, my pleasure. Thanks for having me here

in your kitchen, and that was quite the introduction. Yeah, it's weird hearing, hearing all the great things that you do listed in one sentence. Exactly. Yeah, for me, it's like he likes sandwiches, and I think he listens to music. That's about it. Fair enough. So Shabazz is here today to tell us about his best case ever, Shabazz. Why don't you take it away? An 86-year-old female is brought into the emergency department with chest pain. She states that the chest pain radiates towards her back. She's otherwise healthy, has a history of hypertension for which she takes hydrochlorothiaseide, but she's functionally independent, drives her own car, lives alone. She's a great 86-year-old. She's as healthy as an 82-year-old. She looked like a 78 year old. Okay. She's a great 86 year old. She's as healthy as an 82 year old. She looked like a

78 year old. Okay. She's noted to be hypertensive in the emergency department. So at this point,

Rajeve, what are you wondering? Well, you know, she's got a couple of vascular risk factors,

so ACS, you know, until otherwise rolled out. But that story you're giving me about hypertension and

it's radiating to her back? That sounds like one of the big baddies that we don't want to miss.

So what would you do next? Assuming her ECG is normal, let's say. So non-specific ECG and we still

need to rule out dissection? That person's probably going to get a CAT scan, I think, in my department. Okay. So CT scan is done. Again, looking for a dissection, just like you thought. The radiology resident calls you over and says she's got a type B aortic dissection. Okay, wow. So that's a great pickup. Yeah. So what are you going to do now? So type B dissection can probably be medically managed, but you definitely want to get, you know, their heart rate down, blood pressure down, sort of minimize those sheer forces in the aorta, consult vascular, get admitted probably to ICU.

Yeah. So that's exactly what happened for this patient. And then you high five yourself, right? Another life save. Great diagnosis made.

Yeah. I just, I feel like there's like a twist coming somewhere here. I feel like

I'm hanging out with M. Night Shyam Island. I wish I had that kind of storytelling prowess. But what

actually ended up happening, so she did go to the ICU. She was started on the labatal law infusion.

Unfortunately, she developed an acute kidney injury from the libeta law, and she ended up actually

needing dialysis. After she was on dialysis, she got, you know, multi-organ dysfunction, and she actually died

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