We're here at Emergency Medicine Update Conference 2014, and we've got with us Dr. Michael

Betzner.

He's going to tell us his best case ever, and it's a total surprise to me, so this one's

going to be exciting.

Mike, first, before we get into that, Mike's a very prominent emergency doctor in Canada. Tell us a little bit about yourself.

Well, thanks for having me. First of all, I'm a full-time Royal College trained Emerge Doc from

Calgary, and that's the basis of my practice, tertiary care center. I'm also an air transport

physician, the medical director of Starris Air Amunds, which is a long-established rotary air transfer service in Alberta and Saskatchewan and Manitoba now. And so that's a huge part of my practice. And a lot of entertaining cases that I come across are as a result of the air transport. And the one I'm going to talk about is in fact from there. All right, Mike, let it rip. Let's see your best case ever. So, you know, it's hard to pick one. We see so many cool things as a Merge Docs. It's quite a privilege as far as I'm concerned. But the one that comes out for me, most recently at least, was a 15-year-old boy who was brought in to Merge at a small place where we were dispatched to, and essentially he was brought

in in full cardiac arrest, 15 years of old, had collapsed at home, hadn't been seen for five or

10 minutes. It was apparently well early in the day, a bit of a funny story in that he was an autistic

boy and had some behavioral issues as a result of that. Anyway, he's brought to hospital in full arrest, and we arrived shortly thereafter because we happened

to be sort of flying near the area and drop down to help them at their request.

And essentially, it'd probably been there about 10 minutes when we got there.

They're doing CPR on this boy, and he's in and out of what looked like course VF.

So, you know, we're basically, you know, doing the standard

ACLS type things, which hardly ever work, as everyone knows. And the interesting part of the case was

trying like heck to get answer your history. What's going on with this guy? Is he been sick? Is he had a

virus? You know, is there any family history, cardiac illness, all that kind of stuff. And no one really

knew. The parents arrived about 15 minutes into this case, and I quickly went to talk to them to try and get some more information because they were still in and out of VF, and we would get some transient with electrical therapy return of circulation, but it certainly wasn't great, he would go right back into VF again, and it actually had some episodes of Torsad as well, which I thought was interesting. And so parents arrived, and, you know,

I very quickly asked him, you know, is he on any meds? No, he's not on any meds. Is he not on any meds? You know, has he been sick lately? No, not sick at all. And so I go back to the room and we're working on him still in and out of tracotta. It just wasn't adding up. Wasn't adding up.

He got a gas and he's acedotic as you'd expect going in and out of an arrest like that.

pH is sort of 6.9 as K was, wasn't he adding up. He got a gas and he's acedotic as you'd expect going in and out of an

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