Yes, this is E.MK's best case ever mini podcast series, and I'm your host, Dr. Anton Hellman.

Here we are at North York General Hospital's Emergency Medicine Update Conference, and for the first time time we have had the pleasure and honor of

having dr scott weingart of em crit fame give us his best case ever so i'll just cut to the chase

dr winegart let a rip what's your best case ever well you asked me for my best case this is

one of my worst cases but it it's probably best case ever? Well, you asked me for my best case. This is one of my worst

cases, but it's probably the case that taught me the most. So I think it fits the bill for what

you're asking for, Anton. This was the case I actually experienced during my critical care

fellowship, and we had had a patient with a bad traumatic brain injury. He had had a car crash,

and he had come in with a very low GCS

and we had spent the past two months nursing him back to health.

And I never thought he, when I first saw him, would ever be to the point where we were

about to discharge this patient.

And his neurologic function had improved to the point where all of us was sure.

After some stint in a rehab facility, he would go back

to his family and have a perfectly normal life. So this was a win, a success story. But the patient

was still intubated, and we didn't think he'd make it with extubation yet. He got agitated

every so often, and he needed to be calmed down, get a little medication. And so we wanted to send him to the rehab facility because being in the hospital is bad, but he wouldn't make it extirated. So we decided to perform a trache. And we did our own tracheosomies there. We did them percutaneously with a needle seltinger type technique. And I did the trache with my attending. and it was a little bit low. This guy doesn't have

much of a neck, and I didn't have much to work with, and I dove down underneath his sternal notch,

and I got it, and it went well. It was a little bit leery, because it was a low trache. It was

probably a few rings down than would have been ideal. And no problem, got the x-ray.

And I went home that day.

I was on call, I think four days later.

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