On this month's best case ever, we've got the one and only Dr. Mike Betzner, an ED doc from Calgary,

who's also the medical director for the Stars Air Ambulance Service. Now, Dr. Betzner and I,

along with Michael Mish and James Brokenshar, I've been collaborating on the EM cases, Crit

Cases blog. So the way it works is Dr. Betzner sends us his best critical care of transport

medicine cases where there isn't much evidence to guide us.

And we create an interactive blog out of them, taking you step by step through the decision process.

And Mike has been such a great collaborator to work with.

So welcome back to EMCases, Mike, for another one of your best cases ever.

Well, first, Anton, thanks for having me back.

You guys have been great to work with.

I think we're having fun with the Cases blog, and certain your group's doing a great job,

getting those reviewed by some tremendously talented people.

So I think if people haven't been looking at that, I'd encourage them, too.

There's some neat stuff on there.

The case I'm going to talk about today sort of speaks to a theme that I like to personally

talk about, and that is what to do when you don't have this stuff.

And this applies very frequently in the air transport work that I do and in trying to

help rural physicians who every day have to look

after very sick patients without help and without gear and without the extra stuff that those of us

that do work in tertiary care just are used to having at our beck and call. And so this particular

case is a 74-year-old woman that was in a small rural hospital, about 45-minute flight away from where I work.

And she had presented with very severe shortness of breath.

...