MedBound Hub recently organized a Clinical Case Discussion (CCD) led by Dr. Bhavesh Joshi, an emergency care specialist at Leelavati Hospital, Mumbai, and a current fellow in critical care medicine. The session focused on familiarizing participants with the systematic approach to handling emergencies, recognizing critical signs, and implementing effective diagnostic and therapeutic steps. Attendees were participants from MedBound Hub discussion forum. Around 50 participants with diverse backgrounds including MBBS, Pharmacy, Life Science, students, and professionals attended the interactive session.
The discussion was introduced by Sonali Pradhan, Program Manager at MedBound Hub, who gave an overview of MedBound Hub and welcomed Dr. Joshi to lead the case-based learning session.
At the beginning of the session, Dr. Joshi engaged the participants in identifying common emergencies encountered in hospital casualty units. These included:
Trauma-related cases such as road traffic accidents, burns, and limb injuries.
Diabetic ketoacidosis (DKA) and other endocrine emergencies.
Hypertensive emergencies, where uncontrolled high blood pressure can rapidly cause organ damage.
Respiratory emergencies like acute asthma exacerbations.
Cerebrovascular accidents (strokes), often resulting from hypertension, trauma, or vascular blockage.
ENT emergencies, such as severe allergic reactions or acute pharyngitis that can threaten the airway.
Abdominal and gastrointestinal emergencies, such as acute bleeding or surgical conditions.
Dr. Joshi emphasized that these conditions can be categorized system-wise: CNS, respiratory, cardiovascular, abdominal, and trauma-related, helping clinicians maintain a structured approach during initial evaluation. He reminded participants that the first step in any emergency remains the assessment of airway, breathing, and circulation (ABC) before moving to specific diagnoses.
He explained the relevance of heart sounds (S1, S2, S3 gallop, and S4 gallop) and their underlying mechanisms in diagnosing cardiac conditions. These auscultatory findings, he noted, provide early clues about conditions such as heart failure or volume overload.
The pharmacology of emergency cardiovascular management was also covered, including drugs used in acute settings to stabilize patients.
The highlight of the session was the case of Ramesh, a patient presenting with acute breathlessness. Dr. Joshi described its signs and symptoms (such as progressive breathlessness, fatigue, and syncope), the pathogenesis involving increased pulmonary vascular resistance, and the investigations including echocardiography and right heart catheterization. Treatment modalities, ranging from supportive care with oxygen therapy to specific pharmacological agents such as vasodilators were outlined. Dr. Joshi guided participants through the differential diagnoses, beginning with ruling out cardiac causes such as left ventricular failure and pulmonary edema, as well as respiratory causes including asthma or pulmonary embolism finally concluded to be pulmonary artery hypertension (PAH).
Participants were walked through the stepwise approach:
Stabilization – Ensuring airway patency, administering oxygen, and monitoring vital signs.
Examination – Evaluating signs such as raised jugular venous pressure (JVP), which can indicate right heart strain.
Investigations – ECG, chest X-ray, echocardiography, and relevant blood tests.
Management – Tailored based on the diagnosis, whether cardiac failure, pulmonary hypertension, or respiratory pathology.
Emergencies must be approached in a systematic, stepwise manner, beginning with airway, breathing, and circulation.
Cardiac auscultation (S1–S4 sounds) remains a valuable bedside tool for identifying heart failure and other conditions.
Pulmonary artery hypertension presents with nonspecific symptoms such as breathlessness but requires careful evaluation through echocardiography and hemodynamic assessment.
Jugular venous pressure (JVP) is a simple yet critical bedside parameter in assessing right heart function.
Pharmacological management in cardiovascular emergencies should be timely and tailored to the patient’s hemodynamic status.
Case-based discussions, such as Ramesh’s acute breathlessness, reinforce the importance of clinical reasoning in emergency medicine.
The session provided participants with exposure to emergency medicine, blending theoretical knowledge with real-world scenarios.
MedBound Hub (https://www.medboundhub.com) is an initiative aimed at creating the largest online discussion platform for healthcare professionals and students. This platform serves as a gateway to engaging conversations on important healthcare topics, featuring expert opinions and lively debates. Whether it's big advances in the medical industry, tackling challenges in the healthcare sector or learning how to crack medical exams, MedBound Hub has something for everyone.
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