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ECG Blog #434 — WHY Did this Patient Arrest?

Ken Grauer, MD

The ECG in Figure-1 — was obtained from a middle-aged man who presented to the ED ( E mergency D epartment ) in cardiac arrest. ROSC ( R eturn O f S pontaneous C irculation ) was obtained — and ECG #1 was recorded. In view of this history — How would YOU interpret the ECG in Figure-1 ? Should you activate the cath lab? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ).

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Updated: How To Detect Bucket Handle Injuries With CT

The Trauma Pro

A bucket-handle injury is a relatively uncommon complication of blunt trauma to the abdomen. It only occurs in a few percent of patients, but is much more likely if they have a seat belt sign. The basic pathology is that the bowel mesentery (small bowel of sigmoid colon) gets pulled away from the intestinal wall. This injury is problematic because it may take a few days for the bowel itself to die and perforate.

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Acute Transverse Myelitis in Children

Pediatric EM Morsels

Ooooo the infamous chief complaint of “ weakness ” ……. We just love those don’t we? Although neurological complaints may not be a crowd’s favorite, it is one we must become comfortable with. Timely recognition and treatment can be life-improving and life-saving! So, with that goal in mind, let us digest another delicious morsel on weakness – Acute Transverse Myelitis in Children : Acute Transverse Myelitis in Children: Basics Rare, non-compressive, inflammatory condition of the spinal cord

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How medical school fails students

Sensible Medicine

In prior posts, I was critical of the culture among trainees. One essay described the phenomenon of calling in fake sick. Another asked what the balance is between accommodation and the rigors of the job. These essays were about the effort, dedication and professionalism of trainees. Sensible Medicine is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.

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BiPAP for preoxygenation (the PREOXI trial)

First 10 EM

Preparation for intubation, appropriate preoxygenation, and preventing peri-intubation arrests has been one of my core topics for conference talks. My initial airway series emphasized “optimizing the basics” and carefully considering “is this patient ready for intubation?”. My “RSI and then they die” lecture is by far my most watched video on YouTube.

EMS 120
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“This Thing Has Killed Less Than Or About As Many As Flu Would Kill In A Normal Year In Kids, I Say Hardly Any” & “80-Year-Olds, Their Time To Death In General Is Not That Long.”

Science Based Medicine

If were are supposed to be indifferent to the deaths of young people because "hardly any" died, and we are supposed to be indifferent to the deaths of older people because "their time to death in general is not that long," which of the 1.1 million COVID deaths should we care about? The post “This Thing Has Killed Less Than Or About As Many As Flu Would Kill In A Normal Year In Kids, I Say Hardly Any” & “80-Year-Olds, Their Time To Death In General Is Not That Long.” first appeared on Science

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EMCrit 377 – Breaking News – The PREOXI Trial changes everything about Preoxygenation for Intubations in the Critically Ill

EMCrit

the PREOXI trial validates what I have been saying for 15 years about preoxygenation for the critically ill patient EMCrit Project by Scott Weingart, MD FCCM.

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More Trending

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Regard for Power: Part 2

Sensible Medicine

A few weeks ago, I wrote a “ Friday Reflection ” inspired by the quotation: “Regard for power implies disregard for those without power…” The line came from Robert Caro’s 1974 epic biography, The Power Broker: Robert Moses and the Fall of New York. I got carried away and offered up the quote to our readers as a prompt for an essay.

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Opioid Use Disorder in the ED - An Interview with Corey Hazekamp, MD, MS

EB Medicine

In this episode, Sam Ashoo, MD and T.R. Eckler, MD interview Corey Hazekamp, MD, MS, one of authors of the June 2024 Emergency Medicine Practice article, Managing Emergency Department Patients With Opioid Use Disorder Current State of Opioid Epidemic Overview of overdose deaths and trends. Data and statistics about opioid overdose mortality rates.

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“Fauci Files” and Florida’s Grand Jury Investigations Fail to Deliver

Science Based Medicine

Although multiple antivaccine investigations have failed to deliver any substantive evidence of alleged crimes, the latest antivax flops won't flip anyone. The post “Fauci Files” and Florida’s Grand Jury Investigations Fail to Deliver first appeared on Science-Based Medicine.

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Adenomatosis: Understanding a Complex Condition

Emergency Live

An Intricate World of Adenomatous Polyps Adenomatosis occurs when numerous adenomatous polyps form within the body. Adenomatous polyps are benign glandular tumors. They can arise in various organs, but are most common in the colon. These polyps vary greatly in shape and size and, although benign in the early stages, can become neoplastic cells if […] The post Adenomatosis: Understanding a Complex Condition appeared first on Emergency Live.

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JC: Does the outcome from refractory VF differ from recurrent VF in DOSE-VF patients?

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed This secondary analysis of the DOSE VF trial highlights double sequential external defibrillation (DSED) as a superior strategy over standard and vector change defibrillation for refractory ventricular fibrillation (RVF) in out-of-hospital cardiac arrest, improving survival rates and neurological outcomes significantly.

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The Importance of Proper Control Arms

Sensible Medicine

This is a story about placebo effects. I raise the issue because the prominent journal JAMA-Psychiatry published a paper purporting to show that placebos have great effects in many psychiatric conditions. The erroneous conclusion provides excellent teaching points. First a Thought Experiment Say I gave 100 cyclists a red supplement designed to increase muscle contraction and increase pedal power.

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Journal Feed Weekly Wrap-Up

EMDocs

We always work hard, but we may not have time to read through a bunch of journals. It’s time to learn smarter. Originally published at JournalFeed , a site that provides daily or weekly literature updates. Follow Dr. Clay Smith at @spoonfedEM , and sign up for email updates here. #1: PREOXI RCT – Preoxygenation with Noninvasive Ventilation vs. Non-rebreather Mask Spoon Feed Noninvasive ventilation (NIV) was superior to a standard non-rebreather (NRB) oxygen mask for preoxygenation of critically

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Dr. Jay Bhattacharya: “An Infection Is A Severe Problem For Older Populations, and Also For People Who Have Certain Chronic Conditions. For Younger Populations Under 70, It’s Much Milder.”

Science Based Medicine

A doctor who actually treated COVID patients said at the start of the pandemic, "Just because they are young doesn’t mean they aren’t vulnerable." The post Dr. Jay Bhattacharya: “An Infection Is A Severe Problem For Older Populations, and Also For People Who Have Certain Chronic Conditions. For Younger Populations Under 70, It’s Much Milder.” first appeared on Science-Based Medicine.

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Prehospital "Altered mental status and hypotension due to probable DKA" (everyone must know this ECG diagnosis)

Dr. Smith's ECG Blog

A patient presented with hypotension and altered mental status and presumption of DKA. As the medics arrived, they handed me this ECG: What medication did I call for IMMEDIATELY when I saw this? This is obviously severe hyperkalemia and the patient is near cardiac arrest. The medics had no idea. I called for 2 grams of Calcium Chloride. There was no IV access, so we obtained intraosseous (IO) access, but she arrested before we could give her all the calcium.

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Paediatric Emergency Medicine – Premier Conference – Day 1

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed Discover the highlights of Day 1 at the Premier conference on Paediatric Emergency Medicine. The post Paediatric Emergency Medicine – Premier Conference – Day 1 appeared first on St.Emlyn's.

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REBEL Core Cast 124.0 – Hyperinsulinemia Euglycemia Therapy

RebelEM

Take Home Points Management of severe beta-blocker and calcium-channel blocker toxicity should occur in a stepwise fashion: potential gastric decontamination, multiple lines of access, judicious fluids, calcium, glucagon, and vasopressors as needed. Initiation of high dose insulin therapy requires a tremendous amount of logistical and cognitive resources as it requires cross-disciplinary collaboration and is prone to mismanagement.

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Paxlovid doesn’t work for long COVID either (The STOP-PASC trial)

First 10 EM

As we have covered multiple times before, the evidence for paxlovid is heavily conflicted and mostly negative. There is very little reason to be using this agent clinically. However, despite an utter lack of evidence, many people have held out hope that paxlovid might be the miracle cure for the nebulous long COVID syndrome (referred […] The post Paxlovid doesn’t work for long COVID either (The STOP-PASC trial) appeared first on First10EM.

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Ultraprocessed Foods

Science Based Medicine

What are “ultraprocessed foods” and are they a health risk? One would think there is reason for concern, given all the hyped headlines, but as is often the case the data is somewhat complicated. The complexity begins with the fact that there is no agreed-upon operational definition of “ultraprocessed food” (UPF). Processed food generally refers to food products that are already prepared […] The post Ultraprocessed Foods first appeared on Science-Based Medicine.

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The Critical Roles of Clinicians in Product Development

MDisrupt

In the rapidly evolving landscape of healthcare technology, the integration of clinicians into product development teams has emerged as a crucial element for success. As a panelist on "Clinicians who VC," I had the opportunity to discuss the multifaceted roles clinicians play in product development and the unique value they bring to the table.

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Annals of B Pod: Uterine Incarceration

Taming the SRU

HISTORY OF PRESENT ILLNESS Patient is a G3P2 female in her 20s at 12 weeks gestational age (wGA), presenting with urinary retention. She reports that for the past two weeks she has had to strain to urinate. She was seen by her midwife provider for evaluation of this issue several days ago, at which time she underwent an ultrasound that was suggestive of uterine incarceration.

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How mine accident rescue works

Emergency Live

The complexity of rescue operations Rescue operations following mining accidents represent some of the most dangerous and complex rescue challenges. Coordination, advanced technologies, and specialized skills are essential to overcome obstacles such as collapses, floods, and critical weather conditions. Preparation and initial response Preparation is key in this process.

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From Collision to Clarity: PECARN cervical spine injury prediction rule for injured children

ALiEM

For years, adult literature has provided clear guidelines for cervical spine imaging through the NEXUS and Canadian C-spine Rule (CCR) tools. These have been invaluable in helping clinicians decide when to image the neck in trauma patients. Similarly, the Pediatric Emergency Care Applied Research Network (PECARN) has developed robust tools for assessing blunt head trauma in children.

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Forget “turbo cancers” caused by COVID-19 vaccines. Does COVID itself cause cancer?

Science Based Medicine

The Washington Post recently published an article asking if COVID-19 infection can cause cancer. Probably not, but cancer caused by a virus is more more plausible than "turbo cancer" caused by the vaccine. The post Forget “turbo cancers” caused by COVID-19 vaccines. Does COVID itself cause cancer? first appeared on Science-Based Medicine.

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Healthcare Workers in the AI Revolution: Pioneers or Passive Users?

Sensible Medicine

In today's rapidly evolving technological landscape, innovation is challenging human adaptability such that we are barely able to predict which technology will exist within the next six months. One of the most striking examples of this acceleration is the release of Large Language Models (LLMs). In November 2022, OpenAI launched ChatGPT-3.5. Over the following 18 months, not only were two upgrades released for ChatGPT but users also got the ability to create their own GPTs through more specific

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Medical Malpractice Insights: “Sign right here and you’re good to go”

EMDocs

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. The goal of MMI-LFL is to improve patient safety, educate physicians and reduce the cost and stress of medical malpractice lawsuits. To opt in to the free subscriber list, click here. Stories of med mal lawsuits can save lives.

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Master in Crisis & Disaster Management: Enrolment open

Emergency Live

Advanced Training for Security and Civil Protection Professionals: Registrations Open Until November 8, 2024 The Università Cattolica del Sacro Cuore is launching a new Master’s program in Crisis & Disaster Management, led by Professor Marco Lombardi. This interdisciplinary program aims to provide qualifications and professional recognition in the field of Civil Protection, healthcare, and specific […] The post Master in Crisis & Disaster Management: Enrolment open appeared

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Palpitations while awaiting CABG

Dr. Smith's ECG Blog

Written by Willy Frick A 57 year old man with was admitted to the hospital with chest pain. He underwent coronary angiography which showed severe multivessel disease, and he agreed to proceed with workup for CABG. Overnight, his cardiac telemetry showed the following: Telemetry Sample 1 What do you think? The rhythm terminated before it could be captured on 12-lead.

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The New York Times promotes “lab leak” conspiracy theories

Science Based Medicine

Last week, the New York Times ran an op-ed by Alina Chan, Queen of lab leak conspiracy theories and then gave it a prominent place in its Sunday Magazine this weekend. How is it wrong? Let me count the ways. The post The New York Times promotes “lab leak” conspiracy theories first appeared on Science-Based Medicine.

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Churnalism on NPR

Sensible Medicine

I was hopeful that our series on churnalism would change the world of healthcare and biomedical research journalism. I thought that journalists would never again commit one of the seven deadly sins of churnalism. Sensible Medicine is a reader-supported publication. I you appreciate our work, consider becoming a free or paid subscriber. They would never assume causation when a study only showed an association (1).

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ACC’s Validated Chest Pain Algorithm | Preoxygenation With NIV

JournalFeed

The JournalFeed podcast for the week of June 10-14, 2024. These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member. Monday Spoon Feed: This was a validation study for the recently published American College of Cardiology (ACC) Expert Consensus Decision Pathway for chest pain.

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Four focal themes for Interschutz

Emergency Live

At the center of attention will be climate change, civil protection, artificial intelligence, and sustainability. We are halfway through the journey leading up to INTERSCHUTZ, scheduled in Hannover from June 1st to June 6th, 2026. The next edition of the world’s leading trade fair for fire and rescue services, civil protection, and security is exactly […] The post Four focal themes for Interschutz appeared first on Emergency Live.

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Short Oral Antibiotic Therapy for Pediatric Febrile Urinary Tract Infections: A Randomized Trial

EM Ottawa

Methodology: 3.5/5 Usefulness: 2.5/5 Montini G, et al. Pediatrics. 2024 Jan 1;153(1):e2023062598. Question and Methods: This multicenter, parallel-group randomized controlled trial intended to determine the non-inferiority of a 5-day versus 10-day course of oral clavulin for treating of febrile urinary tract infections (fUTI) in children. Findings: The primary outcome of recurrence of UTI within 30 […] The post Short Oral Antibiotic Therapy for Pediatric Febrile Urinary Tract Infections:

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Emergency Physician Empowers Children to Read

ACEP Now

Nick Vasquez, MD, FACEP, gets to see the impact of social determinants of health every day in the emergency department. Like most in our specialty, he wants to help solve problems. He’s spent 12 years in this place “of inquiry and service,” as he calls it, trying to understand some of the root causes of health inequities. Dr. Vasquez honed in on one piece of the puzzle that he’s now passionate about trying to change: childhood literacy.

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Basics of Slit Lamp Examination

Mind The Bleep

Anatomy of a Slit Lamp Biomicroscope The slit lamp consists of: An illumination arm which offers a range of settings to facilitate examining the eye. This swivels on a pivot to allow for the light beam to illuminate the eye from different angles. A viewing arm with a binocular microscope. A joystick which allows both fine and gross horizontal displacement of the slit lamp on the table; twisting the top of the joysticks allows for vertical displacement of the slit lamp.

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What does the real patient experience scale look like?

NRC Health

You won’t want to miss an exceptional keynote to kick off our event, featuring Geeta Nayyar, M.D., M.B.A., a globally recognized chief medical officer, technologist, and bestselling author who helps leaders leverage a human approach to innovation, including rapid advances in AI, to achieve better health and business outcomes. The post What does the real patient experience scale look like?