Ken Grauer, MD
NOVEMBER 30, 2024
I was sent this tracing — and told that providers thought that the rhythm was 3rd-degree ( ie, complete ) AV block. Do YOU agree? Figure-1: The initial ECG in today’s case. NOTE: The tracing in Figure-1 is an 8-lead rhythm strip ( and not a complete 12-lead ECG ). This offers the advantage of providing 8 leads with simultaneously-recorded viewpoints of the same 7 beats that we see in this tracing.
EM Ottawa
NOVEMBER 28, 2024
What do you do when expert nurses tell you they can’t obtain IV access? Do you spend 20 minutes performing an invasive central line? Does your resident finally get two IO EPAs? Or do you save the day with a slick, ultrasound guided IV? Obtaining peripheral ultrasound guided IV access is not only a core […] The post Ultrasound Guided Peripheral IVs appeared first on EMOttawa Blog.
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Dr. Smith's ECG Blog
NOVEMBER 27, 2024
Pendell and I and the geniuses at Powerful Medical (Producers of the PMCardio Queen of Hearts OMI AI app ) are working on an objective, mathematical definition of hyperacute T-waves , based on real OMI outcomes and hyperacute T-wave annotation that has excellent interrater agreement (between me and Pendell), and it will end up being a logistic regression using these 3 variables: 1) area under the curve (AUC) relative to the QRS size 2) increased symmetry , as defined by time from T-wave onset to
St. Emlyn
NOVEMBER 26, 2024
St.Emlyn's - Emergency Medicine #FOAMed In this podcast, Liz Crowe discusses the effect bad behaviour has on teams and ultimately patient safety. The post Podcast – Bad Behaviour in Teams with Liz Crowe at Tactical Trauma 2024 appeared first on St.Emlyn's.
Sensible Medicine
NOVEMBER 24, 2024
Marty Makary, an editorial board member of Sensible Medicine, is up for FDA commissioner. In honor of that, we reprint one of his essays. Elsewhere I have a short piece on how the media coverage of him has been biased, and why I support his nomination. In the piece below Marty was correct that there is no data to support year over year COVID boosters, and I, like most Americans, don’t get them.
EMCrit
NOVEMBER 28, 2024
I discussed the reasons for migrating to BlueSky here. I've received positive feedback from several FOAMed expats who migrated to Bluesky and enjoy it there. I've also received some questions about getting started on BlueSky, so here is a brief guide to moving into MedSky. [1] Set up your account & profile This is essentially […] EMCrit Project by Josh Farkas.
Science Based Medicine
NOVEMBER 29, 2024
Dr. Zubin Damania praised and promoted RFK Jr.-loving doctors. We criticized these doctors and corrected their factual errors. See the difference? The post ZDoggMD on RFK Jr.’s Rise: “I’m Talking About Like These Science Based Medicine Guys” first appeared on Science-Based Medicine.
Emergency Care Today brings together the best content for emergency care practitioners from the widest variety of industry thought leaders.
St. Emlyn
NOVEMBER 24, 2024
St.Emlyn's - Emergency Medicine #FOAMed GLP-1A toxicity: What do emergency clinicians need to know about drugs like Ozempic® and Wegovy®? #FOAMed @stemlyns Greg Yates takes through a paper reporting overdoses in US practice. The post GLP-1A toxicity: What do emergency clinicians need to know about drugs like Ozempic® and Wegovy®? appeared first on St.Emlyn's.
Sensible Medicine
NOVEMBER 25, 2024
When a clinical trial is published, people are relieved. The researchers did the work, analyzed the data, published the report and surely feel a sense of completion. Clinicians are relieved because we have more evidence to use in patient care. The question is how certain we should be about the trial’s result. In April, I covered the work of Dena Zeraatker , from McMaster University, who elegantly showed that there were thousands of ways to analyze data from observational studies.
American Medical Compliance
NOVEMBER 29, 2024
Continuous Glucose Monitoring (CGM) technology is transforming the approach to diabetes care for healthcare providers, including endocrinologists, diabetes educators, and nurses, as well as for the patients they support. Unlike traditional methods that rely on periodic fingerstick tests, CGM offers real-time insights into glucose levels, trends, and fluctuations, empowering proactive management and improving patient outcomes.
EMCrit
DECEMBER 1, 2024
John Holcomb, author of the PROPPR trial, on massive transfusion in 2024 EMCrit Project by Scott Weingart, MD FCCM.
Dr. Smith's ECG Blog
NOVEMBER 30, 2024
Written by Jesse McLaren, with edits from Meyers Four patients presented with chest pain or shortness of breath, and ECGs labeled ‘inferior STEMI’. Using principles of hyperacute T waves, do any have inferior occlusion MI? Patient 1 : 60 year old with shortness of breath Patient 2 : 40 year old with chest pain Patient 3 : 65 year old with chest pain Patient 4 : 55 year old, prior inferior MI, with chest pain See this recent post on the new and evolving science of hyperacute T waves, including 1.
Don't Forget the Bubbles
NOVEMBER 27, 2024
Imagine this – a six-week-old infant with a fever of 38.3⁰C presents to your emergency department. They look well and, apart from fever, have no other symptoms. There are no sick contacts at home. Although they look well, you don’t want to miss a serious diagnosis, so what do you do? You’ve so many questions. Which of the many febrile infant clinical decision tools should you use?
Sensible Medicine
NOVEMBER 29, 2024
PR is an 82-year-old woman who is brought to the emergency room after “an episode.” During her first 12 hours in the hospital, she saw an emergency medicine resident and attending, a neurology resident and attending, and finally an internal medicine intern and resident who were covering the “night-float” shift. By the time these last two met her, she was pretty well wiped out, so the case they presented to us, her admitting team, was mostly cobbled together from the other
EM Literature of Note
NOVEMBER 25, 2024
Following on the success of Toy Story 2, Inside Out 2, and Avatar 2, we have WOMAN-2, yet another trial featuring emergency medicine’s third-favorite medication: tranexamic acid. However, where those sequels succeeded, WOMAN-2 is more like Miss Congeniality 2 – the one we’re not going to talk about again. But, don’t take it from me – take it from the ChatGPT Agent I created!
First 10 EM
NOVEMBER 25, 2024
The First10EM monthly wrap up is a place for me to share updates about the website, about my academic life, and also interesting content, such as books, podcasts, and other FOAMed, that I have encountered in the prior month (or now quarter). Obviously the format means the focus is mostly on content I have found, […] The post The First10EM monthly wrap-up for autumn 2024 appeared first on First10EM.
Dr. Smith's ECG Blog
NOVEMBER 29, 2024
Written by Willy Frick A young woman with a history of paroxysmal nocturnal hemoglobinuria presented with acute substernal chest pain. Five days prior, she had a similar presentation to a different hospital. She underwent coronary angiography which showed thrombotic occlusion of an RPL branch s/p aspiration thrombectomy. The report describes heavy plaque in the proximal RCA by IVUS, but no lesions in the previously occluded RPL branch and no stent was deployed.
Don't Forget the Bubbles
NOVEMBER 29, 2024
It’s a busy day in the paediatric ED. A worried parent rushes in carrying a toddler who’s just had a gulp from an unlabelled bottle in the garage. The child looks unsettled but otherwise fine—for now. “It was just a bit of the stuff we use for cleaning the car windscreen,” the parent says. You smell the faint odour of alcohol on the child’s breath A quick mental note: methanol poisoning?
Sensible Medicine
NOVEMBER 26, 2024
The disparities in health outcomes in the US, most notably between black and white, is appalling. It is an effect of our country’s original sin, compounded by hundreds of years of racism. Whether you examine specific health issues -- COVID , gun violence , cardiovascular death – or overall mortality , the differences are repugnant, embarrassing, and heart breaking.
EMDocs
DECEMBER 1, 2024
Authors: Grant Gerstner, DO (EM Resident Physician, San Antonio, TX); Kyle Smiley, MD (EM Resident Physician, San Antonio, TX) // Reviewed by: Sophia Görgens, MD (EM Physician, BIDMC, MA); Cassandra Mackey, MD (Assistant Professor of Emergency Medicine, UMass Chan Medical School); Alex Koyfman, MD (@EMHighAK) Welcome to EM@3AM, an emDOCs series designed to foster your working knowledge by providing an expedited review of clinical basics.
Board Bombs
NOVEMBER 29, 2024
You've survived Thanksgiving, now survive managing a pediatric airway obstruction by foreign body. This case will make you wish your in-laws came back to visit for Christmas. Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind at here. Cite this podcast as: Briggs, Blake; Husain, Iltifat. 241.
JournalFeed
NOVEMBER 29, 2024
The JournalFeed podcast for the week of Nov 25-29, 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 secondary analysis of 2 RCTs found no significant difference between rocuronium or succinylcholine on first attempt success or severe complications in critically ill patients undergoing endotracheal intubation.
Don't Forget the Bubbles
NOVEMBER 25, 2024
A 7-week-old baby presents to the Emergency Department (ED) with a one-day history of coryza and cough. Parents have recorded a temperature of 38°C at home. In triage, she is noted to be alert and feeding well. Her initial observations show a temperature of 38.2°C, HR 152 bpm, RR 45/min, and oxygen saturation 97% in room air. You perform a viral swab test at ED which comes back positive for SARS-CoV-2.
Thinking Critical Care
NOVEMBER 30, 2024
So over the years I’ve learnt invaluable stuff from each and every one of the colleagues I’ve managed to build a network with, and certainly I have learnt – and unlearnt – a lot from this guy. Here, Rory and I discuss the concept of interfaces that a group of us painstakingly crafted over the last year. So I hope this starts to spark some interest.
RebelEM
NOVEMBER 25, 2024
Background: In 2018, the BEAM Trial, a small single-center randomized clinical trial, conducted in the emergency department at Hennepin County Medical Center, demonstrated that bougie use significantly increased the first-attempt intubation success rate compared to the endotracheal tube with stylet (98% vs 87% (absolute difference, 11% [95% CI, 7% to 14%]). 1 Conversely, the 2021 BOUGIE trial—a larger, multicenter randomized clinical trial conducted by the same investigators—found no significant
Sensible Medicine
NOVEMBER 28, 2024
A few years ago, meeting on zoom, Vinay had an improbable idea: What if we worked together on a single substack. The idea was Sensible Medicine — a place to debate ideas in biomedicine, to host debates, to tell stories from the trenches, to dissect articles. What would a substack look like that featured not just one voice, or two voices, but a range of voices in medicine.
The Evolution & Medicine Review
NOVEMBER 26, 2024
Ongoing selection for adaptation to high altitude Ye, S., Sun, J., Craig, S. R., Di Rienzo, A., Witonsky, D., Yu, J. J., Moya, E. A., Simonson, T. S., Powell, F. L., Basnyat, B., Strohl, K. P., Hoit, B. D., & Beall, C. M. (2024).
EMergucate
NOVEMBER 25, 2024
72 year-year-old man with history of type II DM and has a single kidney. Presented with 2 weeks of diarrhoea. He has been in bed for 2 weeks. Unresponsive. Last proper meal was 2 weeks ago.
AED Leader
NOVEMBER 25, 2024
California is leading the way in public safety with a new law that could save countless lives during cardiac emergencies. Effective January 1, 2017, the state’s Health and Safety Code 19300 mandates that certain high-occupancy buildings must install Automated External Defibrillators (AEDs). This legislation reflects a growing recognition of how crucial AEDs are in improving survival rates for sudden cardiac arrest (SCA).
The Skeptics' Guide to EM
NOVEMBER 30, 2024
Date: November 10, 2024 Reference: Couper et al. The Paramedic 3 Trial: A randomized clinical trial of drug route in out-of-hospital cardiac arrest. October 31, 2024 NEJM Access to the SGEM Podcast episode at this LINK. Guest Skeptic: Missy Carter is a PA currently practicing in critical care after having attended the University of Washington's MEDEX program.
PEMBlog
NOVEMBER 25, 2024
The Kocher criteria can help you rule out a septic hip. Transient Synovitis is a much better diagnosis. It used to be called Toxic Synovitis, but that name was too scary so it got changed. Lyrics In a kid with hip pain I’ve got to explain The Kocher criteria And using your brain Cannot bear weight A fever complaint White count 12K ESR 40 today I’ve they’ve got all four The hips septic for sure But if they have none Then show them the door Note: CRP of >2.5 can replace ESR>40, but it was
Core Ultrasound
NOVEMBER 29, 2024
In this video tutorial, we provide a detailed guide to operating the Sonosite LX ultrasound machine. Designed for both beginners and those familiar with ultrasound technology, this demonstration will walk you through the essential features and functions of this device. You’ll learn how to power it on, optimize image quality, navigate the user interface, save and review images, and utilize its advanced settings to improve your workflow. > The post 5 Minute Sono – Sonosite LX Machine Basics
EMergucate
NOVEMBER 24, 2024
The supine chest x-ray shows left sided deep sulcus sign (lucency diving deep into left upper quadrant) indicative of a … Continue reading →
EM Ottawa
NOVEMBER 29, 2024
Methodology: 3.5/5 Usefulness: 3.5/5 CMAJ. 2023 Dec 3;195(47):E1614-E1621. de Wit K, et al. doi: 10.1503/cmaj.230634. Question and Methods: The Falls Decision Rule was derived to identify older adults with fall who do not require CT to rule out intracranial bleeding, using logistic regression. Findings: The rule demonstrated 98.6% sensitivity and 20.3% specificity for detecting significant […] The post Derivation of the Falls Decision Rule to exclude intracranial bleeding without head CT
Stop and Think
NOVEMBER 28, 2024
Just a short note to say thank you to those who follow this Substack. I am grateful to have readers. It’s Thanksgiving here and it is nice that my brain gets a holiday. Peace be with you all. JMM Stop and Think is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.
Maria Yang, MD
DECEMBER 1, 2024
The sixth instance of the word “mental” is on page 509 in the section about “First-Day and First-Year Administrative Reforms” for The Department of Housing and Urban Development (emphasis mine): The Office of the Secretary should execute regulatory and subregulatory guidance actions, across HUD programs and applicable to all relevant stakeholders, that would restrict program eligibility when admission would threaten the protection of the life and health of individuals and fail to encourage upwar
Core Ultrasound
NOVEMBER 29, 2024
In this video tutorial, we provide a comprehensive guide to the basic operation of the Mindray TeX ultrasound machine. Whether you’re new to ultrasound or exploring this device for the first time, this step-by-step demonstration will help you confidently navigate its features and settings. We cover everything from powering on the machine and adjusting image quality to using the touch interface, saving and reviewing images, and making the most of its key functions.
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