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ECG Blog #419 — The Cause of ECG #1?

Ken Grauer, MD

I was sent the 2 ECGs shown in Figure-1 — which were recorded from an elderly man whose heart beat "has been irregular for years". No clear history for recent chest pain — but the patient "has not been well" for the previous week. Regarding the 2 ECGs in Figure-1 : ECG #1 is the initial tracing obtained at the scene by the EMS ( E mergency M edical S ystems ) team — in association with an alert but markedly hypotensive patient.

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Giving TXA Via An Intraosseous Line?

The Trauma Pro

Seriously injured patients frequently develop coagulopathy, which makes resuscitation (and survival) more challenging. A few years ago, the CRASH-2 study lent support for using tranexamic acid (TXA) in select trauma patients to improve survival. This drug is cheap and has antifibrinolytic properties that may be beneficial if given for life-threatening bleeding within 3 hours of initial injury.

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Lung Abscess in Children

Pediatric EM Morsels

We have digested many Morsels regarding various pulmonary complaints. While some are very rare (ex, Pulmonary Embolism , Pulmonary Hypertensive Crisis , Negative Pressure Pulmonary Edema , CPAM ) others are commonly encountered (ex, Croup , Bronchiolitis , Sinusitis ). It is pneumonia , however, that often generates the most conversations. When should I consider a CXR ?

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Doctors Who Performatively Fetishized RCTs Aren’t Out to Advance Medical Research, But Rather to Sow Doubt & Mistrust

Science Based Medicine

Actually running an RCT is a lot harder than merely calling for one. Those who recognized this obvious fact are not against RCTs. The post Doctors Who Performatively Fetishized RCTs Aren’t Out to Advance Medical Research, But Rather to Sow Doubt & Mistrust first appeared on Science-Based Medicine.

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MIT hosts COVID-19 policy debate

Sensible Medicine

Since the start of the pandemic, I have written 200 op-eds on COVID-19 policy and published 20+ peer reviewed articles. I was opposed to school closure, masking kids, vaccine mandates, especially for young men in college who already had COVID-19, and took on many other controversial topics. Yet, from 2020-2022, I was not asked to debate these topics at any university.

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SGEM#432: SPEED, Give Me What I Need – To Diagnose Acute Aortic Dissections

The Skeptics' Guide to EM

Reference: Gibbons et al. The sonographic protocol for the emergent evaluation of aortic dissections (SPEED protocol): A multicenter, prospective, observational study. AEM February 2024. Date: February 28, 2024 Guest Skeptic: Dr. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. He is the Vice Chair of the Emergency Department at Nassau University […] The post SGEM#432: SPEED, Give Me What I Need – To Diagnose Acute Aortic Dissections first appeared on Th

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EM@3AM: Pneumocephalus

EMDocs

Authors: Mounir Contreras Cejin, MD (EM Resident Physician, UT Southwestern – Dallas, TX); Felipe Gonzalez Gutierrez (Medical Student, UT Southwestern – Dallas, TX); Emmanuel Ohuabunwa, MD, MBA (Attending Physician, UT Southwestern – Dallas, TX) // Reviewed by: Sophia Görgens, MD (EM Physician, Northwell, NY); Cassandra Mackey, MD (Assistant Professor of Emergency Medicine, UMass Chan Medical School); Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Welcome to EM@3AM, an emDOCs series

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More Evidence that Ignoring Safe Sleep Advice Puts Babies at Risk of Unexpected Death

Science Based Medicine

A new stud of thousands of cases confirms that sharing a sleep surface with a caregiver significantly increases the risk of unexpected death in infancy. The post More Evidence that Ignoring Safe Sleep Advice Puts Babies at Risk of Unexpected Death first appeared on Science-Based Medicine.

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From Guideline Recommendations to Articulated Harms and Benefits

Sensible Medicine

In the ideal, clinical guidelines incorporate evidence and expert opinion and enable clinicians to make evidence-based decisions without having to read the primary literature. These guidelines serve as an authority, defining high-quality care and how medical care should be delivered. Clinical guidelines have potential benefits: improved health outcomes, consistency of care, and reduced uncertainty (for the clinician).

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Decompensated. Liver disease in the ED. St Emlyn’s

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed A review of Acute on Chronic Liver Disease (ACLD / decompensated liver disease) in the ED. How we can improve patient outcomes. #FOAMed @stemlyns The post Decompensated. Liver disease in the ED. St Emlyn’s appeared first on St.Emlyn's.

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When the conventional algorithm diagnoses the ECG as COMPLETELY NORMAL, but there is in fact OMI, what does the Queen of Hearts PM Cardio AI app say? (with 10 case examples)

Dr. Smith's ECG Blog

I have often written about how an ECG interpreted as "normal" by a conventional algorithm may well be manifesting OMI, or even long QT or hyperkalemia. I have collected 51 OMI cases that were diagnosed as completely normal by the conventional automated computer algorithm. Shifa Karim and Gabe Keller helped with a project to assess all these ECGs with the Queen of Hearts.

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The ISEMPH abstract deadline is Friday, March 1

The Evolution & Medicine Review

Abstracts for the 9th annual meeting of the International Society for Evolution, Medicine, and Public Health are welcome for talks, posters, discussions and symposia. But the deadline is looming! Friday, March 1 is the deadline for abstract submissions for ISEMPH2024!

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Quality differences of supplements vs. drugs

Science Based Medicine

When it comes to drugs or dietary supplements, accuracy should be a given. What’s on the label should accurately describe what’s in the bottle. No exceptions. When it comes to ensuring the products we buy are of high quality, we’re all effectively reliant on regulation to protect us. As a pharmacist, I can’t personally verify that each tablet in your prescription contains […] The post Quality differences of supplements vs. drugs first appeared on Science-Based Medicine.

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The World of Ambulances: Types and Innovations

Emergency Live

An Overview of Different Types of Ambulances in Europe and Their Functionalities The Diverse Faces of Rescue: Ambulances A, B, and C The ambulance service is a fundamental pillar of the healthcare emergency system, with ambulances classified into three main categories: Type A, B, and C. Type A ambulances are essential for first aid, ready […] The post The World of Ambulances: Types and Innovations appeared first on Emergency Live.

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Diagnostic reasoning as artificial intelligence emerges: a distributed cognition framework

First 10 EM

This is an invited guest post by Dr. Cory Rohlfsen (@CoryRohlfsen) based on an interesting twitter thread of his from a few month back. Dr. Rohlfsen is a hybrid internal medicine clinician at the University of Nebraska Medical Center. He splits his time between hospitalist duties and primary care clinic. He is passionate about fostering […] The post Diagnostic reasoning as artificial intelligence emerges: a distributed cognition framework appeared first on First10EM.

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I Am Afraid of Early Cancer Screening: Part III

Sensible Medicine

I can’t stand celebrity doctors. That said, I am kind of a fan of Peter Attia. This is an accomplishment for Dr. Attia because one of my criteria for calling someone a celebrity doctor is that I can’t stand them. I appreciate Dr. Attia because he’s a smart guy who seems much more interested in improving people’s lives than hawking his wares.

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"Seizure" in a 60 year old male

Dr. Smith's ECG Blog

This 60 yo male had an apparent tonic clonic seizure. He had no history of seizures. He was unconscious for 8 minutes and slowly awoke in the ambulance, complaining of nausea only. First responders found him to be very tachycardic , confused, perserverating and with no memory of the event. There was tongue biting. Lightheadedness continued. The tachycardia was gone by the time paramedics arrived.

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What Is Somatic Therapy?

Science Based Medicine

Is modern medicine descending into pseudoscience, or is scientific medicine still going strong? Unfortunately, I think both of these things can happen at the same time. On the one hand, scientific research in medicine is progressing nicely. We are seeing the results of scientific breakthroughs made decades ago, with monoclonal antibody therapies, new therapeutic targets, the beginning of real genetic therapy, brain-machine […] The post What Is Somatic Therapy?

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Adrenaline: The Life-Saving Drug in Medical Emergencies

Emergency Live

A Crucial Ally Against Severe Allergic Reactions Adrenaline, also known as epinephrine, plays a vital role in the human body, preparing it to respond quickly to stressful or dangerous situations. This substance, naturally produced by the adrenal glands, speeds up the heart rate, dilates the airways, and increases blood flow to the muscles, providing crucial […] The post Adrenaline: The Life-Saving Drug in Medical Emergencies appeared first on Emergency Live.

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Paediatric IV Fluid Prescribing

Mind The Bleep

Prescribing fluids in paediatrics is simple but there is a system to it that you will need to learn if you have not worked in paediatrics before. This article breaks it down for you with examples of IV fluid prescribing. Please see this separate article for fluids and feeds in neonates. The important thing to remember is that children are not just small adults.

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Should I Change My Mind About Aspirin for the Prevention of Cardiac Events?

Sensible Medicine

Studies that tempt me to change my mind are worth telling you about. The story this week centers on the use of aspirin for prevention of cardiac events in people without heart disease. I used italics because this story ONLY applies to people without heart disease—so called primary prevention. In 2018, the NEJM and the Lancet published three trials that randomized tens of thousands of patients without heart disease to either low-dose aspirin or a placebo.

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Emergency Department Evaluation of Cholestatic Labs

EMDocs

Authors: Amelia Campbell, MD (EM Resident Physician, Carl R. Darnall Army Medical Center) and Alec Pawlukiewicz, MD (EM Attending Physician, Carl R. Darnall Army Medical Center) // Reviewed by: Joshua Lowe, MD (EM Attending Physician, USAF); Marina Boushra (EM-CCM, Cleveland Clinic Foundation); Brit Long, (@long_brit) Disclaimer: The views expressed in this post are those of the authors and do not reflect the official policy or position of the Department of the Army, DoD, or the US Government.

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Global Health map – connecting UK emergency care practitioners

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed In our modern world global health is vitally and increasingly important. Anisa Jafar takes us through a project designed to connect and map global health practitioners. Follow the links and join the network. The post Global Health map – connecting UK emergency care practitioners appeared first on St.Emlyn's.

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Revolution in the Skies: The New Frontier of Air Rescue

Emergency Live

With the purchase of 10 H145 helicopters, DRF Luftrettung marks a new era in medical rescue The Evolution of Air Rescue Air rescue represents a crucial component in emergency services, offering a rapid response in critical situations where every second counts. Helicopters, with their ability to land and take off vertically, access remote locations, and […] The post Revolution in the Skies: The New Frontier of Air Rescue appeared first on Emergency Live.

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Fenbendazole is fast becoming the laetrile of the 2020s

Science Based Medicine

Antivaxxers who "repurposed" deworming drugs like ivermectin and fenbendazole are peddling cancer "miracle cure" testimonials that remind me of laetrile and Stanislaw Burzynski. Truly, everything old is new again. The post Fenbendazole is fast becoming the laetrile of the 2020s first appeared on Science-Based Medicine.

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EM Quick Hits 55 – Induction Agents, Gabapentinoids, Neuroprotective Intubation, Approach to Paresthesias, Preventing Burnout

Emergency Medicine Cases

Anand Swaminathan on an update on the appropriate selection of induction agents. Hans Rosenberg on when to use gabapentinoids for pain control in the ED. Katie Lin on pearls for neuroprotective intubation. Nour Khatib and Hamza Jalal on an approach to paresthesias in the ED. Eric Wortmann on preventing burnout in emergency medicine. Please support EM Cases with a donation [link] The post EM Quick Hits 55 – Induction Agents, Gabapentinoids, Neuroprotective Intubation, Approach to Paresthesi

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Exploring the Benefits: Why Nurses Should Consider Working With One Healthcare Staffing Agency

Core Medical Group

Navigating the complexities of the travel healthcare industry can feel daunting, given the abundance of staffing agencies available. Nurses choose to travel for various reasons. The main appeal of travel nursing is the freedom it provides, enabling nurses to determine their work locations and schedules.

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The First10EM monthly wrap-up for February 2024

First 10 EM

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. Obviously the format means the focus is mostly on content I have found, but I hope […] The post The First10EM monthly wrap-up for February 2024 appeared first on First10EM.

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85 years of dedication: the anniversary of the Italian Firefighters

Emergency Live

A Celebration of Courage, Innovation, and Community Commitment From Origins to Modernity: A Journey of Heroism The 85th anniversary of the Italian Firefighters marks a significant milestone in the history of one of the country’s most respected and beloved corps. Officially established in 1939, the Italian Firefighters have traversed decades of national history, evolving from […] The post 85 years of dedication: the anniversary of the Italian Firefighters appeared first on Emergency L

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Skeptics in Pub. Cholera. Chapter 11a

Science Based Medicine

The morning started too early. For some reason, I snapped awake just before sunrise and could not fall back to sleep. Probably that ball of guilt in the pit of my stomach. I suspected it is a minor example of what a condemned man feels on the morning of his execution. I lay in bed and stared thoughtlessly at the ceiling waiting […] The post Skeptics in Pub.

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ECG Pointers: Ashman’s Phenomenon

EMDocs

Authors: Rachel Bridwell (Attending EM Physician); Brannon Inman, MD (EM Crit Care, Orlando Health); Lloyd Tannenbaum (Staff Physician, Hackensack University Medical Center) // Reviewed by: Jamie Santistevan, MD ( @jamie_rae_EMdoc, EM Physician, Presbyterian Hospital, Albuquerque, NM); Manpreet Singh, MD ( @MPrizzleER ); Brit Long, MD ( @long_brit ) Case: You’re working on shift and the nurses hand you an ECG asking what you want for rate control on this: Do you think this is atrial fibrillatio

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