Sat.Nov 11, 2023 - Fri.Nov 17, 2023

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Speaking urgent care flow fluently

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed Simplifying urgent care data translation is essential for hospital flow improvement. This post provides a perspective on how to achieve this. The post Speaking urgent care flow fluently appeared first on St.Emlyn's.

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FAST Is Fast, and FAST Is Last

The Trauma Pro

Ever been in a trauma activation where it seems like the first thing that happens is that someone steps up to the patient with the ultrasound probe in hand? And then it takes 5 minutes of pushing and prodding to get the exam done? Well, it’s not supposed to be that way. The whole point of adhering to the usual ATLS protocol is to ensure that the patient stays alive through and well after your exam.

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Cuffed Endotracheal Tubes for Children: ReBaked Morsel

Pediatric EM Morsels

While doing literature review for my scholarly project it dawned on me that it might be time to dust off a classic morsel from the bottom of the cookie jar. On this 10 year anniversary, we chose to throw this one back in the oven to include some even more delicious data on cuffed endotracheal tube (ETT) use. No matter whether you have the wisdom of many years of practice ( old doc like Dr.

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The Great Barrington Declaration and “natural herd immunity” versus public health three years later

Science Based Medicine

Over the weekend, Jeffrey Tucker, founder of the Brownstone Institute, crowed about how the Great Barrington Declaration and its recommendation of a "natural herd immunity" approach to the pandemic changed everything three years ago. Unfortunately, as the John Snow Project pointed out last week, the "natural herd immunity" approach has done what could be irreparable damage to public health science and, more importantly, the political and social will to promote public health practices not just fo

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ICU Physiology in 1000 Words: The Right Atrial Pressure Does Not Determine Cardiac Output – Part 2

PulmCCM

Jon-Emile S. Kenny MD [ @heart_lung ] In part 1 , right atrial pressure [P ra ] and cardiac output/venous return [CO/VR] were considered as two hemodynamic measures bound at the operating point [OP] of the circulatory system. Within the sphere of macrohemodynamics, the OP is the true dependent variable – meaning that P ra and CO do not affect each other [1, 2].

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Massive Haemorrhage: Science and Practice

Broome Docs

This is another lecture by the always amazing Dr Justin Morgenstern from the series of talks he delivered on his tour of Perth in September 2023. In this talk I challenged Justin to go on a very deep dive into the literature around the modern management of the massively bleeding trauma patient. What is the best way to resuscitate and replace all those blood products in these severely unwell people?

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How to Make a Logo using AI

Life in the Fast Lane

Sheralyn Guilleminot and Mike Cadogan How to Make a Logo using AI AI in healthcare: A review of the AI tools Midjourney and DALL•E•3 to create logos and images; their unique features, differences, and the importance of effective instruction (prompting).

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JC: The DAShED Study – Diagnosis of Acute Aortic Syndrome in the Emergency Department

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed We review a paper from the EMJ looking at the diagnosis of acute aortic syndrome in the ED and the accuracy of clinical decision rules and clinician gestalt The post JC: The DAShED Study – Diagnosis of Acute Aortic Syndrome in the Emergency Department appeared first on St.Emlyn's.

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Climate Change – What can Healthcare do?

EM Ottawa

With our shorter, milder winters (no skating on the Rideau Canal this past year), and our warmer, drier summers (thick wildfire smoke blanketing Ottawa in June), along with accelerating extreme weather events; derechos, ice storms and tornados – it is clear that climate change is not a future problem in faraway places. It is very […] The post Climate Change – What can Healthcare do?

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Acute Dyspnea and Right Bundle Branch Block

Dr. Smith's ECG Blog

I was texted this ECG just as I was getting into bed. It is of an elderly woman who complained of shortness of breath and had a recent stent placed. I was told that the Queen of Hearts had called it OMI with high confidence. What do you think? Ken (below) is appropriately worried about pulmonary embolism from the ECG. What I had not told him before he made that judgement is that the patient also had ultrasound B-lines of pulmonary edema.

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The Swan Song of a Chiropractic Heretic

Science Based Medicine

After 41 years of private practice as a chiropractor and 60 years of writing books and articles, the age of 94 finds me rethinking my career, wondering if my contributions to the literature justify the path I took. The post The Swan Song of a Chiropractic Heretic first appeared on Science-Based Medicine.

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The Science of Silence

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed In a world of constant noise and stimuation should we try to find more time for silence? The post The Science of Silence appeared first on St.Emlyn's.

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A Major Breakthrough In Obesity Treatment

Sensible Medicine

When the primary investigator showed the main results slide of the SELECT trial here at the American Heart Association meeting, there was applause. I am not sure how I feel about clinicians clapping for positive results, but the fact remains that the SELECT trial is a big deal. In SELECT, the injectable glucagon-like peptide 1 (GLP-1) agonist semaglutide was studied against placebo in more than 17,000 obese or overweight patients who had atherosclerotic disease.

Outcomes 101
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SAEM Clinical Images Series: Pediatric Genitourinary Bleeding

ALiEM

A 4-year-old female with no significant past medical history is brought to the Emergency Department by her grandmother for concern for two days of progressive vaginal bleeding. The grandmother first noted blood in the patient’s underwear the previous morning when she was helping the patient wipe and she noticed it again prior to arrival, this time saturating the patient’s underwear.

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Dr. Jay Bhattacharya: “The Unspoken Root Idea Of His Is That The General Public Owed It To Doctors To Not Get COVID Because It Would Place Doctors At Risk Of Getting COVID. Of Course This Is An Inversion. “

Science Based Medicine

Frontline fealthcare workers are also part of the public. Our lives have value too. The post Dr. Jay Bhattacharya: “The Unspoken Root Idea Of His Is That The General Public Owed It To Doctors To Not Get COVID Because It Would Place Doctors At Risk Of Getting COVID. Of Course This Is An Inversion. “ first appeared on Science-Based Medicine.

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How the Human Understanding Metric + strategy boosts NPS

NRC Health

Gundersen Health System and M Health Fairview are among the NRC Health partners that have implemented the HUme into their patient experience surveys. Supporting this effort with intentional strategies to engage leaders and teams, these systems are now enjoying unprecedented increases in NPS. The post How the Human Understanding Metric + strategy boosts NPS appeared first on NRC Health.

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How important are old ECGs in Non-obvious cases of potential OMI?

Dr. Smith's ECG Blog

In the last post, we saw how important old ECGs are in assessing the current ECG in a patient without atypical presentation (in this previous case, the patient had no chest pain, and the apparent inferior OMI did not have reciprocal ST depression in lead aVL). Here is that last post: A 90-something with acute stroke. She has no chest symptoms. What is the diagnosis?

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Instructors' Collection ECG: Isolated Posterior Wall M.I.

ECG Guru

This interesting case was provided by Dr. Bojana Uzelac, Emergency Medicine physician. We are paraphrasing a translation of her comments here. The patient is a 50-year-old complaining of chest pain. The ECG shows a rare occurrence – an isolated POSTERIOR WALL MI (PWMI). Note that leads V1 through V4 show the usual signs of posterior wall MI. We see ST segment depression, which represents a reciprocal view of the ST elevation present on the posterior wall of the left ventricle.

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First Whole Eye Transplant

Science Based Medicine

A whole eye transplant did not restore vision, but is still an important advance. The post First Whole Eye Transplant first appeared on Science-Based Medicine.

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Fracture Fridays: You can dance if you want to

PEMBlog

The case A self-proclaimed dance team superstar presents after injuring her foot at a regional competition. She tried to finish the routine after landing awkwardly. But was having difficulty bearing weight. She applied ice overnight and despite ibuprofen is still in pain, and presents to the ED the next day.On her exam the neruovascular exam is normal, and she has pain along the proximal edge of the 5th metatarsal.

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SGEM#420: I get knocked down, but I get up again – do I have a scaphoid fracture?

The Skeptics' Guide to EM

Date: November 2, 2023 Reference: Coventry et al. Which clinical features best predict occult scaphoid fractures? A systematic review of diagnostic test accuracy studies. Emerg Med J. Aug 2023 Guest Skeptic: Dr. Matt Schmitz is an Orthopaedic Surgeon who sub-specializes in adolescent sports and hip preservation. He will soon be transitioning out of the US military after […] The post SGEM#420: I get knocked down, but I get up again – do I have a scaphoid fracture?

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Cardiomyopathy

Mind The Bleep

The word cardiomyopathy is used as a general term referring to the abnormal structure or function of the heart. Strictly speaking, the definition of cardiomyopathy excludes myocardial dysfunction due to coronary artery disease, systemic hypertension and valvular or congenital heart disease. However, you will still hear terms such as ‘ischaemic cardiomyopathy’ commonly used in clinical practice to describe heart failure secondary to ischaemia.

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What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

Dr. Smith's ECG Blog

A 70-something female with no previous cardiac history presented with acute chest pain. She awoke from sleep last night around 4:45 AM (3 hours prior to arrival) with pain that originated in her mid back. She stated the pain was achy/crampy. Over the course of the next hour, this pain turned into a pressure in her chest. She said this was midsternal and felt like a tightness.

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How Long to Wait for an Ambulance in Addis Ababa?

Emergency Live

Ambulance Response Times in Addis Ababa: Challenges and Solutions in an Urban Context In any urban center, the swift response of emergency services, especially ambulances, is crucial to saving lives. Addis Ababa, the capital city of Ethiopia, is no exception to this need. However, the response times of emergency ambulances in Addis Ababa can be […] The post How Long to Wait for an Ambulance in Addis Ababa?

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REBEL Core Cast 112.0 – Awareness During Paralysis

RebelEM

Take Home Points: Dose your RSI meds correctly. Reach for post-intubation sedation at the same time you are asking for your induction agent and paralytic. Propofol is a great choice for post-intubation sedation, and if your patient becomes hypotensive do not be afraid of adding on a pressor! REBEL Core Cast 112.0 – Awareness During Paralysis [“[link] Click here for Direct Download of the Podcast Awareness during paralysis is real.

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Friday Reflection 33: Making Your Doctor Laugh

Sensible Medicine

RF is a 74-year-old man with multiple, progressive medical problems. He sees his doctor frequently and often needs his assistance to arrange home care and other services so that he might maintain his independence despite his increasing disability. Sensible Medicine is a reader-supported publication. If you appreciate our work, consider becoming a free or paid subscriber.

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The Annual ILCOR Update – what’s new in adult life support

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed A summary of the annual consensus update from the International Liaison Committee on Resuscitation looking particularly at ECPR, DSED, Drowning and prognostication The post The Annual ILCOR Update – what’s new in adult life support appeared first on St.Emlyn's.

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Healing the Unsung Heroes: Treating Traumatic Stress in First Responders

Emergency Live

Unlocking the Path to Recovery for Those Who Brave the Frontlines of Trauma First responders are the silent heroes who face the darkest moments of humanity. They tread where others dare not, experience the unbearable, and stand strong in the face of unimaginable tragedies. The weight they carry, both physically and mentally, often leads to […] The post Healing the Unsung Heroes: Treating Traumatic Stress in First Responders appeared first on Emergency Live.

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ICU Physiology in 1000 Words: The Right Atrial Pressure Does Not Determine Cardiac Output – Part 1

PulmCCM

Jon-Emile S. Kenny MD [ @heart_lung ] It is axiomatic that association is not causation. Sometimes, however, this principle is lost in the fuliginous fog of literature and life. It feels like we’ve known all of macrohemodynamics already, known the right atrial pressure [P ra ] and cardiac output [CO], known them rounding in the evenings, mornings, afternoons, measuring them, as we do our lives with coffee spoons.

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How Standardizing Consumables Offers Hospitals Quick Wins for Cost Savings

PDC Healthcare

Health Systems Aim to Improve Efficiencies & Reduce Costs Consolidating vendors and standardizing products is a fundamental way for hospital supply chain professionals to achieve cost savings and improve efficiencies for their facilities. Health systems are working to reduce the number of vendors in an attempt to increase purchase volumes with their primary suppliers and […] The post How Standardizing Consumables Offers Hospitals Quick Wins for Cost Savings appeared first on connectID

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Urgent care flow

Life in the Fast Lane

Stevan Bruijns Urgent care flow Speaking urgent care flow fluently - to highlight some important new ideas and provide a fresh perspective on old concepts.

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Ambulances in Addis Ababa: models and manufacturers

Emergency Live

Exploring the Varieties of Ambulance Models and Their Origins in Ethiopia’s Capital In the sprawling metropolis of Addis Ababa, where the rapid pace of urban life meets the unforeseen challenges of emergency situations, the diversity of ambulance models is a critical factor in ensuring the city’s safety and well-being. In this article, we delve into […] The post Ambulances in Addis Ababa: models and manufacturers appeared first on Emergency Live.

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CT Angiography Head and Neck: Indications and Limitations

EMDocs

Authors: Mary Hamblen, DO (EM Resident Physician, TX); Justin Hacnik, MD (EM Resident Physician, TX); Katherine Spencer, MD (EM Resident Physician, TX); J.D. Cambron, DO (EM Attending Physician, TX) // Reviewed by: Joshua Lowe, MD (EM Attending Physician, USAF); Marina Boushra, MD (EM-CCM Attending, Cleveland Clinic Foundation); Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case A 37-year-old male presents to the emergency department with a severe, unrelenting headache that started su

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Diagnostics and Therapeutics: Ear Emergencies in the Department

Taming the SRU

Chief complaints involving the ear are a common occurrence in Emergency Departments across the US and include presenting symptoms such as ear pain or fullness, hearing loss, redness, trauma, vertigo, and foreign bodies. A retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 through 2011 identified 8.6 million visits resulting in otologic diagnoses, encompassing about 1.01% of all adult visits and 6.79% of pediatric visits (1).

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Mentoring relationships made easy

Life in the Fast Lane

Theresa Jacques Mentoring relationships made easy Theresa Jacques introduces a free resource for developing and maintaining a productive mentor – mentee relationship.

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World Landslide Forum in Florence: A Crucial Meeting for Global Risk Management

Emergency Live

Joining Scientific and Technological Forces to Combat Landslides Globally Tuesday, November 14 marks the beginning of a significant event in the city of Florence: the 6th World Landslide Forum (WLF6). This meeting, attended by more than 1100 experts from 69 countries, takes place at the Palazzo dei Congressi and aims to create a common platform […] The post World Landslide Forum in Florence: A Crucial Meeting for Global Risk Management appeared first on Emergency Live.

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Maintenance Fluids in Critical Illness

Don't Forget the Bubbles

One-liner… Understanding how to manage maintenance fluids in critically unwell children best is a basic but important way to improve outcomes. Background Prescribing maintenance fluids can seem like a straightforward tick-off from the to-do list for many of us. However, considering human mass is composed of 60% water ( 70% for term neonates), we must get this right.