Mount Sinai EM
JULY 24, 2023
This week, I wanted to touch a bit on Meconium Aspirators as apart of our GI Bleed intubation tool kit. At some point during second year, many of my fellow classmates and I started throwing these into airway boxes at Elmhurst. Especially in cardiac/resus, I think knowing to reach for one when you need one is critical, though I don’t think they need to be in every airway box.
ECG Guru
JULY 24, 2023
This is a "classic" ECG of very good quality for you to use in a classroom setting. The Patient: A 57-year-old man who complains of a sudden onset of "sharp" chest pain while on a long bike ride. The pain does not radiate, and nothing makes it worse or better. He is pale, cool, and diaphoretic. His medical history is unknown. The ECG: This ECG could be considered "classic" for an inferior wall ST elevation M.I. caused by occlusion of the right coronary artery.
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Don't Forget the Bubbles
JULY 24, 2023
Discitis is an inflammatory condition involving the intervertebral discs and end plates of vertebral bodies. It encompasses a spectrum of conditions that includes discitis , spondylodiscitis , and vertebral osteomyelitis. Discitis is uncommon. However, there is a bimodal peak in children, those under 6 years and adolescents. Neonates can also be affected.
RebelEM
JULY 24, 2023
Background: Rapid Sequence Intubation (RSI) is a procedure fraught with potential complications including hypotension which, in turn, can result in cardiovascular collapse. While there are numerous potential causes of hypotension peri-RSI, induction medications represent an important, modifiable variable. Over the last decade, airway experts have advocated for reduced induction agent dosing to lessen the risk of hypotension particularly in at risk patients.
Science Based Medicine
JULY 24, 2023
Dr. Peter McCullough and a number of "anti-COVID-19 vaccine" antivaxxers out there has pivoted to quackery to "detox" from the supposedly malign effects of COVID-19 vaccines. Everything old is new again, this time with nattokinase. The post “Base Spike Detox” and Signature Spike Support Formulas: Nattokinase quackery to treat COVID-19 and COVID-19 “vaccine injury” first appeared on Science-Based Medicine.
Medagadget
JULY 24, 2023
Researchers at the National University of Singapore have created a wound sensor patch that measures various wound biomarkers that can indicate would healing. Chronic wounds are an ongoing problem for many patients, and developing new ways to monitor and treat these painful lesions would be very useful. This battery-free wound patch contains five colorimetric sensors that change color in response to various wound biomarkers.
Emergency Live
JULY 24, 2023
Fire alarm – Italy is in danger of going up in smoke Besides the alarm about floods and landslides, there is always something we have to consider and that is of course drought. This kind of very intense heat comes naturally from particular and very intense cyclones and perturbations, and all this might appear normal, […] The post Climate Change and Drought: The Fire Emergency appeared first on Emergency Live.
Emergency Care Today brings together the best content for emergency care practitioners from the widest variety of industry thought leaders.
Emergency Live
JULY 24, 2023
Although not much is said about them, there are also cardiac tumours: they are extremely rare, with an incidence of around 0.2% compared to other oncological cases The post Cardiac tumours, an overview of benign and malignant neoplasms appeared first on Emergency Live.
Taming the SRU
JULY 24, 2023
THE CASE A male in his 60s presented to the emergency department for right upper quadrant abdominal pain. His past medical history included coronary artery disease, type II diabetes, atrial fibrillation, alcohol use disorder, cirrhosis complicated by portal venous hypertension, chronic kidney disease, prior Escherichia coli (E. coli) empyema due to complicated pneumonia, and a prior perisplenic abscess requiring percutaneous drainage.
Emergency Medicine Journal
JULY 24, 2023
Background Establishing the benefits of patient and public involvement (PPI) in emergency care research is important to improve the quality and relevance of research. Little is known about the extent of PPI in emergency care research, its methodological and reporting quality. This scoping review aimed to establish the extent of PPI in emergency care research, identify PPI strategies and processes and assess the quality of reporting on PPI in emergency care research.
University of Maryland Department of Emergency Med
JULY 24, 2023
Background: Prior evidence1,2 has suggested that early “pan-scan” after ROSC provides clinically-relevant informat.
Emergency Medicine Journal
JULY 24, 2023
Background In England, reported COVID-19 mortality rates increased during winter 2020/21 relative to earlier summer and autumn months. This study aimed to examine the association between COVID-19-related hospital bed-strain during this time and patient outcomes. Methods This was a retrospective observational study using Hospital Episode Statistics data for England.
AED Leader
JULY 24, 2023
On Monday 24 July, LeBron James Jr., the son of Los Angeles Lakers star LeBron James, suffered a cardiac arrest while training with the University of Southern California’s men’s basketball team. The Los Angeles Fire Department was called and the onsite medical team reportedly administered CPR and provided electrical shocks with a closely located AED (according to a statement from the American Heart Association ).
Emergency Medicine Journal
JULY 24, 2023
Background Improving out-of-hospital cardiac arrest (OHCA) prognosis within the working-age population is important, but no studies have investigated the effects of COVID-19 pandemic specifically on the working-age population with OHCAs. We aimed to determine the association between the 2020 COVID-19 pandemic and OHCA outcomes and bystander resuscitation efforts among the working-age population.
ALiEM
JULY 24, 2023
Dr. Sara Krzyzaniak (EM program director at Stanford) hosts this episode with Dr. Michelle Lin (ALiEM/UCSF) featuring all-star guests Dr. Alexis Pelletier-Bui (EM associate program director at Cooper University Hospital) and Dr. Elizabeth Werley (EM program director at Penn State Hershey). Both our guests serve as key representatives on behalf of the EM specialty on the AAMC ERAS Supplemental Application Working Group and provide you with a sneak peek behind what is coming for the totally revamp
Emergency Medicine Journal
JULY 24, 2023
Background Optimal decision-making regarding who to admit to critical care in pandemic situations remains unclear. We compared age, Clinical Frailty Score (CFS), 4C Mortality Score and hospital mortality in two separate COVID-19 surges based on the escalation decision made by the treating physician. Methods A retrospective analysis of all referrals to critical care during the first COVID-19 surge (cohort 1, March/April 2020) and a late surge (cohort 2, October/November 2021) was undertaken.
Sensible Medicine
JULY 24, 2023
Last week I wrote about the COURAGE trial. At the time, in 2007, the cardiology world was stunned to learn that opening partially blocked coronary arteries—in stable patients—did not lead to fewer heart attacks or less cardiac death compared to tablets alone. I chose the verb stunned because nearly the entire focus of cardiology at the time was the search for ischemia due to these blockages—so that they could be “fixed.” Od habits are hard to break, so, post-COURAGE
Emergency Medicine Journal
JULY 24, 2023
Not just a minor injury The term minor in the vernacular of emergency medicine is relative, often a misnomer can serve to downplay and underestimate the complexity of some injuries and the potential adverse ramifications and outcomes for patients with some minor injuries. Rightly, the primary focus for emergency medicine is saving lives; nonetheless, I was delighted to see two papers in this issue on very common non-life threatening presentations to the ED, ankle injuries and scaphoid injuries.
Sensible Medicine
JULY 24, 2023
Everyone gets excited when a top researcher was found to oversee a trainee who photoshopped a western blot. “Yes! we found an example of fraud” “OMG, the culture in his laboratory was so horrible.” “Yay, science is self-correcting!” Some of these things were said recently, when the Stanford University president resigned to spend more time doing research (which, ironically, was the problem).
Emergency Medicine Journal
JULY 24, 2023
Ankle injuries are one of the most common presentations to the Emergency Department (ED), but few emergency physicians would consider them to represent a diagnostic challenge. In our armoury, we already have the Ottawa ankle rules (which are highly sensitive for bony injury) and access to plain radiographs. However, Deutekom et al present a systematic review of studies evaluating the diagnostic accuracy of ultrasound for ankle injuries. 1 Why should we consider another diagnostic modality for su
Emergency Medicine Journal
JULY 24, 2023
A newspaper on my neighbour’s stoop declares a Historic Drought in New England, but in my hospital’s basement, water leaks from the ceiling. A yellow sign warns of the "Wet Floor" with a cartoon man in free fall, seconds away from his own trip to the ED. In our triage area, a pool of patients stretches out on beds that extend down the hallway.
Emergency Medicine Journal
JULY 24, 2023
Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication.
Emergency Medicine Journal
JULY 24, 2023
Clinical Introduction A 36-year-old woman presented to the ED with sudden-onset right flank and iliac fossa pain that began 3 hours prior to arrival, associated with vomiting and diarrhoea. She denied dysuria or fever. Her observations were within normal range. Examination of her abdomen revealed right flank tenderness ( figure 1 ). A point-of-care ultrasound was obtained.
Emergency Medicine Journal
JULY 24, 2023
Background Although frequent emergency department (ED) users have been widely studied in cross-sectional settings, there is some evidence suggesting that most frequent ED users do not remain frequent users over multiple consecutive years. The objective of this study was to explore the association between persistent multiyear frequent ED use and individuals’ characteristics.
Emergency Medicine Journal
JULY 24, 2023
Background Ankle injuries are one of the most common presentations in the ED. Although fractures can be ruled out using the Ottawa Ankle Rules, the specificity is low, which means many patients may still receive unnecessary radiographs. Even once fractures are ruled out, assessment of ankle stability is recommended to rule out ruptures, but the anterior drawer test has only moderate sensitivity and low specificity and should be performed only after swelling has receded.
Emergency Medicine Journal
JULY 24, 2023
Clinical introduction A 48-year-old man came to the emergency department (ED) due to a lump sensation in his throat after dinner. Neither obvious pharyngeal/laryngeal foreign body was seen with flexible nasopharyngoscopy nor apparent oesophageal abnormalities on the lateral neck radiograph ( figure 1A ). Due to persistent discomfort, he underwent oesophagogastroduodenoscopy without findings of upper gastrointestinal lesions.
Emergency Medicine Journal
JULY 24, 2023
Clinical Introduction An 80-year-old man with a medical history of hypertension, dyslipidaemia, coronary artery disease, alcohol consumption and atrial fibrillation, not anticoagulated, presented to the emergency department with sudden onset of pleuritic chest pain, dyspnoea and fever. Initial blood pressure was 165/93 mm Hg, with a heart rate of 100 beats/min, peripheral oxygen saturation of 91% (FiO 2 21%) and an otherwise unremarkable physical examination.
Emergency Medicine Journal
JULY 24, 2023
Clinical introduction The patient had recently been diagnosed with heart failure and dilated cardiomyopathy (left ventricular ejection fraction: 20%). Medication included furosemide, spironolactone, bisoprolol, perindopril, indapamide. The patient was found with a cardiac arrest. After successful basic life support and stabilized circulation, the following ECG was recorded (see figure 1 ).
Emergency Medicine Journal
JULY 24, 2023
Background Endotracheal tube (ETT) malposition is frequent in paediatric intubation. The current recommendations for ETT insertion depths are based on formulae that hold various limitations. This study aimed to develop age-based, weight-based and height-based curve charts and tables for ETT insertion depth recommendations in children. Methods In this retrospective single-centre study, we determined the individual optimal ETT insertion depths in paediatric patients by evaluating postintubation ra
Emergency Medicine Journal
JULY 24, 2023
Background microMend, a novel microstaple skin closure device, may be able to close simple lacerations. This study aimed to evaluate the feasibility and acceptability of using microMend to close these wounds in the ED. Methods This was an open-label, single-arm clinical study conducted at two EDs within a large urban academic medical centre. Wounds closed with microMend underwent assessments performed at days 0, 7, 30 and 90.
Emergency Medicine Journal
JULY 24, 2023
Given increasing demand and constraints in ED staffing, pharmacists are a potential resource to expand the Children’s Emergency Department (CED) workforce. We determined whether a pharmacist in the CED could independently safely discharge eligible patients and whether the role would be acceptable to families. A single community non-prescribing pharmacist was recruited to participate in CED care during weekdays (10:00–18:00) over a 12-week period (17 November 2021 to 11 February 2022,
Emergency Medicine Journal
JULY 24, 2023
Background Plain radiographs cannot identify all scaphoid fractures; thus ED patients with a clinical suspicion of scaphoid injury often undergo immobilisation despite normal imaging. This study determined (1) the prevalence of scaphoid fracture among patients with a clinical suspicion of scaphoid injury with normal radiographs and (2) whether clinical features can identify patients that do not require immobilisation and further imaging.
Emergency Medicine Journal
JULY 24, 2023
This month’s update is by a team from Emergency Medicine Research in Oxford (EMROx). We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper.
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