The Trauma Pro

JANUARY 22, 2024

The blood pressure cuff is one of those devices trauma professionals don’t give a second thought to. Old timers like me remember using the cuff with a sphygmomanometer and stethoscope to get manual blood pressures. I’ve had to do this twice in recent months on airplanes, and I had forgotten how much work this is. But technology makes things easier for us.

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147

EMCrit

JANUARY 22, 2024

background: ANTHARTIC trial Prophylaxis against VAP (ventilator associated pneumonia) has is already supported by a few studies in the literature, perhaps most notably the ANTHARTIC trial. That was a multi-center RCT evaluating 48 hours of therapy with ampicillin-sulbactam for patients intubated following cardiac arrest. Antibiotic therapy reduced early-onset VAP, with a trend towards more ventilator-free […] EMCrit Project by Josh Farkas.

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123

Sensible Medicine

JANUARY 22, 2024

Two quick stories as background. I remember caring for an older man who presented with a minor heart attack. We got him squared away easily. I was then struck by his history because more than a decade ago, doctors discovered severe multi-vessel coronary disease and they had recommended bypass surgery. They told him he would die without it. He refused.

Outcomes 119

Outcomes Research 119

Science Based Medicine

JANUARY 22, 2024

Wakefield redux? Antivax scientist Byram Bridle just took the "new school" antivax movement old school by implying that COVID-19 vaccines might cause an "epidemic of autism." Everything old is new again, sort of. The post “New school” antivax goes old school as Byram Bridle asks if COVID-19 vaccines will drive an “epidemic” of autism first appeared on Science-Based Medicine.

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First 10 EM

JANUARY 22, 2024

Over the last few years, I have seen a steady increase in the number of non-inferiority trials being published. This makes some sense, as they generally require fewer participants, and are therefore cheaper and easier to run. However, it presents a problem, as most of us (including myself) don’t really understand the statistics being performed, […] The post You don’t understand non-inferiority trials (and neither do I) appeared first on First10EM.

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EM Ottawa

JANUARY 22, 2024

Methodology: 3.5/5 Usefulness: 4/5 Friedman BW, et al. Neurology. 2023 Oct 3;101(14):e1448-e1454. Question and Methods: This double-blinded RCT of 209 patients presenting to the ED with moderate to severe migraines compared high- to low- dose dexamethasone (16 mg vs 4 mg) on sustained headache relief 48 hours post discharge. Findings: There was no significant difference in sustained […] The post Randomized Trial Comparing Low- vs High-Dose IV Dexamethasone for Patients With Moderate to

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Emergency Live

JANUARY 22, 2024

The Ambulance That Transformed Military Emergencies The Origins of a Revolutionary Innovation The introduction of the Fiat Type 2 ambulance in 1911 marked a crucial transitional era in the field of military rescue. Its birth during the Libyan campaign was not only a technological advancement but also a breakthrough in the strategy of rescue in […] The post Fiat Type 2: evolution of battlefield rescue appeared first on Emergency Live.

Military 91

Military 91

Emergency Live

JANUARY 22, 2024

From British Origins to Global Modernization From British Waterguard to the modern organization The history of the Coast Guard begins in the United Kingdom in 1809 with the creation of the Waterguard, a department of the British customs authority originally dedicated to preventing smuggling. This initiative was in response to the need to combat the […] The post Coast Guard: a global maritime safety story appeared first on Emergency Live.

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85

Emergency Medicine Journal

JANUARY 22, 2024

Objectives Sympathetic crashing acute pulmonary edema (SCAPE) is a subset of heart failure with a dramatic presentation. The unique physiology of this condition requires a different management strategy from the conventional practice. The trial objective was to compare the efficacy of high-dose and low-dose GTN in patients with SCAPE. Methods This was an open-label randomised control trial conducted in a tertiary care teaching hospital in India from 11 November 2021 to 30 November 2022.

Outcomes 75

Outcomes Hospitals 75

Emergency Live

JANUARY 22, 2024

An Essential Guide to Identifying and Managing a Cardiac Emergency Heart Attack Symptoms: Warning Signs Myocardial infarction, commonly known as a heart attack, is a serious medical condition that occurs when blood flow to the heart is suddenly blocked. Symptoms can vary significantly among individuals, but there are some common warning signs to recognize.

Resuscitation 78

Resuscitation 78

ALiEM

JANUARY 22, 2024

A 40-year-old male, tailor by occupation, was brought to the Emergency Department with complaints of high-grade fever for the past 11 days. Fever was documented to be 102°F and was not associated with any chills or rigors. The patient also complained of shortness of breath for one week associated with a dry cough, as well as an altered sensorium for one day.

Documentation/Coding 64

Documentation/Coding Academics Emergency Department Hospitals 64

Emergency Live

JANUARY 22, 2024

Understanding Osteoporosis and Its Management Osteoporosis is a condition characterized by a decrease in bone mass and density, increasing the risk of fractures. This disorder, often referred to as a “silent disease“, does not exhibit obvious symptoms until unexpected fractures occur, typically after a minor fall or a minor accident. Warning signs, such as height […] The post Osteoporosis: a silent challenge to bone health appeared first on Emergency Live.

Fractures 72

Fractures 72

RebelEM

JANUARY 22, 2024

A 46-year-old woman with a history of borderline high cholesterol levels presents with acute-onset chest pain 2 days ago with progressively worsening shortness of breath. Her only medication is an oral contraceptive pill that she has taken for over 20 years. Vital signs show HR of 121 bpm, BP of 124/80 mm Hg, RR of 24/min, T of 37.2°C, and SpO2 of 93% on room air.

EMS 57

EMS EKG/ECG 57

Emergency Live

JANUARY 22, 2024

An Innovative Approach to Predicting Recovery from Depression What Depression Is: Symptoms, Causes, and Treatments Depression is a mood disorder that affects millions of people worldwide. It is characterized by profound sadness, loss of interest or pleasure in daily activities, accompanied by a variety of physical and psychological symptoms. Its causes are complex and multifactorial, […] The post Toward a new understanding of depression appeared first on Emergency Live.

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Emergency Medicine Ireland

JANUARY 22, 2024

Welcome back to the tasty morsels of critical care podcast. Today we’ll cover some key exam content, all be it not something you’re likely to run into in the ICU too often. The thyroid is a deceptive little organ, tucked in the neck, quietly secreting hormones and interfering in negative feedback loops. It usually restricts its mischief to outpatient clinics by running hot or cold on a chronic basis, occasionally hypertrophying and interfering with its more important neighbour the ai

Sepsis 52

Sepsis Resuscitation Wellness Administration 52

Emergency Live

JANUARY 22, 2024

Celebrating International Hug Day: How a Simple Gesture Can Transform Our Health A Universal Gesture with Scientific Roots Yesterday, January 21st, we celebrated International Hug Day, and it’s essential to reflect on the health benefits of this gesture. According to Emi Bondi, a psychiatrist and director of the mental health department at the Papa Giovanni […] The post The healing power of the hug: more than a gesture, a therapy appeared first on Emergency Live.

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63

Emergency Medicine Journal

JANUARY 22, 2024

Welcome to February 2024’s primary survey for the EMJ. I very much hope as we move into the second month of 2024, things can be as calm as possible in the world of emergency medicine (EM). Pain is one of the most common reasons that people present to the emergency department (ED). Therefore, it seems fitting this month’s journal is covering topics from sedation and pain management through to toxicology and critical care.

EMS 52

EMS Emergency Department 52

EMergucate

JANUARY 22, 2024

Answers PH = 7.507, that is alkalaemia pCO2 = 28 mmHg. So, we have respiratory alkalosis.

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52

Emergency Medicine Journal

JANUARY 22, 2024

Psychedelic drugs such as lysergic acid diethylamide (LSD) and psilocybin (‘magic mushrooms’) induce hallucinations and distort thought-processes. The intensity of a psychedelic ‘trip’ can cause distress, agitation, and even psychosis. A recent report showed that at least 8.4% of drug-related presentations to European emergency departments involve psychedelics. 1 This proportion may increase as the clinical use of these agents expands. 2 There are multiple ways to control

Emergency Department 45

Emergency Department 45

Don't Forget the Bubbles

JANUARY 22, 2024

Choosing Wisely is an international initiative to reduce unnecessary tests, treatments, and procedures. The campaign started in the United States in 2012, in Canada two years later, and in the United Kingdom in 2016. Choosing Wisely has expanded to more than 20 countries, including European countries, Brazil, Japan, India, Australia, and New Zealand.

Emergency Department 90

Emergency Department Best Practices Radiology Radiology 90

Emergency Medicine Journal

JANUARY 22, 2024

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.

Research 40

Research 40

Emergency Medicine Journal

JANUARY 22, 2024

This month’s update is by the Academic Department of Military Emergency Medicine and University Hospitals Plymouth NHS Trust. 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.

Airway Management 40

Airway Management Military Academics Resuscitation 40

Emergency Medicine Journal

JANUARY 22, 2024

A short-cut systematic review was conducted using a described protocol. The three-part question addressed was: In patients with COVID-19 infection, does blood group type O versus non-O blood groups lead to a lower risk of severe COVID-19 infection? MEDLINE, Embase, and Cochrane databases were searched for relevant evidence. Altogether, 238 papers were found using the search strategy developed.

Outcomes 40

Outcomes 40

Emergency Medicine Journal

JANUARY 22, 2024

Prior reports describe the care children receive in community EDs (CEDs) compared with paediatric EDs (PEDs) as uneven. The Emergency Medical Services for Children (EMSC) initiative works to close these gaps using quality improvement (QI) methodology. Project champion from a community hospital network identified the use of safe pharmacological and non-pharmacological anxiolysis and analgesia (A&A) as one such gap and partnered with EMSC to address it.

Emergency Department 40

Emergency Department Academics Hospitals 40

Emergency Medicine Journal

JANUARY 22, 2024

Many overdose deaths are associated with patient co-use of opioids and other substances, such as benzodiazepines. 1–3 However, the literature is sparse surrounding the characteristics, treatment, outcomes, costs, disposition and resource utilisation of people who co-use compared with those who use opioids alone. This is an Institutional Review Board-exempt retrospective review of de-identified ED data available for the state of Maryland through the Healthcare Cost and Utilization Project (

Outcomes 40

Outcomes Emergency Department Poisoning Documentation/Coding 40

Emergency Medicine Journal

JANUARY 22, 2024

Clinical introduction A 13-year-old boy was brought to the ED after being hit by an oncoming car. As the car approached him from his side, he tried to stop the car by turning around and put both his hands in front of him. He tried to break the subsequent fall by stretching both arms outwards before hitting the road. On arrival in the ED, he held both shoulders in an abducted position above his head.

Dislocations 40

Dislocations Resuscitation 40

Emergency Medicine Journal

JANUARY 22, 2024

Background Current diabetic ketoacidosis (DKA) treatment guidelines recommend using normal saline (NS); however, NS may delay DKA resolution by causing more hyperchloremic metabolic acidosis compared with balanced crystalloids. This study’s objective was to determine the feasibility of a future multicentred randomised controlled trial (RCT) comparing intravenous Ringer’s lactate (RL) with NS in managing ED patients with DKA.

Emergency Department 40

Emergency Department Academics Outcomes 40

Emergency Medicine Journal

JANUARY 22, 2024

Clinical Introduction A previously healthy 39-year-old male presented to the emergency department with intermittent right arm swelling for 1 month, which worsened over 4 days ( figure 1 ). He is a right-handed chef and often raised his right arm at work. He denied fever or recent trauma. On examination, radial artery pulse was palpable. There was no cervical or axillary lymphadenopathy.

Emergency Department 40

Emergency Department 40

Emergency Medicine Journal

JANUARY 22, 2024

Background Nitrous oxide (N 2 O) has multiple benefits in paediatric procedural sedation (PPS), but use is restricted by its limited analgesic properties. Analgesic potency could be increased by combining N 2 O and intranasal fentanyl (INF). We assessed safety and efficacy data from 10 years (2011–2021) of our N 2 O PPS programme. Methods Prospectively collected data from a sedation registry at a paediatric emergency department (PED) were reviewed.

Emergency Department 40

Emergency Department Outcomes 40

Emergency Medicine Journal

JANUARY 22, 2024

Background The NHS has the target of reducing its carbon emission by 80% by 2032. Part of its strategy is using pharmaceuticals with a less harmful impact on the environment. Nitrous oxide is currently used widely within the NHS. Nitrous oxide, if released into the atmosphere, has a significant environmental impact. Methoxyflurane, delivered through the Penthrox ‘green whistle’ device, is a short-acting analgesic and is thought to have a smaller environmental impact compared with nit

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40

Emergency Medicine Journal

JANUARY 22, 2024

Worldwide, the healthcare sector is responsible for approximately 4.4% of the global carbon footprint. 1 As a healthcare system we need to reduce our environmental footprint, along with the rest of society, to ensure a safe and liveable future. This must be done in an evidence-based way, to ensure that any changes we make in our practice do really reduce our environmental impact rather than working on a best guess.

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40

Emergency Medicine Journal

JANUARY 22, 2024

Background The optimal way to hold an endotracheal tube (ETT) during intubation has not been studied. In this randomised clinical trial, we examined the effect of site—holding the ETT in two different positions on time and ease of intubation by anaesthesia trainees. Methods A single-centre, randomised trial of intubations of stable patients with uncomplicated airways was conducted from 15 September 2019 to 31 May 2021 in the All India Institute of Medical Sciences, Bhubaneswar, India.

Outcomes 40

Outcomes 40

Emergency Medicine Journal

JANUARY 22, 2024

Background Intranasal sufentanil is a potent opioid which can be used in patients with traumatic injuries presenting to the ED. Although previous studies have demonstrated the superiority of intranasal sufentanil over intravenous morphine in terms of pain relief, its clinical superiority in patients with traumatic injuries receiving adequate multimodal analgesia with acetaminophen and non-steroidal anti-inflammatory drugs is uncertain.

Emergency Department 40

Emergency Department Outcomes 40