Tue.Feb 20, 2024

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Trauma Activation Vs. Stroke Code

The Trauma Pro

Let’s look at an uncommon scenario that crops up from time to time. Most seasoned trauma professionals have seen this one a time or two: An elderly male is driving on a sunny afternoon, and crashes his car into a highway divider at 25 miles per hour. EMS responds and notes that he has a few facial lacerations, is awake but confused. They note some possible facial asymmetry and perhaps a bit of upper extremity weakness.

Stroke 278
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Tachycardia and hyperkalemia. What will happen after therapy with 1 gram of Ca gluconate and some bicarbonate?

Dr. Smith's ECG Blog

A 20-something type, 1 diabetic presented by EMS with altered mental status. Blood pressure was 117/80, pulse 161, Resp 45, SpO2 100 on oxygen. Here is the 12-lead ECG: Wide complex tachycardia What do you think? The providers thought that this wide QRS was purely due to (severe) hyperkalemia. They treated with 4 ampules (200 mL) of bicarb and 1 gram of calcium gluconate.

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Everyone keeping blood pressure low because of the SPRINT trial is practicing bad medicine

Sensible Medicine

SPRINT is a large randomized trial that has changed practice and led many providers to lower blood pressure beyond prior targets. Here is the conclusion of the paper: But is this trial reliable? I always say that a clinical trial can only change your practice if the control arm is your practice. SPRINT messed this up. The trial didn’t just target less than 140 in the control arm — it did something beyond this.

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Is the blind Subclavian “trauma line” a thing of the past?

Greater Sydney Area HEMS

Obtaining access in shocked trauma patients can be notoriously difficult due to circulatory collapse. Those who are shocked, shut down with limited or no other options for peripheral access require central access. The cohort of patients that require this intervention in the pre-hospital setting are likely to be the most critically unwell patients we encounter.

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emDOCs Videocast: EBM Update – Pancreatitis

EMDocs

Welcome to the emDOCs Videocast – please subscribe to our YouTube channel. These videos will cover post summaries, take homes on clinical condition, and EBM/guideline literature updates. Today we look at the WATERFALL trial and hypertriglyceridemic pancreatitis. The post emDOCs Videocast: EBM Update – Pancreatitis appeared first on emDOCs.net - Emergency Medicine Education.

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Valuing foreign doctors: a resource for Italy

Emergency Live

The Amsi urges the recognition and integration of international healthcare professionals The Association of Foreign Doctors in Italy (Amsi), led by Prof. Foad Aodi, has highlighted the crucial importance of valorizing and integrating foreign healthcare professionals into the fabric of the Italian national healthcare system. This appeal assumes particular significance at a time when the […] The post Valuing foreign doctors: a resource for Italy appeared first on Emergency Live.

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emDOCs Videocast: EBM Update – Fluids in Pancreatitis and Hypertriglyceridemic Pancreatitis

EMDocs

Welcome to the emDOCs Videocast – please subscribe to our YouTube channel. These videos will cover post summaries, take homes on clinical condition, and EBM/guideline literature updates. Today we focus on pancreatitis. Fluids in Pancreatitis #1 : de-Madaria E, Buxbaum JL, Maisonneuve P, et al; ERICA Consortium. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis.

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Four-factor prothrombin complex concentrate versus andexanet alfa for the reversal of traumatic brain injuries

Emergency Medicine Journal

Background Andexanet alfa was approved in 2018 for reversal of direct oral anticoagulants but due to issues of cost and access, four-factor prothrombin complex concentrate (4F-PCC) continues to be used for this indication. The objective of this study is to evaluate outcomes of reversal with these agents in patients with isolated traumatic brain injuries (TBI).

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The power of patient advocacy

NRC Health

Dave “e-Patient Dave” deBronkart, a cancer survivor, blogger, and healthcare activist shares his story of how a cancer diagnosis helped him become a more empowered, engaged patient, which improved his health and led to a new calling for him. The post The power of patient advocacy appeared first on NRC Health.

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Triage in major incidents: development and external validation of novel machine learning-derived primary and secondary triage tools

Emergency Medicine Journal

Background Major incidents (MIs) are an important cause of death and disability. Triage tools are crucial to identifying priority 1 (P1) patients—those needing time-critical, life-saving interventions. Existing expert opinion-derived tools have limited evidence supporting their use. This study employs machine learning (ML) to develop and validate models for novel primary and secondary triage tools.

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ECG of the Week – 21st February 2024

EMergucate

The following ECG is from a 60 year old lady with chest pain and dyspnoea a few hours after finishing a triathlon. At the scene she was hypothermic at 32 degrees.

EKG/ECG 52
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Diagnosis of Acute Aortic Syndrome in the Emergency Department (DAShED) study: an observational cohort study of people attending the emergency department with symptoms consistent with acute aortic syndrome

Emergency Medicine Journal

Background The diagnosis of acute aortic syndrome (AAS) is commonly delayed or missed in the ED. We describe characteristics of ED attendances with symptoms potentially associated with AAS, diagnostic performance of clinical decision tools (CDTs) and physicians and yield of CT aorta angiogram (CTA). Methods This was a multicentre observational cohort study of adults attending 27 UK EDs between 26 September 2022 and 30 November 2022, with potential AAS symptoms: chest, back or abdominal pain, syn

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Imaging Case of the Week 584

EMergucate

The neck x-ray is from an adult patient with dysphagia after dinner. What can be seen?

EMS 52
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Primary survey: highlights from this issue

Emergency Medicine Journal

Many medical journals run themed issues where authors are invited to submit articles, usually around a specific clinical condition, and coordinated by guest editors. We have long debated whether we should take this approach at the Emergency Medicine Journal. Perhaps the sheer variety of conditions we see on a day-to-day basis in emergency medicine means that a broader approach to publication of our monthly issues should be maintained.

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Lab case 437 interpretation

EMergucate

Answers: PH = 7.34, that is very mild acidaemia. HCO3 = 14 mmol/L. So, we have metabolic acidosis. Next we need to calculate Anion Gap and compensation.

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Abstracts from international emergency medicine journals

Emergency Medicine Journal

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.

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Lab case 438

EMergucate

80 year old lady with type 2 DM was referred for high blood sugar.

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Journal update monthly top five

Emergency Medicine Journal

This month’s update is by the EMJ journal update monthly top five core team. 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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Comparison of diuretics and fluid expansion in the initial treatment of patients with normotensive acute pulmonary embolism: a systematic review and meta-analysis

Emergency Medicine Journal

Background Right ventricular (RV) dysfunction is the main cause of death in patients with normotensive acute pulmonary embolism (PE). The optimal management for this subset of patients remains uncertain. This systematic review and meta-analysis focused on the comparison of diuretics and fluid expansion in patients with acute PE presenting with RV dysfunction and haemodynamic stability.

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Unusual cause of recurrent aspiration pneumonia

Emergency Medicine Journal

Clinical introduction An 88-year-old man with intermittent fever, cough, vomiting and progressive dysphagia was transferred to our ED. His medical history was moderate hypertension and hyperlipidaemia. His family disclosed he had frequent repeated aspiration pneumonia within 3 months. A chest radiograph showed an obvious consolidation of the right lower lobe.

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Thematic analysis of 'Prevention of Future Deaths reports related to emergency departments in England and Wales 2013-2022

Emergency Medicine Journal

Since 2013, coroners in England and Wales have issued ‘Prevention of Future Deaths’ (PFD) reports to individuals or organisations if, following an inquest, they believe action should be taken to prevent further avoidable deaths. The Chief Coroner’s annual report details the operation of the coroner’s service and does not collate PFD findings. 1 By contrast, Australia’s coronial system collates all inquest findings, informing injury prevention and health-professional

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Predictors of adverse outcomes in elders hospitalised for isolated orthopaedic trauma: a multicentre cohort study

Emergency Medicine Journal

Background Patients >64 years of age now represent more than 51% of injury hospitalisations in Canada. The tools used to identify older patients who could benefit the most from an interdisciplinary approach include complex parameters difficult to collect in the ED, which suggests that better tools with higher accuracy and using items that can be derived from routinely collected data are needed.

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Consensus statement on the interhospital transfer of patients with acute aortic syndrome: TRAVERSING Delphi study

Emergency Medicine Journal

Background Standardisation of referral pathways and the transfer of patients with acute aortic syndromes (AAS) to regional centres are recommended by NHS England in the Acute Aortic Dissection Toolkit. The aim of the Transfer of Thoracic Aortic Vascular Emergencies to Regional Specialist INstitutes Group study was to establish an interdisciplinary consensus on the interhospital transfer of patients with AAS to specialist high-volume aortic centres.

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Survey of current policy regarding the recognition and management of acute aortic syndrome in Great Britain

Emergency Medicine Journal

Acute aortic syndrome (AAS) is a life-threatening condition constituting acute aortic dissection (AAD), intramural haematoma and penetrating aortic ulcer. 1 2 The diagnosis of AAS is plagued by uncertainty, 3 up to 38% of cases are missed at first ED presentation and up to 25% are diagnosed 24 hours after ED presentation. 4 The Aortic Dissection Detection Risk Score 5 and the Canadian Clinical Practice Guideline 4 are clinical decision tools available to aid progression to the definitive investi

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Seventy-five-year-old woman with month-long fever, cavity lung lesions and cutaneous ulcer

Emergency Medicine Journal

Clinical Introduction An elderly Asian woman presented to the ED with month-long fever, rhinorrhea and productive cough. She subsequently developed tender bruise-like skin nodules over her trunk and limbs, which quickly progressed to form cavity ulcers 2 weeks before ED visit ( figure 1 ). Despite various antimicrobial therapies, her symptoms did not improve.

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Mortality and risk factors associated with misdiagnosis of acute aortic syndrome in Ontario, Canada: a population-based study

Emergency Medicine Journal

Introduction Acute aortic syndrome (AAS) is a life-threatening aortic emergency. It describes three diagnoses: acute aortic dissection, acute intramural haematoma and penetrating atherosclerotic ulcer. Unfortunately, there are no accurate estimates of the miss rate for AAS, risk factors for missed diagnosis or its effect on outcomes. Methods A population-based retrospective cohort study of anonymously linked data for residents of Ontario, Canada, was carried out.

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Finding the needle in the haystack: towards better diagnosis of acute aortic syndromes

Emergency Medicine Journal

McLatchie and colleagues present observational data on the prevalence of acute aortic syndromes (AAS) in 27 emergency departments (ED) in the UK, over 2–55 days. 1 They found that the prevalence of AAS was around 1 in 300 patients presenting to ED with chest, back or abdominal pain; or ‘malperfusion’ (defined as stroke, myocardial infarction, bowel or limb ischaemia), while the CT aortogram rate was 7%.

Stroke 40