April, 2024

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ECG Blog #426 — Are STEMI Criteria Met?

Ken Grauer, MD

The ECG in Figure-1 — was obtained from a 70-ish year old man with episodic CP ( C hest P ain ) over the previous 2-3 days , being awakened from sleep now for a more severe CP episode. QUESTIONS: In view of this history — How would YOU interpret this ECG? Should you activate the cath lab? Figure-1: The initial ECG in today's case. MY Initial Thoughts on Today's CASE: Although it is difficult from the brief history we are given, to determine the true onset of whatever might be happening — the pat

EKG/ECG 382
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Traveling Ticks: Tickborne Illnesses and International Travel

Pediatric EM Morsels

Traveling Ticks are more than just ticking off a checklist before you get ready to travel! Climate change and changes in land usage have contributed to an expanded range of ticks (Beard 2016). There are species of ticks found on every continent and carrying a variety of vectors capable of infecting humans. Globally, ticks are the second most common vector to transmit illnesses after mosquitos (Parola 2018).

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Preperitoneal Packing Vs Angioembolization: Part 1

The Trauma Pro

In this series, I will review the two major techniques for addressing troublesome bleeding from pelvic fractures. This post will review the evolution of packing techniques and more fully describe the concept of preperitoneal packing. Next, I’ll review an early paper that compared the snippets of information we had to angioembolization. In the last post in the series, I’ll discuss a paper in press that compares the efficacy and hospital charges of the two techniques.

Fractures 147
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Unproven healthcare will bankrupt America

Sensible Medicine

Last week, the US FDA held a meeting to decide if a new surrogate endpoint (Minimal Residual Disease or MRD negativity) could be used to give more & faster drug approvals for patients with newly diagnosed multiple myeloma. Multiple myeloma drugs can cost $600,000 per year of treatment, but if MRD is permitted for drug approval, I suspect we will see a deluge of uncertain drugs added to the roster, and the costs per year per patient will swell to a million dollars or more.

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Dr. Vinay Prasad: It’s “Good” That Parents Who Want To Vaccinate Their Kids Against COVID Get Reported To Child Protective Services

Science Based Medicine

Trying to limit pediatric COVID was literally the pandemic's worst sin for pro-infection doctors, warranting severe punishment. This is how desperately they wanted them infected. The post Dr. Vinay Prasad: It’s “Good” That Parents Who Want To Vaccinate Their Kids Against COVID Get Reported To Child Protective Services first appeared on Science-Based Medicine.

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EPIC-SR: The negative paxlovid data Pfizer has been sitting on

First 10 EM

As mentioned in my most recent review, publication bias has been a major concern when trying to decide whether to prescribe paxlovid. Pfizer rushed to publish their positive study (EPIC-HR), but refused to release the results of a second simultaneous study (EPIC-SR) that was stopped (due to futility) at the exact same time. With the […] The post EPIC-SR: The negative paxlovid data Pfizer has been sitting on appeared first on First10EM.

EMS 130
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ECG Blog #427 — To Cath this Elderly Patient?

Ken Grauer, MD

The ECG in Figure-1 — was obtained on the scene by EMS ( E mergency M edical S ervices ). The patient was a man in his 90s, who ~1 hour earlier, noted the onset of severe CP ( C hest P ain ). He was hemodynamically stable — but clearly distressed with a sense of “impending doom” at the time ECG #1 was recorded. Despite the patient’s age — he was independent, lived alone, had good mental function — and had family support.

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Video: Minimally Invasive Repair Of Rectal Injuries

The Trauma Pro

Extraperitoneal rectal injury repair has evolved considerably over the past 40 years. Way back when, this injury automatically triggered exploration, diverting colostomy with washout of the distal colon, and presacral drain insertion (remember those?). We eventually backed off on the presacral drains (pun intended), which didn’t make a lot of sense anyway.

Wellness 147
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The US FDA's cancer drug approval process is broken and needs audit

Sensible Medicine

The US FDA is under tremendous political pressure to approve drugs, and indeed they tout the number of approved drugs as a measure of the quality of their work. Unfortunately, you can approve bad drugs. Selenexor is a toxic poison that does not increase survival. Belantumab causes eye damage and had to be pulled from the US market Idelalisib, copanlisib, duvelisib— the entire P13k inhibitor class —may have resulted in increased deaths.

Poisoning 133
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Once a Doctor Has Minimized Literal Death for Young People, Should We Value Their Opinion on Any Topic Less Consequential Than Literal Death?

Science Based Medicine

Is potential death worse than real death? The post Once a Doctor Has Minimized Literal Death for Young People, Should We Value Their Opinion on Any Topic Less Consequential Than Literal Death? first appeared on Science-Based Medicine.

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Functional Neurologic Disorders

EM Ottawa

Patients living with functional neurologic disorders (FND) have been deeply stigmatized by the medical system. In a patient survey by FND Hope (an international organization for the research and advocacy around FND) 82% of patient respondents felt they had been treated poorly due to stigma relating to their FND diagnosis, primarily by emergency physicians [1] […] The post Functional Neurologic Disorders appeared first on EMOttawa Blog.

Research 133
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ECG Blog #425 — Are there P Waves?

Ken Grauer, MD

I was sent the ECG in Figure-1 — told only that the patient was 70 years old, and had a history of an ASD ( A trial S eptal D efect ). Serum K+ was normal. The patient was hemodynamically stable with ECG #1. QUESTIONS: How would YOU interpret the rhythm in Figure-1 ? Are there P waves? Figure-1: The initial ECG in today's case. MY Initial Thoughts on Today's CASE: Knowing that today's patient has a history of an ASD ( A trial S eptal D efect ) — is relevant to the interpretation of today's inter

EKG/ECG 284
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Are you a perfect diagnostician? No? Then give your patients a break

First 10 EM

Give your patients a break. Nobody is a perfect diagnostician. Not even the best trained physician can determine, with 100% accuracy, which patients have serious pathology. Even with advanced testing, we aren’t close to perfect. However, if you listen to the subtext of breakroom complaints, it seems like we expect patients to be better diagnosticians […] The post Are you a perfect diagnostician?

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SGEM#436: For the Longest Time – To Give TNK for an Acute Ischemic Stroke

The Skeptics' Guide to EM

Reference: Albers GW et al. TIMELESS Investigators. Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection. NEJM Feb 2024 Date: April 12, 2024 Guest Skeptic: Dr. Vasisht Srinivasan is an Emergency Medicine physician and neurointensivist at the University of Washington and Harborview Medical Center in Seattle, WA. He is an assistant professor in Emergency […] The post SGEM#436: For the Longest Time – To Give TNK for an Acute Ischemic Stroke first appeared on The Skeptics Guid

Stroke 128
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Medicare doesn't pay because there is no evidence you live longer or better as a result

Sensible Medicine

On Friday, the New York Times ran this story. The article begins by explaining that mammograms don’t find all breast tumors — of course they don’t! Even MRI and ultrasound do not. In fact, no imaging modality does. The only way to find all the tumors would be to remove the breast and have a pathologist examine every tiny bit of it.

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COVID-19 vaccine-caused “turbo cancer” nonsense just keeps getting more turbocharged and nonsensical

Science Based Medicine

No matter how implausible it is or how weak the evidence for it is, the myth that COVID vaccines cause "turbo cancer" just won't die. Quite the contrary, alas. Antivaxxers are—dare I say?—turbocharging it with bad science. The post COVID-19 vaccine-caused “turbo cancer” nonsense just keeps getting more turbocharged and nonsensical first appeared on Science-Based Medicine.

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Suicidal Ideation and Self-Harm in Children

EB Medicine

In this episode, Sam Ashoo, MD interviews Ashley A. Foster, MD, Bijan Ketabchi, MD, MPH and Jennifer A. Hoffmann, MD, MS on the March 2024 Pediatric Emergency Medicine Practice article, Evaluation and Management of Suicidal Ideation and Self-Harm in Children in the Emergency Department Introduction Understanding Suicidal Ideation and Self Harm in Youths Screening Tools and Approaches Ask Suicide-Screening Questions (ASQ) Toolkit Columbia Suicide Severity Rating Scale (C-SSRS) Prehospital Care

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ECG Cases 49 – ECG and POCUS for Dyspnea and Chest Pain

Emergency Medicine Cases

In this ECG Cases blog, Jesse McLaren and Rajiv Thavanathan explore how ECG and POCUS complement each other for patients presenting to the emergency department with shortness of breath or chest pain. They explain complementary diagnostic insights into pericardial effusion and cardiac tamponade, occlusion MI and RV strain. The post ECG Cases 49 – ECG and POCUS for Dyspnea and Chest Pain appeared first on Emergency Medicine Cases.

EKG/ECG 119
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Ventricular Fibrillation, ICD, LBBB, QRS of 210 ms, Positive Smith Modified Sgarbossa Criteria, and Pacemaker-Mediated Tachycardia

Dr. Smith's ECG Blog

An elderly man collapsed. There was no bystander CPR. Medics found him in ventricular fibrillation. He was defibrillated, but they also noticed that he was being internally defibrillated and then found that he had an implantable ICD. He was unidentified and there were no records available After 7 shocks, he was successfully defibrillated and brought to the ED.

EKG/ECG 118
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PTM Journal Club: Blood Product and ACE-CPR use Prehospital

EM Ottawa

In this Prehospital Journal Club Recap, let us take a deep dive into the use of blood products, as well as the adjunct use of automated controlled elevation in CPR. Resuscitation with blood products in patients with trauma-related hemorrhagic shock receiving prehospital care (RePHILL): a multicentre, open-label, randomized, controlled, phase 3 trial Background The use […] The post PTM Journal Club: Blood Product and ACE-CPR use Prehospital appeared first on EMOttawa Blog.

CPR 114
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A Discussion with Dr. Dena Zeraatkar regarding analytic flexibility in observational studies

Sensible Medicine

Gosh was this a great conversation about her recent paper on specification curve analysis of nutritional observational studies. Here is Dr. Zeraatkar’s bio: Dena Zeraatkar, PhD is an Assistant Professor in the Departments of Anesthesia and Health Research Methods, Evidence, and Impact (HEI) at McMaster University. She earned her doctoral degree at McMaster University in the Health Research Methodology graduate program.

Research 112
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Every Time Dr. Jay Bhattacharya Talks About COVID, He Proves He Was Totally Wrong About COVID

Science Based Medicine

Dr. Jay Bhattacharya March 2020: "If it’s true that the novel coronavirus would kill millions without shelter-in-place orders and quarantines, then the extraordinary measures being carried out in cities and states around the country are surely justified." The post Every Time Dr. Jay Bhattacharya Talks About COVID, He Proves He Was Totally Wrong About COVID first appeared on Science-Based Medicine.

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Pulmcrit wee: The cutoff razor

EMCrit

A razor is a rule of thumb that is helpful, although it isn't always correct. In medicine we're familiar with Occam's razor (the rule of parsimony). The cutoff razor states: if a continuous variable is dichotomized using a cutoff, then values near the cutoff provide little information. A simple illustration of the cutoff razor is […] EMCrit Project by Josh Farkas.

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The Brain Injury Guidelines: Can we avoid talking to neurosurgeons?

First 10 EM

One of the biggest headaches in modern medicine is the apparent requirement to call busy specialists just to confirm what seems like an obvious treatment plan. In emergency medicine, this often happens when a patient needs to be admitted under one service, but with a medical problem related to another speciality. We get stuck in […] The post The Brain Injury Guidelines: Can we avoid talking to neurosurgeons?

EMS 111
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Chest pain, resolved. Does it need emergent cath lab activation (some controversy here)? And much much more.

Dr. Smith's ECG Blog

A 50-something male with hypertension and 20- to 40-year smoking history presented with 1 week of stuttering chest pain that is worse with exertion, which takes many minutes to resolve after resting and never occurs at rest. It is a ssociated with mild dyspnea on exertion. At times the pain does go to his left neck. It was present on arrival at triage but then resolved before bed placement in the ED.

EKG/ECG 110
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Choosing with Intention. Liz Crowe

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed What you don’t do, determines what you can do Tim Ferris One of the most powerful personal lessons I have learned in recent years is every time I say YES […] The post Choosing with Intention. Liz Crowe appeared first on St.Emlyn's.

EMS 103
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Don’t Forget About the IO in the Critically Ill Patient

RebelEM

Critically ill patients requiring resuscitation often present with many challenges including the ability to secure safe, sterile, fast, and reliable intravenous (IV) access. Over the years emergency and critical care physicians have tried many ways to establish IV access in emergencies including the “crash” or “dirty” central line. If you are not familiar with this term, it’s the act of rapidly trying to place a central line (usually femoral), placing the needle for access over strict sterile pr

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New Study Finds No Link Between Autism and Acetaminophen Use During Pregnancy

Science Based Medicine

A new study designed to better account for hidden confounding factors has found no link between acetaminophen use during pregnancy and the risk of neurodevelopmental conditions in childhood. The post New Study Finds No Link Between Autism and Acetaminophen Use During Pregnancy first appeared on Science-Based Medicine.

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Survey Readiness Training for Healthcare Providers

American Medical Compliance

The following Survey Readiness Training for Healthcare Providers is designed to educate healthcare providers on the purpose and importance of survey readiness in healthcare. Surveys may play a large role in your healthcare facility. Also, it is important to understand the purpose and the regulations associated with them. Because of this, AMC can help your healthcare organization become more aware of healthcare surveys.

Outcomes 105
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EM Quick Hits 56 – Nitroglycerin in SCAPE, REBOA, Diverticulitis Imaging, CRAO, Penicillin Allergy, Physician Personality

Emergency Medicine Cases

In this month's EM Quick Hits podcast: Justin Morgenstern on the first RCT of high dose nitroglycerin in SCAPE, Andrew Neill on Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) indications and evidence, Brit Long on indications for CT in suspected diverticulitis, Tahara Bhate on Central Retinal Artery Occlusion (CRAO) and diagnostic error, Matthew McArthur on penicillin allergy labels, myths and penicillin challenges, and Susan Lu on how ED physician personality influences patie

EMS 104
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Is OMI an ECG Diagnosis?

Dr. Smith's ECG Blog

Written by Jesse McLaren A 70 year old with prior MIs and stents to LAD and RCA presented to the emergency department with 2 weeks of increasing exertional chest pain radiating to the left arm, associated with nausea. The pain recurred at rest 90 minutes prior to presentation, felt like the patient’s prior MIs, and was not relieved by 6 sprays of nitro.

EKG/ECG 108
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GCS 8 obviously doesn’t mean intubate (in tox or otherwise)

First 10 EM

Although it made a bit of a splash when published, this article really didn’t interest me. Obviously, GCS 8 doesn’t mean intubate. I didn’t think anyone was simplistic enough to practice medicine based on a jingle. Clearly trajectory matters. If a patient’s GCS hit 8 and they are on a clinical course where you expect […] The post GCS 8 obviously doesn’t mean intubate (in tox or otherwise) appeared first on First10EM.

EMS 100
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PTM Journal Club: BVM Ventilation and Refractory Shock in Out-Of-Hospital Cardiac Arrest

EM Ottawa

In this edition of PTM Journal Club explore the impact of bag-valve-mask ventilation as well as the use of lidocaine and/or amiodarone on the survivability of out-of-hospital cardiac arrest. Bag-Valve-Mask Ventilation and Survival From Out-of-Hospital Cardiac Arrest: A Multicenter Study Background and Objectives Around 60,000 out-of-hospital cardiac arrests (OHCA) occur in Canada each year, which […] The post PTM Journal Club: BVM Ventilation and Refractory Shock in Out-Of-Hospital Card

Shock 101
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The Failed “We Want Them Infected” Movement Is Trying to Rebrand Itself As The “All We Really Wanted Was Poor Kids in School” Movement.

Science Based Medicine

Part 2: In 2020, pro-infection doctors said "It’s fantastic news that we have a lot of cases." Today, they performatively lament "learning loss for children, especially in poor families". What happened to their assurances that the mass infection of unvaccinated youth will rapidly lead to herd immunity? The post The Failed “We Want Them Infected” Movement Is Trying to Rebrand Itself As The “All We Really Wanted Was Poor Kids in School” Movement. first appeared on Science-Based Medicine.

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R-A-C-E session at RCEM CPD conference. St Emlyn’s

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed This was a really powerful session that took us on a journey from the past, to the present and left us with a feeling of hope for the future. I’ll […] The post R-A-C-E session at RCEM CPD conference. St Emlyn’s appeared first on St.Emlyn's.

Teamwork 101
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Brief Resolved Unexplained Events (BRUE)

EB Medicine

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the April 2024 Pediatric Emergency Medicine Practice article, Brief Resolved Unexplained Events: Practical Evaluation and Management in the Emergency Department Introduction The Evolution of BRUE Understanding BRUE Guidelines The Importance of Pre-Hospital Care in BRUE Cases Investigating the Event: Questions to Ask Medical and Family History: Key Factors Environmental and Social Considerations Definitions and Risk Assessment Physical

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Take the OMI Quiz and Test yourself against the Queen of Hearts

Dr. Smith's ECG Blog

Quiz The PM Cardio Queen of Hearts AI model for ECG interpretation from Powerful Medical is still in its early days. Do you think you can outperform the toddler version of the AI model? Version 2.0 will soon be available with four times the training data. The QoH groups ECGs into OMI and NOT OMI. Each category is subdivided into three levels of confidence.

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