January, 2022

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HIPAA AND BATTLING PARENTS

Total Medical ComplianceHIPAA

Dealing with a minor’s medical records can be a minefield when a child is from a blended family or the parents have a contentious divorce going. Things get especially sticky when you add in stepparents and grandparents, and when a minor controls all or a portion of their own records. It’s a good time to review the basics. Custody versus Parental Rights: Don’t confuse custody with parental rights.

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129. Spontaneous Pneumothorax and Quidditch

Board Bombs

Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here: emrapidbombs.supercast.com Harry Potter might have saved the world, but all Quidditch players have to retire eventually right?? Or else you end up with a spontaneous pneumothorax.Let's talk all about this classic diagnosis.

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EvK RCT | PE-SARD | VTE Tx Update | HEP-COVID | PE Rule Out Pathway

JournalFeed

It’s the JournalFeed Podcast for the week of January 24-28, 2022. We cover the EvK RCT - etomidate vs ketamine for RSI, PE-SARD - predicting major bleed in PE treatment, a major update on antithrombotics for VTE, HEP-COVID - anticoagulation for COVID patients, and a new PE rule out pathway.

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Telemedicine: a Solution to the Predicted Physician Shortage?

Advanced Medical Reviews

A new study published by the Association of American Medical Colleges (AAMC) found that the United States could see an estimated shortage of between 37,800 and 124,000 physicians by 2034, including shortfalls in both primary and specialty care. Years before this study was conducted, telemedicine was being utilized to treat patients living in remote communities or areas with a shortage of doctors.

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Select FOAMed EM Cases Summit Videos

Emergency Medicine Cases

A few select videos from EM Cases Summit 2021 have been made FOAMed and available here and on our youtube channel. The latest release is with Dr. Rob Simard who explains the failings of the ACLS protocol for PEA arrest, how PoCUS pulse checks can help us differentiate true PEA from pseudoPEA, and how to integrate this information and our PoCUS skills into the flow of our cardiac arrest management.

EMS 52
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Utterly Chilling

Dr. No

It has been a long time coming, as we enter the final stages of the rollout of the NHS (Self-Destruction) Regulations 2022. After a two year period unlike anything ever seen before in the NHS, with a seriously demoralised and depleted workforce, NHS managers are gearing up to fire many tens of thousands of NHS frontline staff. The managers and their staff are, of course, just following orders, following in the footsteps of others who, at times of moral darkness, just followed orders, and removed

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MLK Day To Me

Dr. Mike Sevilla

As an Asian-American man, I do not pretend to know what it’s like to be a Black man today. And, I do not pretend to know what it was like to be Dr. Martin Luther King, Jr in the 1950s and 1960s. All I know about that time is what I have seen in television and on the internet. So, on this national holiday, where we, as a nation, are asked to remember this man and his message.

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Talking About Race in Emergency Medicine

JournalFeed

It’s a special edition of the JournalFeed Podcast. Today, we are talking about race in EM with the authors of a recent op-ed in Annals of Emergency Medicine. We tackle some tough questions about racism and how we can be better allies as EM colleagues. Here are today’s show notes from the authors Cortlyn Brown, Kimberly Brown, Italo Brown, and Rosny Daniel: Allegories on race and racism - TED Talk Mapping Police Violence Maatouk-Bürmann B, Ringel N, Spang J, Weiss C, Möltner A, Riemann U, Langewi

EMS 52
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Medical Decisions: Some are Easy and Some Not So Much

Stop and Think

Let’s start with the easy decisions: sick patients who are asking for our help. When someone falls and breaks a hip, the decision is easy. You fix it. When someone presents in shock because of AV block and a low heart rate, you place a pacemaker. When someone presents with bacterial infection, you use antibiotics. It gets trickier when we consider preventive interventions.

Stroke 52
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EM Quick Hits 35 – 10 Best Papers of 2021, Peripartum Cardiomyopathy, Crashing Asthmatic, Febrile Neutropenia, Anaphylaxis update

Emergency Medicine Cases

In this months EM Quick Hits podcast: Ken Milne expertly walks us through the 10 biggest EM papers of 2021, Brit Long on a careful structured approach to Febrile Neutropenia to improve outcomes, Catherine Varner on how not to miss Peripartum Cardiomyopathy, Joe Nemeth on Anaphylaxis update and Anand Swaminathan gives us his approach to the Crashing Asthmatic.

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SGEM#355: Bigger Isn’t Better When It Comes to Chest Tubes

The Skeptics' Guide to EM

Date: December 28th, 2021 Reference: Kulvatunyou et al. The small (14 Fr) percutaneous catheter (P-CAT) versus large (28–32 Fr) open chest tube for traumatic hemothorax: A multicenter randomized clinical trial. J Trauma and Acute Care Surgery. November 2021. Guest Skeptic: Dr. Chris Root is a second-year resident physician in the Department of Emergency Medicine at the University […] The post SGEM#355: Bigger Isn’t Better When It Comes to Chest Tubes first appeared on The Skeptics Guide to Emerg

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Remembering The Snow Day

Dr. Mike Sevilla

It’s so interesting, because this photo was taking this very week in 2019, otherwise known as Pre-Pandemic times. I’ve been looking at the forecast over the past couple of days, and some people are saying that for around here, we may expect 12 inches of snow or more. Monday is a holiday for a lot of people out there (not me). But, when snow is forecast like this, it really makes me think back to “back in the day” when I was hoping, as a little kid, for that snow day.

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Episode 65 – Acute Joint Pain

EB Medicine

Interview with author: Rachel Sullivan, MD Why joint pain ? Differential Diagnosis Mono vs Poly Articular Presentation? Figure 1 Infectious, degenerative, autoimmune, crystal deposition, reactive, traumatic Septic Arthritis- Bimodal incidence Risks Septic arthritis is polyarticular in 15% to 20% of cases, and in these cases, the mortality is high Gonococcal Highest risk Commonly affected joints Symptomatic or asymptomatic infection Lyme Arthritis Viral – Zika, chikungunya, human parvovirus B

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Gender Pay Gap | Subsegmental PE | Etomidate or Ketamine for RSI | Ketamine Nebs

JournalFeed

It’s the JournalFeed Podcast for the week of January 10-14, 2022. We cover the gender pay gap in EM leadership, subsegmental PE anticoagulation or not, a point/counterpoint on etomidate or ketamine firstline for RSI, and ketamine nebs for pain control.

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7 steps to missing posterior Occlusion MI, and how to avoid them

Dr. Smith's ECG Blog

This fantastic case and post was written by Jesse McLaren (@ECGcases), edited by Smith Case You’re shown an ECG from a patient in the waiting room with chest pain. What do you think? Sinus bradycardia, normal conduction, normal axis, normal R wave progression, no hypertrophy. There’s primary ST depression in the precordial leads maximal in V3-4, and an inverted T wave in V2.

EKG/ECG 52
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Ep 164 Cardiogenic Shock Simplified

Emergency Medicine Cases

What is the preferred order of vasopressors and ionotropes in the management of cardiogenic shock? In which patients would dobutamine be preferred over milrinone and vice versa? How can we best pick up occult cardiogenic shock before it floured shock kicks in? What are the best strategies to efficiently get the patient in cardiogenic shock to definitive care, whether that be the cath lab or the operating room?

Shock 52
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42

Dr. No

Those familiar with the Hitch-Hiker’s Guide to the Galaxy will know that the number 42 is the ‘Answer to the Ultimate Question of Life, the Universe, and Everything’; it necessarily follows that it must also be the answer to today’s ultimate question, how to end the covid pandemic. Dr No has spent the New Year break trying to get to the bottom of this cryptic answer.

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Snowstorm Coming: Calm Down People

Dr. Mike Sevilla

Yes, our weather friends are giving us the heads-up that we may be getting some snow going into early Monday morning. You know what that means? Yes, people just go nuts and crazy for the coming snowstorm or the cute name that they will call this on social media, whether it be “snowpocalypse” or “snowmageddon” or whatever. I don’t want to be all snarky (but I know that’s why you love me) but let me be the first to say (again), “Hey people, it’s January and we live in Ohio.

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SGEM#354: Everybody Walk the Dinosaur and Not Take the MSU

The Skeptics' Guide to EM

Date: December 21st, 2021 Guest Skeptic: Dr. Howard “Howie” Mell began his career as a firefighter / paramedic in Chicago. He became double board certified in Emergency Medicine (EM) and Emergency Medical Services (EMS). Howie also has a Master of Public Health. Reference: Grotta JC et al. Prospective, multicenter, controlled trial of mobile stroke units.

Stroke 52
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POCUS for PS | Deaths OTC Meds | ED Sepsis Teams | Dispo Early v Late | New ASA Difficult Airway

JournalFeed

It’s the JournalFeed Podcast for the week of January 3-7, 2022. We cover POCUS for pyloric stenosis, deaths from OTC cough medicine in children, ED sepsis teams reduce mortality, dispo times early vs late in your shift, and new ASA 2022 difficult airway guidelines.

Sepsis 52
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Focus On: Pyloric Stenosis

Pediatric Emergency Playbook

Myth: “No olive, no problem” Reality: Rare finding, since we diagnose earlier Pyloric stenosis occurs in young infants because the pyloric sphincter hypertrophies, causing near-complete obstruction of the gastric outlet. More common in boys, preterm babies, first-born. Less common in older mothers. Association with macrolide use. Presentation Young infant arrives with forceful vomiting, but can’t quite get enough to eat “the hungry, hungry, not-so-hippo”.

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Ketamine vs Midazolam/ Haloperidol for acute agitation

EMergucate

Original paper here What is this study about Authors hypothesized that given intramuscularly, Ketamine would work quicker (and safer) when … Continue reading →

EMS 52
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COVID Oral Antivirals EUA Guide

EM Updates

pdf Paxlovid Patient/Caregiver Fact Sheet Paxlovid Healthcare Professionals Fact Sheet Paxlovid FDA Checklist [updated Oct 2022] molnupiravir EUA & patient info

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Taking A Risk

Dr. Mike Sevilla

I’m going to do something I’ve never done before. I’m going to ask you, the reader, to give me a review on Google. I have to tell you, this is a big risk, because I have no idea what is going to happen here. Why now? Well, let me ask you, how many time have you read the reviews on Amazon before you make a purchase? How about this? How many times have you read the reviews of a doctor before you made a decision whether to pick a new doctor.

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Nirmatrelvir-Ritonavir for ‘Standard Risk’ COVID-19

PulmCCM

Jon-Emile S. Kenny MD [ @heart_lung ] “… but prejudices, like odorous bodies, have a double existence, both solid and subtle – solid as the pyramids, subtle as the twentieth echo of an echo, or as the memory of hyacinths which once scented the darkness.” -Mary Ann Evans Background As previously described , the SARS-CoV-2 main protease inhibitor [Mpro] is an existential feature of the virus.

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Calcium OHCA | NEAR4KIDS | Syncope Calculator | Limit Cardiac Tests | Top Articles 2021

JournalFeed

It’s the JournalFeed Podcast for the week of December 27-31, 2021. We cover calcium for OHCA, NEAR4KIDS, Canadian Syncope Calculator, limiting cardiac testing in low risk patients, and the top articles of 2021.

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Who benefits most from screening for atrial fibrillation?

Stop and Think

There was big news in the AF world: JAMA has published a major paper on screening for atrial fibrillation. The 16-person United States Preventive Services Task Force ( USPSTF ) authored the review and concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for AF. USPSTF is a notable group because they are independent experts in critical appraisal.

Stroke 40
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Imaging Case of the Week 491

EMergucate

The following chest x-ray is from an 88 year old who has presented with acute onset left sided chest pain followed by diaphoresis and dyspnoea. Patient is afebrile.

EMS 52
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SGEM#357: COVID it’s Getting Harder and Harder to Breathe but will Budesonide Help?

The Skeptics' Guide to EM

Date: January 22nd, 2022 Reference: Yu et al. Inhaled budesonide for COVID-19 in people at high risk of complications in the community in the UK (PRINCIPLE): a randomised, controlled, open-label, adaptive platform trial. Lancet 2021 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called First10EM.com.

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Appreciate The Sunrise

Dr. Mike Sevilla

Just another day for a health care worker in America. I was driving to work this morning, and my mind was wandering all over the place thinking about work and life. And, then I turn the corner, and I see the sunrise, and I had to stop. And, sometimes life does that to you. We’re knee deep every day in our usual day-to-day things, and then something happens to just stop you in your tracks.

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EPIC-HR Evaluates Nirmatrelvir-Ritonavir for COVID-19

PulmCCM

Jon-Emile S. Kenny MD [ @heart_lung ] “When she smiles without her teeth in place she looks like a witch. But with them in her mouth she’s very pretty.” -Judy Blume Basic Biology The SARS-CoV-2 genome encodes structural proteins [i.e., spike, envelope, membrane, nucleocapsid] and polyproteins [i.e., pp1a and pp1ab]. When the guts of SARS-CoV-2 spew into a cell, viral mRNA acts as a template for polyprotein inception.

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Neonatal HSV Score | HFO2 COVID | CODA RCT F/U | PE-SCORE | Multislice CT SAH

JournalFeed

It’s the JournalFeed Podcast for the week of January 17-21, 2022. We cover a neonatal invasive HSV risk score, high-flow oxygen for COVID, long-term follow up of antibiotics vs surgery for appendicitis, the PE-SCORE, and the high accuracy of multislice CT for SAH out to 24 hours.

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More Bicycle Accidents and Auto Crash Fatalities During the Covid Crisis

Medical Law

With lockdowns and more people working from home, the global pandemic significantly reduced traffic in California and across the nation. You would expect bicycle accidents and traffic deaths to decrease accordingly. In fact, the reverse occurred. Traffic fatalities have actually increased during the Covid crisis. Bicycle Accident Statistics During the Pandemic.

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Imaging Case of the Week 487 Answer

EMergucate

The facial x-ray shows irregularity of the left inferior orbital floor & fluid in the left maxillary antrum (blood in … Continue reading →

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Kitsios – The Lung Microbiome in Pneumonia and ARDS

University of Maryland CC Project

Dr. George Kitsios, Assistant Professor of Medicine in the Division of Pulmonary, Allergy and Critical Care Medicine at the University of Pittsburgh presents during critical care grand rounds on the Lung Microbiome in pneumonia and ARDS. Dr. George Kitsios, Assistant Professor of Medicine in the Division of Pulmonary, Allergy and Critical Care Medicine at the University of Pittsburgh presents during critical care grand rounds on the Lung Microbiome in pneumonia and ARDS.

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Small Towns Against The World

Dr. Mike Sevilla

“My cup runneth over with kindness” -- Dr. Mike Sevilla I have to tell all of you that I have been overwhelmed (in a good way) with all the feedback that I have received about my essay last week about my hospital and my community. When I go into the hospital, I always have someone stop me, or give me a thumbs up as I’m looking down the hall. When I’m in the store (with my mask on), I have people turn their grocery cart all the way around to make sure that it’s me, and then they say so many kind

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COVID STEROID 2 Trial Investigates Dexamethasone 6 mg or 12 mg in COVID-19

PulmCCM

Jon-Emile S. Kenny MD [ @heart_lung ] “If you’re afraid of butter, use cream.” -Julia Child Background Early observational studies and the RECOVERY collaborative group initially demonstrated the benefit of corticosteroid therapy in oxygen-requiring, COVID-19-patients; additional randomized studies as well as a meta-analysis of these reports corroborated this.