June, 2023

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Nursing Malpractice: The Basics – Part 2

The Trauma Pro

What are common sources of malpractice complaints against nurses? The most common event is medication error. Most people worry about common errors like wrong dose, wrong drug, and wrong route of administration. But one less commonly considered drug-related responsibility is assessment for side effects and toxicity of medications administered. Other common reasons include failure to adequately monitor and assess the patient, and failure to supervise a patient that results in harm.

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Hypothermia and drowning

Don't Forget the Bubbles

A PEM adventure It’s time for another PEM adventure. Join us on another journey (with an inbuilt time travel machine) in managing Elsa, a 2-year-old girl who is a HUGE fan of the Disney movie, Frozen. Elsa was found face down in the family pool 20 minutes after last visual contact and was picked up without resuscitation. Emergency Medical Services found her apneic and pulseless.

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PATCH

The Bottom Line

In adult patients with major trauma, who are at risk for trauma-induced coagulopathy does early administration of 1g of tranexamic acid (TXA) followed by an infusion of 1g over 8 hours, compared with placebo, increase survival with a favourable functional outcome at 6 months?

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Is Robert F. Kennedy, Jr. antivaccine? Judge him by his own words!

Science Based Medicine

Last week, an antivaxxer on Substack—where else?—tried to argue that Robert F. Kennedy, Jr. is not antivaccine by encouraging you to judge him by his own words. I agree. You should judge RFK Jr. by his own words, as they show definitively that he has been antivaccine since at least 2005. The post Is Robert F. Kennedy, Jr. antivaccine? Judge him by his own words!

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Contrast Induced Nephropathy – sense at last. St Emlyn’s

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed New guidelines from @RCollEM and @RCRadiologists finally agree that contrast CT should not be delayed in the critically ill/injured #FOAMed The post Contrast Induced Nephropathy – sense at last. St Emlyn’s appeared first on St.Emlyn's.

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The CT FIRST Trial: Should We Pan-CT After ROSC?

RebelEM

Background: Achieving ROSC in out of hospital cardiac arrest (OHCA) is no easy feat but, care doesn’t end with ROSC. Post-ROSC management is nuanced and challenging but helps to ensure good outcomes. Identification of the underlying cause of the cardiac arrest is a critical area of focus in post-arrest care. Although myocardial infarction, dysrhythmias and pulmonary emboli are common pathologies to consider, there are a host of other causes including subarachnoid hemorrhage, trauma and electroly

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Delayed Presentation Of Right Diaphragm Injury

The Trauma Pro

Diaphragm injury from blunt trauma is uncommon, occurring in only a few percent of patients after high-energy mechanisms. They usually occur on the left side and are more frequently seen after t-bone type car crashes and in pedestrians struck by a car. Blunt diaphragm injury on the right side is very unusual. Even so, it is more easily detected due to obvious displacement of the liver that can be seen on chest x-ray.

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First10EM Journal Club: June 2023

Broome Docs

Hi All, we are back with another instalment of the Journal Club with Justin Morgenstern. Big news this month is that Justin has just been invited to visit my home shop as the honorary WG Smith Fellow and deliver a series of EBM lectures to the local teams in Western Australia. So we are planning to take this show on th eraod and do some live sessions later in 2023.

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Three New Studies Show the COVID Vaccines Are Very Safe for Children

Science Based Medicine

Three new studies tell us what we already knew- vaccine isn't perfect, but it's far safer than the virus for children. The post Three New Studies Show the COVID Vaccines Are Very Safe for Children first appeared on Science-Based Medicine.

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AMAX4 Algorithm

Life in the Fast Lane

Neil Long and Chris Nickson AMAX4 Algorithm AMAX4 is a best-practice algorithm for critical care clinicians in anaphylaxis and asthma resuscitation.

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Anaphylactic Shock

RebelEM

Anaphylactic Shock is an acute, life-threatening hypersensitivity disorder, with a generalized, rapidly evolving, multi-systemic allergic reaction (IgE-mediated disorder). If not treated rapidly can become fatal. Scott Weingart, MD put together a manual titled the Resuscitation Crisis Manual , which in short, is composed of two-page protocols for various situations that involve crashing patients.

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Guidelines For Diagnosis Of Diaphragmatic Injury

The Trauma Pro

In today’s post, I will review the diaphragmatic injury practice guidelines published by the Eastern Association for the Surgery of Trauma (EAST). I will follow this up on Friday with an interesting delayed diaphragm injury case. Diaphragm injury is a troublesome one to diagnose. It is essentially an elliptical sheet of muscle that is doubly curved, so it does not lend itself well to diagnosis by axial imaging.

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A routine resuscitation

Don't Forget the Bubbles

I remember how I felt when. I first watched “ Just a Routine Operation “, – the story of the events that led to the tragic death of Elaine Bromiley. Elaine Bromiley went into hospital for a routine operation. Despite an appropriate pre-operative assessment, the anaesthetists tasked with intubating Elaine found themselves in a Can’t Intubate, Can’t Oxygenate scenario, though they failed to recognise it at the time.

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No, metformin is probably not the cure for long COVID

First 10 EM

The internet is alive with rumors of a simple, cheap, low-risk cure for long COVID. Sound too good to be true? That’s because it almost certainly is. Let’s talk about this COVIT-OUT trial and what it says about metformin. The paper Bramante CT, Buse JB, Liebovitz DM, et al. Outpatient treatment of COVID-19 and incidence […] The post No, metformin is probably not the cure for long COVID appeared first on First10EM.

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Dr. Jay Bhattacharya Responds to Words I Never Said

Science Based Medicine

My critics lack the courage to accurately quote me. That tells you everything about them and nothing about me. The post Dr. Jay Bhattacharya Responds to Words I Never Said first appeared on Science-Based Medicine.

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Wearable Ultrasound for Deep Tissue Monitoring

Medagadget

Researchers at the University of California San Diego have created a wearable ultrasound system that can monitor deep tissues, as far as 16.5 cm (6.5 inches) below the surface of the body. Moreover, the team employed a machine learning algorithm to reduce the noise associated with movement, helping to obtain reliable readings while the wearer goes about their day.

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The COVID-OUT Trial: Does Metformin Reduce the Risk of Long COVID?

RebelEM

Background: The COVID-19 pandemic has been the focus of massive research efforts over the last three years. Our understanding of the disease and effective treatments to reduce mortality have progressed rapidly during this time. However, the medical community is only just starting to understand long-COVID (WHO Definition: the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation).

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Welcome to Intern Year: Five Tips for the New Intern

SheMD

It's that time of the year. July 1st is almost here and hospitals around the country will welcome in their new interns. To those starting on the wards as interns, this series is for YOU! We're sharing advice from SheMD authors on how to not only SURVIVE but THRIVE during your intern year. Wishing you all the best next week. You CAN do this! January 1st may be the start of the New Year, but for everyone in the medical field we all know that the year really begins on July 1st.

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Fetal Growth Restriction and Small for Gestational Age Babies

Don't Forget the Bubbles

You are asked to see a baby boy in the labour ward. He was born at 38 weeks and 5 days gestational age and weighs 2600 grams. His mother is healthy, but she does mention that her first-born daughter was also small. She weighed 2570 grams at 39 weeks and is now perfectly healthy. The parents are of South-Asian descent. There were no issues during the pregnancy, and estimated fetal growth by ultrasound was constant.

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HEMS Debrief #3 – Geoff Healy

Greater Sydney Area HEMS

In this episode, Senior Staff Specialist Dr Geoff Healy reflects on a formative case with unexpected long term follow-up, and how this has shaped his clinical career as both a physician, and mentor.

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The Pandemic As Spectacle

Science Based Medicine

Though calls for "debates" are made by unserious people, unserious people can do serious damage when they are willing to spread disinformation about vaccines, all because a doctor with principles isn't willing to play his part in their absurd theater. The post The Pandemic As Spectacle first appeared on Science-Based Medicine.

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Defibrillator, a bit of history

Emergency Live

An early prototype defibrillator was built by the American surgeon Claude S. Beck at the University of Cleveland in 1974; it saved the life of a 14-year-old boy who suffered ventricular fibrillation during surgery The post Defibrillator, a bit of history appeared first on Emergency Live.

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Finally, a cure fore sepsis: Herbs

First 10 EM

Can herbs cure sepsis? The EXIT-SEP trial was just published, and demonstrated a decrease in all cause mortality from xuebijing – a product manufactured by a pharmaceutical company from a combination of Carthamus tinctorius flowers (Honghua in Chinese), Paeonia lactiflora roots (Chishao), Ligusticum chuanxiong rhizomes (Chuanxiong), Angelica sinensis roots (Danggui), and Salvia miltiorrhiza roots (Danshen). […] The post Finally, a cure fore sepsis: Herbs appeared first on First10EM.

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How Long Should EM Residency Be? New Studies Shed Light

ACEP Now

U.S. emergency medicine (EM) residency training length has been a decades-long dilemma: four vs. three years. Two important questions befall educators and residents. First, is three years enough time to become an EM physician? Second, does an additional year add sufficient value to justify the time and expense? To date, the debate has been lively yet largely conceptual.

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Boundaries of knowledge

Don't Forget the Bubbles

This post, from Ben Symon on XXX, is the first of our 2022 DFTB conference. Some tickets are still left for DFTB23 in Adelaide, so sign up while you can. Ben Symon is a pediatric emergency medicine physician. He’s fascinated by the interactions and boundaries between how we interact together as clinicians and with our patients. Kindness is central to our speciality – but it should be central to all of our specialities.

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Etomidate for RSI induction? St Emlyn’s

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed If you’re working in the UK then you will know that there is currently a shortage of ketamine (I know!). Specifically we are struggling to get hold of the 10mg/ml … Etomidate for RSI induction? St Emlyn’s Read More » The post Etomidate for RSI induction? St Emlyn’s appeared first on St.Emlyn's.

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Steve Kirsch and Brandolini’s law

Science Based Medicine

The amount of energy needed to refute b t is an order of magnitude bigger than that needed to produce it. The post Steve Kirsch and Brandolini’s law first appeared on Science-Based Medicine.

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Pyelonephritis: causes, symptoms, diagnosis and treatment

Emergency Live

Pyelonephritis is an inflammatory disease of the kidney and renal pelvis that can be acute or chronic. The disease is often associated with a more or less extensive infection of the organ parenchyma The post Pyelonephritis: causes, symptoms, diagnosis and treatment appeared first on Emergency Live.

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PE risk in severe exertional dyspnea

First 10 EM

I think the conclusions of the paper are incredibly obvious, and therefore not practice changing, but I worry that a superficial read might lead to misinterpretation, and therefore the paper is probably worth covering. (This is the same research group that published the infamous PESIT study, and all the subsequent misinformation about PE risk in […] The post PE risk in severe exertional dyspnea appeared first on First10EM.

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Issue #4: The Latest in Critical Care, 6/12/23

PulmCCM

Induced hypothermia after cardiac arrest is also called “active temperature control” or “targeted temperature management.” The treatment became widespread after a trial ( NEJM 2002, n=275) showed large neurologic and survival benefits from hypothermia; however, subsequent trials mostly failed to replicate those findings. A Cochrane review analyzing 12 studies with 3956 participants concluded that: There was no detectable benefit to cooling to temperatures lower than 36 &#

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Single ventricle defects and the hunt for the best shunt

Don't Forget the Bubbles

In this case-based article, we’ll talk about single ventricle defects and their management (both medical and surgical), then look at the two main shunt options during Stage 1 reconstruction. Single ventricle defects Many complex congenital heart defects have single ventricle physiology. This means that one ventricle is too small, weak or obstructed to pump effectively, leaving the other ventricle to supply both systemic and pulmonary circulations in parallel via a shunt such as the ductus

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ICS #SOA23 – Day 1

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed We love a jolly @StEmlyns and true to form we were off to the UK Intensive Care Society State of the Art conference this week in Birmingham. This is always … ICS #SOA23 – Day 1 Read More » The post ICS #SOA23 – Day 1 appeared first on St.Emlyn's.

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A Letter to My Critics: To Refute Me, Stand Up For Your Own Words

Science Based Medicine

Calling me a "lockerdowner" generates likes and retweets from "free-thinkers", but it doesn't refute anything I wrote. Since you obviously need help, I'd like to give you a clear roadmap to refute my ideas. All you have to do is stand up for your own words and make the affirmative case that the purposeful infection of unvaccinated children and young adults was wise and a net positive.

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Inflammations of the heart: myocarditis

Emergency Live

Myocarditis is an inflammation of the heart muscle that affects the middle layer of the heart wall, the muscular tonaca called the myocardium The post Inflammations of the heart: myocarditis appeared first on Emergency Live.

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Pencil-on-Paper Wearable Sensor

Medagadget

Researchers at Penn State have developed a low-cost, wearable sensor using pencil-on-paper technology. This approach involves depositing graphite (pencil ‘lead’) on paper that has been treated with sodium chloride, to create a conductive, low-cost sensor. Previously, these researchers had developed such sensors to detect moisture and even used them to develop a smart diaper ( yes, really ).

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Rethinking the Role of TXA: Are We Asking Too Much?

RebelEM

Background: Injuries are a major cause of death worldwide. Hemorrhage accounts for about 1/3 of all trauma deaths and as such, it should be our goal to find treatments to decrease death from hemorrhage. Our bodies have a finely tuned system that allows blood to flow freely and not clot too easily while also allowing the body to form clots when needed.

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Bubble Wrap PLUS – June 2023

Don't Forget the Bubbles

Can’t get enough of Bubble Wrap? The Bubble Wrap Plus is a monthly paediatric journal club reading list from Anke Raaijmakers, working with Professor Jaan Toelen and his team at the University Hospitals in Leuven. This comprehensive list is developed from 34 journals, including major and subspecialty paediatric journals. We suggest this list can help you discover relevant or interesting articles for your local journal club or allow you to keep a finger on the pulse of paediatric research.