November, 2023

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Children in Ambulance: Guidelines and Technological Innovations

Emergency Live

Specialized Solutions for the Safety of Small Passengers During Emergency Transport Transporting children by ambulance requires special care and precautions. In emergency situations, ensuring the safety of young patients is a top priority. This article explores international regulations and technological innovations that help make pediatric ambulance transport safe and effective.

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FAST Is Fast, and FAST Is Last

The Trauma Pro

Ever been in a trauma activation where it seems like the first thing that happens is that someone steps up to the patient with the ultrasound probe in hand? And then it takes 5 minutes of pushing and prodding to get the exam done? Well, it’s not supposed to be that way. The whole point of adhering to the usual ATLS protocol is to ensure that the patient stays alive through and well after your exam.

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Massive Haemorrhage: Science and Practice

Broome Docs

This is another lecture by the always amazing Dr Justin Morgenstern from the series of talks he delivered on his tour of Perth in September 2023. In this talk I challenged Justin to go on a very deep dive into the literature around the modern management of the massively bleeding trauma patient. What is the best way to resuscitate and replace all those blood products in these severely unwell people?

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ECG Video Blog #403 (220) — Ps,Qs,3Rs Approach to this Tachycardia.

Ken Grauer, MD

== — CLICK HERE — for a V ideo presentation of this case! Below are slides used in my video presentation. For full discussion of this case — See ECG Blog #220 — == The long lead II rhythm strip shown in Figure-1 was obtained from an 51-year-old man who presented to the ED ( Emergency Department ) with "palpitations" that began 1 hour earlier. HOW would you interpret this tracing?

EKG/ECG 424
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Entirely predictable: More parents don't want routine vaccination for their kids

Sensible Medicine

The CDC has just reported that more parents than ever are getting vaccine exemptions for their children entering Kindergarten. For many of us who have witnessed the CDC’s repeated blunders with kids COVID19 vaccines, this result is entirely predictable. The CDC has lost the trust of the American people, and it will keep getting worse. First, let me say, I warned them.

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The Great Barrington Declaration and “natural herd immunity” versus public health three years later

Science Based Medicine

Over the weekend, Jeffrey Tucker, founder of the Brownstone Institute, crowed about how the Great Barrington Declaration and its recommendation of a "natural herd immunity" approach to the pandemic changed everything three years ago. Unfortunately, as the John Snow Project pointed out last week, the "natural herd immunity" approach has done what could be irreparable damage to public health science and, more importantly, the political and social will to promote public health practices not just fo

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A Beginner’s Guide to Vasoactive Drug use in Children with Septic Shock

Don't Forget the Bubbles

Four-year-old Ed is being resuscitated for presumed Invasive Group A Streptococcal Sepsis from tonsilitis. He presented tachycardic and hypotensive with a capillary refill time of 5 seconds. After 40ml/kg of IV 0.9% NaCl, his HR came down a little, but the effect was short-lived. He has an HR of 190/min, and his BP is 85/35 mmHg. The CRT is unchanged.

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More Trending

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AIR – Learning from the Airway Registry (November 2023)

Greater Sydney Area HEMS

Airway Registry learning points reflect the challenges described and wisdom shared by Sydney HEMS personnel and guests at the Clinical Governance Airway Registry presentations. Cases are discussed non-contemporaneously, anonymised and amalgamated over a period of time to draw together unifying take-home messages. Details of specific cases are removed and/or changed, such that any similarity to real-life patients or scenarios is coincidental.

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ECG Blog #405 — Is AV Block Complete (vs AV Dissociation)

Ken Grauer, MD

== CLICK HERE — for a V ideo presentation of this case! ( 19:40 min. ) Below are slides used in my video presentation. For full discussion of this case — See ECG Blog #191 — == The 2-lead rhythm strip shown in Figure-1 was obtained from an elderly woman who presented to the ED following a syncopal episode. On the basis of this rhythm strip — she was diagnosed as being in complete AV Block.

EKG/ECG 396
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Doctors and 'experts' who got it wrong during the COVID-19 pandemic

Sensible Medicine

Doctors and ‘experts’ who got COVID policy wrong are asking for forgiveness. Their errors hurt children— resulting in massive learning losses— and caused broader destabilization to the economy, work life, social communities and more. Do they deserve forgiveness? And, why did they err in the first place? Recently Scott Galloway, the NYU professor, appeared on Bill Maher.

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Trust in science and vaccines continues to decline. Why?

Science Based Medicine

Recent evidence shows that public trust in science and vaccines has declined markedly since the pandemic. Why is this, and is there anything we can do about it? The post Trust in science and vaccines continues to decline. Why? first appeared on Science-Based Medicine.

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Why I Changed My Mind About Preventing Heart Disease

Stop and Think

I have changed my mind about a lot of things over the past two decades of practice. No change has been bigger than how I feel about preventing heart disease. The medical jargon here is primary prevention. (Re: preventing a first cardiac event). I will tell this story in three chapters. Chapter 1: What I used to think about primary prevention In years past, I interpreted the studies of primary prevention as only slightly positive.

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Speaking urgent care flow fluently

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed Simplifying urgent care data translation is essential for hospital flow improvement. This post provides a perspective on how to achieve this. The post Speaking urgent care flow fluently appeared first on St.Emlyn's.

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SGEM#421: I Think I’d Have a Heart Attack – Maybe Not in a Rural Area?

The Skeptics' Guide to EM

Date: November 22, 2023 Reference: Stopyra et al. Delayed First Medical Contact to Reperfusion Time Increases Mortality in Rural EMS Patients with STEMI. AEM November 2023. Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. She is the cofounder of FOAMcast and a […] The post SGEM#421: I Think I’d Have a Heart Attack – Maybe Not in a Rural Area?

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ECG Blog #402 — Will Adenosine Convert This?

Ken Grauer, MD

You are told that the patient next door is in the regular SVT ( S upra V entricular T achycardia ) rhythm shown in Figure-1. QUESTIONS: Is the rhythm AVNRT or AVRT? Is Adenosine likely to convert this rhythm? Figure-1: How would YOU interpret this ECG? MY Thoughts on the ECG in Figure-1: When faced with a challenging cardiac arrhythmia — It is a "luxury" to have access to a long lead rhythm strip containing 3 simultaneously -recorded leads.

EKG/ECG 350
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Is boosting bone mass through pharmacotherapy really the best way to prevent fractures in the elderly?

Sensible Medicine

When I first met Teppo Järvinen, it felt like I was meeting a celebrity (not like a Mick Jagger celebrity, more like a David Sackett celebrity). Teppo is the senior author on the NEJM article, Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear. For anyone interested in medical reversal, this article is up there with CAST , the WHI , and the vertebroplasty articles as landmark articles.

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What the heck happened to The BMJ? (2023 version)

Science Based Medicine

The BMJ, once a bastion of evidence-based medicine, has become disturbingly susceptible to publishing biased "investigations" that feed antivax narratives. Its latest report on VAERS by Jennifer Block, who in the past has defended Gwyneth Paltrow and Goop and whose history is not one of supporting science, is just another example of this deterioration.

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Sudden Cardiac Death in College Athletes

Stop and Think

I had thoughts. Maybe you did too. There were just so many media reports of cardiac arrest in athletes. This is a column about two things—a medical problem (cardiac arrest) and the way our brains work. During the pandemic we learned that the vaccine against SARS-CoV-2 could cause myocarditis—or inflammation of the heart. Young males had the highest risk of this adverse effect.

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How to Make a Logo using AI

Life in the Fast Lane

Sheralyn Guilleminot and Mike Cadogan How to Make a Logo using AI AI in healthcare: A review of the AI tools Midjourney and DALL•E•3 to create logos and images; their unique features, differences, and the importance of effective instruction (prompting).

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The Deep Freeze: A Review of Frostbite Management

EM Ottawa

Introduction Frostbite is a frequent presenting complaint to emergency departments (EDs) in cold climates. It is more common among those without housing, those with mental health disorders as well as those who work or engage in outdoor activities.(1) These injuries can be debilitating requiring surgical intervention, debridement or amputation in the most severe cases.

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ECG Video Blog #404 (344) — Mobitz I, Mobitz II. or neither?

Ken Grauer, MD

== — CLICK HERE — for a V ideo presentation of this case! ( 15 minutes ) Below are slides used in my video presentation. For full discussion of this case — See ECG Blog #344 — == How would YOU interpret the lead II rhythm strip shown in Figure-1 ? Is the rhythm Mobitz I or Mobitz II 2nd-degree AV Block? Or — Is it “ something else ”? Figure-1: How would YOU interpret this lead II rhythm strip?

EKG/ECG 248
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Non-significant Studies Can Teach A Lot

Sensible Medicine

Many doctors believe that closing the left atrial appendage (with a device) will help reduce stroke and bleeding. The idea behind stroke reduction is that occluding the appendage takes away a common area where clots form. The reason for less bleeding is that patients with proper occlusion can often be taken off anticoagulant drugs. These are nice ideas.

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Dr. Jerome Adams Was Right. They Wanted Them Infected. That’s a Fact.

Science Based Medicine

"Many were fine with exposing kids (and school workers) to a deadly virus, with no vaccine or treatment, in the name of herd immunity. That’s a fact."- Dr. Jerome Adams The post Dr. Jerome Adams Was Right. They Wanted Them Infected. That’s a Fact. first appeared on Science-Based Medicine.

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Bloodborne Pathogen Exposures Continue in Operating Room Settings

NIOSH Science Blog

Despite legislation and improved technology, data from Massachusetts hospitals show that sharps injuries have increased in the operating room (OR) [1]. These injuries place healthcare workers at risk of exposure to bloodborne pathogens (BBPs). There is an urgent need to renew efforts to protect healthcare workers inside the operating room. The Massachusetts data highlight a gap and the need to establish a national surveillance program that would help hospitals develop further measures to prevent

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Propofol-related Infusion Syndrome

Don't Forget the Bubbles

One-liner… Although commonly used, Propofol can have severe adverse effects. Propofol Infusion Syndrome (PRIS) can lead to significant morbidity and mortality in children. What is Propofol? Commonly referred to as “the milk of amnesia”, propofol is a drug used for induction and maintenance of general anaesthesia and for procedural sedation. Propofol is prepared in a lipid emulsion, giving it a characteristic milky white appearance, and due to its ability to dissolve in fats, it is rapidly redist

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Quiz post: 2 similar patients with similar ECGs. Which, if any, or both, are OMI? Will you outperform the Queen of Hearts?

Dr. Smith's ECG Blog

Written by Pendell Meyers Two adult patients in their 50s called EMS for acute chest pain that started within the last hour. Both were awake and alert with normal vital signs. Both cases had an EMS ECG that was transmitted to the ED physician asking "should we activate the cath lab?" What do you think? Here they are: Patient 1, ECG1: Zoll computer algorithm stated: " STEMI , Anterior Infarct" Patient 2, ECG1: Zoll computer algorithm stated: "ST elevation, probably benign early repolarization.

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INTERACT3: Management of intracranial hemorrhage

First 10 EM

Evidentiary amnesia is a term I use to describe the phenomenon I frequently encounter in which evidence seems to be forgotten over time. When I hear people lecture about the management of intracranial hemorrhage, and even when I invite incredibly smart people to write about neurologic emergencies, blood pressure management is always recommended. But why?

EMS 119
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Do you think a bone marrow transplant is worth it?

Sensible Medicine

Years ago, I was late to a dinner party at a new, trendy downtown restaurant. I had been working as an attending on the bone marrow transplant service, and the day got away from me. I had to take care of a patient who had a serious adverse reaction when she received her stem cell infusion. Another patient was suffering from a catastrophic fungal infection, and graft versus host disease threatened the life of a third.

Hospitals 129
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I Agree with Dr. Vinay Prasad: It’s Entirely Predictable That More Parents Don’t Want Routine Vaccination for Their Kids

Science Based Medicine

Dr. Prasad didn't predict this sad outcome, he worked tirelessly to cause it. So did many other doctors. The post I Agree with Dr. Vinay Prasad: It’s Entirely Predictable That More Parents Don’t Want Routine Vaccination for Their Kids first appeared on Science-Based Medicine.

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JC: The DAShED Study – Diagnosis of Acute Aortic Syndrome in the Emergency Department

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed We review a paper from the EMJ looking at the diagnosis of acute aortic syndrome in the ED and the accuracy of clinical decision rules and clinician gestalt The post JC: The DAShED Study – Diagnosis of Acute Aortic Syndrome in the Emergency Department appeared first on St.Emlyn's.

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Paediatric Neck Lumps

Don't Forget the Bubbles

Neck lumps are a common presenting complaint to the paediatric emergency department with many aetiologies, sometimes resulting in a diagnostic conundrum. Thorough history taking and detailed examination can aid in diagnosis. Causes of paediatric neck lumps can be broadly divided into three categories – congenital , inflammatory and neoplastic.

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Innovative Applications of AI in Healthcare

Life in the Fast Lane

Sheralyn Guilleminot and Mike Cadogan Innovative Applications of AI in Healthcare 4 Innovative Applications of AI in Healthcare (and 2 Important Precautions!) AI is a tool to complement your expertise, but that it shouldn’t be used as a substitute for your own good judgement.

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Acute Dyspnea and Right Bundle Branch Block

Dr. Smith's ECG Blog

I was texted this ECG just as I was getting into bed. It is of an elderly woman who complained of shortness of breath and had a recent stent placed. I was told that the Queen of Hearts had called it OMI with high confidence. What do you think? Ken (below) is appropriately worried about pulmonary embolism from the ECG. What I had not told him before he made that judgement is that the patient also had ultrasound B-lines of pulmonary edema.

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A Surgeon Turns Activist

Sensible Medicine

A few years ago, Dr. Richard T. Bosshardt waded into a minefield. He had been a Fellow of the American College of Surgeons (ACS) for over thirty years when he expressed his opinion that the ACS’s diversity, equity, and inclusion initiatives were threatening their dedication to excellence. Dr. Bosshardt has garnered support for his objections and has published his opinions in The Wall Street Journal, City Journal, and National Review.

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Robert F. Kennedy Jr. comes home to his antivax roots…again

Science Based Medicine

Robert F. Kennedy Jr. gave the keynote speech at the second annual meeting of his antivax organization, Children's Health Defense. Once again, he demonstrated that not only is he still antivax as hell, but that his proposals are even more bizarre than before. Truly, it was a homecoming for him. The post Robert F. Kennedy Jr. comes home to his antivax roots…again first appeared on Science-Based Medicine.

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The Emergency Care Voice Rescued from a Sea of Politics

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed Emergency care practitioners are known for creating order from chaos, being pragmatic amidst difficult circumstances and advocating for patients when others cannot. The post The Emergency Care Voice Rescued from a Sea of Politics appeared first on St.Emlyn's.

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ACMT Toxicology Visual Pearl: Poison Dart Frog

ALiEM

The toxin from the golden poison dart frog most resembles which of the following in its mechanism of action? Botulinum toxin Bufotoxin Grayanotoxin Palytoxin Tetrodotoxin Photo adapted from Wilfried Berns (Wikimedia Commons) Reveal the Answer 3. Grayanotoxin – a sodium channel opener Background The golden poison dart frog ( Phyllobates terribilis ), often considered one of the most poisonous animals on the planet, secretes onto its skin the lipophilic alkaloid batrachotoxin , which irreversibly

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