February, 2024

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ECG Blog #415 — The Cath showed NO Occlusion!

Ken Grauer, MD

Today’s patient is an older woman who experienced a number of fainting epiodes over the previous week. No CP ( C hest P ain ). Shortly after arrival in the ED ( E mergency D epartment ) — she suffered a cardiac arrest. The ECG in Figure-1 was obtained following successful resuscitation. Stat Echo — obtained shortly after successful resuscitation revealed anterior wall akinesis.

EKG/ECG 361
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Air Embolism From an Intraosseous (IO) Line

The Trauma Pro

Intraosseous (IO) lines are a godsend when we are faced with a patient who desperately needs access but has no veins. The tibia is generally easy to locate and the landmarks for insertion are straightforward. They are so easy to insert and use, we sometimes “set it and forget it”, in the words of infomercial guru Ron Popeil. But complications are possible.

Fractures 263
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Travel-Related Illnesses in Children

Pediatric EM Morsels

There have been many times I have encountered a triage note which states “ patient recently returned from … (insert awesome foreign country) … ” Not only does this leave me daydreaming about my future travel adventures, but has often caused me to take pause. Thoughts of what endemic illnesses could this child potentially have been exposed to in their travels?

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How antivaxxers weaponize vaccine safety studies to falsely portray vaccines as dangerous

Science Based Medicine

Antivaxxers have weaponized a huge multinational vaccine safety study of 99 million patient records that found rare adverse events and concluded that the benefits of COVID-19 vaccines outweigh the risks. How? A combination of the Nirvana fallacy and spin. The post How antivaxxers weaponize vaccine safety studies to falsely portray vaccines as dangerous first appeared on Science-Based Medicine.

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The Patient

Sensible Medicine

You can only listen to, or read, what doctors have to say for so long. Today, in our Friday, “reflective writing” slot, an essay from someone in the bed rather than beside it. Adam Cifu Sensible Medicine is a reader-supported publication. If you appreciate our work, consider becoming a free or paid subscriber. After ten days tethered to an IV of cyclosporine, the surgeon explained that he would remove my colon, create a stoma, and hitch a colostomy bag to my abdomen.

Hospitals 139
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The NICO Trial: NIV in Comatose Patients with Acute Poisoning

RebelEM

Background: Patients with decreased level of consciousness due to alcohol, drugs, or medications commonly present to the ED. These patients can be at risk of vomiting and aspiration and often prompts clinicians to pursue definitive airway management to avoid pneumonia and other complications. It is unclear, though, if the risks of intubation (including ventilator associated pneumonia) outweighs the benefits.

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How will you save this critically ill patient? A fundamental and lifesaving ECG interpretation that everyone must recognize instantly.

Dr. Smith's ECG Blog

Written by Pendell Meyers A woman in her 30s called EMS for acute symptoms including near-syncope, nausea, diaphoresis, and abdominal pain. EMS arrived and found her to appear altered, critically ill, and hypotensive. An ECG was performed: What do you think? Extremely wide complex monomorphic rhythm just over 100 bpm. The QRS is so wide and sinusoidal that the only real possibilities left are hyperkalemia or Na channel blockade.

EKG/ECG 128

More Trending

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Top resus papers for TBS. St Emlyn’s

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed This week I am in Zermatt, Switzerland for ‘The Big Sick’ conference. This is something I have been looking forward to years, but major heart surgery (valves not pipes) and […] The post Top resus papers for TBS. St Emlyn’s appeared first on St.Emlyn's.

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COVID-19 antivax quacks are now “repurposing” ivermectin for cancer

Science Based Medicine

A year ago, I noticed that COVID-19 quacks were touting the "repurposing" of ivermectin to treat cancer. Now, familiar COVID-19 antivaxxers—cough, cough, FLCCC—have turbocharged this quackery. The post COVID-19 antivax quacks are now “repurposing” ivermectin for cancer first appeared on Science-Based Medicine.

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AJPH Highlights Health Worker Mental Health

NIOSH Science Blog

The American Journal of Public Health recently published a special supplement with 15 articles focusing on health worker mental health. This special issue of the journal was sponsored and edited by the National Institute for Occupational Safety and Health (NIOSH) and stems from the health worker mental health initiative from the Centers for Disease Control and Prevention and NIOSH.

Research 123
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Another Study on Peripheral Vasopressors

RebelEM

Background: Use of vasopressors is a common practice to support hemodynamics and optimization of tissue perfusion in patients presenting with shock. Historically the administration of vasopressors was restricted to central venous catheters (CVC) due to concerns for local tissue injury resulting from vasoconstriction if extravasation occurred from a peripheral IV.

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Ketamine and Etimodate: Into the Void

EM Ottawa

We’re increasingly cognizant of the physiological importance of maintaining specific hemodynamics during resuscitation. Practice patterns vary broadly, so we’ve done a deep dive into the various evidence around the use of ketamine and etomidate in specific clinical scenarios. Physiology of the rapid sequence intubation Rapid sequence intubation (RSI) is the nearly simultaneous administration […] The post Ketamine and Etimodate: Into the Void appeared first on EMOttawa Blog.

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Use Of A Solid Organ Injury Protocol For Pediatrics

The Trauma Pro

Kids are frequent flyers when it comes to abdominal injury, with about 15% of their injuries involving this anatomic area. Solid organ injuries, mainly the liver and spleen, are the most prevalent ones. The American Pediatric Surgical Association (APSA) published a practice guideline way back in 2000 that outlined a consistent way to care for children with solid organ injuries.

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What is this ECG finding? Do you understand it before you hear the clinical context?

Dr. Smith's ECG Blog

Written by Pendell Meyers First try to interpret this ECG with no clinical context: The ECG shows an irregularly irregular rhythm, therefore almost certainly atrial fibrillation. After an initially narrow QRS, there is a very large abnormal extra wave at the end of the QRS complex. These are Osborn waves usually associated with hypothermia. There is also large T wave inversion and long QT.

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The Menace of Wellness Influencers

Science Based Medicine

Wellness influencers are often also conspiracy theorists, as both mindsets rely upon the same underlying methods, motivation, and narrative. The post The Menace of Wellness Influencers first appeared on Science-Based Medicine.

Wellness 139
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The Study of the Week Is a Beautiful Example of Science Done Well

Sensible Medicine

Academic medicine sometimes gets it right. This is a positive story about a negative trial. Neurologist Hooman Kamel from the Weil Cornell Medical Center in NY had an idea about atrial fibrillation and stroke. Old thinking held that clots formed in the left atrium during periods of irregular rapid fibrillatory activity. Stroke came when these clots moved northward to the brain.

Wellness 119
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The AcT Trial: Tenecteplase vs Alteplase for Acute Ischemic Stroke

RebelEM

Background : Alteplase, a class of medication that converts plasminogen to plasmin leading to fibrin degradation and subsequent clot lysis, has been the standard of care for acute ischemic stroke (AIS) patients that meet eligibility criteria. Tenecteplase, a modified version of alteplase, is being increasingly utilized for AIS due to its favorable pharmacological profile, ease of administration, and cost effectiveness.

Stroke 121
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SGEM#430: De Do Do Do, De Dash, Dash DAShED – Diagnosing Acute Aortic Syndrome in the ED.

The Skeptics' Guide to EM

Reference: McLatchie et al and DAShED investigators. 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. EMJ Nov 2023. Date: February 11, 2024 Guest Skeptic: Nirdosh Ashok Kumar, Emergency Medicine Specialist – Aga Khan University Hospital, Karachi, Pakistan. […] The post SGEM#430: De Do Do Do, De Dash, Dash DAShED – Diagnosing Acute Aortic Sy

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Nail In The Neck: A Novel Removal Option

The Trauma Pro

Here’s a post from my archive describing a different way to remove the foreign body. This is the technique I used, instead of the standard neck incision. The final incision was just a slight extension of the puncture wound, measuring only 1cm. I was able to grasp the head and pull it out without difficulty. The surprising thing to me was the amount of force I needed to apply to actually pull it out!

Wellness 147
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A young man with persistent palpitations

Dr. Smith's ECG Blog

Written by Pendell Meyers A teenager was playing basketball when he suddenly developed palpitations and lightheadedness. He presented soon afterward at the Emergency Department with ongoing symptoms. Mentation and blood pressure were normal. He had no chest pain or shortness of breath. Heart rates on the monitor fluctuated from 180-250 bpm. Here is his triage ECG: What do you think?

EKG/ECG 118
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Yet more evidence that we physicians need to clean up our act

Science Based Medicine

A recent study found that physicians and scientists who are perceived as "experts" are prevalent within the antivax community and more influential because of their status as physicians and scientists. Why do physicians continue to tolerate antivax quacks within our ranks? The post Yet more evidence that we physicians need to clean up our act first appeared on Science-Based Medicine.

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Decompensated. Liver disease in the ED. St Emlyn’s

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed A review of Acute on Chronic Liver Disease (ACLD / decompensated liver disease) in the ED. How we can improve patient outcomes. #FOAMed @stemlyns The post Decompensated. Liver disease in the ED. St Emlyn’s appeared first on St.Emlyn's.

Outcomes 115
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AI-Assisted Learning and Teaching

Life in the Fast Lane

Sheralyn Guilleminot and Mike Cadogan AI-Assisted Learning and Teaching AI-assisted learning and teaching is an often-overlooked use of artificial intelligence in medicine! Here are 4 ways to do it.

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From Guideline Recommendations to Articulated Harms and Benefits

Sensible Medicine

In the ideal, clinical guidelines incorporate evidence and expert opinion and enable clinicians to make evidence-based decisions without having to read the primary literature. These guidelines serve as an authority, defining high-quality care and how medical care should be delivered. Clinical guidelines have potential benefits: improved health outcomes, consistency of care, and reduced uncertainty (for the clinician).

Outcomes 112
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Nail In The Neck: Part 2

The Trauma Pro

This case involves an accidental nail gun injury to the neck. The patient is hemodynamically stable, neurologically intact, the airway is patent and not threatened, and there is no apparent hematoma. There is a small puncture near the sternocleidomastoid muscle on the right, fairly high on the neck. The nail is not palpable on either side. And the patient only complains of a little discomfort when he swallows.

Wellness 147
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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.

EKG/ECG 115
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Pesticide in Oat Products – Should You Worry?

Science Based Medicine

You know the rule about headlines - if there is a question in a headline the answer is almost always "no". This article is no exception. The post Pesticide in Oat Products – Should You Worry? first appeared on Science-Based Medicine.

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Testicular torsion

Don't Forget the Bubbles

I have long been fascinated by testicles. My first real encounter with the healthcare system took place when I was about seven years old and had to go into hospital for an orchidopexy, so I can empathize with all the young people who come through our emergency department with acute testicular pain. This week, NCEPOD (National Confidential Enquiry into Patient Outcomes and Death) produced a much-anticipated report on how we manage acute testicular torsion in young people.

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How to make a medical podcast using AI (part 2)

Life in the Fast Lane

Sheralyn Guilleminot and Franz Wiesbauer How to make a medical podcast using AI (part 2) The original hope was that using AI might allow us to create a single podcast episode in one afternoon. But things didn’t go quite the way we planned.

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The Latest in Critical Care, 2/5/24 (Issue #28)

PulmCCM

Fever in the ICU: Guideline Update The Society of Critical Care Medicine (SCCM) and the Infectious Diseases Society of America (IDSA) issued an interim update to their 2008 recommendations for the management of fever in the ICU. PulmCCM is not affiliated with SCCM or IDSA. Virtually all the recommendations were based on weak evidence and represent a consensus of expert opinion.

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What Would You Do? Nail In The Neck

The Trauma Pro

Here’s a very interesting case for you. A construction worker was carrying an object inside a building WHILE HOLDING HIS NAIL GUN! As he passed through the door, his elbow hit the frame and he brushed his neck with the business end of the gun. Guess what happened? He experienced sharp pain, then noted pain every time he swallowed. He checked himself out in the mirror, and there was a small puncture wound in the right side of his neck.

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Right Ventricular Heart Failure

EB Medicine

In this episode, Sam Ashoo, MD, and T.R. Eckler MD interview Nick Harrison, MD and Daniel Brenner, MD, two of the authors of the February 2024 Emergency Medicine Practice article, Emergency Department Management of Patients With Right Heart Failure Pathophysiology Presenting Symptoms Differential Diagnosis Specific Acute Causes PE Sepsis RVMI PPV ARDS COVID-19 Specific Chronic Causes CTEPH Left Heart Failure Congenital Heart Disease LVAD Lung Disease Group 3 Pulmonary Hypertension Pulmonary A

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The Great Barrington Declaration Wasn’t a Plan For Public Health Officials. It Was a List of Absurd Demands of Them.

Science Based Medicine

The authors of the GBD advised and influenced many politicians at the highest level. They claim to have delineated many practical policies to protect the vulnerable, and they said it would’ve been possible, certainly. So an obvious question emerges. Why didn’t they protect the vulnerable? The post The Great Barrington Declaration Wasn’t a Plan For Public Health Officials.

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ECG Cases 48 – ECG Interpretation in Cardiac Arrest

Emergency Medicine Cases

In this month's ECG Cases blog Dr. Jesse McLaren reviews interpretation of the pre-arrest ECG: identifying high risk ECGs requiring empiric treatment like calcium for hyperkalemia, magnesium for long QT, or reperfusion for Occlusion MI; the intra-arrest ECG: identifying pseudo-PEA; and post-arrest ECG: the importance of serial ECGs to reduce false positive STEMI, role of POCUS to help with the differential of diffuse ST depression with reciprocal ST elevation in aVR, and identifying signs of Occ

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Can We Select “Better” Residents?

Sensible Medicine

Two things are clear about the internal medicine residents I get to work with. First, their qualifications are spectacular: academic accolades, research, publications, clinical medicine experiences prior to residency, even real-life professional experiences. When they enter internship, their CVs dwarf those of my residency colleagues (’93 - ’96).

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Best Practices for Healthcare Organizations to Ensure OSHA Compliance

American Medical Compliance

Ensuring the safety and well-being of both patients and staff is paramount. With the Occupational Safety and Health Administration (OSHA) setting standards to protect workers from occupational hazards, healthcare organizations face unique challenges in maintaining compliance due to the complexity of their operations and the diverse array of risks inherent in patient care.

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Genitourinary symptoms in younger children

Don't Forget the Bubbles

Topic Paediatric Genitourinary Presentations Author Helena Winstanley and Tara George Duration Up to 2 hrs Facilitator Level ST4 and above Learner level FY1 and above (can be adapted depending on the level) Outline Pre-reading Basics Case 1 Case 1: Discussion Case 2 Case 2: Discussion Advanced Case 1 Advanced Case 1: Discussion Advanced Case 2 Advanced Case 2: Discussion Quiz Basics (10 mins) Main session : (2 x 15 minute) case discussion covering the key points and evidence including an optiona

Wellness 105