Ken Grauer, MD
FEBRUARY 3, 2024
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.
The Trauma Pro
FEBRUARY 27, 2024
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.
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Pediatric EM Morsels
FEBRUARY 2, 2024
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?
Science Based Medicine
FEBRUARY 26, 2024
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.
Dr. Smith's ECG Blog
FEBRUARY 22, 2024
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.
Sensible Medicine
FEBRUARY 9, 2024
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.
EM Ottawa
FEBRUARY 15, 2024
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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St. Emlyn
FEBRUARY 6, 2024
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.
Science Based Medicine
FEBRUARY 5, 2024
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.
Dr. Smith's ECG Blog
FEBRUARY 2, 2024
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.
RebelEM
FEBRUARY 1, 2024
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.
Sensible Medicine
FEBRUARY 12, 2024
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.
The Trauma Pro
FEBRUARY 23, 2024
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.
St. Emlyn
FEBRUARY 27, 2024
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.
Science Based Medicine
FEBRUARY 7, 2024
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.
Dr. Smith's ECG Blog
FEBRUARY 16, 2024
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?
The Skeptics' Guide to EM
FEBRUARY 11, 2024
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
Life in the Fast Lane
FEBRUARY 8, 2024
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.
The Trauma Pro
FEBRUARY 16, 2024
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!
First 10 EM
FEBRUARY 8, 2024
Long time readers will know that I generally dislike guidelines. Although there are exceptions, I think that guidelines are often more problematic than helpful. However, I know that many people work in places that have medicolegal structures that leave them feeling completely paralyzed, and unable to practice in the absence of a relevant guideline. The […] The post ACEP says its OK to use topical anesthetics for simple corneal abrasions appeared first on First10EM.
Science Based Medicine
FEBRUARY 23, 2024
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.
Dr. Smith's ECG Blog
FEBRUARY 20, 2024
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.
Sensible Medicine
FEBRUARY 27, 2024
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).
PulmCCM
FEBRUARY 5, 2024
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.
The Trauma Pro
FEBRUARY 9, 2024
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.
First 10 EM
FEBRUARY 5, 2024
In the Rapid Review series, I briefly review the key points of a clinical review paper (which often extends to multiple papers because I can’t help myself). The topic this time: Propofol Related Infusion Syndrome (PRIS). Like many rapid review topics, this was chosen for my own education because I have next to no experience […] The post Propofol Related Infusion Syndrome (PRIS) appeared first on First10EM.
Science Based Medicine
FEBRUARY 12, 2024
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.
Dr. Smith's ECG Blog
FEBRUARY 9, 2024
Written by Jesse McLaren A 65 year old with a history of atrial flutter, CABG and end-stage renal disease on dialysis presented with 3 days of fluctuating chest pain, which was ongoing at triage. What do you think? Do you need posterior leads? There’s atrial flutter with controlled ventricular response, a non-specific intra-ventricular conduction delay, borderline right axis, normal R wave progression and normal voltages.
Sensible Medicine
FEBRUARY 6, 2024
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).
Emergency Medicine Cases
FEBRUARY 13, 2024
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
The Trauma Pro
FEBRUARY 6, 2024
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.
First 10 EM
FEBRUARY 19, 2024
Nail bed injuries aren’t quite common enough to cause the same debates as TXA, or IV antibiotics, or tPa, but talk to 10 different emergency doctors and you are likely to get 10 different opinions about the management of these injuries. Therefore, even though the NINJA study doesn’t answer the most important question (in my […] The post The NINJA trial: Do you replace the fingernail after nail bed repair?
Science Based Medicine
FEBRUARY 21, 2024
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.
Dr. Smith's ECG Blog
FEBRUARY 6, 2024
Written by Pendell Meyers A teenager was involved in a motor vehicle collision and presented to the Emergency Department via EMS altered and potentially critically ill. He was intubated for altered mental status. Chest trauma was suspected on initial exam. Here is his initial ECG around 1330: What do you think? The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia.
Sensible Medicine
FEBRUARY 20, 2024
SPRINT is a large randomized trial that has changed practice and led many providers to lower blood pressure beyond prior targets. Here is the conclusion of the paper: But is this trial reliable? I always say that a clinical trial can only change your practice if the control arm is your practice. SPRINT messed this up. The trial didn’t just target less than 140 in the control arm — it did something beyond this.
Emergency Live
FEBRUARY 24, 2024
An analysis on the spread of dengue, associated risks, preventive measures, and the current situation in Brazil and Italy Dengue is a viral disease transmitted by mosquitoes, particularly by the Aedes aegypti species, but also by Aedes albopictus, both present in various areas worldwide, including Italy. This condition represents one of the main causes of […] The post Dengue alert: critical situation in Brazil and alert in Italy appeared first on Emergency Live.
American Medical Compliance
FEBRUARY 17, 2024
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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