October, 2023

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Early and Empirical High-Dose Cryoprecipitate for Hemorrhage After Traumatic Injury

The Bottom Line

In patients with trauma and critical bleeding who require activation of a major haemorrhage protocol, does the empiric administration of 3 pools of cryoprecipitate (6g fibrinogen) within 90 minutes of randomisation (and no more than 3 hours after injury) improve survival, compared to standard care?

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Back Braces: Are They Really Needed?

The Trauma Pro

Back braces have always confused me. There are so many types: TLSO, LSO, backpack, extension, and even the lowly abdominal binder can function as a brace. And I have never been able to predict which brace my spine colleagues accurately would prescribe for a specific condition or injury. Many vertebral fractures can be treated non-operatively. And it seems intuitive that there would be some benefit from splinting the spine to limit the range of motion to enhance healing.

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If only critical appraisal was this good for *all* studies

Stop and Think

Let’s start with a picture: This is the Kaplan-Meier curve, from an RCT, published in JAMA , of an oral medication vs a placebo given to patients after a myocardial infarction (MI). The group on the drug sustained a 36% reduction in the occurrence a major adverse cardiac or brain event vs placebo. Outcomes included cardiac death, MI, emergency coronary revascularization or stroke.

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The Broselow-Luten System

Pediatric EM Morsels

Taking care of a critically ill child can be nerve-racking to say the least, and downright petrifying for those who don’t do it frequently, even if they are well-trained and brilliant clinicians. Dr. James Broselow, a family medicine-turned-emergency medicine physician from Hickory, North Carolina , recognized that his team spent a lot of time trying to calculate doses of medications rather than spending their mental energy on the actual medical decisions for the resuscitation.

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ECG Blog #400 — Is this a NSTEMI?

Ken Grauer, MD

The ECG in Figure-1 is from an older man with known coronary disease — who presents to the ED ( E mergency D epartment ) with new CP ( C hest P ain ) over the past several days. Troponin is pending. QUESTIONS: In view of this history — How would you interpret the ECG in Figure-1 ? Should the cath lab be activated? Figure-1: The initial ECG in today's case.

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How To Read a Scientific Paper

Don't Forget the Bubbles

Read between the lines. No matter where we are or what type of medicine we practice, it is likely that we all were told at one point that we were expected to be lifelong learners. This is important as medical knowledge is constantly evolving. Dr. David Sackett, the father of evidence-based medicine, once said: I The traditional way to stay current is by reading the relevant scientific literature.

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New Technology: Using AI To Interpret Pelvic X-rays

The Trauma Pro

Look out, radiologists! The computers are coming for you! Radiologists use their extensive understanding of human anatomy and combine it with subtle findings they see on x-ray shadow pictures. In doing this, they can identify a wide variety of diseases, anomalies, and injuries. But as we have seen with vision systems and game playing (think chess), computers are getting pretty good at doing this as well.

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Battle of the Portables – VScan SL by GE Healthcare

Critical Care North Hampton

We’ve been busy again to bring you the fastest review of GE’s new offering. The VScan SL probe is due to be released and we were lucky enough to get our hands on this fab device. Was it as good as its sister device, the VSCan Air? Take a look at our 3-person review. Below.

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Typhoid Fever in Children

Pediatric EM Morsels

Post-COVID everyone seems to be posting the perfect picture of their travels to the far reaches of the world. While this is an exciting change, it allows transmission of illness to countries where they are not endemic. Recently, a pediatric patient presented to the ED who just returned from abroad with a gastroenteritis presentation. In addition to my passion for PEM, I also share a passion for global health.

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Dr. William Makis and “turbo cancer”: Falsely blaming COVID-19 vaccines for cancer

Science Based Medicine

A prominent oncologist and cancer biologist, Wafik El-Deiry, recently amplified claims that COVID-19 vaccines cause "turbo cancer," wanting a "civil discourse about science and actual answers that are missing." Unfortunately, calls for "civil discourse" by an eminent oncologist about unfounded claims only lends undeserved credibility to them. So, once more into the fray.

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Texas Residency Program Unexpectedly Announces Closure

ACEP Now

The CHRISTUS Health-Texas A&M Spohn Emergency Medicine Residency Program announced Friday that its program will close in June 2026 after the current emergency medicine residents complete their training. An official reason for the closure was not immediately available from the hospital administration, but residents there said they were told the surprise move was likely because of financial reasons.

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Experiential learning with a TWIST: Ovarian Torsion

EM Ottawa

I was in the OR for the first day of my anesthesia rotation when suddenly the pain hit me. It was in my left flank, radiating to my back — so much pain I could hardly think. A flurry of tests later, my ultrasound showed good doppler flow, and my lab work was pristine. I had […] The post Experiential learning with a TWIST: Ovarian Torsion appeared first on EMOttawa Blog.

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Paediatric Idiopathic Intracranial Hypertension

Don't Forget the Bubbles

A 3-year-old girl presents with acute onset convergent strabismus. Fundoscopy examination reveals papilloedema. What are the next steps in the management of their daughter? First thoughts – is this a space-occupying lesion? If you haven’t seen it already, please check out HeadSmart. It details presentations commonly associated with a brain tumour in each age group.

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Forget Simplicity, Give Us Truth

Sensible Medicine

In the United States, Covid vaccine policy continues to be out of step with the world and out of touch with the people. If the CDC wishes to regain trust, they should make honesty, not simplicity their guiding principle. Subscribe now Once again, a new Covid vaccine has debuted, and once again, the Center for Disease Control (CDC) has issued a recommendation that baffles me.

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Expert human ECG interpretation and/or the Queen of Hearts could have saved this patient's anterior wall

Dr. Smith's ECG Blog

This is a re-post of an excellent case from 2021. See it again now, along with our new Queen of Hearts functionality. We've come a long way in 2 years! And the pace only quickens. A man in his mid 60s with history of CAD and stents experienced sudden onset epigastric abdominal pain radiating up into his chest at home, waking him from sleep. He called EMS who brought him to the ED.

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He pushed hydroxychloroquine three years ago: Harvey Risch and false claim of “turbo cancers” caused by COVID-19 vaccines

Science Based Medicine

Last week, I discussed Dr. William Makis' false claims of "turbo cancers" due to COVID-19 vaccines. Now it's hydroxychloroquine-promoting epidemiologist Harvey Risch's turn. The post He pushed hydroxychloroquine three years ago: Harvey Risch and false claim of “turbo cancers” caused by COVID-19 vaccines first appeared on Science-Based Medicine.

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Traumatizing Patients with Trauma Activations

ACEP Now

Each time she moved her hand it caught my eye: the glint of her bejeweled fingers sharply contrasting with the spare gurney and paper-thin blanket. The fat heaviness of her rings seemed startling against her bony fingers, as if they should have shrunk in parallel with her collagen and fat. She fought against the technician removing her belongings while her protestations melded with my trauma survey.

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Little People, Big Updates: Updates in Pediatric Emergency Medicine

EM Ottawa

Do you remember when every newborn under 30 days with a fever needed an LP/admission/blood cultures? Well. times are a little different but its nuanced. The goal of this update is to provide a practical update in pediatric emergency medicine to the average Canadian adult or community emergency clinician. We will review the following three […] The post Little People, Big Updates: Updates in Pediatric Emergency Medicine appeared first on EMOttawa Blog.

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HEMS Debrief #7 – Jackie Buckthought

Greater Sydney Area HEMS

(Apologies – re-posting as yesterday did not arrange the podcast link correctly!) In the seventh episode of the Sydney HEMS Debrief series, Sydney HEMS CCP and Educator Jackie Buckthought shares a challenging case from her training. Jackie discusses how this case has affected her work flow, resilience, and more recently her perspective as an educator.

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JAMA Pediatrics rejected our letter criticizing a study that pulled school children into the school yard and made a dog sniff them to see if they had COVID19

Sensible Medicine

A few months ago, a sensational letter came out in JAMA Pediatrics. The authors took California school children out of the classroom, and had them line up in the school yard. Then a dog sniffed them to see if they had COVID19. Students were told not to look backwards at the dog, but inevitably some students must have snuck a peak. The dog sat down next to suspected COVID19 kids, indicating they might have COVID19 (towards their peers).

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PulmCrit blogitorial: Why I don’t believe the AMIKINHAL trial

EMCrit

Some folks on twitter asked my thoughts on AMIKINHAL trial, so I thought I'd jot them here. AMIKINHAL is a multi-center RCT that evaluated the ability of inhaled amikacin to prevent VAP (ventilator-associated pneumonia) among patients who had been intubated for three days. It's available here at NEJM. It was a positive trial, which is […] EMCrit Project by Josh Farkas.

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Overhyping Vaccines Wasn’t Pro-Vaccine. It Was Pro-Stop-Worrying-About-COVID.

Science Based Medicine

Overselling the vaccine in 2021 was not being pro-vaccine. It was pro-stop-worrying-about-the pandemic, from the doctors who assured us herd immunity was imminent. The post Overhyping Vaccines Wasn’t Pro-Vaccine. It Was Pro-Stop-Worrying-About-COVID. first appeared on Science-Based Medicine.

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VACEP Legal Victory Illustrates Why the Prudent Layperson Standard Still Matters

ACEP Now

Maryland enacted the first “prudent layperson standard” (PLP) in state law in 1993 (see related timeline). The PLP standard they devised protected a patient’s access to emergency medical services, including on-call services, if the medical condition of the patient manifests itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson could reasonably expect that the absence of immediate medical attention could result in serious jeopardy to the health of t

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Massive hemorrhage: The clinical approach

First 10 EM

Case Your patient is bleeding. A lot. Their vital signs are abnormal. They look very sick. (I am being intentionally vague, because the post is going to look at massive hemorrhage in general, rather than getting into the specifics of any one condition.) This post is a condensed clinical summary of appropriate actions in the […] The post Massive hemorrhage: The clinical approach appeared first on First10EM.

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Four patients with chest pain and ‘normal’ ECG: can you trust the computer interpretation?

Dr. Smith's ECG Blog

Written by Jesse McLaren Four patients presented with chest pain. All initial ECGs were labeled ‘normal’ or ‘otherwise normal’ by the computer interpretation, and below are the ECGs with the final cardiology interpretation. If you were working in a busy emergency department, would you like to be interrupted to interpret these ECGs or can these patients safely wait to be seen because of the normal computer interpretation?

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Lactation – A brief guide for the emergency provider

EM Ottawa

You are seeing your next patient in urgent care, a 35-year-old female with a wrist injury who has been waiting for 6-hours. After sending her for an x-ray and offering pain control in the ED, she tells you she is 3-months post-partum and is currently nursing. She asks if there are any pumps available in […] The post Lactation – A brief guide for the emergency provider appeared first on EMOttawa Blog.

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PulmCrit Blogitorial – New IDSA/SCCM guidelines on fever evaluation in ICU

EMCrit

More guidelines! Today we'll walk through some interesting bits of the new IDSA/SCCM guideline on evaluation of new fever in the adult ICU patient (available free here). how should temperature be evaluated? This is frankly a mess. Bladder catheter or esophageal probe are best, but usually not used. Rectal temperature is 2nd best, but unwieldy […] EMCrit Project by Josh Farkas.

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Has MSU economics professor Mark Skidmore been “exonerated” over his retracted paper claiming that COVID vaccines killed 278,000?

Science Based Medicine

Tech bro turned antivax influencer Steve Kirsch is claiming that Michigan State University economist Mark Skidmore has been "exonerated" after having had a paper retracted claiming 278K deaths from COVID-19 vaccines in 2021 alone. In reality, Skidmore just republished a revised version of his retracted paper in an antivax journal after the MSU IRB failed miserably in its oversight duties.

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CRYOSTAT-2: Early Empiric Cryoprecipitate in Major Trauma

RebelEM

Background: Hemorrhage is the leading cause of trauma related mortality. The initial injury is often complicated by multifactorial coagulopathy that can exacerbate bleeding. Fibrinogen is the precursor to fibrin and a major component of stable clot formation. Fibrinogen and fibrin are often depleted during major trauma as a result of consumption, breakdown, and dilution.

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Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage

The Bottom Line

In trauma patients with exsanguinating haemorrhage, does the use of the REBOA (resuscitative endovascular balloon occlusion of the aorta) device with standard care in the emergency department, compared with standard care alone, impact 90-day-mortality?

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Does this T wave pattern mean anything?

Dr. Smith's ECG Blog

Written by Michael Doyle DO and Timothy Palmieri MD. Edited by Bracey, Meyers, Grauer, and Smith A 50-something-year-old female with a history of an unknown personality disorder and alcohol use disorder arrived via EMS following cardiac arrest with return of spontaneous circulation. The described rhythm was an irregular, wide complex rhythm. By EMS report, open pill bottles were found nearby at the scene, including quetiapine, fluoxetine, hydroxyzine, and gabapentin.

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