The Bottom Line
OCTOBER 18, 2023
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?
The Trauma Pro
OCTOBER 3, 2023
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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Stop and Think
OCTOBER 30, 2023
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.
Ken Grauer, MD
OCTOBER 21, 2023
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.
Pediatric EM Morsels
OCTOBER 27, 2023
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.
Don't Forget the Bubbles
OCTOBER 30, 2023
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.
EM Ottawa
OCTOBER 12, 2023
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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Science Based Medicine
OCTOBER 9, 2023
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.
ACEP Now
OCTOBER 13, 2023
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.
Pediatric EM Morsels
OCTOBER 6, 2023
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.
First 10 EM
OCTOBER 23, 2023
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.
EM Ottawa
OCTOBER 19, 2023
Canada’s healthcare system, once a source of national pride, is now facing critical challenges that have led many to view it as “unwell” or “sick.” Access to healthcare services has become a pressing concern, sparking a call for change and revitalization. The 911 Emergency System was initially designed as a means to manage emergencies and […] The post Transforming Canada’s Healthcare Landscape with Paramedics appeared first on EMOttawa Blog.
RebelEM
OCTOBER 30, 2023
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.
Science Based Medicine
OCTOBER 2, 2023
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.
ACEP Now
OCTOBER 9, 2023
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.
Don't Forget the Bubbles
OCTOBER 25, 2023
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.
Sensible Medicine
OCTOBER 3, 2023
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.
EM Ottawa
OCTOBER 5, 2023
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.
Dr. Smith's ECG Blog
OCTOBER 1, 2023
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.
Science Based Medicine
OCTOBER 1, 2023
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.
ACEP Now
OCTOBER 26, 2023
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
Greater Sydney Area HEMS
OCTOBER 13, 2023
(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.
Sensible Medicine
OCTOBER 19, 2023
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).
EMCrit
OCTOBER 26, 2023
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.
First 10 EM
OCTOBER 9, 2023
Is there anything emergency doctors love to debate more than airway? We have fancy new tools versus old school badassery. I sort of want to fit into both camps. I want to be the doc who has always succeeded with direct laryngoscopy, while also being young enough to adapt to new technology as it comes […] The post The DEVICE trial: Not as convincing as you think?
Science Based Medicine
OCTOBER 23, 2023
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.
The Bottom Line
OCTOBER 23, 2023
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?
Dr. Smith's ECG Blog
OCTOBER 18, 2023
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?
Emergency Live
OCTOBER 9, 2023
New record for REAS 2023: 29,000 attendees from 33 countries in Europe and around the world REAS 2023 marked a new milestone with an attendance of 29,000 visitors, an increase of 16% compared to the previous edition in 2022. This great success was the result of three intense days dedicated to emergency, first aid and […] The post REAS 2023: an international success for emergency services appeared first on Emergency Live.
EMCrit
OCTOBER 24, 2023
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.
EM Ottawa
OCTOBER 26, 2023
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.
Science Based Medicine
OCTOBER 16, 2023
A recent study reaffirms the high degree of correlation among physicians between antivax views and an embrace of quackery. This is an old finding that needs to be documented periodically and shows why the acceptance of non-science-based treatments by physicians endangers vaccination efforts. The post Alternative medicine and antivax: Two crappy tastes that taste crappy together—particularly when among physicians first appeared on Science-Based Medicine.
RebelEM
OCTOBER 11, 2023
Take Home Points: Patients with recent onset atrial fibrillation can safely be cardioverted if they are 1) on anticoagulation 2) Low risk based on CHADS-VASC with onset < 48 hours or 3) High risk based on CHADS-VASC with onset < 12 hours. In anaphylaxis, think, “If A, B or C, give E.” If the patient has compromise to airway, breathing or circulation, they should get immediate epinephrine.
Dr. Smith's ECG Blog
OCTOBER 23, 2023
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.
St. Emlyn
OCTOBER 18, 2023
St.Emlyn's - Emergency Medicine #FOAMed Big news for the UK this week, with the release of 2 publications in JAMA reflecting novel approaches to the management of the major trauma patient with active haemorrhage. (1,2) … CRYOSTAT-2 @ St Emlyns Read More » The post CRYOSTAT-2 @ St Emlyns appeared first on St.Emlyn's.
Life in the Fast Lane
OCTOBER 29, 2023
Kane Guthrie Haemorrhage Control Haemorrhage Control: Principles and Cognitive Aid with Cliff Reid. Don't Let Your Patient Bleed to Death!
ACEP Now
OCTOBER 30, 2023
What does your program offer that residents can’t get anywhere else? We are the first community emergency medicine program in the country. Residents train at an academic Level I trauma center and several freestanding emergency departments (EDs). We offer innovative ultrasound training, which includes nerve blocks in the ED, and annually participate in SAEM Sonograms.
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