May, 2024

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ECG Blog #432 — "Should I Shock this Patient?"

Ken Grauer, MD

I was sent the ECG in Figure-1 — without the benefit of any history. Is this VT? What is the 1st thing — that YOU would do? Figure-1: I was sent this ECG without any history. Is this VT? MY Thoughts on Today’s CASE: As tempting as it might be to reach for the defibrillator on seeing the ECG shown in Figure-1 — My initial reaction was different. At 1st glance , my impression from seeing ECG #1 — was that the rhythm is very fast and irregular — with a highly variable QRS morphology — and, without

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More On MRI And External Fixators

The Trauma Pro

I’ve covered the problem of performing MRI on patients with external fixators. This is typically a problem that arises in head-injured patients with extremity or pelvic fixators for concomitant fractures. MRI is an indispensable tool for the evaluation of head, spine, and soft tissue trauma. However, a great deal of effort is required to ensure that any patient scheduled for this test is “MRI compatible.

Fractures 261
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Doctors take money from pharmaceutical firms so they die with a slightly bigger number in the bank

Sensible Medicine

Imagine if your car mechanic took $10,000 a year from Michelin tires for “consulting” and then tended to recommend their tires over Pirelli — even if the latter are on sale or better quality or both. Imagine if your Governor took campaign contributions from Panera bread and then strangely exempted Panera bread from the new minimum wage law.

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“Tranq Dope”: A New Menace

EM Ottawa

The North American opioid crisis is rapidly expanding, resulting in unprecedented levels of harm and strain on the healthcare system. The opioid epidemic is not new to ED providers across the country, but the true extent of harm is quite shocking. In Canada, there has been 40,642 apparent opioid toxicity deaths and 39,435 opioid-related hospitalizations […] The post “Tranq Dope”: A New Menace appeared first on EMOttawa Blog.

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An EPiC mental model. St Emlyn’s

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed The practice of coordinating, consulting and managing an entire acute clinical service in real-time is fairly unique to emergency medicine. Central to this is the EPiC (or emergency physician in charge) role #FOAMed @stemlyns with @codingbrown The post An EPiC mental model. St Emlyn’s appeared first on St.Emlyn's.

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The ultimate COVID-19 antivax conspiracy theory, courtesy of The Brownstone Institute and Jeffery Tucker

Science Based Medicine

I've long argued that antivax beliefs, indeed all science denial, is conspiracy theory. Leave it to The Brownstone Institute's Jeffery Tucker to make my point better for me than I ever could. Of course, Brownstone was always going to "go there." The post The ultimate COVID-19 antivax conspiracy theory, courtesy of The Brownstone Institute and Jeffery Tucker first appeared on Science-Based Medicine.

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Cardiac Arrest – the 5 C’s

Life in the Fast Lane

Kane Guthrie Cardiac Arrest – the 5 C’s Cardiac Arrest - the 5 C's with Cliff Reid. Causes Of Cardiac Arrest You NEVER Thought Of?! Meet The Hs & Ts & Cs!

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Universal Depression Screening Leads to Unnecessary Harm

Sensible Medicine

Regardless of the reason for a primary care visit in the United States, patients are routinely asked how often they feel “hopeless” or "like a failure” These questions come from the PHQ-9. The PHQ-9 has since been validated and is now widely used to screen for depression. Since the United States Preventive Services Task Force (USPSTF) first recommended depression screening 22 years ago, the practice has become standard in primary care despite an absence of evidence.

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Ep 195 Management of Subarachnoid Hemorrhage

Emergency Medicine Cases

Once the diagnosis of nontraumatic subarachnoid hemorrhage (SAH) has been made, our job is not done. Mortality in SAH patients can be up to 30% even without neurological deficit. Paying attention to the time-sensitive details of ED management of SAH patients can have a significant impact on their outcome. In this second part of our 2-part podcast series on subarachnoid hemorrhage with Dr.

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An undergraduate who is an EKG tech sees something. The computer calls it completely normal. How about the physicians?

Dr. Smith's ECG Blog

This was sent by an undergraduate (not yet in medical school, but applying now) who works as an ED technician (records all EKGs, helps with procedures, takes vital signs) and who reads this blog regularly. Edited by Smith He also sent me this great case. A 63 year old man with a history of hypertension, hyperlipidemia, prediabetes, and a family history of CAD developed chest pain, shortness of breath, and diaphoresis after consuming a large meal at noon.

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Pro-Infection Doctors Didn’t Just Want Kids in School. They Wanted Them There Unvaccinated, Untested, and Unmasked. They Wanted Them Infected.

Science Based Medicine

The virus massively disrupted schools around the world, and those of us who did nothing more than acknowledge this obvious reality were absurdly blamed for it. The post Pro-Infection Doctors Didn’t Just Want Kids in School. They Wanted Them There Unvaccinated, Untested, and Unmasked. They Wanted Them Infected. first appeared on Science-Based Medicine.

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JC: Serratus Anterior Plane Blocks for rib fractures in the ED. St Emlyn’s

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed JC: Review of an RCT of serratus anterior plane blocks in the emergency department for chest/rib injury. Is this now a standard of care? @stemlyns #FOAMed The post JC: Serratus Anterior Plane Blocks for rib fractures in the ED. St Emlyn’s appeared first on St.Emlyn's.

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Closing Velocity And Injury Severity

The Trauma Pro

Trauma professionals, both prehospital and in trauma centers, make a big deal about “closing velocity” when describing motor vehicle crashes. How important is this? So let me give you a little quiz to illustrate the concept: Two cars, of the same make and model, are both traveling on a two lane highway at 60 mph in opposite directions.

Wellness 245
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Ketamine in the ED - An Interview with Reuben Strayer, MD

EB Medicine

In this episode, Sam Ashoo, MD and T.R. Eckler, MD interview Reuben J. Strayer, MD, author of the May 2024 Emergency Medicine Practice article, Current Concepts in Ketamine Therapy in the Emergency Department Diving Into Ketamine Use in Emergency Medicine Understanding Ketamine: From Origins to Emergency Use Exploring the Ketamine Brain Continuum Ketamine Dosing and Administration Techniques Combining Ketamine with Neuroleptic Medications Practical Approaches to Ketamine for Pain Management In

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PTM Journal Club: Trauma Care

EM Ottawa

In this month’s PTM Journal Club, we explored the most recent literature on trauma care in the pre-hospital setting. If you missed last months PTM Journal Club, make sure to check-it out by clicking HERE. Ketamine vs Morphine for Out-Of-Hospital Traumatic Pain Background and Objectives Inadequate analgesia is a common challenge in the out-of-hospital treatment […] The post PTM Journal Club: Trauma Care appeared first on EMOttawa Blog.

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Chest pain: Are these really "Nonspecific ST-T wave abnormalities", as the cardiologist interpretation states?

Dr. Smith's ECG Blog

Written by Jesse McLaren, with a very few edits by Smith A 60-year-old presented with chest pain. The ECG did not meet STEMI criteria, and the final cardiology interpretation was “ST and T wave abnormality, consider anterior ischemia”. But are there any other signs of Occlusion MI? There’s only minimal ST elevation in III, which does not meet STEMI criteria of 1mm in two contiguous leads.

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A poorly framed article on COVID-19 vaccine injury in the New York Times

Science Based Medicine

A poorly framed article on people who believe that COVID-19 vaccines injured them is being trumpeted by antivaxxerst. Where the New York Times and its reporter Apoorva Mandavilli go wrong? The post A poorly framed article on COVID-19 vaccine injury in the New York Times first appeared on Science-Based Medicine.

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Friday Reflection #39: What to Expect When You Are Aging

Sensible Medicine

MM is 94 years old. Her only active medical issues are hypertension and vitamin D deficiency. She takes only 20 mg of lisinopril and 1000 units of vitamin D3 each day. She has no cognitive decline and gardens every day if the Chicago weather allows. Her Friday afternoon appointment is the doctor’s last of the week. Sensible Medicine is a reader-supported publication.

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What Is: Lunchothorax?

The Trauma Pro

Here’s an operative tip for trauma professionals who find themselves in the OR. Heard of “lunchothorax?” I’m sure most of you haven’t. The term originated in a 1993 paper on the history of thoracoscopic surgery. It really hasn’t been written about in the context of trauma surgery, though. Lunchothorax is an empyema caused by pleural contamination in patients with concomitant diaphragm and hollow viscus injury.

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PulmCrit: Why the new study associating piptazo with increased mortality is wrong

EMCrit

Piperacillin-tazobactam is an antibiotic that a lot of people love to hate. Combine this with the conservatism that often (rightfully) surrounds drug safety, and it creates a lot of volatility. Before going further, we should review some recent history regarding piptazo. In the early 2010's, a series of retrospective correlational studies found that patients treated […] EMCrit Project by Josh Farkas.

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Effect of Bougie Use on First-Attempt Success in Tracheal Intubations: A Systematic Review and Meta-Analysis

EM Ottawa

Methodology: 4/5 Usefulness: 3/5 von Hellmann R, et al. Ann Emerg Med. 2024 Feb;83(2):132-144. Question and Methods: Systematic review of 18 studies (12 RCT) of adult patients comparing bougie use vs standard of care in tracheal intubations to evaluate first-attempt success. Findings: Bougie was associated with increased first-attempt intubation success overall (RR 1.11 95%CI 1.06 […] The post Effect of Bougie Use on First-Attempt Success in Tracheal Intubations: A Systematic Review and M

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Wide complex tachycardia, resistant to cardioversion. Some fascinating features here.

Dr. Smith's ECG Blog

An elderly dialysis patient presented with chest pain. She has poor LV function. Previous echo 4 months ago (confirmed with ED bedside echo): The estimated left ventricular ejection fraction is 30%. Severely decreased LV function. Regional wall motion abnormality-inferior, inferolateral, septum, anterolateral, anterior and apex, lateral. Here is her ECG: Regular Wide Complex Tachycardia.

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How To Approach Psychogenic Symptoms

Science Based Medicine

Remember back in 1997, the Pokemon seizure episode? Hundreds of children reported symptoms, including seizures, after watching a specific episode of the Pokemon cartoon that includes a sequence of flashing alternating red and blue lights. The press reported the episode at face value, attributing the reaction to a known phenomenon of photosensitive epilepsy.

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Medical Student Accommodations

Sensible Medicine

Recently, I learned about a student on their clinical rotations who had to be sent home at precisely 9 hours. No matter how busy the day or service, the student would leave at the 9 hour mark. The reason? The student had a disability accommodation because he suffered from attention deficit hyperactivity disorder. Subscribe now In medicine there is a tension.

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The “Backward Finochietto” Problem

The Trauma Pro

Resuscitative thoracotomy is a (sometimes) life-saving procedure reserved for trauma patients in extremis. Thankfully, most trauma centers do very few of these a year. However, that makes it one of those “high severity – low frequency” procedures that generate many, many quality improvement problems. Many of these issues are due to operator unfamiliarity or equipment availability.

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What Are the Best AI Detectors?

Life in the Fast Lane

Sheralyn Guilleminot and Mike Cadogan What Are the Best AI Detectors? We investigated to see which tools are the best detectors of artificial intelligence in medical writing. One tool was the clear winner, while others clearly struggled with accuracy!

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Andexanet alfa: expensive and harmful?

First 10 EM

We have previously discussed the many pharmaceutical advertisements published by the New England Journal of Medicine, thinly disguised as science, such as the original open label uncontrolled look at andexanet alfa. (Connolly 2019) At that point, I concluded that andexanet alfa should clearly not be used (although our pharmacies didn’t listen and wasted a lot […] The post Andexanet alfa: expensive and harmful?

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Handed this ECG from triage. What will you do?

Dr. Smith's ECG Blog

Written by Sean Trostel MD I returned to my desk after seeing a patient and saw this screening ECG sitting on my desk to be read. The patient was a man in his 80s with chief complaint listed as: "hyperglycemia, weakness, ground level fall." ECG #1 @ 15:30 What do you think? Slow, irregular rhythm - likely slow atrial fibrillation Very wide QRS measuring ~180 ms in some leads, not fitting LBBB morphology and wider than vast majority of LBBB No signs of OMI, no modified Sgarbossa criteria Peaked T

EKG/ECG 111
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Woke Washing the Pandemic: If You Really Were Progressive, You’d Want Them Infected

Science Based Medicine

Genuine concern is consistent concern. The post Woke Washing the Pandemic: If You Really Were Progressive, You’d Want Them Infected first appeared on Science-Based Medicine.

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Building Disaster Preparedness solutions for citizens 

Emergency Live

B-prepared, a Horizon Europe project (www.b-prepared-project.eu), is committed to building a culture of citizen-centred disaster preparedness through engaging digital platforms with the support of the B-prepared co-creation group. In the wake of a significant number of recent catastrophic events, B-prepared has emerged as a beacon of hope in the quest to reduce the devastating impact […] The post Building Disaster Preparedness solutions for citizens appeared first on Emergency Live.

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What’s With Those Capital Letters In Drug Names?

The Trauma Pro

Call me slow. I’ve subconsciously seen those capital letters in drug names for years. But I never really paid attention or thought much about them. For whatever reason, I just now realized that they are EVERYwhere! So I decided to investigate. Technically, they are called tall man letters. Here are some examples: Certain parts of the drug name are capitalized to highlight differences from a drug with similar spelling.

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The Impact of Technology on Workplace Violence Prevention 

American Medical Compliance

Workplace violence is a significant concern across various industries, affecting employee safety, productivity, and overall organizational morale. Moreover, it encompasses a range of harmful behaviors, including physical assaults, threats, harassment, and verbal abuse, occurring within a work setting. As stated in OSHA’s fact sheet , each year, 2 million American workers fall victim to workplace violence.

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Racemic Epinephrine is on a national shortage in the United States (May 2024)

PEMBlog

Racepinephrine (Racemic epinephrine) is used for croup patients who have stridor at rest and post extubation stridor. It is currently on national shortage and many facilities have a very limited supply of the nebules on hand. In times of shortage, intravenous EPINEPHRINE 1 mg/mL can be utilized as a nebulized solution in place of racepinephrine using the dosing of 0.5 mg/kg to a max of 5 mg.

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Do you need to be a trained health care professional to diagnose subtle OMI on the ECG?

Dr. Smith's ECG Blog

An undergraduate (not yet in medical school) who works as an ED technician (records all EKGs, helps with procedures, takes vital signs) and who reads this blog regularly arrived at work and happened to glance down and see this previously recorded ECG on a table in the ED. It was recorded at 0530: What do you think? The young ED tech immediately suspected LAD OMI.

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Dr. Vinay Prasad Pretends to Admit Error: I Was Optimistic That Vaccination Would Halt the Spread of the Virus—I Was Wrong. 

Science Based Medicine

While admitting error is never easy and should always be applauded, the first step is to honestly admit error. The post Dr. Vinay Prasad Pretends to Admit Error: I Was Optimistic That Vaccination Would Halt the Spread of the Virus—I Was Wrong. first appeared on Science-Based Medicine.

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Eye injury preventing the eye from opening or closing

Emergency Medicine Journal

Clinical introduction An octogenarian presented to the hospital post-fall from a bed, sustaining left facial and chest bruises without consciousness loss. He had diabetes, hypertension, stroke and atrial fibrillation, and was on aspirin 100 mg and edoxaban 30 mg daily. Vital signs were stable. Examination showed left periorbital swelling and anterior thoracic bruising.

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JC: Is First Pass Success an important outcome in PHEA research? St Emlyn’s

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed This JC from St Emlyn's looks at a paper from SJTRM and explores the association between first-pass success (FPS) during pre-hospital intubation and 30-day mortality in patients treated by Finnish helicopter emergency medical services (HEMS). The post JC: Is First Pass Success an important outcome in PHEA research?