January, 2024

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The evolution of ambulances: is the future autonomous?

Emergency Live

The Advent of Driverless Ambulances and Their Implications for the Healthcare System Innovation and Development in Driverless Ambulances Driverless ambulances represent a groundbreaking innovation in the field of healthcare. Autonomous driving technology is already finding applications in the transportation of medications and supplies within hospital complexes.

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EM Cases Best of 2023 Top 10

Emergency Medicine Cases

Based on a blend of number of listens, feedback from listeners, website visits and personal faves, EM Cases Best of 2023 Top 10. The post EM Cases Best of 2023 Top 10 appeared first on Emergency Medicine Cases.

EMS 101
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SGEM #425: Are You Ready for This? Pediatric Readiness of Emergency Departments

The Skeptics' Guide to EM

Reference: Remick KE, et al. National Assessment of Pediatric Readiness of US Emergency Departments during the Covid-19 Pandemic. JAMA Netw Open. July 2023 Date: Dec 11, 2023 Guest Skeptic: Dr. Rachel Hatcliffe is a pediatric emergency medicine attending at Children’s National Hospital in Washington, DC. Her research focuses on prehospital care of children with anaphylaxis. […] The post SGEM #425: Are You Ready for This?

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Best Of EAST 2024 #8: Whole Blood And VTE

The Trauma Pro

The pendulum has swung from the use of whole blood in the early 20th century, to component therapy in the 1960s, and now a gradual move toward incorporating whole blood again. More and more papers are being published, and many trauma centers are looking for ways to integrate whole blood into their massive transfusion protocols. Much of the literature has been dedicated to safety and effectiveness, but little has examined thrombotic complications from its use.

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Mechanical Ventilation Basics

EM Ottawa

Mechanical ventilation has a lot of nuance associated with it, but a lot of reference guides focus on care in the ICU. There is certainly a need for more practical application for the ED doc or initial setup of patients on the vent. With both ER and ICU experience, this post acts as a quick […] The post Mechanical Ventilation Basics appeared first on EMOttawa Blog.

EMS 143
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The Wellness Company: How antivaccine grift becomes plain old quackery

Science Based Medicine

The Wellness Company, promoted by Dr. Peter McCullough, is the product of a trend in which antivax doctors have predictably become just quacks. At least in this case, there is an amusing quack fight at the heart of it all. The post The Wellness Company: How antivaccine grift becomes plain old quackery first appeared on Science-Based Medicine.

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Cardiopulmonary Point of Care Ultrasound – Book Review

Critical Care North Hampton

Many thanks to Dr Manoj Wickramsinghe for his review of this fabulous POCUS textbook. He is a trainee in Anaesthesia and ICM, based in Leeds, and one of the CCN editorial team. About the book authors Editors; Hatem Soliman-Aboumarie, Marcelo Haertel Miglioranza, Luna Gargani, Giovanni Volpicelli. The authors and editors of this book include some.

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Paxlovid evidence: still very little reason to prescribe

First 10 EM

We are once again buried in a wave of viral respiratory illnesses, and much of the burden of illness is still COVID. I did a pretty thorough review of all COVID antiviral therapies in 2022, both on First10EM and on the EMCases Journal Jam, but that was 2 years ago. I think most of us […] The post Paxlovid evidence: still very little reason to prescribe appeared first on First10EM.

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Best Of EAST 2024 #9: The Burden Of Transferred TBI Patients

The Trauma Pro

In theory, tiered trauma centers should allow patients with lesser injuries to be treated at lower levels and more severe trauma at higher-level centers. This parallels the resource availability at those centers. In reality, many patients with injuries that seem complex (solid organ, children, and TBI) are transferred due to a “lack of comfort” in taking care of them or the perception that they may deteriorate quickly.

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PulmCrit hot take: VAP prophylaxis (PROPHY-VAP trial)

EMCrit

background: ANTHARTIC trial Prophylaxis against VAP (ventilator associated pneumonia) has is already supported by a few studies in the literature, perhaps most notably the ANTHARTIC trial. That was a multi-center RCT evaluating 48 hours of therapy with ampicillin-sulbactam for patients intubated following cardiac arrest. Antibiotic therapy reduced early-onset VAP, with a trend towards more ventilator-free […] EMCrit Project by Josh Farkas.

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Real-World Applications of Artificial Intelligence in Medicine

Life in the Fast Lane

Sheralyn Guilleminot and Mike Cadogan Real-World Applications of Artificial Intelligence in Medicine Interview with critical care clinician, and AI enthusiast, Dr Sameer Shaikh on the many ways to use AI to save time and increase efficiency in healthcare

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Coronary Artery Calcium Scans Are Not the Answer

Stop and Think

Since Andrew Foy and I wrote our Case Against Coronary Artery Scans in an academic journal, the test has only increased in popularity. Grin. The imaging test measures the amount of calcium in the coronary arteries. It’s not covered by health insurers, but smart businesspeople have placed the cost at a manageable $100—which is only a fraction of what you’d be billed for a medical grade CT scan.

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Antivax quacks are continuing to make up fantastical biological mechanisms for COVID-19 vaccine “shedding”

Science Based Medicine

A couple of weeks ago, I discussed why antivax quacks' claimed biological mechanisms for COVID-19 vaccine "shedding" reminded me of homeopaths. Confabulation about fantastical scientific mechanisms continues, courtesy of "A Midwestern Doctor." The post Antivax quacks are continuing to make up fantastical biological mechanisms for COVID-19 vaccine “shedding” first appeared on Science-Based Medicine.

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Pre-Hospital Antibiotics in Sepsis?

RebelEM

Background: Sepsis remains one of the leading causes of morbidity and mortality. It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Time to antibiotic therapy (from triage, not from onset of infection) has become a quality metric to improve the time to administration of these medications. In an effort to administer antibiotics earlier, many studies have attempted to give antibiotics in the prehospital setting but the benefit of this int

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The Evidence that Established Coronary Artery Bypass Surgery is Worth Studying

Sensible Medicine

Two quick stories as background. I remember caring for an older man who presented with a minor heart attack. We got him squared away easily. I was then struck by his history because more than a decade ago, doctors discovered severe multi-vessel coronary disease and they had recommended bypass surgery. They told him he would die without it. He refused.

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PulmCrit – Validation of my model for converting VBGs to ABGs

EMCrit

background and general concept My research project in fellowship was the construction of a mathematical model to convert VBG values into ABG values. The fundamental concept for the model was pretty simple: we can approximate the respiratory quotient (RQ) of tissue in the hand as being constant. This indicates that changes in oxygen content and […] EMCrit Project by Josh Farkas.

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Cannabidiol in refractory status epilepticus

Don't Forget the Bubbles

A UK-based study found that 4% of admissions to a tertiary paediatric intensive care unit (PICU) over a 10-year period were due to refractory status epilepticus (RSE) – seizures which fail to terminate despite appropriate first and second-line treatments. Of those patients admitted with RSE, a subset will go on to develop super-refractory status epilepticus (SRSE).

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Trials and Expiration Dates

Stop and Think

Randomized clinical trials are the best way to know what works in medicine. While medical interventions (drugs or devices) remain the same, situations often change. One of the cool things that our Cardiology Trials substack project (Andrew Foy and Mohammad Ruzieh and I are cataloging the seminal trials) is teaching me, is that medications/devices proven effective in trials decades ago, may no longer have benefit now.

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A good journal breaks bad: AAP spreads misinformation about glyphosate

Science Based Medicine

The latest report from the American Academy of Pediatrics is filled with misinformation and missing key articles that support the well-researched conclusion that there is no legitimate evidence of negative health effects of glyphosate. The post A good journal breaks bad: AAP spreads misinformation about glyphosate first appeared on Science-Based Medicine.

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The Latest in Critical Care, 1/29/24 (Issue #27)

PulmCCM

AHA Updates its Cardiac Arrest Guidelines In December 2023, the American Heart Association published a “focused update” to its landmark guidelines for the management of cardiac arrest. PulmCCM is not affiliated with the American Heart Association. Read the document for all the details (it’s not long). Here’s PulmCCM’s take on the new changes.

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What happens when doctors run unethical trials? They get promoted

Sensible Medicine

What happens to doctors who run unethical clinical trials? Ans: they get praised and promoted In this essay, I am going to explain to you why the recent study CONTACT-2— presented now at a cancer conference— is a problematic trial. Next, I am going to discuss why these trials persist. The reason is that the investigators are rewarded not punished.

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Cold air for croup (An RCT)

First 10 EM

I love when people use science to investigate the many simple assumptions we make about the world. Not every trial needs to look novel (mostly read “me too”) drugs or fancy procedures. I also have a child in the age range for croup, and we are in our winter viral season in Canada, so this […] The post Cold air for croup (An RCT) appeared first on First10EM.

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JC: Intubation for the low GCS tox patient. St Emlyn’s

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed Virchester (the home of St Emlyn’s) is a large conurbation that suffers from many of the issues that affect large urban populations in the western world. One part of that […] The post JC: Intubation for the low GCS tox patient. St Emlyn’s appeared first on St.Emlyn's.

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Randomized Trial Comparing Low- vs High-Dose IV Dexamethasone for Patients With Moderate to Severe Migraine

EM Ottawa

Methodology: 3.5/5 Usefulness: 4/5 Friedman BW, et al. Neurology. 2023 Oct 3;101(14):e1448-e1454. Question and Methods: This double-blinded RCT of 209 patients presenting to the ED with moderate to severe migraines compared high- to low- dose dexamethasone (16 mg vs 4 mg) on sustained headache relief 48 hours post discharge. Findings: There was no significant difference in sustained […] The post Randomized Trial Comparing Low- vs High-Dose IV Dexamethasone for Patients With Moderate to

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Chiropractic Subluxation Theory: Science or Gobbledegook?

Science Based Medicine

Many chiropractors continue to claim that vertebral subluxations can affect organ function by interfering with nerve flow in spinal nerves, a view that is scientifically indefensible. The post Chiropractic Subluxation Theory: Science or Gobbledegook? first appeared on Science-Based Medicine.

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Civil Protection in Italy: a history of solidarity and innovation

Emergency Live

From the Unification of Italy to the Modern Emergency Management System The Roots of Civil Protection The history of Civil Protection in Italy has its roots in solidarity and civic assistance. Even in post-unification Italy, emergency relief efforts were not considered a priority of the state but rather entrusted to the military and volunteer organizations. […] The post Civil Protection in Italy: a history of solidarity and innovation appeared first on Emergency Live.

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A Surprising Look at the Evidence for Beta-Blockers After MI

Sensible Medicine

Let’s go back in time and look at the evidence behind one of cardiology’s most accepted practices. You might be surprised. I surely was. The practice is the use of beta-blockers after myocardial infarction (MI). I can’t recall seeing a recent post-MI patient who was not on a beta-blocker. It’s a quality measure now. Doctors and hospitals incur penalties if a patient with an MI is not on a beta-blocker—unless there is a darn good reason put down in the chart.

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You don’t understand non-inferiority trials (and neither do I)

First 10 EM

Over the last few years, I have seen a steady increase in the number of non-inferiority trials being published. This makes some sense, as they generally require fewer participants, and are therefore cheaper and easier to run. However, it presents a problem, as most of us (including myself) don’t really understand the statistics being performed, […] The post You don’t understand non-inferiority trials (and neither do I) appeared first on First10EM.

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Ensuring Safety and Comfort: 3M N95 Fit Test Training for Healthcare Providers 

American Medical Compliance

The year 2024 marks another significant chapter in the healthcare industry’s ongoing battle against infectious diseases, and the numbers speak volumes. The CDC’s FluSurv-NET system, a sentinel network of healthcare facilities, documented over 104,000 flu-related hospitalizations across 13 states during past flu seasons. As healthcare heroes continue their unwavering service on the front lines, the spotlight remains firmly fixed on the importance of personal protective equipment (PP

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Three normal high sensitivity troponins over 4 hours with a "normal ECG"

Dr. Smith's ECG Blog

Written by Willy Frick A 46 year old man with a history of type 2 diabetes mellitus presented to urgent care with complaint of "chest burning." The documentation does not describe any additional details of the history. The following ECG was obtained. ECG 1 What do you think? The ECG shows sinus bradycardia but is otherwise normal. There is TWI in lead III, but this can be seen in normal ECGs.

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Adulteration of Herbal Supplements Continues

Science Based Medicine

The supplement industry continues to be plagued by deliberate adulteration of products. The post Adulteration of Herbal Supplements Continues first appeared on Science-Based Medicine.

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Medicine in the Roman Army: A Journey Through History

Emergency Live

From Origins to the Sophisticated Care Systems for Legionaries Origins and Development of Roman Military Medicine Medicine in the Roman army underwent significant evolution over the centuries. During the time of Julius Caesar and the conquest of Gaul (58-51 BC), wounded soldiers were left in the camp while the army continued its march. With the […] The post Medicine in the Roman Army: A Journey Through History appeared first on Emergency Live.

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Small Trials vs Large Trials

Sensible Medicine

I got the idea of this story from our project over at Cardiology Trials , where we are cataloging the seminal trials in cardiology. Gosh, I am learning a ton about medical evidence. Please do head over there and join the learning. When I rounded in the coronary care units back at Indiana University in the early 1990s, there was momentum to use IV-magnesium (Mg) in patients after myocardial infarction.

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Don’t Forget the Orbeez!

Don't Forget the Bubbles

Orbeez, those colourful, water-absorbent polymer beads, have become increasingly popular among children for play and craft activities. However, their small size and appealing appearance can pose significant health risks to young children. What are Orbeez made of? Orbeez are made from a superabsorbent polymer (SAP), primarily composed of cross-linked polyacrylate.

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Extracorporeal Life Support in Infarct-Related Cardiogenic Shock

EM Ottawa

Methodology: 4/5 Usefulness: 3.5/5 Thiele H, et al. N Engl J Med. 2023 Oct 5;389(14):1286-1297. Editorial: Routine Early ECLS in Infarct-Related Cardiogenic Shock? Question: Does early ECLS therapy confer a mortality benefit in patients with MI complicated by cardiogenic shock? Methods: Open label RCT with 417 patients comparing 30-day all-cause mortality between ECLS versus standard […] The post Extracorporeal Life Support in Infarct-Related Cardiogenic Shock appeared first on EMOttawa B

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Chest pain and a computer ‘normal’ ECG. Therefore, there is no need for a physician to look at this ECG.

Dr. Smith's ECG Blog

Written by Jesse McLaren, comments by Smith A 55 year old with a history of NSTEMI presented with two hours of exertional chest pain, with normal vitals. Below is the triage ECG, with a computer interpretation (Marquette 12 SL) of “normal” which was confirmed by the over-reading cardiologist. What do you think? Should this patient continue to stay in the waiting room, without interruption of the physician to interpret the ECG, because the computer interpretation is normal?

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Hospital Measures Prevented COVID Transmission

Science Based Medicine

A new study finds that hospital measures to limit the spread of COVID-19 worked, and we probably should keep them. The post Hospital Measures Prevented COVID Transmission first appeared on Science-Based Medicine.

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