May, 2023

article thumbnail

ECG Blog #380 — What is "Swirl"?

Ken Grauer, MD

The ECG in Figure-1 — was obtained from an older woman with persistent CP ( C hest P ain ) over the previous day. Her symptoms lessened after Nitroglycerin — so the decision was made not to activate the cath lab. Do YOU agree with this decision? Figure-1: The initial ECG in today's case. MY Thoughts on the ECG in Figure-1: In a patient with CP that had been persistent over the previous day ( until Nitroglycerin was given ) — the initial ECG shown in Figure-1 is extremely worrisome.

EKG/ECG 297
article thumbnail

Serial Hemoglobin / Hematocrit – Huh? Part 1

The Trauma Pro

The serial hemoglobin (Hgb) determination. We’ve all done them. Not only trauma professionals, but other in-hospital clinical services as well. But my considered opinion is that they are not of much use. They inflict pain. They wake patients up at inconvenient hours. And they are difficult to interpret. So why do them? I’m reposting this mini-series on serial hemoglobin draws in light of a new paper that was published in the Journal of Trauma Nursing.

Fractures 130
Insiders

Sign Up for our Newsletter

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

article thumbnail

Closed Head Injury – PECARN for < 3 Months: Rebaked Morsel

Pediatric EM Morsels

We all know that Gravity Works ! While this fact can adversely affect anyone, it offers the greatest challenge for those who cannot protect themselves , like children less than 3 months of age ! We last pondered this in 2011 Morsel , just a couple years after PECARN head injury data was published. Since that time there have been several studies externally validating the PECARN rule in all age groups and in multiple different countries.

article thumbnail

HEMS Debrief #1 – Dr Cliff Reid

Greater Sydney Area HEMS

In the first in this series, HEMS physician and podcast host Dr Samuel Bulford interviews senior staff specialist Dr Cliff Reid who describes a case that changed his life and set his approach to mission preparation and training on a new trajectory.

article thumbnail

The DIMPLES study

Don't Forget the Bubbles

What’s the relationship between COVID-19 and diabetes? May saw the e-publication of the DIMPLES study. Let’s take a deep dive into this paper and its implications for PEM internationally. Ponmani C, Nijman RG, Roland D, Barrett M, Hulse T, Whittle V, Lyttle MD on behalf of PERUKI. Children presenting with diabetes and diabetic ketoacidosis to Emergency Departments during the COVID-19 pandemic in the UK and Ireland: an international retrospective observational study.

article thumbnail

Unsafe and Ineffective: Aseem Malhotra

Science Based Medicine

British consulting cardiologist Dr. Aseem Malhotra has become the latest darling of the COVID-19 minimization and antivaccine movement in the UK. Previously known for anti-statin views and advocacy of the Pioppi diet who pivoted to more dangerous misinformation during the pandemic. The post Unsafe and Ineffective: Aseem Malhotra first appeared on Science-Based Medicine.

117
117
article thumbnail

ECG Blog #381 — Why was the Troponin Normal?

Ken Grauer, MD

The ECG in Figure-1 was obtained from a 60-ish year old man with a history of coronary disease ( including prior CABG ) — who presented to the ED ( E mergency D epartment ) with new CP ( C hest P ain ) of 3 hours duration , diaphoresis and nausea/vomiting. The patient was hypotensive at the time his initial ECG in Figure-1 was obtained. The decision was made not to immediately perform cardiac cath — because there is no ST elevation in Figure-1 — and because the initial troponin was negative.

EKG/ECG 195

More Trending

article thumbnail

Vegan Diets in Children

Pediatric EM Morsels

Our world has become inundated with the newest food and diet crazes. It seems like every social media persona provides “expert” opinions on the best way to nourish our bodies. Adults are one thing, but how does that translate to our growing, developing pediatric patients? Today we are focusing on vegan diets in children , and which nutritional deficiencies we need to remain vigilant to spot!

article thumbnail

EMCrit 349 – The EMCrit Burnout Model

EMCrit

My attempt to model my empirical experience with Burnout EMCrit Project by Scott Weingart, MD FCCM.

137
137
article thumbnail

Trick of Trade: Dual Foley catheter to control massive epistaxis

ALiEM

Massive epistaxis is considered a medical emergency that requires immediate attention. Symptoms of massive epistaxis include sudden and heavy bleeding from the nose, difficulty breathing, dizziness, and a rapid heartbeat. If left untreated, it can lead to significant blood loss, shock, airway obstruction, and even death. We report a case of a 50-year-old man with end stage renal disease with massive nasal bleeding from the left nostril, shortness of breath, and confusion.

article thumbnail

Repurposed to Radical: How drug repurposing created a global right-wing market for COVID early treatment fraud

Science Based Medicine

A condensed timeline of the events, people, and far-right global politics that repurposed science and medicine to promote fake miracle cures for COVID-19 and spread deadly disinformation with a focus on the United States, France, and Brazil. The post Repurposed to Radical: How drug repurposing created a global right-wing market for COVID early treatment fraud first appeared on Science-Based Medicine.

107
107
article thumbnail

ECG Blog #378 — Wenckebach with PVCs?

Ken Grauer, MD

The ECG in Figure-1 — was obtained from an older woman with chest pain. How would YOU interpret this tracing? What kind of AV block is present? — OR — Is there no clear evidence of any AV block? Figure-1: The initial ECG in today’s case. ( To improve visualization — I've digitized the original ECG using PMcardio ). MY Thoughts on the ECG in Figure-1: This tracing is challenging to interpret because of the changing QRS morphology — and because of the uncertainty regarding atrial activity.

EKG/ECG 195
article thumbnail

How Fast Do Trauma Patients Die?

The Trauma Pro

For years, I’ve taught my residents participating in trauma activations, “Your patient is bleeding to death until proven otherwise.” This concept served as the basis of the [poorly documented] “Golden Hour” and for decades has directed our efforts at getting patients to a center with an immediately available OR as quickly as possible.

article thumbnail

A Simplified Approach to Managing the Difficult Airway in Children

Don't Forget the Bubbles

A 5-year-old boy with a past medical history of Crouzon syndrome presents in the Pediatric ED. He is febrile and tachypnoeic, with low blood pressure and a capillary refill time of 4 seconds. His oxygen saturations are 86% in air, and he has a GCS of 8/15. His notes suggest that he was a difficult intubation in the neonatal intensive care unit. While you prepare the difficult airway cart, a young trainee asks about cannot intubate cannot oxygenate scenarios.

article thumbnail

Top Five Things I Wish I Had Known Before Starting My Intern Year

SheMD

To all the 4th year medical students out there CONGRATULATIONS! We know Match Day was not exactly how you pictured in this post-COVID19 world, but it is still a huge accomplishment and you should be so proud! While the world is a little different right now than we thought it would be, we know that you all are both excited and anxious to begin your residency.

OB/GYN 98
article thumbnail

Trick of Trade: Inflating the Esophageal Balloon of a Blakemore/Minnesota Tube without a Manometer 

ALiEM

A heavy alcohol drinker, who is well known to your Emergency Department, presents with altered mental status, except that he looks different this time. He looks really bad, stating that he has been vomiting blood. He is hypotensive. He then vomits a copious amount of blood right in front of you. You intubate the patient and initiate the massive transfusion protocol, but everything you pour into him seemingly comes right back out.

article thumbnail

A review of the utility of the ECG in Pediatric Syncope

PEMBlog

Syncope is described as a brief loss of consciousness and postural tone caused by transient global cerebral hypoperfusion. It is followed by a complete recovery. An estimated 80% of pediatric syncope is due to autonomic (vasovagal or neurocardiogenic) syncope. Our role as providers is to identify the patients who have a life-threatening etiology to their syncope.

article thumbnail

HR2023

Thinking Critical Care

Super excited for this. No issues with travel this year, the H&R family all keen on getting together again, the lineup is awesome, most of the OGs able to make it, lots of new additions, and the programme is looking really sweet. Am totally amped to have Katie Wiskar as the Chair of The Hospitalist as she’s putting together a great group with sharp lectures and super interesting workshops.

article thumbnail

BHP Corner – Out of Hospital Discharge: Pearls and Pitfalls

EM Ottawa

Welcome Back to BHP Corner For those who are new to this segment of the EMOttawa Blog, here’s a little refresher. In the Base Hospital Program (BHP) Corner, we aim to review interesting and evolving topics, as they pertain to the prehospital/paramedicine world. Advances, reviews, and changes to Ontario and local practices, you name […] The post BHP Corner – Out of Hospital Discharge: Pearls and Pitfalls appeared first on EMOttawa Blog.

article thumbnail

The basics of Long-Term Ventilation (LTV) in children

Don't Forget the Bubbles

You’ve just started working in the Children’s Emergency Department (CED). The triage nurse comes to let you know about Robin. He is eight years old, with a background of cerebral palsy and severe scoliosis. He has come in today because he has noisy breathing with rattly secretions that seem to be getting worse. The community physiotherapist (who has been visiting daily for the last 4 days) told Mum that Robin’s oxygen saturations were low.

article thumbnail

Letter to a Medical Student: There Is No Elite RCT Strike Force

Science Based Medicine

None of us have to fantasize what we would have done during a pandemic. What you actually did the past three years is exactly what you would have done. The post Letter to a Medical Student: There Is No Elite RCT Strike Force first appeared on Science-Based Medicine.

97
article thumbnail

Cell Culture Chamber Mimics Mechanical States of Disease

Medagadget

Researchers at the University of Göttingen in Germany have developed a cell culture chamber that lets them culture tissue samples, mimic the mechanical conditions that tissues experience in various disease states, and closely monitor tissue reactions. The technology could be particularly useful for pre-clinical drug testing, allowing researchers to test the effects of various drug candidates on tissues without the need to use experimental animals.

article thumbnail

Trick of Trade: Removal of Entrapped Metal Zipper

ALiEM

A young boy is brought to the pediatric emergency screaming at the top of his lungs by his parents. His penile skin is trapped in the zipper of his jeans. On a busy shift, you want a simple way to handle zipper injuries that minimizes pain, doesn’t require resource-intensive procedural sedation, and is quick. Background The 4 most common types of zippers are nylon coil zip, plastic mold zip, metal zip, and invisible zip.

article thumbnail

NICE Head Injury Guidelines 2023: Now who do we scan?

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed On Thursday 18th May the National Institute for Health and Care Excellence (NICE) released the updated head injury guidelines: assessment and early management [NG232] There have been three head injury … NICE Head Injury Guidelines 2023: Now who do we scan? Read More » The post NICE Head Injury Guidelines 2023: Now who do we scan?

article thumbnail

PulmCrit: “ARDS” is not a real thing

EMCrit

My dear pulmonologists, I have some bad news. Santa Claus isn't real. Neither is “ARDS.” “ARDS” has traditionally been conflated with a specific histopathological form of lung injury: diffuse alveolar damage (DAD). Lectures, chapters, and articles typically juxtapose these two entities, promoting the concept that they're one and the same.

92
article thumbnail

Incivility in Critical Care:  adding insult to the injuries

Don't Forget the Bubbles

You are working with your colleagues to assist an 8-year-old with multiple injuries following a high-impact traffic collision. You’re thinking about the next steps and voicing the options; you hear an impatient voice saying, “Are up for this? Should I do it?” from one of the team. What does incivility look like? Whilst not a new concept, incivility is still a widely reported concern within healthcare.

article thumbnail

Why Scientific Plausibility Matters

Science Based Medicine

Why plausibility must play a central role in scientific medicine. The post Why Scientific Plausibility Matters first appeared on Science-Based Medicine.

98
article thumbnail

Cancer Organoids Offer Insights into Treatment Outcomes

Medagadget

Researchers at the Hubrecht Institute in the Netherlands have developed a biobank of cancer organoids using tissue samples obtained from head and neck cancer patients. So far, the team used the biobank to validate tumor biomarkers. Excitingly, they also correlated patient treatment responses with organoid treatment responses, suggesting that the organoids provide a good proxy for testing new treatments and for designing a personalized treatment plan for individual patients.

article thumbnail

A Comparison of Prehospital Pediatric Analgesic Use of Ketamine and Opioids

EM Ottawa

Methodology: 3/5 Usefulness: 3/5 Frawley, John et al. “A Comparison of Prehospital Pediatric Analgesic Use of Ketamine and Opioids.” Prehospital emergency care, 1-5. 8 Mar. 2023, doi:10.1080/10903127.2023.2183295 Question and methods: This study sought to compare the pain reduction achieved and adverse event profile of ketamine vs opioids used for pediatric analgesia in the prehospital […] The post A Comparison of Prehospital Pediatric Analgesic Use of Ketamine and Opioids appeared first

article thumbnail

REBEL Cast Ep116: The CLOVERS Trial – Restrictive vs Liberal Fluids in Sepsis-Induced Hypotension

RebelEM

Background: IV fluids are part of the standard resuscitation bundle in septic shock, however it is unclear if they provide a significant benefit. These patients can have a vasodilated vascular bed and the initial use of fluids is hypothesized to serve two purposes: Augmenting the macrovascular system (stroke volume and cardiac output) and augmenting the microvascular perfusion (capillary blood flow).

Sepsis 86
article thumbnail

PDC Partners with Pulsara to Streamline Communication Between EMS, Hospital Personnel, and Emergency Management

PDC Healthcare

Patient tracking during large-scale events is a challenge. Patients may be passed between first responders, ground transport, air transport, and then transferred from one facility to another. For routine calls with individual patients, it’s feasible to track who transported the patient and where they ended up. But in mass-casualty incidents and large-scale hazards, chaotic scenes […] The post PDC Partners with Pulsara to Streamline Communication Between EMS, Hospital Personnel, and Emergen

article thumbnail

Learning about human factors in the emergency department

Don't Forget the Bubbles

In May 2022, Holly and Joe, two students on the joint QMUL and DFTB PEM MSc , created video presentations on human factors. We’ve incorporated some of our favourite elements from their presentations in this blog post. You’re in the paediatric emergency department, typing some notes for the child you’ve just discharged. You’re just about aware of the tannoy in the background.

article thumbnail

Evidence-based medicine vs. basic science in medical school

Science Based Medicine

Last week Dr. Vinay Prasad wrote a Substack arguing that medical students should learn the principles of evidence-based medicine before basic science.This is a recipe for amplifying the main flaw in EBM that science-based medicine was meant to correct, and Dr. Prasad's arguments would have been right at home on an integrative medicine blog. [Note ADDENDUM.

88
article thumbnail

Smart Sutures Sense Inflammation, Deliver Drugs, Cells

Medagadget

Researchers at MIT have developed smart sutures with a hydrogel coating that contains sensing and drug delivery components, and could even be used to implant therapeutic cells. The sutures are made using pig tissues that have been decellularized with detergents to reduce the possibility that they could provoke an immune reaction. The surrounding hydrogel layer contains microparticles that can release peptides when enzymes involved in inflammation are present, and other microparticles that allow

article thumbnail

Topical NSAIDs for Acute Pain Management

EM Ottawa

I was early in my PGY-1 year when I first witnessed an adverse effect from oral nonsteroidal anti-inflammatory drugs (NSAIDs). It was a busy morning with long patient wait times, and I picked up the chart of a 19-year-old female presenting with abdominal pain. She told me that she had severe abdominal pain overnight, and […] The post Topical NSAIDs for Acute Pain Management appeared first on EMOttawa Blog.

article thumbnail

Rosh Review EM Scholar Monthly Question

RebelEM

You are working in a rural ED, and an older woman from a local assisted care facility arrives via ambulance in obvious respiratory distress. EMS is able to tell you that she is currently being treated for pneumonia. The patient is on a nonrebreather mask, and vital signs on arrival are BP 110/50 mm Hg, HR 120 bpm, RR 40/min, T 98.6°F (37°C), and SpO2 86%.

EMS 84
article thumbnail

When do you use X-ray vs CT for pediatric head injuries?

Canadian EM

A 3-year-old boy is brought to the ED by his anxious parents following a head injury he sustained while playing in the playground. He was running when he tripped and bumped his head against the metal steps. As you observe him calmly playing on his tablet in the waiting room, his parents are inquiring about the necessity of skull x-rays. You consider the role of such imaging in investigating pediatric head injuries –.