Emergency Live
DECEMBER 5, 2023
The benefits and challenges in the digital age: the telemedicine revolution in emergency care Telemedicine is playing an increasingly significant role in emergency care, revolutionizing the way care is delivered. The ability to conduct remote medical consultations has opened up new opportunities for faster and more efficient response to medical emergencies.
The Trauma Pro
DECEMBER 5, 2023
Blunt cardiac injury can be an enigma. Significant injuries are uncommon, and the literature on it consists of case reports and small series. The group at Scripps La Jolla has an excellent review article on the topic that is currently in press. This post will relate some of the key points in this nicely prepared article. Use the correct nomenclature.
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Ken Grauer, MD
DECEMBER 23, 2023
The ECG in Figure-1 — was obtained from a patient with palpitations. The patient was hemodynamically stable in association with this rhythm. QUESTIONS: What is the rhythm in Figure-1 ? — How certain are you of your answer? — Why is QRS morphology changing ? Figure-1: The initial ECG in today's case. My Interpretation of the ECG in Figure-1: Since the patient is hemodynamically stable — there is time for systematic assessment of the rhythm.
Science Based Medicine
DECEMBER 11, 2023
A new study is making the rounds in the antivax crankosphere. The study found that the modified mRNA used in the Pfizer vaccine can cause a frame shift (to be explained) that results in the production of proteins besides the intended spike protein. The findings are, as you probably guessed, a big nothingburger compared to how they are being spun. The post Do mRNA vaccines produce harmful “junk proteins” that “gunk up” the cell and cause unintended “off-target” immune responses?
Sensible Medicine
DECEMBER 18, 2023
Good morning all. This Monday, I take a day off. For the study of the week, Vinay Prasad contrasts the different recommendations on the treatment of childhood obesity. The USPSTF or United States Preventive Services Task Force is an independent volunteer panel of experts in disease prevention and evidence-based medicine. They are as close to neutral judges of medical evidence as it gets.
EM Ottawa
DECEMBER 7, 2023
Aortic Stenosis is the most common valvular heart disease in Canada. In fact, after hypertension and coronary artery disease, it is the third most common cardiovascular condition. The prevalence of valvular heart disease increases sharply with age. Approximately 1 in 10 of your patients over the age of 75 has aortic stenosis. The most common […] The post The Way is Shut: Aortic Stenosis appeared first on EMOttawa Blog.
Don't Forget the Bubbles
DECEMBER 18, 2023
“Okay team, we’ve been following the APLS algorithm for 30 minutes and have considered all reversible causes. This child has been in cardiac arrest for at least an hour and none of the interventions we have carried out have made a difference. The blood gas is incompatible with life. I think we should stop resuscitation. Does anyone have any objections?
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Ken Grauer, MD
DECEMBER 29, 2023
QUESTION: HOW would YOU interpret the ECG in Figure-1 — if no clinical information was provided? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). = The H ISTORY in T oday's C ASE: The patient in today's case is a teenager who presented to the ED ( E mergency D epartment ) in cardiac arrest after electrocution.
Science Based Medicine
DECEMBER 4, 2023
On Thursday, Steve Kirsch gave his long-hyped talk about "record-level data" from New Zealand that supposedly demonstrates that COVID-19 vaccines have killed more than 10 million people worldwide. His "analysis" of illegally obtained data from a "whistleblower" was so ridden with false assumptions and rookie errors that even some antivaxxers couldn't accept it.
Sensible Medicine
DECEMBER 28, 2023
Vinay started with this: Professor Frank Harrell responded As has often been the case, hyperbole limits the value of some of your opinions Vinay. To say that the FDA is a rubber stamp is ludicrous. Sure there are shortcomings as with any organization but sponsors know they can't get approval without a heck of a lot of work. I don’t know. The laxity of the FDA has lately surprised me—especially for devices.
EMCrit
DECEMBER 10, 2023
Within the past year, two major societies have released guidelines on ARDS: the ATS (American Thoracic Society) and the ESICM (European Society of Intensive Care Medicine). Don’t be fooled by their names – both of these organizations are fundamentally international in scope. Some authors on the ATS document were from Europe, and similarly some authors […] EMCrit Project by Josh Farkas.
The Skeptics' Guide to EM
DECEMBER 2, 2023
Reference: Shaikh N, et al. Identifying children likely to benefit from antibiotics for acute sinusitis: a randomized clinical trial. JAMA July 2023 Date: October 17, 2023 Guest Skeptic: Dr. Alasdair Munro is a clinical research fellow specializing in pediatric infectious disease at the University of Southampton. He is currently involved with clinical trials of vaccines […] The post SGEM#422: And It was all Yellow-Nasal Discharge and Antibiotics in Pediatric Sinusitis first appeared on The Skep
The Trauma Pro
DECEMBER 29, 2023
The 37th Annual Assembly of the Eastern Association for the Surgery of Trauma is just around the corner! And, as in previous years, I will be publishing regular posts on some of the abstracts I find the most interesting. Here are some of the topics I’ve selected: MAP and spinal cord injury VTE in pediatric patients Chest irrigation and retained hemothorax Accuracy of eFAST More on the 35mm rule for pneumothorax Pan-scanning and missed injuries King Airway vs i-Gel Airway Whole blood transf
Ken Grauer, MD
DECEMBER 1, 2023
== CLICK HERE — for a V ideo presentation of this case! ( 19:40 min. ) Below are slides used in my video presentation. For full discussion of this case — See ECG Blog #351 — == The ECG in Figure-1 — was obtained from a previously healthy older man who contacted EMS ( E mergency M edical S ervices ) because of "chest tightness" that began ~1 hour earlier.
Science Based Medicine
DECEMBER 18, 2023
On Friday, CNN host Kasie Hunt interviewed antivax presidential candidate Robert F. Kennedy, Jr. Although she did better than most journalists confronting him for his past antivax statements in that she played a clip of one of his antivax statements, she clearly hadn't anticipated his response, which should have been very predictable given that he's been using it for at least 15 years.
PEMBlog
DECEMBER 7, 2023
The Case A middle-school aged boy presents with a slightly pruritic rash that started along the side of his chest, but then soon spread to encompass several dozen similar lesions across his torso, especially his back. he has had no other symptoms, including fever or upper respiratory complaints. There are no new food, personal care product, or animal exposures.
ECG Guru
DECEMBER 18, 2023
If a wide complex tachycardia occurs, the probability is very high that it is a ventricular tachycardia (approx. 80%, in patients with a previous myocardial infarction (.) approx. 90%). Here we see a broad complex tachycardia that looks like an RBBB + LAFB, which is regular. In this constellation, 3 causes must be considered: 1. fascicular tachycardia from the left posterior fascicle of the left tawara fascicle (QRS width usually only around 130 ms, but sometimes significantly longer). 2.
Life in the Fast Lane
DECEMBER 18, 2023
Neil Long Button Battery Update 3.0 Want to know the latest on button battery management, prevention and immediate care? Look no further than our latest tox offering.
The Trauma Pro
DECEMBER 19, 2023
In my last post, I discussed the growing number of choices for plasma replacement. Today I’ll look at some work that was done that tried to determine if any one of them is better than the others when used for the massive transfusion protocol (MTP). As noted last time, fresh frozen plasma (frozen within 8 hours, FFP) and frozen plasma (frozen within 24 hours, FP) have a shelf life of 5 days once thawed.
Ken Grauer, MD
DECEMBER 8, 2023
== CLICK HERE — for a V ideo presentation of this case! (22:3 0 min. ) Below are slides used in my video presentation. For full discussion of this case — See ECG Blog #292 — == The 2 ECGs shown in Figure-1 were obtained from a man in his 30s — who presented to the ED ( E mergency D epartment ) with chest pain that began several hours earlier. ECG #2 was recorded 1 hour after ECG #1.
Science Based Medicine
DECEMBER 7, 2023
Is it possible to refute an infinite amount of AI-generated health misinformation? The post Misinformation is pervasive, and AI will turbocharge it first appeared on Science-Based Medicine.
Sensible Medicine
DECEMBER 30, 2023
I started it all by claiming on Twitter that the FDA was a rubber stamp. From boosters for 6 month old babies (no data), to postpartum depression drugs that are basically Xanax , to bad cancer drug approvals, in my mind, the FDA is failing the American people. In a recent post, John Mandrola reviewed 5 cardiology devices approved by the FDA with questionable data.
The Skeptics' Guide to EM
DECEMBER 16, 2023
Reference: Punches et al. Patient Perceptions of Microaggressions and Discrimination Towards Patients During Emergency Department Care. AEM Dec 2023 Date: December 14, 2023 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and assistant Professor at the University of Calgary. He is also an avid FOAM supporter/producer through various online outlets including TheSGEM.
Life in the Fast Lane
DECEMBER 14, 2023
Sheralyn Guilleminot and Mike Cadogan AI Prompting Techniques 4 AI Prompting Techniques to Help You Stay Ahead in Medicine. AI prompting techniques are the key to using artificial intelligence efficiently and getting usable output.
The Trauma Pro
DECEMBER 15, 2023
I’ll spend the next two posts discussing plasma. This is an important component of any trauma center’s massive transfusion protocol (MTP). Coagulopathy is the enemy of any seriously injured patient, and this product is used to attempt to fix that problem. And now there are two flavors available: liquid plasma and fresh frozen plasma. But there is often confusion when discussing these products, especially when there are really three flavors!
Ken Grauer, MD
DECEMBER 15, 2023
== CLICK HERE — for a V ideo presentation of this case! ( 18:00 min. ) Below are slides used in my video presentation. For full discussion of this case — See ECG Blog #392 — == The ECG in Figure-1 was obtained from a man in his 60s — who described the sudden onset of "chest tightness" that began 20 minutes earlier, but who now ( at the time this ECG was recorded ) — was no longer having symptoms.
Science Based Medicine
DECEMBER 29, 2023
As the adage says: "A man is judged by the company he keeps." The post Doctors Shouldn’t Legitimize Pro-Tobacco, Child-Labor Advocates first appeared on Science-Based Medicine.
Broome Docs
DECEMBER 9, 2023
Welcome to another episode of the Emergency Medicine Journal Club with Dr Justin Morgenstern. This month we cover a bunch of papers that look at a lot of topics and try to answer questions such as: Can I push Keppra safely? Does BP management in haemorrhagic stroke matter? How good is my intuition about PE diagnosis? Is it a good idea to keep geriatric patients in the ED overnight?
Dr. Smith's ECG Blog
DECEMBER 24, 2023
Written by Pendell Meyers A woman in her 20s with connective tissue disorder and history of aortic root and valve repair presented with palpitations. Here is her triage ECG: What do you think? Atrial flutter with 2:1 conduction. The atrial flutter rate is approximately 200 bpm, with 2:1 AV conduction resulting in ventricular rate almost exactly 100 bpm.
Sensible Medicine
DECEMBER 21, 2023
Over the last week, a debate has simmered between the pages of my Substack , Sensible Medicine, and the Sensible Medicine podcast, which you can watch here. Sensible Medicine Mandrola and Prasad are back Listen now 4 days ago · 60 likes · 18 comments · Vinay Prasad and John Mandrola Briefly put the argument is: Yes, of course, medicine would benefit from more large, well done randomized studies, and better epidemiologic evidence, but this is expensive, costly, requires coordinatio
Emergency Live
DECEMBER 12, 2023
The crucial role of women in emergency response and post-crisis reconstruction The Rise of Women in Civil Protection Roles In recent years, there has been a significant increase in female presence in civil protection roles globally. This shift reflects a growing recognition of the value that women bring to these crucial roles, not just as […] The post Women in Civil Protection: Agents of Change and Resilience appeared first on Emergency Live.
St. Emlyn
DECEMBER 30, 2023
St.Emlyn's - Emergency Medicine #FOAMed We generally try and review studies that are close to use in practice. but occasionally we spot something that is just interesting and which might give us a clue as … JC: Selective aortic arch perfusion. St Emlyn’s Read More » The post JC: Selective aortic arch perfusion. St Emlyn’s appeared first on St.Emlyn's.
Science Based Medicine
DECEMBER 1, 2023
"I used to think medicine could be separated from politics. Gosh. That was super dumb." The post Medical Conservatives: Mixing Politics and Medicine is a Bad Idea, If I Disagree with Your Politics first appeared on Science-Based Medicine.
The Skeptics' Guide to EM
DECEMBER 30, 2023
Reference: Roussel et al. Overnight stay in the emergency department and mortality in older patients, JAMA Intern Med 2023 Date: December 18, 2023 Guest Skeptic: Dr. Chris Carpenter, Vice Chair of Emergency Medicine at Mayo Clinic. Case: An 85-year-old patient (Ms. McG) presents to your emergency department (ED) after being found by family on the […] The post SGEM#424: Ooh-Ooh, I Can’t Wait – To Be Admitted to Hospital first appeared on The Skeptics Guide to Emergency Medicine.
Dr. Smith's ECG Blog
DECEMBER 11, 2023
Occlusion myocardial infarction is a clinical diagnosis Written by Willy Frick (@Willyhfrick). Willy is a cardiology fellow with a keen interest in the ECG in OMI. A woman in her late 70s presented with left arm pain. The arm pain started the day prior when she was at the dentist's office for a root canal. Her systolic blood pressure at the dentist was over 200 mm Hg.
Sensible Medicine
DECEMBER 8, 2023
My father was an avid reader of obituaries. Once, when I was a teenager, I told him that his habit of reading them every morning with his cappuccino was weird. At the time, I considered anything I didn’t understand weird, and the word “morbid” wasn’t part of my lexicon. My father, never one to take the bait from his occasionally irksome son, explained that reading obituaries was an excellent way to learn recent history.
ECG Guru
DECEMBER 23, 2023
The Patient: A 60-year-old man at work. He experienced a sudden onset of substernal chest pain, nausea & vomiting, and dizziness. He states the pain is a 5 on 1-10 scale. No cardiac history or current medications. The ECGs: The first ECG , taken at 12:30:05, shows a sinus rhythm with ventricular bigeminy. In some leads, you can see the sinus P waves hidden in the beginnings of the PVCs, so we know the underlying sinus rhythm is about 82 bpm.
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