December, 2023

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Telemedicine in emergency care

Emergency Live

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.

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What You Need To Know About Blunt Cardiac Injury

The Trauma Pro

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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ECG Blog #409 — Every-Other-Beat.

Ken Grauer, MD

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.

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Do mRNA vaccines produce harmful “junk proteins” that “gunk up” the cell and cause unintended “off-target” immune responses?

Science Based Medicine

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?

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For obese kids, the USPSTF recommends diet and exercise; the American Academy of Pediatrics recommends surgery and ozempic

Sensible Medicine

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.

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The Way is Shut: Aortic Stenosis

EM Ottawa

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.

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Use Of Radio-opaque Markers In Penetrating Trauma

The Trauma Pro

As I was browsing through my journal list this week, I ran into an interesting title for an article that is currently in press. “The use of radio-opaque markers is medical dogma” Catchy, especially since I love writing about dogma vs what is really supported by the literature. The author questions the justification of this practice and posits that there are risks to extrapolating information based on radiographs with markers placed by the trauma team.

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ECG Blog #410 — How Tall are the T Waves?

Ken Grauer, MD

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.

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Steve Kirsch’s “mother of all revelations” about the “deadliness” of COVID-19 vaccines goes poof

Science Based Medicine

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.

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PulmCrit: New ARDS guidelines reveal a shambolic state of affairs

EMCrit

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.

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Is the FDA too lax?

Sensible Medicine

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.

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AFL WITH 2:1 CONDUCTION IN A PATIENT WITH PREEXISTING RBBB + LAFB

ECG Guru

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.

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Coming Soon! The Best Of EAST 2024

The Trauma Pro

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

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ECG Blog #406 — To Do Additional Leads?

Ken Grauer, MD

== 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.

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RFK Jr. and his “I’m not anti-vaccine” rejoinder to being confronted with his past antivax statements: A primer

Science Based Medicine

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.

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Briefs: Heralding the rosy pits

PEMBlog

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.

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A young woman with palpitations. What med is she on? With what medication is she non-compliant? What management?

Dr. Smith's ECG Blog

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.

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Button Battery Update 3.0

Life in the Fast Lane

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.

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Liquid Plasma vs FFP: Impact On Your Massive Transfusion Protocol

The Trauma Pro

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.

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ECG Video Blog #407 (292): Why the Patient Died?

Ken Grauer, MD

== 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.

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Misinformation is pervasive, and AI will turbocharge it

Science Based Medicine

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.

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First10EM Journal Club: December 2023

Broome Docs

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?

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Occlusion myocardial infarction is a clinical diagnosis

Dr. Smith's ECG Blog

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.

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AI Prompting Techniques

Life in the Fast Lane

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.

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Liquid Plasma vs FFP: Definitions

The Trauma Pro

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!

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ECG Video Blog #408 (392) — 20 Minutes Later.

Ken Grauer, MD

== 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.

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Doctors Shouldn’t Legitimize Pro-Tobacco, Child-Labor Advocates

Science Based Medicine

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.

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Is the FDA too lax: Part 2

Sensible Medicine

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.

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Women in Civil Protection: Agents of Change and Resilience

Emergency Live

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.

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Concerning EKG with a Non-obstructive angiogram. What happened?

Dr. Smith's ECG Blog

This is written by Willy Frick, an amazing cardiology fellow in St. Louis. [link] A 62 year old man with a history of hypertension, type 2 diabetes mellitus, and carotid artery stenosis called 911 at 9:30 in the morning with complaint of chest pain. He described it as "10/10" intensity, radiating across his chest from right to left. EMS obtained the following vital signs: pulse 50, respiratory rate 16, blood pressure 96/49.

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ECG Pointers: STEMI Equivalents from the American College of Cardiology

EMDocs

Authors: Genevieve Pentecost, MD (@genpentecost, Emergency Medicine Resident, Washington University School of Medicine in St Louis) and Aaron Lacy, MD (@AaronLacyMD, Assistant Professor of Emergency Medicine, Washington University School of Medicine in St Louis) // Reviewed by: Jamie Santistevan, MD (EM Physician, Presbyterian Hospital, Albuquerque, NM); Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Introduction Welcome back to ECG Pointers from emDOCS.

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