June, 2024

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ECG Blog #435 — Did Cath Show Acute Ischemia?

Ken Grauer, MD

The ECG in Figure-1 — was obtained from a middle-aged woman with positional tachycardia and diaphoresis with change of position from suprine to sitting. Although CP ( C hest P ain ) was not a prominent symptom — ACS ( A cute C oronary S yndrome ) was suspected from the chest lead T wave inversion seen on this ECG. QUESTIONS: How would YOU interpret the ECG in Figure-1 ?

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The VIP Syndrome In Healthcare (Very Important Person)

The Trauma Pro

The VIP syndrome occurs in healthcare when a celebrity or other well-connected “important” person receives a level of care that the average person does not. This situation was first documented in a paper published in the 1960s, which noted that VIP patients have worse outcomes. Who is a VIP? It may be a celebrity. A family member. Or even a colleague.

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Trending Sources

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Topical Therapies for Pediatric Burns

Pediatric EM Morsels

The management of pediatric thermal burns always seems to be a hot topic , whether we are caring for a little future chef who splashed a scalding microwaved noodle cup on himself, or a toddling youngster who pulled a pot of boiling water on herself. Or maybe you have the adventurous adolescent who was a little too aggressive with the lighter fluid before igniting the campfire.

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I’ve Been Silenced, Censored, and Cancelled. The Reason Why Matters.

Science Based Medicine

When conference organizers told me not to make my talk "political", they were really saying there were certain people and ideas I wasn't allowed to criticize. I didn't get it at the time. I get it now. The post I’ve Been Silenced, Censored, and Cancelled. The Reason Why Matters. first appeared on Science-Based Medicine.

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Anthony Fauci failed during the coronavirus response

Sensible Medicine

The first two weeks of March 2020 were jolting. Governments read the Imperial College London report (modeling a million deaths in the US), watched horrifying scenes in Bergamo (a city with median age in the 80s fyi), and collectively embraced policies that had no precedent in human history: The global closing of borders, schools, business, and the use of the police state to enforce this lockdown.

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Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

Dr. Smith's ECG Blog

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. What do you think? If this EKG were handed to you to screen from triage without any clinical information, what would you think?

EKG/ECG 136
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ECG Blog #436 — Bigeminy or Alternans?

Ken Grauer, MD

The ECG in Figure-1 — was obtained from an older man with known coronary disease. He was on a number of medications — including antiplatelet agents, a statin drug and Digoxin. The patient presented to the ED ( E mergency D epartment ) for an episode of syncope. He developed cardiac arrest shortly after the ECG in Figure-1 was recorded. QUESTIONS: How would YOU interpret the ECG in Figure-1 ?

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Acute Transverse Myelitis in Children

Pediatric EM Morsels

Ooooo the infamous chief complaint of “ weakness ” ……. We just love those don’t we? Although neurological complaints may not be a crowd’s favorite, it is one we must become comfortable with. Timely recognition and treatment can be life-improving and life-saving! So, with that goal in mind, let us digest another delicious morsel on weakness – Acute Transverse Myelitis in Children : Acute Transverse Myelitis in Children: Basics Rare, non-compressive, inflammatory condition of the spinal cord

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Why is The New York Times now promoting an anti-science agenda?

Science Based Medicine

This essay stems from concerns about two editorials published in The New York Times recently. We felt that they were problematic in that the past is viewed through a blurred prism to produce revisionist history. The post Why is The New York Times now promoting an anti-science agenda? first appeared on Science-Based Medicine.

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SGEM#442: I’m on the Right Track Baby I Was Born This Way

The Skeptics' Guide to EM

Reference: Kruse et al. Systematic Review, Quality Assessment, and Synthesis of Guidelines for Emergency Department Care of Transgender and Gender-diverse People Recommendations for Immediate Action to Improve Care. WJEM December 2023 Date: May 30, 2024 Guest Skeptic: Dr. Kay Dingwell is a rural emergency physician working in Prince County, PEI with a special interest in gender-affirming care and improving the care of trans and gender-diverse patients.

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How medical school fails students

Sensible Medicine

In prior posts, I was critical of the culture among trainees. One essay described the phenomenon of calling in fake sick. Another asked what the balance is between accommodation and the rigors of the job. These essays were about the effort, dedication and professionalism of trainees. Sensible Medicine is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.

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ECG Blog #434 — WHY Did this Patient Arrest?

Ken Grauer, MD

The ECG in Figure-1 — was obtained from a middle-aged man who presented to the ED ( E mergency D epartment ) in cardiac arrest. ROSC ( R eturn O f S pontaneous C irculation ) was obtained — and ECG #1 was recorded. In view of this history — How would YOU interpret the ECG in Figure-1 ? Should you activate the cath lab? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ).

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Prehospital: What’s The Best Chest Seal For Sucking Chest Wounds?

The Trauma Pro

The treatment of a “sucking chest wound” in the field has typically been with application of some type of occlusive dressing. Many times, a generic adhesive dressing is applied, typically the same kind used to cover IV sites. This is quick, easy, cheap, and readily available in the ambulance. But there is a danger that this could result in development of tension pneumothorax, because the dressing not only keeps air from getting in but also keeps any buildup of pneumothorax from getti

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The pediatric can’t intubate can’t oxygenate scenario (Use a knife)

First 10 EM

A can’t intubate can’t oxygenate scenario will always be scary, but after years of mental rehearsal and some real world experience, the idea of surgical front of neck access in an adult doesn’t bother me much. (I think that is an important mental space for emergency physicians to find if you want to be able […] The post The pediatric can’t intubate can’t oxygenate scenario (Use a knife) appeared first on First10EM.

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“Fauci Files” and Florida’s Grand Jury Investigations Fail to Deliver

Science Based Medicine

Although multiple antivaccine investigations have failed to deliver any substantive evidence of alleged crimes, the latest antivax flops won't flip anyone. The post “Fauci Files” and Florida’s Grand Jury Investigations Fail to Deliver first appeared on Science-Based Medicine.

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PulmCrit: Bilevel Sequence Intubation (BSI) – The new standard

EMCrit

introduction Bilevel Sequence Intubation (BSI) refers to initiation of noninvasive bilevel positive pressure ventilation with a backup rate prior to intubation (either using a BiPAP machine or a full-featured mechanical ventilator). BSI is distinct from traditional rapid sequence intubation (RSI), since BSI involves the delivery of machine-initiated, pressure-controlled breaths following administration of sedation and paralytics. […] EMCrit Project by Josh Farkas.

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Should women in their 40’s be screened for breast cancer?

Sensible Medicine

I met Dr. Karsten Juhl Jørgensen at Forward’s innovative “4words24” conference in April. I was struck by Karsten’s deep knowledge of the medical literature, critical appraisal skills, and thoughtful approach to decision making. Here is a brief video of him summarizing the talk he gave at the conference. He reached out after the USPSTF published the new breast cancer guidelines.

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ECG #433 — Which Lead Convinced Me?

Ken Grauer, MD

The ECG in Figure-1 was obtained from a previously healthy older man — who presented to the ED ( E mergency D epartment ) with new but atypical CP ( C hest P ain ) for several hours. QUESTIONS: Given this history — How would YOU interpret this ECG? Which lead is the most concerning? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ).

EKG/ECG 352
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Updated: How To Detect Bucket Handle Injuries With CT

The Trauma Pro

A bucket-handle injury is a relatively uncommon complication of blunt trauma to the abdomen. It only occurs in a few percent of patients, but is much more likely if they have a seat belt sign. The basic pathology is that the bowel mesentery (small bowel of sigmoid colon) gets pulled away from the intestinal wall. This injury is problematic because it may take a few days for the bowel itself to die and perforate.

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BiPAP for preoxygenation (the PREOXI trial)

First 10 EM

Preparation for intubation, appropriate preoxygenation, and preventing peri-intubation arrests has been one of my core topics for conference talks. My initial airway series emphasized “optimizing the basics” and carefully considering “is this patient ready for intubation?”. My “RSI and then they die” lecture is by far my most watched video on YouTube.

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“This Thing Has Killed Less Than Or About As Many As Flu Would Kill In A Normal Year In Kids, I Say Hardly Any” & “80-Year-Olds, Their Time To Death In General Is Not That Long.”

Science Based Medicine

If were are supposed to be indifferent to the deaths of young people because "hardly any" died, and we are supposed to be indifferent to the deaths of older people because "their time to death in general is not that long," which of the 1.1 million COVID deaths should we care about? The post “This Thing Has Killed Less Than Or About As Many As Flu Would Kill In A Normal Year In Kids, I Say Hardly Any” & “80-Year-Olds, Their Time To Death In General Is Not That Long.” first appeared on Science

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From Collision to Clarity: PECARN cervical spine injury prediction rule for injured children

ALiEM

For years, adult literature has provided clear guidelines for cervical spine imaging through the NEXUS and Canadian C-spine Rule (CCR) tools. These have been invaluable in helping clinicians decide when to image the neck in trauma patients. Similarly, the Pediatric Emergency Care Applied Research Network (PECARN) has developed robust tools for assessing blunt head trauma in children.

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EMCrit 377 – Breaking News – The PREOXI Trial changes everything about Preoxygenation for Intubations in the Critically Ill

EMCrit

the PREOXI trial validates what I have been saying for 15 years about preoxygenation for the critically ill patient EMCrit Project by Scott Weingart, MD FCCM.

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Cervical Spine Imaging in Kids – the PECARN rule

Don't Forget the Bubbles

Why is this study needed? Cervical spine injuries are a rare but serious finding following blunt trauma, affecting around 1-2% of presentations. In adult trauma cases, there has been significant research to help decide which patients require X-ray or CT imaging for possible cervical spine injuries, leading to the development of the National Emergency X-Ray (NEXUS) prediction rule and the Canadian C-Spine Rule (CCR).

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Ten Tips for Better Presentations – Part 1

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed Presentation skills - what are they and why do we need to have them? This post covers the things to consider before you even open any presentation software. The post Ten Tips for Better Presentations – Part 1 appeared first on St.Emlyn's.

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The ETM Course Podcast is back! The Trauma Physician with Chris Bowles

ETM Course

We are excited to announce that after a hibernation period, the ETM Course podcast is back! In our first episode of the new podcast we talk to Dr Christine Bowles, Emergency Physician and Trauma Physician at St George Hospital, one of Sydney’s Major Trauma Centres. Also available on Apple Spotify YouTube iHeart Podchaser PlayerFM In this episode we talk in detail about the evolution of the “Trauma Physician” role and Emergency Physicians working on inpatient trauma services, th

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How antivaxxers weaponize vaccine safety studies to falsely portray vaccines as dangerous, part 2: The children

Science Based Medicine

A few months ago, I wrote about how antivaxxers misrepresent vaccine safety studies to portray vaccines as dangerous, using a large study of outcomes in adults as an example. They're doing it again, but this time it's a large study of COVID-19 vaccines in children. The post How antivaxxers weaponize vaccine safety studies to falsely portray vaccines as dangerous, part 2: The children first appeared on Science-Based Medicine.

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The Andexxa Showpiece

EM Literature of Note

Every so often a masterclass performance arises in the medical literature. A performance transcending the boundaries of what was once thought possible. A shining exemplar of human achievement. This is a trial, published in the New England Journal of Medicine , with the following features: Conducted by an institute sponsored by pharma. Designed by the first author, a consultant for pharma, and two employees of pharma.

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A woman in her 50s with multiple episodes of syncope

Dr. Smith's ECG Blog

By Sofiya Diurba MD, reviewed by Meyers, Grauer A woman in her 50s with PMH known RBBB and prior syncopal events presents to the ED for five syncopal events over the last 24 hours. Each event is associated with a prodrome of mild substernal CP, SOB, and “brain fog.” EMS reports intermittent sinus tachycardia and bradycardia secondary to some type of heart block during transport.

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Spinal Immobilization: a Twisted Tale

EM Ottawa

For decades, “spinal immobilization”, or spinal motion restriction (SMR) using backboards and cervical collars has been a “cornerstone of EMS protocols, aimed at minimizing secondary spinal cord injuries during trauma patient management. Originating in the 1960s, this practice was propelled by anecdotal evidence and early case reports suggesting that un-immobilized cervical spine injuries could worsen […] The post Spinal Immobilization: a Twisted Tale appeared first on EM

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A Discussion with Professor Venk Murthy on Coronary Artery Disease

Sensible Medicine

When I type the words coronary artery disease I bet that you picture angiograms with stenotic lesions— blockages in colloquial language. Indeed a high grade plaque from atherosclerosis in the inside of a coronary artery can limit flow to the heart muscle. But. But. Not as much as you think. You know why? Because there is something called the coronary microcirculation.

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EMCrit Wee – Controlled Automated Reperfusion of the Whole Body (CARL) ECPR / ECLS Yields Amazing Results

EMCrit

Today, we talk about a paper that showed impressive neurologically intact survival for all-rhythms presenting in cardiac arrest, both OHCA and IHCA. It uses a new set of strategies and technologies called CARL. The Paper Treatment of Refractory Cardiac Arrest by Controlled Reperfusion of the Whole Body: A Multicenter, Prospective Observational Study Supplemental Material […] EMCrit Project by Scott Weingart, MD FCCM.

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The Lab Leak Theory and the Complicit Media

Science Based Medicine

How the media's need for tales of intrigue and villains fosters the political weaponization of uncertainty The post The Lab Leak Theory and the Complicit Media first appeared on Science-Based Medicine.

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ECG Cases 50 – STEMI: A Failed Paradigm, Enter Occlusion MI

Emergency Medicine Cases

Dr. Jesse McLaren illustrates the paradigm shift from STEMI to Occlusion MI (OMI) through 9 cases, and drives home the points that if there is STEMI criteria, consider false positives (eg. secondary and proportional to LVH or BER); if there is no STEMI criteria, consider false negatives and look for other signs of occlusion (eg. acute Q waves or loss of R waves, hyperacute T waves, or reciprocal STD/TWI) and if the ECG is nondiagnostic, consider other OMI signs including clinical (refractory isc

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SGEM#443: Don’t Stop Me Now – REBOA for Hemorrhage Control in Trauma Patients?

The Skeptics' Guide to EM

Reference: Jansen et al. Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial. JAMA. 2023 Date: June 10, 2024 Guest Skeptic: Dr. Rob Leeper is an intensivist, trauma surgeon, and general surgeon at Western University where he also serves as the director of the Royal College Surgical Foundations program.

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VF arrest at home, no memory of chest pain. Angiography non-diagnostic. Does this patient need an ICD? You need all the ECGs to know for sure.

Dr. Smith's ECG Blog

Written by Willy Frick A man in his 50s was at home with his family when they heard a thud and rushed into the room to find him unconscious with agonal respirations. His daughter immediately started CPR and another family member called EMS. When EMS arrived the patient was in ventricular fibrillation. They shocked him twice before return of spontaneous circulation.

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Regard for Power: Part 2

Sensible Medicine

A few weeks ago, I wrote a “ Friday Reflection ” inspired by the quotation: “Regard for power implies disregard for those without power…” The line came from Robert Caro’s 1974 epic biography, The Power Broker: Robert Moses and the Fall of New York. I got carried away and offered up the quote to our readers as a prompt for an essay.

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