March, 2024

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ECG Blog #419 — The Cause of ECG #1?

Ken Grauer, MD

I was sent the 2 ECGs shown in Figure-1 — which were recorded from an elderly man whose heart beat "has been irregular for years". No clear history for recent chest pain — but the patient "has not been well" for the previous week. Regarding the 2 ECGs in Figure-1 : ECG #1 is the initial tracing obtained at the scene by the EMS ( E mergency M edical S ystems ) team — in association with an alert but markedly hypotensive patient.

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Giving TXA Via An Intraosseous Line?

The Trauma Pro

Seriously injured patients frequently develop coagulopathy, which makes resuscitation (and survival) more challenging. A few years ago, the CRASH-2 study lent support for using tranexamic acid (TXA) in select trauma patients to improve survival. This drug is cheap and has antifibrinolytic properties that may be beneficial if given for life-threatening bleeding within 3 hours of initial injury.

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Rebaked: Inborn Errors of Metabolism presenting in the ED

Pediatric EM Morsels

Often our job requires us to consider the presence of needles of significant illness in the haystack of nonspecific symptoms. With the help of our favorite geneticist , Dr. Liz Baker, we will dive into the haystack headfirst and find those needles. Hopefully, without getting poked. Let’s consider Inborn Errors of Metabolism Presenting in the ED : Inborn Errors of Metabolism: Basics Common Presentations, Uncommon Kiddos For the child with lethargy, vomiting, acidosis, hypoglycemia , organom

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A (different) perspective on statins in the primary prevention of heart disease

Sensible Medicine

Dear Readers, I publish the following opinion piece regarding the use of statin drugs in low-risk individuals without heart disease even though I disagree with most of the authors’ arguments. Since this is a rebuttal to an editorial I wrote, it would be helpful to first read the linked article in the lead sentence. I do like the authors’ conclusions.

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COVID-19 Vaccination Significantly Reduces Risk of Severe Inflammatory Syndrome in Kids

Science Based Medicine

A new analysis of 2023 MIS-C cases reveals that the COVID-19 vaccine significantly reduces the risk of this dreaded complication. The post COVID-19 Vaccination Significantly Reduces Risk of Severe Inflammatory Syndrome in Kids first appeared on Science-Based Medicine.

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Posterior Circulation Strokes

EM Ottawa

Posterior circulation ischemia accounts for approximately 20-25% of all ischemic strokes and is a significant cause of patient disability. The diagnosis can be extremely challenging as findings are often not typically focal. Posterior strokes are misdiagnosed more than 3x more often than anterior circulation strokes.1 Similar to anterior circulation strokes, posterior strokes are most commonly […] The post Posterior Circulation Strokes appeared first on EMOttawa Blog.

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Our JAMA Paper on Industry Payments and Sowell's Conflict of Visions

Stop and Think

My career in cardiology can be separated into two decade-long blocks. The first decade I practiced like most other cardiologists. I went with the flow, followed the guidelines. I went to few meetings, read few studies and as a result had little (mental) tension. Then I started writing about medical evidence. This required studying the evidence. Over time, I learned the skill of critical appraisal.

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More Trending

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Gelastic Seizures: No Laughing Matter

Pediatric EM Morsels

We encounter seizures commonly in the Emergency Department. While they can be dramatic and devastating, we have learned to become comfortable with the wide variety that may present in children. From the simple febrile seizure to the complex seizure, we know how to stabilize and how to evaluate. While fortunately most seizure activity is short lived, we also know that status epilepticus can be difficult to manage, and persistent seizures should make us consider specific etiologies (ex.

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Martin Kulldorff was wrongly fired from Harvard Medical School

Sensible Medicine

Martin Kulldorff was a professor at Harvard Medical School who argued during the pandemic that school closure was misguided policy, lockdowns were inappropriate and draconian, vaccine mandates were unjust, natural immunity conferred protection against subsequent severe disease, kids did not need to be vaccinated, and that two year old children should not wear cloth masks in daycare.

Academics 145
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ECPR evidence – a historical journey

Intensive Blog

Everything ECMO 048: History of ECPR evidence and considerations for future research Author: Dr George Walker Peer reviewer: A/Prof Aidan Burrell Introduction The first recorded attempts to resuscitate patients were as early as 1530 where Swiss physician Paracelsus used fireplace bellows to reinflate the lungs of those who had stopped breathing. Several more centuries passed before techniques more akin to modern day cardio-pulmonary resuscitation were reported.

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Doctors Who Performatively Fetishized RCTs Aren’t Out to Advance Medical Research, But Rather to Sow Doubt & Mistrust

Science Based Medicine

Actually running an RCT is a lot harder than merely calling for one. Those who recognized this obvious fact are not against RCTs. The post Doctors Who Performatively Fetishized RCTs Aren’t Out to Advance Medical Research, But Rather to Sow Doubt & Mistrust first appeared on Science-Based Medicine.

Research 130
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Overdiagnosis: Would we better better off not looking?

First 10 EM

There is little doubt that the use of testing has increased dramatically in emergency medicine during my career. Between 2001 and 2010 the use of CT in emergency departments increased 3-fold (and the use of MRI increased 9-fold, but for some reason it is still almost impossible for me to get one done.) (Carpenter 2015) […] The post Overdiagnosis: Would we better better off not looking?

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ChatGPT And Your Research Paper

The Trauma Pro

Generative artificial intelligence (AI) is the newest shiny toy. The best-known example, ChatGPT, burst onto the scene in November 2022 and caught most of us off guard. The earliest versions were interesting and showed great promise for a variety of applications. The easiest way to think about this technology is to compare it to the auto-complete feature in your search engine.

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Lung Abscess in Children

Pediatric EM Morsels

We have digested many Morsels regarding various pulmonary complaints. While some are very rare (ex, Pulmonary Embolism , Pulmonary Hypertensive Crisis , Negative Pressure Pulmonary Edema , CPAM ) others are commonly encountered (ex, Croup , Bronchiolitis , Sinusitis ). It is pneumonia , however, that often generates the most conversations. When should I consider a CXR ?

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A broken study of time-restricted eating exposes broken thinking amongst Top People

Sensible Medicine

You may have heard the ruckus about the study showing that intermittent fasting was associated with a 91% higher rate of dying of heart disease. I call it a ruckus because after the AHA sent out a press release about the study, two things happened: The mainstream health press covered it as they do (breathlessly) for any clickable story. The Top People of cardiology and health went ballistic in their criticism of the paper.

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PulmCrit Wee: Propofol induced eyelid opening apraxia – the struggle is real

EMCrit

Eyelid opening apraxia refers to a specific inability to open the eyelids. This may result from non-dominant hemispheric strokes. On superficial examination it will mimic unconsciousness, but upon further examination the patient is awake and able to respond to stimuli with their extremities. I've seen a similar phenomena of eyelid opening apraxia a few times […] EMCrit Project by Josh Farkas.

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Dr. Jay Bhattacharya, April 2021: “The Central Problem Right Now I Think Is The Fear That People Still Feel About COVID.”

Science Based Medicine

Doctors portrayed those who tried to avoid the virus as pathetic, disordered weaklings, afflicted by irrational panic, fear, and anxiety. It only makes sense if you remember one thing, they wanted you infected. The post Dr. Jay Bhattacharya, April 2021: “The Central Problem Right Now I Think Is The Fear That People Still Feel About COVID.” first appeared on Science-Based Medicine.

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SAEM Clinical Images Series: Purple Finger

ALiEM

A 30-year-old female with a past medical history of Crohn’s Disease presented to the ED for evaluation of an acutely bruised right 4th finger. She stated she was typing on a computer keyboard approximately 10 minutes prior to presentation and she noticed a sudden popping sensation at the base of her right ring finger. After the popping sensation, she noticed a cool sensation of the finger and numbness to the entire finger.

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How To Design Your Trauma Bay

The Trauma Pro

In the last two posts, I discussed the size of your trauma bay and how to measure it. This can obviously be helpful if you are updating or building new resuscitation rooms. But what about all the stuff that goes into it? Where is the best place to put it? If you are in the enviable position of being able to stock a brand-new room, here are some tips.

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High dose nitroglycerin is correct dose nitroglycerin

First 10 EM

Looking back, I am somewhat surprised I never published a First10 approach to sympathetic crashing pulmonary edema. I guess it never felt necessary, as it was the first ever EMCrit post, and therefore felt well covered in the FOAMed community. However, a full 15 years after that first EMCrit podcast (congrats on the decade and […] The post High dose nitroglycerin is correct dose nitroglycerin appeared first on First10EM.

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Should I Change My Mind About Aspirin for the Prevention of Cardiac Events?

Sensible Medicine

Studies that tempt me to change my mind are worth telling you about. The story this week centers on the use of aspirin for prevention of cardiac events in people without heart disease. I used italics because this story ONLY applies to people without heart disease—so called primary prevention. In 2018, the NEJM and the Lancet published three trials that randomized tens of thousands of patients without heart disease to either low-dose aspirin or a placebo.

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SGEM#432: SPEED, Give Me What I Need – To Diagnose Acute Aortic Dissections

The Skeptics' Guide to EM

Reference: Gibbons et al. The sonographic protocol for the emergent evaluation of aortic dissections (SPEED protocol): A multicenter, prospective, observational study. AEM February 2024. Date: February 28, 2024 Guest Skeptic: Dr. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. He is the Vice Chair of the Emergency Department at Nassau University […] The post SGEM#432: SPEED, Give Me What I Need – To Diagnose Acute Aortic Dissections first appeared on Th

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Dr. Marty Makary: “We’ll Have Herd Immunity by April” & “It’s Okay To Have an Incorrect Scientific Hypothesis. But When New Data Proves It Wrong, You Have To Adapt.”

Science Based Medicine

Part 1: Doctors who said the pandemic ended 3-years ago now have the audacity to lament the "damaged public trust in the medical profession." The post Dr. Marty Makary: “We’ll Have Herd Immunity by April” & “It’s Okay To Have an Incorrect Scientific Hypothesis. But When New Data Proves It Wrong, You Have To Adapt.” first appeared on Science-Based Medicine.

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Quick Hit: Elders Risk Assessment

EM Literature of Note

A few words regarding an article highlighted in one of my daily e-mails – a report regarding the Elders Risk Assessment tool (ERA) from the Mayo Clinic. The key to the highlight is the assertion this score can be easily calculated and presented in-context to clinicians during primary care visits, allowing patients with higher scores to be easily identified for preventive interventions.

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How Big Should Your Trauma Bay Be?

The Trauma Pro

Trauma professionals are never satisfied with the size of their trauma bay. Today, I’ll write about optimal trauma bay size. Next week, I’ll describe my system for quantifying the space in your trauma bay and address the equipment layout in your resuscitation room. Trauma resuscitation rooms vary tremendously. They can range from very spacious… to very tight… Most trauma bays that I have visited were somewhere between 225 and 300 square feet (21-28 sq meters), although some were quit

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AI Tools for Learning

Life in the Fast Lane

Sheralyn Guilleminot and Mike Cadogan AI Tools for Learning AI Tools for Learning - a review of a selection of tools - which ones work and which ones don’t, plus, the future of AI-assisted learning

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MIT hosts COVID-19 policy debate

Sensible Medicine

Since the start of the pandemic, I have written 200 op-eds on COVID-19 policy and published 20+ peer reviewed articles. I was opposed to school closure, masking kids, vaccine mandates, especially for young men in college who already had COVID-19, and took on many other controversial topics. Yet, from 2020-2022, I was not asked to debate these topics at any university.

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2024 Match Week

ACEP Now

ACEP Now wishes to congratulate the medical students who matched into emergency medicine today! This year, it is estimated that only about 137 of more than 3,000 spots remained unfilled as of Monday, March 11, 2024. This is in comparison to more than 550 unmatched positions last year. While the full explanation for the rebound in emergency medicine remains unknown, one potential reason is a large increase in international medical graduate applicants this year.

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Dr. Martin Kulldorff, Who Posted Pictures of Guillotines and Promised Herd Immunity Would Arrive 3-6 Months After Lockdowns Ended, Fired for “Clinging to the Truth”.

Science Based Medicine

"Science cannot survive in a society that does not value truth and strive to discover it." The post Dr. Martin Kulldorff, Who Posted Pictures of Guillotines and Promised Herd Immunity Would Arrive 3-6 Months After Lockdowns Ended, Fired for “Clinging to the Truth”. first appeared on Science-Based Medicine.

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ACMT Toxicology Visual Pearl: The Bark with Some Bite

ALiEM

Which medication can be derived from the bark of the pictured tree? Aspirin Atropine Colchicine Quinine Reveal the Answer 1. Aspirin Background The photo shows a weeping willow, a member of the Salix genus of trees. Willow tree bark contains salicin from which aspirin (acetylsalicylic acid) can be derived. For over 3500 years, willow bark has been used as a traditional medicine to treat fevers and pain [1].

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Wide Complex Tachycardia -- VT, SVT, or A Fib with RVR? If SVT, is it AVNRT or AVRT?

Dr. Smith's ECG Blog

A 69 y.o. male with pertinent past medical history including Atrial fibrillation, atrial flutter, cardiomyopathy, Pulmonary Embolism, and hypertension presented to the Emergency Department via ambulance for respiratory distress and tachycardia. Per EMS report, patient believes he has been in atrial fibrillation for 5 days, since coming down with flu-like illness with rhinorrhea, productive cough, SOB.

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Diagnostic reasoning as artificial intelligence emerges: a distributed cognition framework

First 10 EM

This is an invited guest post by Dr. Cory Rohlfsen (@CoryRohlfsen) based on an interesting twitter thread of his from a few month back. Dr. Rohlfsen is a hybrid internal medicine clinician at the University of Nebraska Medical Center. He splits his time between hospitalist duties and primary care clinic. He is passionate about fostering […] The post Diagnostic reasoning as artificial intelligence emerges: a distributed cognition framework appeared first on First10EM.

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Being Comfortable Being Uncomfortable – A Medical Student’s Perspective

Sensible Medicine

On February 8th, Lisa Rosenbaum published an excellent and thought-provoking piece in the New England Journal titled: On Being Well While Doing Well — Distinguishing Necessary from Unnecessary Discomfort in Training. This article, and the accompanying podcast , has stimulated more conversation than a “non-research” article has in years.

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EM@3AM: Pneumocephalus

EMDocs

Authors: Mounir Contreras Cejin, MD (EM Resident Physician, UT Southwestern – Dallas, TX); Felipe Gonzalez Gutierrez (Medical Student, UT Southwestern – Dallas, TX); Emmanuel Ohuabunwa, MD, MBA (Attending Physician, UT Southwestern – Dallas, TX) // Reviewed by: Sophia Görgens, MD (EM Physician, Northwell, NY); Cassandra Mackey, MD (Assistant Professor of Emergency Medicine, UMass Chan Medical School); Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Welcome to EM@3AM, an emDOCs series

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Some Doctors Cared Much More About Sore Arms Than Cold Bodies

Science Based Medicine

The campaign against boosters was just a small part of a pathetic, pandemic-long pattern where doctors expressed grave concern about the mildest harms of measures to limit COVID, even purely theoretical ones, while being totally indifferent to literally anything the virus could do, including the deaths of children and young adults. The post Some Doctors Cared Much More About Sore Arms Than Cold Bodies first appeared on Science-Based Medicine.

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Ep 192 ED Adult Asthma Management Strategies For Improved Prognosis – A Stepwise Approach

Emergency Medicine Cases

In this part 1 of our 2-part podcast series on Asthma Management we explore a systematic approach to managing patients presenting to the ED with asthma exacerbations. Our discussion will emphasize the critical role of a thorough history and physical examination in effectively stratifying patient risk and guiding treatment/disposition decisions. Additionally, we'll examine the importance of providing comprehensive discharge medications and instructions to mitigate both mortality and morbidity ass

EMS 107
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Implicit Bias Training for Dental Healthcare Providers

American Medical Compliance

The following Implicit Bias Training for Dental Healthcare Providers course is designed to educate dental healthcare providers on how to recognize and mitigate implicit bias in the workplace. Most of us don’t recognize our own biases, yet we have them. It is the very nature of being human. In this implicit bias course, we’ll define diversity, show why it matters in your dental practice, discover what prevents it, and learn how to foster it.

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