July, 2023

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Cerebral Edema and Diabetic Ketoacidosis: Rebaked

Pediatric EM Morsels

Authors: Drs. Kendra Jackson and Rebecca Raffler While we’ve gotten to snack on a Morsel on this subject before , new guidelines and research surrounding DKA and cerebral edema have come to light since the first go ‘round! Thankfully, Dr. Fox wasn’t too “ salty” when we asked to rehydrate this topic. Rates of type 1 diabetes have increased since the COVID-19 pandemic.

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PEG Tube Dislogement

Mount Sinai EM

Why is this a pearl? We get G-tube dislodgments quite often at Sinai, and they can be an easy patient encounter with a quick note and quick dispo. But they made me so nervous as an intern and early 2! Now I love ‘em and you can love ‘em too! ** GJ-tubes or J-tubes do not get replaced in the ED. Tell me about the PEG tube. Gastrostomy tube (G-tube) or Percutaneous Endoscopic Gastrostomy tube (PEG tube) is a tube placed in the stomach for long-term enteral nutritional support.

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SGEM#408: Hey, I, Oh I’m Still Alive – Is it due to TXA?

The Skeptics' Guide to EM

Date: July 1, 2023 Reference: PATCH-Trauma Investigators and ANZICS Clinical Trial Group. Prehospital Tranexamic Acid for Severe Trauma. NEJM 2023. Guest Skeptic: Dr. Salim Rezaie is a community emergency physician in San Antonio, TX. He is the Creator and founder of REBEL EM, a free, critical appraisal blog that tries to cut down knowledge translation gaps of […] The post SGEM#408: Hey, I, Oh I’m Still Alive – Is it due to TXA?

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RFK Jr. resurrects an old antivax half-truth about “saline placebos” in randomized controlled trials of vaccines

Science Based Medicine

Robert F. Kennedy, Jr. has resurrected the antivax claim that the childhood vaccine schedule has never been tested in randomized controlled trials (RCTs) with a saline placebo controls (and therefore the vaccine schedule is unsafe). This is an old and deceptive antivax half-truth that ignores both what constitutes a scientifically valid placebo and the ethical requirements for RCTs.

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Teleangiectasias: what are they?

Emergency Live

Telangiectasias are caused by enlarged blood vessels. This condition is much more common than you think and you will probably have come across this problem at least once in your life The post Teleangiectasias: what are they? appeared first on Emergency Live.

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REBEL Core Cast 104.0 – Subtle ECGs in Acute Coronary Occlusion

RebelEM

Take Home Points Provider assessment of how the patient looks is extremely important. If it looks and feels like a STEMI clinically, get serial ECGs and consult Cardiology immediately. POCUS has been a phenomenal tool in the management and early diagnosis of a lot of abnormal ECG and chest pain presentations. Isolated elevation in aVR with diffuse ST depressions can be a sign of Left Main occlusion.

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Proximal Tibiofibular Joint Dislocation in Children

Pediatric EM Morsels

In the past, we have discussed several causes of Knee Pain in children. Some of those causes are benign (ex, Osgood Schlatter’s Disease ) while others are scary (ex, osteosarcoma ). Evaluating the limping child , though, requires us to ponder not only the common (ex, Toddler’s Fracture ), but also to be vigilant for the severe (ex, Septic Arthritis ).

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Medical School Application Letters of Recommendation

SheMD

Disclaimer: This post was written before the COVID-19 pandemic. Some of the interview information may not be relevant during the 2020-2021 & 2021-2022 academic years. Hello premeds! ,, AMCAS , ,, AACOMAS , and ,, TMDSAS all opened in the beginning of May. We are kicking it into high-gear with premeds so they can turn in their medical school applications as soon as they are able.

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Aspartame and Cancer

Science Based Medicine

Despite the leaked new classification as a "possible" carcinogen, the evidence still shows aspartame is safe. The post Aspartame and Cancer first appeared on Science-Based Medicine.

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Water retention, how to deal with it

Emergency Live

Water retention is a problem that affects most women. However, most people confuse water retention and cellulite The post Water retention, how to deal with it appeared first on Emergency Live.

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"I just want to work on my car"

Sensible Medicine

I always tell junior faculty that your contract means little, and, indeed, I found that to be the case, when a mid-career faculty departed and I inherited a third of his lung cancer patients. Yet, like most unexpected clinical changes in my career, I ended up learning unexpected truths. One man taught me about lung cancer screening. He was the most improbable 74 year old.

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JC: The UK-REBOA trial. Has the balloon popped? St Emlyn’s

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed Zaf Qasim @resusone reviews the UKREBOA trial. No benefit shown, but is this really the end of REBOA in trauma? #FOAMed @stemlyns The post JC: The UK-REBOA trial. Has the balloon popped? St Emlyn’s appeared first on St.Emlyn's.

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The Latest in Critical Care, 7/31/23 (Issue #10)

PulmCCM

New Practice Guidelines for Diagnosis and Management of Acute Respiratory Distress Syndrome As mentioned here previously , a group of U.S. and European experts arrived at a consensus of new recommendations for the management of acute respiratory distress syndrome (ARDS), now publishing their guidance in JAMA. The highlights include: A trial of high-flow nasal cannula oxygen was advised before intubating patients.

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SGEM#411: Heads Won’t Roll – Prehospital Cervical Spine Immobilization

The Skeptics' Guide to EM

Date: July 21, 2023 Reference: McDonald et al. Patterns of change in prehospital spinal motion restriction: a retrospective database review. AEM July 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.

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Testicular Torsion

EM Ottawa

Acute scrotal pain is a common in emergency departments, comprising ~ 0.5% of all presentations. However, torsion is another very time sensitive diagnosis that is ubiquitous across all ages as seen by this Rosen’s table. Incidence / Epidemiology Unfortunately, epidemiological data is poor. Acute scrotal complaints make up approximately 0.5% of all ED visits […] The post Testicular Torsion appeared first on EMOttawa Blog.

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Schizophrenia: definition, causes, symptoms, diagnosis and treatment

Emergency Live

Schizophrenia comes from the Greek and literally means “separate mind”: those affected struggle to distinguish reality from imagination It is a psychiatric disorder that seriously compromises self-perception. In addition to negatively affecting social relationships and the performance of normal daily activities. This disease also affects perception, memory, attention, learning and emotions.

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Instructors' Collection ECG: Inferior Posterior M.I.

ECG Guru

This is a "classic" ECG of very good quality for you to use in a classroom setting. The Patient: A 57-year-old man who complains of a sudden onset of "sharp" chest pain while on a long bike ride. The pain does not radiate, and nothing makes it worse or better. He is pale, cool, and diaphoretic. His medical history is unknown. The ECG: This ECG could be considered "classic" for an inferior wall ST elevation M.I. caused by occlusion of the right coronary artery.

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COVID-19 has exposed the toothlessness of state medical boards

Science Based Medicine

A report in The Washington Post last week revealed just how badly state medical boards have been failing when dealing with physicians spreading COVID-19 misinformation and using quackery to prevent and treat the disease. None of this is anything new, unfortunately. The pandemic has merely stress tested state medical boards, and most have failed because of political choices made long ago.

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Discitis

Don't Forget the Bubbles

Discitis is an inflammatory condition involving the intervertebral discs and end plates of vertebral bodies. It encompasses a spectrum of conditions that includes discitis , spondylodiscitis , and vertebral osteomyelitis. Discitis is uncommon. However, there is a bimodal peak in children, those under 6 years and adolescents. Neonates can also be affected.

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Interview Series: Tips to Answer Five Common Medical School and Residency Interview Questions

SheMD

Disclaimer: This post was written before the COVID-19 pandemic. Some of the interview information may not be relevant during the 2020-2021 & 2021-2022 academic years. Now that it’s the heart of interview season for both medical school applicants and residency applicants, I wanted to share some tips on how to answer commonly asked interview questions.

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What is the Emergency Number of Ambulance

Ziqitza HealthCare Ltd

Ambulance emergency number It’s heartbreaking to know that millions of emergencies end in the loss of lives. What shakes us is the lack of awareness of ambulance emergency numbers and the affordability of ambulance services. These reasons may sound a little weird in the digital era we are living in, but it’s true. You may argue that one can simply Google for an emergency number when needed.

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Rhizarthrosis: definition, causes, symptoms, diagnosis and treatment

Emergency Live

Also called trapeziometacarpal osteoarthritis, rhizarthrosis is a particular form of osteoarthritis that affects the carpometacarpal joint of the hand The post Rhizarthrosis: definition, causes, symptoms, diagnosis and treatment appeared first on Emergency Live.

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VT or SVT? Here, Both!

ECG Guru

Complex ECGs like this one have to be approached systematically. Firstly, we can see a normal sinus rhythm. A is the first beat of a wide complex tachycardia. This must be a ventricular tachycardia. Although there is a P-wave before the first beat of the tachycardia, it is not premature. Therefore, there is no SVT with aberrant conduction. The first beat of the tachycardia looks different from the subsequent beats because there is a fusion beat present.

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By the Numbers: the Emergency Medicine Blogs and Podcasts Rankings

ACEP Now

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.

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G6PD Deficiency

Don't Forget the Bubbles

4-year-old Mark presents with lethargy, jaundice, and abdominal pain after eating one portion (40g) of broad beans. Could he have G6PD deficiency? G6PD , short for glucose-6-phosphate dehydrogenase, is an enzyme active in all cell types and is key to protecting red blood cells from oxidative damage and early destruction. A child with reduced G6PD enzyme activity has increased red blood cell breakdown – haemolysis – when exposed to specific triggers.

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Peri-Intubation Hypotension – Dose Induction Dose Matter?

RebelEM

Background: Rapid Sequence Intubation (RSI) is a procedure fraught with potential complications including hypotension which, in turn, can result in cardiovascular collapse. While there are numerous potential causes of hypotension peri-RSI, induction medications represent an important, modifiable variable. Over the last decade, airway experts have advocated for reduced induction agent dosing to lessen the risk of hypotension particularly in at risk patients.

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SGEM#410: Do You See What I See? Video Laryngoscope for Intubation

The Skeptics' Guide to EM

Date: July 21, 2023 Reference: Prekker et al. Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults. NEJM 2023 Guest Skeptic: Dr. Jeff Jarvis is the Chief Medical Officer and System Medical Director for the Metropolitan Area EMS Authority in Fort Worth, Texas, also known as MedStar. He is board certified in both Emergency Medicine […] The post SGEM#410: Do You See What I See?

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Bladder cancer: what is it?

Emergency Live

Bladder cancer is a malignant transformation of the cells - mainly those called transitional cells - which cover the inner walls of the bladder, the organ responsible for collecting and expelling urine once it has been filtered by the kidneys The post Bladder cancer: what is it? appeared first on Emergency Live.

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Sudden Shortness of Breath - Pulmonary Embolism

ECG Guru

ECG 1 is from a 57-year-old male with no prior cardiac disease. He reports acute shortness of breath for 2 days. We see a sinus rhythm with left anterior fascicular block (LAFB) and conspicuous T-wave inversions in the inferior leads and in V1-V6. These are typical ECG changes that may indicate a pulmonary embolism. ECG 2 was taken from the same patient 1 year earlier.

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Xylazine: “Zombie Drug” is an Emerging Threat

ACEP Now

CASE A 30-year-old woman presents to the emergency department with left arm pain from a chronic wound. She notes that the wound has been present for greater than a year and it becomes malodorous and painful and oozes intermittently. She reports fevers up to 103 degrees Fahrenheit. She endorses a one-year history of near-syncopal episodes associated with shortness of breath, headache, and neck pain.

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Fracture Fridays: Keeping up with the Joneses

PEMBlog

The case A self-proclaimed dance team superstar presents after injuring her foot at a regional competition. She tried to finish the routine after landing awkwardly. But was having difficulty bearing weight. She applied ice overnight and despite ibuprofen is still in pain, and presents to the ED the next day.On her exam the neruovascular exam is normal, and she has pain along the proximal edge of the 5th metatarsal.

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Tips to Prevent Road Accidents While Driving

Ziqitza HealthCare Ltd

Prevention of Road Accidents Misfortunes one can endure- they come from outside, they are accidents. Every year, approximately 1.5 lakh people die on Indian roads, which translates, on average, into 1130 accidents and 422 deaths every day or 47 accidents and 18 deaths every hour. Nowadays, road crashes are the biggest challenge of our life. Road accidents not only take lives but also leave survivors with life-long chronic injuries and disabilities.

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RFK Jr.: A fart-filled argument gives way to an antisemitic conspiracy theory that COVID-19 is an “ethnically targeted” bioweapon

Science Based Medicine

Late last week, RFK Jr. endured some hilariously bad press about an NYC press event at which two of his supporters argued over climate change, one with lots of farts. However, the fart jokes soon gave way to darker side of the fundraise, a Q&A in which RFK Jr. shared an antisemitic conspiracy theory claiming that COVID-19 might have been "targeted" against Caucasians and Blacks, while sparing Jews and the Chinese.

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Kidney cancer: definition, causes, symptoms, diagnosis and treatment

Emergency Live

Kidney cancer is the most frequent among those affecting the urinary tract, after that of the prostate and bladder The post Kidney cancer: definition, causes, symptoms, diagnosis and treatment appeared first on Emergency Live.

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Network Five: Emergency Medicine Case Series

Life in the Fast Lane

Pramod Chandru Network Five: Emergency Medicine Case Series Network Five Emergency Medicine Case 1 discussing an interesting case of a patient who presents with chest pain and pre-syncope.

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DEVICE

The Bottom Line

In critically ill adults undergoing tracheal intubation, does the use of a videolaryngoscope (VL) compared to a direct laryngoscope (DL) improve the first-pass success rate?

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Don’t Sweat It! Heat Related Illness

EM Ottawa

Global temperatures are increasing and are projected to continue warming. The rates of warming across out planet are not uniform. In Canada, the loss of snow and sea ice reduces the reflectivity of the surface leading to increased absorption of solar radiation and a faster rate of warming compared to more southern regions. As a […] The post Don’t Sweat It!