July, 2023

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ECG Blog #388 — Why Does Lead V1 Look Funny?

Ken Grauer, MD

The ECG in Figure-1 was obtained from an 18-year old woman — who moments before been resuscitated from out-of-hospital cardiac arrest. QUESTIONS: In light of the above clinical history. How would YOU interpret her post-resuscitation ECG? Does this ECG in Figure-1 provide clue(s) to the etiology of this patient's cardiac arrest? Figure-1: The initial ECG in today's case — obtained following resuscitation from cardiac arrest of an 18-year old woman.

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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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Fever in the Asplenic Patient

Mount Sinai EM

Fever in the Asplenic Patient Why we care Fever in a patient with impaired splenic function = early sign of sepsis Infections in this population can develop precipitously with very minimal antecedent symptoms, and can become fulminant and fatal within hours of symptom onset DIC can occur early in the course Patient population Anatomic Asplenia (post-splenectomy, congenital asplenia) Functional Asplenia (e.g. sickle cell anemia) Hyposplenia (from atrophy, infarction, engorgement, or infiltration

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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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Thyroid Storm Management

Mount Sinai EM

TR Pearl: Thyroid Storm Management Endocrine emergency: severe clinical manifestations of thyrotoxicosis Mortality rate of thyroid storm is 10-30% Often precipitated in patients with hx of hyperthyroidism by an acute event such as surgery (thyroid or non-thyroidal surgery), trauma, infection, acute iodine load (including amiodarone), or parturition Risk factor includes irregular use or discontinuation of antithyroid drugs Diagnosing Thyroid Storm : The distinction between severe thyrotoxicosis a

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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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The Latest in Critical Care, 7/3/23 (Issue #7)

PulmCCM

Video laryngoscopy was superior to direct laryngoscopy in first-pass success among ED residents and CCM fellows intubating critically ill patients (DEVICE trial). Surprisingly to me, video laryngoscopy (VL) has not consistently been shown to increase first-pass intubation success over direct laryngoscopy (DL) in critically ill patients. Most studies have been small, single center, and only some have favored video.

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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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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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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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"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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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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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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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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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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Recommendations for endotracheal tube insertion depths in children

Emergency Medicine Journal

Background Endotracheal tube (ETT) malposition is frequent in paediatric intubation. The current recommendations for ETT insertion depths are based on formulae that hold various limitations. This study aimed to develop age-based, weight-based and height-based curve charts and tables for ETT insertion depth recommendations in children. Methods In this retrospective single-centre study, we determined the individual optimal ETT insertion depths in paediatric patients by evaluating postintubation ra

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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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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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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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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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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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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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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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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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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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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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Updates in the Management of Refractory Ventricular Tachycardia or Ventricular Fibrillation Arrest

ACEP Now

Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. 1 Ventricular tachycardia (VT) and ventricular fibrillation (VF) represent the most common initial rhythms for patients presenting to the ED in out-of-hospital cardiac arrest, as well as for patients who develop cardiac arrest while in the ED. 2,3 In general, patients who develop cardiac arrest with an initial r

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Acute Pericarditis & Myocarditis

EB Medicine

In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the July 2023 Emergency Medicine Practice article, Diagnosing and Treating Pericarditis and Myocarditis in the Emergency Department Epidemiology Nomenclature Etiology Differential diagnosis Prehospital care ED history and physical Diagnostics ECG Labs Imaging (X-ray, CT, US, MRI) Treatment Special populations COVID-19 Athletes MIS-C In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the July 2023 Emergency Medicine Practice a

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Blurred vision? It might be time to think about glasses

Emergency Live

If you have blurred vision, the cause could be failing eyesight and you may need new glasses. The reasons, however, could also be others! In fact, if the blurred vision is persistent, it may also be a sign of other health problems: let's see what they are and when it is a good idea to contact your doctor and have a more thorough examination The post Blurred vision?

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Can diltiazem replace adenosine as part of the initial management of stable supraventricular tachycardia?

Canadian EM

A 50-year-old female presents to your ER with a chief complaint of palpitations. A 12-lead ECG shows supraventricular tachycardia at a rate of 165 bpm, and she is put on telemetry. She is clinically stable. You attempt the modified Valsalva maneuver with no effect. You explain that you will have to give her medication to bring her heart rhythm back to normal.

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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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