Sat.Apr 20, 2024 - Fri.Apr 26, 2024

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ECG Blog #426 — Are STEMI Criteria Met?

Ken Grauer, MD

The ECG in Figure-1 — was obtained from a 70-ish year old man with episodic CP ( C hest P ain ) over the previous 2-3 days , being awakened from sleep now for a more severe CP episode. QUESTIONS: In view of this history — How would YOU interpret this ECG? Should you activate the cath lab? Figure-1: The initial ECG in today's case. MY Initial Thoughts on Today's CASE: Although it is difficult from the brief history we are given, to determine the true onset of whatever might be happening — the pat

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Preperitoneal Packing Vs Angioembolization: Part 1

The Trauma Pro

In this series, I will review the two major techniques for addressing troublesome bleeding from pelvic fractures. This post will review the evolution of packing techniques and more fully describe the concept of preperitoneal packing. Next, I’ll review an early paper that compared the snippets of information we had to angioembolization. In the last post in the series, I’ll discuss a paper in press that compares the efficacy and hospital charges of the two techniques.

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The US FDA's cancer drug approval process is broken and needs audit

Sensible Medicine

The US FDA is under tremendous political pressure to approve drugs, and indeed they tout the number of approved drugs as a measure of the quality of their work. Unfortunately, you can approve bad drugs. Selenexor is a toxic poison that does not increase survival. Belantumab causes eye damage and had to be pulled from the US market Idelalisib, copanlisib, duvelisib— the entire P13k inhibitor class —may have resulted in increased deaths.

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EPIC-SR: The negative paxlovid data Pfizer has been sitting on

First 10 EM

As mentioned in my most recent review, publication bias has been a major concern when trying to decide whether to prescribe paxlovid. Pfizer rushed to publish their positive study (EPIC-HR), but refused to release the results of a second simultaneous study (EPIC-SR) that was stopped (due to futility) at the exact same time. With the […] The post EPIC-SR: The negative paxlovid data Pfizer has been sitting on appeared first on First10EM.

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ECG Blog #427 — To Cath this Elderly Patient?

Ken Grauer, MD

The ECG in Figure-1 — was obtained on the scene by EMS ( E mergency M edical S ervices ). The patient was a man in his 90s, who ~1 hour earlier, noted the onset of severe CP ( C hest P ain ). He was hemodynamically stable — but clearly distressed with a sense of “impending doom” at the time ECG #1 was recorded. Despite the patient’s age — he was independent, lived alone, had good mental function — and had family support.

EKG/ECG 332
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COVID-19 vaccine-caused “turbo cancer” nonsense just keeps getting more turbocharged and nonsensical

Science Based Medicine

No matter how implausible it is or how weak the evidence for it is, the myth that COVID vaccines cause "turbo cancer" just won't die. Quite the contrary, alas. Antivaxxers are—dare I say?—turbocharging it with bad science. The post COVID-19 vaccine-caused “turbo cancer” nonsense just keeps getting more turbocharged and nonsensical first appeared on Science-Based Medicine.

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Medicare doesn't pay because there is no evidence you live longer or better as a result

Sensible Medicine

On Friday, the New York Times ran this story. The article begins by explaining that mammograms don’t find all breast tumors — of course they don’t! Even MRI and ultrasound do not. In fact, no imaging modality does. The only way to find all the tumors would be to remove the breast and have a pathologist examine every tiny bit of it.

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EM Quick Hits 56 – Nitroglycerin in SCAPE, REBOA, Diverticulitis Imaging, CRAO, Penicillin Allergy, Physician Personality

Emergency Medicine Cases

In this month's EM Quick Hits podcast: Justin Morgenstern on the first RCT of high dose nitroglycerin in SCAPE, Andrew Neill on Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) indications and evidence, Brit Long on indications for CT in suspected diverticulitis, Tahara Bhate on Central Retinal Artery Occlusion (CRAO) and diagnostic error, Matthew McArthur on penicillin allergy labels, myths and penicillin challenges, and Susan Lu on how ED physician personality influences patie

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Science Based Satire: BOMBSHELL NEWS!!! The Virus I Told You Not to Worry About and Worked to Infect You With… CAME FROM A LAB!!!

Science Based Medicine

"Last year, @WashburneAlex made a bombshell prediction supporting the lab leak theory. New documents released yesterday confirm his prediction." - Dr. Jay Bhattacharya January 2024 The post Science Based Satire: BOMBSHELL NEWS!!! The Virus I Told You Not to Worry About and Worked to Infect You With… CAME FROM A LAB!!! first appeared on Science-Based Medicine.

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Top papers podcast 2023/24. Part 2. St Emlyn’s

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed Part 2 of our podcast on top papers from 2023/24 with @EMManchester and @docb #FOAMed @stemlyns The post Top papers podcast 2023/24. Part 2. St Emlyn’s appeared first on St.Emlyn's.

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Take the OMI Quiz and Test yourself against the Queen of Hearts

Dr. Smith's ECG Blog

Quiz The PM Cardio Queen of Hearts AI model for ECG interpretation from Powerful Medical is still in its early days. Do you think you can outperform the toddler version of the AI model? Version 2.0 will soon be available with four times the training data. The QoH groups ECGs into OMI and NOT OMI. Each category is subdivided into three levels of confidence.

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RCEM best practice guideline: suspected cannabinoid hyperemesis syndrome in emergency departments

Emergency Medicine Journal

Cannabinoid hyperemesis syndrome (CHS) is an episodic syndrome of cyclic vomiting in the context of the prolonged use of cannabis. The Royal College of Emergency Medicine Toxicology Special Interest Group has produced guidance to support emergency medicine clinicians with the recognition and treatment of people experiencing CHS. Considerations regarding recognition, investigation and communication are discussed, and recommendations regarding treatment options (which include haloperidol and capsa

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Don’t Blame the Patient

Science Based Medicine

When patients are diagnosed with cancer, or a terminal illness of any kind, they report that there are a couple of near universal reactions by the people around them. First, everyone has advice for them. Everyone thinks they know what caused their illness and what will cure it. The floodgates of free advice and misinformation open. Everyone also wants them to stay […] The post Don’t Blame the Patient first appeared on Science-Based Medicine.

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Top papers podcast 2023/24. St Emlyn’s

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed This month we hacve two podcasts covering our recent posts on top 10 resuscitation papers. This blog covers the first 5 papers. Part 2 will be out later in the […] The post Top papers podcast 2023/24. St Emlyn’s appeared first on St.Emlyn's.

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Red Blood Cells: Pillars of Oxygenation in the Human Body

Emergency Live

Discover the Vital Importance of These Tiny Blood Components What Are Red Blood Cells? They are vital cells that help people to live. The cells called erythrocytes provide oxygen throughout the body. Their unique shape increases the surface area for better breathing. The absence of a nucleus inside means more space for the iron proteins […] The post Red Blood Cells: Pillars of Oxygenation in the Human Body appeared first on Emergency Live.

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External validation of a rapid algorithm using high-sensitivity troponin assay results for evaluating patients with suspected acute myocardial infarction

Emergency Medicine Journal

Objective We sought to validate the clinical performance of a rapid assessment pathway incorporating the Siemens Atellica IM high sensitivity cardiac troponin I (hs-cTnI) assay in patients presenting to the emergency department (ED) with suspected acute myocardial infarction (AMI). Methods This was a multicentre prospective observational study of adult ED patients presenting to five Australian hospitals between November 2020 and September 2021.

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Dacryocystitis 

Don't Forget the Bubbles

You are called to the postnatal ward to review a 22-hour-old infant with feeding difficulties. On examination, two bluish, soft swellings are located medially to the inner canthus on both eyes. The infant is unsettled but has a mild fever. What do you do? What is dacryocystitis? Dacryocystitis is an inflammation of the lacrimal sac. This oval-shaped structure receives tear drainage from the eye and sits in a groove formed by the lacrimal bone and frontal process of the maxilla.

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Chelation Did Not Work But Science Did

Sensible Medicine

I remember when Dr. Gervasio Lamas stunned the world of cardiology when he presented the results of the TACT 1 trial. I chose the verb stun because chelation was way outside the box that contains medical thinking. This was not a drug or a procedure. It is a way to remove heavy metals from the body. And it was practiced not by doctors, but alternative medicine practitioners.

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The Essential Role of Guanine in DNA and RNA

Emergency Live

Discovering the Importance of One of the Four Fundamental Nucleotides for Life What is Guanine? One of the four main building blocks of DNA and RNA is guanine. It’s a special nitrogen-containing compound that pairs with adenine, cytosine, and thymine (or uracil in RNA) to form the genetic code. What makes guanine unique is its […] The post The Essential Role of Guanine in DNA and RNA appeared first on Emergency Live.

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Cessation of Smoking Trial in the Emergency Department (COSTED): a multicentre randomised controlled trial

Emergency Medicine Journal

Background Supporting people to quit smoking is one of the most powerful interventions to improve health. The Emergency Department (ED) represents a potentially valuable opportunity to deliver a smoking cessation intervention if it is sufficiently resourced. The objective of this trial was to determine whether an opportunistic ED-based smoking cessation intervention can help people to quit smoking.

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Cold Water Immersion Not Always Beneficial

Science Based Medicine

Two papers look at the effects of cold water immersion after exercise, with mixed results. The post Cold Water Immersion Not Always Beneficial first appeared on Science-Based Medicine.

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POCUS findings of hemodynamically unstable PE with cardiac arrest

EMDocs

Authors: Joseph R. Peters, (DO, RDMS, FACOEP, FACEP, FACOI); Carolina Hartje, DO // Reviewed by: Stephen Alerhand, MD; Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Introduction There are an estimated 300,000-600,000 Americans who develop venous thromboembolisms (VTE) each year, including deep venous thromboembolisms (DVT) and pulmonary embolism (PE). 1-3 VTE is responsible for hospitalizing over 250,000 Americans every year, and there are an estimated 100,000 deaths annually associat

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Mammography: A Crucial Tool in the Fight Against Breast Cancer

Emergency Live

Learn how mammography works and why it is essential for early detection What is Mammography? Mammography is a healthcare imaging method that uses low-dose X-rays to examine breast tissue for any potentially dangerous changes. This check-up is considered the best tool for early detection of breast cancer because it can detect growths and small deposits […] The post Mammography: A Crucial Tool in the Fight Against Breast Cancer appeared first on Emergency Live.

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Abstracts from international Emergency Medicine journals

Emergency Medicine Journal

Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication.

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DanGer Shock – Microaxial Flow Pump in Infarct-Related Cardiogenic Shock

The Bottom Line

Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock Møller JE et al. 2024. NEJM. DOI: 10.1056/NEJMoa2312572 Clinical Question In adults presenting with STEMI and cardiogenic shock does the use of a microaxial flow pump (Impella CP) compared to standard care reduce death from any cause at day 180?

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Improving Your Critical Appraisal Skills #3

Sensible Medicine

I love case control studies. When done well, they are simple, relatively easy to perform studies, that can be hugely impactful, usually by suggesting that an exposure is harmful. Case control studies have saved millions of lives, demonstrating the adverse effects of substances such as tobacco smoke, DES, and dexfenfluramine. Case control studies can also mislead us.

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CRI, Valastro: "Conflicts endanger the planet's balance."

Emergency Live

Earth Day. Red Cross, Valastro: “Conflicts and humanitarian crises endanger the planet’s balance. From CRI, a universal sustainable development, thanks to the youth” “The ongoing conflicts and humanitarian crises, combined with recent health, social, and environmental emergencies, are jeopardizing the balance of our planet and slowing down the commitment made by the 2030 Agenda in […] The post CRI, Valastro: "Conflicts endanger the planet's balance." ap

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Science-Based Satire: More Parents Turn to Kinesiology Diapers for Fussy Infants

Science Based Medicine

Are parents really turning to diapers made using kinesiology tape to help their fussy babies? Of course not. That would be incredibly silly, and profitable. This is satire. The post Science-Based Satire: More Parents Turn to Kinesiology Diapers for Fussy Infants first appeared on Science-Based Medicine.

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SGEM#437: Don’t Be Fooled by the Meds I Got, I Still Need an ESP Block – For My Rib Fractures

The Skeptics' Guide to EM

Reference: Ramesh S, Ayyan SM, Rath DP, Sadanandan DM. Efficacy and safety of ultrasound-guided erector spinae plane block compared to sham procedure in adult patients with rib fractures presenting to the emergency department: A randomized controlled trial. AEM April 2024 Date: April 19, 2024 Guest Skeptic: Dr. Suchismita Datta. She is an Assistant Professor and Director of […] The post SGEM#437: Don’t Be Fooled by the Meds I Got, I Still Need an ESP Block – For My Rib Fractures first appeared o

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Journal Feed Weekly Wrap-Up

EMDocs

We always work hard, but we may not have time to read through a bunch of journals. It’s time to learn smarter. Originally published at JournalFeed , a site that provides daily or weekly literature updates. Follow Dr. Clay Smith at @spoonfedEM , and sign up for email updates here. #1: Should We Use New Duke Criteria for Infective Endocarditis? Spoon Feed This external validation compared the 2023 Duke-International Society for Cardiovascular Infectious Diseases Diagnostic (ISCVID) Criteria aga

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A unique training day the course on airway management

Emergency Live

High participation of attendees at the comprehensive theoretical-practical course on airway management During emergency situations, proper airway management is a delicate yet fundamental phase to ensure the patient’s life is out of danger. Airway management represents the foundation of every resuscitative treatment, an essential starting point for every subsequent therapeutic choice.

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How Much O2 Is Right in COVID?

RebelEM

Background: Hypoxemic respiratory failure is a frequent complicating feature of severe COVID-19 infection. Early in the pandemic, extensive efforts were made to identify the best approach to oxygenation in this group of patients. Best practices settled on aggressive use of non-invasive ventilation (NIV) and delaying invasive mechanical ventilation (IMV) where feasible.

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Making a Difference in Our Community: CMG's Week of Giving

Core Medical Group

At CMG, one of our core values is making a difference, something we live out every day both professionally and personally. Each quarter, our leadership team selects a charity for our quarterly donations, directing our efforts towards supporting that cause. We also encourage our employees to utilize their Volunteer Time Off (VTO), allowing them up to 8 hours per calendar year to volunteer with a 501(c)(3) organization of their choice.

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Create safe environments for employees and patients

NRC Health

Learn how to create safe environments for employees, nurses, & patients from Shawna Grissom & Shelby Chapman from Children's Hospital Colorado. The post Create safe environments for employees and patients appeared first on NRC Health.

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Understanding leukemia: types and treatments

Emergency Live

An in-depth look at the causes, classification, and treatment options of leukemia What is Leukemia? Leukemia is a cancer of the blood cells that begins in the bone marrow. It occurs when abnormal cells grow uncontrollably, outnumbering healthy cells. This disease mainly affects white blood cells and disrupts the normal production of blood cells. Classification […] The post Understanding leukemia: types and treatments appeared first on Emergency Live.

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Tools you should use: Pediatric NIH Stroke Scale

PEMBlog

Pediatric strokes are rare and challenging to diagnose. There is a validated Pediatric Stroke Scale from the NIH that can be used in conjunction with a stroke protocol that involves Neurology, Radiology, and a local/regional Stroke Team. Review the tool at MD Calc, the direct link is – [link] – MD Calc Pediatric NIH Stroke Scale Important notes The overall true predictive value of the Pediatric NIH stroke scale continues to be studied.

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Grand Rounds Recap 4.17.24

Taming the SRU

Active Shooter Incidents - Mass Casualty Simulation - Climate Change - Hazmat/Decon Active shooter incidents Important to have situational awareness, which is generally defined as knowing what is going on around you Three main tactics for defense in an active shooter situation: Run, hide, and/or fight Run - Evacuation is going to be based on specific circumstances: location of shooter and whether it can be accomplished safely.