Sat.Feb 03, 2024 - Fri.Feb 09, 2024

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The Latest in Critical Care, 2/5/24 (Issue #28)

PulmCCM

Fever in the ICU: Guideline Update The Society of Critical Care Medicine (SCCM) and the Infectious Diseases Society of America (IDSA) issued an interim update to their 2008 recommendations for the management of fever in the ICU. PulmCCM is not affiliated with SCCM or IDSA. Virtually all the recommendations were based on weak evidence and represent a consensus of expert opinion.

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ECG Blog #415 — The Cath showed NO Occlusion!

Ken Grauer, MD

Today’s patient is an older woman who experienced a number of fainting epiodes over the previous week. No CP ( C hest P ain ). Shortly after arrival in the ED ( E mergency D epartment ) — she suffered a cardiac arrest. The ECG in Figure-1 was obtained following successful resuscitation. Stat Echo — obtained shortly after successful resuscitation revealed anterior wall akinesis.

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Nail In The Neck: Part 2

The Trauma Pro

This case involves an accidental nail gun injury to the neck. The patient is hemodynamically stable, neurologically intact, the airway is patent and not threatened, and there is no apparent hematoma. There is a small puncture near the sternocleidomastoid muscle on the right, fairly high on the neck. The nail is not palpable on either side. And the patient only complains of a little discomfort when he swallows.

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The Patient

Sensible Medicine

You can only listen to, or read, what doctors have to say for so long. Today, in our Friday, “reflective writing” slot, an essay from someone in the bed rather than beside it. Adam Cifu Sensible Medicine is a reader-supported publication. If you appreciate our work, consider becoming a free or paid subscriber. After ten days tethered to an IV of cyclosporine, the surgeon explained that he would remove my colon, create a stoma, and hitch a colostomy bag to my abdomen.

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The Menace of Wellness Influencers

Science Based Medicine

Wellness influencers are often also conspiracy theorists, as both mindsets rely upon the same underlying methods, motivation, and narrative. The post The Menace of Wellness Influencers first appeared on Science-Based Medicine.

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Top resus papers for TBS. St Emlyn’s

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed This week I am in Zermatt, Switzerland for ‘The Big Sick’ conference. This is something I have been looking forward to years, but major heart surgery (valves not pipes) and […] The post Top resus papers for TBS. St Emlyn’s appeared first on St.Emlyn's.

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AI-Assisted Learning and Teaching

Life in the Fast Lane

Sheralyn Guilleminot and Mike Cadogan AI-Assisted Learning and Teaching AI-assisted learning and teaching is an often-overlooked use of artificial intelligence in medicine! Here are 4 ways to do it.

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COVID-19 antivax quacks are now “repurposing” ivermectin for cancer

Science Based Medicine

A year ago, I noticed that COVID-19 quacks were touting the "repurposing" of ivermectin to treat cancer. Now, familiar COVID-19 antivaxxers—cough, cough, FLCCC—have turbocharged this quackery. The post COVID-19 antivax quacks are now “repurposing” ivermectin for cancer first appeared on Science-Based Medicine.

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Can We Select “Better” Residents?

Sensible Medicine

Two things are clear about the internal medicine residents I get to work with. First, their qualifications are spectacular: academic accolades, research, publications, clinical medicine experiences prior to residency, even real-life professional experiences. When they enter internship, their CVs dwarf those of my residency colleagues (’93 - ’96).

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Chest pain with anterior ST depression: look what happens if you use posterior leads.

Dr. Smith's ECG Blog

Written by Jesse McLaren A 65 year old with a history of atrial flutter, CABG and end-stage renal disease on dialysis presented with 3 days of fluctuating chest pain, which was ongoing at triage. What do you think? Do you need posterior leads? There’s atrial flutter with controlled ventricular response, a non-specific intra-ventricular conduction delay, borderline right axis, normal R wave progression and normal voltages.

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ACEP says its OK to use topical anesthetics for simple corneal abrasions

First 10 EM

Long time readers will know that I generally dislike guidelines. Although there are exceptions, I think that guidelines are often more problematic than helpful. However, I know that many people work in places that have medicolegal structures that leave them feeling completely paralyzed, and unable to practice in the absence of a relevant guideline. The […] The post ACEP says its OK to use topical anesthetics for simple corneal abrasions appeared first on First10EM.

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The Role of Compliance Officers in Healthcare Organizations: Challenges and Responsibilities

American Medical Compliance

Compliance officers’ responsibilities extend far beyond merely checking boxes and ticking off regulatory requirements. In fact, 61% of the compliance teams from a Thomson Reuters report also work on long-range strategies for their companies by putting regulatory and legislative changes as a top priority. Compliance officers take on a more complex task such as the creation of medical compliance plans for their company’s long-term success.

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Grand Rounds Recap 1.31.24

Taming the SRU

AirCare - Derm Emergencies - R4 Capstone - Landmarks of EM - Global Health - Toxicology Aircare Grand ROunds WITH Drs. Tillotson and Hinckley Simulation Communication on arrival to a scene is key, both between you and your flight nurse before you enter the ambulance and with the EMS crew Reassessing the potential reasons for shock in a trauma is important to pick up causes that are not initially on your mind initially (blood products for hemorrhage, controlling a significant scalp bleed, relievi

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A teenager involved in a motor vehicle collision with abnormal ECG

Dr. Smith's ECG Blog

Written by Pendell Meyers A teenager was involved in a motor vehicle collision and presented to the Emergency Department via EMS altered and potentially critically ill. He was intubated for altered mental status. Chest trauma was suspected on initial exam. Here is his initial ECG around 1330: What do you think? The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia.

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Propofol Related Infusion Syndrome (PRIS)

First 10 EM

In the Rapid Review series, I briefly review the key points of a clinical review paper (which often extends to multiple papers because I can’t help myself). The topic this time: Propofol Related Infusion Syndrome (PRIS). Like many rapid review topics, this was chosen for my own education because I have next to no experience […] The post Propofol Related Infusion Syndrome (PRIS) appeared first on First10EM.

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Dr. Kelly Brogan Wakes Up to the “Ball Earth Hoax”. What Does This Reveal About Prominent Professors From Prominent Medical Schools?

Science Based Medicine

What did I mean when I said Dr. Kelly Brogan "won the pandemic"? The post Dr. Kelly Brogan Wakes Up to the “Ball Earth Hoax”. What Does This Reveal About Prominent Professors From Prominent Medical Schools? first appeared on Science-Based Medicine.

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Rash Week! My aching feet!

PEMBlog

Just look at the rash – then scroll down to reveal the diagnosis. That’s it. And oh yeah, she did spend time in a hot tub during a recent trip. The nodules on the platter surface of the feet are painful. She is systemically well appearing. It’s Pseudomonas Hot-Foot Syndrome! This malady is characterized by the acute onset in children of exquisitely tender plantar nodules and a benign, self-limited course.

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Diagnostics and Therapeutics: The Who, What, Where, When and Why of Lumbar Punctures

Taming the SRU

Imhotep was an egyptian chancellor and has been credited with the discovery of csf. Metropolitan Museum of Art, CC0, via Wikimedia Commons The ancient Egyptian physician Imhotep is often credited with the discovery of cerebral spinal fluid (CSF) —over 5,000 years ago! (1) However, it wasn’t until the 1890s that purposeful, successful, and safe attempts to access this fluid were documented (2).

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ALiEM AIR Series | Toxicology Module

ALiEM

Welcome to the AIR Toxicology Module! After carefully reviewing all relevant posts in the past 12 months from the top 50 sites of the Digital Impact Factor [1], the ALiEM AIR Team is proud to present the highest quality online content related to related to toxicology in the Emergency Department. 8 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board.

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Policy Playbook: Labor Actions and Unionization in Healthcare

EMDocs

Author: Ryan Leone, MSc, Medical Student at Columbia University // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) What’s the issue? Across several sectors, labor strikes and unionization were prominent throughout the last year. Despite a plateau in overall union membership of around 10% in 2023 1 , major labor actions shook the U.S. and gained national attention, including high-profile strikes by the United Auto Workers (UAW), the Screen Actors Guild – American F

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Kidney colic: prevention and treatment

Emergency Live

A comprehensive guide to understanding, preventing, and effectively treating kidney colic. Kidney colic is an acute disorder characterized by intense and sudden pain localized in the lower abdomen or back. This condition mainly occurs due to the presence of kidney stones in the ureter, the thin tube that connects the kidneys to the bladder. These […] The post Kidney colic: prevention and treatment appeared first on Emergency Live.

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REBEL Core Cast 117.0 – Infections of Pregnancy

RebelEM

Take Home Points Infections are a leading cause of maternal mortality worldwide. Prompt recognition is critical in management. Most infectious processes will require admission and close observation for improvement or decompensation. REBEL Core Cast 117.0 – Infections of Pregnancy Click here for Direct Download of the Podcast Urinary Tract Infection/Pyelonephritis Epidemiology: Occurs in as many as 15% of pregnant women and between 20-40% of pregnant women with asymptomatic bacteriuria will

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Science Based Satire: What I Would Have Done

Science Based Medicine

A man who experienced the pandemic entirely from his laptop, explains what he would have done had he actually done anything. The post Science Based Satire: What I Would Have Done first appeared on Science-Based Medicine.

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emDOCs Podcast – Episode 94: GLP-1 Agonist Complications

EMDocs

Today on the emDOCs cast with Jess Pelletier and Brit Long, we discuss the GLP-1 agonist craze, complications, and medication compounding. Episode 94: GLP-1 Agonist Complications Background: GLP-1 agonists are used for weight loss and diabetes; include the following: Semaglutide (Wegovy) GLP-1 agonist FDA approved for weight loss by SQ injection Liraglutide (Saxenda) GLP-1 agonist FDA approved for weight loss by SQ injection Semaglutide (Ozempic) GLP-1 agonist FDA approved for type 2 diabetes by

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Masks are nearly all off

Sensible Medicine

There is an old George Carlin joke: on the freeway, everyone driving slower than you is an idiot and anyone driving faster is a maniac. I think many of us feel the same about masking. Anyone who wears it longer than you is an idiot, and anyone who took it off sooner is a maniac. At the airport in SF, masks are nearly completely gone. SF of course is the last bastion of masking, as masking correlates with more democratic voters and not public health principles.

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EMCrit 368 – The Acute Critical Care Medication Reconciliation with Josh Farkas

EMCrit

The acute crit care med rec EMCrit Project by Scott Weingart, MD FCCM.

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Abortion Care in the Emergency Department

EM Ottawa

Abortion history in Canada is Complex. Countless hardships were overcome on the long journey to the legalization of medical induced abortion (IA). This blog post will focus on what you need to know as an acute care provider. Context: Unsafe abortions are the leading preventable causes of maternal death and morbidity (4.7-13.2% of maternal deaths). […] The post Abortion Care in the Emergency Department appeared first on EMOttawa Blog.

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Critical Care Evidence Updates – December 2023

The Bottom Line

What’s new in the Critical Care literature – monthly updates

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Can Data Just Speak for Itself?

Sensible Medicine

Tomorrow over at CardiologyTrials we will describe the CAPRICORN trial of carvedilol vs placebo in patients post myocardial infarction. Carvedilol is now widely accepted for this indication, but CAPRICORN featured a super-interesting twist regarding how we interpret data given pre-experiment choices. Do tune in. (Also, the bad typo in the original e-mail is fixed.

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Skeptics in the Pub. Cholera. Chapter 9a.

Science Based Medicine

For once, I beat the alarm clock by a good hour. Anxiety is better than sunrise for becoming and staying awake. I had too many things to do, and neither the time nor the skill set to accomplish them. As the week progressed, I had become increasingly aware that every hour we did not act meant more death and disease—and I could […] The post Skeptics in the Pub.

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Igniting Human Understanding: Cami Mitelman

NRC Health

You may not immediately see the connection between running ultramarathons in the mountains and leading a product innovation team, but to Jon Tanner, Product Leader, the parallels are obvious. Both involve setting ambitious goals, overcoming obstacles, and finding fulfillment in testing limits. The post Igniting Human Understanding: Cami Mitelman appeared first on NRC Health.

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