Sat.Feb 10, 2024 - Fri.Feb 16, 2024

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Nail In The Neck: A Novel Removal Option

The Trauma Pro

Here’s a post from my archive describing a different way to remove the foreign body. This is the technique I used, instead of the standard neck incision. The final incision was just a slight extension of the puncture wound, measuring only 1cm. I was able to grasp the head and pull it out without difficulty. The surprising thing to me was the amount of force I needed to apply to actually pull it out!

Wellness 147
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Yet more evidence that we physicians need to clean up our act

Science Based Medicine

A recent study found that physicians and scientists who are perceived as "experts" are prevalent within the antivax community and more influential because of their status as physicians and scientists. Why do physicians continue to tolerate antivax quacks within our ranks? The post Yet more evidence that we physicians need to clean up our act first appeared on Science-Based Medicine.

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The NICO Trial: NIV in Comatose Patients with Acute Poisoning

RebelEM

Background: Patients with decreased level of consciousness due to alcohol, drugs, or medications commonly present to the ED. These patients can be at risk of vomiting and aspiration and often prompts clinicians to pursue definitive airway management to avoid pneumonia and other complications. It is unclear, though, if the risks of intubation (including ventilator associated pneumonia) outweighs the benefits.

Poisoning 132
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AJPH Highlights Health Worker Mental Health

NIOSH Science Blog

The American Journal of Public Health recently published a special supplement with 15 articles focusing on health worker mental health. This special issue of the journal was sponsored and edited by the National Institute for Occupational Safety and Health (NIOSH) and stems from the health worker mental health initiative from the Centers for Disease Control and Prevention and NIOSH.

Research 123
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Nail In The Neck: The Operation

The Trauma Pro

We’ve made sure that our victim of the nail gun to the neck did not need an emergent operation. Vitals are stable, there’s no uncontrolled hemorrhage, and the patient is neurologically intact. We’ve imaged him using CT angiography, and the nail does not appear to have injured any vital structures. How do we get it out of there? There are two things that need to be considered: where and how.

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Ketamine and Etimodate: Into the Void

EM Ottawa

We’re increasingly cognizant of the physiological importance of maintaining specific hemodynamics during resuscitation. Practice patterns vary broadly, so we’ve done a deep dive into the various evidence around the use of ketamine and etomidate in specific clinical scenarios. Physiology of the rapid sequence intubation Rapid sequence intubation (RSI) is the nearly simultaneous administration […] The post Ketamine and Etimodate: Into the Void appeared first on EMOttawa Blog.

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A young man with persistent palpitations

Dr. Smith's ECG Blog

Written by Pendell Meyers A teenager was playing basketball when he suddenly developed palpitations and lightheadedness. He presented soon afterward at the Emergency Department with ongoing symptoms. Mentation and blood pressure were normal. He had no chest pain or shortness of breath. Heart rates on the monitor fluctuated from 180-250 bpm. Here is his triage ECG: What do you think?

EKG/ECG 118

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SGEM#430: De Do Do Do, De Dash, Dash DAShED – Diagnosing Acute Aortic Syndrome in the ED.

The Skeptics' Guide to EM

Reference: McLatchie et al and DAShED investigators. Diagnosis of Acute Aortic Syndrome in the Emergency Department (DAShED) study: an observational cohort study of people attending the emergency department with symptoms consistent with acute aortic syndrome. EMJ Nov 2023. Date: February 11, 2024 Guest Skeptic: Nirdosh Ashok Kumar, Emergency Medicine Specialist – Aga Khan University Hospital, Karachi, Pakistan. […] The post SGEM#430: De Do Do Do, De Dash, Dash DAShED – Diagnosing Acute Aortic Sy

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Mayo Clinic Promotes Reiki

Science Based Medicine

The Mayo Clinic is a prestigious medical institution with a deserved international reputation. It also promotes rank pseudoscience. It does this, apparently, for all the reasons we have explored here at SBM over the years. I have seen first hand how one or a few true believers can promote so-called alternative medicine at their institutions, meeting little resistance from colleagues and administrators […] The post Mayo Clinic Promotes Reiki first appeared on Science-Based Medicine.

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ECG Cases 48 – ECG Interpretation in Cardiac Arrest

Emergency Medicine Cases

In this month's ECG Cases blog Dr. Jesse McLaren reviews interpretation of the pre-arrest ECG: identifying high risk ECGs requiring empiric treatment like calcium for hyperkalemia, magnesium for long QT, or reperfusion for Occlusion MI; the intra-arrest ECG: identifying pseudo-PEA; and post-arrest ECG: the importance of serial ECGs to reduce false positive STEMI, role of POCUS to help with the differential of diffuse ST depression with reciprocal ST elevation in aVR, and identifying signs of Occ

EKG/ECG 108
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Genitourinary symptoms in younger children

Don't Forget the Bubbles

Topic Paediatric Genitourinary Presentations Author Helena Winstanley and Tara George Duration Up to 2 hrs Facilitator Level ST4 and above Learner level FY1 and above (can be adapted depending on the level) Outline Pre-reading Basics Case 1 Case 1: Discussion Case 2 Case 2: Discussion Advanced Case 1 Advanced Case 1: Discussion Advanced Case 2 Advanced Case 2: Discussion Quiz Basics (10 mins) Main session : (2 x 15 minute) case discussion covering the key points and evidence including an optiona

Wellness 105
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Jo's Journey: Leading Healthcare Staffing as CFO with CoreMedical Group

Core Medical Group

Introducing Jo Newell, Chief Financial Officer at CoreMedical Group. This feature branches off from our Friday's Finest, where we previously showcased our exceptional recruiters. Now, we're shifting gears to shine a light on our executive team. With a tenure of 15 years at CMG, Jo offers valuable insights on her path into the field and her journey to becoming CFO.

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ABG Versus VBG in the Emergency Department

EMDocs

Authors: Rachel Kelly, MD ( EM Resident Physician, Stony Brook University Hospital); Robert Nocito, MD (EM Attending Physician, Stony Brook University Hospital) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University in St. Louis); Marina Boushra, MD (EM-CCM, Cleveland Clinic Foundation); Brit Long, MD (@long_brit) Case Emergency Medical Services brings in a 62-year-old male with COPD in acute on chronic hypoxemic respiratory failure (usually on 3 L nasal cannula, now o

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The invisible link: viruses and cancers

Emergency Live

We explore how some viruses may be causing cancer diseases and what are the prevention strategies The Connection Between Viruses and Cancer Research has shown that some viruses, known as oncoviruses, can contribute to the development of tumors in various organs of the human body. Among these, the human papillomavirus (HPV) is the most well-known […] The post The invisible link: viruses and cancers appeared first on Emergency Live.

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Ultrasound of the Month: Peritonsillar Abscess

Taming the SRU

THE CASE A female in her 20’s presented to the emergency department with concern for oral swelling. She had previously been evaluated at an outside facility for sore throat and was subsequently diagnosed with acute pharyngitis and left tonsillar hypertrophy. She was placed on a course of antibiotics and sent home, however, she continued to have worsening throat pain and edema of her left tonsil with associated difficulty swallowing.

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Adios Aduhelm

Science Based Medicine

The controversial and never-proven-effective drug to treat Alzheimer's disease, aducanumab (Aduhelm) has been discontinued. The post Adios Aduhelm first appeared on Science-Based Medicine.

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ToxCard: Anticholinergic Plant Toxicity

EMDocs

Authors: Angela Pikus, MD Emergency Medicine Resident, Atrium Health’s Carolinas Medical Center); Christine Murphy, MD (Emergency Medicine Attending, Medical Toxicologist, Atrium Health’s Carolinas Medical Center) // Reviewed by: Anthony Spadaro, MD (@TSpadaro91, Medical Toxicology Fellow, Rutgers New Jersey Medical School, Newark, NJ); James Dazhe Cao, MD (@JamesCaoMD, Associate Professor of EM, Medical Toxicology, UT Southwestern Medical Center, Dallas, TX); Alex Koyfman, MD (@EMHighAK); Brit

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Zika in Europe: an underestimated emergency?

Emergency Live

Between Climate Change and Health Risks The Zika alarm has brought attention back to the growing concern for vector-borne diseases in Europe, with a particular focus on the risks that the Zika virus poses to the continent. Originally identified in Uganda in 1947, the Zika virus has spread significantly in various regions of the world, […] The post Zika in Europe: an underestimated emergency?

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Dear Colleagues. Wake Up, You Are Being Used

Stop and Think

I really don’t like scolds. I have hesitated to write this short piece because it makes me seem like a scold. But I can’t help myself. This week I saw on my Facebook feed a picture celebrating the 500th implant of a preventive cardiac device. The picture featured smiling doctors and super-happy industry reps. The writer expressed happiness that they had helped so many people.

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No, you don’t need to order an MRI in first episode psychosis

First 10 EM

Usually, I reserve stand alone blog posts for high quality papers. Usually, garbage science is either ignored, or reserved for brief mentions in the Research Roundups. However, the conclusion of this paper, which states “it is becoming increasingly difficult to justify not making MRI a mandatory part of the clinical assessment of [first episode psychosis]”, […] The post No, you don’t need to order an MRI in first episode psychosis appeared first on First10EM.

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Ep 191 The Future of EM – Systems Thinking

Emergency Medicine Cases

In order fix EM, each of us needs to understand systems issues and systems thinking, and advocate for a better system based on sound systems principles and specific solutions. In this main episode EM Cases podcast Anton is joined by Dr. Alecs Chochinov and Dr. Davie Petrie, two systems thinkers and leaders in EM. They discuss solutions for how to fix EM in 5 spheres: having a coordinated mission, optimizing access points, accountability, disaster preparedness and adaptation/evolution.

EMS 78
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Disasters Expo USA

Emergency Live

March 6th & 7th, 2024 – Miami Beach Convention Center Emergency Live is proud to partner with Disasters Expo USA this year! The global event for mitigating the world’s most costly disasters is coming to the Miami Beach Convention Center on March 6th & 7th and we are excited to offer special access for our […] The post Disasters Expo USA appeared first on Emergency Live.

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Vomiting, Diarrhea, and "Bubbles in my Chest"

Dr. Smith's ECG Blog

A 60-something complained of vomiting, diarrhea overnight, and "bubbles in my chest" that started just prior to calling 911. He had this ECG recorded prehospital: Smith interpretation: There are hyperacute T-waves in III and aVF, and reciprocal STD in aVL with a reciprocally inverted T-wave in aVL. There are also hyperacute T-waves in V3 and V4. There is STD in V1 and V2.

EKG/ECG 77
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Music for Reducing Pain in Newborns

Science Based Medicine

Newborns are exposed to painful procedures for good reason every day. Treating pain is important in this population, and music might play a role. At least it definitely won't hurt. The post Music for Reducing Pain in Newborns first appeared on Science-Based Medicine.

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Annals of B Pod: Anti-Xa Overdose

Taming the SRU

HISTORY OF PRESENT ILLNESS A female in her 30s arrives to the emergency department via emergency medical services. Per report, she called to declare ingestion of an unknown amount of several medications (possibly insulin, antihypertensives, and anticoagulants) in an attempt for self-harm. She initially agreed to be transported to the hospital by ambulance, but jumped from the moving vehicle and was subsequently struck and pinned under the fuselage for 10-15 minutes.

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The science of love: what happens on Valentine's Day

Emergency Live

On the day dedicated to lovers, let’s find out together what happens in our bodies and brains when love knocks on the door Valentine’s Day: The Chemical Catalyst of Love February 14 isn’t just a date on the calendar reserved for exchanging chocolates and romantic declarations. Valentine’s Day acts as an emotional and chemical catalyst, […] The post The science of love: what happens on Valentine's Day appeared first on Emergency Live.

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A Note On Criticism Of Yesterday's Study of the Week

Sensible Medicine

Yesterday, someone made an error on the Internet. And I think it was me. Here is a link to my take of the ARCADIA trial. In brief, the trial compared apixaban vs aspirin in patients who had had a stroke of unknown source and evidence of atrial cardiopathy. The trial was stopped early for futility. Recurrent stroke (the primary endpoint) occurred in 40 patients in each group.

Stroke 70
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emDOCs Podcast – Episode 95: The Metric That Really Matters

EMDocs

Today on the emDOCs cast we have back Rob Orman, MD ( @emergencypdx ). Emergency Physician and founder of Orman Physician Coaching Host of the Stimulus Podcast Learn more at roborman.com Rob and several other amazing clinicians and educators are putting on Awake and Aware , a 3 day conference May 1-3 in Bend Oregon. A 3-day interactive workshop focusing on skills to thrive in your incredibly demanding job (and life).

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Hypertrophic Cardiomyopathy Part 2: Workup and Treatment

Kings County Downstate EM

Co-authors: Taylor Murtaugh MD, Esteban Davila MDWe're back after a quick hiatus for part 2. You can find part 1 here.The Case ContinuedHistory and PhysicalWhen suspecting HCM, the history should focus on overall fitness as well as adverse responses to exertion such as chest pain, shortness of breath, palpitations, and syncope. […] The post Hypertrophic Cardiomyopathy Part 2: Workup and Treatment appeared first on County EM.

EMS 75
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SXSW Health and MedTech Track 2024: Innovation and Health

Emergency Live

A must-attend event for healthcare and technology professionals and enthusiasts An Innovation Showcase The 2024 edition of the SXSW Health and MedTech Track emerges as an essential meeting point for those seeking the latest advancements and future perspectives in the healthcare and medical technology sector. This event, taking place from March 8th to 12th in […] The post SXSW Health and MedTech Track 2024: Innovation and Health appeared first on Emergency Live.

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Skeptics in the Pub. Cholera. Chapter 9b

Science Based Medicine

“You are here early,” he said. “Yeah. I’m trying to decide what to do about this pump and the seawater cure. So far, my attempts are falling flat.” I told him about the couple pumping water and my lack of success in stopping them from taking the water home. “No surprise,” said Bonham. “Water is supposed to be as safe as mothers” […] The post Skeptics in the Pub.

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SAEM Clinical Images Series: An Ultrasonographic Rabbit Hole

ALiEM

An 86-year-old man with a past medical history of coronary artery disease, hypertension, hyperlipidemia, chronic kidney disease, COPD, choledocholithiasis requiring ERCP and sphincterotomy 2 years ago presented with five days of feeling unwell. History was limited due to cognitive impairment. His daughter had reported to staff he had been feeling unwell for five days, intermittently having nausea and generalized abdominal pain, subjective fevers, chest pain, and shortness of breath.

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Pediatric Collab Preview | AI and tech: Friend or foe of the healthcare experience?

NRC Health

The NRC Health 2024 Pediatric Collaborative is truly a can’t-miss experience, with exceptional presentations that will stir innovative ideas. Check out a preview of one of the sessions! The post Pediatric Collab Preview | AI and tech: Friend or foe of the healthcare experience? appeared first on NRC Health.

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A united front against cancer in children

Emergency Live

Politicians, doctors, and experts mobilize on World Day Against Pediatric Cancer The reality of pediatric cancer Pediatric cancer represents a heterogeneous group of oncological diseases that affect children and adolescents. Unlike tumors that develop in adults, pediatric cancers often arise from cells that grow and divide rapidly. These diseases require specific therapeutic approaches tailored to […] The post A united front against cancer in children appeared first on Emergency Live.

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Conjunctivitis in kids

Don't Forget the Bubbles

It’s a classic presentation. Your patient is a toddler with a sticky red eye that – despite their parent’s best efforts to pull their hands away from their face – they cannot help but rub. Their parent is asking you if it’s contagious and if they need antibiotics. Conjunctivitis: An overview Conjunctivitis, inflammation of the conjunctiva, is characterised by infection or inflammation of the conjunctiva.

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See What PM Cardio Digitization can do with this ECG

Dr. Smith's ECG Blog

This was a patient with chest pain. The ECG was faxed to a cardiologist. But it was very difficult for him to see. He showed this to me the next day.

EKG/ECG 61
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Dr. Mike’s perspectives on how to ignite a better patient experience

NRC Health

Patients are demanding more from their healthcare experiences than ever before, but in the face of mounting pressures, meeting expectations may feel like a daunting task for care teams. The post Dr. Mike’s perspectives on how to ignite a better patient experience appeared first on NRC Health.