Sat.Feb 24, 2024 - Fri.Mar 01, 2024

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ECG Blog #419 — The Cause of ECG #1?

Ken Grauer, MD

I was sent the 2 ECGs shown in Figure-1 — which were recorded from an elderly man whose heart beat "has been irregular for years". No clear history for recent chest pain — but the patient "has not been well" for the previous week. Regarding the 2 ECGs in Figure-1 : ECG #1 is the initial tracing obtained at the scene by the EMS ( E mergency M edical S ystems ) team — in association with an alert but markedly hypotensive patient.

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Giving TXA Via An Intraosseous Line?

The Trauma Pro

Seriously injured patients frequently develop coagulopathy, which makes resuscitation (and survival) more challenging. A few years ago, the CRASH-2 study lent support for using tranexamic acid (TXA) in select trauma patients to improve survival. This drug is cheap and has antifibrinolytic properties that may be beneficial if given for life-threatening bleeding within 3 hours of initial injury.

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Lung Abscess in Children

Pediatric EM Morsels

We have digested many Morsels regarding various pulmonary complaints. While some are very rare (ex, Pulmonary Embolism , Pulmonary Hypertensive Crisis , Negative Pressure Pulmonary Edema , CPAM ) others are commonly encountered (ex, Croup , Bronchiolitis , Sinusitis ). It is pneumonia , however, that often generates the most conversations. When should I consider a CXR ?

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How antivaxxers weaponize vaccine safety studies to falsely portray vaccines as dangerous

Science Based Medicine

Antivaxxers have weaponized a huge multinational vaccine safety study of 99 million patient records that found rare adverse events and concluded that the benefits of COVID-19 vaccines outweigh the risks. How? A combination of the Nirvana fallacy and spin. The post How antivaxxers weaponize vaccine safety studies to falsely portray vaccines as dangerous first appeared on Science-Based Medicine.

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Decompensated. Liver disease in the ED. St Emlyn’s

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed A review of Acute on Chronic Liver Disease (ACLD / decompensated liver disease) in the ED. How we can improve patient outcomes. #FOAMed @stemlyns The post Decompensated. Liver disease in the ED. St Emlyn’s appeared first on St.Emlyn's.

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Air Embolism From an Intraosseous (IO) Line

The Trauma Pro

Intraosseous (IO) lines are a godsend when we are faced with a patient who desperately needs access but has no veins. The tibia is generally easy to locate and the landmarks for insertion are straightforward. They are so easy to insert and use, we sometimes “set it and forget it”, in the words of infomercial guru Ron Popeil. But complications are possible.

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From Guideline Recommendations to Articulated Harms and Benefits

Sensible Medicine

In the ideal, clinical guidelines incorporate evidence and expert opinion and enable clinicians to make evidence-based decisions without having to read the primary literature. These guidelines serve as an authority, defining high-quality care and how medical care should be delivered. Clinical guidelines have potential benefits: improved health outcomes, consistency of care, and reduced uncertainty (for the clinician).

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More Evidence that Ignoring Safe Sleep Advice Puts Babies at Risk of Unexpected Death

Science Based Medicine

A new stud of thousands of cases confirms that sharing a sleep surface with a caregiver significantly increases the risk of unexpected death in infancy. The post More Evidence that Ignoring Safe Sleep Advice Puts Babies at Risk of Unexpected Death first appeared on Science-Based Medicine.

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EM Quick Hits 55 – Induction Agents, Gabapentinoids, Neuroprotective Intubation, Approach to Paresthesias, Preventing Burnout

Emergency Medicine Cases

Anand Swaminathan on an update on the appropriate selection of induction agents. Hans Rosenberg on when to use gabapentinoids for pain control in the ED. Katie Lin on pearls for neuroprotective intubation. Nour Khatib and Hamza Jalal on an approach to paresthesias in the ED. Eric Wortmann on preventing burnout in emergency medicine. Please support EM Cases with a donation [link] The post EM Quick Hits 55 – Induction Agents, Gabapentinoids, Neuroprotective Intubation, Approach to Paresthesi

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The ISEMPH abstract deadline is Friday, March 1

The Evolution & Medicine Review

Abstracts for the 9th annual meeting of the International Society for Evolution, Medicine, and Public Health are welcome for talks, posters, discussions and symposia. But the deadline is looming! Friday, March 1 is the deadline for abstract submissions for ISEMPH2024!

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Protecting the Well-being of the Nation’s Health Workforce

NIOSH Science Blog

The American Journal of Public Health recently published a special supplement with 15 articles focusing on health worker mental health. As part of this special issue, our article Protecting the Mental Health and Well-being of the Nation’s Health Workforce summarizes the scope of the issue and prevention efforts underway at the Centers for Disease Control and Prevention (CDC) and the National Institute for Occupational Safety and Health (NIOSH).

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Quality differences of supplements vs. drugs

Science Based Medicine

When it comes to drugs or dietary supplements, accuracy should be a given. What’s on the label should accurately describe what’s in the bottle. No exceptions. When it comes to ensuring the products we buy are of high quality, we’re all effectively reliant on regulation to protect us. As a pharmacist, I can’t personally verify that each tablet in your prescription contains […] The post Quality differences of supplements vs. drugs first appeared on Science-Based Medicine.

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The World of Ambulances: Types and Innovations

Emergency Live

An Overview of Different Types of Ambulances in Europe and Their Functionalities The Diverse Faces of Rescue: Ambulances A, B, and C The ambulance service is a fundamental pillar of the healthcare emergency system, with ambulances classified into three main categories: Type A, B, and C. Type A ambulances are essential for first aid, ready […] The post The World of Ambulances: Types and Innovations appeared first on Emergency Live.

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Paediatric IV Fluid Prescribing

Mind The Bleep

Prescribing fluids in paediatrics is simple but there is a system to it that you will need to learn if you have not worked in paediatrics before. This article breaks it down for you with examples of IV fluid prescribing. Please see this separate article for fluids and feeds in neonates. The important thing to remember is that children are not just small adults.

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"Seizure" in a 60 year old male

Dr. Smith's ECG Blog

This 60 yo male had an apparent tonic clonic seizure. He had no history of seizures. He was unconscious for 8 minutes and slowly awoke in the ambulance, complaining of nausea only. First responders found him to be very tachycardic , confused, perserverating and with no memory of the event. There was tongue biting. Lightheadedness continued. The tachycardia was gone by the time paramedics arrived.

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What Is Somatic Therapy?

Science Based Medicine

Is modern medicine descending into pseudoscience, or is scientific medicine still going strong? Unfortunately, I think both of these things can happen at the same time. On the one hand, scientific research in medicine is progressing nicely. We are seeing the results of scientific breakthroughs made decades ago, with monoclonal antibody therapies, new therapeutic targets, the beginning of real genetic therapy, brain-machine […] The post What Is Somatic Therapy?

Research 101
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85 years of dedication: the anniversary of the Italian Firefighters

Emergency Live

A Celebration of Courage, Innovation, and Community Commitment From Origins to Modernity: A Journey of Heroism The 85th anniversary of the Italian Firefighters marks a significant milestone in the history of one of the country’s most respected and beloved corps. Officially established in 1939, the Italian Firefighters have traversed decades of national history, evolving from […] The post 85 years of dedication: the anniversary of the Italian Firefighters appeared first on Emergency L

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I Am Afraid of Early Cancer Screening: Part III

Sensible Medicine

I can’t stand celebrity doctors. That said, I am kind of a fan of Peter Attia. This is an accomplishment for Dr. Attia because one of my criteria for calling someone a celebrity doctor is that I can’t stand them. I appreciate Dr. Attia because he’s a smart guy who seems much more interested in improving people’s lives than hawking his wares.

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Global Health map – connecting UK emergency care practitioners

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed In our modern world global health is vitally and increasingly important. Anisa Jafar takes us through a project designed to connect and map global health practitioners. Follow the links and join the network. The post Global Health map – connecting UK emergency care practitioners appeared first on St.Emlyn's.

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Exploring the Benefits: Why Nurses Should Consider Working With One Healthcare Staffing Agency

Core Medical Group

Navigating the complexities of the travel healthcare industry can feel daunting, given the abundance of staffing agencies available. Nurses choose to travel for various reasons. The main appeal of travel nursing is the freedom it provides, enabling nurses to determine their work locations and schedules.

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The evolution of operations centers in emergencies

Emergency Live

A journey through emergency management in Europe and the crucial role of emergency call centers Emergency call centers represent the cornerstone of crisis response, serving as the first point of contact for citizens in distress. Their role is of vital importance to ensure effective emergency management, coordinating available resources and directing field interventions.

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Pneumocystis jirovecii Pneumonia and HIV: A Practical Guide for ED Diagnosis and Management

EMDocs

Authors: Kamoga Dickson, MD (EM Resident Physician, Makerere University of Health Sciences); Jessica Pelletier, DO (EM Education Fellow, Washington University in St. Louis) // Reviewed by: Joshua Lowe, MD (USAF Physician); Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case A 42-year-old female with advanced acquired immunodeficiency syndrome (AIDS) presents to the Emergency Department (ED) with two weeks of progressive dyspnea that worsens with exertion, associated with a dry cough an

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CPD update for UoT CPD conference, Whistler 2024. St Emlyn’s

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed Key papers from the university of toronto CPD update in emergency medicine Whistler 2024 #uoftem24 #FOAMed #EBM #EM @stemlyns @davidcarr333 The post CPD update for UoT CPD conference, Whistler 2024. St Emlyn’s appeared first on St.Emlyn's.

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The First10EM monthly wrap-up for February 2024

First 10 EM

The First10EM monthly wrap up is a place for me to share updates about the website, about my academic life, and also interesting content, such as books, podcasts, and other FOAMed, that I have encountered in the prior month. Obviously the format means the focus is mostly on content I have found, but I hope […] The post The First10EM monthly wrap-up for February 2024 appeared first on First10EM.

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Hildegard of Bingen: pioneer of medieval medicine

Emergency Live

An Legacy of Knowledge and Care Hildegard of Bingen, an eminent figure of the Middle Ages, left an indelible mark in the field of natural sciences with an encyclopedic treatise encompassing the medical and botanical knowledge of the time. Her works, “Physica” and “Causae et curae“, represent pillars of medieval medicine, providing detailed descriptions of […] The post Hildegard of Bingen: pioneer of medieval medicine appeared first on Emergency Live.

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Grand Rounds Recap 2.14.24

Taming the SRU

ENRICH Trial - the leadership journey - EMS grand rounds - r4 capstone - r1 clinical knowledge - pediatric lecture ENRICH Trial WITH visiting professor Dr. david wright ICH makes up only 10-15% of all strokes yet has a higher mortality than ischemic strokes and SAH Current 2022 AHA/ASA guidelines for spontaneous ICH (prior to ENRICH Trial) minimally-invasive evacuation may reduce mortality compared to medical management it may be reasonable to choose minimally-invasive evacuation over convention

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St Emlyn’s podcast round up January 2024.

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed Our regular podcast round up with @docib and @emmanchester of the best of the blog from January 2024. This month we focus on habits, the management of the comatose overdose patient and retention/recruitment issues in UK emergency medicine. #foamed @stemlyns The post St Emlyn’s podcast round up January 2024. appeared first on St.Emlyn's.

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The Research Roundup (February 2024)

First 10 EM

Welcome back to another edition of the research roundup, where we discuss an eclectic collection of articles selected through the very rigorous process of whatever I happened to find interesting in my recent reading. The BroomeDocs podcast version can be found here: [link] Putting nail bed repair to bed? Jain A, Greig AVH, Jones A, […] The post The Research Roundup (February 2024) appeared first on First10EM.

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Adrenaline: The Life-Saving Drug in Medical Emergencies

Emergency Live

A Crucial Ally Against Severe Allergic Reactions Adrenaline, also known as epinephrine, plays a vital role in the human body, preparing it to respond quickly to stressful or dangerous situations. This substance, naturally produced by the adrenal glands, speeds up the heart rate, dilates the airways, and increases blood flow to the muscles, providing crucial […] The post Adrenaline: The Life-Saving Drug in Medical Emergencies appeared first on Emergency Live.

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The Story of IV-Insulin after MI

Sensible Medicine

I will show you a glaring example of how even investigators miss (or ignore) obvious uncertainty. The intervention in question is the aggressive control of blood sugar in patients with diabetes who present with an acute myocardial infarction. Most know that subcutaneous insulin is a common way to control blood sugar in some patients. But in the hospital, we can be more aggressive and use IV insulin infusions, which allow tight control of glucose levels.

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ECG Pointers: Ashman’s Phenomenon

EMDocs

Authors: Rachel Bridwell (Attending EM Physician); Brannon Inman, MD (EM Crit Care, Orlando Health); Lloyd Tannenbaum (Staff Physician, Hackensack University Medical Center) // Reviewed by: Jamie Santistevan, MD ( @jamie_rae_EMdoc, EM Physician, Presbyterian Hospital, Albuquerque, NM); Manpreet Singh, MD ( @MPrizzleER ); Brit Long, MD ( @long_brit ) Case: You’re working on shift and the nurses hand you an ECG asking what you want for rate control on this: Do you think this is atrial fibrillatio

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SAEM Clinical Images Series: Neonatal Rash

ALiEM

An 18-day-old male presented for a rash on his face for two days. The patient was born via spontaneous vaginal delivery full term without complications to a mom who has a history of genital HSV but without active lesions at delivery and on acyclovir. The patient presented with a vesicular rash on his face including around his eyes. He had conjunctival discharge noted by mom.

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Revolution in the Skies: The New Frontier of Air Rescue

Emergency Live

With the purchase of 10 H145 helicopters, DRF Luftrettung marks a new era in medical rescue The Evolution of Air Rescue Air rescue represents a crucial component in emergency services, offering a rapid response in critical situations where every second counts. Helicopters, with their ability to land and take off vertically, access remote locations, and […] The post Revolution in the Skies: The New Frontier of Air Rescue appeared first on Emergency Live.

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NIV for status asthmaticus

Don't Forget the Bubbles

Non-invasive BiPAP can be a successful ventilation strategy for status asthmaticus, removing the need for intubation and the complications associated with this. A 6-year-old known asthmatic presents to ED with a two-day history of cough and coryza, worsening wheeze and work of breathing over the last day. He is usually managed with beclomethasone twice daily and salbutamol as needed.

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Medical Malpractice Insights: Excellent documentation supports standard of care and avoids lawsuit

EMDocs

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. The goal of MMI-LFL is to improve patient safety, educate physicians and reduce the cost and stress of medical malpractice lawsuits. To opt in to the free subscriber list, click here. Stories of med mal lawsuits can save lives.

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EMCrit 369 – Iodinated Contrast Issues: Part 1 – Is Contrast-Induced Nephropathy (CIN) a Thing in Patients with Tenuous Renal Function

EMCrit

Do you still need to worry about contrast in patients with tenuous renal function? EMCrit Project by Scott Weingart, MD FCCM.

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Revolutionizing Airport Firefighting: Munich's Panther Trucks and Allison Transmissions

Emergency Live

Speed, Precision, and Power: How Munich Airport’s Firefighting Fleet Sets New Standards in Emergency Response At Munich Airport, Germany’s second-largest airport, a new era of firefighting is underway with the deployment of four Rosenbauer Panther 8×8 vehicles. These giants, weighing 52 tons each, are equipped with two Allison fully automatic transmissions, enabling them to reach […] The post Revolutionizing Airport Firefighting: Munich's Panther Trucks and Allison Tr

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