The Trauma Pro
OCTOBER 23, 2023
Look out, radiologists! The computers are coming for you! Radiologists use their extensive understanding of human anatomy and combine it with subtle findings they see on x-ray shadow pictures. In doing this, they can identify a wide variety of diseases, anomalies, and injuries. But as we have seen with vision systems and game playing (think chess), computers are getting pretty good at doing this as well.
Ken Grauer, MD
OCTOBER 21, 2023
The ECG in Figure-1 is from an older man with known coronary disease — who presents to the ED ( E mergency D epartment ) with new CP ( C hest P ain ) over the past several days. Troponin is pending. QUESTIONS: In view of this history — How would you interpret the ECG in Figure-1 ? Should the cath lab be activated? Figure-1: The initial ECG in today's case.
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Pediatric EM Morsels
OCTOBER 27, 2023
Taking care of a critically ill child can be nerve-racking to say the least, and downright petrifying for those who don’t do it frequently, even if they are well-trained and brilliant clinicians. Dr. James Broselow, a family medicine-turned-emergency medicine physician from Hickory, North Carolina , recognized that his team spent a lot of time trying to calculate doses of medications rather than spending their mental energy on the actual medical decisions for the resuscitation.
Science Based Medicine
OCTOBER 23, 2023
Tech bro turned antivax influencer Steve Kirsch is claiming that Michigan State University economist Mark Skidmore has been "exonerated" after having had a paper retracted claiming 278K deaths from COVID-19 vaccines in 2021 alone. In reality, Skidmore just republished a revised version of his retracted paper in an antivax journal after the MSU IRB failed miserably in its oversight duties.
ACEP Now
OCTOBER 26, 2023
Maryland enacted the first “prudent layperson standard” (PLP) in state law in 1993 (see related timeline). The PLP standard they devised protected a patient’s access to emergency medical services, including on-call services, if the medical condition of the patient manifests itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson could reasonably expect that the absence of immediate medical attention could result in serious jeopardy to the health of t
Don't Forget the Bubbles
OCTOBER 25, 2023
A 3-year-old girl presents with acute onset convergent strabismus. Fundoscopy examination reveals papilloedema. What are the next steps in the management of their daughter? First thoughts – is this a space-occupying lesion? If you haven’t seen it already, please check out HeadSmart. It details presentations commonly associated with a brain tumour in each age group.
EMCrit
OCTOBER 26, 2023
Some folks on twitter asked my thoughts on AMIKINHAL trial, so I thought I'd jot them here. AMIKINHAL is a multi-center RCT that evaluated the ability of inhaled amikacin to prevent VAP (ventilator-associated pneumonia) among patients who had been intubated for three days. It's available here at NEJM. It was a positive trial, which is […] EMCrit Project by Josh Farkas.
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The Skeptics' Guide to EM
OCTOBER 21, 2023
Date: October 20, 2023 Reference: Cai et al. Implementation of a Clinical Management Tool for Spinal Epidural Abscess Early Diagnosis. AEM October 2023. Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Case: You are in your group meeting and have heard about a case at a nearby emergency department (ED) where the […] The post SGEM#418: I Ain’t Missing You – Spinal Epidural Abscess first appeared on The Skeptics Guide to Emergency Medicine.
EM Ottawa
OCTOBER 26, 2023
You are seeing your next patient in urgent care, a 35-year-old female with a wrist injury who has been waiting for 6-hours. After sending her for an x-ray and offering pain control in the ED, she tells you she is 3-months post-partum and is currently nursing. She asks if there are any pumps available in […] The post Lactation – A brief guide for the emergency provider appeared first on EMOttawa Blog.
EMCrit
OCTOBER 24, 2023
More guidelines! Today we'll walk through some interesting bits of the new IDSA/SCCM guideline on evaluation of new fever in the adult ICU patient (available free here). how should temperature be evaluated? This is frankly a mess. Bladder catheter or esophageal probe are best, but usually not used. Rectal temperature is 2nd best, but unwieldy […] EMCrit Project by Josh Farkas.
Science Based Medicine
OCTOBER 27, 2023
Are men who grow a beard next month at risk of neck injuries caused by chiropractic subluxations? Of course they are. And what about those leftover pandemic beards? Shave. Shave now! This is definitely a real problem. I mean, I can't just make something up.on the internet. The post Science-Based Satire: Chiropractors Brace for November Neck Pain Tsunami first appeared on Science-Based Medicine.
The Bottom Line
OCTOBER 23, 2023
In trauma patients with exsanguinating haemorrhage, does the use of the REBOA (resuscitative endovascular balloon occlusion of the aorta) device with standard care in the emergency department, compared with standard care alone, impact 90-day-mortality?
ALiEM
OCTOBER 27, 2023
A 26-year-old male with no significant past medical history presented to the ED after slipping on wet pavement and hitting his head on the ground three hours prior. He endorsed a constant, achy 7/10 headache accompanied by nausea and photophobia. He denied vomiting, dizziness, diplopia, loss of consciousness, or seizures. Nothing made it better or worse.
Dr. Smith's ECG Blog
OCTOBER 23, 2023
Written by Michael Doyle DO and Timothy Palmieri MD. Edited by Bracey, Meyers, Grauer, and Smith A 50-something-year-old female with a history of an unknown personality disorder and alcohol use disorder arrived via EMS following cardiac arrest with return of spontaneous circulation. The described rhythm was an irregular, wide complex rhythm. By EMS report, open pill bottles were found nearby at the scene, including quetiapine, fluoxetine, hydroxyzine, and gabapentin.
Science Based Medicine
OCTOBER 25, 2023
Large study finds association of red meat consumption and type II diabetes - but the data needs to be put into perspective. The post Study Correlates Red Meat Consumption and Type II Diabetes first appeared on Science-Based Medicine.
Emergency Live
OCTOBER 26, 2023
An engineering masterpiece that marked an important turning point in the history of Italian ambulances The Fiat 238 Autoambulanza “Unificata,” known for its refined Fiat/Savio evolution, represents a crucial chapter in the history of ambulances in Italy. This model marked Fiat’s first significant attempt to enter the market for Mobile Resuscitation Units, a sector until […] The post Fiat 238 Autoambulance "Unified" appeared first on Emergency Live.
ALiEM
OCTOBER 23, 2023
A 32-year-old man with a history of traumatic globe rupture from a stab wound two months ago, status post repair, presented to the emergency department for worsening right eye pain and green malodorous drainage for the past three days. These symptoms started when he got a fleck of sawdust in the right eye about four days prior to presentation, which he was able to brush out with his finger.
PulmCCM
OCTOBER 23, 2023
Piperacillin-Tazobactam vs. Cefepime for Kidney Injury and Neurologic Dysfunction (ACORN Trial) Piperacillin-tazobactam, marketed as Zosyn, has been one of the most-prescribed broad spectrum antibiotics for many years, used for its bactericidal activity against most gram-negative and anaerobic bacteria, including Pseudomonas. Cefepime has similar antibacterial activity, and both are widely used in the ICU as empiric coverage in patients with potentially serious gram-negative infections.
Medagadget
OCTOBER 26, 2023
Researchers at the University of Massachusetts Amherst have developed a new method of detecting very small amounts of DNA. The breakthrough could allow clinicians to spot genetic markers of disease at the point-of-care, as the approach does not require conventional laboratory analysis, which is usually time-consuming and costly. In fact, the approach has led to a 100-fold increase in DNA detection sensitivity, with no corresponding increase in cost.
Emergency Live
OCTOBER 27, 2023
ISO 9001 Certification to the Italian Red Cross: Recognition of Excellence in Volunteer Training and Commitment to Safety and Organizational Development Training is a fundamental pillar for any organization that aims to operate effectively and responsibly, especially when it comes to volunteerism and field assistance. In this context, the Italian Red Cross (ICRC) has reached […] The post CRI: Excellence in Training with ISO 9001 Certificate from CSQA appeared first on Emergency Live.
ECG Guru
OCTOBER 24, 2023
Why is this a left bundle branch block? We see a SR with broad QRS complexes (more than 120 ms). These are positive in the leftward leads I and aVL and in V5 and V6. In the more rightward leads III, aVR, and V1-V3, the QRS complexes are predominantly negative with deep S waves. This is a typical LBBB pattern.
Taming the SRU
OCTOBER 23, 2023
THE CASE A female in her early 20s, G4P2012, presents to the emergency department (ED) with a 5 day history of left lower quadrant abdominal pain which has been worsening since onset. She states her pain is similar to pain that she felt during a prior ectopic pregnancy. She reports that her previous ectopic pregnancy was treated medically. She has taken a home pregnancy test which was positive, and her last menstrual period was over one month ago.
Medagadget
OCTOBER 26, 2023
Researchers at Northwestern University have developed a sophisticated microfluidic system that incorporates tissue from up to eight different organ systems. The technology is unprecedented in allowing researchers to study complex interactions between different organs during disease. Moreover, it also allows for more comprehensive drug testing that investigates the effects of drug candidates on multiple organ systems at once.
Emergency Live
OCTOBER 24, 2023
Success for FormAnpas at Dallara Academy Headquarters: The “Rebirth” Edition After Pandemic On Saturday, October 21, Anpas Emilia-Romagna, the association that brings together 109 regional public assistance agencies, held its annual FormAnpas event at the extraordinary Dallara Automobili headquarters in Varano de’ Melegari, Parma. This edition was particularly significant, marking the revival of activities after […] The post FormAnpas 2023: the rebirth of public assistanc
Core Medical Group
OCTOBER 27, 2023
Meet Kara, a seasoned Travel Nurse Recruiter with 12 years of experience. Her journey is a combination of professional dedication and a passion for connecting with people. In this blog, we'll look into what inspired Kara to pursue a career in healthcare recruitment, her most memorable experiences, the qualities she values in healthcare candidates, her strategies for successful matches, and how she stays updated on industry trends.
Science Based Medicine
OCTOBER 26, 2023
An examination of COVID-19 vaccine refusal in Hong Kong suggests that fostering trust in health authorities, boosting confidence in vaccines, and combating misinformation are all necessary as we prepare for the next pandemic. The post COVID-19 Vaccination and Factors Contributing to Vaccine Refusal first appeared on Science-Based Medicine.
Medagadget
OCTOBER 23, 2023
Researchers at ETH Zurich in Switzerland have developed an alternative to injections as a way to deliver large drugs, such as peptides, minimally invasively into the blood stream. The suction cup created by these researchers is inspired by octopus suckers, and it affixes to the mucosal lining of the inside of the cheek. The cup stays in place because a vacuum is drawn when the patient presses it onto their cheek lining.
Emergency Live
OCTOBER 27, 2023
What to do after a flood: what to do, what to avoid, and Civil Defense advice The waters can mercilessly affect those around particular places with high hydrogeological risk, but it is not for nothing that we have to worry about what may happen. When the tragedy has passed, however, other questions must also be […] The post The aftermath of floods - what happens after the tragedy appeared first on Emergency Live.
RebelEM
OCTOBER 25, 2023
Take Home Points: A CCTA is an anatomic test to determine if a patient has normal coronary arteries, non-obstructive disease, or obstructive disease. The warranty period for a CCTA is anywhere from 3-10 years depending on the characteristics of the plaque. A nuclear stress test is a functional study that allows for ischemia-driven management. The warranty period of a nuclear stress test is 2 years.
Sensible Medicine
OCTOBER 26, 2023
Reading Vinay’s article last week called to mind one of my favorite articles. In 1999 I started teaching a course to 4 th year medical students called “Critical Appraisal of the Landmark Medical Literature.” The idea behind the course was simple. By the time a medical student has reached the 4 th year, he or she has learned from textbooks, review articles, and lectures.
Medagadget
OCTOBER 23, 2023
Researchers at MIT have developed an enhanced mRNA vaccine system that can elicit a greater immune response at lower doses. The vaccine technology is so potent that it may be useful for intranasal COVID-19 vaccines. This would have the benefit of localized immunity in the nasal mucus membranes that could kill the SARS-CoV-2 virus before it enters the body.
Emergency Live
OCTOBER 26, 2023
Red Cross offers a series of useful tips for parents to ensure the safety of children during Halloween festivities Halloween is fast approaching, and little superheroes, cartoon and TV show characters are about to invade neighborhoods in search of treats. It is a festive time eagerly anticipated by little ones, but it is also an […] The post Red Cross: Tips for Risk-Free Trick-or-Treating appeared first on Emergency Live.
Don't Forget the Bubbles
OCTOBER 23, 2023
A 5-month-old infant presents to the Paediatric ED. His parents have noticed that he has been making funny movements’ over the last few weeks. He has also seemed a bit more withdrawn and miserable. “Could it be colic? Or reflux?” they ask. This is a fairly common presentation with small babies. Determining what parents mean by ‘funny movements’ can be hard.
Life in the Fast Lane
OCTOBER 26, 2023
Kane Guthrie Impending Doom Cliff Reid starts us off on this series by looking at the patient that presents saying they're 'going to die' - "The Impending Doom Patient".
EMCrit
OCTOBER 21, 2023
We categorized intubation errors and published a paper about it. EMCrit Project by Scott Weingart, MD FCCM.
Emergency Live
OCTOBER 24, 2023
AirLink’s H125 helicopter provides inter-facility transfers and emergency assistance in a hard-to-reach area In the picturesque eastern Oregon town of Klamath Falls, small community life meets advanced health care thanks to AirLink, an air ambulance service that connects the quiet small-town lifestyle with large-scale medical care. Surrounded by the majestic Cascade Mountain Chains, forests and […] The post AirLink of Klamath Falls: first-level medical care in a remote community appe
EMDocs
OCTOBER 21, 2023
Author: Devin Morris, MD (EM Resident Physician, UTSW / Parkland Memorial Hospital); Colin Danko, MD (EM Attending Physician, UTSW / Parkland Memorial Hospital) // Reviewed by: Sophia Görgens, MD (EM Resident Physician, Zucker-Northwell NS/LIJ, NY); Cassandra Mackey, MD (Assistant Professor of Emergency Medicine, UMass Chan Medical School); Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Welcome to EM@3AM, an emDOCs series designed to foster your working knowledge by providing an exped
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