Sensible Medicine
NOVEMBER 30, 2023
Three recent events tell us that US healthcare is doomed. First, health care premiums have risen to new heights. Second, Medicare has agreed to pay for GRAIL cancer screening as part of coverage with evidence development and third, many doctors protested Cigna’s denial of coverage for a double lung transplant for stage IV lung cancer, leading the insurer to agree to cover it.
Ken Grauer, MD
NOVEMBER 25, 2023
== CLICK HERE — for a V ideo presentation of this case! ( 19:40 min. ) Below are slides used in my video presentation. For full discussion of this case — See ECG Blog #191 — == The 2-lead rhythm strip shown in Figure-1 was obtained from an elderly woman who presented to the ED following a syncopal episode. On the basis of this rhythm strip — she was diagnosed as being in complete AV Block.
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The Trauma Pro
NOVEMBER 28, 2023
The November issue of the Trauma MedEd newsletter will be sent out soon! It’s chock full of tips and tricks dealing with trauma practice guidelines This issue is being released over the weekend. If you are already a subscriber, you will receive it automatically. If not and you sign up any time before then, you will receive it, too. Otherwise, you’ll have to wait until it goes out to the general public a week or two later.
Don't Forget the Bubbles
NOVEMBER 27, 2023
Four-year-old Ed is being resuscitated for presumed Invasive Group A Streptococcal Sepsis from tonsilitis. He presented tachycardic and hypotensive with a capillary refill time of 5 seconds. After 40ml/kg of IV 0.9% NaCl, his HR came down a little, but the effect was short-lived. He has an HR of 190/min, and his BP is 85/35 mmHg. The CRT is unchanged.
Science Based Medicine
NOVEMBER 27, 2023
Recent evidence shows that public trust in science and vaccines has declined markedly since the pandemic. Why is this, and is there anything we can do about it? The post Trust in science and vaccines continues to decline. Why? first appeared on Science-Based Medicine.
Ken Grauer, MD
DECEMBER 1, 2023
== CLICK HERE — for a V ideo presentation of this case! ( 19:40 min. ) Below are slides used in my video presentation. For full discussion of this case — See ECG Blog #351 — == The ECG in Figure-1 — was obtained from a previously healthy older man who contacted EMS ( E mergency M edical S ervices ) because of "chest tightness" that began ~1 hour earlier.
The Skeptics' Guide to EM
NOVEMBER 25, 2023
Date: November 22, 2023 Reference: Stopyra et al. Delayed First Medical Contact to Reperfusion Time Increases Mortality in Rural EMS Patients with STEMI. AEM November 2023. Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. She is the cofounder of FOAMcast and a […] The post SGEM#421: I Think I’d Have a Heart Attack – Maybe Not in a Rural Area?
Emergency Care Today brings together the best content for emergency care practitioners from the widest variety of industry thought leaders.
Science Based Medicine
NOVEMBER 25, 2023
Dr. Prasad didn't predict this sad outcome, he worked tirelessly to cause it. So did many other doctors. The post I Agree with Dr. Vinay Prasad: It’s Entirely Predictable That More Parents Don’t Want Routine Vaccination for Their Kids first appeared on Science-Based Medicine.
First 10 EM
NOVEMBER 27, 2023
Evidentiary amnesia is a term I use to describe the phenomenon I frequently encounter in which evidence seems to be forgotten over time. When I hear people lecture about the management of intracranial hemorrhage, and even when I invite incredibly smart people to write about neurologic emergencies, blood pressure management is always recommended. But why?
Stop and Think
NOVEMBER 26, 2023
I have changed my mind about a lot of things over the past two decades of practice. No change has been bigger than how I feel about preventing heart disease. The medical jargon here is primary prevention. (Re: preventing a first cardiac event). I will tell this story in three chapters. Chapter 1: What I used to think about primary prevention In years past, I interpreted the studies of primary prevention as only slightly positive.
Emergency Medicine Cases
NOVEMBER 28, 2023
On this month's EM Quick Hits podcast: Anand Swaminathan on update to ED management of postpartum hemorrhage, Nour Khatib on serotonin syndrome and its mimics, Katie Lin on an approach to recognition and management of severe TBI and brain herniation syndromes, Hans Rosenberg on the ED management of ulcerative colitis, Heather Cary on pediatric c-spine immobilization controversies and techniques, Navpreet Sahsi on the difference between humanitarian and development work The post EM Quick Hits 53
Science Based Medicine
DECEMBER 1, 2023
"I used to think medicine could be separated from politics. Gosh. That was super dumb." The post Medical Conservatives: Mixing Politics and Medicine is a Bad Idea, If I Disagree with Your Politics first appeared on Science-Based Medicine.
Dr. Smith's ECG Blog
NOVEMBER 29, 2023
Written by Pendell Meyers Two adult patients in their 50s called EMS for acute chest pain that started within the last hour. Both were awake and alert with normal vital signs. Both cases had an EMS ECG that was transmitted to the ED physician asking "should we activate the cath lab?" What do you think? Here they are: Patient 1, ECG1: Zoll computer algorithm stated: " STEMI , Anterior Infarct" Patient 2, ECG1: Zoll computer algorithm stated: "ST elevation, probably benign early repolarization.
SheMD
NOVEMBER 27, 2023
Wondering if you can be a doctor and have a family? Or how you can manage being a parent AND a physician? We are bringing you stories of female physicians that prove you CAN do it! Dr. Sriraman joins us on the blog to discuss "mommy guilt" and how our children REALLY see us, as incredible Moms in Medicine. Flashback, 2004. I introduce myself to a female neighbor who I had never met and we started chatting.
Emergency Live
NOVEMBER 30, 2023
The First Ambulance and the Revolution in Medical Rescue in the 19th Century These days theaters are crowded for the release of “Napoleon,” Ridley Scott‘s new film that traces the rise to power up to the exile on the island of St. Helena of Emperor Napoleon Bonaparte, played by Joaquin Phoenix. The film is having […] The post Napoleon and the first ambulance in history appeared first on Emergency Live.
Science Based Medicine
NOVEMBER 29, 2023
Results of the largest study on internet use, well-being, and mental health. The post Internet Use and Mental Well-Being first appeared on Science-Based Medicine.
Sensible Medicine
NOVEMBER 27, 2023
Don’t get hung up on the specific medical problem. The point of this Study of the Week is how to think about trial results. The medical question comes up pretty often: What to do with moderate anemia (low red blood cell counts) in a patient recovering from a heart attack (myocardial infarction = MI)? (We measure something called the hemoglobin level or Hgb to quantify the anemia.
EB Medicine
DECEMBER 1, 2023
In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the December 2023 Pediatric Emergency Medicine Practice article, Management of Pediatric Toxic Ingestions in the Emergenc y Department. Need help now? Call the Poison Help Line at: 1‑800‑222‑1222 Epidemiology Prehospital Care ED History and Physical Exam Diagnostic Studies Labs EKG Imaging Urine Toxicology Testing Treatment Hemodialysis Activated Charcoal Whole Bowel Irrigation Gastric Lavage Ipecac Drug Specific Therapies Acetaminophe
Emergency Live
NOVEMBER 30, 2023
Renewal of the State Police Fleet with the Alfa Romeo Tonale sports car New “Panther” of the Italian Police Force The Italian State Police recently welcomed an iconic new member to its fleet: the Alfa Romeo “Tonale.” This modern and sporty car, nicknamed “Pantera,” represents a significant upgrade for the Italian police force, combining style […] The post Alfa Romeo Tonale: The New Panther of the Italian Police appeared first on Emergency Live.
Taming the SRU
NOVEMBER 27, 2023
Before we dive in, let’s take this opportunity to review some relevant fingertip anatomy. The dorsal aspect of the fingertip is home to the perionychium, which is composed of the nail body, lateral and proximal nail folds, nail bed, and surrounding soft tissues. Deep to the proximal nail fold is the nail root surrounded by the germinal matrix, which is extends proximally to the lunula and is responsible for the majority of nail growth [1].
Sensible Medicine
DECEMBER 1, 2023
PP is a 67-year-old woman who comes to clinic with six weeks of progressive weakness. She feels aching in her buttocks, thighs, and shoulders. She is unable to rise from a chair unassisted and can walk only if supported by a companion. PP has a long history of hypertension and type II diabetes, both well controlled. She has coronary artery disease and had stable angina until she started an appropriate medical regimen.
EM Ottawa
NOVEMBER 30, 2023
In general, the public perception of CPR is filled with inaccuracies, and recently the New Yorker wrote about the Hidden Harms of CPR. In the article, Dr. Sunita Puir, a palliative care doctor, talks about how it is an “open secret in medicine that CPR is brutal and rarely effective,” yet how the public seems […] The post Decoding Code Status: A Goals of Care Framework appeared first on EMOttawa Blog.
Emergency Live
DECEMBER 1, 2023
The First Eye-Responsive Progressive Lens Born By Behavioural Artificial Intelligence EssilorLuxottica, constantly engaged in the research and design of visual solutions increasingly performing, launched in May – Varilux® XR Series has, the new and innovative progressive lens: based on a predictive model and the analysis of behaviour profile and movements of the wearer.
Dr. Smith's ECG Blog
NOVEMBER 27, 2023
Written by Jesse McLaren A 45 year old presented with two weeks of recurring non-exertional chest pain, now constant for an hour. Below is old and then new ECG (old on top; new below). What do you think? Both ECGs have normal sinus rhythm, normal conduction and normal voltages. There’s a change in axis that may interfere with direct lead-to-lead comparison, but there appear to be larger T waves in I/aVL and new TWI in III/aVF.
Sensible Medicine
NOVEMBER 28, 2023
For many doctors in academic medicine, publishing in peer reviewed journal is an important part of their careers. Fortunately, over the last 25 years, promotions criteria have matured so it is not quite publish or perish anymore. People can rise through the academic ranks as gifted clinicians, creative and effective educators, and talented administrators.
EMDocs
NOVEMBER 29, 2023
Welcome to the emDOCs Videocast – please subscribe to our YouTube channel. These videos will cover post summaries, take homes on clinical condition, and EBM/guideline literature updates. Our first video provides EBM updates on steroids in severe community-acquired pneumonia and CT in post ROSC OHCA. EBM Update: Steroids in Severe CAP and CT in Post ROSC OHCA #1: Dequin PF, Meziani F, Quenot JP, et al; CRICS-TriGGERSep Network.
Emergency Live
DECEMBER 1, 2023
Innovation and Comparison at the Center of the Emergency-Urgency Theoretical-Practical Congress in Bari, Italy The two-day Emergency-Urgency Theoretical-Practical Congress has just concluded at the Hi Hotel in Bari, Italy, putting under a magnifying glass a number of issues to which physicians are subjected, transforming the Apulian capital into a hub of innovation and medical knowledge […] The post Theoretical Practical Emergency-Urgency Congress, A Memorable Event appeared first on Emerg
Core Medical Group
NOVEMBER 29, 2023
Welcome back to the second installment of our travel nursing series! Building on our previous discussion on navigating assignments, we’re now exploring the importance of continuous learning and achieving the perfect work-life balance.
Emergency Medicine Journal
NOVEMBER 28, 2023
Clinical introduction A 9-year-old boy visited our ED with left eye pain with visual loss. His left eye was hit by a rope while he was watching his friend jumping with the rope 2 days ago. The injured eye is shown in figure 1. The intraocular pressure of the injured eye was 23.3 mm Hg, with only light perception. Question What is the most likely diagnosis?
Greater Sydney Area HEMS
NOVEMBER 26, 2023
In the ninth episode of the Sydney HEMS Debrief series, we have the first half of a two-part episode! Join us as Sydney HEMS Senior Staff Specialist Dr Brian Burns discusses the recognition, aetiology and treatment of different types of shock in our pre-hospital trauma patients. Whilst pre-hospital clinicians may have a natural bias towards hypovolaemic shock secondary to blood loss, Dr Burns discusses the many mimics of hypovolaemic shock, and how it is crucial we remain mindful of other causat
Emergency Live
DECEMBER 1, 2023
Guidelines for Emergency Management with HIV-Positive Patients: Precautions and Protective Tools The Importance of Training for Rescuers In the context of medical emergencies, first responders play a crucial role in providing immediate care. When it comes to intervening on HIV-infected patients, specific training and knowledge of safety procedures become even more important.
Sensible Medicine
NOVEMBER 25, 2023
I’ve stayed away from throwing shade at lay coverage of nutrition science since our articles, Nutrition Churnalism Part 1 and Part 2 , that we published way back in August of 2023. It’s not that I don’t love a good observational study showing that eating chilies four times a week is more effective than any medication at preventing cardiovascular disease or that eating organic food cuts cancer risk by 25%.
EMDocs
NOVEMBER 27, 2023
Authors: Katey DG Osborne, MD (EM Attending Physician; Tacoma, WA), Rachel Bridwell, MD (EM Attending Physician; Tacoma, WA) // Reviewed by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (@long_brit, EM Attending Physician, San Antonio, TX) Welcome to emDOCs revamp! This series provides evidence-based updates to previous posts so you can stay current with what you need to know.
Emergency Medicine Journal
NOVEMBER 28, 2023
Aims and Objectives The term ‘sonic environment’ describes the overall ensemble of sounds within spaces. Poor sonic environments in hospitals have been found to ‘impede the recovery process’ for patients and reduce staff performance. Sonic environments are often overlooked in hospital design, leading to spaces which are not supportive for care.
Emergency Live
NOVEMBER 25, 2023
A Constant Commitment to Cultural Change and the Protection of Women The Alarming Phenomenon of Violence Against Women The International Day for the Elimination of Violence against Women, established by the United Nations, sheds light on a disturbing reality: 107 women killed since the beginning of the year, victims of domestic violence. This tragic and […] The post Italian Red Cross on the Front Line in the Fight Against Violence Against Women appeared first on Emergency Live.
Pediatric Education
NOVEMBER 26, 2023
PediatricEducation.org is taking short Thanksgiving break The next case will be published on 12/4/23. In the meantime, please take a look at the different Archives and Curriculum Maps listed at the top of the page. We appreciate your patronage, Donna D’Alessandro and Michael D’Alessandro, curators.
ALiEM
NOVEMBER 29, 2023
Which of the following agents, when injected along with heroin, is associated with the skin changes pictured? Cocaine Fentanyl Methamphetamine Xylazine Photo by Dr. Matthew Salzman Reveal the Answer 4. Xylazine Background Xylazine is a synthetic substance approved by the U.S. Food and Drug Administration for veterinary use, specifically for its muscle relaxant, sedative, and analgesic effects [1].
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