Sat.Nov 25, 2023 - Fri.Dec 01, 2023

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US healthcare is headed for disaster

Sensible Medicine

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.

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ECG Blog #405 — Is AV Block Complete (vs AV Dissociation)

Ken Grauer, MD

== 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.

EKG/ECG 405
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In The Next Trauma MedEd Newsletter: Practice Guidelines

The Trauma Pro

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.

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A Beginner’s Guide to Vasoactive Drug use in Children with Septic Shock

Don't Forget the Bubbles

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.

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Trust in science and vaccines continues to decline. Why?

Science Based Medicine

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.

Research 141
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ECG Blog #406 — To Do Additional Leads?

Ken Grauer, MD

== 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.

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More Trending

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INTERACT3: Management of intracranial hemorrhage

First 10 EM

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?

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I Agree with Dr. Vinay Prasad: It’s Entirely Predictable That More Parents Don’t Want Routine Vaccination for Their Kids

Science Based Medicine

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.

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EM Quick Hits 53 Postpartum Hemorrhage, Serotonin Syndrome, TBI Herniation Syndromes, Ulcerative Colitis, Pediatric C-Spine Immobilization, Global EM

Emergency Medicine Cases

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

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Why I Changed My Mind About Preventing Heart Disease

Stop and Think

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.

Research 111
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Quiz post: 2 similar patients with similar ECGs. Which, if any, or both, are OMI? Will you outperform the Queen of Hearts?

Dr. Smith's ECG Blog

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.

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Medical Conservatives: Mixing Politics and Medicine is a Bad Idea, If I Disagree with Your Politics

Science Based Medicine

"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.

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SGEM#421: I Think I’d Have a Heart Attack – Maybe Not in a Rural Area?

The Skeptics' Guide to EM

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?

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Napoleon and the first ambulance in history

Emergency Live

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.

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Being a Mother In Medicine: Any Regrets?

SheMD

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.

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Internet Use and Mental Well-Being

Science Based Medicine

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.

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Pediatric Toxic Ingestions

EB Medicine

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

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Alfa Romeo Tonale: The New Panther of the Italian Police

Emergency Live

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.

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Mastering Minor Care: Paronychia and Felon

Taming the SRU

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].

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The Quandary of a "Positive" Trial with a Non-significant Result?

Sensible Medicine

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.

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Chest pain and new regional/reciprocal ECG changes compared to previous ECGs: code STEMI?

Dr. Smith's ECG Blog

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.

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Varilux® XR Series™ by EssilorLuxottica

Emergency Live

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.

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emDOCs Videocast: EBM Update – Steroids in Severe CAP and CT in Post ROSC OHCA

EMDocs

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.

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To Treat or Not to Treat

Sensible Medicine

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.

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Decoding Code Status: A Goals of Care Framework

EM Ottawa

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.

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Theoretical Practical Emergency-Urgency Congress, A Memorable Event

Emergency Live

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

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emDOCs Revamp: DRESS

EMDocs

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.

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Friday Reflection 34: Disagreement and Chagrin in Therapeutic Decision Making

Sensible Medicine

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.

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Crafting Your Story in Travel Nursing: Continuous Learning and Harmonizing Work-Life Balance

Core Medical Group

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.

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Rescuers and Patients with HIV: Essential Safety Protocols

Emergency Live

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.

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Child with left eye pain

Emergency Medicine Journal

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?

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