Sat.Nov 04, 2023 - Fri.Nov 10, 2023

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Bloodborne Pathogen Exposures Continue in Operating Room Settings

NIOSH Science Blog

Despite legislation and improved technology, data from Massachusetts hospitals show that sharps injuries have increased in the operating room (OR) [1]. These injuries place healthcare workers at risk of exposure to bloodborne pathogens (BBPs). There is an urgent need to renew efforts to protect healthcare workers inside the operating room. The Massachusetts data highlight a gap and the need to establish a national surveillance program that would help hospitals develop further measures to prevent

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ECG Video Blog #403 (220) — Ps,Qs,3Rs Approach to this Tachycardia.

Ken Grauer, MD

== — CLICK HERE — for a V ideo presentation of this case! Below are slides used in my video presentation. For full discussion of this case — See ECG Blog #220 — == The long lead II rhythm strip shown in Figure-1 was obtained from an 51-year-old man who presented to the ED ( Emergency Department ) with "palpitations" that began 1 hour earlier. HOW would you interpret this tracing?

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Entirely predictable: More parents don't want routine vaccination for their kids

Sensible Medicine

The CDC has just reported that more parents than ever are getting vaccine exemptions for their children entering Kindergarten. For many of us who have witnessed the CDC’s repeated blunders with kids COVID19 vaccines, this result is entirely predictable. The CDC has lost the trust of the American people, and it will keep getting worse. First, let me say, I warned them.

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AIR – Learning from the Airway Registry (November 2023)

Greater Sydney Area HEMS

Airway Registry learning points reflect the challenges described and wisdom shared by Sydney HEMS personnel and guests at the Clinical Governance Airway Registry presentations. Cases are discussed non-contemporaneously, anonymised and amalgamated over a period of time to draw together unifying take-home messages. Details of specific cases are removed and/or changed, such that any similarity to real-life patients or scenarios is coincidental.

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Guidelines for Consultants to the Trauma Service

The Trauma Pro

My last two posts were dedicated to the use of consultants for your trauma patients. Here are my thoughts on best practices in using their services. Trauma surgeons often rely on consultants to assist in the care of their patients. Orthopedic surgeons and neurosurgeons are some of the more frequent consultants, but various other surgical and medical specialists may be needed.

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ECG Blog #402 — Will Adenosine Convert This?

Ken Grauer, MD

You are told that the patient next door is in the regular SVT ( S upra V entricular T achycardia ) rhythm shown in Figure-1. QUESTIONS: Is the rhythm AVNRT or AVRT? Is Adenosine likely to convert this rhythm? Figure-1: How would YOU interpret this ECG? MY Thoughts on the ECG in Figure-1: When faced with a challenging cardiac arrhythmia — It is a "luxury" to have access to a long lead rhythm strip containing 3 simultaneously -recorded leads.

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Robert F. Kennedy Jr. comes home to his antivax roots…again

Science Based Medicine

Robert F. Kennedy Jr. gave the keynote speech at the second annual meeting of his antivax organization, Children's Health Defense. Once again, he demonstrated that not only is he still antivax as hell, but that his proposals are even more bizarre than before. Truly, it was a homecoming for him. The post Robert F. Kennedy Jr. comes home to his antivax roots…again first appeared on Science-Based Medicine.

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Glasses Provide Audible Prompts for Blind Wearers

Medagadget

A team at the University of Technology Sydney has developed an assistive technology for blind people and those with low vision. The system consists of glasses that can view their surroundings through an on-board camera, appraise the objects nearby using computer vision technology, and then play a sound that provides a cue for the wearer as to their surroundings.

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Decision Rules are Destroying Medicine

Broome Docs

Controversial title… courtesy of Dr Justin Morgenstern. In this podcast Justin tells me about the evidentiary basis for our modern obsession with clinical decision rules and tools. We discuss the reasons that these tools may seem like a great idea, the reality of practice and how we may be able to do better in the future. So if you have ever used a decision tool in the ED – Wells, Ottawa, PECARN, San Francisco, HEART… or any other acronym you need to stop and have a listen to u

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Do you think a bone marrow transplant is worth it?

Sensible Medicine

Years ago, I was late to a dinner party at a new, trendy downtown restaurant. I had been working as an attending on the bone marrow transplant service, and the day got away from me. I had to take care of a patient who had a serious adverse reaction when she received her stem cell infusion. Another patient was suffering from a catastrophic fungal infection, and graft versus host disease threatened the life of a third.

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Coffee enemas: This TikTok trend can be deadly

Science Based Medicine

There's no evidence flushing coffee into your rectum is safe or effective, despite what you may see on TikTok. The post Coffee enemas: This TikTok trend can be deadly first appeared on Science-Based Medicine.

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Robotic Ankle Helps with Postural Control in Amputees

Medagadget

Researchers at North Carolina State University have developed a robotic prosthetic ankle that can provide stability for lower limb amputees. The ankle uses electromyographic sensors placed on the sites of muscles in the residual limb that then convey the intentions of the wearer with regard to movement. So far, the system has been shown to assist with postural control, which in this context refers to the many complex and unconscious movements that the muscles in our legs make to maintain balance

Research 105
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The third Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT3): an international, stepped wedge cluster randomised controlled trial

EM Ottawa

Methodology: 4/5 Usefulness: 4/5 Ma L, et al. Lancet 2023 Jul 1;402(10395):27-40. Question and Methods: Do 6 month outcomes improve after implementation of a goal-directed care bundle that corrects prognostically poor physiological abnormalities (systolic hypertension, fever, hyperglycemia, abnormal anticoagulation) for acute intracranial hemorrhage?

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Non-significant Studies Can Teach A Lot

Sensible Medicine

Many doctors believe that closing the left atrial appendage (with a device) will help reduce stroke and bleeding. The idea behind stroke reduction is that occluding the appendage takes away a common area where clots form. The reason for less bleeding is that patients with proper occlusion can often be taken off anticoagulant drugs. These are nice ideas.

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Journal Club 5 Appendicitis Delay to Appendectomy – Safe?

Emergency Medicine Cases

You diagnose uncomplicated appendicitis in the ED. The on call General Surgery team wants to wait until the next morning to perform an appendectomy. Is your patient at risk for appendiceal perforation with a delay to surgery? Dr. Rohit Mohindra and Dr. Shelley McLeod analyze the latest RCT that attempts to answer this question, the PERFECT study, on this EM Cases Journal Club.

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Magnetic Dressing Improves Diabetic Wound Healing

Medagadget

Researchers at the National University of Singapore have developed a magneto-responsive hydrogel wound dressing that also contains two different regenerative cell types. The hydrogel is also embedded with magnetic particles that can be stimulated using an external magnetic field. The action of the magnetic field on the gel-encapsulated particles causes mechanical stresses within the gel to act on the cells, stimulating them to grow and enhancing their regenerative potential.

Research 102
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U.S. Infant Mortality Increases for First Time in 20 Years

Science Based Medicine

Recently published CDC data has revealed an increase in the number of infant deaths in 2022, the first in two decades. The United States continues to struggle with serious healthcare disparities and to lag behind other countries when it comes to keeping young children alive. The post U.S. Infant Mortality Increases for First Time in 20 Years first appeared on Science-Based Medicine.

CDC 101
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What Vomiting Tells Us in Urgent Medical Situations

Emergency Live

Deciphering the Language of Vomiting: A Guide for Disease Recognition in Emergencies Vomiting is the body’s response to a wide range of disorders and diseases, and is often a sign of medical emergency. Learning to decipher the language of vomiting can be critical for timely diagnosis and effective medical intervention. So let’s try to understand […] The post What Vomiting Tells Us in Urgent Medical Situations appeared first on Emergency Live.

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November 2023 News from the College

ACEP Now

ACEP Calls Out Insurer Abuses During Surprise Billing Congressional Hearing ACEP member Seth Bleier, MD, FACEP, testified in front of the influential House Ways and Means Committee during a public hearing in October to call out insurers and advocate for fixes to the severely flawed implementation of the No Surprises Act. Dr. Bleier raised concerns that the Independent Dispute Resolution process has been virtually inaccessible for smaller practices and called out cases where physician groups were

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2023 AHA Update on Management Cardiac Arrest or Life-Threatening Toxicity Due to Poisoning

EMDocs

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association 2023 Guideline for managing cardiac arrest or life-threatening toxicity due to poisoning was recently released. This post will focus on the key parts of the guideline that affect ED evaluation and management. Top 10 Take Home Pearls 1. Treatment of cardiac arrest and life-threatening toxicity due to poisoning often requires specialized treatments that most clinicians do not use frequentl

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The Latest in Critical Care, 11/6/23 (Issue #19)

PulmCCM

Convalescent plasma for ARDS due to Covid-19 Convalescent plasma, donated by patients after recovering from Covid-19 and distributed by the Red Cross, represented one of the many ethical and policy controversies generated by the pandemic. The therapy was approved for emergency use in 2020 by FDA after an observational study of 10 patients showed likely benefit (yes, 10, which should remind us of our collective desperation).

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Which Hospitals in Addis Ababa Have a First Aid Service?

Emergency Live

Discover Key Hospitals in Addis Ababa for Emergency Care and First Aid Services Addis Ababa, the capital city of Ethiopia, is home to a growing population and a diverse healthcare system. First aid services play a crucial role in providing immediate medical care and initial support to individuals in need of urgent assistance. In this […] The post Which Hospitals in Addis Ababa Have a First Aid Service?

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Wide complex and apparent hyperacute T-waves. Does absence of change from previous ECG mean that it is not New?

Dr. Smith's ECG Blog

By Magnus Nossen, edits by Grauer and Smith The patient is a 70-something female with DMII, HTN and an extensive prior history of coronary artery disease and myocardial infarctions. She's had multiple PCI procedures. She also has sick sinus syndrome (SSS) and intermittent high grade AV block for which she had a dual chamber pacemaker implanted. On the day of presentation she complained of typical chest pain, and stated it feels like prior MI.

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Ep 188 Hemoptysis – ED Approach and Management

Emergency Medicine Cases

Key principles and approach to management of both non-massive and massive hemoptysis with Dr. Scott Weingart and Dr. Bourke Tillmann, who answer questions such as: What are the factors to consider in the decision to intubate patients with massive hemoptysis? How can one reliably distinguish hemoptysis from pseudohemoptysis? What is the evidence for tranexamic acid in patients with hemoptysis?

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emDOCs Podcast – Episode 89: Antibiotics for Uncomplicated Diverticulitis

EMDocs

Today on the emDOCs cast with Brit Long, MD ( @long_brit) , we discuss the controversy of antibiotics for patients with uncomplicated diverticulitis. For more on the ED evaluation of diverticulitis, please see Part 1. Episode 89: Antibiotics for Uncomplicated Diverticulitis Background: Previously antibiotics were utilized for all patients with diverticulitis.

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Protecting Hospitals in Armed Conflict: The Directives of International Humanitarian Law

Emergency Live

Specific protections for wounded and medical personnel according to IHL standards during wars In the context of tragic theaters of war, international humanitarian law (IHL) emerges as a beacon of civilization, offering protection to the defenseless and those working to provide relief and treatment. Health facilities and units, including hospitals, according to IHL, should not […] The post Protecting Hospitals in Armed Conflict: The Directives of International Humanitarian Law appeared firs

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Ozone Therapy

Science Based Medicine

Ozone therapy sits in the border zone between science and pseudoscience. The post Ozone Therapy first appeared on Science-Based Medicine.

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The power of children’s books

Don't Forget the Bubbles

Starting conversations with stories There’s something about a bookshop – a calm and comforting sense that I am surrounded by stories. The knowledge that within each beautiful book are words, illustrations, and photographs from which I can learn so much. I gently run my fingers over the front cover of a book that I know my daughter will like. Turning it over, I scan the back.

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Grand Rounds Recap 11.1.23

Taming the SRU

Morbidity & Mortality - Global Health - MAHA - Imaging Decision Rules - BRASH - R4 Capstone Morbidity & Mortality WITH Dr. Yates Foot Infection NSTIs are rare but deadly pathology that need to be considered with any soft tissue infection NSTI is a clinical diagnosis, but there are many imaging and laboratory assessments to help increase clinical suspicion Expedited disposition to the OR for NSTIs under 12 hours from ED presentation significantly decreases mortality Emesis Transaminitis i

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Setting Sail to Save Lives: The World's Most Advanced Hospital Ships

Emergency Live

Exploring the Cutting-Edge Medical Facilities Aboard These Lifesaving Vessels Hospital ships are a beacon of hope in times of disaster, conflict, and humanitarian crises. These seafaring medical facilities are equipped with state-of-the-art technology and skilled medical professionals ready to provide critical care and surgical interventions. In this article, we will explore some of the most […] The post Setting Sail to Save Lives: The World's Most Advanced Hospital Ships appeared fir

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EMCrit 361 – Life Threatening Tox and Toxicologic Cardiac Arrests from the AHA

EMCrit

AHA Guidelines on Critical Care Toxicology EMCrit Project by Scott Weingart, MD FCCM.

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