Sat.Apr 13, 2024 - Fri.Apr 19, 2024

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ECG Blog #425 — Are there P Waves?

Ken Grauer, MD

I was sent the ECG in Figure-1 — told only that the patient was 70 years old, and had a history of an ASD ( A trial S eptal D efect ). Serum K+ was normal. The patient was hemodynamically stable with ECG #1. QUESTIONS: How would YOU interpret the rhythm in Figure-1 ? Are there P waves? Figure-1: The initial ECG in today's case. MY Initial Thoughts on Today's CASE: Knowing that today's patient has a history of an ASD ( A trial S eptal D efect ) — is relevant to the interpretation of today's inter

EKG/ECG 284
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The Evolution Of Penetrating Neck Trauma Management – Part 2: Initial Steps

The Trauma Pro

In my previous post, I described the early days of penetrating neck injury management and introduced a paper suggesting that this concept should be revised. Today, I will summarize a paper by Siletz and Inaba that is currently in press and outlines what the contemporary way of treating these injuries should be. Step 1. If present, rapidly control external hemorrhage and airway compromise.

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Unproven healthcare will bankrupt America

Sensible Medicine

Last week, the US FDA held a meeting to decide if a new surrogate endpoint (Minimal Residual Disease or MRD negativity) could be used to give more & faster drug approvals for patients with newly diagnosed multiple myeloma. Multiple myeloma drugs can cost $600,000 per year of treatment, but if MRD is permitted for drug approval, I suspect we will see a deluge of uncertain drugs added to the roster, and the costs per year per patient will swell to a million dollars or more.

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Dr. Vinay Prasad: It’s “Good” That Parents Who Want To Vaccinate Their Kids Against COVID Get Reported To Child Protective Services

Science Based Medicine

Trying to limit pediatric COVID was literally the pandemic's worst sin for pro-infection doctors, warranting severe punishment. This is how desperately they wanted them infected. The post Dr. Vinay Prasad: It’s “Good” That Parents Who Want To Vaccinate Their Kids Against COVID Get Reported To Child Protective Services first appeared on Science-Based Medicine.

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SGEM#436: For the Longest Time – To Give TNK for an Acute Ischemic Stroke

The Skeptics' Guide to EM

Reference: Albers GW et al. TIMELESS Investigators. Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection. NEJM Feb 2024 Date: April 12, 2024 Guest Skeptic: Dr. Vasisht Srinivasan is an Emergency Medicine physician and neurointensivist at the University of Washington and Harborview Medical Center in Seattle, WA. He is an assistant professor in Emergency […] The post SGEM#436: For the Longest Time – To Give TNK for an Acute Ischemic Stroke first appeared on The Skeptics Guid

Stroke 128
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Suicidal Ideation and Self-Harm in Children

EB Medicine

In this episode, Sam Ashoo, MD interviews Ashley A. Foster, MD, Bijan Ketabchi, MD, MPH and Jennifer A. Hoffmann, MD, MS on the March 2024 Pediatric Emergency Medicine Practice article, Evaluation and Management of Suicidal Ideation and Self-Harm in Children in the Emergency Department Introduction Understanding Suicidal Ideation and Self Harm in Youths Screening Tools and Approaches Ask Suicide-Screening Questions (ASQ) Toolkit Columbia Suicide Severity Rating Scale (C-SSRS) Prehospital Care

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PTM Journal Club: Blood Product and ACE-CPR use Prehospital

EM Ottawa

In this Prehospital Journal Club Recap, let us take a deep dive into the use of blood products, as well as the adjunct use of automated controlled elevation in CPR. Resuscitation with blood products in patients with trauma-related hemorrhagic shock receiving prehospital care (RePHILL): a multicentre, open-label, randomized, controlled, phase 3 trial Background The use […] The post PTM Journal Club: Blood Product and ACE-CPR use Prehospital appeared first on EMOttawa Blog.

CPR 114

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The Brain Injury Guidelines: Can we avoid talking to neurosurgeons?

First 10 EM

One of the biggest headaches in modern medicine is the apparent requirement to call busy specialists just to confirm what seems like an obvious treatment plan. In emergency medicine, this often happens when a patient needs to be admitted under one service, but with a medical problem related to another speciality. We get stuck in […] The post The Brain Injury Guidelines: Can we avoid talking to neurosurgeons?

EMS 111
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Is OMI an ECG Diagnosis?

Dr. Smith's ECG Blog

Written by Jesse McLaren A 70 year old with prior MIs and stents to LAD and RCA presented to the emergency department with 2 weeks of increasing exertional chest pain radiating to the left arm, associated with nausea. The pain recurred at rest 90 minutes prior to presentation, felt like the patient’s prior MIs, and was not relieved by 6 sprays of nitro.

EKG/ECG 108
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Survey Readiness Training for Healthcare Providers

American Medical Compliance

The following Survey Readiness Training for Healthcare Providers is designed to educate healthcare providers on the purpose and importance of survey readiness in healthcare. Surveys may play a large role in your healthcare facility. Also, it is important to understand the purpose and the regulations associated with them. Because of this, AMC can help your healthcare organization become more aware of healthcare surveys.

Outcomes 105
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R-A-C-E session at RCEM CPD conference. St Emlyn’s

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed This was a really powerful session that took us on a journey from the past, to the present and left us with a feeling of hope for the future. I’ll […] The post R-A-C-E session at RCEM CPD conference. St Emlyn’s appeared first on St.Emlyn's.

Teamwork 101
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PTM Journal Club: BVM Ventilation and Refractory Shock in Out-Of-Hospital Cardiac Arrest

EM Ottawa

In this edition of PTM Journal Club explore the impact of bag-valve-mask ventilation as well as the use of lidocaine and/or amiodarone on the survivability of out-of-hospital cardiac arrest. Bag-Valve-Mask Ventilation and Survival From Out-of-Hospital Cardiac Arrest: A Multicenter Study Background and Objectives Around 60,000 out-of-hospital cardiac arrests (OHCA) occur in Canada each year, which […] The post PTM Journal Club: BVM Ventilation and Refractory Shock in Out-Of-Hospital Card

Shock 101
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Is It OK for Internists to Wear Masks Forever?

Sensible Medicine

If you can’t believe we are still talking about this, that is sort of the point of the post. Personally, I could not wait to put mask wearing behind me, but I still find the issue of masking in healthcare facilities interesting. I have written my own essays about it on Sensible Medicine on September 28 th , 2022 , and January 11 th , 2024. The parallels to universal precautions, the balance of comfort, communication, and patient safety, and the issues of power in the doctor patient relatio

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Navigating Advance Directives Training for Healthcare Providers

American Medical Compliance

The following Navigating Advance Directives Training for Healthcare Providers is designed to educate healthcare providers on the legal significance of advance directives. During an emergency or at the end of life, you may face questions about your medical treatment and not be able to answer them. You also may assume your loved ones know what you would want, but that’s not always true.

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Video beats direct laryngoscopy for intubation--even for experts

PulmCCM

Video laryngoscopy was introduced in 2001 as a technique for orotracheal intubation. Although an increasing share of intubations have been performed using video laryngoscopy, and it’s recommended for difficult airways, uncertainty has remained as to whether video was superior than conventional direct laryngoscopy for average risk intubations. In the relatively few studies comparing video to direct laryngoscopy, intubations were usually performed by inexperienced trainees, and sample sizes

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Salem Family Care

Dr. Mike Sevilla

I’m excited to share that I will be joining a new Primary Care office in Salem, Ohio called Salem Family Care. My current patients will have nothing to worry about, since I will not be leaving Salem, and my patients will not need to find a new doctor. Salem Family Care is located at 718 East Third Street in Salem, Ohio. Salem Family Care was created with the partnership of Dr.

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Accidental Tracheostomy Decannulation

Northwestern EM Blog

Written by: Chezlyn Patton, MD (NUEM ‘27) Edited by: Keara Kilbane, MD (NUEM ‘25) Expert Commentary by : Matt McCauley, MD (NUEM ‘21) Introduction Tracheostomy is a common procedure in the US with over 110,000 trachs placed annually (1). Complications occur at a rate of approximately 40-50%, however most complications are minor, with only 1% being catastrophic (1).

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Understanding Medication Safety Training

American Medical Compliance

The following Understanding Medication Safety Training educates healthcare providers on common medication safety issues. Ensuring patient safety during health services delivery is fundamental for an efficient healthcare system. Additionally, a strong organizational culture of patient safety and quality enables service providers to prepare for a variety of reasons.

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56 year old male had 5/10 chest pain for several hours, then presented to the ED in the middle of the night with 1/10 pain.

Dr. Smith's ECG Blog

A 56 year old male with PMHx significant for hypertension had chest pain for several hours, then presented to the ED in the middle of the night. He reported chest pain that developed several hours prior to arrival and was 5/10 in intensity. The pain was located in the mid to left chest and developed after riding his bike. There was associated fatigue when symptoms developed and mild shortness of breath at onset of chest pain however that has since resolved.

EKG/ECG 96
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UKs Phased Smoking Ban

Science Based Medicine

UK MPs have just passed the Tobacco and Vapes Bill by a 383 to 67 vote. If the measure becomes law it will ban the sale of tobacco products to anyone born after January 1, 2009. This is not just an age limit – this is a permanent phased ban. If the law passes and stands, anyone born after that date will […] The post UKs Phased Smoking Ban first appeared on Science-Based Medicine.

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11th Kongress der Arbeitsgemeinschaft fur Notfallmedizin. St Emlyn’s

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed Our conference report from the 11th Kongress der Arbeitsgemeinschaft fur Notfallmedizin in Graz Austria in 2024. r@stemlyns Blog themes on trauma, cardiac arrest and research. #FOAMed The post 11th Kongress der Arbeitsgemeinschaft fur Notfallmedizin. St Emlyn’s appeared first on St.Emlyn's.

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Core Elements for Antibiotic Stewardship Training

American Medical Compliance

The following Core Elements of Antibiotic Stewardship Training educates healthcare providers on the importance of antibiotic stewardship in healthcare. Additionally, antibiotic stewardship is the effort to measure and improve how clinicians prescribe antibiotics to patients who use them. Furthermore, improving antibiotic prescribing and use is critical to effectively treat infections, protect patients from harm caused by unnecessary antibiotic use, and combat antibiotic resistance.

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Medical Malpractice Insights: A Tale of 2 Injection Injuries

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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Dr. John Ioannidis: “The Biggest Mistakes I am Sure Are Mine.”

Science Based Medicine

Part 3: Dr. John Ioannidis said his biggest mistake was the he "underestimated how much power politics and media and powers outside of science, could have on science." Really? The post Dr. John Ioannidis: “The Biggest Mistakes I am Sure Are Mine.” first appeared on Science-Based Medicine.

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Capri becomes a cardioprotected island

Emergency Live

Being prepared to deal with cardiac arrests is vital for any area. Thanks to the initiative of the Municipality, Capri is becoming a safe area in this regard A way to make citizens and tourists feel safer With the installation of over 20 modern defibrillators and the organization of training events, the island proves to […] The post Capri becomes a cardioprotected island appeared first on Emergency Live.

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Illinois Recognizing and Reporting Child Abuse and Neglect Healthcare Training

American Medical Compliance

The Illinois Recognizing and Reporting Child Abuse and Neglect Training course is designed to educate healthcare providers (HCP) on the signs of child abuse and neglect. Child abuse and neglect are unfortunately pervasive issues that can have long-lasting impacts on a child’s health and well-being. As a healthcare provider, you are often on the front lines to spot potential signs of abuse or neglect.

Burns 95
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Is a Cuff Enough?

Taming the SRU

Haber EN, Sonti R, Simkovich SM, Pike CW, Boxley CL, Fong A, Weintraub WS, Cobb NK. Accuracy of Noninvasive Blood Pressure Monitoring in Critically Ill Adults. J Intensive Care Med. 2024 Jan 12:8850666231225173. doi: 10.1177/08850666231225173. Epub ahead of print. PMID: 38215002. P: 1852 patients admitted to tertiary care MICU with a variety of precipitating conditions I: Invasive blood pressure monitoring C: Noninvasive blood pressure monitoring O: 67 % of measurements in agreement using 10 % M

Sepsis 82
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There is no evidence that COVID-19 vaccines are causing cancers associated with “accelerated aging”

Science Based Medicine

A recent presentation at AACR found a link between markers of accelerated aging and an increased risk of cancer. Then antivaxxers got a hold of it to blame COVID-19 vaccines not just for cancer, but for "accelerated aging" causing it. The post There is no evidence that COVID-19 vaccines are causing cancers associated with “accelerated aging” first appeared on Science-Based Medicine.

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Microplastics and fertility: a new threat

Emergency Live

An innovative study has uncovered an alarming threat: the presence of microplastics in the ovarian follicular fluids of women undergoing Assisted Reproductive Techniques (ART) This research, led by Luigi Montano and a multidisciplinary team of experts, found an average concentration of 2191 particles per milliliter of nano and microplastics with a mean diameter of 4.48 […] The post Microplastics and fertility: a new threat appeared first on Emergency Live.

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Enhancing Patient Care: The Vital Role of Assistive Technology in Occupational Therapy

Core Medical Group

Occupational Therapy (OT) is a crucial healthcare profession dedicated to helping individuals achieve independence and improve their daily life activities. Central to this mission is the integration of assistive technology, a dynamic field that continues to revolutionize patient care and inclusivity. Let's explore why assistive technology is vital in occupational therapy and how it's shaping the future of independence.

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Approach to Hernias in the ED

Taming the SRU

Hernias 101 A hernia is described as, “the abnormal protrusion of abdominal contents through a defect involving the normal confines of the abdominal compartments” (9). It often involves a portion of the intestine protruding through a weak point of the abdominal wall. The location and size of the hernia often determines the symptoms and complications that a patient will present with.

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EM@3AM: Auricular Hematoma

EMDocs

Authors: Jacob Tauferner, MD (EM Resident Physician, UTSW/ Dallas, TX); Mihir Patel, MD (EM Attending Physician, Dallas, TX) // Reviewed by: Sophia Görgens, MD (EM Physician, Northwell, 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 expedited review of clinical basics.

EMS 81
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Tragedy during a Ryanair flight: man dies on board

Emergency Live

What should have been a routine journey turned into a nightmare for a family eagerly awaiting the arrival of their child: a man suffers a sudden and fatal illness during a commercial flight The day seemed to start like any other flight: Giuseppe Stilo, 33, and his pregnant wife were on their way back to […] The post Tragedy during a Ryanair flight: man dies on board appeared first on Emergency Live.

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California Injury and Illness Prevention Program (IIPP) Training in Healthcare

American Medical Compliance

The following California Injury and Illness Prevention Program (IIPP) for High Hazard Employers in Healthcare 4.5 educates healthcare providers (HCP) on how to establish, implement, and maintain an effective injury and illness prevention program at the workplace. Moreover, this IIPP training in healthcare course focuses on providing comprehensive knowledge and skills needed to implement effective injury prevention program training for healthcare providers.

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Finally a Positive Trial for the Impella Ventricular Support Device

Sensible Medicine

Let me craft a story about one of the worst-case scenarios in cardiology. A common cause of cardiogenic shock occurs when a blocked coronary artery (myocardial infarction or MI) causes the heart to fail. That happens because the obstruction to flow involves a lot of downstream heart muscle. It’s a terrible scenario because if the doctor could only get that artery open fast enough the patient would likely survive.

Shock 73
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Tasty Morsels of Critical Care 078 | Hyponatraemia – diagnostic approach

Emergency Medicine Ireland

Welcome back to the tasty morsels of critical care podcast. Today we cover an incredibly common inpatient issue – hypnatraemia. We’ll often find 1 or 2 of these in our high dependency unit at any given time, mainly due to the requirement for frequent testing of Na levels that seems beyond the remit of normal ward level care. The approach I describe here is neither comprehensive or especially robust but it is how I approach it.

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Protective Gene Discovered Against Alzheimer's

Emergency Live

A Columbia University study reveals a gene that reduces the risk of Alzheimer’s by up to 70%, paving the way for new therapies A Remarkable Scientific Discovery An extraordinary breakthrough in Alzheimer’s treatment has sparked new hopes for addressing the disease. Researchers at Columbia University have identified a gene that reduces the risk of developing […] The post Protective Gene Discovered Against Alzheimer's appeared first on Emergency Live.