Sat.Sep 09, 2023 - Fri.Sep 15, 2023

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Best Of AAST #3: When To Place A Chest Tube For Hemothorax

The Trauma Pro

There is an art to deciding when to place a chest tube for either hemothorax or pneumothorax. For the most part, the trauma professional examines the imaging and then uses some unknown internal metric to declare that it is “too big.” Then it’s time to insert some type of chest drain. There have been attempts over the years to make this decision more quantitative.

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When Did “Herd Immunity” Become a Taboo Phrase?

Science Based Medicine

Doctors who repeatedly predicted herd immunity in 2020 and 2021, mocking and berating those who disagreed, now treat herd immunity as a taboo phrase. The post When Did “Herd Immunity” Become a Taboo Phrase? first appeared on Science-Based Medicine.

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SGEM#415: Buckle Down for some Ultrasound to Diagnosis Distal Forearm Fractures

The Skeptics' Guide to EM

Reference: Snelling et al. Ultrasonography or radiography for suspected pediatric distal forearm fractures. New England Journal of Medicine June 2023 Date: July 19, 2023 Guest Skeptic: Dr. Casey Parker is a Rural Generalist that includes in his practice emergency medicine, anesthesia, and critical care. He is also a fully-fledged ultrasonographer. Casey currently splits his time […] The post SGEM#415: Buckle Down for some Ultrasound to Diagnosis Distal Forearm Fractures first appeared on The Ske

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Emergency Physician Climbs the Seven Summits

ACEP Now

Ben Mattingly, MD, tries to live by the adage, “One should be adventurous and daring, but not reckless.” The challenge is that the line between adventurous and reckless is often paper-thin. Take, for example, his recent expedition to Nepal to summit Mount Everest. When he arrived at the base camp, he found out three rope-fixing sherpas had just been killed in the famously dangerous Khumbu Icefall.

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Best Of AAST #4: Starting VTE Prophylaxis After Solid Organ Injury

The Trauma Pro

Venous thromboembolic disease (VTE) continues to be a major issue in trauma patients. Most trauma centers have prophylaxis guidelines to try to reduce this problem. These guidelines typically recognize specific injuries that increase the risk of bleeding if anticoagulants are given. Typical ones include hemorrhagic injuries to the brain, pelvic and spine fractures, and solid organ injuries.

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Dr. Vinay Prasad fully embraces the antivax message of “do not comply”

Science Based Medicine

COVID-19 "contrarians" like Dr. Vinay Prasad have long complained about being labelled "antivaccine," which they view as unfair. Why, then, do they embrace antivax messages like "do not comply," even if they don't use the exact words? The post Dr. Vinay Prasad fully embraces the antivax message of “do not comply” first appeared on Science-Based Medicine.

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The ECLS-SHOCK Trial: ECPR in Infarct-Related Cardiogenic Shock

RebelEM

Background: Cardiogenic shock develops in up to 10% of patients with acute myocardial infarction (AMI) and carries a 30 day mortality rate around 50%. Revascularization of the culprit lesion remains one of the few established treatments though there are numerous other unproven modalities including extracorporeal life support (ECLS). Many centers have attempted ECLS to achieve hemodynamic stabilization in this group of patients.

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Best of AAST 2023 #2: Immediate Postoperative Prosthesis

The Trauma Pro

Blunt vehicular trauma is the most common cause of severe lower extremity trauma, particularly motorcycle crashes. Occasionally, the injury is so severe that the limb cannot be saved, and amputation is necessary. The conventional treatment is to protect the amputation incision, provide physical therapy, and fit a prosthesis once the stump is mature.

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Threadworms

Don't Forget the Bubbles

5-year-old Willow arrives in the ED at 3 a.m. Her mum says she has been waking up screaming on the last few nights, clutching her vulval area and saying it hurts. Her parents have noticed she is scratching her bottom a lot, too, and they’ve had an email from school saying there are cases of threadworms in the reception class. Threadworms ( Enterobius vermicularis , also known as pinworms or seatworms) are the most common helminthic infection in the Western World.

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ECG Cases 45 ECG in Weakness and Neurological Symptoms

Emergency Medicine Cases

In this ECG Cases blog Dr. Jesse MacLaren guides us through 10 cases of patients who present with generalized weakness or acute neurologic symptoms and discusses how to look for ECG signs of dysrhythmias, electrolyte emergencies, acute coronary occlusion, and demand ischemia in patients with generalized weakness and in patients with neurologic symptoms, to consider predisposing factors like LVH; seizure-like activity from cardiac syncope; TIA/CVA embolic sources like atrial fibrillation or LV th

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A 60-year-old diabetic with chest pain, cath lab activated

Dr. Smith's ECG Blog

I came to work one day and one of my partners said, "Hey, Steve, we had a STEMI this afternoon!" I said, "Cool, can I see the ECG?' Of course he said: "Yes, it was a 60 year old diabetic with Chest pain." So he showed me the ECG recorded in triage: What did I say? "That is not a STEMI. That is Arterial Pulse Tapping Artifact (APTA)." He said: "What?

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Best of AAST #1: Aspirin Vs Low Molecular Weight Heparin For VTE Prophylaxis

The Trauma Pro

The 82nd Annual Meeting of the American Association for the Surgery of Trauma begins next week. As is my custom, I will be reviewing some of the more interesting (to me) oral presentation abstracts until the last day of the meeting. When reading abstracts, keep in mind that you are seeing just a snippet of a finished manuscript. The authors are given very little print space to fully describe their research idea, their methods, and their results’ significance.

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Can we use D-dimer to assess for left atrial clot in atrial fibrillation?

First 10 EM

This is a guest post by Dr. Lanujan Kaneswaran. Lanujan is a second-year Family Medicine resident at the University of Toronto. He has a background in medical health informatics and machine learning. His areas of interest include artificial intelligence and machine learning in medicine, and health equity through advocacy and technology. When managing atrial fibrillation […] The post Can we use D-dimer to assess for left atrial clot in atrial fibrillation?

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BUCKLE trial: on the SGEM (episode 415)

Broome Docs

This month I am back on the SGEM podcast – this time on the all new Paeds section with Dr Dennis Ren. In this episode we do a deep dive into the BUCKLED trial that looked at the use of bedside ultrasound vs. plain film X-rays for the initial investigation of paediatric forearm fractures. This is a really neat Australian trial run by my friend Dr Peter Snelling and friends in Queensland.

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RCTs Can Inform Even the Most Dire Medical Situations

Sensible Medicine

Investigators from Leipzig Germany called the trial ECLS-SHOCK. It studied the use of extracorporeal life support in patients with cardiogenic shock due to acute myocardial infarction. ECLS-SHOCK delivered shocking results. First some background. Cardiogenic shock is medical jargon to describe the really bad situation when the heart cannot deliver enough blood to the body.

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Morocco: local and international rescuers working to save victims

Emergency Live

Earthquake in Morocco: relief efforts amid difficulties and needs In south-western Morocco, a tragedy of devastating proportions shook the country in the night between Friday 08 and Saturday 09 September 2023. A 6.8 magnitude earthquake killed over two thousand people and left thousands of others without a roof to shelter under. The Atlas mountain range, […] The post Morocco: local and international rescuers working to save victims appeared first on Emergency Live.

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Brain Computer Interface Decodes Speech and Facial Expressions

Medagadget

Researchers at the University of California San Francisco have developed a brain computer interface that can lets someone with severe paralysis communicate with both speech and facial expressions, in the form of a digital avatar. The breakthrough advances what has been possible, with previous brain computer interface systems providing speech only, and allows people to communicate more completely, encompassing facial expressions, which are an important aspect of natural communication.

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Complete Human Embryo Model Made From Stem Cells

Science Based Medicine

Researchers create an embryo model from human embryonic stem cells. The post Complete Human Embryo Model Made From Stem Cells first appeared on Science-Based Medicine.

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James: A Coast Guard Vet Turned Allied Team Lead

Core Medical Group

Meet our Allied Team Lead with 2.5 years of dedication and commitment, James. His exceptional journey in the healthcare recruitment world has earned him the role as team lead after his 16 years of service. With an impressive background in the United States Coast Guard and a passion for helping professionals find their perfect healthcare roles, James brings a unique perspective to the world of healthcare recruitment.

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David Crouch will discuss the latest trends in CBRNe

Emergency Live

David Crouch, world-renowned CBRNe expert, will discuss the benefits of the PEERS initiative In anticipation of the upcoming workshop on September 29, PEERS Project is delighted to introduce you to one of our distinguished speakers, David Crouch. He currently serves as the CBRNe (Chemical, Biological, Radiological, Nuclear, and Explosives) Expertise Leader at TFC Research and Innovation […] The post David Crouch will discuss the latest trends in CBRNe appeared first on Emergency Live.

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Highly Precise Pressure Sensor for Laparoscopic or Robotic Surgical Tools

Medagadget

Researchers at the National University of Singapore have developed a highly sensitive pressure sensor that can provide haptic feedback for surgeons using laparoscopic tools or for use in robotic grippers as part of robotic surgical systems. The technology is inspired by the surface of the lotus leaf, which is extremely sensitive to the pressure exerted by tiny drops of water and will repel them.

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Did a Spicy Social Media Challenge Kill a Massachusetts Teen?

Science Based Medicine

Did an absurdly spicy chip and a social media challenge kill a Massachusetts teen? His family sure thinks so, and it is possible. But skepticism is appropriate unless further details emerge. Still, these chips aren't for kids. The post Did a Spicy Social Media Challenge Kill a Massachusetts Teen? first appeared on Science-Based Medicine.

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EM Quick Hits 51 – Methylene Blue in Septic Shock, TMJ Dislocation, Crohn’s Disease, Analgesia for Renal Colic, Inhaled Steroids for Asthma, Hypocalcemia in Bleeding Trauma Patients

Emergency Medicine Cases

On this month's EM Quick Hits podcast: Anand Swaminathan on the role of methylene blue in septic shock, Nour Khatib on jaw dislocation reduction techniques, Hans Rosenberg on a phenotypic approach to Crohn's disease emergencies, Gil Yehudaiff on evidence based analgesics in renal colic, Brit Long on the importance of inhaled steroids for asthma, and Andrew Petrosoniak on the "lethal diamond" in polytrauma patients and the current state of hypocalcemia in bleeding trauma patients.

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Disaster in Libya, the Italian Red Cross in the front line for assistance

Emergency Live

Cyclone Daniel: over 2,000 dead and thousands missing in Libya The national president of the Italian Red Cross, Rosario Valastro, has launched an urgent appeal for international solidarity in response to the devastating cyclone Daniel that has hit north-east Libya. With over two thousand dead and thousands missing, the situation is critical, and the CRI […] The post Disaster in Libya, the Italian Red Cross in the front line for assistance appeared first on Emergency Live.

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Enzyme Treatment Strips Mucins from Cancer Cells

Medagadget

Researchers at Stanford University have developed a new type of cancer therapy. The technology targets mucins, sugar-coated proteins that help cancer cells to metastasize and avoid the immune system. In particular, mucins enable cancer cells to survive free-floating as they travel through the blood during metastasis and can also trick immune cells into assuming that the cancer cell is not a threat.

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Grand Rounds Recap 9.6.23

Taming the SRU

ultrasound grand rounds: bedside dvt studies - family presence in the ed/icu - r1 clinical knowledge: aicd - r3 small groups: difficult airway management Ultrasound grand rounds: DVT studies WITH Dr. minges Why should we perform bedside DVT studies in the ED? Limited availability of radiology-performed US services in certain hospitals, especially overnight Can avoid unnecessary anticoagulation in patients Reduce time in ED to disposition In terms of workflow, when there is suspicion for a DVT, y

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Reeling In Misrepresentation: Fish Oil Supplements Found Lacking

Science Based Medicine

An analysis of label claims for fish oil supplements finds a lot of tall tales The post Reeling In Misrepresentation: Fish Oil Supplements Found Lacking first appeared on Science-Based Medicine.

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EIL Systems: emergency lighting at REAS 2023

Emergency Live

EIL Systems presents the new ‘Towerlux Hybrid Power’ light tower: lighter, more powerful and portable In a world where innovation drives progress, EIL Systems stands as a beacon of light, pioneering the creation of technological solutions designed to tackle emergencies with a revolutionary approach. Its latest product, the Towerlux Hybrid Power light towers, is transforming […] The post EIL Systems: emergency lighting at REAS 2023 appeared first on Emergency Live.

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Technique Creates Multilayered Tubular Cell Constructs

Medagadget

Researchers at the University of Edinburgh have developed a new method to create multilayered tubes from cells. The technique could be very useful for recreating multilayered tubular constructs that are found in the body, such as the intestines and blood vessels. Accurately modeling such complex structures in the lab could open new doors in terms of medical research and may even pave the way for bioengineered intestinal or vascular constructs that are suitable for implantation in human patients.

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Two Basic Medical Rules

Stop and Think

There are basic things you learn in the first month of internship. Here are two: A clinician should never order a test if the results (positive or negative) will not change what you do after the test. All interventions come with potential benefits and potential harms. A clinician must match these to the individual being treated. Much mischief occurs when these basic tenets are not followed.

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EM@3AM: Extensor Tendon Laceration

EMDocs

Authors: Jacob Kirkland, MD (EM Resident Physician, UTSW – Dallas, TX); Stephen Field, DO (Assistant Professor of EM/Attending Physician, UTSW – 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 ba

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SICS: A Story of Courage and Dedication

Emergency Live

Dogs and humans united to save lives in the water The ‘Scuola Italiana Cani da Salvataggio’ (SICS) is an outstanding organisation, both nationally and internationally, dedicated to the training of dog units specialised in water rescue. Founded in 1989 by Ferruccio Pilenga, SICS has contributed significantly to the safety of people in Italian waters and […] The post SICS: A Story of Courage and Dedication appeared first on Emergency Live.

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Judge for yourself the management of this patient with "NSTEMI, multivessel disease"

Dr. Smith's ECG Blog

Sent by anonymous, edited by Pendell Meyers A man in his 50s with history only of hypertension presented with acute chest pain that started 45 minutes prior to presentation while doing yard work. It radiated to both shoulders and both upper extremities, and there was shortness of breath and diaphoresis as well. He reported a normal stress test a few years ago.

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The Future of Evolutionary Medicine

The Evolution & Medicine Review

Thursday Sept 21 at 5 pm CET, 11 am Eastern daylight time. Free, but registration is required. A deep dive live Frontiers webcast and discussion, featuring Randolph Nesse, Barbara Natterson-Horowitz, Daniel Blumstein, Athena Aktipis, Bernard Crespi, and Molly Fox.

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Journal Feed Weekly Wrap-Up

EMDocs

We always work hard, but we may not have time to read through a bunch of journals. It’s time to learn smarter. Originally published at JournalFeed , a site that provides daily or weekly literature updates. Follow Dr. Clay Smith at @spoonfedEM , and sign up for email updates here. #1: How to Spot Ischemia in RBBB Patients Spoon Feed In non-ischemic right bundle branch block (RBBB) ECGs, we expect discordant ST depression and T wave inversions in leads V1-V3.

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The aftermath of earthquakes - what happens after the tragedy

Emergency Live

Damage, isolation, aftershocks: the consequences of earthquakes If there is one event for which one always has a developed a certain fear, it is the earthquake. Earthquakes can pop up anywhere, whether in the deepest seas or even in areas completely removed from the most populated ones. A recent example is the earthquake that, unfortunately, […] The post The aftermath of earthquakes - what happens after the tragedy appeared first on Emergency Live.

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A 40 year old with nonspecific symptoms including dizziness

Dr. Smith's ECG Blog

A 40 year old with nonspecific symptoms including dizziness. What do you notice about the ECG? There is a very short QT interval. This is often found in hypercalcemia. See Ken Grauer's comments below for detail. Thus, the patient's chemistry was done and revealed ionized hypercalcemia of 6.3 mg/dL (normal 4.4 - 5.2) Followup: he was found to have hyperparathyroidism == MY Comment , by K EN G RAUER, MD ( 9/12 /2023 ): == Today's ECG is remarkable for an uncommon but important finding that we peri

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