Sat.May 25, 2024 - Fri.May 31, 2024

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ECG Blog #432 — "Should I Shock this Patient?"

Ken Grauer, MD

I was sent the ECG in Figure-1 — without the benefit of any history. Is this VT? What is the 1st thing — that YOU would do? Figure-1: I was sent this ECG without any history. Is this VT? MY Thoughts on Today’s CASE: As tempting as it might be to reach for the defibrillator on seeing the ECG shown in Figure-1 — My initial reaction was different. At 1st glance , my impression from seeing ECG #1 — was that the rhythm is very fast and irregular — with a highly variable QRS morphology — and, without

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More On MRI And External Fixators

The Trauma Pro

I’ve covered the problem of performing MRI on patients with external fixators. This is typically a problem that arises in head-injured patients with extremity or pelvic fixators for concomitant fractures. MRI is an indispensable tool for the evaluation of head, spine, and soft tissue trauma. However, a great deal of effort is required to ensure that any patient scheduled for this test is “MRI compatible.

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Doctors take money from pharmaceutical firms so they die with a slightly bigger number in the bank

Sensible Medicine

Imagine if your car mechanic took $10,000 a year from Michelin tires for “consulting” and then tended to recommend their tires over Pirelli — even if the latter are on sale or better quality or both. Imagine if your Governor took campaign contributions from Panera bread and then strangely exempted Panera bread from the new minimum wage law.

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The ultimate COVID-19 antivax conspiracy theory, courtesy of The Brownstone Institute and Jeffery Tucker

Science Based Medicine

I've long argued that antivax beliefs, indeed all science denial, is conspiracy theory. Leave it to The Brownstone Institute's Jeffery Tucker to make my point better for me than I ever could. Of course, Brownstone was always going to "go there." The post The ultimate COVID-19 antivax conspiracy theory, courtesy of The Brownstone Institute and Jeffery Tucker first appeared on Science-Based Medicine.

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Ep 195 Management of Subarachnoid Hemorrhage

Emergency Medicine Cases

Once the diagnosis of nontraumatic subarachnoid hemorrhage (SAH) has been made, our job is not done. Mortality in SAH patients can be up to 30% even without neurological deficit. Paying attention to the time-sensitive details of ED management of SAH patients can have a significant impact on their outcome. In this second part of our 2-part podcast series on subarachnoid hemorrhage with Dr.

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What’s With Those Capital Letters In Drug Names?

The Trauma Pro

Call me slow. I’ve subconsciously seen those capital letters in drug names for years. But I never really paid attention or thought much about them. For whatever reason, I just now realized that they are EVERYwhere! So I decided to investigate. Technically, they are called tall man letters. Here are some examples: Certain parts of the drug name are capitalized to highlight differences from a drug with similar spelling.

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Universal Depression Screening Leads to Unnecessary Harm

Sensible Medicine

Regardless of the reason for a primary care visit in the United States, patients are routinely asked how often they feel “hopeless” or "like a failure” These questions come from the PHQ-9. The PHQ-9 has since been validated and is now widely used to screen for depression. Since the United States Preventive Services Task Force (USPSTF) first recommended depression screening 22 years ago, the practice has become standard in primary care despite an absence of evidence.

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PTM Journal Club: Trauma Care

EM Ottawa

In this month’s PTM Journal Club, we explored the most recent literature on trauma care in the pre-hospital setting. If you missed last months PTM Journal Club, make sure to check-it out by clicking HERE. Ketamine vs Morphine for Out-Of-Hospital Traumatic Pain Background and Objectives Inadequate analgesia is a common challenge in the out-of-hospital treatment […] The post PTM Journal Club: Trauma Care appeared first on EMOttawa Blog.

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Andexanet alfa: expensive and harmful?

First 10 EM

We have previously discussed the many pharmaceutical advertisements published by the New England Journal of Medicine, thinly disguised as science, such as the original open label uncontrolled look at andexanet alfa. (Connolly 2019) At that point, I concluded that andexanet alfa should clearly not be used (although our pharmacies didn’t listen and wasted a lot […] The post Andexanet alfa: expensive and harmful?

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Eye injury preventing the eye from opening or closing

Emergency Medicine Journal

Clinical introduction An octogenarian presented to the hospital post-fall from a bed, sustaining left facial and chest bruises without consciousness loss. He had diabetes, hypertension, stroke and atrial fibrillation, and was on aspirin 100 mg and edoxaban 30 mg daily. Vital signs were stable. Examination showed left periorbital swelling and anterior thoracic bruising.

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Wide complex tachycardia, resistant to cardioversion. Some fascinating features here.

Dr. Smith's ECG Blog

An elderly dialysis patient presented with chest pain. She has poor LV function. Previous echo 4 months ago (confirmed with ED bedside echo): The estimated left ventricular ejection fraction is 30%. Severely decreased LV function. Regional wall motion abnormality-inferior, inferolateral, septum, anterolateral, anterior and apex, lateral. Here is her ECG: Regular Wide Complex Tachycardia.

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The Opportunity of Scarcity in Healthcare

33 Charts

For most of history, medical diagnosis came through a series of chaotic steps. Patients experienced a string of studies, samples, and images coupled with a doctor’s judgment offering a best-guess answer. Or, in many cases, just a guess. Increasingly, diagnosis is being be reduced to simple transactions. Clean point-of-care testing based on molecular and marker diagnosis.

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JC: Is First Pass Success an important outcome in PHEA research? St Emlyn’s

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed This JC from St Emlyn's looks at a paper from SJTRM and explores the association between first-pass success (FPS) during pre-hospital intubation and 30-day mortality in patients treated by Finnish helicopter emergency medical services (HEMS). The post JC: Is First Pass Success an important outcome in PHEA research?

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World Multiple Sclerosis Day

Emergency Live

Understanding Multiple Sclerosis: Understanding the Disease Multiple sclerosis (MS) is a chronic disease in which the immune system attacks nerve fibers in the brain and spinal cord. MS affects the myelin sheath that covers nerve fibers, resulting in a variety of different effects in terms of neurological symptoms. Among the most common outcomes are vision […] The post World Multiple Sclerosis Day appeared first on Emergency Live.

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Quiz post: two patients with chest pain. Do either, both, or neither have OMI?

Dr. Smith's ECG Blog

Written by Pendell Meyers Two patients with acute chest pain. Do either, neither, or both have OMI and need reperfusion? Patient 1: Patient 2: Patient 1: A man in his 40s with minimal medical history presented with acute chest pain radiating to his R shoulder. Triage ECG: Click here to sign up for Queen of Hearts Access Three serial troponins were all undetectable.

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SGEM#440: I’m Gonna Need Someone To Help Me – GRACE4 AUD and CHS Management in the ED

The Skeptics' Guide to EM

Reference: Borgundvaag et al. Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-4): Alcohol use disorder and cannabinoid hyperemesis syndrome management in the emergency department. AEM May 2024 Date: May 22, 2024 Dr. Bjug Borgundvaag Guest Skeptic: Dr. Bjug Borgundvaag is the Founding Director of the Schwartz/Reisman Emergency Medicine Institute (SREMI), at Sinai Health System.

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Measles – An Ancient Foe in Modern Times

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed Measles is a highly contagious viral disease making a resurgence due to declining vaccination rates. It presents with initial symptoms like high fever and coryza, followed by a rash. Rapid isolation and appropriate use of PPE are critical for suspected cases. The post Measles – An Ancient Foe in Modern Times appeared first on St.Emlyn's.

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Extreme Heatwave in New Delhi

Emergency Live

Record Heat in New Delhi At this moment, the city of New Delhi is experiencing an exceptional drought, with temperatures reaching increasingly higher records month by month. Since the beginning of May, maximum temperatures have been steadily rising at the Mungeshpur weather station, reaching 52.3 degrees Celsius. This peak has raised alarm and shown severe […] The post Extreme Heatwave in New Delhi appeared first on Emergency Live.

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Cancer Clinical Trials Don’t Benefit Patients

EM Literature of Note

Hearkening back to my former life as the chair of an Institutional Review Board: you do not promise or imply a potential for benefit to clinical trial participants. Why? Because clinical trials aren’t designed to benefit participants. Participants may be randomized to the “standard of care” arm. The trial drug may not have any improvement in efficacy over the “standard of care” Worse, the trial drug may, in fact, have greater toxicity than the current options.

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Prioritizing our Healthcare Workers: The Importance of Addressing the Intersection of Workplace Violence and Mental Health and Wellbeing

NIOSH Science Blog

Workplace violence impacts the mental health and wellbeing of the healthcare workforce. The negative outcomes not only affect the healthcare worker but can trickle down to patient safety and satisfaction. It is important that healthcare institutions implement workplace violence prevention programs that benefit the entire healthcare workforce. This blog post highlights current efforts across government and industry to address this critical issue.

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REBEL Core Cast 123.0 – Posterior Epistaxis

RebelEM

Take Home Points: Posterior epistaxis is a rare, life-threatning presentation. The key is in identifying and rapidly gaining control with a posterior pack or foley catheter. These patients often require surgical intervention so get ENT to the bedside and admit to a place with a higher level of monitoring. REBEL Core Cast 123.0 – Posterior Epistaxis Click here for Direct Download of the Podcast.

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Rescue Drones: Technological Revolution

Emergency Live

How Drones Are Transforming Search and Rescue Operations The development of drone technologies has brought about a change in search and rescue operations. Devices have been equipped with advanced technologies: expanding thermal cameras with artificial intelligence. This is greatly increasing the efficiency and effectiveness of rescue missions. Today’s article shows how drones are revolutionizing the […] The post Rescue Drones: Technological Revolution appeared first on Emergency Live

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EM@3AM: Sialadenitis

EMDocs

Authors: Alena Hoover, MD (EM Resident Physician, ACMC/Oak Lawn, IL); Thaer Ahmad, MD (EM Attending Physician, Oak Lawn, IL) // Reviewed by: Sophia Görgens, MD (EM Physician, Northwell, NY); Cassandra Mackey, MD (Assistant Professor of Emergency Medicine, UMass Chan Medical School); 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.

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What’s So “Wonderful!” About an Article That Provoked Hateful Revenge Fantasies Against Frontline Doctors and Public Health Officials?

Science Based Medicine

"May he be forever riddled with guilt. May he suffer the loss of a loved one in the same manner. May he die alone." The post What’s So “Wonderful!” About an Article That Provoked Hateful Revenge Fantasies Against Frontline Doctors and Public Health Officials? first appeared on Science-Based Medicine.

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Simple but Effective Ways to Make the Autoclave Process More Efficient

PDC Healthcare

Efficient autoclave processes are essential for maintaining sterile environments in healthcare settings. Unfortunately, the autoclave process can often be time-consuming and resource-intensive if not managed properly. That’s why finding simple yet effective ways to streamline and enhance this process can make a significant difference in both operational efficiency and patient care quality.

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Innovations in Rescue: Technologies that Save Lives

Emergency Live

How AI and AR Are Revolutionizing Rescue Operations Rescue operations are crucial for saving lives in emergency situations. In recent years, the advent of advanced technologies like artificial intelligence and augmented reality has significantly increased the efficiency and quality of these operations. This technological development not only speeds up response times but also improves the […] The post Innovations in Rescue: Technologies that Save Lives appeared first on Emergency Live.

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emDOCs Podcast – Episode 101: Acute Chest Syndrome Part 2

EMDocs

Today on the emDOCs cast with Brit Long, MD ( @long_brit) , we cover part 2 of acute chest syndrome. Episode 101: Acute Chest Syndrome Part 2 Background SCD is an autosomal recessive condition that results in the formation of hemoglobin S (HbS). HbS has reduced solubility in the setting of hypoxia, leading to sickling of the RBCs. Other causes of sickling: acidosis, dehydration, inflammation, infection, fever, and blood stasis.

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The First10EM monthly wrap-up for May 2024

First 10 EM

The First10EM monthly wrap up is a place for me to share updates about the website, about my academic life, and also interesting content, such as books, podcasts, and other FOAMed, that I have encountered in the prior month. Obviously the format means the focus is mostly on content I have found, but I hope […] The post The First10EM monthly wrap-up for May 2024 appeared first on First10EM.

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Khat and Muguka Use in East Africa

Science Based Medicine

Many countries (such as Kenya’s recent regulatory changes regarding Muguka use) are struggling with the dilemma of how to regulate drug use by its citizens. There are many psychoactive drugs (we seem to be good at discovering them) with a variety of effects. Often there may be subjectively desirable effects in the short term, but long term addiction, the potential for withdrawal, […] The post Khat and Muguka Use in East Africa first appeared on Science-Based Medicine.

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Advanced Training for Rescue Professionals

Emergency Live

The Importance of Ongoing and Quality Training For first responders, advanced and continuous training is essential to maintain high skills and provide effective responses to emergencies. Through such training, they can not only update previously acquired techniques but also learn about new technologies and innovate their methods of use. Specialized Training Programs A wide range […] The post Advanced Training for Rescue Professionals appeared first on Emergency Live.

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WTBS 30 Lessons on Emergency Medicine Leadership: The Role of The Leader

Emergency Medicine Cases

Dr. Howard Ovens reflects on the role of leader in the EM in this 2nd part of a 2-part Waiting to Be Seen blog series on EM leadership. He touches on mentoring, being committed, aligning with patients' interests, being a role model and a few quick takes on some controversial issues in EM. The post WTBS 30 Lessons on Emergency Medicine Leadership: The Role of The Leader appeared first on Emergency Medicine Cases.

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Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia

EM Ottawa

Methodology: 4/5 Usefulness: 3.5/5 Carson JL, et al. N Engl J Med. 2023 Dec 28;389(26):2446-2456. doi: 10.1056/NEJMoa2307983. Questions and methods: This multicenter, open-label, RCT of 3604 patients with MI with anemia compared 30-day all-cause mortality and recurrent nonfatal MI between liberal vs restrictive transfusion thresholds. Findings: There was no significant difference in 30-day all-cause mortality […] The post Restrictive or Liberal Transfusion Strategy in Myocardial Infarctio

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CV-EMCrit – Cardiovascular Intensivist Series: Post Cardiopulmonary Bypass (CABG) Care with Trina Augustin

EMCrit

Management of the Post-CABG pt in the ICU EMCrit Project by Katrina Augustin.

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The Importance of First Aid Training

Emergency Live

How First Aid Training Saves Lives and Enhances Safety Training in first aid is essential to ensure the safety and well-being of individuals in emergency situations. This type of training not only equips individuals with the skills to effectively handle emergency situations but also adds confidence and tactical ability to their repertoire when they need […] The post The Importance of First Aid Training appeared first on Emergency Live.

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Is all this "ST Depression" due to ischemia?

Dr. Smith's ECG Blog

Written by Magnus Nossen, with some edits by Smith This ECG was transmitted electronically by EMS for evaluation. The patient is a 70 something female with chest discomfort and dyspnea. How would you interpret the ST changes seen in this ECG? Will you accept this patient for emergent coronary angiogram based on the ECG changes? Does the ECG represent STEMI-negative OMI findings?

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PTM Journal Club Recap: Glucocorticoid and Hemodynamics

EM Ottawa

At this month’s PTM Journal Club, we explored the use of high-dose glucocorticoid on hemodynamics in the prehospital setting; in particular, the STEROHCA trial conducted in Denmark. Effect of prehospital high-dose glucocorticoid on hemodynamics in patients resuscitated from out-of-hospital cardiac arrest: a sub-study of the STEROHCA trial Background and Objectives Out-of-hospital cardiac arrest (OHCA) carries […] The post PTM Journal Club Recap: Glucocorticoid and Hemodynamics appe

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Connect with healthcare experience leaders and innovators at HUB24

NRC Health

Check out the breakout sessions and poster presentation details for NRC Health's 30th annual conference, Human Understanding Beyond | HUB24. Get the details and register today! The post Connect with healthcare experience leaders and innovators at HUB24 appeared first on NRC Health.

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