Sat.Dec 03, 2022 - Fri.Dec 09, 2022

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EMCrit 338 – End of Year Question & Answer Session

EMCrit

Rounding up the questions from the past few months. EMCrit Project by Scott Weingart, MD FCCM.

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TEAM

The Bottom Line

Early Active Mobilization during Mechanical Ventilation in the ICU @chodgsonANZICRC @TEAMtrialICU. NEJM 2022; 387:1747-58 doi:10.1056/NEJMoa2209083 Clinical Question In mechanically ventilated adult patients does the provision of early mobilisation when compared to standard care increase the number of days alive and out of hospital at 180 days?

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Restoring Physician-Patient Trust

American Medical Compliance

Physician-patient trust has been deteriorating for years. There are different reasons for reduced levels of trust between patients and doctors. However, ensuring patients have confidence in their care providers and that doctors feel safe at work will be critical in recentering trust moving forward so patients can receive the highest possible level of care.

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ECG of the Week 7th December 2022

EMergucate

Paramedics ring through to say that they are 10 minutes away with a 65 year old man who has a heart rate of approximately 170 with a thready pulse and a systolic blood pressure of 90.

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Journal Jam 21 Laceration Management – Does Timing of Closure, Irrigation, Gloves Type, Eversion Matter?

Emergency Medicine Cases

In this Journal Jam podcast Anton and Justin welcome special guest Dr. Haley Cochrane. We dive deep into the evidence for timing of closure and infection rate, fluid choice, volume and pressure of irrigation of lacerations, glove type and infection rate, how eversion of wound edges effects cosmetic outcomes and much more. You might be surprised to discover that the evidence for many things we do for lacerations that are considered "standard of care", is either weak or non-existent.

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65 year old with syncope and a 'normal' ECG: discharge home?

Dr. Smith's ECG Blog

A 65 year old with diabetes presented with a syncopal episode while sitting, associated with weakness but no chest pain or shortness of breath. Vital signs were normal and first ECG was labeled as normal by the computer and confirmed by the treating emergency physician and cardiology over-read. What do you think? There’s normal sinus rhythm, normal conduction, normal axis, normal R wave progression, and normal voltages with J waves from early repolarization.

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Announcing the Digital Health Founder’s Fellowship

MDisrupt

Are you a digital health founder or CEO? Join us for an exclusive event designed to help digital health companies accelerate their paths to market and scale their business through expertise and mentorship.

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EMC Journal Club 1 – Does Treating Fever Make A Difference?

Emergency Medicine Cases

In this first EMC Journal Club (where we take the "boring" out of journal clubs and deliver clear, concise, practical practice changing critical appraisal knowledge based on an Emergency Medicine journal article that may have passed your radar - not too detailed and not too brief), Dr. Rohit Mohindra, an Emergency Physician at North York General in Toronto and SREMI researcher works his critical appraisal magic on the article "Fever therapy in febrile adults: systematic review with meta-analyses

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PRONE POSITIONING: From basic concepts to practice

Trigger Lab

This article was first written during the outbreak of the SARS-CoV-2 pandemic, even though at the time the contagion is decreasing, I still think it’s very important to offer a small summary of the theory and techniques used during the process of prone positioning in patients affected with ARDS (Acute Respiratory Distress Syndrome).

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154. C diff colitis: bring your rain boots

Board Bombs

Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here: emrapidbombs.supercast.com. We have a lot to talk about on this podcast, but we’re going to focus on Number 2. hehe. We have plenty more jokes where that came from! Iltifat, Blake, and Marlena chat about C diff, the scary, test-relevant antibiotic resistant bug that can cause some scary colitis.

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Short Course Antibiotics for Peds CAP: A Systematic Review and Meta-Analysis

RebelEM

Background: There is a shifting paradigm with persuasive evidence favoring a shorter duration of antibiotics for outpatient management of community-acquired pneumonia (CAP) in children. The SAFER and CAP-IT trials found that short-course antibiotic therapy was not inferior to standard duration therapy. The SCOUT-CAP Trial found that short-course antibiotic therapy was superior to standard therapy.

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ECG of the Week 30th November 2022 – Interpretation

EMergucate

ECG of the Week 30th November 2022 – Interpretation This ECG was used to illustrate how a systematic approach ensures … Continue reading →

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Thinking Beyond First Order Effects

Stop and Think

Heart disease statistics can be mundane. But not this one. This one makes me Stop and Think. Off the main stage, at the American Heart Association meeting last month, Dr. Rebecca Woodruff, a scientist from CDC, presented a study that found a spike in deaths due to heart disease in 2020. Journalist Marlene Busko covered the abstract. Two factors make this observation notable.

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Bougienage | Spotting Functional Disorders

JournalFeed

The JournalFeed podcast for the week of Nov 28 – Dec 2, 2022. These are summaries from just 2 of the 5 article we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member. Bougienage Spoon Feed Esophageal bougienage is an underutilized bedside technique for managing retained esophageal coins. Spotting Functional Disorders Spoon Feed Inconsistency and incongruence are two keys to diagnosing a functional neurological disorder.

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SGEM #384: Take Me Out Tonight, I Don’t Want to Perforate My Appendix Alright

The Skeptics' Guide to EM

Date: November 16th, 2022 Reference: Lipsett SC, Monuteaux MC, Shanahan KH, et al. Nonoperative Management of Uncomplicated Appendicitis. Pediatrics 2022 Guest Skeptic: Dr. Angelica DesPain is an Assistant Professor of Pediatrics and a pediatric emergency medicine physician at the Baylor College of Medicine Children’s Hospital of San Antonio in San Antonio, TX.

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Imaging Case of the Week 531

EMergucate

The following foot x-rays are from a 50 year old with plantar flexion injury to their foot and inability to … Continue reading →

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Novel prompt for hemmoragic shock resuscitation

University of Maryland Department of Emergency Med

This paper outlines a training course by Hartford Hospital for general surgery and emergency medicine residents. Their goal was to assess pre-a.

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Critical Care Evidence Updates – November 2022

The Bottom Line

What’s new in the Critical Care literature – monthly updates

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Are these Hyperacute T-waves?

Dr. Smith's ECG Blog

I received this ECG in a text message, with the message: "Hey, these look like hyperacute T waves to me, what do you think? It’s an intubated septic nursing home patient." "Here is her old ECG:" What do you think? Here is my response: "There is something wrong with this ECG. It might be another case of pulse tapping artifact. Change the location of the limb Electrodes and repeat the EKG.

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Lab case 388 interpretation

EMergucate

Question 1: PH = 7.55, that is moderate alkalaemia. pCO2 = 26 mmHG (<40), so we have respiratory alkalosis.

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Exercise intensity and cardiovascular mortality

University of Maryland Department of Emergency Med

"The Tortoise and the Hare" fable has been used as a metaphor for the epidemiological differences between slower, low-intensity exercise ve.

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Tasty Morsels of Critical Care 067 | The pulmonary artery catheter

Emergency Medicine Ireland

Welcome back to the tasty morsels of critical care podcast. Today we are going to do our best to charm the yellow snake of the intensive care unit and cover the pulmonary artery floatation catheter. Like a lot, indeed practically all of these topics, I do not in any way consider myself to have great expertise in the topic but I have had to upskill as much as I possibly can in lieu of the typical mis spent youth doing cardiac anaesthesia that most of my colleagues have had.

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It’s Your Call – December 2022

Total Medical ComplianceHIPAA

OSHA: How many exit routes are necessary in the workplace? At least two exit routes must be available for prompt and safe evacuation during an emergency, and these two routes must be located as far away from each other as practical. Single exit routes are permitted when the number of employees, building size, occupancy, or arrangement of the workplace enables employees to evacuate safely.

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Lab case 389

EMergucate

25-year-old police academy student brought to ED due to collapse in training.

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Extubation to Noninvasive Ventilation vs High Flow Nasal Cannula

University of Maryland Department of Emergency Med

Although extubation has historically been the purview of critical care, as ED lengths of stay continue to worsen, and as we see more and mo.

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Predicting 30 day readmission in rib fracture patients

University of Maryland Department of Emergency Med

In this retrospective chart review, 3720 admitted trauma patients with rib fractures were looked at for 30 day readmission. 206 patients i.

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Use of Serratus Anterior plane block for posterior rib fractures

University of Maryland Department of Emergency Med

The use of a serratus anterior plane nerve block has previously been described as effective for anterior and lateral rib fracture pain co.

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Follow up to Trauma Center Accessibility

University of Maryland Department of Emergency Med

In follow-up to last week’s pearl regarding the inequitable distribution of trauma care, there were a few more thoughts: 1.&nbsp.

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