Sat.Jan 27, 2024 - Fri.Feb 02, 2024

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Travel-Related Illnesses in Children

Pediatric EM Morsels

There have been many times I have encountered a triage note which states “ patient recently returned from … (insert awesome foreign country) … ” Not only does this leave me daydreaming about my future travel adventures, but has often caused me to take pause. Thoughts of what endemic illnesses could this child potentially have been exposed to in their travels?

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What is this ECG finding? Do you understand it before you hear the clinical context?

Dr. Smith's ECG Blog

Written by Pendell Meyers First try to interpret this ECG with no clinical context: The ECG shows an irregularly irregular rhythm, therefore almost certainly atrial fibrillation. After an initially narrow QRS, there is a very large abnormal extra wave at the end of the QRS complex. These are Osborn waves usually associated with hypothermia. There is also large T wave inversion and long QT.

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Adulteration of Herbal Supplements Continues

Science Based Medicine

The supplement industry continues to be plagued by deliberate adulteration of products. The post Adulteration of Herbal Supplements Continues first appeared on Science-Based Medicine.

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Cannabidiol in refractory status epilepticus

Don't Forget the Bubbles

A UK-based study found that 4% of admissions to a tertiary paediatric intensive care unit (PICU) over a 10-year period were due to refractory status epilepticus (RSE) – seizures which fail to terminate despite appropriate first and second-line treatments. Of those patients admitted with RSE, a subset will go on to develop super-refractory status epilepticus (SRSE).

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The AcT Trial: Tenecteplase vs Alteplase for Acute Ischemic Stroke

RebelEM

Background : Alteplase, a class of medication that converts plasminogen to plasmin leading to fibrin degradation and subsequent clot lysis, has been the standard of care for acute ischemic stroke (AIS) patients that meet eligibility criteria. Tenecteplase, a modified version of alteplase, is being increasingly utilized for AIS due to its favorable pharmacological profile, ease of administration, and cost effectiveness.

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The Latest in Critical Care, 1/29/24 (Issue #27)

PulmCCM

AHA Updates its Cardiac Arrest Guidelines In December 2023, the American Heart Association published a “focused update” to its landmark guidelines for the management of cardiac arrest. PulmCCM is not affiliated with the American Heart Association. Read the document for all the details (it’s not long). Here’s PulmCCM’s take on the new changes.

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Right Ventricular Heart Failure

EB Medicine

In this episode, Sam Ashoo, MD, and T.R. Eckler MD interview Nick Harrison, MD and Daniel Brenner, MD, two of the authors of the February 2024 Emergency Medicine Practice article, Emergency Department Management of Patients With Right Heart Failure Pathophysiology Presenting Symptoms Differential Diagnosis Specific Acute Causes PE Sepsis RVMI PPV ARDS COVID-19 Specific Chronic Causes CTEPH Left Heart Failure Congenital Heart Disease LVAD Lung Disease Group 3 Pulmonary Hypertension Pulmonary A

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"Can you tweet my paper" vs. "Here are some edits, no need to add me"

Sensible Medicine

Recently, I came across a tweet that lavished praise on an unremarkable article. The article contained, as my friend Bapu Jena likes to say, no new ideas. It merely restated things that had been said before. Immediately, the tweet jumped out at me — there was a disconnect between the flattery and the content. I happen to know the doctor who tweeted this and consider him a straight shooter.

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Update to Start 2024

EM Literature of Note

A brief post collating a few bits of my various work published across the interwebs … The Annals of Emergency Medicine Podcast continues to summarise the meatiest articles from each month, featuring a cycle of new co-hosts, as well: Apple Podcasts Google Podcasts Soundcloud Naturally, there are continuing Journal Club features, covering the following articles: Zone 1 endovascular balloon occlusion of the aorta vs resuscitative thoracotomy for patient resuscitation after severe hemorrha

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Extracorporeal Life Support in Infarct-Related Cardiogenic Shock

EM Ottawa

Methodology: 4/5 Usefulness: 3.5/5 Thiele H, et al. N Engl J Med. 2023 Oct 5;389(14):1286-1297. Editorial: Routine Early ECLS in Infarct-Related Cardiogenic Shock? Question: Does early ECLS therapy confer a mortality benefit in patients with MI complicated by cardiogenic shock? Methods: Open label RCT with 417 patients comparing 30-day all-cause mortality between ECLS versus standard […] The post Extracorporeal Life Support in Infarct-Related Cardiogenic Shock appeared first on EMOttawa B

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The Impacts of AI on Patient Experience and Patient Care

NRC Health

In this episode, we explore consumer & caregiver perspectives on artificial intelligence, from in-room patient monitoring to AI-powered care searches. The post The Impacts of AI on Patient Experience and Patient Care appeared first on NRC Health.

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Small Trials vs Large Trials

Sensible Medicine

I got the idea of this story from our project over at Cardiology Trials , where we are cataloging the seminal trials in cardiology. Gosh, I am learning a ton about medical evidence. Please do head over there and join the learning. When I rounded in the coronary care units back at Indiana University in the early 1990s, there was momentum to use IV-magnesium (Mg) in patients after myocardial infarction.

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Using Artificial Intelligence in the Medical Field

Life in the Fast Lane

Sheralyn Guilleminot and Mike Cadogan Using Artificial Intelligence in the Medical Field Full interview with critical care clinician and AI enthusiast, Dr Sameer Shaikh, on the many ways to use AI to save time and increase efficiency in healthcare

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PulmCrit wee: Polypharmacy in the ICU – when in doubt, deprescribe

EMCrit

Polypharmacy is technically defined as taking five or more medications on a daily basis. Polypharmacy is increasingly becoming the norm among adults, due to several factors (an aging population, increasing numbers of medical problems, and increasingly complex regimens available to treat chronic disorders such as heart failure). Indeed, the term “polypharmacy” is arguably antiquated now […] EMCrit Project by Josh Farkas.

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Trials and Expiration Dates

Stop and Think

Randomized clinical trials are the best way to know what works in medicine. While medical interventions (drugs or devices) remain the same, situations often change. One of the cool things that our Cardiology Trials substack project (Andrew Foy and Mohammad Ruzieh and I are cataloging the seminal trials) is teaching me, is that medications/devices proven effective in trials decades ago, may no longer have benefit now.

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Friday Reflection 35: Why Don’t Doctors Want to See Patients?

Sensible Medicine

At a Thanksgiving gathering, a middle-aged doctor talks to an older relative. While enjoying a pre-feast cocktail, the relative asks, “Why is it that doctors don’t want to see patients?” The doctor bumbles through a reply. Sensible Medicine is a reader-supported publication. If you appreciate our work, consider becoming a paid subscriber.

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Critical Care Reviews… Down Under!

Life in the Fast Lane

Chris Nickson Critical Care Reviews… Down Under! Expressions of interest are open to attend the "Critical Care Reviews Down Under" meeting in Melbourne, December 10th & 11th 2024.

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Annals of B Pod: Phlegmasia Cerulea Dolens

Taming the SRU

HISTORY OF PRESENT ILLNESS The patient is a female in her late 60’s presenting with acute onset of left arm pain and swelling. She initially noticed pain in her left arm with movement while helping her family move earlier on the day of presentation. While changing, she noticed that her arm was swollen to the mid humerus. She feels that this swelling came on over several hours.

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Rheumatoid arthritis: what it is and how it manifests itself

Emergency Live

Understanding the Symptoms, Causes, and Treatment Options for Rheumatoid Arthritis What is Rheumatoid Arthritis? Rheumatoid arthritis is a chronic autoimmune disease that primarily affects the joints, causing inflammation, pain, swelling, and, in some cases, loss of function. Contrary to what one might think, rheumatoid arthritis is not just a joint disease; it can also have […] The post Rheumatoid arthritis: what it is and how it manifests itself appeared first on Emergency Live.

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VExUS/POCUS/Resus Mini-Fellowships 2024

Thinking Critical Care

In the last couple of years VExUS has seemingly sparked a number of clinicians to focus on right-sided or venous congestion and its deleterious consequences. Many of us feel there is sufficient associative evidence and physiological basis to use VExUS to manage patients on a daily basis and do so routinely. Currently, several studies we know of (and probably many we don’t!

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Chest pain and a computer ‘normal’ ECG. Therefore, there is no need for a physician to look at this ECG.

Dr. Smith's ECG Blog

Written by Jesse McLaren, comments by Smith A 55 year old with a history of NSTEMI presented with two hours of exertional chest pain, with normal vitals. Below is the triage ECG, with a computer interpretation (Marquette 12 SL) of “normal” which was confirmed by the over-reading cardiologist. What do you think? Should this patient continue to stay in the waiting room, without interruption of the physician to interpret the ECG, because the computer interpretation is normal?

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Science-Based Satire: Historic Conference Clarifies Vertebral Subluxation Causes

Science Based Medicine

Did a meeting of chiropractors from around the world come to a historic consensus on the true causes of the chiropractic subluxation? No, this is satire. Still read the post though. Please. The post Science-Based Satire: Historic Conference Clarifies Vertebral Subluxation Causes first appeared on Science-Based Medicine.

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What is hyperinsulinemia? Risk factors and prevention

Emergency Live

An in-depth analysis of causes, symptoms, and coping strategies for this increasingly common disorder What is hyperinsulinemia and what are its causes Hyperinsulinemia is characterized by abnormally high levels of insulin in the blood, often associated with insulin resistance. This condition occurs when muscle, adipose, and hepatic cells do not respond adequately to insulin, forcing […] The post What is hyperinsulinemia?

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The UK-REBOA trial

First 10 EM

REBOA (resuscitative endovascular balloon occlusion of the aorta) has been discussed in the emergency medicine world for quite some time now, but always with very limited data. There have been some observational studies that suggested REBOA was associated with worse outcomes, but the outcomes were largely assumed to be the result of confounders. (Norii 2015, […] The post The UK-REBOA trial appeared first on First10EM.

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Lung Protective Ventilation

EM Ottawa

In our first part, we talked about the basics of mechanical ventilation and how to set up the ventilator for the busy ED doc! In part two, we discuss lung protective ventilation and go through a few cases to help solidify what we’ve learned. If you haven’t read part one – check it out here! […] The post Lung Protective Ventilation appeared first on EMOttawa Blog.

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Why Are Sensible Medicine Doctors Indifferent to the Nonsense Comments of Sensible Medicine Commentators? As Instructed, I Consider the Dualities of Interest and Motivating Biases.

Science Based Medicine

Sensible Medicine doctors often utter the words "do an RCT". So why are their readers so ignorant about RCTs? The post Why Are Sensible Medicine Doctors Indifferent to the Nonsense Comments of Sensible Medicine Commentators? As Instructed, I Consider the Dualities of Interest and Motivating Biases. first appeared on Science-Based Medicine.

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The new faces of helicopter rescue: the success of Airbus' H145s

Emergency Live

A Leap Forward in the Air Rescue Sector Thanks to Innovative Technologies of Airbus H145 Helicopters Innovations and Versatility of the Airbus H145 The Airbus H145 helicopter stands out in the field of air rescue due to its unique features, making it a benchmark model in the industry. With its new Helionix avionics suite, this […] The post The new faces of helicopter rescue: the success of Airbus' H145s appeared first on Emergency Live.

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Blood Pressure Management in Neurologic Emergencies: What Does the Evidence Say?

EMDocs

Authors: Sameer Desai, MD (EM Attending Physician, University of Kentucky); Omar Abbas Ahmed Malik, MBBS (Patients’ Aid Foundation, Jinnah Postgraduate Medical Center) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University School of Medicine in St. Louis); Marina Boushra, MD (EM-CCM Attending Physician, Cleveland Clinic Foundation); Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case: A 39-year-old male is brought in by EMS with a sudden-onset severe headache

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The First10EM monthly wrap-up for January 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 focus is on content I have found, but I hope the community gets engaged […] The post The First10EM monthly wrap-up for January 2024 appeared first on First10EM.

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More Americans turning to complementary approaches to pain control

Science Based Medicine

The use of of complementary health approaches overall, and for pain management, is growing among US adults. The post More Americans turning to complementary approaches to pain control first appeared on Science-Based Medicine.

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The defibrillator: a lifesaver in case of cardiac arrest

Emergency Live

Understanding the Functioning and Importance of Defibrillators in Managing Cardiac Emergencies What are Defibrillators Defibrillators are life-saving devices in the treatment of cardiac emergencies, providing an electrical shock to the heart to correct dangerous heart rhythms or cardiac arrests. These devices are particularly important in treating ventricular fibrillation and pulseless ventricular tachycardia, two forms of […] The post The defibrillator: a lifesaver in case of cardiac arre

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