EM Ottawa

OCTOBER 5, 2023

Do you remember when every newborn under 30 days with a fever needed an LP/admission/blood cultures? Well. times are a little different but its nuanced. The goal of this update is to provide a practical update in pediatric emergency medicine to the average Canadian adult or community emergency clinician. We will review the following three […] The post Little People, Big Updates: Updates in Pediatric Emergency Medicine appeared first on EMOttawa Blog.

Pediatrics 131

Pediatrics Wellness Seizures Resuscitation 131

Emergency Live

DECEMBER 5, 2023

The benefits and challenges in the digital age: the telemedicine revolution in emergency care Telemedicine is playing an increasingly significant role in emergency care, revolutionizing the way care is delivered. The ability to conduct remote medical consultations has opened up new opportunities for faster and more efficient response to medical emergencies.

Telemedicine 122

Telemedicine 122

The Skeptics' Guide to EM

DECEMBER 16, 2023

Reference: Punches et al. Patient Perceptions of Microaggressions and Discrimination Towards Patients During Emergency Department Care. AEM Dec 2023 Date: December 14, 2023 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and assistant Professor at the University of Calgary. He is also an avid FOAM supporter/producer through various online outlets including TheSGEM.

Emergency Department 125

Emergency Department Research Outcomes 125

Ken Grauer, MD

NOVEMBER 10, 2023

== — CLICK HERE — for a V ideo presentation of this case! Below are slides used in my video presentation. For full discussion of this case — See ECG Blog #220 — == The long lead II rhythm strip shown in Figure-1 was obtained from an 51-year-old man who presented to the ED ( Emergency Department ) with "palpitations" that began 1 hour earlier. HOW would you interpret this tracing?

EKG/ECG 483

EKG/ECG Emergency Department 483

Speaker: Simran Kaur, Co-founder & CEO at Tattva.Health

AI is transforming clinical trials—accelerating drug discovery, optimizing patient recruitment, and improving data analysis. But its impact goes far beyond research. As AI-driven innovation reshapes the clinical trial process, it’s also influencing broader healthcare trends, from personalized medicine to patient outcomes. Join this new webinar featuring Simran Kaur for an insightful discussion on what all of this means for the future of healthcare!

Outcomes

Pediatric EM Morsels

SEPTEMBER 22, 2023

To celebrate the end of trauma season ( is it ever really over? ), we here at the Ped EM Morsels Bakery have cooked up a morsel to remind you that pediatric trauma can be even more difficult than you think. Never fear. As our fearless leader likes to say: “children are not aliens, but they are a special population with unique anatomy and physiology.” Children compensate for blood and volume loss very well… until they don’t.

Shock 307

Shock Pediatrics Dislocations Hyperthermia / Hypothermia 307

The Trauma Pro

DECEMBER 22, 2023

As I was browsing through my journal list this week, I ran into an interesting title for an article that is currently in press. “The use of radio-opaque markers is medical dogma” Catchy, especially since I love writing about dogma vs what is really supported by the literature. The author questions the justification of this practice and posits that there are risks to extrapolating information based on radiographs with markers placed by the trauma team.

Operations 264

Operations Outcomes 264

Sensible Medicine

DECEMBER 18, 2023

Good morning all. This Monday, I take a day off. For the study of the week, Vinay Prasad contrasts the different recommendations on the treatment of childhood obesity. The USPSTF or United States Preventive Services Task Force is an independent volunteer panel of experts in disease prevention and evidence-based medicine. They are as close to neutral judges of medical evidence as it gets.

Pediatrics 145

Pediatrics Documentation/Coding Burns Academics 145

St. Emlyn

NOVEMBER 14, 2023

St.Emlyn's - Emergency Medicine #FOAMed Simplifying urgent care data translation is essential for hospital flow improvement. This post provides a perspective on how to achieve this. The post Speaking urgent care flow fluently appeared first on St.Emlyn's.

Urgent Care 145

Urgent Care Hospitals Teamwork Leadership 145

First 10 EM

SEPTEMBER 18, 2023

Transfusion seems like the simplest intervention in medicine. The patient is losing blood, so let’s put some back in. Not much more complicated than an oil change. Sure, you need to use a specific brand, but as long as the system is topped up, everything should run just fine. Therefore, when someone (to be left […] The post Massive hemorrhage: a very deep dive appeared first on First10EM.

145

145

Don't Forget the Bubbles

OCTOBER 30, 2023

Read between the lines. No matter where we are or what type of medicine we practice, it is likely that we all were told at one point that we were expected to be lifelong learners. This is important as medical knowledge is constantly evolving. Dr. David Sackett, the father of evidence-based medicine, once said: I The traditional way to stay current is by reading the relevant scientific literature.

Research 144

Research Outcomes 144

EM Ottawa

OCTOBER 12, 2023

I was in the OR for the first day of my anesthesia rotation when suddenly the pain hit me. It was in my left flank, radiating to my back — so much pain I could hardly think. A flurry of tests later, my ultrasound showed good doppler flow, and my lab work was pristine. I had […] The post Experiential learning with a TWIST: Ovarian Torsion appeared first on EMOttawa Blog.

Ultrasounds 144

Ultrasounds EMS 144

Greater Sydney Area HEMS

NOVEMBER 4, 2023

Airway Registry learning points reflect the challenges described and wisdom shared by Sydney HEMS personnel and guests at the Clinical Governance Airway Registry presentations. Cases are discussed non-contemporaneously, anonymised and amalgamated over a period of time to draw together unifying take-home messages. Details of specific cases are removed and/or changed, such that any similarity to real-life patients or scenarios is coincidental.

Airway Management 144

Airway Management Burns Operations Resuscitation 144

The Bottom Line

JUNE 19, 2023

In adult patients with major trauma, who are at risk for trauma-induced coagulopathy does early administration of 1g of tranexamic acid (TXA) followed by an infusion of 1g over 8 hours, compared with placebo, increase survival with a favourable functional outcome at 6 months?

Administration 145

Administration Outcomes Shock 145

Ken Grauer, MD

SEPTEMBER 22, 2023

The ECG in Figure-1 — was obtained from a middle-aged man with palpitations and shortness of breath. He was hemodynamically stable at the time this tracing was recorded. How would YOU interpret the ECG in Figure-1 ? Is there evidence of a recent or ongoing acute MI? What might you do first? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ).

EKG/ECG 446

EKG/ECG Wellness 446

Pediatric EM Morsels

SEPTEMBER 8, 2023

Life is full of hazards! Chance encounters with life’s hazards seem to increase in the Summer time (ex, Trampolines , Snakes , Lawn Mowers , Water , and Heat ). It is good that continue to raise awareness of such hazards so we can prevent them ! Certainly, the care of pediatric patients is known for its “ Seasonality. ” Now that the long days of summer ( for us in the Northern Hemisphere ) might be behind us, some of those hazards may also be receding, but injuries and illnesse

Poisoning 281

Poisoning Pediatrics EMS 281

The Trauma Pro

JUNE 6, 2023

In today’s post, I will review the diaphragmatic injury practice guidelines published by the Eastern Association for the Surgery of Trauma (EAST). I will follow this up on Friday with an interesting delayed diaphragm injury case. Diaphragm injury is a troublesome one to diagnose. It is essentially an elliptical sheet of muscle that is doubly curved, so it does not lend itself well to diagnosis by axial imaging.

Operations 259

Operations Wellness 259

Mount Sinai EM

OCTOBER 2, 2023

Let’s talk about large bore/central vascular access! We’ll review different kinds, their different names, and when to use them! Of note outside the scope of this review: how to insert each of these – I think this is better learned by watching videos, watching others, & doing with guidance. This is also by no means a comprehensive vascular access guide – this is a framework to highlight three commonly used types of central lines in the ED.

Resuscitation 231

Resuscitation Fluid Resuscitation Administration Shock 231

Sensible Medicine

NOVEMBER 30, 2023

Three recent events tell us that US healthcare is doomed. First, health care premiums have risen to new heights. Second, Medicare has agreed to pay for GRAIL cancer screening as part of coverage with evidence development and third, many doctors protested Cigna’s denial of coverage for a double lung transplant for stage IV lung cancer, leading the insurer to agree to cover it.

Research 145

Research Radiology Radiology Administration 145

RebelEM

JUNE 14, 2023

Anaphylactic Shock is an acute, life-threatening hypersensitivity disorder, with a generalized, rapidly evolving, multi-systemic allergic reaction (IgE-mediated disorder). If not treated rapidly can become fatal. Scott Weingart, MD put together a manual titled the Resuscitation Crisis Manual , which in short, is composed of two-page protocols for various situations that involve crashing patients.

Shock 145

Shock Allergic Reactions Resuscitation EMS 145

St. Emlyn

JUNE 2, 2023

St.Emlyn's - Emergency Medicine #FOAMed New guidelines from @RCollEM and @RCRadiologists finally agree that contrast CT should not be delayed in the critically ill/injured #FOAMed The post Contrast Induced Nephropathy – sense at last. St Emlyn’s appeared first on St.Emlyn's.

Resuscitation 145

Resuscitation 145

EMCrit

SEPTEMBER 3, 2023

In many countries, pulmonary and critical care are commonly bundled together. Consequently, a single person will often be responsible for both inpatient ICU management as well as inpatient pulmonary consultation. Honestly, I have some doubts about whether this is an ideal system. As both pulmonology and critical care medicine become increasingly complex, it's becoming impossible […] EMCrit Project by Josh Farkas.

Hospitals 144

Hospitals Wellness 144

EM Ottawa

OCTOBER 19, 2023

Canada’s healthcare system, once a source of national pride, is now facing critical challenges that have led many to view it as “unwell” or “sick.” Access to healthcare services has become a pressing concern, sparking a call for change and revitalization. The 911 Emergency System was initially designed as a means to manage emergencies and […] The post Transforming Canada’s Healthcare Landscape with Paramedics appeared first on EMOttawa Blog.

EMS 144

EMS 144

Don't Forget the Bubbles

NOVEMBER 27, 2023

Four-year-old Ed is being resuscitated for presumed Invasive Group A Streptococcal Sepsis from tonsilitis. He presented tachycardic and hypotensive with a capillary refill time of 5 seconds. After 40ml/kg of IV 0.9% NaCl, his HR came down a little, but the effect was short-lived. He has an HR of 190/min, and his BP is 85/35 mmHg. The CRT is unchanged.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

Life in the Fast Lane

JUNE 11, 2023

Neil Long and Chris Nickson AMAX4 Algorithm AMAX4 is a best-practice algorithm for critical care clinicians in anaphylaxis and asthma resuscitation.

Anaphylaxis 145

Anaphylaxis Best Practices Resuscitation Pediatrics 145

Ken Grauer, MD

DECEMBER 23, 2023

The ECG in Figure-1 — was obtained from a patient with palpitations. The patient was hemodynamically stable in association with this rhythm. QUESTIONS: What is the rhythm in Figure-1 ? — How certain are you of your answer? — Why is QRS morphology changing ? Figure-1: The initial ECG in today's case. My Interpretation of the ECG in Figure-1: Since the patient is hemodynamically stable — there is time for systematic assessment of the rhythm.

EKG/ECG 441

EKG/ECG Wellness 441

Pediatric EM Morsels

OCTOBER 27, 2023

Taking care of a critically ill child can be nerve-racking to say the least, and downright petrifying for those who don’t do it frequently, even if they are well-trained and brilliant clinicians. Dr. James Broselow, a family medicine-turned-emergency medicine physician from Hickory, North Carolina , recognized that his team spent a lot of time trying to calculate doses of medications rather than spending their mental energy on the actual medical decisions for the resuscitation.

Pediatrics 274

Pediatrics Resuscitation Documentation/Coding Wellness 274

The Trauma Pro

JUNE 23, 2023

What are common sources of malpractice complaints against nurses? The most common event is medication error. Most people worry about common errors like wrong dose, wrong drug, and wrong route of administration. But one less commonly considered drug-related responsibility is assessment for side effects and toxicity of medications administered. Other common reasons include failure to adequately monitor and assess the patient, and failure to supervise a patient that results in harm.

Documentation/Coding 246

Documentation/Coding Administration 246

Mount Sinai EM

OCTOBER 26, 2023

Applying the LUCAS with minimal pauses in chest compressions FIRST STEP : LUCAS backboard behind patient’s head SECOND STEP : lift patient forward to slide backboard behind chest THIRD STEP : apply the LUCAS and start GIFs lifted from this video: [link] Whenever my team applies the backboard during a roll, it ends up getting tangled in sheets and clothing and needs additional adjustment to be centered once the patient is rolled back.

200

200

Sensible Medicine

NOVEMBER 10, 2023

The CDC has just reported that more parents than ever are getting vaccine exemptions for their children entering Kindergarten. For many of us who have witnessed the CDC’s repeated blunders with kids COVID19 vaccines, this result is entirely predictable. The CDC has lost the trust of the American people, and it will keep getting worse. First, let me say, I warned them.

CDC 145

CDC Pediatrics Poisoning Hospitals 145

First 10 EM

SEPTEMBER 25, 2023

Introduced to the world by our friend Scott Weingart, delayed sequence intubation (DSI) is often summarized as procedural sedation for the procedure of preoxygenation. (Weingart 2011, Weingart 2015) It is a brilliant concept, makes a ton of sense on paper, and anecdotally has seemed to help a number of my patients. However, any long time […] The post Delayed sequence intubation: An RCT appeared first on First10EM.

EMS 143

EMS 143

RebelEM

JULY 5, 2023

Take Home Points Provider assessment of how the patient looks is extremely important. If it looks and feels like a STEMI clinically, get serial ECGs and consult Cardiology immediately. POCUS has been a phenomenal tool in the management and early diagnosis of a lot of abnormal ECG and chest pain presentations. Isolated elevation in aVR with diffuse ST depressions can be a sign of Left Main occlusion.

EKG/ECG 143

EKG/ECG Sepsis EMS 143

EMCrit

DECEMBER 10, 2023

Within the past year, two major societies have released guidelines on ARDS: the ATS (American Thoracic Society) and the ESICM (European Society of Intensive Care Medicine). Don’t be fooled by their names – both of these organizations are fundamentally international in scope. Some authors on the ATS document were from Europe, and similarly some authors […] EMCrit Project by Josh Farkas.

Documentation/Coding 143

Documentation/Coding 143

EM Ottawa

DECEMBER 7, 2023

Aortic Stenosis is the most common valvular heart disease in Canada. In fact, after hypertension and coronary artery disease, it is the third most common cardiovascular condition. The prevalence of valvular heart disease increases sharply with age. Approximately 1 in 10 of your patients over the age of 75 has aortic stenosis. The most common […] The post The Way is Shut: Aortic Stenosis appeared first on EMOttawa Blog.

Shock 140

Shock 140

Don't Forget the Bubbles

JUNE 19, 2023

You are asked to see a baby boy in the labour ward. He was born at 38 weeks and 5 days gestational age and weighs 2600 grams. His mother is healthy, but she does mention that her first-born daughter was also small. She weighed 2570 grams at 39 weeks and is now perfectly healthy. The parents are of South-Asian descent. There were no issues during the pregnancy, and estimated fetal growth by ultrasound was constant.

Pediatrics 143

Pediatrics Ultrasounds Hyperthermia / Hypothermia Sepsis 143

Critical Care North Hampton

OCTOBER 9, 2023

We’ve been busy again to bring you the fastest review of GE’s new offering. The VScan SL probe is due to be released and we were lucky enough to get our hands on this fab device. Was it as good as its sister device, the VSCan Air? Take a look at our 3-person review. Below.

Ultrasounds 141

Ultrasounds 141

Ken Grauer, MD

NOVEMBER 25, 2023

== CLICK HERE — for a V ideo presentation of this case! ( 19:40 min. ) Below are slides used in my video presentation. For full discussion of this case — See ECG Blog #191 — == The 2-lead rhythm strip shown in Figure-1 was obtained from an elderly woman who presented to the ED following a syncopal episode. On the basis of this rhythm strip — she was diagnosed as being in complete AV Block.

EKG/ECG 440

EKG/ECG 440