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 128

Pediatrics Wellness Seizures Resuscitation 128

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 119

Emergency Department Research Outcomes 119

Science Based Medicine

DECEMBER 11, 2023

A new study is making the rounds in the antivax crankosphere. The study found that the modified mRNA used in the Pfizer vaccine can cause a frame shift (to be explained) that results in the production of proteins besides the intended spike protein. The findings are, as you probably guessed, a big nothingburger compared to how they are being spun. The post Do mRNA vaccines produce harmful “junk proteins” that “gunk up” the cell and cause unintended “off-target” immune responses?

Documentation/Coding 145

Documentation/Coding 145

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

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

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.

Burns 144

Burns Airway Management 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

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.

142

142

RebelEM

SEPTEMBER 21, 2023

Bottom Line Up Top: Troponins should not be routinely sent in patients presenting with SVT. Rarely, they may be necessary if the patient has concerning ischemic symptoms that persist after conversion to sinus rhythm. Clinical Scenario: A 44-year-old man presents with palpitations that started 45 minutes ago. He has no medical problems and denies any prior similar symptoms.

EKG/ECG 140

EKG/ECG Sepsis EMS Outcomes 140

Broome Docs

NOVEMBER 17, 2023

This is another lecture by the always amazing Dr Justin Morgenstern from the series of talks he delivered on his tour of Perth in September 2023. In this talk I challenged Justin to go on a very deep dive into the literature around the modern management of the massively bleeding trauma patient. What is the best way to resuscitate and replace all those blood products in these severely unwell people?

Resuscitation 137

Resuscitation 137

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

The Skeptics' Guide to EM

JULY 2, 2023

Date: July 1, 2023 Reference: PATCH-Trauma Investigators and ANZICS Clinical Trial Group. Prehospital Tranexamic Acid for Severe Trauma. NEJM 2023. Guest Skeptic: Dr. Salim Rezaie is a community emergency physician in San Antonio, TX. He is the Creator and founder of REBEL EM, a free, critical appraisal blog that tries to cut down knowledge translation gaps of […] The post SGEM#408: Hey, I, Oh I’m Still Alive – Is it due to TXA?

EMS 138

EMS Outcomes Hospitals Research 138

Science Based Medicine

DECEMBER 4, 2023

On Thursday, Steve Kirsch gave his long-hyped talk about "record-level data" from New Zealand that supposedly demonstrates that COVID-19 vaccines have killed more than 10 million people worldwide. His "analysis" of illegally obtained data from a "whistleblower" was so ridden with false assumptions and rookie errors that even some antivaxxers couldn't accept it.

CDC 145

CDC 145

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 143

Pediatrics Documentation/Coding Burns Academics 143

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

Greater Sydney Area HEMS

MAY 30, 2023

In the first in this series, HEMS physician and podcast host Dr Samuel Bulford interviews senior staff specialist Dr Cliff Reid who describes a case that changed his life and set his approach to mission preparation and training on a new trajectory.

Leadership 137

Leadership 137

The Bottom Line

OCTOBER 18, 2023

In patients with trauma and critical bleeding who require activation of a major haemorrhage protocol, does the empiric administration of 3 pools of cryoprecipitate (6g fibrinogen) within 90 minutes of randomisation (and no more than 3 hours after injury) improve survival, compared to standard care?

Administration 139

Administration Operations Resuscitation 139

Critical Care North Hampton

SEPTEMBER 25, 2023

In this video, my great friend and fellow editor Dr Marcus Peck, talks us through the world of A.I in POCUS! Let’s face it, our kids are using it to write essays, the military uses it and you can’t seem to be able to speak to a human being on the phone as companies are.

Military 136

Military Ultrasounds 136

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 130

Documentation/Coding 130

ACEP Now

OCTOBER 13, 2023

The CHRISTUS Health-Texas A&M Spohn Emergency Medicine Residency Program announced Friday that its program will close in June 2026 after the current emergency medicine residents complete their training. An official reason for the closure was not immediately available from the hospital administration, but residents there said they were told the surprise move was likely because of financial reasons.

Patient Safety 132

Patient Safety Administration Emergency Department EMS 132

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 135

Resuscitation 135

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

RebelEM

JUNE 1, 2023

Background: Achieving ROSC in out of hospital cardiac arrest (OHCA) is no easy feat but, care doesn’t end with ROSC. Post-ROSC management is nuanced and challenging but helps to ensure good outcomes. Identification of the underlying cause of the cardiac arrest is a critical area of focus in post-arrest care. Although myocardial infarction, dysrhythmias and pulmonary emboli are common pathologies to consider, there are a host of other causes including subarachnoid hemorrhage, trauma and electroly

Outcomes 135

Outcomes Resuscitation Hospitals CPR 135

Science Based Medicine

NOVEMBER 13, 2023

Over the weekend, Jeffrey Tucker, founder of the Brownstone Institute, crowed about how the Great Barrington Declaration and its recommendation of a "natural herd immunity" approach to the pandemic changed everything three years ago. Unfortunately, as the John Snow Project pointed out last week, the "natural herd immunity" approach has done what could be irreparable damage to public health science and, more importantly, the political and social will to promote public health practices not just fo

Infectious Diseases 145

Infectious Diseases Research 145

Sensible Medicine

NOVEMBER 2, 2023

Doctors and ‘experts’ who got COVID policy wrong are asking for forgiveness. Their errors hurt children— resulting in massive learning losses— and caused broader destabilization to the economy, work life, social communities and more. Do they deserve forgiveness? And, why did they err in the first place? Recently Scott Galloway, the NYU professor, appeared on Bill Maher.

Documentation/Coding 145

Documentation/Coding Pediatrics 145

Don't Forget the Bubbles

JUNE 30, 2023

A PEM adventure It’s time for another PEM adventure. Join us on another journey (with an inbuilt time travel machine) in managing Elsa, a 2-year-old girl who is a HUGE fan of the Disney movie, Frozen. Elsa was found face down in the family pool 20 minutes after last visual contact and was picked up without resuscitation. Emergency Medical Services found her apneic and pulseless.

Hyperthermia / Hypothermia 145

Hyperthermia / Hypothermia Military CPR EKG/ECG 145

The Skeptics' Guide to EM

DECEMBER 2, 2023

Reference: Shaikh N, et al. Identifying children likely to benefit from antibiotics for acute sinusitis: a randomized clinical trial. JAMA July 2023 Date: October 17, 2023 Guest Skeptic: Dr. Alasdair Munro is a clinical research fellow specializing in pediatric infectious disease at the University of Southampton. He is currently involved with clinical trials of vaccines […] The post SGEM#422: And It was all Yellow-Nasal Discharge and Antibiotics in Pediatric Sinusitis first appeared on The Skep

Pediatrics 129

Pediatrics Infectious Diseases Emergency Department Research 129

NIOSH Science Blog

NOVEMBER 8, 2023

Despite legislation and improved technology, data from Massachusetts hospitals show that sharps injuries have increased in the operating room (OR) [1]. These injuries place healthcare workers at risk of exposure to bloodborne pathogens (BBPs). There is an urgent need to renew efforts to protect healthcare workers inside the operating room. The Massachusetts data highlight a gap and the need to establish a national surveillance program that would help hospitals develop further measures to prevent

Operations 128

Operations Hospitals 128

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 130

EMS 130

EMCrit

MARCH 21, 2023

Steroid is worthless for pneumonia! Wait, a new study shows it's beneficial! Hang on, a fresh meta-analysis shows that steroid it's useless! And wait, here's a fresh NEJM study showing mortality benefit!! This feels like a roller coaster. What's going on here? Several factors may explain this: Steroid is beneficial, but only in a subset […] EMCrit Project by Josh Farkas.

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Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

Case submitted by anonymous. Written by Smith. Ken's piece at the bottom is excellent. A 50-something presented with s udden onset palpitations 8 hrs prior while sitting at desk at work. He had concurrent sharp substernal chest pain that resolved, but palpitations continued. Over past 3 months, he has had similar intermittent episodes of sharp chest pain while running, but none at rest.

EKG/ECG 129

EKG/ECG Shock Documentation/Coding Academics 129

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 130

Urgent Care Hospitals Teamwork Leadership 130

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 139

Shock 139

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 133

Shock Allergic Reactions Resuscitation EMS 133

Science Based Medicine

DECEMBER 18, 2023

On Friday, CNN host Kasie Hunt interviewed antivax presidential candidate Robert F. Kennedy, Jr. Although she did better than most journalists confronting him for his past antivax statements in that she played a clip of one of his antivax statements, she clearly hadn't anticipated his response, which should have been very predictable given that he's been using it for at least 15 years.

CDC 141

CDC 141

Sensible Medicine

NOVEMBER 7, 2023

When I first met Teppo Järvinen, it felt like I was meeting a celebrity (not like a Mick Jagger celebrity, more like a David Sackett celebrity). Teppo is the senior author on the NEJM article, Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear. For anyone interested in medical reversal, this article is up there with CAST , the WHI , and the vertebroplasty articles as landmark articles.

Fractures 135

Fractures Research Hospitals 135

Don't Forget the Bubbles

JUNE 30, 2023

A PEM adventure Meet Polly, a 6-year-old girl with a penchant for shopping. Besides a few febrile convulsions when she was two, she’s a healthy 6-year-old. Having just bought the most gorgeous pair of red ballet pumps that would go delightfully with the red bow she bought in Harrods last week, she was skipping down Regent’s Street with her nanny. As they crossed the front of Liberty, a huge letter L came plummeting down, crashing in front of her.

Head Injuries 145

Head Injuries Seizures Outcomes Pediatrics 145