February, 2025

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ECG Blog #467 — The Cath Lab was Deactivated

Ken Grauer, MD

I was sent the ECG in Figure-1 obtained from a previously healthy man his 60s, who contacted EMS ( E mergency M edical S ervices ) for new-onset severe burning CP ( C hest P ain ) that radiated to the jaw and throat. On seeing the ECG in Figure-1 the EMS crew activated the cath lab. QUESTION: Do you agree with this decision by the EMS crew to activate the cath lab?

EKG/ECG 411
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Death Verification

Mind The Bleep

As a new F1 in August, it can feel like quite a daunting task to verify a death, particularly if you have never seen this done before. This step by step guide will take you through the process of death verification to help make this task easier as you settle into your new role. Verifying a Death You will usually be asked to verify a death by nursing staff from the ward the patient is on.

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Should thrombolytics be given >4.5 hours after stroke onset?

PulmCCM

Neurologists’ job just got harder. Patients who present with ischemic stroke more than 4.5 hours after symptom onset generally do not receive intravenous thrombolytics (tPA or TNK). That’s because outside that accepted window, the risk of intracranial hemorrhage was believed to outweigh the benefits of thrombolytics in restoring blood flow to at-risk brain tissue.

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The Trashing of Science by Robert F Kennedy Jr

Science Based Medicine

If confirmed, Kennedy will keep trashing science and will continue exploiting the trashed science he helps create for his own benefit. The post The Trashing of Science by Robert F Kennedy Jr first appeared on Science-Based Medicine.

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Sometimes a patient is fortunate to have a cardiac arrest

Dr. Smith's ECG Blog

Written by Pendell Meyers A man in his 60s presented with acute chest pain. Here is his triage ECG: What do you think? There is sinus rhythm with clear LVH. Leads V5-6 are suspicious for upright, enlarged T waves that are possibly inappropriate for the QRS complex, especially V6. But without a baseline for comparison, it would be difficult for me to say that it is specific and diagnostic for OMI.

EKG/ECG 86
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TBS Top papers 2025 (part 1)

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed We are back at the TBS (The Big Sick) Conference in Zermatt, exploring key research papers that challenge critical care practices. Highlights include arterial blood pressure monitoring, intra-arrest DBP in cardiac arrest, SAPBs for rib fractures, the DanGer shock trial, and double sequential defibrillation timing.

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Complications of Kratom Use

Northwestern EM Blog

Written by: Dean Hayes (NUEM 27) Edited by: Andrew Long (NUEM 25 ) Expert Commentary by: Rafael Lima, MD A mid 20s male presents to the ED after seizure-like activity. Per the patient's partner at bedside, he had a 2-3 minute convulsive episode and the description is consistent with a likely seizure. The patient has never had a seizure before and is A&Ox4 upon arrival to the ED with reassuring examination.

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SGEM #467: Send me on my way…without Cervical Spine Imaging

The Skeptics' Guide to EM

Reference: Leonard JC et al. PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study. Lancet Child Adolesc Health. June 2024. Date: Oct 15, 2024 Dr. Tabitha Cheng Guest Skeptic: Dr. Tabitha Cheng is a Southern California native and board-certified emergency medicine physician and completed an EMS fellowship as well.

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The Telepathy Tapes – More FC Pseudoscience

Science Based Medicine

Documentaries can be powerful. They can use the mature art-form of cinema in order to convey a specific narrative. The viewer can get drawn into that narrative, unaware they are being exposed to a very one-sided or limited take on a complex topic. A recently, for example, participated in a fun review of the Earthing Movie which was basically propaganda for the […] The post The Telepathy Tapes More FC Pseudoscience first appeared on Science-Based Medicine.

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EMCrit RACC-Lit – January 2025

EMCrit

EMCrit RACC-Lit for January 2025 All the literature goodness! EMCrit Project by Scott Weingart, MD FCCM.

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There IS Beauty in Medicine

EM Ottawa

Medicine often carries an aura of mystiquea profession elevated by society as a noble calling, a higher pursuit. But for those of us in the trenches, the reality is far simpler (: medicine is a job. A demanding, high-stakes, and sometimes unforgiving job, but a job nonetheless. This isnt a dismissal of its importance but […] The post There IS Beauty in Medicine appeared first on EMOttawa Blog.

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Major Trauma – Injuries by Assault

Don't Forget the Bubbles

Topic Major Trauma – Injuries by Assault Author Hannah Downing Expert Reviewer Vicki Currie Facilitator Level ST4+ Learner Level Foundation doctors, ANPs, core and middle grade level paediatric/ED trainees Outline Pre-reading Background Basic Case 1: Kick to the Head Case 1: Discussion Basic Case 2: Stab Wound to the Chest Case 2: Discussion Advanced Case 3: Non-Fatal Strangulation Case 3: Discussion Advanced Case 4: Gunshot Wound to the Abdomen Case 4: Discussion Simulation Quiz Take Home

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Referrals

Mind The Bleep

Often one of the scariest things you can do as you will most likely be speaking to a more senior colleague in an unfamiliar speciality. However, as an F1, you may well know the patient best and therefore you may be best placed to refer the patient. Our Webinar Introduce yourself and say on whose behalf you are making the referral Remember, you hold all the information about the patient and are therefore in the driving seat Use the SBAR approach and you wont go far wrong Know why you are referrin

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Traumatic ICH - An Interview with Erin D'Agostino, MD

EB Medicine

In this episode, Sam Ashoo, MD interviews Erin D'Agostino, MD about the February 2025 Emergency Medicine Practice article, Management of Traumatic Intracranial Hemorrhage in the Emergency Department Pathophysiology Types of Traumatic Brain Injuries Pre-Hospital Care Critical History and Physical Examination Neurological Assessment and Monitoring Laboratory and Imaging Studies Emergency Department Treatment Surgical Interventions and Considerations Patient DemographicsSummary of major points disc

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We are not antivaccine, we are pro unattainable vaccine

Science Based Medicine

When it comes to vaccines: If it exists we resist. The post We are not antivaccine, we are pro unattainable vaccine first appeared on Science-Based Medicine.

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ECG Pointers: Hyperkalemia or Toddler Squiggles?

EMDocs

Authors: Lloyd Tannenbaum, MD (EM Attending Physician, Geisinger Wyoming Valley, PA); Mai Saber, DO (EM Attending Physician, Hackensack University Medical Center, NJ); Rachel Bridwell, MD (EM Attending Physician, Charlotte, NC) // Reviewer: Brit Long, MD (@long_brit) Hello and welcome back to ECG Pointers, a series designed to make you more confident in your ECG interpretations.

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Podcast – Skills Fade with Nathalie Pattyn at Tactical Trauma 24

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed Emergency medicine demands constant practice, yet many clinicians experience skills fade due to lack of exposure. Nathalie Pattyn explores how this decline occurs, why its a systemic issue rather than an individual failure, and what changes are needed to maintain competency. The post Podcast – Skills Fade with Nathalie Pattyn at Tactical Trauma 24 appeared first on St.Emlyn's.

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NRC Health ranked #1 Best in KLAS for Healthcare Experience Management

NRC Health

NRC Health is honored to receive the Best in KLAS 2025 Award for Healthcare Experience Management, highlighting our commitment to excellence and innovation. The post NRC Health ranked #1 Best in KLAS for Healthcare Experience Management appeared first on NRC Health.

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Dealing with difficult colleagues

Mind The Bleep

This is a tricky area to cover as it can be challenging to us both personally and professionally when things dont go well with a colleague, particularly when we know that this might impact patient care and/or our own mental health. The longer these negative interactions go on, the more likely they are to significantly impact on outcomes for our patients, our colleagues and ourselves.

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RFK Jr hearings/ Eulogy Values & NIH delays

Sensible Medicine

We are back with a riveting discussion

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How Much O2 In Trauma | Ped vs. Adult Trauma Centers

JournalFeed

The JournalFeed podcast for the week of Jan 27-31, 2025. These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member. Tuesday Spoon Feed: There was no difference in patient centered outcomes between trauma patients who received either restrictive or liberal oxygen therapy in this RCT.

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Implementation of Electronic Health Record Integration and Clinical Decision Support to Improve Emergency Department Prescription Drug Monitoring Program Use

EM Ottawa

Methodology 3/5 Usefulness 2/5 Hoppe JA, et al. Ann Emerg Med. 2024 Jan;83(1):3-13. Question and Methods: The study evaluated whether integrating prescription drug monitoring program (PDMP) tools with clinical decision support in EHR workflows improved PDMP usage and opioid prescribing practices using a stepped-wedge design. Findings: PDMP usage improved modestly during clinical alerts (23.8%), but […] The post Implementation of Electronic Health Record Integration and Clinical Decision Su

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Journal Feed Weekly Wrap-Up

EMDocs

We always work hard, but we may not have time to read through a bunch of journals. Its time to learn smarter. Originally published at JournalFeed , a site that provides daily or weekly literature updates. Follow Dr. Clay Smith at @spoonfedEM , and sign up for email updates here. #1: Can We Use PERC-35 to Rule Out PE in Younger Patients? Spoon Feed In a meta-analysis of patients with septic shock, starting norepinephrine earlier had no mortality benefit, though heterogeneity and bias limit clinic

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Find inspiration during the Peds Collaborative Roundtable Sessions

NRC Health

Join us for the Pediatric Collaborative Roundtable Sessions for a fast-paced, engaging event where youll connect with healthcare leaders, learn from case studies, and explore strategies to enhance patient care, utilize data-driven decision-making, and foster interdisciplinary collaboration. The post Find inspiration during the Peds Collaborative Roundtable Sessions appeared first on NRC Health.

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Breaking Bad News

Mind The Bleep

As a resident doctor, you will have face situations where you have to convey potentially distressing information, whether it is explaining a diagnosis or blood results to a patient or giving difficult news to relatives. Breaking bad news well is an essential communication skill which can strengthen the relationship between a patient and a doctor and create an environment where the patient and/or their families feel respected and supported.

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249. Clean kill: when intubation kills your pt

Board Bombs

You intubate. and then your patient codes. What did you do wrong? When is "ABC" the wrong order? Let's dive into this nuanced topic in critical care. Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind at here. Cite this podcast as: Briggs, Blake. 249. Clean kill: how intubation kills your pt.

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Winter Break

Pediatric Education

PediatricEducation.org is taking a short break. The next case will be published on 2/10/25. In the meantime, please take a look at the different Archives and Curriculum Maps listed at the top of the page. We appreciate your patronage, Donna DAlessandro and Michael DAlessandro, curators.

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Electrical instability in a healthy 50 year old. How to manage?

Dr. Smith's ECG Blog

Written by Magnus Nossen (with 2 important comments by Smith at the bottom) The patient in todays case is a 50 year old man who presented due to "dizziness" and episodes of presyncope. The patient's symptoms had started about 14 days prior to admission but worsened significantly during the course of the last 24 hours. Previously healthy, taking no medication and exercising regularly.

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What has gotten better and what has gotten worse since you started in medicine

Sensible Medicine

I asked 6 doctors — at different stages of their career — to tell you, dear Reader, what has gotten better and what has gotten worse since they began in medicine. I also took a stab at it. Here are our answers. If you leave your answer in the comments, I will curate and publish the most interesting responses. Vinay Prasad, MD Vinay Prasad’s Better and Worse I started in medicine 19 years ago, and during this time there have been gains and setbacks.

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Missed Injury / Delayed Diagnosis

The Trauma Pro

Missed injuries (or delayed diagnosis in polite conversation) are the bane of any trauma program. Trauma professionals want to know that theyve identified all significant injuries in their patients so no future harm will occur due to them. But what exactly is a missed injury? The definitions tend to vary a bit, which is why their incidence varies so widely in the literature (1 – 39%).

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Clerking Patients: A few tips

Mind The Bleep

Here we assume you know the basics , and instead we focus on the common pitfalls with tips on how to be safe & well reasoned. Not all FY1s have the opportunity to clerk patients but the underlying principles are of great value if youre doing an FY1-led ward round. Be Thorough The expectation is that you are slow and thorough if you rush you can make mistakes & you end up spending more time worrying than seeing patients.

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New Year, New Me?

EM Literature of Note

Its been a long haul for Emergency Medicine Literature of Note and, as AI becomes a greater portion of my professional life, correspondingly, the time shrinks for a long-form Emergency Medicine post. So, in an experiment, Ive created and migrated to a more-modern platform the Medicine Minute Substack. The hope is, with short format thoughts, there can be more-frequent updates and the longer rants can still have either a life here, or in ACEPNow.

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SAEM Clinical Images Series: Snake it Off

ALiEM

A 35-year-old male with no past medical history presented to the Emergency Department with eye redness. Two days prior, the patient reported he was cutting brush with a chainsaw when he felt something spray into his face. After inspecting the area, the patient found the remnants of a dead rattlesnake that unfortunately got in the way of his chainsaw.

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Balancing Innovation and Reality: Evaluating AI’s Role in STEMI Diagnosis

RebelEM

Background: ST-segment elevation myocardial infarction (STEMI) is a critical condition requiring rapid diagnosis and intervention. While ECGs play a central role in detecting STEMI, misinterpretations often occur, leading to unnecessary catheterization or missed diagnoses. With advancements in artificial intelligence (AI), there is potential for machine learning models to assist in more accurate detection of STEMI.

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Randomize NIH grant giving

Sensible Medicine

A pause in NIH study sections has been met with fear and anxiety from researchers. At many universities, including mine, professors live on soft money. No grants? If you are assistant professor, you can be asked to pack your desk. If you are a full professor, the university slowly cuts your pay until you see yourself out. Everyone talks about you afterwards, calling you a failed researcher.

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The 88th Bubble Wrap x Chesterfield GP Training group

Don't Forget the Bubbles

This month, Bubble Wrap has a primary care slant with a takeover from the GP trainee group in Chesterfield. The articles are relevant and interesting for those working in the acute care system. With millions of journal articles published yearly, it is impossible to keep up. The Bubble wrap team scoured the literature, so you don’t have to. With a wide variety of topics, take a few minutes and look at what’s new in paediatrics.

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Microbiology Discussions

Mind The Bleep

A lot of your time as an FY1 will be spent on the phone to various other specialities. Youll come across patients with infections in all your rotations, and – if they dont present with one – it may develop during admission. So, its a good idea to make talking to Microbiology as productive (and painless!) as possible. Calling micro for advice Calling other specialities to ask advice was always a palm-sweating, tongue-tying experience for me.