May, 2024

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Artificial Platelets Under Development!

The Trauma Pro

Uncontrolled bleeding is the bane of trauma professionals everywhere. Early in a resuscitation, we focus on identifying potential sources. We’ve developed numerous techniques for plugging them up. And we have processes in place to replace the blood that’s been lost. Unfortunately, blood products are a perishable item. Packed red blood cells have a typical shelf-life of 42 days.

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Pro-Infection Doctors Didn’t Just Want Kids in School. They Wanted Them There Unvaccinated, Untested, and Unmasked. They Wanted Them Infected.

Science Based Medicine

The virus massively disrupted schools around the world, and those of us who did nothing more than acknowledge this obvious reality were absurdly blamed for it. The post Pro-Infection Doctors Didn’t Just Want Kids in School. They Wanted Them There Unvaccinated, Untested, and Unmasked. They Wanted Them Infected. first appeared on Science-Based Medicine.

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An EPiC mental model. St Emlyn’s

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed The practice of coordinating, consulting and managing an entire acute clinical service in real-time is fairly unique to emergency medicine. Central to this is the EPiC (or emergency physician in charge) role #FOAMed @stemlyns with @codingbrown The post An EPiC mental model. St Emlyn’s appeared first on St.Emlyn's.

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Ketamine in the ED - An Interview with Reuben Strayer, MD

EB Medicine

In this episode, Sam Ashoo, MD and T.R. Eckler, MD interview Reuben J. Strayer, MD, author of the May 2024 Emergency Medicine Practice article, Current Concepts in Ketamine Therapy in the Emergency Department Diving Into Ketamine Use in Emergency Medicine Understanding Ketamine: From Origins to Emergency Use Exploring the Ketamine Brain Continuum Ketamine Dosing and Administration Techniques Combining Ketamine with Neuroleptic Medications Practical Approaches to Ketamine for Pain Management In

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Friday Reflection #39: What to Expect When You Are Aging

Sensible Medicine

MM is 94 years old. Her only active medical issues are hypertension and vitamin D deficiency. She takes only 20 mg of lisinopril and 1000 units of vitamin D3 each day. She has no cognitive decline and gardens every day if the Chicago weather allows. Her Friday afternoon appointment is the doctor’s last of the week. Sensible Medicine is a reader-supported publication.

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Effect of Bougie Use on First-Attempt Success in Tracheal Intubations: A Systematic Review and Meta-Analysis

EM Ottawa

Methodology: 4/5 Usefulness: 3/5 von Hellmann R, et al. Ann Emerg Med. 2024 Feb;83(2):132-144. Question and Methods: Systematic review of 18 studies (12 RCT) of adult patients comparing bougie use vs standard of care in tracheal intubations to evaluate first-attempt success. Findings: Bougie was associated with increased first-attempt intubation success overall (RR 1.11 95%CI 1.06 […] The post Effect of Bougie Use on First-Attempt Success in Tracheal Intubations: A Systematic Review and M

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The “Backward Finochietto” Problem

The Trauma Pro

Resuscitative thoracotomy is a (sometimes) life-saving procedure reserved for trauma patients in extremis. Thankfully, most trauma centers do very few of these a year. However, that makes it one of those “high severity – low frequency” procedures that generate many, many quality improvement problems. Many of these issues are due to operator unfamiliarity or equipment availability.

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PulmCrit: Why the new study associating piptazo with increased mortality is wrong

EMCrit

Piperacillin-tazobactam is an antibiotic that a lot of people love to hate. Combine this with the conservatism that often (rightfully) surrounds drug safety, and it creates a lot of volatility. Before going further, we should review some recent history regarding piptazo. In the early 2010's, a series of retrospective correlational studies found that patients treated […] EMCrit Project by Josh Farkas.

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What Are the Best AI Detectors?

Life in the Fast Lane

Sheralyn Guilleminot and Mike Cadogan What Are the Best AI Detectors? We investigated to see which tools are the best detectors of artificial intelligence in medical writing. One tool was the clear winner, while others clearly struggled with accuracy!

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Medical Student Accommodations

Sensible Medicine

Recently, I learned about a student on their clinical rotations who had to be sent home at precisely 9 hours. No matter how busy the day or service, the student would leave at the 9 hour mark. The reason? The student had a disability accommodation because he suffered from attention deficit hyperactivity disorder. Subscribe now In medicine there is a tension.

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Tasty Morsels of Critical Care 080 | Pulmonary Hypertension Overview

Emergency Medicine Ireland

Welcome back to the tasty morsels of critical care podcast. This time we’re looking at pulmonary hypertension. Mainly cause I recently had to give a talk on it so it’s fresh in my rapidly diminishing brain cells and thought I should get it all written down before I forget it. We’re going to try it as a 2 parter. Part 1 will cover a broad overview of pulmonary hypertension and part 2 will focus on management strategies for a PH patient in the ICU.

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NFTI And STAT: Can They Replace The Cribari Grid?

The Trauma Pro

In my last post, I reviewed using the Cribari grid to evaluate over- and under-triage at your trauma center. This technique has been a mainstay for nearly two decades but has shortcomings. The most important one is that it relies only on the Injury Severity Score (ISS) to judge whether some type of mistriage occurred. The ISS is usually calculated after discharge, so it can only be applied after the fact.

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A poorly framed article on COVID-19 vaccine injury in the New York Times

Science Based Medicine

A poorly framed article on people who believe that COVID-19 vaccines injured them is being trumpeted by antivaxxerst. Where the New York Times and its reporter Apoorva Mandavilli go wrong? The post A poorly framed article on COVID-19 vaccine injury in the New York Times first appeared on Science-Based Medicine.

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If an ED doc sees cholecystitis on ultrasound, believe them

PulmCCM

Acute cholecystitis on ultrasound. Image by James Heilman, MD - Own work, CC BY-SA 3.0, [link] The diagnosis of cholecystitis can be made quickly and accurately in the emergency department using point-of-care ultrasound, according to a new meta-analysis. The authors analyzed 7 studies (n=1772) that tested point-of-care ultrasound performed by emergency physicians against the reference standard of final diagnosis (by discharge diagnosis, formal abdominal ultrasound by radiology, or surgical patho

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Ep 194 Subarachnoid Hemorrhage – Recognition, Workup and Diagnosis Deep Dive

Emergency Medicine Cases

Anton is joined by the world's leading EM researcher in subarachnoid hemorrhage diagnosis Dr. Jeff Perry and EM-Stroke team clinician Dr. Katie Lin for a deep dive into why we still miss this life-threatening diagnosis, the key clinical clues, proper use of decision tools, indications for CT, indications for CTA, indications for LP and CSF interpretation for the sometimes elusive diagnosis of subarachnoid hemorrhage.

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Action Is The Antidote For Rumination - An Interview with Rob Orman, MD

EB Medicine

In this episode, Sam Ashoo, MD interviews Rob Orman, MD, founder of Orman Physician Coaching , about routine examination of our careers in emergency medicine. Understanding Career Cycles and Embracing Change The Importance of Career Reflection and Making Trades Navigating Career Satisfaction and Preventing Burnout Proactive Career Management and Reflection Strategies Exploring Career Alternatives and Rediscovering Joy in Medicine Balancing Work, Love, Play, and Health for a Satisfying Life When

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JC – Chat GPT and AI vs Humans in medical assessment – is there a difference?

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed Can ChatGPT write clinical cases and MCQs unrecognisable from those written by humans? The post JC – Chat GPT and AI vs Humans in medical assessment – is there a difference? appeared first on St.Emlyn's.

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Preperitoneal Packing Vs Angioembolization: Part 3

The Trauma Pro

In the previous post in this series, I described an early review article summarizing several older studies comparing these two hemorrhage control techniques for pelvic fractures. Today, I’ll review another paper fresh off the press, published just this month. This paper comes from the orthopedics and neurosurgical groups at the University of Texas-San Antonio.

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Male and Female Brains are Different

Science Based Medicine

Neuroanatomical research has long established that there are statistical differences at the macroscopic level in male and female brains. There are also functional differences in terms of memory and cognition. However, these differences are largely statistical, and exist in a mosaic of different traits. This means that, if we look at specific features (whether anatomical or functional) there are male-female differences, but […] The post Male and Female Brains are Different first appeared on

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Anesthesiologists at Cedars-Sinai unionize

PulmCCM

Anesthesiologists employed by Cedars-Sinai formed a union, representing the latest in a series of unionizations by physicians in the U.S. According to physician union leaders quoted in news reports, Cedars-Sinai proposed an update to a 2020 contract that amounted to a 10% pay cut, and then broke off negotiations with the group. The anesthesiologists cited understaffing and patient care concerns as other key factors driving the breakdown.

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The Ultrasound-Guided Genicular Nerve Block

ACEP Now

Chronic knee pain is common and debilitating. Patients often seek care in the emergency department (ED) setting when flares of pain affect their ability to ambulate, climb stairs, or even stand up from sitting. 1 In many cases, these patients have been dealing with pain for years and have already exhausted the standard analgesic cocktail of acetaminophen, NSAIDs, and/or topical agents.

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New Biomarkers in Blood for Early Cancer Diagnosis

Emergency Live

Discovery of 618 Cancer-Associated Proteins for 19 Types of Cancer Thanks to two studies led by the University of Oxford and published in Nature Communications, a total of 618 proteins in the blood have been identified that may indicate the presence of 19 different types of tumors. Among these, 107 could reveal the risk of […] The post New Biomarkers in Blood for Early Cancer Diagnosis appeared first on Emergency Live.

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When a Medicine Works but Overall Benefit is Minimal to None

Sensible Medicine

The story of reversal agents for anticoagulants exposes many of the complexities of treating human beings. I like the story and I think you will too. Some background, then to the ANNEXA-I study. The new anticoagulants are called direct acting oral anticoagulants or DOACs. Rivaroxaban (Xarelto) and apixaban (Eliquis) are the two most popular. These drugs surpassed the old one, warfarin, because of convenience, efficacy and safety.

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Annals of B Pod: Stump Appendicitis

Taming the SRU

HISTORY OF PRESENT ILLNESS A male in his 50s presents with right lower quadrant pain. The pain developed one day prior to presentation and was gradual in onset. He describes the pain as constant and sharp without radiation, rated at an 8/10. The pain has been worsening since symptom onset and has not been relieved with acetaminophen or ibuprofen. Of note, the patient had a prior appendectomy three months prior due to an acute suppurative appendicitis that was otherwise uncomplicated.

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Dr. Vinay Prasad Pretends to Admit Error: I Was Optimistic That Vaccination Would Halt the Spread of the Virus—I Was Wrong. 

Science Based Medicine

While admitting error is never easy and should always be applauded, the first step is to honestly admit error. The post Dr. Vinay Prasad Pretends to Admit Error: I Was Optimistic That Vaccination Would Halt the Spread of the Virus—I Was Wrong. first appeared on Science-Based Medicine.

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RCEM CPD conference 2024 review. St Emlyn’s

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed Our rapid round up of the RCEM CPD conference in Newport 2024. Talks on trauma, paediatrics, policy, education and more @rcollem @stemlyns #FOAMEd The post RCEM CPD conference 2024 review. St Emlyn’s first appeared on St.Emlyn's. The post RCEM CPD conference 2024 review. St Emlyn’s appeared first on St.Emlyn's.

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Do you need to be a trained health care professional to diagnose subtle OMI on the ECG?

Dr. Smith's ECG Blog

An undergraduate (not yet in medical school) who works as an ED technician (records all EKGs, helps with procedures, takes vital signs) and who reads this blog regularly arrived at work and happened to glance down and see this previously recorded ECG on a table in the ED. It was recorded at 0530: What do you think? The young ED tech immediately suspected LAD OMI.

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Exploring the Different Shapes of Ambulances

Emergency Live

A World of Variety for Every Emergency Ambulances, vital vehicles for emergency medical transport, come in a wide array of shapes and sizes, designed to meet the diverse needs of both patients and emergencies. From standard ambulances to highly specialized units, the variety of these vehicles is astounding. Here’s an overview of the main types […] The post Exploring the Different Shapes of Ambulances appeared first on Emergency Live.

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EM@3AM: Brainstem Strokes

EMDocs

Authors: Ernesto Hernandez, MD (EM Resident Physician, Advocate Christ Medical Center, Oak Lawn, IL); Jennifer Woodruff, MD (EM Attending Physician, Advocate Christ Medical Center, Oak Lawn, IL) // Reviewed by: Sophia Görgens, MD (EM Physician, Northwell, NY); Cassandra Mackey, MD (Assistant Professor of Emergency Medicine, UMass Chan Medical School); Brit Long, MD (@long_brit) Welcome to EM@3AM, an emDOCs series designed to foster your working knowledge by providing an expedited review of clini

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The Frustration of Not Being Able to Sort Signal From Noise

Sensible Medicine

A treatment to reduce stroke is tested in a clinical trial. In the treatment group, 2.3% of patients had a stroke vs 2.9% in the control arm. The question that everyone wants to know is whether this -0.6% difference is signal or noise. For this, we look to the 95% confidence intervals. In the PROTECTED TAVR trial, the confidence intervals went from -1.7% (a lower stroke rate) to 0.5% (a higher rate of stroke).

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Woke Washing the Pandemic: If You Really Were Progressive, You’d Want Them Infected

Science Based Medicine

Genuine concern is consistent concern. The post Woke Washing the Pandemic: If You Really Were Progressive, You’d Want Them Infected first appeared on Science-Based Medicine.

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NYGH Emergency Medicine Update 2024

First 10 EM

I gave 2 talks at the North York General Emergency Medicine Update this year. These are the resources for these talks. Usually, these resources are only for conference attendees, but this year I recorded versions of both talks, so you can watch them even if you didn’t make it to Canada’s premier emergency medicine conference […] The post NYGH Emergency Medicine Update 2024 appeared first on First10EM.

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Grand Rounds 5.8.24

Taming the SRU

r1 clinical knowledge - r4 capstone - research grand rounds - the art of em - Community corner - PEM Lecture r1 Clinical knowledge: transplant complications WITH dr. gabor Time-sensitive peri-transplant emergencies: Bleeding fistula- stop the bleed. Flood syndrome- start fluids, give antibiotics, consult surgery. Have a high suspicion for infection in transplant patients.

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Improving the qualities of ventilations during CPR

Emergency Live

The ventilation maneuver during cardiopulmonary resuscitation (CPR) is a complex intervention influenced by various factors related to the patient, the operator, and the environment. Therefore, researchers have highlighted the importance of objectively and reliably measuring the quality of ventilation during CPR through a scientific study The objective of the study, conducted by Dr.

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Early repol or anterior OMI?

Dr. Smith's ECG Blog

Chest Pain – Benign Early Repol or OMI? Written by Destiny Folk, MD, Adam Engberg, MD, and Vitaliy Belyshev MD A man in his early 60s with a past medical history of hypertension, type 2 diabetes, obesity, and hyperlipidemia presented to the emergency department for evaluation of chest pain. He reported substernal chest pressure with radiation to his left arm that started at work several hours prior to arrival and had somewhat improved since onset.

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Medical Malpractice Insights: Brain Abscess

EMDocs

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. The goal of MMI-LFL is to improve patient safety, educate physicians and reduce the cost and stress of medical malpractice lawsuits. To opt in to the free subscriber list, click here. Stories of med mal lawsuits can save lives.

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Tattoos Still Won’t Boost Your Immune System

Science Based Medicine

Does the repeated stress on your immune system from getting tattoo after tattoo make you better able to fight off infections? No, no it does not. The post Tattoos Still Won’t Boost Your Immune System first appeared on Science-Based Medicine.

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