2024

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ECG Blog #435 — Did Cath Show Acute Ischemia?

Ken Grauer, MD

The ECG in Figure-1 — was obtained from a middle-aged woman with positional tachycardia and diaphoresis with change of position from suprine to sitting. Although CP ( C hest P ain ) was not a prominent symptom — ACS ( A cute C oronary S yndrome ) was suspected from the chest lead T wave inversion seen on this ECG. QUESTIONS: How would YOU interpret the ECG in Figure-1 ?

EKG/ECG 408
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The VIP Syndrome In Healthcare (Very Important Person)

The Trauma Pro

The VIP syndrome occurs in healthcare when a celebrity or other well-connected “important” person receives a level of care that the average person does not. This situation was first documented in a paper published in the 1960s, which noted that VIP patients have worse outcomes. Who is a VIP? It may be a celebrity. A family member. Or even a colleague.

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Anthony Fauci failed during the coronavirus response

Sensible Medicine

The first two weeks of March 2020 were jolting. Governments read the Imperial College London report (modeling a million deaths in the US), watched horrifying scenes in Bergamo (a city with median age in the 80s fyi), and collectively embraced policies that had no precedent in human history: The global closing of borders, schools, business, and the use of the police state to enforce this lockdown.

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I’ve Been Silenced, Censored, and Cancelled. The Reason Why Matters.

Science Based Medicine

When conference organizers told me not to make my talk "political", they were really saying there were certain people and ideas I wasn't allowed to criticize. I didn't get it at the time. I get it now. The post I’ve Been Silenced, Censored, and Cancelled. The Reason Why Matters. first appeared on Science-Based Medicine.

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Podcast – Occlusive Myocardial Infarction, ECGs and Artificial Intelligence with Steve Smith

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed A podcast with Steve Smith ECG educator extraordinaire where we discuss occlusive myocardial infarction and the future of AI and ECG interpretation. The post Podcast – Occlusive Myocardial Infarction, ECGs and Artificial Intelligence with Steve Smith appeared first on St.Emlyn's.

EKG/ECG 134
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Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

Dr. Smith's ECG Blog

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. What do you think? If this EKG were handed to you to screen from triage without any clinical information, what would you think?

EKG/ECG 139
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SGEM#442: I’m on the Right Track Baby I Was Born This Way

The Skeptics' Guide to EM

Reference: Kruse et al. Systematic Review, Quality Assessment, and Synthesis of Guidelines for Emergency Department Care of Transgender and Gender-diverse People Recommendations for Immediate Action to Improve Care. WJEM December 2023 Date: May 30, 2024 Guest Skeptic: Dr. Kay Dingwell is a rural emergency physician working in Prince County, PEI with a special interest in gender-affirming care and improving the care of trans and gender-diverse patients.

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The pediatric can’t intubate can’t oxygenate scenario (Use a knife)

First 10 EM

A can’t intubate can’t oxygenate scenario will always be scary, but after years of mental rehearsal and some real world experience, the idea of surgical front of neck access in an adult doesn’t bother me much. (I think that is an important mental space for emergency physicians to find if you want to be able […] The post The pediatric can’t intubate can’t oxygenate scenario (Use a knife) appeared first on First10EM.

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Our JAMA Paper on Industry Payments and Sowell's Conflict of Visions

Stop and Think

My career in cardiology can be separated into two decade-long blocks. The first decade I practiced like most other cardiologists. I went with the flow, followed the guidelines. I went to few meetings, read few studies and as a result had little (mental) tension. Then I started writing about medical evidence. This required studying the evidence. Over time, I learned the skill of critical appraisal.

Research 138
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PulmCrit: Bilevel Sequence Intubation (BSI) – The new standard

EMCrit

introduction Bilevel Sequence Intubation (BSI) refers to initiation of noninvasive bilevel positive pressure ventilation with a backup rate prior to intubation (either using a BiPAP machine or a full-featured mechanical ventilator). BSI is distinct from traditional rapid sequence intubation (RSI), since BSI involves the delivery of machine-initiated, pressure-controlled breaths following administration of sedation and paralytics. […] EMCrit Project by Josh Farkas.

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ECG Blog #419 — The Cause of ECG #1?

Ken Grauer, MD

I was sent the 2 ECGs shown in Figure-1 — which were recorded from an elderly man whose heart beat "has been irregular for years". No clear history for recent chest pain — but the patient "has not been well" for the previous week. Regarding the 2 ECGs in Figure-1 : ECG #1 is the initial tracing obtained at the scene by the EMS ( E mergency M edical S ystems ) team — in association with an alert but markedly hypotensive patient.

EKG/ECG 437
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Dysphagia and Cervical Spine Injury

The Trauma Pro

Cervical spine injury presents a host of problems, but one of the least appreciated ones is dysphagia. Many clinicians don’t even think of it, but it is a relatively common problem, especially in the elderly. Swallowing difficulties may arise for several reasons: Prevertebral soft tissue swelling may occur with high cervical spine injuries, leading to changes in the architecture of the posterior pharynx Rigid cervical collars , such as the Miami J and Aspen, and halo vests all force the neck int

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Doctors take money from pharmaceutical firms so they die with a slightly bigger number in the bank

Sensible Medicine

Imagine if your car mechanic took $10,000 a year from Michelin tires for “consulting” and then tended to recommend their tires over Pirelli — even if the latter are on sale or better quality or both. Imagine if your Governor took campaign contributions from Panera bread and then strangely exempted Panera bread from the new minimum wage law.

Academics 145
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Dr. John Ioannidis: Yet Another Doctor Who Treats Theoretical Death From The Vaccine With More Gravity Than Actual Death From COVID

Science Based Medicine

Actual death is worse than theoretical death. This didn't used to be controversial in medicine. The post Dr. John Ioannidis: Yet Another Doctor Who Treats Theoretical Death From The Vaccine With More Gravity Than Actual Death From COVID first appeared on Science-Based Medicine.

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JC: Prehospital Partial Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for Exsanguinating Subdiaphragmatic Hemorrhage

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed Background – What do we already know about REBOA? In 2023, Dr Zaf Qasim reviewed the UK REBOA trial for us on St Emlyn’s (The UK-REBOA trial – Has the […] The post JC: Prehospital Partial Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for Exsanguinating Subdiaphragmatic Hemorrhage appeared first on St.Emlyn's.

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Cardiopulmonary Point of Care Ultrasound – Book Review

Critical Care North Hampton

Many thanks to Dr Manoj Wickramsinghe for his review of this fabulous POCUS textbook. He is a trainee in Anaesthesia and ICM, based in Leeds, and one of the CCN editorial team. About the book authors Editors; Hatem Soliman-Aboumarie, Marcelo Haertel Miglioranza, Luna Gargani, Giovanni Volpicelli. The authors and editors of this book include some.

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How will you save this critically ill patient? A fundamental and lifesaving ECG interpretation that everyone must recognize instantly.

Dr. Smith's ECG Blog

Written by Pendell Meyers A woman in her 30s called EMS for acute symptoms including near-syncope, nausea, diaphoresis, and abdominal pain. EMS arrived and found her to appear altered, critically ill, and hypotensive. An ECG was performed: What do you think? Extremely wide complex monomorphic rhythm just over 100 bpm. The QRS is so wide and sinusoidal that the only real possibilities left are hyperkalemia or Na channel blockade.

EKG/ECG 139
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Mechanical Ventilation Basics

EM Ottawa

Mechanical ventilation has a lot of nuance associated with it, but a lot of reference guides focus on care in the ICU. There is certainly a need for more practical application for the ED doc or initial setup of patients on the vent. With both ER and ICU experience, this post acts as a quick […] The post Mechanical Ventilation Basics appeared first on EMOttawa Blog.

EMS 143
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Are you a perfect diagnostician? No? Then give your patients a break

First 10 EM

Give your patients a break. Nobody is a perfect diagnostician. Not even the best trained physician can determine, with 100% accuracy, which patients have serious pathology. Even with advanced testing, we aren’t close to perfect. However, if you listen to the subtext of breakroom complaints, it seems like we expect patients to be better diagnosticians […] The post Are you a perfect diagnostician?

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Ep 193 The Crashing Asthmatic – Recognition and Management of Life Threatening Asthma

Emergency Medicine Cases

In this part 2 of our 2-part podcast on asthma with Dr. Sameer Mal and Dr. Leeor Sommer, we dig into the recognition and management of life-threatening asthma. We answer such questions as: what are the key elements in recognition of threatening asthma? What are the most time-sensitive interventions required to break the vicious cycle of asthma? What are the best options for dosing and administering magnesium sulphate, epinephrine, fentanyl and ketamine in the management of the crashing asthmatic

EMS 136
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From Collision to Clarity: PECARN cervical spine injury prediction rule for injured children

ALiEM

For years, adult literature has provided clear guidelines for cervical spine imaging through the NEXUS and Canadian C-spine Rule (CCR) tools. These have been invaluable in helping clinicians decide when to image the neck in trauma patients. Similarly, the Pediatric Emergency Care Applied Research Network (PECARN) has developed robust tools for assessing blunt head trauma in children.

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EMCrit 377 – Breaking News – The PREOXI Trial changes everything about Preoxygenation for Intubations in the Critically Ill

EMCrit

the PREOXI trial validates what I have been saying for 15 years about preoxygenation for the critically ill patient EMCrit Project by Scott Weingart, MD FCCM.

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The Andexxa Showpiece

EM Literature of Note

Every so often a masterclass performance arises in the medical literature. A performance transcending the boundaries of what was once thought possible. A shining exemplar of human achievement. This is a trial, published in the New England Journal of Medicine , with the following features: Conducted by an institute sponsored by pharma. Designed by the first author, a consultant for pharma, and two employees of pharma.

Outcomes 126
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How medical school fails students

Sensible Medicine

In prior posts, I was critical of the culture among trainees. One essay described the phenomenon of calling in fake sick. Another asked what the balance is between accommodation and the rigors of the job. These essays were about the effort, dedication and professionalism of trainees. Sensible Medicine is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.

Research 140
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How antivaxxers weaponize vaccine safety studies to falsely portray vaccines as dangerous

Science Based Medicine

Antivaxxers have weaponized a huge multinational vaccine safety study of 99 million patient records that found rare adverse events and concluded that the benefits of COVID-19 vaccines outweigh the risks. How? A combination of the Nirvana fallacy and spin. The post How antivaxxers weaponize vaccine safety studies to falsely portray vaccines as dangerous first appeared on Science-Based Medicine.

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Non-fatal strangulation

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed The Faculty of Forensic & Legal Medicine's guidelines for managing non-fatal strangulation (NFS). These guidelines advocate a trauma-informed, multidisciplinary approach to improve outcomes for patients who have experienced NFS. @stemlyns #FOAMed The post Non-fatal strangulation appeared first on St.Emlyn's.

Forensics 126
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Cardiac Arrest – the 5 C’s

Life in the Fast Lane

Kane Guthrie Cardiac Arrest – the 5 C’s Cardiac Arrest - the 5 C's with Cliff Reid. Causes Of Cardiac Arrest You NEVER Thought Of?! Meet The Hs & Ts & Cs!

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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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Posterior Circulation Strokes

EM Ottawa

Posterior circulation ischemia accounts for approximately 20-25% of all ischemic strokes and is a significant cause of patient disability. The diagnosis can be extremely challenging as findings are often not typically focal. Posterior strokes are misdiagnosed more than 3x more often than anterior circulation strokes.1 Similar to anterior circulation strokes, posterior strokes are most commonly […] The post Posterior Circulation Strokes appeared first on EMOttawa Blog.

Stroke 140
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EPIC-SR: The negative paxlovid data Pfizer has been sitting on

First 10 EM

As mentioned in my most recent review, publication bias has been a major concern when trying to decide whether to prescribe paxlovid. Pfizer rushed to publish their positive study (EPIC-HR), but refused to release the results of a second simultaneous study (EPIC-SR) that was stopped (due to futility) at the exact same time. With the […] The post EPIC-SR: The negative paxlovid data Pfizer has been sitting on appeared first on First10EM.

EMS 133
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SGEM#436: For the Longest Time – To Give TNK for an Acute Ischemic Stroke

The Skeptics' Guide to EM

Reference: Albers GW et al. TIMELESS Investigators. Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection. NEJM Feb 2024 Date: April 12, 2024 Guest Skeptic: Dr. Vasisht Srinivasan is an Emergency Medicine physician and neurointensivist at the University of Washington and Harborview Medical Center in Seattle, WA. He is an assistant professor in Emergency […] The post SGEM#436: For the Longest Time – To Give TNK for an Acute Ischemic Stroke first appeared on The Skeptics Guid

Stroke 129
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Cervical Spine Imaging in Kids – the PECARN rule

Don't Forget the Bubbles

Why is this study needed? Cervical spine injuries are a rare but serious finding following blunt trauma, affecting around 1-2% of presentations. In adult trauma cases, there has been significant research to help decide which patients require X-ray or CT imaging for possible cervical spine injuries, leading to the development of the National Emergency X-Ray (NEXUS) prediction rule and the Canadian C-Spine Rule (CCR).

CPR 121
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The ETM Course Podcast is back! The Trauma Physician with Chris Bowles

ETM Course

We are excited to announce that after a hibernation period, the ETM Course podcast is back! In our first episode of the new podcast we talk to Dr Christine Bowles, Emergency Physician and Trauma Physician at St George Hospital, one of Sydney’s Major Trauma Centres. Also available on Apple Spotify YouTube iHeart Podchaser PlayerFM In this episode we talk in detail about the evolution of the “Trauma Physician” role and Emergency Physicians working on inpatient trauma services, th

Hospitals 119
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Ep 195 Management of Subarachnoid Hemorrhage

Emergency Medicine Cases

Once the diagnosis of nontraumatic subarachnoid hemorrhage (SAH) has been made, our job is not done. Mortality in SAH patients can be up to 30% even without neurological deficit. Paying attention to the time-sensitive details of ED management of SAH patients can have a significant impact on their outcome. In this second part of our 2-part podcast series on subarachnoid hemorrhage with Dr.

Outcomes 121
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Should women in their 40’s be screened for breast cancer?

Sensible Medicine

I met Dr. Karsten Juhl Jørgensen at Forward’s innovative “4words24” conference in April. I was struck by Karsten’s deep knowledge of the medical literature, critical appraisal skills, and thoughtful approach to decision making. Here is a brief video of him summarizing the talk he gave at the conference. He reached out after the USPSTF published the new breast cancer guidelines.

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Paul Marik: Disparaging chemotherapy in order to sell cancer quackery

Science Based Medicine

Everything old is new once again, as COVID-19 quacks rehash old cancer quack claims that chemotherapy doesn't work in order to sell their preferred cancer quackery. The post Paul Marik: Disparaging chemotherapy in order to sell cancer quackery 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.