Sensible Medicine
OCTOBER 15, 2024
It is my pleasure to introduce this article by Joseph Marine, MD in response to mandatory masking policies in a number of California hospitals. There is simply no randomized evidence to support these policies, and they make little sense in 2024. I worry about the mental abilities of the public health officers who instituted these policies, and that their actions will further erode trust in public health.
Dr. Smith's ECG Blog
OCTOBER 17, 2024
Written by Jesse McLaren Two patients in their 70s presented to the ED with chest pain and RBBB. Do either, both, or neither have occlusion MI? Patient 1 : a 75 year old called paramedics with one day of left shoulder pain which migrated to the central chest, which was worse with deep breaths. Past medical history included RBBB without other cardiac history, but old ECG was not available.
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Ken Grauer, MD
OCTOBER 10, 2024
I was sent the ECG shown in Figure-1 — told only that the patient was a middle-aged man with septicemia. QUESTIONS: Is this rhythm too fast to be sinus tachycardia? Are flutter waves hidden within the QRS and T waves? Are we seeing the retrograde P waves of AVNRT? Is this ATach ( A trial T achycardia )? Figure-1: The initial ECG in today's case. MY Thoughts on Today’s CASE: In my opinion — none of the above answers are optimal to describe the rhythm in Figure-1.
The Trauma Pro
OCTOBER 11, 2024
I’ve written many posts in the past about the arguments surrounding chest tube size: large bore vs. small bore (pigtail). For the longest time, only a few decent papers were looking into this debate, and subject numbers were small. The best the papers could say was that “small-bore chest tubes are not inferior to large-bore tubes.” Not that this is not the same as saying, “small-bore tubes are better than large-bore tubes.” But finally, after more than ten years, th
Mount Sinai EM
OCTOBER 10, 2024
Many of us–myself included–often find ourselves spending more time on our smartphones than we intend to. One recent survey showed that 57% of Americans feel addicted to their smartphones. Another survey finds that millennials and gen z feel the most addicted. Earlier this year, Dr. Vivek Murthy, the U.S. Surgeon General, called for a warning label on social media platforms in a New York Times guest essay.
Science Based Medicine
OCTOBER 11, 2024
It doesn't bode well for the future that "leaders" of major American institutions look at naked emperors and compliment them on their beautiful clothes. The post The President of Stanford Wants Us To Debate Which Number is Larger, 9 or 133 first appeared on Science-Based Medicine.
Dr. Smith's ECG Blog
OCTOBER 15, 2024
This was sent to me by an undergraduate name Hans Helseth, who is an EKG tech, but who is an expert OMI ECG reader. He wrote most of it and I (Smith) edited. A prehospital “STEMI” activation was called on a 75 year old male ( Patient 1 ) with a history of hyperlipidemia and LAD and Cx OMI with stent placement. He arrived to the ED by helicopter at 1507, about three hours after the start of his chest pain while chopping wood around noon.
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American Medical Compliance
OCTOBER 14, 2024
Assisted living facilities are a lifeline for elderly and vulnerable individuals who need care and support in a safe, nurturing environment. Yet, even in these compassionate settings, caregivers often face the challenge of managing aggressive behaviors among residents. Imagine the case of Mrs. Stevens, a once gentle and kind woman who, after the onset of dementia, began exhibiting sudden outbursts of anger.
St. Emlyn
OCTOBER 10, 2024
St.Emlyn's - Emergency Medicine #FOAMed I’m back at the Sage in Gateshead for day 2 of the conference. David Williams and William Rutherford lectures. These are two prestigious named lectures at ASC. Dr John Ryan […] The post RCEM ASC conference 2024. Day 2. appeared first on St.Emlyn's.
Science Based Medicine
OCTOBER 16, 2024
JAMA Internal Medicine just published an article titled: Acupuncture vs Sham Acupuncture for Chronic Sciatica From Herniated Disk, A Randomized Clinical Trial. In an accompanying editorial comment, Jerard Z. Kneifati-Hayek and Mitchell H. Katz write: “This was a methodologically rigorous study; there were multiple experienced acupuncturists, the comparison group used a well thought-out sham control, and patients were followed up for 1 […] The post Latest Acupuncture Pseudoscience fir
Dr. Smith's ECG Blog
OCTOBER 12, 2024
Written by Bobby Nicholson What do you think of this “STEMI”? A man in his 90s with a history of HTN, CKD, COPD, and OSA presented to the emergency department after being found unresponsive at home. With EMS, patient had a GCS of 3 and was saturating 60% on room air. He improved to 100% with the addition of non-rebreather, however remained altered and was intubated by EMS with ketamine and succinylcholine.
Sensible Medicine
OCTOBER 14, 2024
Last Monday I wrote about one of the most positive drug trials in all of cardiology. In the RALES trial, the mineralocorticoid receptor antagonist (MRA) spironolactone substantially reduced death rates in patients with heart failure due to a weak heart. There were two big limitations to the RALES story. One was that the most common kind of heart failure now is heart failure with preserved heart function.
EMDocs
OCTOBER 12, 2024
We always work hard, but we may not have time to read through a bunch of journals. It’s 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: LR or NS for Sickle Cell Pain Crisis? Spoon Feed For sickle cell patients (particularly Hgb SS) with a vaso-occlusive episode (VOE), large volume resuscitation (>2L) with lactated ringers (LR) has been shown to
St. Emlyn
OCTOBER 12, 2024
St.Emlyn's - Emergency Medicine #FOAMed The final day of the RCEM Annual Scientific Conference with papers on chest pain, trauma, psychosocial, diagnostics and more. #rcemasc #FOAMed @stemlyns The post RCEM Annual Scientific Conference. Day 3. appeared first on St.Emlyn's.
Science Based Medicine
OCTOBER 10, 2024
Accumulated evidence does not demonstrate that elderberry has meaningful beneficial effects. The post Elderberry (What is it good for) first appeared on Science-Based Medicine.
Dr. Smith's ECG Blog
OCTOBER 10, 2024
Written by Pendell Meyers A man in his early sixties with no significant medical history (including a "negative cardiac workup a few years ago" for unclear indication) called 911 for acute chest pain constantly for the past 5 hours. EMS arrived and recorded vital signs within normal limits and the following ECG during active pain: EMS1 @ 0157: What do you think?
Sensible Medicine
OCTOBER 16, 2024
Dr. Satel is a bit of a regular here on Sensible Medicine. Today she returns to a topic that she wrote about in January 2023 , changing our organ donation laws to increase organ availability. Adam Cifu Sensible Medicine is a reader-supported publication. If you support our work, consider becoming a free or paid subscriber. What if we could solve the organ donor shortage with a simple tax credit?
EM Ottawa
OCTOBER 17, 2024
We remain amid an opioid crisis in Canada, with over 8000 deaths (or 22/day) in 2023. The harms of opioid use in society are devastating and cannot be understated – but so too are the harms from stimulant and other substance use. In 2023 there were 3479 apparent stimulant toxicity deaths, which is approximately 10/day. […] The post S’now Problem: Keep your Cool when Stimulants turn up the Speed appeared first on EMOttawa Blog.
EMDocs
OCTOBER 14, 2024
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.
The Bottom Line
OCTOBER 13, 2024
Potassium Supplementation and Prevention of Atrial Fibrillation After Cardiac Surgery: The TIGHT K Randomized Clinical Trial O’Brien. JAMA 2024; 332:979 – 988. doi:10.1001/jama.2024.17888 Clinical Question In adult patients undergoing coronary artery bypass surgery (CABG) is supplementing potassium when serum concentration is ≤ 3.5 mEq/L non-inferior to supplementation when serum concentration is ≤ 4.
Don't Forget the Bubbles
OCTOBER 10, 2024
With millions of journal articles published yearly, it is impossible to keep up. This time the team from Bristol Royal Children’s Hospital ED tell us what is new in the world of paediatric literature… Led by Dr John Coveney a Paediatric Emergency Medicine Trainee in Bristol who has revived The Journal Club at Bristol Royal Children’s Hospital ED on a monthly basis.
EM Ottawa
OCTOBER 15, 2024
Methodology: 3/5 Usefulness: 4/5 Essat M, et al. Ann Emerg Med. 2024 Jun 18:S0196-0644(24)00260-9 Question and Methods: Using systematic review methodology, the authors aimed to determine sensitivity and specificity in the use of D-Dimer in the work-up for Acute Aortic Syndrome. Findings: A total of 25 studies were included in the primary meta-analysis; summary sensitivity […] The post Diagnostic Accuracy of D-Dimer for Acute Aortic Syndromes: Systematic Review and Meta-Analysis appeared
First 10 EM
OCTOBER 14, 2024
Another month, another set of articles. Some clinically relevant. Some just thought provoking. One is more than 100 years old. Yes, I look everywhere for these papers. The BroomeDocs podcast version can be found here: [link] Clinically but not statistically significant: what do you do? Turgeon AF, Fergusson DA, Clayton L,et al. Liberal or Restrictive […] The post The October 2024 Research Roundup appeared first on First10EM.
EMDocs
OCTOBER 10, 2024
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.
The Skeptics' Guide to EM
OCTOBER 12, 2024
Reference: Ma K et al. A national survey of children’s experiences and needs when attending Canadian pediatric emergency departments. PLoS One. June 2024 Date: Oct 1, 2024 Guest Skeptic: Dr. Andrew (Andy) Tagg is an Emergency Physician with a special interest in education and lifelong learning. He is the co-founder of website lead of Don’t Forget the Bubbles (DFTB).
RebelEM
OCTOBER 16, 2024
Take Home Points Orogastric lavage may still play an important role in treatment of the overdose patient. Do not perform lavage if the ingestion has limited toxicity at any dose or the ingested dose is unlikely to cause significant toxicity. Strongly consider orogastric lavage in a patient who has taken an overdose of drugs that are particularly toxic, suspected extreme doses associated with high morbidity/mortality and do not have easily available and effective antidotes.
EB Medicine
OCTOBER 11, 2024
In this special episode Sam Ashoo, MD interviews Ryan Johnson, Pharm. D. who shares strategies to address the recent IV fluid shortage caused by Hurricane Helene. 00:00 Introduction and Episode Overview 01:10 Meet Ryan Johnson: Clinical Pharmacist 02:06 Role of Clinical Pharmacists in Emergency Medicine 05:03 IV Fluid Shortage: Causes and Impact 05:56 Institutional Strategies to Mitigate IV Fluid Shortages 14:52 Provider-Level Solutions for Fluid Conservation 22:11 Pharmacy and Nursing Staff Rol
Mind The Bleep
OCTOBER 17, 2024
What my elective entailed I undertook a four-week Pre-Hospital Emergency Medicine (PHEM) elective with the Midlands Air Ambulance Charity. This entailed two day shifts on the helicopter and one night shift on the critical care car each week. Through this role, as an observer, I was able to experience various pre-hospital emergencies; the most common scenarios I attended were cardiac arrests, but I also attended trauma patients at the scene of road traffic accidents, fractures in a wilderness med
Don't Forget the Bubbles
OCTOBER 14, 2024
Some definitions Asylum seeker: A person who has fled their country and applied to another country to be recognised as a refugee but has not yet been granted this status. Refugee: Someone whose asylum application has been successful. The government recognizes they cannot return to their country of origin owing to a well-founded fear of being persecuted for the reasons provided for in the United Nations Refugee Convention or European Convention on Human Rights (such as persecution due to race, se
Taming the SRU
OCTOBER 16, 2024
research grand rounds - r1 core content: thromboembolic disease in pregnancy - r4 discharge/transfer/treat: hand injuries - ed discharge after trauma - pediatric respiratory emergencies and airway management Research Grand Rounds WITH dr. Freiermuth Peer Review Not common practice until the 1970s Intent was to ensure scientific integrity Equity The Process Read, summarize manuscript, comment on strengths and weaknesses, determine whether article fits with the priorities of the journal Recommend
EM Ottawa
OCTOBER 10, 2024
We often talk about PoCUS for first-trimester bleeding. Is there an IUP? NDIUP? IDK? Yet one of the most common questions patients ask is; “Can you see the heartbeat?” While measuring fetal heart rate is not always our top priority, I’m here to convince you of the following: Measuring it still has clinical value. […] The post PoCUS Pearl – Measuring Fetal Heart Rate appeared first on EMOttawa Blog.
EMergucate
OCTOBER 15, 2024
An 80yr male presents with 2 weeks increasing shortness of breath, he has a history of CABG. What can be seen on the ECG: If these were new findings what might you be concerned about?
Mind The Bleep
OCTOBER 17, 2024
I am a GP at a large practice based in a town in southwest Scotland, and I also work as a doctor in the Emergency Department in our local district general hospital. But it doesn’t stop there. Like dozens of other doctors, nurses, and paramedics across Scotland, I have the privilege of being a responder with BASICS Scotland. What is a BASICS responder and who can do it?
Don't Forget the Bubbles
OCTOBER 16, 2024
You’re embarking on your first paediatric registrar rotation – welcome to this exciting next stage of your career, and congratulations on getting here! This article is not intended to be a set of step-by-step instructions but to give you some ideas to consider and some tips and tricks from first-time registrars who have recently gone through this transition.
ALiEM
OCTOBER 11, 2024
A 76-year-old female presented with a lingering cough and an oral lesion to the left lower cheek. She reported ten days of improving flu-like symptoms but had a persistent cough and nasal congestion. On the day of presentation, she developed a painful, intermittently bleeding “blood blister” to the left lower cheek that had increased in size, as well as new red spots on her arms and legs.
EM Ottawa
OCTOBER 10, 2024
Ever tried injecting local anesthetic into the bottom of someone’s foot? If you have, you’ll understand the incredible pain and difficulty in trying to anesthetize this region. Fortunately, there’s a better way to anesthetize the plantar foot, and avoid getting kicked in the face or causing a needle-stick injury: performing an ultrasound-guided tibial nerve block.1 […] The post PoCUS Pearl – Tibial Nerve Block appeared first on EMOttawa Blog.
Emergency Live
OCTOBER 15, 2024
MUM-T Technology Aims to Enable Faster, More Efficient Crisis Response Worldwide Collaboration between drones and helicopters is poised to revolutionize emergency and rescue operations. Airbus Helicopters and its European partners recently completed a large-scale demonstration to test the interoperability between piloted and unmanned aerial systems (MUM-T).
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