Ken Grauer, MD
NOVEMBER 15, 2024
Today's case was contributed by Dr. Magnus Nossen ( from Fredrikstad, Norway ). Dr. Nossen was at his computer — reviewing ECGs from patients recently admitted to his group's hospital service. He came across the ECG shown in Figure-1 — obtained from a woman in her 70s who was admitted to the hospital for new CP ( C hest P ain ). QUESTION: How would YOU interpret the ECG in Figure-1 ?
Stop and Think
NOVEMBER 19, 2024
The OPTION trial compared two strategies to reduce stroke and bleeding after catheter ablation of atrial fibrillation. The current strategy is to continue an anticoagulant medication. The alternative tested in OPTION is to implant a left atrial appendage device—abbreviated as LAAC (left atrial appendage closure). AF ablation is one of the most common procedures in my field.
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Pediatric EM Morsels
NOVEMBER 15, 2024
Seizures are super scary for a parent to witness, but not all seizures mean danger. There is actually a diagnosis of seizures that has “ BENIGN” in the name! Have you ever had that feeling of falling that rapidly wakes you from sleep? While it’s unlikely that you were having Benign Epilepsy with CentroTemporal Spikes (BECTS) seizures or a benign Rolandic seizure, that tenuous state between sleeping and waking is a time when some odd neurologic things can happen, including BECTS.
Science Based Medicine
NOVEMBER 15, 2024
When RFK Jr. does to the U.S. what he did to Samoa, doctors will say they are horrified, that they love vaccines, blah blah blah. But it will be too late. The post If You Sanewashed RFK Jr., Or If You Sanewashed Doctors Who Did, You Own the Next 4 Years first appeared on Science-Based Medicine.
St. Emlyn
NOVEMBER 19, 2024
St.Emlyn's - Emergency Medicine #FOAMed Traditionally, large-bore chest tubes have been standard for managing hemothorax, but smaller tubes are now proving just as effective in stable patients, with added benefits like reduced pain and fewer tube days. This review explores outcomes in drainage efficacy, complication rates, and patient comfort, showing that small-bore thoracostomy may be a reliable alternative for non-emergent cases.
Dr. Smith's ECG Blog
NOVEMBER 14, 2024
This was texted to me by a paramedic while I was out running one day: "54 yo male chest pain started at 1pm. History of diabetes type II and stent placement in 2018. I’m seeing hyperacute T waves III, aVF, down sloping depression I and aVL. Thoughts?" What do you think? I responded: "Definite inferior OMI. And Right Ventricular. Activated the Cath Lab.
RebelEM
NOVEMBER 13, 2024
Take Home points : Always suspect an open joint if there is a laceration, regardless of size, the lies over joint CT scan of the affected joint is widely considered to be the standard approach to evaluation but the saline load test may be useful in certain circumstances. Obtain emergency orthopedics consultation for all open joints and administer antibiotics and update tetanus in all patients REBEL Core Cast 131.0 – Traumatic Arthrotomy Click here for Direct Download of the Podcast.
Emergency Care Today brings together the best content for emergency care practitioners from the widest variety of industry thought leaders.
Science Based Medicine
NOVEMBER 16, 2024
It means pertussis and measles outbreaks will be happening under your watch and you'll be held responsible while your boss is an anti-vaxx crank. Enjoy! The post What Does it Mean to Own the Next 4 Years? first appeared on Science-Based Medicine.
EMDocs
NOVEMBER 19, 2024
Authors: Bricey Bayonnet, MD ( EM Resident Physician, Atrium Health’s Carolinas Medical Center, Charlotte, NC); Christine Murphy, MD (EM Attending Physician; Medical Toxicologist, Atrium Health’s Carolinas Medical Center, Charlotte, NC) // Reviewed by: James Dazhe Cao, MD (@JamesCaoMD, Associate Professor of EM, Medical Toxicology, UT Southwestern Medical Center, Dallas, TX); Anthony Spadaro MD, (@TSpadaro91, Fellow in Medical Toxicology, Rutgers NJMS); Alex Koyfman, MD (@EMHighAK); Brit Long, M
Sensible Medicine
NOVEMBER 15, 2024
“What kind of a doctor are you?” “I’m a general internist.” “Like an intern?” Laughing, “Don’t you think I’m too old to be an intern? No, I do general internal medicine, mostly outpatient primary care, but I do some inpatient general medicine as well.” “Oh, so you’re like a GP.” “Sort of… ” Sensible Medicine is a reader-supported publication.
RebelEM
NOVEMBER 18, 2024
View Course Dates This 2-day course provides an in-depth look at effective surgical airway management techniques that you will actually use in your next emergency airway. There is a unique focus on airway anatomy and imaging combined with one-of-a-kind opportunity to practice the techniques on a large variety of non-embalmed, specially prepared cadavers.
Dr. Smith's ECG Blog
NOVEMBER 17, 2024
Written by Willy Frick A 51 year old man with hypertension presented with three hours of acute onset, severe midsternal chest pain associated with two episodes of nausea and vomiting. ECG 1 What do you think? Smith : Inferior leads have subtle ST Elevation with reciprocal STD in aVL. The end of the T-wave in all of II, III, aVF has a rapid downturn, suggesting early T-wave inversion.
American Medical Compliance
NOVEMBER 14, 2024
Defined by the World Health Organization as the reluctance or refusal to vaccinate despite the availability of vaccines, vaccine hesitancy is influenced by complex factors including misinformation, cultural beliefs, and fear of adverse effects. To help address this growing concern, pediatric immunization training equips healthcare providers with the skills, knowledge, and empathy necessary to effectively address vaccine hesitancy.
Science Based Medicine
NOVEMBER 13, 2024
When physicians spread medical misinformation, the potential harm to health is far greater than their direct patient care. And yet, in a recent study, medical boards rarely discipline physicians for spreading misinformation. The JAMA article looked at 3128 medical board disciplinary proceedings involving physicians. Spreading misinformation to the community was the least common reason, at 0.1%.
Sensible Medicine
NOVEMBER 19, 2024
Posting this article was a no brainer. It is a critical appraisal deep dive by “friend of the stack” David Rind that combines the “letter to the editor” feel that we like so much as well some nice EBM history. Enjoy. Adam Cifu Sensible Medicine is a reader-supported publication. If you appreciate our work, consider becoming a free or paid subscriber.
The Bottom Line
NOVEMBER 16, 2024
What’s new in the Critical Care literature – monthly updates
Dr. Smith's ECG Blog
NOVEMBER 19, 2024
These ECGs were texted to me by one of our previous ultrasound fellows, Will Smoot An elderly male arrived via EMS for acute substernal chest pain with radiation to left shoulder and arm that awakened him from sleep at 0030. He took two full strength aspirin prior to EMS arrival. The pain was relieved by one prehospital NTG spray. He arrived at the ED just shy of two hours after onset, pain free.
ALiEM
NOVEMBER 18, 2024
A 48-year-old male with no significant past medical history presented to the Emergency Department with a left-sided facial rash and associated burning left eye pain that started four days prior. He was seen at an ophthalmology clinic when his symptoms started and given oral valacyclovir which he took for three days without improvement. He also endorsed left-sided facial weakness and diplopia for the last eight days.
EMDocs
NOVEMBER 13, 2024
Today on the emDOCs cast with Brit Long, MD ( @long_brit) , we cover the literature on evaluation and management of primary SBP. Episode 110: Primary Spontaneous Bacterial Peritonitis Background: End-stage liver disease with cirrhosis and ascites is a major cause of death worldwide. Primary spontaneous bacterial peritonitis (SBP) is one of the most common infections in those with cirrhosis and ascites.
Science Based Medicine
NOVEMBER 19, 2024
Perhaps the neck manipulation was a bit too aggressive. The post A New DC Degree. What the World Needs Now. first appeared on Science-Based Medicine.
Broome Docs
NOVEMBER 17, 2024
Palatinus HN, Johnson MA, Wang HE, Hoareau GL, Youngquist ST. Early intramuscular adrenaline administration is associated with improved survival from out-of-hospital cardiac arrest. Resuscitation. 2024 Aug;201:110266. doi: 10.1016/j.resuscitation.2024.110266. Epub 2024 Jun 9. PMID: 38857847 Bottom line: This before and after study demonstrates an association between early IM epinephrine and survival from cardiac arrest.
Sensible Medicine
NOVEMBER 14, 2024
What does our philosophy have to do with RFK Jr and MAHA?
Don't Forget the Bubbles
NOVEMBER 18, 2024
As you roll into your night shift, getting briefed and handed the urgent pager, you exit the briefing room and go into the hum of the neonatal intensive care unit. The familiar beeps of monitors and the soft cries of a premature infant fill the air, but then—a sharp, unusual beep cuts through. Moments later, a nurse calls, “Doctor, could you check this blood pressure?
First 10 EM
NOVEMBER 18, 2024
Back for another month of interesting, arcane, important, or baffling articles. As we enter the winter in the Northern hemisphere, and I have little interest in heading outside, I will probably spend more time reading, so these write ups might get longer for the next few months. For now, the weather remains fine, golf season […] The post The November 2024 Research Roundup appeared first on First10EM.
St. Emlyn
NOVEMBER 19, 2024
St.Emlyn's - Emergency Medicine #FOAMed Traditionally, large-bore chest tubes have been standard for managing hemothorax, but smaller tubes are now proving just as effective in stable patients. Dive in to explore the latest evidence in trauma management and see if small-bore thoracostomy is suitable for your practice’s patient population. The post Small Bore vs Large Bore Thoracostomy for Traumatic Haemothorax. appeared first on St.Emlyn's.
Emergency Live
NOVEMBER 19, 2024
Serious side effects raise safety questions for new weight-loss drugs In recent years, glucagon-like peptide-1 receptor agonists (GLP-1), such as semaglutide and liraglutide (marketed respectively as Wegovy and Ozempic), have revolutionized the treatment of obesity and type 2 diabetes. However, Despite the many benefits, cases of serious side effects have emerged, raising questions about the […] The post Weight Loss Drugs: Serious side effects appeared first on Emergency Live.
PEMBlog
NOVEMBER 18, 2024
You don’t need to send comprehensive viral tests in the majority of children with cough and congestion. Just make a clinical diagnosis dang it! Lyrics Adeno, rhino, entero too swabbing a nose just for something to do RSV, HSV, EBV, no! Save all that money and let the kid go Influenza, COVID, why not some more? Big viral panels? Show them the door!
EMDocs
NOVEMBER 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.
Taming the SRU
NOVEMBER 18, 2024
Overview Hiccups are one of the most common human reflexes and fascinatingly occur in adults, children, neonates and in utero! The official medical term for hiccups is “singultus” which is derived from the Latin root word singult and means “to catch one’s breath while sobbing”. While there is no established purpose for hiccups in adults, it is hypothesized that its role in utero is to prevent amniotic fluid aspiration and for respiratory muscle and diaphragmatic training prior to delivery.
St. Emlyn
NOVEMBER 19, 2024
St.Emlyn's - Emergency Medicine #FOAMed All the best from the blog from August 2024, in our easy to digest podcast. The post September 2024 Round-Up – Patient Experience in the ED, Dirty Adrenaline, and More! appeared first on St.Emlyn's.
Emergency Live
NOVEMBER 18, 2024
Curcumin, a molecule extracted from turmeric, could open new perspectives in the treatment of SMA Spinal muscular atrophy (SMA) is a rare genetic disorder affecting motor neurons, the nerve cells that control muscle movement. This condition, often diagnosed in the early years of life, causes progressive muscle weakness and, in severe cases, can lead to […] The post Turmeric: a new hope for SMA patients appeared first on Emergency Live.
PulmCCM
NOVEMBER 18, 2024
Pulmonary embolism and its recommended therapies are stratified according to risk: Patients with massive pulmonary embolism (i.e., hypotension) generally receive systemic thrombolytics, because their risk of death is higher than their bleeding risks from tPA. Patients with mild, low-risk PEs receive anticoagulation, because thrombolytics’ bleeding risk would far outweigh any potential benefit.
The Skeptics' Guide to EM
NOVEMBER 16, 2024
Date: October 28, 2024 Reference: Verma et al. Clinical evaluation of a machine learning–based early warning system for patient deterioration. CMAJ September 2024 Guest Skeptic: Michael Page is currently the Director of Artificial Intelligence (AI) Commercialization at Unity Health Toronto. He leads an AI team intending to improve patient outcomes and healthcare system efficiency.
EM Ottawa
NOVEMBER 14, 2024
Urine drug (or toxicologic) screens are a fairly standard tool used in addictions, psychiatry and the Emergency Department (ED), often employed to detect substance use in patients presenting with altered mental status, trauma, psychiatric or abnormal behaviour. Yet, the reliance on these screens is fraught with inaccuracies, clinical irrelevance, and significant ethical concerns, particularly from […] The post Blurred Lines: The Ethical Pitfalls of Urine Drug Screens appeared first on EMOt
St. Emlyn
NOVEMBER 14, 2024
St.Emlyn's - Emergency Medicine #FOAMed Emergency medicine is shaped by our ability to respond effectively to both routine cases and extreme, high-stakes incidents. While civilian incidents dominate prehospital care, the intersection of civilian and military […] The post Podcast – Care in the Hot Zone with Claire Park at Tactical Trauma 2024 appeared first on St.Emlyn's.
Emergency Live
NOVEMBER 18, 2024
Quantum entanglement may be key to the speed and efficiency of brain connections Entanglement, one of the most fascinating and counterintuitive phenomena in quantum mechanics, may be the key to understanding how fast and efficient communications are within the brain. The brain: a network of quantum connections? Our brain cells, the neurons, communicate with each […] The post Quantum Mechanics and the Mystery of the Mind appeared first on Emergency Live.
ECG Guru
NOVEMBER 16, 2024
The Patient: Sixty-year-old man with a complaint of severe substernal chest pain. Denies hx of M.I., but reports feeling short of breath on exertion for about a year. Hx of hypertension, but admits he is non-compliant with his medication. Appears pale and diaphoretic, BP 110/68. The ECG: The rhythm is sinus at 62 bpm. The QRS is slightly wide at 110 ms (.11 seconds), but still within normal limits.
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