Ken Grauer, MD
OCTOBER 25, 2024
The ECG in Figure-1 was obtained from a middle-aged man who presented with a 2 week history of progressively increasing CP ( C hest P ain ) with exertion. He had his most severe episode of CP the day before he was seen with this ECG. His CP was much less compared to the day before — but it had not yet completely resolved. An initial Troponin drawn less than 1 hour after the ECG in Figure-1 was recorded was over 10,000.
The Trauma Pro
OCTOBER 29, 2024
CT scans are commonly used to aid the workup of patients with blunt trauma. They are occasionally useful in penetrating trauma, specifically when penetration into a body cavity is uncertain, and the patient has no hard signs that would send him or her immediately to the operating room. Is there any role for CT in operative penetrating trauma, after the patient has already been to the OR?
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The Trauma Pro
OCTOBER 22, 2024
Today’s post is directed to all those prehospital trauma professionals out there. Car crashes account for a huge number of injuries worldwide. About 40% of people involved are trapped in the vehicle. And unfortunately, entrapped individuals are much more likely to die. There are four basic groups (and their category in parentheses) of trapped car occupants : those who can self-extricate or extricate with minimal assistance (self-extrication) individuals who cannot self-extricate due to pai
Science Based Medicine
OCTOBER 24, 2024
Millions of Americans are taking herbal remedies that may be toxic to the liver. The post Widespread Use of Dietary Supplements Linked to Liver Damage first appeared on Science-Based Medicine.
Sensible Medicine
OCTOBER 25, 2024
The woman with palpitations. The man with whom you used to joke and trade barbs who now sits silently, absent, while you talk to his wife. The woman whose depression dominates every visit; her depression being the one problem she refuses to address. The man whose joy and charisma makes every visit an absolute pleasure, despite his painful disability about which you can really do nothing.
St. Emlyn
OCTOBER 22, 2024
St.Emlyn's - Emergency Medicine #FOAMed This post accompanies the podcast “Simulation for Elite Team Performance,” which was recorded live at the Tactical Trauma 2024 conference in Sundsvall, Sweden. We are grateful to the organizing team […] The post Podcast – Simulation for Elite Team Performance with Andrew Petrosoniak at Tactical Trauma 2024 appeared first on St.Emlyn's.
Emergency Medicine Journal
OCTOBER 23, 2024
Patients who present to the ED usually have their BP measured as part of their routine triage assessment. BP measurements suggesting hypertension (≥140 systolic or ≥90 diastolic 1 ) are a frequent incidental finding, unrelated to the patient’s presenting complaint, but require follow-up. 2 Hypertension is associated with an increased risk of cardiovascular events, so its detection in ED may be an opportunity to initiate further investigations and management. 3 Guidance produced
Emergency Care Today brings together the best content for emergency care practitioners from the widest variety of industry thought leaders.
Science Based Medicine
OCTOBER 24, 2024
The Free Press = Unherd = Persuasion = Reason = Tablet The post The “Heterodox” Media: Using Groupthink and Misinformation to Inhibit Free Thought first appeared on Science-Based Medicine.
EM Ottawa
OCTOBER 24, 2024
Precedex (dexmedetomidine) is an alpha-2 adrenergic agonist increasingly used in critical care environments for sedation and anxiolysis. It offers a unique profile of sedation without respiratory depression, making it an attractive option in various clinical scenarios. Historically, it has been used more frequently in the ICU than in Emergency Departments, likely due to provider comfort. […] The post Is there a Precedence for Precedex in the ED?
Dr. Smith's ECG Blog
OCTOBER 27, 2024
This was submitted by a paramedic, Hailey Kennedy A late 50s male called 911 following 2 hours of chest pain that started while working at his desk. He reported the crushing chest pain radiated down his left arm. Pt took an antacid with no relief and decided to call at the request of his wife. Here is his EMS ECG: What do you think? This was sent to me with no clinical information, and my initial impression viewing it on my phone was "It’s a tricky one.
First 10 EM
OCTOBER 28, 2024
As with everything that comes out of the PECARN group, this is a huge study, and is therefore one that everyone needs to know about. That being said, despite working in two very busy community hospitals with a high percentage of pediatrics visits, c-spine injuries are just not an issue I struggle with. I have […] The post The PECARN c-spine rule could cause a lot of harm appeared first on First10EM.
Science Based Medicine
OCTOBER 23, 2024
A recent meta-analysis of eye movement desensitization and reprocessing (EMDR) therapy concludes that the evidence “confirms” EMDR is effective in treating depression. It is a great example of the limitations of meta-analysis, and how easy it is to create essentially a false narrative using poor quality research. EMDR was “developed” by Dr.
Core Medical Group
OCTOBER 25, 2024
This week, CoreMedical Group is celebrating its 25 th anniversary. From beginning its journey in 1999, to thriving today in 2024, CoreMedical Group has grown and flourished.
Dr. Smith's ECG Blog
OCTOBER 24, 2024
Written by Pendell Meyers A woman in her 70s with with multiple medical comorbidities began to have episodes of weakness and pre-syncope off and on for several days, then suffered three episodes of syncope within a few hours. She was brought to an Emergency Department for evaluation. On arrival she was awake, alert, and asymptomatic, with normal vital signs except for heart rate in the low 50s.
ALiEM
OCTOBER 28, 2024
A 2-year, 11-month-old female with a history of constipation was brought to the ED by her mother for abdominal pain. The mother noticed that the patient’s abdomen had been enlarging for months. When they visited the pediatrician several months ago, the pediatrician also noticed a mildly enlarged abdomen but the patient was asymptomatic at that time.
Emergency Medicine Cases
OCTOBER 22, 2024
On this month's EM Quick Hits podcast: Kevin Wasko on post-tonsillectomy hemorrhage management, Brit Long on assessment and management of post-CABG surgical incision infections, Anand Swaminathan on evidence, pitfalls and tips on using Bougies, Leah Flannigan on when to suspect vascular injury in patients with low energy mechanism pelvic fractures, Andrew Petrosoniak on debriefing after cases: why, when and how.
EMDocs
OCTOBER 25, 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: Hypertensive Crisis Averted…New AHA Statement on Asymptomatic Hypertension Spoon Feed This article emphasizes the difference between hypertensive emergency and asymptomatic elevated blood pressure (BP); while hypert
Sensible Medicine
OCTOBER 28, 2024
The study of the week will take a short break. I head to Curitiba Brazil tomorrow for the Brazilian EP society meeting. I have five lectures. I will be back next week. And there will be plenty of studies to choose from because we are entering the fall season of medical meetings. This week, Sensible Medicine features a guest column from Zachary R. Caverley, a Cardiology Physician Assistant working in the Northwest coast of Oregon.
EM Ottawa
OCTOBER 28, 2024
Methodology: 4/5 Usefulness: 4/5 Geraghty LE, et al. N Engl J Med. 2024 May 30;390(20):1885-1894. doi: 10.1056/NEJMoa2402785. Question and Methods: Study aimed to determine if video laryngoscopy improves first-attempt intubation success in neonates compared to direct laryngoscopy through a randomized controlled trial. Findings: 74% first pass success with video laryngoscopy and 45% with direct laryngoscopy […] The post Video versus Direct Laryngoscopy for Urgent Intubation of Newborn Infa
ALiEM
OCTOBER 25, 2024
A 64-year-old male with a history of bipolar 1 disorder, PTSD, anxiety, depression, obsessive-compulsive disorder, GERD, and HTN presented to the ED with the chief complaint of foreign body and self-injury. He reported years of sticking sewing needles into his right arm, most recently yesterday. He explained that inserting needles makes him feel better with mild associated pain.
The Bottom Line
OCTOBER 26, 2024
Restrictive vs Liberal Transfusion Strategy in Patients With Acute Brain Injury @fabio_taccone. JAMA. 2024. PMID: 39382241 Clinical Question In patients with acute brain injury, does a liberal, compared to a restrictive strategy of blood transfusion, improve neurological outcomes at 180 days?
EMDocs
OCTOBER 25, 2024
Today on the emDOCs cast with Brit Long, MD ( @long_brit) , and Rachel Bridwell, MD ( @rebridwell ), we cover corneal abrasions and DRESS. Episode 109: Corneal Abrasion and DRESS Corneal Abrasion Epidemiology Ocular diagnoses comprise 8% of total ED visits with 45% of those being corneal abrasions. Corneal epithelium is easily damaged, however, regenerates quickly with a healing time of 24-48 hours.
St. Emlyn
OCTOBER 26, 2024
St.Emlyn's - Emergency Medicine #FOAMed This article reviews a recent study on the use of Tranexamic Acid (TXA) in traumatic brain injury (TBI) patients with intracranial hemorrhage (ICH), focusing on prehospital care. The study, a subgroup analysis from the Prehospital TXA for TBI Trial, compared different TXA dosing regimens and found that a 2-g TXA bolus significantly reduced 28-day mortality compared to placebo.
NRC Health
OCTOBER 28, 2024
Addressing workplace violence is an important element of the CMO role at health systems and hospitals, this associate CMO says. The post How CMOs can combat workplace violence appeared first on NRC Health.
Emergency Live
OCTOBER 28, 2024
Revocation of the authorisation of obetycholic acid for the treatment of primary biliary cholangitis (CBP) The recent decision by the European Commission to withdraw marketing authorisation for obeticlic acid for the treatment of primary bile cholangitis (PBC) is a blow to thousands of patients with this rare liver disease. The news has raised major concerns […] The post The European Commission revokes the approval of the drug against CBP appeared first on Emergency Live.
Board Bombs
OCTOBER 28, 2024
We are live from Maine while at our podcast retreat (yes that’s a thing). Let’s talk about a classic envenomation. Plus we have a surprise guest join us. 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; Husain, Iltifat. 238. Stabbed at the beach?
PEMBlog
OCTOBER 28, 2024
Night terrors are super scary. And the kid doesn’t even remember them! They’re more like sleep walking than nightmares and parents are often worried that it’s a seizure or something more serious. Lyrics [verse] Woke up late at night flailing and crying Couldn’t wake him up though the parents were trying Oh why the unstoppable fussing and screamin’ Could it be a seizure or possession by a demon?
Taming the SRU
OCTOBER 28, 2024
Pneumomediastinum is defined as the presence of air in the mediastinum after rupture of air-filled structures such as the esophagus or trachea, or small parts of the lung such as alveoli. This can occur spontaneously or after trauma. Pneumomediastinum is often benign and self limited. However, in more serious cases it can require close monitoring and sometimes surgical intervention.
NRC Health
OCTOBER 28, 2024
Addressing workplace violence is an important element of the CMO role at health systems and hospitals, this associate CMO says. The post How CMOs can combat workplace violence appeared first on NRC Health.
Emergency Live
OCTOBER 27, 2024
Changing the way surgeons prepare for surgery can reduce water consumption in hospitals A recent study by the Campus Bio-Medico in Rome has revealed an astonishing truth: changing the way surgeons prepare for surgery can drastically reduce water consumption in hospitals. The study For two years, researchers have closely monitored water consumption during thousands of […] The post The green revolution in operating rooms: reducing water use appeared first on Emergency Live.
Thinking Critical Care
OCTOBER 26, 2024
These are without a doubt some of the hidden gems of any boutique conference. At H&R we’ve always had a great time with these, time for instructors to pass on some really actionable, hands-on skills to a small group of really motivated clinicians. BJJ or Self-Defense for Humans & Health Care Workers – we feel that BJJ is a natural companion to medicine.
EMergucate
OCTOBER 27, 2024
Today’s ECG is a 45yr male who presents to ED with a 12hr history of epigastric pain and diaphoresis. He is an ex smoker, no other cardiac risk factors.
JournalFeed
OCTOBER 26, 2024
The JournalFeed podcast for the week of Oct 21-25, 2024. 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. Monday Spoon Feed : This article emphasizes the difference between hypertensive emergency and asymptomatic elevated blood pressure (BP). While hypertensive emergency requires prompt treatment to lower BP, treatment of asymptomatic elevated BP in acute care settings may be harmful.
ETM Course
OCTOBER 25, 2024
ETM Course Director Andy Buck was lucky enough to be invited to speak on Trauma Education at the fantastic ANZTS Conference in Brisbane this week. If you’re looking for the references from Andy’s talk, you can find them here. Thanks to everyone who came to the presentation and the conference, it’s always great to catch up with like-minded people who have a passion for trauma!
Mind The Bleep
OCTOBER 22, 2024
What is digital? To a Victorian doctor, the term digital would have referred to the anatomy of our fingers or toes and the nerves and vasculature contained within. This term came from the Latin digitus , which (surprisingly) means finger or toe. A digit has also meant a whole number less than ten for hundreds of years; perhaps they look a bit like fingers.
Thinking Critical Care
OCTOBER 26, 2024
( version francaise ci-dessous ) At our hospital, typical of community hospital intensive care units that do not have an extensive structure of junior and senior trainees who generally staff the university hospitals after hours, medical coverage depends on collaboration between nurses and intensive care doctors as well as their emergency room colleagues.
ALiEM
OCTOBER 23, 2024
Ultrasound-guided procedures are difficult enough just identifying the anatomy. Performing a nerve block with the ultrasound in one hand and the needle in the other hand adds extra challenges. The simplest 1-person approach involves attaching a syringe with local anesthetic directly to the end of the procedural needle. A 2-person approach involves attach the syringe to a custom tubing-needle setup such as below.
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