Ken Grauer, MD
DECEMBER 28, 2024
I was sent the ECG in Figure-1 told only that the patient was an older adult who reported dizziness with activity. QUESTIONS: What is the rhythm? ( HINT: There are at least 4 important findings that should be noted ). Is there AV block? Figure-1: The initial ECG in today's case. ( To improve visualization I've digitized the original ECG using PMcardio ).
Sensible Medicine
DECEMBER 28, 2024
Dharini Bhammar, PhD, MBBS, is a respiratory physiologist and evidence enthusiast. As a new mum, her pediatrician recommended the RSV monoclonal antibody for her baby. After reviewing the evidence, she declined it. We are excited to share her clearly written argument as an excellent example of evidence translation. Core concepts discussed include effect size, net benefit and the external validity of clinical trials.
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St. Emlyn
DECEMBER 23, 2024
St.Emlyn's - Emergency Medicine #FOAMed David Purkarthofer reviews the highlights from the fantastic EuSEM conference held in Copenhagen earlier this year. #FOAMed @stemlyns The post EuSEM 2024 in review appeared first on St.Emlyn's.
Science Based Medicine
DECEMBER 27, 2024
The time to start speaking out to defend vaccines from RFK Jr. is now. The post Dr. Marty Makary, What Are You Going To Do If RFK Jr. Demands That Revoke Approval For Vaccines? first appeared on Science-Based Medicine.
RebelEM
DECEMBER 23, 2024
Background: Sickle cell disease (SCD) affects an estimated 300,000 infants born worldwide each year and has a total estimated prevalence of 100,000 in the United States alone ( Piel 2017 ). Within this population, over 90% of healthcare encounters are due to painful vaso-occlusive episodes (VOE) ( Kidwell 2021 ). VOE is often complicated by hypovolemia, making fluid administration a common intervention ( Lovett 2017 ).
EMDocs
DECEMBER 23, 2024
Authors: Molly Rinkevich, PharmD, PGY2 EM Pharm Resident (Geisinger Wyoming Valley, Wilkes Barre, PA); Howard Rainey, DO (Geisinger Medical Center, Danville, PA); Drew Schmucker, PharmD (Geisinger Wyoming Valley, Wilkes Barre, PA); Lloyd Tannenbaum, MD (APD, Geisinger Wyoming Valley, Wilkes Barre, PA) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case: Its 3 am on a busy shift and EMS rolls in with a 67-year-old male coming in from home with a history of ischemic card
EMCrit
DECEMBER 27, 2024
All things stabilizing tamponade and performing pericardiocentesis EMCrit Project by Scott Weingart, MD FCCM.
Emergency Care Today brings together the best content for emergency care practitioners from the widest variety of industry thought leaders.
Mind The Bleep
DECEMBER 27, 2024
Im currently in my third year of working in a rural district general hospital Accident and Emergency Department, and one of the things that has struck me most is the use of pre-hospital medicine. Being in an area where it can take an hour and a half to get to the us, as the nearest trauma unit, really puts into perspective the need to have people trained to a level where they can provide immediate aid to people within the Golden Hour.
Sensible Medicine
DECEMBER 29, 2024
An introduction to oncology for medical students
Northwestern EM Blog
DECEMBER 23, 2024
Written by: Chezlyn Patton, MD, (NUEM 27) Edited by: David Adler, MD (NUEM 25) Expert Commentary by : Melissa Marinelli, MD Expert Commentary Doctors in the ER are under intense time pressure to see many patients quickly and make hundreds of decisions over the course of a single shift. This actually fosters a natural honing of communication skills, because rapport must be developed quickly with anyone who walks through the door.
EMCrit
DECEMBER 23, 2024
All the literature goodness for December 2024 EMCrit Project by Scott Weingart, MD FCCM.
St. Emlyn
DECEMBER 27, 2024
St.Emlyn's - Emergency Medicine #FOAMed Intraosseous (IO) access is essential in prehospital emergency care when intravenous access is challenging. A Danish retrospective cohort study of over 5,000 patients found fewer than five cases of osteomyelitis, no osteonecrosis or compartment syndrome, and no complications in children. Despite a high mortality rate (60% at 180 days) potentially underestimating long-term risks, the study's robust design supports IO access as a generally safe and effe
Emergency Medicine Journal
DECEMBER 30, 2024
The authors are an Emergency Physician and a Midwife on board the Geo Barents, Médecins Sans Frontières’ search and rescue ship in the Central Mediterranean Sea. Médecins Sans Frontières depends on private donations to support its work— www.msf.org.uk We are handed a little girl, maybe 3-year old and wrapped tight in winter clothes.
PulmCCM
DECEMBER 30, 2024
PEERLESS, ABC-SEPSIS, IV vs IO, BALANCE, FAST, SAHARA, TESLA/LASTE, Epic sued, ChatGPT vs MDs, more
PEMBlog
DECEMBER 30, 2024
Guess who’s back? Back again. Epi Pen. Jab a friend. Give that EpiPen even if you think it might possibly be anaphylaxis! Lyrics His palms are sweaty, knees weak, arms are heavy, He’s allergic, it’s anaphylaxis already. He’s chokin’, his throat’s closin’, hives all over, IgE mediated, peanut exposure Mucosa swollen, he’s gaspin’ for breath, Heart poundin’ like a drum, he’s scared to death. multi system reaction, puking and wheezin
Mind The Bleep
DECEMBER 23, 2024
Introduction Thyroid Eye Disease (TED) is an autoimmune disease characterised by extraocular muscle swelling and orbital fat expansion 1. It affects approximately 50,000 people in the UK, most commonly occurring in those diagnosed with Graves disease, although a minority of cases do affect euthyroid or hypothyroid patients 1,2. Symptoms may include lid retraction , proptosis , watery eyes and double vision 3.
St. Emlyn
DECEMBER 23, 2024
St.Emlyn's - Emergency Medicine #FOAMed Day 1 review from the London Conference 2024 with Zaf Qasim. Also check out our podcasts from the same conference on our podcast channel. #FOAMed The post Talking trauma – London Trauma Conference Day 1 appeared first on St.Emlyn's.
Emergency Medicine Journal
DECEMBER 30, 2024
We would like to thank the author for their comments. We would be happy to provide some further explanation regarding the questions and comments regarding our paper. 1 A correction has now been issued for points (2) and (3). (1) In regards to the cost discrepancy of andexanet alfa, we cited and referenced the correct cost of the medication as of 2019, at the time of the study.
The Skeptics' Guide to EM
DECEMBER 28, 2024
Date: December 26, 2024 Reference: Steinhauser S et al. Emergency department staff compassion is associated with lower fear of enacted stigma among patients with opioid use disorder. AEM December 2024 Guest Skeptic:Dr. Suchismita Datta. She is anAssistant Professor and Director of Research in theDepartment of Emergency Medicine at the NYU Grossman Long Island Hospital Campus.
EMergucate
DECEMBER 29, 2024
PH = 7.39, that is within the normal range. pCO2 = 30 mmHg, that is slightly low. This patient might have respiratory alkalosis. Next, we should look at the compensation for respiratory acidosis.
PulmCCM
DECEMBER 27, 2024
"Covert consciousness," hyperglycemia guideline update, reviews on midodrine, antipsychotics, steroids, delirium, more
Emergency Medicine Cases
DECEMBER 23, 2024
In this Global EM post we provide examples of Global EM partnerships and tools for developing these partnerships to foster global solidarity in improving emergency medicine as a specialty and help EM societies not only strengthen their systems but also enhance global health outcomes. The post Global EM 7 Global Emergency Medicine Partnerships appeared first on Emergency Medicine Cases.
Emergency Medicine Journal
DECEMBER 30, 2024
In a recent article by Sadek et al ( Sadek E, et al. Emerg Med J 2024; 41: 162 – 7 ), we noted several incorrect statements and respectfully ask the authors to correct the following points: In the introduction of their article (Sadek et al , p163), 1 Sadek et al 1 stated the following: "The costs of low dose and high dose of andexanet alfa are approximately $29 040 and $58 080, respectively.
Dr. Smith's ECG Blog
DECEMBER 29, 2024
Dizziness is so unlikely to be OMI without an obvious ECG, that I am going to pretend that this patient presented with chest pain. The PMCardio Queen of Hearts app asks you, before giving an interpretation of OMI ("STEMI-Equivalent"), whether the patient's clinical presentation is high risk for OMI. If no, then she will tell you that the case is outside of the intended use group.
PEMBlog
DECEMBER 23, 2024
The Emergency Department never closes – not even on Christmas Day. This song reminds us all that the ED is always open, and that we are there for our patients during the holidays. But we still miss our families… Lyrics When Ive got to work on Christmas Ill tell you what Ill do I will treat all sorts of problems Cough and cold and strep and flu Ill unwrap a diagnosis With a test or three I will splint a buckle fracture like I trim a tree If your child is sick on Christmas We will neve
Sensible Medicine
DECEMBER 30, 2024
The debate of the week on social media centered on the role of immigrants working on US visa programs. Dr Ashish Jha posted on X an observational study in the BMJ that he co-authored, which found that international medical graduates outperformed US doctors. The flawed study offers many lessons in critical appraisal. First a note on Dr. Jha, whom I have not met and mean no malice.
Science Based Medicine
DECEMBER 30, 2024
One of many shameful incidents in the life of antivax activist Robert F. Kennedy Jr. was his promotion of anti-MMR fear mongering during a measles epidemic in Samoa. Now that he could become HHS Secretary, his apologists are frantically trying to gaslight you. Here's how. The post Gaslighting RFK Jr.s role in the deadly Samoan measles outbreak first appeared on Science-Based Medicine.
Emergency Medicine Journal
DECEMBER 30, 2024
Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication.
The Trauma Pro
DECEMBER 24, 2024
In the previous post, I reviewed some basic information on DOAC reversal. Five years ago, it was costly and questionably effective. So what has happened in the meantime? In this post, I’ll review a big trial the pharma company was excited about and make a few comments. ANNEXA-I Study This study sought to evaluate the hemostatic effect of Andexanet administration in patients taking a Factor Xa inhibitor who suffered an intracranial hemorrhage.
Dr. Smith's ECG Blog
DECEMBER 23, 2024
Written by Willy Frick A woman in her 70s is hospitalized with undifferentiated shock after being found down at home. Her family had not heard from her and called EMS. Paramedics found her bradycardic, hypotensive, and tachypneic. She was resuscitated and admitted to ICU for presumed sepsis. Several days into hospitalization, she continued to have occasional episodes of sinus rhythm and sinus bradycardia with periods of Mobitz I AV block and 2:1 block.
Sensible Medicine
DECEMBER 23, 2024
When you read the PLATO trial in the NEJM , nothing seems awry. It was a comparison of ticagrelor vs clopidogrel as the second antiplatelet drug (added to aspirin) in more than 18,000 patients who were having an acute coronary syndrome (most often an MI). The primary endpoint of CV death, MI or stroke occurred in 9.8% in the ticagrelor arm vs 11.7% of those on clopidogrel.
First 10 EM
DECEMBER 23, 2024
Another month, another set of articles. Perhaps some are useful. Perhaps some will guide your practice. At least one should completely blow your mind. More research was needed Taccone FS, Rynkowski Bittencourt C, Mller K, Lormans P, Quintana-Daz M, Caricato A, Cardoso Ferreira MA, Badenes R, Kurtz P, Sndergaard CB, Colpaert K, Petterson L, Quintard […] The post The December 2024 Research Roundup appeared first on First10EM.
Emergency Medicine Journal
DECEMBER 30, 2024
This month’s update is by the Aberdeen Royal Infirmary Emergency Department in Scotland. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper.
Emergency Medicine Cases
DECEMBER 23, 2024
Which elements of your current pre-shift preparation contribute most to your mental clarity and performance, and what new practices might further optimize your readiness? With interruptions shown to increase task errors and decision fatigue, how can you strike a balance between being approachable to colleagues and safeguarding your focus for patient care?
Dr. Smith's ECG Blog
DECEMBER 27, 2024
Submitted anonymously, written by Willy Frick A man in his 70s with a history of remote MI (details unavailable) and prior stent placement presented to cardiology clinic for routine follow up. He complained of days to weeks of palpitations and dyspnea. His clinic ECG is shown. What do you think? In an elderly patient complaining of palpitations, we have an ECG with heart rate 140 bpm.
Sensible Medicine
DECEMBER 25, 2024
Recently, at the American Society of Hematology and concurrently published in the New England Journal was a randomized controlled trial of treating smoldering myeloma. The investigators congratulated themselves and said there's a new standard of care. But the reality is the trial has fatal flaws, and reflects the failures of our field. Smoldering myeloma is an interesting disease.
EM Updates
DECEMBER 29, 2024
Depending on how you count, I’ve now been doing emergency medicine for 20 years. This is how I see patients. The protocol below does not apply to resuscitation patients. For resuscitation patients, see The First Five Minutes of Resuscitation. I apply this protocol to just about every patient. When you are systematic, you don’t miss stuff.
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