Mind The Bleep

FEBRUARY 2, 2025

This is a tricky area to cover as it can be challenging to us both personally and professionally when things dont go well with a colleague, particularly when we know that this might impact patient care and/or our own mental health. A simple sentence like This interaction hasnt gone well. Can I just check if everything is ok with you?

Documentation/Coding 98

Documentation/Coding Outcomes Burns Wellness 98

RebelEM

JUNE 7, 2023

Moderate Patients The vast majority of patients will present with a concerning history but clinically may look relatively well. In that population, it is essential to recognize that the absence of oropharyngeal lesions/burns cannot exclude the presence of gastrointestinal injury internally. References Hoffman RS, Burns MM, Gosselin S.

Poisoning 97

Poisoning Burns Resuscitation Pediatrics 97

Don't Forget the Bubbles

OCTOBER 7, 2024

Up to 5% of burns occur secondary to electrical injuries, and this rises to 27% in developing countries. Significant injuries can occur even in the absence of extensive burns or other signs of external injury. Children, especially toddlers, may insert objects into outlets, leading to shocks or burns.

Burns 80

Burns Fluid Resuscitation Shock Resuscitation 80

American Medical Compliance

AUGUST 14, 2024

This training not only raises awareness but also empowers dental teams to take action, ensuring that they can contribute to the safety and well-being of their patients. ” This broad definition underscores the variety of ways in which a child’s well-being can be compromised.

Burns 105

Burns Documentation/Coding Wellness 105

Sensible Medicine

DECEMBER 18, 2023

That is my conclusion as well, and I favor large, pragmatic randomized trials in adults and kids with staggered starting times (adults first — to protect kids from harms we may not yet know). If the AAP continues in this direction, they will burn through any remaining credibility. Better food? An exercise coach?

Pediatrics 145

Pediatrics Documentation/Coding Burns Academics 145

Dr. Smith's ECG Blog

JANUARY 5, 2024

Written by Willy Frick A 46 year old man with a history of type 2 diabetes mellitus presented to urgent care with complaint of "chest burning." Smith comment: No patient over 25 years of age with unexplained chest burning should be discharged without a troponin rule out, no matter how normal the ECG. The following ECG was obtained.

EKG/ECG 121

EKG/ECG Burns Urgent Care Documentation/Coding 121

Ken Grauer, MD

JULY 22, 2023

The ECG in Figure-1 was obtained from an elderly man with a history of coronary disease — who contacted EMS for "burning" chest discomfort that woke him at 3am. Not only is this slight ST elevation missing from leads V2,V3 in ECG #1 — but the ST segment in these leads ( as well as in neighboring leads V1; and V4,V5 ) is distinctly flat!

EKG/ECG 195

EKG/ECG Burns EMS Wellness 195

Pediatric EM Morsels

AUGUST 11, 2023

Having authored 575 ( well, now 576 ) of them, I am often quite convinced that there are no new topics to discuss. This is the 601st Ped EM Morsel ! Then July happens and we get 14 more amazing interns who help educate me and remind me that there is always more to learn.

Burns 130

Burns Pediatrics EMS Outcomes 130

Northwestern EM Blog

MAY 2, 2022

There is lower quality evidence for reduced myocardial infarction and mortality risk as well. In fact, HBOT is primarily used to reduce associated cognitive, behavioral, and neurologic changes (collectively known as delayed neuropsychiatric sequelae). However, several factors limit HBOT use.

Burns 52

Burns Poisoning EKG/ECG Operations 52

Taming the SRU

SEPTEMBER 15, 2023

Limited availability of radiology-performed US services in certain hospitals, especially overnight Can avoid unnecessary anticoagulation in patients Reduce time in ED to disposition In terms of workflow, when there is suspicion for a DVT, you need to first calculate a Wells’ Score for a DVT If low/moderate risk, can start with a D-dimer prior to committing (..)

CPR 90

CPR Burns Airway Management Wellness 90

American Medical Compliance

APRIL 15, 2024

Child abuse and neglect are unfortunately pervasive issues that can have long-lasting impacts on a child’s health and well-being. Therefore, this serious form of abuse can have profound and lasting effects on a child’s emotional and physical well-being.

Burns 95

Burns Wellness Outcomes 95

Ultrasound Gel

SEPTEMBER 28, 2022

Well listen in to the discussion of this interesting randomized controlled trial designed to answer this burning question. Well listen in to the discussion of this interesting randomized controlled trial designed to answer this burning question. Should we be using POCUS to guide nasogastric tube placement?

Burns 52

Burns Wellness 52

Dr. Smith's ECG Blog

AUGUST 18, 2024

He did well. Burns and Buttner — LITFL ( Life-In-The-Fast-Lane ) — in the June 4, 2021 and July 7, 2022 posts. The QRS shows LVH and there are diffuse ST-T abnormalities likely in part appropriate for the LVH, though memory T waves are also a consideration. Smith: this can usually be seen on chest x-ray.

EKG/ECG 110

EKG/ECG Fractures Burns Wellness 110

Taming the SRU

FEBRUARY 7, 2024

Vaughan SJS/TEN and DRESS are life-threatening drug reactions that require immediate discontinuation of the drug and specialist involvement In SJS/TEN, if >10% skin involvement or worsening symptoms, transfer the patient to a Burn Center DRESS has characteristic multi organ involvement, so a high level of suspicion for complications should be maintained (..)

Administration 98

Administration PPE Ultrasounds Poisoning 98

Don't Forget the Bubbles

SEPTEMBER 11, 2024

I have been a doctor for half of my life, and my journey to burnout has been a 25-year slow burn that began the day I graduated. Focusing on the job in front of them became harder, and this sense of depletion lasted well beyond leaving the office. But after every great burn, there is a space for growth. That I was not fine.

Burns 88

Burns Hospitals Emergency Department Wellness 88

ACEP Now

MARCH 14, 2024

Per EMS, the patient was found at the bottom of a high voltage line with diffuse burns and amputation of his left forearm. FIGURE 1: Electrical burns of the patient’s bilateral feet. FIGURE 2: Traumatic amputation and electrical burn of the patient’s left arm. He was intubated by EMS due to the extent of his injuries.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

EMDocs

DECEMBER 4, 2023

The Wells’ Criteria for DVT can help risk stratify [2,3]. If the patient’s Wells score is ≤ 0, DVT is nearly clinically excluded and no further immediate lab or ultrasound is necessary. In patients with a Wells’ score of 1-2 (moderate risk), DVT can be ruled out with a negative d-dimer rather than an US.

Ultrasounds 96

Ultrasounds Documentation/Coding Wellness EMS 96

RebelEM

JULY 20, 2023

EMS radios in for a burn patient and to anticipate a difficult airway. The patient is horribly burned. She was smoking with her home O2 on and has severe mixed partial and full thickness burns to the chest, neck, face, and airway. INTRODUCTION You’re moonlighting in a remote access hospital. They’re rolling up now.

EMS 75

EMS Burns Airway Management Wellness 75

Medagadget

OCTOBER 31, 2023

This brings us to the burning question: does it work? It works pretty well, especially with the up-to-40X digital amplification. But what’s more critical is the ability to visualize and analyze data in real-time, as well as the options to record, save data, and share data. In short, yes.

EKG/ECG 90

EKG/ECG Burns Wellness Telemedicine 90

Taming the SRU

JUNE 24, 2024

Conduction Abnormalities AV blocks, which can also be seen in patients with MI, may require pacing as well, due to ischemia affecting the electrical pathways of the heart. Skin burns and irritation can also result from the pacing pads and cause pain. Sedation can be adequately achieved with benzodiazepines.

Advances Cardiac Life Support (ACLS) 90

Advances Cardiac Life Support (ACLS) CPR Burns Resuscitation 90

The Skeptics' Guide to EM

OCTOBER 31, 2020

She is the host of EM Bootcamp in Las Vegas, as well as a usual speaker and faculty member for The Center for Continuing Medical Education (CCME). She is the host of EM Bootcamp in Las Vegas, as well as a usual speaker and faculty member for The Center for Continuing Medical Education ( CCME ).

Burns 52

Burns Emergency Department EMS Wellness 52

Taming the SRU

NOVEMBER 4, 2023

D Thompson and Goel C-spine Imaging: NEXUS is a large, well-done study validating criteria for low-risk of cervical injury that are easy to remember and use at the bedside, and is used in our clinical decision guidelines on AgileMD. Eschars can form quickly and cause limited expansion of the torso and compartment syndrome of the extremities.

Hyperthermia / Hypothermia 84

Hyperthermia / Hypothermia Resuscitation Burns Emergency Department 84

Taming the SRU

AUGUST 27, 2024

This differential is broad and reflects the clinical diversity of their presentations - in this post we will parse through the specifics of bullous lesions as well as what there is to do for them acutely.

Emergency Department 83

Emergency Department Dehydration Burns Sepsis 83

Taming the SRU

JANUARY 1, 2024

However, in at least 10% of patients, blind insertion of a peripheral IV may be unsuccessful for a variety of reasons including obesity, edema, IV drug use, surgical scars, dialysis, burns, and others (1,2). In this post, we will review multiple alternative sites and techniques available for establishing peripheral access.

Emergency Department 92

Emergency Department Ultrasounds Administration Burns 92

RebelEM

APRIL 29, 2024

CVC vs PIV The critically ill patient is often associated with pathology that makes IV access difficult such as shock state, hypovolemia, obesity, IV drug abuse, end-stage renal disease, cardiac arrest, as well as other conditions. Studies have compared IO to peripheral intravenous (PIV) and central venous (CVC) access for resuscitation.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Don't Forget the Bubbles

MARCH 31, 2025

Some special patients (burns and trauma) were not described in the study. Infants who died while in a neonatal care unit were excluded (these have a well-defined process of review using the Post Mortem Review Tool, PMRT). Lack of fluid monitoring throughout the PICU stay led to underreporting of MODS resulting from late-onset FO.

Sepsis 59

Sepsis Fluid Resuscitation Shock Resuscitation 59

American Medical Compliance

JUNE 4, 2024

It is not merely a physical response but involves emotional and psychological aspects as well. Pain can be sharp, dull, throbbing, or burning. Characterized by a shooting or burning sensation, neuropathic pain often follows a nerve pathway and can be continuous or intermittent. O stands for onset, meaning when the pain started.

Burns 52

Burns Outcomes Wellness 52

ALiEM

OCTOBER 11, 2023

Pufferfish, also known as fugu, is served as a delicacy and perioral numbness is a well-known effect [4]. Shebl E, Mirabile VS, Sankari A, Burns B. It is thought that the “spread” of toxicity from pufferfish across the world may be secondary to increasing global water temperatures [8]. How CK, Chern CH, Huang YC, Wang LM, Lee CH.

Poisoning 81

Poisoning Burns Wellness Outcomes 81

ACEP Now

AUGUST 15, 2023

While there has been ample discussion of “the practice of mindfulness” in health care workers that improves mental well-being, when do we have this time? However, expressing genuine gratitude for yourself and others is powerful for your mental and physical well-being. However, they should not define our wellness. Acta Clin Belg.

Emergency Department 90

Emergency Department Military Resuscitation Wellness 90

RebelEM

AUGUST 7, 2023

This helps relieve agitation/pain while maintaining spontaneous breathing and airway reflexes allowing for adequate pre-oxygenation as well as facilitates other resuscitation interventions including IV access, vasopressors, fluids, etc. that would not be possible in an agitated/combative patient.

Head Injuries 98

Head Injuries Airway Management Outcomes Burns 98

Pediatric Emergency Playbook

DECEMBER 1, 2015

Victims of electrical injuries present either in extremis or as the seeming well patient with insidious, developing disease. Most patients do well, and the burn heals by secondary intention. Most patients do well, and the burn heals by secondary intention. Injury from electrical burns can be subtle.

Burns 40

Burns Emergency Department EKG/ECG Shock 40

ALiEM

FEBRUARY 9, 2024

Pulses are well felt in all four limbs. She would be low risk by gestalt or structured scoring systems (Wells or revised Geneva), and a negative D-dimer would essentially rule out pulmonary embolism here. The discomfort has a burning character, though he has never been diagnosed with reflux before. It started 2 hours ago.

EKG/ECG 110

EKG/ECG Emergency Department Burns Wellness 110

ACEP Now

OCTOBER 10, 2024

On physical exam, you notice what appears to be a blister from a burn on her right palm (see photo on cover). When you are done, you tell the mother what you found and ask her if there is any way the child could have been burned. The child should be undressed, and the exam conducted in a well-lit room.

Forensics 40

Forensics Domestic Violence Burns Pediatrics 40

EB Medicine

NOVEMBER 1, 2018

Nachi: Each year, in the US, approximately 10,000 patients present with electrical burns or shocks. You’re probably familiar with this concept when you see high voltages arcing through the air without direct contact with the actual electrical source, leading to diffuse burns. Most electrical injuries present with burns to the skin.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

Taming the SRU

AUGUST 4, 2024

We discussed some practices to push learners outside of their comfort zone and promote learning, based on their level as well as their goals for the shift.

Dislocations 85

Dislocations Emergency Department Documentation/Coding Burns 85

ACEP Now

APRIL 2, 2024

degress Fahrenheit), caustics (low pH), and voltage—causing a Ca++ and Na+ action potential influx that confers the sensation of pain and burning to the brain. They are found in large numbers in the mouth, throat, and stomach, as well as throughout the body. Referral for ophthalmology for patients with signs of corneal damage.

Burns 40

Burns Poisoning Seizures Stroke 40

EMDocs

NOVEMBER 27, 2023

Burn center transfer for management of severe exfoliative dermatitis Predictive factors for serious cases have yet to be identified, however allopurinol associated DRESS has a higher associated progression to serious DRESS and death rate. and/or N-acetylcysteine (NAC).

EMS 96

EMS Sepsis Burns EKG/ECG 96