First 10 EM

APRIL 22, 2024

As mentioned in my most recent review, publication bias has been a major concern when trying to decide whether to prescribe paxlovid. Pfizer rushed to publish their positive study (EPIC-HR), but refused to release the results of a second simultaneous study (EPIC-SR) that was stopped (due to futility) at the exact same time. With the […] The post EPIC-SR: The negative paxlovid data Pfizer has been sitting on appeared first on First10EM.

EMS 137

EMS 137

Dr. Smith's ECG Blog

APRIL 22, 2024

A 50-something male with hypertension and 20- to 40-year smoking history presented with 1 week of stuttering chest pain that is worse with exertion, which takes many minutes to resolve after resting and never occurs at rest. It is a ssociated with mild dyspnea on exertion. At times the pain does go to his left neck. It was present on arrival at triage but then resolved before bed placement in the ED.

EKG/ECG 117

EKG/ECG Outcomes Ultrasounds Hospitals 117

Science Based Medicine

APRIL 22, 2024

No matter how implausible it is or how weak the evidence for it is, the myth that COVID vaccines cause "turbo cancer" just won't die. Quite the contrary, alas. Antivaxxers are—dare I say?—turbocharging it with bad science. The post COVID-19 vaccine-caused “turbo cancer” nonsense just keeps getting more turbocharged and nonsensical first appeared on Science-Based Medicine.

99

99

Emergency Medicine Journal

APRIL 22, 2024

Cannabinoid hyperemesis syndrome (CHS) is an episodic syndrome of cyclic vomiting in the context of the prolonged use of cannabis. The Royal College of Emergency Medicine Toxicology Special Interest Group has produced guidance to support emergency medicine clinicians with the recognition and treatment of people experiencing CHS. Considerations regarding recognition, investigation and communication are discussed, and recommendations regarding treatment options (which include haloperidol and capsa

Best Practices 98

Best Practices Emergency Department 98

Sensible Medicine

APRIL 22, 2024

I remember when Dr. Gervasio Lamas stunned the world of cardiology when he presented the results of the TACT 1 trial. I chose the verb stun because chelation was way outside the box that contains medical thinking. This was not a drug or a procedure. It is a way to remove heavy metals from the body. And it was practiced not by doctors, but alternative medicine practitioners.

Academics 83

Academics 83

Emergency Medicine Journal

APRIL 22, 2024

Objective We sought to validate the clinical performance of a rapid assessment pathway incorporating the Siemens Atellica IM high sensitivity cardiac troponin I (hs-cTnI) assay in patients presenting to the emergency department (ED) with suspected acute myocardial infarction (AMI). Methods This was a multicentre prospective observational study of adult ED patients presenting to five Australian hospitals between November 2020 and September 2021.

Emergency Department 98

Emergency Department Outcomes EKG/ECG Hospitals 98

Don't Forget the Bubbles

APRIL 22, 2024

You are called to the postnatal ward to review a 22-hour-old infant with feeding difficulties. On examination, two bluish, soft swellings are located medially to the inner canthus on both eyes. The infant is unsettled but has a mild fever. What do you do? What is dacryocystitis? Dacryocystitis is an inflammation of the lacrimal sac. This oval-shaped structure receives tear drainage from the eye and sits in a groove formed by the lacrimal bone and frontal process of the maxilla.

Infectious Diseases 84

Infectious Diseases Sepsis Pediatrics Operations 84

EMDocs

APRIL 22, 2024

Authors: Joseph R. Peters, (DO, RDMS, FACOEP, FACEP, FACOI); Carolina Hartje, DO // Reviewed by: Stephen Alerhand, MD; Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Introduction There are an estimated 300,000-600,000 Americans who develop venous thromboembolisms (VTE) each year, including deep venous thromboembolisms (DVT) and pulmonary embolism (PE). 1-3 VTE is responsible for hospitalizing over 250,000 Americans every year, and there are an estimated 100,000 deaths annually associat

Ultrasounds 82

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 82

Emergency Medicine Journal

APRIL 22, 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.

Research 97

Research 97

RebelEM

APRIL 22, 2024

Background: Hypoxemic respiratory failure is a frequent complicating feature of severe COVID-19 infection. Early in the pandemic, extensive efforts were made to identify the best approach to oxygenation in this group of patients. Best practices settled on aggressive use of non-invasive ventilation (NIV) and delaying invasive mechanical ventilation (IMV) where feasible.

Outcomes 75

Outcomes Best Practices EMS Shock 75

AED Leader

APRIL 22, 2024

You witness someone collapse from a sudden cardiac arrest. Every second counts in these critical situations. Immediate action is vital to increase their chances of survival. This is where Automated External Defibrillators (AEDs) come into play. Lifepak AED defibrillators are known for their advanced technology and life-saving capabilities, making them a leader in the AED market.

CPR 52

CPR Shock Resuscitation Operations 52

American Medical Compliance

APRIL 22, 2024

The following Utah Protective Orders in the Workplace Training for Healthcare Providers educates healthcare providers on workplace violence protective orders in Utah. Also, a Workplace Violence Protective Order can help to stop violence in the workplace. We ensure that through our course, your staff will be more knowledgeable of protective orders for healthcare providers in the state of Utah.

Outcomes 52

Outcomes 52

PulmCCM

APRIL 22, 2024

Patients with acute ST-elevation myocardial infarction with cardiogenic shock treated with the Impella CP flow pump for mechanical circulatory support had increased survival at 6 months compared to those receiving standard care, the DanGer Shock randomized trial showed.

Shock 52

Shock 52

Emergency Medicine Journal

APRIL 22, 2024

A short cut review of the literature was carried out to examine the evidence supporting antithrombotic treatment and/or endovascular therapy to reduce mortality and/or prevent future stroke following blunt cerebrovascular injury (BCVI). Five papers were identified as suitable for inclusion using the reported search strategy. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the best papers are tabulated.

Stroke 52

Stroke Outcomes 52

EMergucate

APRIL 22, 2024

20 year-year-old man brought to ED after a car accident. His blood pressure was 80/41 and he was unconscious. His blood gases showed the following: PH = 6.

52

52

Emergency Medicine Journal

APRIL 22, 2024

This month’s update comes from the Emergency Department at Northern General Hospital, Sheffield. 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 Department 52

Emergency Department Outcomes Hospitals 52

EMergucate

APRIL 22, 2024

The chest x-ray shows cardiomegaly & Oreo Cookie sign. The chest x-ray of this paediatric patient shows a massive cardiomegaly.

EMS 52

EMS 52

Emergency Medicine Journal

APRIL 22, 2024

Royal College of Emergency Medicine (RCEM) Best Practice Guidelines are produced by a variety of special interest groups or convened expert advisory groups which sit under the umbrella of the College’s Quality in Emergency Care Committee (QECC). 1 They are produced to bridge the gap between systematically derived evidence-based recommendations and the need for emergency clinicians to provide quality care and advice to patients, or to respond to evolving trends.

Best Practices 52

Best Practices 52

EMergucate

APRIL 22, 2024

The lumbar spine x-ray shows anterior compression fracture of L1 & fracture of spinous process of T12 vertebra.

Fractures 52

Fractures EMS 52

Emergency Medicine Journal

APRIL 22, 2024

Clinical introduction A healthy 16-year-old boy presented with a 3-day history of odynophagia. This occurred after a football struck his anterior chest and neck region. The odynophagia radiated to the retrosternal area. Dysphagia, dyspnoea and fever were not noted. His only abnormal vital sign was an RR of 24 beats per minute. His neck appeared normal, and his voice exhibited clarity and normal pitch without hoarseness or stridor.

Fractures 52

Fractures 52

EMergucate

APRIL 22, 2024

The chest x-ray shows pneumomediastinum.

EMS 52

EMS 52

Emergency Medicine Journal

APRIL 22, 2024

Intra-abdominal infections are the second most common source of severe sepsis and successful treatment relies on early intervention and appropriate resources. 1–3 The COVID-19 pandemic has disrupted the global healthcare system as evidenced by a national study in England showing reduced admissions and higher 90-day mortality for common acute surgical conditions. 4 5 We examined intra-abdominal infection-related mortality trends from 1999 to 2021, which encompasses the COVID-19 pandemic.

Sepsis 52

Sepsis 52

Emergency Medicine Journal

APRIL 22, 2024

High-sensitivity troponin (hsTn) is used with ECG and clinical evaluation to stratify patients attending ED as low risk for acute myocardial infarctions (AMI). Diagnostic pathways incorporate a single test threshold for stratification with these assays. The Siemens Atellica VTLi Point-Of-Care-hsTnI assay (POC-hsTnI) has an 8 min turn-around which may expedite decision-making.

EKG/ECG 52

EKG/ECG 52

Emergency Medicine Journal

APRIL 22, 2024

Reviewing and acting on diagnostic reports is a professional obligation. 1 This includes X-ray of the chest (CXR) reports which recommend follow-up imaging and only become available after the patient has been discharged. Emergency departments (EDs) are required to have safe systems in place to manage radiology reports. 2 It is not known how many repeat CXRs are indicated or if repeat CXRs yield clinically significant findings.

Radiology 52

Radiology Radiology Emergency Department Outcomes 52

Emergency Medicine Journal

APRIL 22, 2024

Background Management of acute kidney injury (AKI) in the ED can be difficult due to uncertainty regarding the aetiology. This study investigated the diagnostic value of venous system ultrasound for determining the aetiological subtypes of AKI in the ED. Methods This multidisciplinary prospective cohort study was conducted in a single academic ED over the course of a year.

Ultrasounds 52

Ultrasounds Academics 52

Emergency Medicine Journal

APRIL 22, 2024

Clinical introduction A 57-year-old man presented acutely with involuntary movements of his left hand. He had hypertension, chronic kidney disease and chronic obstructive pulmonary disease. These movements were best described as sudden, recurrent and arrhythmic loss of tone and power of the left wrist and fingers ( video 1 ). They were most prominent when extending the left wrist, but were absent when the arms were at rest and were not elsewhere.

52

52

Emergency Medicine Journal

APRIL 22, 2024

Background Tools to increase the turnaround speed and accuracy of imaging reports could positively influence ED logistics. The Caire ICH is an artificial intelligence (AI) software developed for ED physicians to recognise intracranial haemorrhages (ICHs) on non-contrast enhanced cranial CT scans to manage the clinical care of these patients in a timelier fashion.

Research 52

Research Outcomes 52

Emergency Medicine Journal

APRIL 22, 2024

In this edition of the Emergency Medicine Journal , Dr Cooper and her colleagues explore the facilitators and barriers to the effectiveness of different general practitioner service models in or alongside EDs (GP-ED). 1 The availability of these services in the UK expanded in response to a 2017 budget commitment of £100 million to enhance A&E services including the colocation of on-site GP services. 2 The authors observed that the demand for ED services is influenced by a range of indiv

Emergency Department 52

Emergency Department Urgent Care Hospitals 52

Emergency Medicine Journal

APRIL 22, 2024

Clinical introduction A previously healthy 46-year-old man experienced acute mid-calf pain while playing paddle tennis. He treated himself with non-steroidal anti-inflammatory drugs and local cold application, and took a rest. One week later, he consulted the ED due to persistent pain and swelling in the area. Examination revealed tenderness to palpation of the medial belly of the gastrocnemius muscle.

Ultrasounds 52

Ultrasounds 52

Emergency Medicine Journal

APRIL 22, 2024

Smoking cessation is currently topical with recent government announcements regarding restricting the sale of disposable vapes and a consultation on raising the legal age of buying tobacco from 18 years, so that anyone born after a certain year will never be able to buy cigarettes legally. This edition of the EMJ contains a randomised controlled multicentre trial of smoking cessation initiated in the emergency department (ED). 1 The intervention group received brief smoking cessation advice as w

Emergency Department 52

Emergency Department Wellness 52

Emergency Medicine Journal

APRIL 22, 2024

Since electronic cigarettes (e-cigarettes) first appeared in the tobacco product marketplace over a decade ago, they have been evaluated as another tool for promoting successful smoking cessation. The randomised controlled trial by Pope et al reported in this issue of the Emergency Medicine Journal, adds to a growing literature on the use of e-cigarettes as a smoking cessation intervention, providing evidence in a novel, pragmatic setting—emergency departments (EDs). 1 A 2024 Cochrane revi

Administration 52

Administration Emergency Department 52

Emergency Medicine Journal

APRIL 22, 2024

‘Free vapes given to smokers at hospitals could help thousands quit, study suggests.’ And ‘Calls for free vapes to be handed out in emergency departments.’ These were the headlines describing this month’s Editor’s Choice, the Cessation of Smoking Trial in the Emergency Department (COSTED), when it was published on-line in March.

Emergency Department 52

Emergency Department Hospitals 52

Emergency Medicine Journal

APRIL 22, 2024

In the ED, laboratory high-sensitivity cardiac troponin (hs-cTn) tests facilitate ‘rule-out’ of myocardial infarction (MI). 1 Contemporary point-of-care (POC) troponin tests have inferior analytical sensitivity, 2 preventing rapid ‘rule-out’ strategies in near-patient settings. The new Siemens Atellica VTLi POC test meets hs-cTn criteria. 3 Between June and September 2022, adult ED patients (≥16 years) with symptoms suspicious for MI and no ST-segment elevation on E

Emergency Department 52

Emergency Department EKG/ECG 52