Mon.Sep 23, 2024

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Acute artery occlusion -- which one?

Dr. Smith's ECG Blog

Written by Willy Frick with edits by Ken Grauer A woman in her 70s with a history of hypertension presented with acute onset shortness of breath. She was out walking her dog when she developed sudden dizziness and light-headedness. When EMS found her, she was dyspneic and diaphoretic. Her ECG is shown below: What do you think? The conventional machine algorithm interpreted this ECG as STEMI.

EKG/ECG 118
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EMCrit 384 – The Vascular Guy on Vascular Access

EMCrit

All things Vascular Access with the Vascular Guy EMCrit Project by Scott Weingart, MD FCCM.

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When Trials Are Stopped Early for Benefit.

Sensible Medicine

We often forget this but clinical trials are experiments on humans. To minimize risks to participants, trials have independent oversight boards that make recommendations on stopping trials early. A typical example is when one group in the trial shows obviously better results. The group of experts judge whether it would be ethical to continue the trial—because if the effect is so much better in one arm of the trial, the other arm is getting inferior care.

Stroke 95
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NONSUSTAINED VT

ECG Guru

Extract from a Holter ECG, 2 continuous strips, recorded at 25 mm/s. At the top you can see a broad complex tachycardia without recognizable P waves, which ends spontaneously after 2 beats in the lower section. This is a VT. The very first beat in the 1st strip is most probably a fusion beat. After the end of the VT in the 2nd strip, a narrow QRS complex appears, here you can also recognize that atrial fibrillation is present.

EKG/ECG 90
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Smoking cessation in the emergency department (The COSTED trial)

First 10 EM

If I am honest, on most of my shifts, other substances seem to be far more destructive than nicotine. I spend a lot of time talking to patients about suboxone, or dealing with the consequences of alcohol. I definitely talk to people about smoking, but aside from brief counseling and occasionally prescribing nicotine replacement for […] The post Smoking cessation in the emergency department (The COSTED trial) appeared first on First10EM.

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Managing Stress for Caregivers in Assisted Living

American Medical Compliance

Caregiving is an inherently demanding profession, especially within assisted living facilities, where caregivers must balance the dual responsibilities of delivering high-quality care and managing their own emotional and physical well-being. The Alzheimer’s Association’s 2024 Alzheimer’s Disease Facts and Figures report highlights that 70% of dementia caregivers find coordinating care to be a significant source of stress.

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Clinical Conundrums: Should Ketamine be Preferred Over Etomidate in RSI?

RebelEM

Bottom Line Up Top: Based on the available evidence, we should strongly consider ketamine over etomidate as our default induction agent in critically ill patients. Clinical Scenario: A 48 year old man presents with fever, hypotension, hypoperfusion and hypoxemia. Workup reveals multifocal pneumonia and oxygenation only marginally improves with non-invasive ventilation.

EMS 74

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PEMPix 2024 Online Case #1: Mission: SPACE

PEMBlog

PEMPix is the American Academy of Pediatrics Section on Emergency Medicine’s annual visual diagnosis competition. This year, in addition to the 10 finalists Maneesha Agarwal will be presenting at the National Conference and Exhibition we will be sharing four cases online in advance of the conference. This is the first of the four cases. This case was submitted by Dr.

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Key moments to recognize when not to use a defibrillator safely

AED Leader

Curious about when using a defibrillator might backfire? Indeed, this life-preserving tool is mighty. However, discerning when to refrain from use is equally essential. Aware that AEDs (those life-reserving zap machines) could exacerbate harm in specific situations? Indeed, that’s accurate. Today, we’re exploring the subject of “When Not To Use A Defibrillator.” We’ll examine those pivotal moments when holding back is wiser than intervening.

Shock 52
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From diabetes to Parkinson’s: a revolutionary discovery

Emergency Live

Researchers have discovered a type 2 diabetes drug can slow progression of Parkinson’s symptoms Parkinson’s disease, a neurodegenerative disorder affecting millions of people worldwide, has always been a challenge for medical research. However, a recent study published in the New England Journal of Medicine has opened up promising new prospects for treating this disease.

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Medical Music Mondays: HSP

PEMBlog

What if the Fab Four from Liverpool sang about Henoch-Schönlein purpura – AKA IgA vasculitis. Wouldn’t that be neat? Probably not. Anyway. Listen to this song, it’s fun. Lyrics H-S-P Palpable purpura and swelling of the knee protein in the pee hypertension is a thing that you might see If the urine and B-P are okay You can send them home to be seen on another day[chorus] H-S-P I-G-A vasculitis of the kidney know the rash, catch some pee, get a BP Lyrics [Verse] HSP Palpable pur

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Winter in sight: Prepare for a wave of respiratory viruses

Emergency Live

Flu viruses and COVID-19 are preparing to visit us, putting our immune system to the test The arrival of autumn brings not only a pleasant change of season, but also an increased risk of contracting respiratory infections. Flu viruses, COVID-19 and other pathogens are preparing to visit us, putting our immune system to the test. […] The post Winter in sight: Prepare for a wave of respiratory viruses appeared first on Emergency Live.

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The Latest In Critical Care, 9/23/24 (#57)

PulmCCM

Links: Ekström M et al; REDOX Collaborative Research Group. Long-Term Oxygen Therapy for 24 or 15 Hours per Day in Severe Hypoxemia. N Engl J Med. 2024 Sep 19;391(11):977-988. doi: 10.1056/NEJMoa2402638. Epub 2024 Sep 10. PMID: 39254466. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Nocturnal Oxygen Therapy Trial Group.

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The return of cholera: a global threat

Emergency Live

Recent WHO data show an alarming increase in cholera cases and deaths, especially in Africa Cholera, an acute infectious disease caused by the bacterium Vibrio cholerae, is returning to many parts of the world. This epidemic, which appeared to have been eradicated in many regions, poses a serious threat to global public health. The latest […] The post The return of cholera: a global threat appeared first on Emergency Live.

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Caring for children after a kidney transplant

Don't Forget the Bubbles

You are working in the paediatric emergency department of a busy District General Hospital. The triage nurse wants you to see the next patient, a young person who has had a kidney transplant. How does your differential diagnosis change? What about your diagnostic workup? Do you need to consult Paediatric Nephrology, and if so, do you need to call them overnight?