Sensible Medicine
JULY 22, 2024
I call it therapeutic fashion. Practice patterns. Beliefs. Ways of doing things. Examples: patients with new heart failure get coronary angiography; patients with chest pain without evidence of heart attack get stress tests; certain drugs and devices become favored over generics. The curious thing about many therapeutic fashions is their lack of evidentiary support.
Don't Forget the Bubbles
JULY 22, 2024
Pre-school wheezers remain a poorly understood cohort of children despite seeing them every day in paediatric EDs. Unfortunately, the number of acute wheeze exacerbations coming through the doors is still rising , but are we equipped to manage these children? In the UK, national guidance advises giving oral prednisolone early when treating paediatric asthma attacks.
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St. Emlyn
JULY 22, 2024
St.Emlyn's - Emergency Medicine #FOAMed Background As I think I have mentioned before, I spend some of my time as a major trauma consultant on the major trauma ward (MTW). You may be shocked to […] The post JC: Evaluation of Lidocaine Patches for Elderly Patients with Rib Fractures: A Feasibility Study appeared first on St.Emlyn's.
Emergency Medicine Journal
JULY 22, 2024
Naloxone is a potent opioid receptor antagonist that reliably reverses life-threatening respiratory depression in opioid overdose but can precipitate severe withdrawal in opioid-dependent individuals. 1 Guidelines recommend naloxone specifically for respiratory depression and not for reduced level of consciousness alone, with lower doses recommended in patients who may be opioid-dependent. 2 3 The extent to which such guidelines are applied in practice has received little attention.
Northwestern EM Blog
JULY 22, 2024
Written by : Jilan Shimberg, MD (NUEM ‘26) Edited by : Michael Tandlich, MD (NUEM ‘24) Expert Commentary by : Matthew B Maas, MD MS Expert Commentary Posterior Reversible Encephalopathy Syndrome (PRES) is a potentially catastrophic but frequently overlooked diagnosis. It often coexists in a pathophysiological spectrum with Reversible Cerebral Vasoconstriction Syndrome (RCVS).
Emergency Medicine Journal
JULY 22, 2024
Background The outcomes of patients who call an ambulance but are discharged at scene reflect the safety and quality of emergency medical service (EMS) care. While previous studies have examined the outcomes of patients discharged at scene, none have specifically focused on paramedic-initiated discharge. This study aims to describe the outcomes of adult patients discharged at scene by paramedics and identify factors associated with 72-hour outcomes.
Taming the SRU
JULY 22, 2024
INDICATIONS Arthrocentesis is a common procedure performed in the Emergency Department, in which a needle is inserted into a joint to withdraw fluid from the joint capsule. This procedure may be performed for diagnostic and/or therapeutic purposes [1]. Diagnostic arthrocentesis is often performed to distinguish between septic arthritis and other common causes of acute monoarthritis including hemarthrosis, crystal arthropathies (gout, psedogout), and autoimmune arthropathies (SLE, RA, etc.) [2].
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Total Medical ComplianceHIPAA
JULY 22, 2024
Health and Human Services (HHS) has finalized disincentives for Information Blocking and healthcare providers. Here is a summary: The HHS rule impacts the Merit-based Incentive Payment System (MIPS) by penalizing clinicians who engage in information blocking. MIPS eligible clinicians found to be information blockers by the HHS Office of Inspector General will receive a zero score in the Promoting Interoperability performance category for the year in which the violation occurs.
PEMBlog
JULY 22, 2024
Bogus man! Kids can get kidney stones too. This alt-rock homage discusses imaging, pain control, and more. Lyrics Everyone knows that kidney stones cause so much pain colicky anguish radiation to the flank and symptoms all the same toradol is the first choice along with fluids if you’re a nice doc an ultrasound can show hydronephrosis if a stone’s blocked [chorus] kidney stones can happen in children think about the pain, the pee, the ultrasound if you feel me don’t forget to c
Emergency Medicine Journal
JULY 22, 2024
As the attending physician in the ED, I have already heard the case presentation from the resident. "Doctor," the patient says, "there’s something wrong with my blood." I notice the patient’s gestures, his hand movements. His filler words are ‘eh ’ and ‘esto ’ rather than ‘um’ or ‘well’, the melody of his speech not unlike the sounds of my own childhood.
Emergency Live
JULY 22, 2024
Women with Endometriosis have a higher risk of developing ovarian cancer, according to a study What is Endometriosis? Endometriosis is a chronic gynecological disease that affects women, most frequently of childbearing age. It is caused by the abnormal presence of endometrial cells (the tissue lining the inner wall of the uterus) in organs other than […] The post Endometriosis: new study reveals fourfold increased risk of ovarian cancer appeared first on Emergency Live.
Emergency Medicine Journal
JULY 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.
Board Bombs
JULY 22, 2024
PE workup? Sure. Oh by the way they're pregnant.yep. Let's discuss how this is workup needs to be simplified and not feared. Also, say goodbye to VQ scans. Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here. Cite this podcast as: Briggs, Blake; Husain, Iltifat. 230. PE and Pregnancy.
Emergency Medicine Journal
JULY 22, 2024
Introduction This month’s update comes from the Royal Melbourne Hospital ED in Victoria, Australia. 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 highlighted the main findings, key limitations and clinical bottom line for each paper.
Emergency Live
JULY 22, 2024
Trias i Pujol Hospital presents an innovative technique that is simpler and more effective than traditional surgeries Trias i Pujol German University Hospital in Barcelona takes a decisive step forward in the fight against atrial fibrillation, the world’s most common cardiac arrhythmia. For the first time in Catalonia, Can Ruti cardiologists have adopted an innovative […] The post Atrial fibrillation: Trias i Pujol presents a new technique with high-energy pulses appeared first on Em
Emergency Medicine Journal
JULY 22, 2024
Introduction Episodes of physical and verbal violence, as well as psychological humiliation, are experienced daily by ED staff. 1 These incidents are increasing exponentially and can cause workplace disaffection contributing to severe burnout of ED healthcare personnel. 1 2 Several studies have investigated aggression and violence in the ED, focusing on the characteristics of patients who assault healthcare personnel in the ED.
Science Based Medicine
JULY 22, 2024
Former President Donald Trump bragged in his acceptance speech at the Republican National Convention that "right-to-try" had saved "thousands of lives"? What's the real story? (Hint: Nowhere near that.) The post Donald Trump bragged that “right-to-try” has saved thousands of lives. It hasn’t. first appeared on Science-Based Medicine.
Emergency Medicine Journal
JULY 22, 2024
Previous UK nomenclature referred to emergency medicine as ‘accident and emergency’—often, in moments of frustration, it was said to have evolved to ‘anything and everything’ The concentration of multiple groups of patients, many acutely ill and distressed, some left with nowhere else to turn due to a failing system, in one place only serves to amplify frustrations.
Emergency Medicine Journal
JULY 22, 2024
Mass violence events, especially in healthcare settings, have devastating consequences and long-lasting effects on the victims and the community. The rate of violent events in Mexico, especially in hospital settings, has increased since 2006, but has become more evident in 2018. Guanajuato State, located in central Mexico, is among the states most affected by the wave of violence, especially active shooter events.
Emergency Medicine Journal
JULY 22, 2024
Background The optimal Early Warning System (EWS) scores for identifying patients at risk of clinical deterioration among those transported by ambulance services remain uncertain. This retrospective study compared the performance of 21 EWS scores to predict clinical deterioration using vital signs (VS) measured in the prehospital or emergency department (ED) setting.
Emergency Medicine Journal
JULY 22, 2024
Background and objectives The ability to rule appendicitis in or out using ultrasound is limited by studies where the appendix is not visualised. We determined whether the absence of indirect ultrasound signs can rule out appendicitis in children undergoing a radiology-performed ultrasound in which the appendix is not visualised Methods This was a single-centre retrospective observational study of patients aged 3–13 with a clinical suspicion of acute appendicitis evaluated in a Paediatric
Emergency Medicine Journal
JULY 22, 2024
Background Paediatric laceration repair procedures are common in the ED; however, post-discharge recovery remains understudied. Perioperative research demonstrates that children exhibit maladaptive behavioural changes following stressful and painful medical procedures. This study examined post-discharge recovery following paediatric laceration repair in the ED.
Emergency Medicine Journal
JULY 22, 2024
Emergency care for children has evolved over the past 50 years, focusing on optimising their evaluation and treatment in EDs. Research focusing on the unique needs of children and their families has improved patient outcomes in the ED, outpatient and inpatient settings. In the ED setting, research on improving sedation and procedural care for paediatric patients has emphasised medication efficacy and safety, standardised protocols, incorporating non-pharmacological interventions and reducing acu
Emergency Medicine Journal
JULY 22, 2024
Welcome to the August 2024 issue of Emergency Medicine Journal. August is a time of new beginnings with newly qualified doctors and those promoted to postgraduate specialty training schemes commencing work in our emergency departments (EDs). Welcome to our new valued colleagues! Don’t forget the EMJ Podcast—a fantastic source of digestible evidence base updates.
Emergency Medicine Journal
JULY 22, 2024
Urgent action is needed on the prehospital administration of tranexamic acid for trauma victims. This is the only conclusion that can be reached after reading the shocking results from Girardello et al. 1 It is unacceptable to withhold a lifesaving treatment. It is unacceptable to treat someone differently based on their sex or age when their potential to benefit from the treatment is the same regardless.
Emergency Medicine Journal
JULY 22, 2024
Background Tranexamic acid (TXA) decreases mortality in injured patients and should be administered as soon as possible. Despite international guidelines recommending TXA in the prehospital setting, its use remains low. The aim of this study was to assess the prehospital administration of TXA for injured patients in a Swiss region. Methods We conducted a retrospective observational study in Switzerland between 2018 and 2021.
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