RebelEM

FEBRUARY 19, 2024

Background: Use of vasopressors is a common practice to support hemodynamics and optimization of tissue perfusion in patients presenting with shock. Historically the administration of vasopressors was restricted to central venous catheters (CVC) due to concerns for local tissue injury resulting from vasoconstriction if extravasation occurred from a peripheral IV.

Administration 137

Administration Sepsis EMS Shock 137

First 10 EM

FEBRUARY 19, 2024

Nail bed injuries aren’t quite common enough to cause the same debates as TXA, or IV antibiotics, or tPa, but talk to 10 different emergency doctors and you are likely to get 10 different opinions about the management of these injuries. Therefore, even though the NINJA study doesn’t answer the most important question (in my […] The post The NINJA trial: Do you replace the fingernail after nail bed repair?

EMS 115

EMS 115

Science Based Medicine

FEBRUARY 19, 2024

Over the weekend, NBC News aired a story on whole body MRI scans. Although it did include the usual cautions about false positives and the harm they cause, the caution was diluted by the story's focus a rare case of a woman who had a brain tumor detected. Overall, it was false balance that reminded me of vaccine/autism stories 20 years ago. The post False balance in an NBC news story on whole body MRI scans first appeared on Science-Based Medicine.

79

79

Taming the SRU

FEBRUARY 19, 2024

Blood pressure monitoring is an important but frequently misunderstood cornerstone of emergency medicine. There are many opinions swirling around the complexities of accuracy, logistics, and practice patterns regarding invasive arterial blood pressure (IABP) monitoring and noninvasive blood pressure (NIBP) or cuff measurements. This post will not cover how to insert arterial lines ( see this prior Taming the SRU post by Dr Baez ) , instead we will cover the utility, mechanics, and pitfalls of IA

Shock 59

Shock Resuscitation Ultrasounds Research 59

Science Based Medicine

FEBRUARY 19, 2024

This is going to be a mostly reference free blog entry. Mostly a rambling opinion about my biases and opinions about science. And you know what they say about opinions. I seem to fret an inordinate amount about adjectives. So often they do not belong in front the nouns found here at the blog. I remain a touch annoyed at the need […] The post More Unneeded Adjectives first appeared on Science-Based Medicine.

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66

Don't Forget the Bubbles

FEBRUARY 19, 2024

In a world where gaming addiction is on the rise, and at the same time, we see the benefits of gaming and grassroots Esports, you can see how confusing and contradictory the different narratives are around gaming. Despite becoming more mainstream in the last decade, there is plenty of misunderstanding from parents and professionals if they don’t play, and a lack of understanding from many young people who do.

Academics 59

Academics Leadership Research Teamwork 59

Maria Yang, MD

FEBRUARY 19, 2024

Although “mental endurance” is more wordy than “grit”, I prefer the extra syllables. “Grit” sounds difficult and uncomfortable: Jaws clenched, the jagged surfaces of molars grinding together, or granules of sand scratching the surface of your eyeball. “Grit” also suggests firmness and unyielding. It doesn’t matter what the conditions are: I will not change my strategy or tactics.

Fractures 52

Fractures 52

PulmCCM

FEBRUARY 19, 2024

Let Families Activate Rapid Response Teams, Says SCCM The Society of Critical Care Medicine (SCCM) issued a new guideline on how hospitals and care teams should respond to emergencies outside the ICU or ED (i.e., on the medical and surgical wards). Read it here. Most of the advice is uncontroversial (e.g., collect timely and accurate vital signs, train team members on how to recognize deteriorating patients, etc).

Hospitals 52

Hospitals Resuscitation Burns Documentation/Coding 52

EMergucate

FEBRUARY 19, 2024

There is right chest wall subcutaneous emphysema.

Fractures 52

Fractures EMS 52

Sensible Medicine

FEBRUARY 19, 2024

William Withering first used digitalis in 1798. Wikipedia describes it as the beginning of modern therapeutics. FDA approved digoxin for use in 1998. Since then there has been controversy over its use. The only time I’ve ever been a protagonist in a debate, has been my defense of digoxin as a useful drug. Subscribe now In recent years, a large number of observational studies have been published—most of which associate dig use with increased death rates.

Hospitals 97

Hospitals Wellness EKG/ECG 97

EMergucate

FEBRUARY 19, 2024

There is a cavity in the left hilum.

EMS 52

EMS 52