Tue.May 28, 2024

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More On MRI And External Fixators

The Trauma Pro

I’ve covered the problem of performing MRI on patients with external fixators. This is typically a problem that arises in head-injured patients with extremity or pelvic fixators for concomitant fractures. MRI is an indispensable tool for the evaluation of head, spine, and soft tissue trauma. However, a great deal of effort is required to ensure that any patient scheduled for this test is “MRI compatible.

Fractures 217
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Universal Depression Screening Leads to Unnecessary Harm

Sensible Medicine

Regardless of the reason for a primary care visit in the United States, patients are routinely asked how often they feel “hopeless” or "like a failure” These questions come from the PHQ-9. The PHQ-9 has since been validated and is now widely used to screen for depression. Since the United States Preventive Services Task Force (USPSTF) first recommended depression screening 22 years ago, the practice has become standard in primary care despite an absence of evidence.

Outcomes 140
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Ep 195 Management of Subarachnoid Hemorrhage

Emergency Medicine Cases

Once the diagnosis of nontraumatic subarachnoid hemorrhage (SAH) has been made, our job is not done. Mortality in SAH patients can be up to 30% even without neurological deficit. Paying attention to the time-sensitive details of ED management of SAH patients can have a significant impact on their outcome. In this second part of our 2-part podcast series on subarachnoid hemorrhage with Dr.

Outcomes 122
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Eye injury preventing the eye from opening or closing

Emergency Medicine Journal

Clinical introduction An octogenarian presented to the hospital post-fall from a bed, sustaining left facial and chest bruises without consciousness loss. He had diabetes, hypertension, stroke and atrial fibrillation, and was on aspirin 100 mg and edoxaban 30 mg daily. Vital signs were stable. Examination showed left periorbital swelling and anterior thoracic bruising.

Stroke 98
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emDOCs Podcast – Episode 101: Acute Chest Syndrome Part 2

EMDocs

Today on the emDOCs cast with Brit Long, MD ( @long_brit) , we cover part 2 of acute chest syndrome. Episode 101: Acute Chest Syndrome Part 2 Background SCD is an autosomal recessive condition that results in the formation of hemoglobin S (HbS). HbS has reduced solubility in the setting of hypoxia, leading to sickling of the RBCs. Other causes of sickling: acidosis, dehydration, inflammation, infection, fever, and blood stasis.

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WTBS 30 Lessons on Emergency Medicine Leadership: The Role of The Leader

Emergency Medicine Cases

Dr. Howard Ovens reflects on the role of leader in the EM in this 2nd part of a 2-part Waiting to Be Seen blog series on EM leadership. He touches on mentoring, being committed, aligning with patients' interests, being a role model and a few quick takes on some controversial issues in EM. The post WTBS 30 Lessons on Emergency Medicine Leadership: The Role of The Leader appeared first on Emergency Medicine Cases.

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Connect with healthcare experience leaders and innovators at HUB24

NRC Health

Check out the breakout sessions and poster presentation details for NRC Health's 30th annual conference, Human Understanding Beyond | HUB24. Get the details and register today! The post Connect with healthcare experience leaders and innovators at HUB24 appeared first on NRC Health.

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HiQuiPs: Design Thinking in Quality Improvement

Canadian EM

Is your team about to embark on a new Quality Improvement (QI) project that involves patients but you’re not sure how to structure it? Are you looking for a meaningful and empathetic approach that champions the user perspective from start to finish and complements traditional QI methods? Design thinking has been gaining attention across a wide range of industries over the past several years, building a strong reputation for its emphasis on forging.

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How to Properly Dispose of AED Batteries: A Step-by-Step Guide

AED Leader

AED (Automated External Defibrillator) batteries play a crucial role in ensuring the proper functioning of these life-saving devices. However, like any other battery, AED batteries have a limited lifespan and must be replaced periodically. But what should you do with the old batteries? This comprehensive guide will walk you through the step-by-step process of properly disposing of AED batteries.

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Opioid Addiction Training for Dental Healthcare Professionals

American Medical Compliance

The Opioid Addiction Training for Dental Healthcare Professionals educates dental healthcare professionals (DHCP) on the issue of opioid addiction. Opioid addiction is a pressing public health crisis, and dental healthcare professionals are at the forefront of this battle. Dentists and oral surgeons frequently prescribe opioids for pain management, particularly after surgical procedures.

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The Importance of AED Defibrillator Portable Machines in Emergency Situations

AED Leader

In emergencies, every second counts. When someone experiences sudden cardiac arrest, immediate intervention is crucial to increase their chances of survival. This is where AED (Automated External Defibrillator) defibrillator portable machines play a vital role. These life-saving devices are designed to deliver an electric shock to the heart, restoring its normal rhythm and potentially saving a person’s life.

Shock 52
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Ep 195 ED Management of Spontaneous Subarachnoid Hemorrhage

Emergency Medicine Cases

Once the diagnosis of nontraumatic subarachnoid hemorrhage (SAH) has been made, our job is not done. Mortality in SAH patients can be up to 30% even without neurological deficit. Paying attention to the time-sensitive details of ED management of SAH patients can have a significant impact on their outcome. In this second part of our 2-part podcast series on subarachnoid hemorrhage with Dr.

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Abstracts from international emergency medicine journals

Emergency Medicine Journal

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.

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Persistent Pulmonary Hypertension of the Newborn

Don't Forget the Bubbles

Having been the neonatal SHO for a few weeks now, you feel in your element, grunting baby reviews? Done! Screened baby for infections? Also done, deliveries? You have lost track of how many you have attended. So, when you get the call to attend a forceps delivery due to prolonged labour and meconium-stained liquor, you walk into the labour ward with a smile, ready to go.

Sepsis 52
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Journal update monthly top five

Emergency Medicine Journal

This month’s update is by the Royal Bolton Hospital. 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. The papers are ranked as: Worth a peek—interesting, but not yet ready for prime time.

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Imaging Case of the Week 594

EMergucate

The lateral neck x-ray is from a patient with dysphagia. What can be seen? Answer will be posted later.

EMS 52
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SONO case series: point-of-care ultrasound for intubation confirmation

Emergency Medicine Journal

Case presentation A woman in her 60s with a medical history of chronic obstructive pulmonary disease, obstructive sleep apnoea and diabetes mellitus presents for 1 week of worsening shortness of breath and fever despite increasing usage of her home nebulisers. The patient describes daily fever, increased cough and mild achy chest pain. She denies abdominal pain, nausea, vomiting, orthopnoea, leg swelling or other symptoms on review of systems.

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ECG of the Week 29th May

EMergucate

The following ECG is from a 64-year-old man who presents with severe abdominal pain.

EKG/ECG 52
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Newborn with abdominal distention

Emergency Medicine Journal

Clinical introduction An 18-day-old male patient presented to the ED with a 2-day history of abdominal distension and blood in the faeces. The patient was born at 34 weeks. Meconium was passed within the first 24 hours. On physical examination, vital signs were normal. There was marked abdominal distention with dilated veins on the abdominal wall and bowel sounds quieter than usual.

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ECG Blog #431 — My New ECG-Rhythm Podcasts!

Ken Grauer, MD

I recently recorded a series of 4 podcasts regarding KEY concepts in ECG interpretation. Easy LINKS — tinyurl.com/KG-ECG-Podcasts — [link] — Other ECG Audio PEARLS I previously made for my ECG Blog can be found in the right column of each page on this blog just below this icon — under, "ECG Audio PEARLS". My New E CG P odcasts ( 5/28/2024 ): These podcasts are part of the Mayo Clinic Cardiovascular CME Podcasts Series ( "Making Waves" ) — hosted by Dr.

EKG/ECG 313
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Optimal timing for the Modified Early Warning Score for prediction of short-term critical illness in the acute care chain: a prospective observational study

Emergency Medicine Journal

Introduction The Modified Early Warning Score (MEWS) is an effective tool to identify patients in the acute care chain who are likely to deteriorate. Although it is increasingly being implemented in the ED, the optimal moment to use the MEWS is unknown. This study aimed to determine at what moment in the acute care chain MEWS has the highest accuracy in predicting critical illness.

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Ultrasound-guided fascia iliaca blocks for hip fracture: is the juice worth the squeeze?

Emergency Medicine Journal

Hip fractures require prompt, effective analgesia. However, there is evidence from national audits in the UK that pain is often managed ineffectively in this population. 1 The fascia iliaca compartment block (FIB) provides targeted analgesia without the systemic risks of opioids and non-steroidal anti-inflammatories. 2 In this technique, a large volume of long-acting local anaesthetic (such as 40 mL 0.25% bupivacaine) is deposited beneath the fascia iliaca where it spreads along the fascial plan

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Development and validation of an assessment tool for adult simulated ultrasound-guided fascia iliaca block: a prospective monocentric study

Emergency Medicine Journal

Background Fascia iliaca block (FIB) is an effective technique for analgesia. While FIB using ultrasound is preferred, there is no current standardised training technique or assessment scale. We aimed to create a valid and reliable tool to assess ultrasound-guided FIB. Method This prospective observational study was conducted in the ABS-Lab simulation centre, University of Poitiers, France between 26–29 October and 14–17 December 2021.

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Pain in the ED: does anyone manage it well?

Emergency Medicine Journal

Introduction Most patients presenting to the ED are in pain but previous work from the UK has shown that this is often not asked about, recorded or treated effectively. 1 The Royal College of Emergency Medicine (RCEM) Best Practice Guidelines (BPGs) on Management of Pain in Adults 2 and Children 3 advocate recording a pain score, delivering timely and adequate analgesia, then assessing the response.

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An unusual mediastinal shift

Emergency Medicine Journal

Clinical introduction A woman aged 61 years with a history of diabetes mellitus presented to the ED with acute dyspnoea and altered consciousness for 1 day. Her RR was 36 breaths/min and BP was 81/60 mm Hg. Examination revealed decreased breath sounds in the left lung. A CXR was performed ( figure 1 ). Question Based on the imaging, which of the following is the most likely diagnosis?

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Prognostic awareness of seriously ill older adults in the emergency department

Emergency Medicine Journal

Three-quarters of older adults visit an ED in the last 6 months of life. 1 For older patients with serious, life-limiting illnesses, those who have good awareness of their illness severity have better outcomes. Prognostic awareness is associated with better-informed decisions about patient care, 2 improved ability to cope with illnesses 3 and increased acceptance of illnesses, 4 yielding more patient-centred care at the end of life.

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Primary survey: highlights from this issue

Emergency Medicine Journal

Welcome to the June 2024 issue of the Emergency Medicine Journal. As we head into another heady summer in the northern hemisphere (though that’s wishful thinking for those of us in the UK), we once again have a superb array of papers on topics as diverse as acute headache, fascia iliaca block and patient predictions of their own mortality. We hope that you may enjoy digesting this wonderful offering on a light and sunny evening.

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Predictive performance of the common red flags in emergency department headache patients: a HEAD and HEAD-Colombia study

Emergency Medicine Journal

Objectives Only a small proportion of patients presenting to an ED with headache have a serious cause. The SNNOOP10 criteria, which incorporates red and orange flags for serious causes, has been proposed but not well studied. This project aims to compare the proportion of patients with 10 commonly accepted red flag criteria (singly and in combination) between patients with and without a diagnosis of serious secondary headache in a large, multinational cohort of ED patients presenting with headac

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Is arrival by ambulance a risk factor for myocardial infarction in emergency department patients with cardiac sounding chest pain?

Emergency Medicine Journal

Patients commonly present to the ED with cardiac sounding chest pain 1 and a non-diagnostic ECG, yet an important proportion will be suffering from a myocardial infarction (MI) eligible for percutaneous coronary intervention. 2 Age, male sex, hypertension, diabetes mellitus, hyperlipidaemia, ischaemic heart disease and smoking are all associated with an increased likelihood of an MI, 2 but another potential predictor may be mode of ED arrival.