Pediatric EM Morsels
APRIL 19, 2024
Trauma season is at hand and like all other pediatric emergency departments in the country, we find our ED breaking ( pun intended ) at the seams with orthopedic injuries. We see all different flavors of upper extremity injuries. Yes, we’re talking about your clavicular , proximal humeral, supracondylar, lateral condylar , scaphoid and metacarpal fractures.
The Trauma Pro
APRIL 19, 2024
In my previous post, I described the early days of penetrating neck injury management and introduced a paper suggesting that this concept should be revised. Today, I will summarize a paper by Siletz and Inaba that is currently in press and outlines what the contemporary way of treating these injuries should be. Step 1. If present, rapidly control external hemorrhage and airway compromise.
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Ken Grauer, MD
APRIL 5, 2024
The ECG in Figure-1 was obtained from a middle-aged woman — who presented with low back pain, shortness of breath and marked hypertension — but no CP ( C hest P ain ). QUESTIONS: In view of this history — How would YOU interpret this ECG? Are the large, peaked T waves ( especially in lead V2 ) — likely to indicate hyperacute deWinter T waves? Figure-1: The initial ECG in today's case.
Sensible Medicine
APRIL 14, 2024
Last week, the US FDA held a meeting to decide if a new surrogate endpoint (Minimal Residual Disease or MRD negativity) could be used to give more & faster drug approvals for patients with newly diagnosed multiple myeloma. Multiple myeloma drugs can cost $600,000 per year of treatment, but if MRD is permitted for drug approval, I suspect we will see a deluge of uncertain drugs added to the roster, and the costs per year per patient will swell to a million dollars or more.
Emergency Medicine Cases
APRIL 2, 2024
In this part 2 of our 2-part podcast on asthma with Dr. Sameer Mal and Dr. Leeor Sommer, we dig into the recognition and management of life-threatening asthma. We answer such questions as: what are the key elements in recognition of threatening asthma? What are the most time-sensitive interventions required to break the vicious cycle of asthma? What are the best options for dosing and administering magnesium sulphate, epinephrine, fentanyl and ketamine in the management of the crashing asthmatic
Science Based Medicine
APRIL 14, 2024
Trying to limit pediatric COVID was literally the pandemic's worst sin for pro-infection doctors, warranting severe punishment. This is how desperately they wanted them infected. The post Dr. Vinay Prasad: It’s “Good” That Parents Who Want To Vaccinate Their Kids Against COVID Get Reported To Child Protective Services first appeared on Science-Based Medicine.
Pediatric EM Morsels
APRIL 5, 2024
Traveling Ticks are more than just ticking off a checklist before you get ready to travel! Climate change and changes in land usage have contributed to an expanded range of ticks (Beard 2016). There are species of ticks found on every continent and carrying a variety of vectors capable of infecting humans. Globally, ticks are the second most common vector to transmit illnesses after mosquitos (Parola 2018).
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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.
EM Ottawa
APRIL 11, 2024
Patients living with functional neurologic disorders (FND) have been deeply stigmatized by the medical system. In a patient survey by FND Hope (an international organization for the research and advocacy around FND) 82% of patient respondents felt they had been treated poorly due to stigma relating to their FND diagnosis, primarily by emergency physicians [1] […] The post Functional Neurologic Disorders appeared first on EMOttawa Blog.
Dr. Smith's ECG Blog
APRIL 24, 2024
Quiz The PM Cardio Queen of Hearts AI model for ECG interpretation from Powerful Medical is still in its early days. Do you think you can outperform the toddler version of the AI model? Version 2.0 will soon be available with four times the training data. The QoH groups ECGs into OMI and NOT OMI. Each category is subdivided into three levels of confidence.
Science Based Medicine
APRIL 28, 2024
Is potential death worse than real death? The post Once a Doctor Has Minimized Literal Death for Young People, Should We Value Their Opinion on Any Topic Less Consequential Than Literal Death? first appeared on Science-Based Medicine.
Emergency Medicine Cases
APRIL 2, 2024
In this ECG Cases blog, Jesse McLaren and Rajiv Thavanathan explore how ECG and POCUS complement each other for patients presenting to the emergency department with shortness of breath or chest pain. They explain complementary diagnostic insights into pericardial effusion and cardiac tamponade, occlusion MI and RV strain. The post ECG Cases 49 – ECG and POCUS for Dyspnea and Chest Pain appeared first on Emergency Medicine Cases.
The Trauma Pro
APRIL 26, 2024
In this series, I will review the two major techniques for addressing troublesome bleeding from pelvic fractures. This post will review the evolution of packing techniques and more fully describe the concept of preperitoneal packing. Next, I’ll review an early paper that compared the snippets of information we had to angioembolization. In the last post in the series, I’ll discuss a paper in press that compares the efficacy and hospital charges of the two techniques.
First 10 EM
APRIL 2, 2024
Give your patients a break. Nobody is a perfect diagnostician. Not even the best trained physician can determine, with 100% accuracy, which patients have serious pathology. Even with advanced testing, we aren’t close to perfect. However, if you listen to the subtext of breakroom complaints, it seems like we expect patients to be better diagnosticians […] The post Are you a perfect diagnostician?
Sensible Medicine
APRIL 25, 2024
The US FDA is under tremendous political pressure to approve drugs, and indeed they tout the number of approved drugs as a measure of the quality of their work. Unfortunately, you can approve bad drugs. Selenexor is a toxic poison that does not increase survival. Belantumab causes eye damage and had to be pulled from the US market Idelalisib, copanlisib, duvelisib— the entire P13k inhibitor class —may have resulted in increased deaths.
Dr. Smith's ECG Blog
APRIL 6, 2024
This case came from a friend whose sister was the patient. She knew I was interested in ECGs, so she took a photo of this one. A young woman presented with acute chest pain. This was her presenting ECG: What do you think? This is clearly Brugada phenotype. There is downsloping ST Elevation in V1 and V2. To an experienced interpreter, it is clearly not due to OMI.
Science Based Medicine
APRIL 7, 2024
Dr. Jay Bhattacharya March 2020: "If it’s true that the novel coronavirus would kill millions without shelter-in-place orders and quarantines, then the extraordinary measures being carried out in cities and states around the country are surely justified." The post Every Time Dr. Jay Bhattacharya Talks About COVID, He Proves He Was Totally Wrong About COVID first appeared on Science-Based Medicine.
Emergency Medicine Cases
APRIL 23, 2024
In this month's EM Quick Hits podcast: Justin Morgenstern on the first RCT of high dose nitroglycerin in SCAPE, Andrew Neill on Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) indications and evidence, Brit Long on indications for CT in suspected diverticulitis, Tahara Bhate on Central Retinal Artery Occlusion (CRAO) and diagnostic error, Matthew McArthur on penicillin allergy labels, myths and penicillin challenges, and Susan Lu on how ED physician personality influences patie
The Trauma Pro
APRIL 2, 2024
Extraperitoneal rectal injury repair has evolved considerably over the past 40 years. Way back when, this injury automatically triggered exploration, diverting colostomy with washout of the distal colon, and presacral drain insertion (remember those?). We eventually backed off on the presacral drains (pun intended), which didn’t make a lot of sense anyway.
First 10 EM
APRIL 15, 2024
One of the biggest headaches in modern medicine is the apparent requirement to call busy specialists just to confirm what seems like an obvious treatment plan. In emergency medicine, this often happens when a patient needs to be admitted under one service, but with a medical problem related to another speciality. We get stuck in […] The post The Brain Injury Guidelines: Can we avoid talking to neurosurgeons?
Sensible Medicine
APRIL 24, 2024
On Friday, the New York Times ran this story. The article begins by explaining that mammograms don’t find all breast tumors — of course they don’t! Even MRI and ultrasound do not. In fact, no imaging modality does. The only way to find all the tumors would be to remove the breast and have a pathologist examine every tiny bit of it.
Dr. Smith's ECG Blog
APRIL 18, 2024
Written by Jesse McLaren A 70 year old with prior MIs and stents to LAD and RCA presented to the emergency department with 2 weeks of increasing exertional chest pain radiating to the left arm, associated with nausea. The pain recurred at rest 90 minutes prior to presentation, felt like the patient’s prior MIs, and was not relieved by 6 sprays of nitro.
Science Based Medicine
APRIL 5, 2024
Part 2: In 2020, pro-infection doctors said "It’s fantastic news that we have a lot of cases." Today, they performatively lament "learning loss for children, especially in poor families". What happened to their assurances that the mass infection of unvaccinated youth will rapidly lead to herd immunity? The post The Failed “We Want Them Infected” Movement Is Trying to Rebrand Itself As The “All We Really Wanted Was Poor Kids in School” Movement. first appeared on Science-Based Medicine.
The Skeptics' Guide to EM
APRIL 13, 2024
Reference: Albers GW et al. TIMELESS Investigators. Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection. NEJM Feb 2024 Date: April 12, 2024 Guest Skeptic: Dr. Vasisht Srinivasan is an Emergency Medicine physician and neurointensivist at the University of Washington and Harborview Medical Center in Seattle, WA. He is an assistant professor in Emergency […] The post SGEM#436: For the Longest Time – To Give TNK for an Acute Ischemic Stroke first appeared on The Skeptics Guid
St. Emlyn
APRIL 27, 2024
St.Emlyn's - Emergency Medicine #FOAMed What you don’t do, determines what you can do Tim Ferris One of the most powerful personal lessons I have learned in recent years is every time I say YES […] The post Choosing with Intention. Liz Crowe appeared first on St.Emlyn's.
EM Ottawa
APRIL 18, 2024
In this Prehospital Journal Club Recap, let us take a deep dive into the use of blood products, as well as the adjunct use of automated controlled elevation in CPR. Resuscitation with blood products in patients with trauma-related hemorrhagic shock receiving prehospital care (RePHILL): a multicentre, open-label, randomized, controlled, phase 3 trial Background The use […] The post PTM Journal Club: Blood Product and ACE-CPR use Prehospital appeared first on EMOttawa Blog.
Sensible Medicine
APRIL 1, 2024
First of all, Happy April Fools day. I thought about writing a fake-trial post. But thought the better of it. I normally tell you about a single study on Monday. This week, I want to alert you to the potential bigness of next weekend, when the American College of Cardiology meets in Atlanta. Sunday is an especially important day, as we will hear the results of three clinical trials—each of which could change cardiology in major ways.
Dr. Smith's ECG Blog
APRIL 14, 2024
A 56 year old male with PMHx significant for hypertension had chest pain for several hours, then presented to the ED in the middle of the night. He reported chest pain that developed several hours prior to arrival and was 5/10 in intensity. The pain was located in the mid to left chest and developed after riding his bike. There was associated fatigue when symptoms developed and mild shortness of breath at onset of chest pain however that has since resolved.
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.
The Trauma Pro
APRIL 30, 2024
In my last post, I reviewed an early paper on preperitoneal packing (PPP). Today, I’ll look at an earlier review article summarizing some smaller studies comparing it to angioembolization. In the next post, I’ll look at a brand new paper that includes a cost analysis as well. Interestingly, the use of AE and PPP vary geographically. Angioembolization has been a mainstay in the US for some time, and PPP has been more commonly used in Europe.
St. Emlyn
APRIL 19, 2024
St.Emlyn's - Emergency Medicine #FOAMed This was a really powerful session that took us on a journey from the past, to the present and left us with a feeling of hope for the future. I’ll […] The post R-A-C-E session at RCEM CPD conference. St Emlyn’s appeared first on St.Emlyn's.
First 10 EM
APRIL 29, 2024
Although it made a bit of a splash when published, this article really didn’t interest me. Obviously, GCS 8 doesn’t mean intubate. I didn’t think anyone was simplistic enough to practice medicine based on a jingle. Clearly trajectory matters. If a patient’s GCS hit 8 and they are on a clinical course where you expect […] The post GCS 8 obviously doesn’t mean intubate (in tox or otherwise) appeared first on First10EM.
Sensible Medicine
APRIL 30, 2024
Gosh was this a great conversation about her recent paper on specification curve analysis of nutritional observational studies. Here is Dr. Zeraatkar’s bio: Dena Zeraatkar, PhD is an Assistant Professor in the Departments of Anesthesia and Health Research Methods, Evidence, and Impact (HEI) at McMaster University. She earned her doctoral degree at McMaster University in the Health Research Methodology graduate program.
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.
Science Based Medicine
APRIL 12, 2024
A new study designed to better account for hidden confounding factors has found no link between acetaminophen use during pregnancy and the risk of neurodevelopmental conditions in childhood. The post New Study Finds No Link Between Autism and Acetaminophen Use During Pregnancy first appeared on Science-Based Medicine.
The Trauma Pro
APRIL 23, 2024
In the last post, I described the first crucial step in the contemporary management of penetrating neck trauma, control of obvious external hemorrhage. Let’s move on to the nuts and bolts of figuring out what needs to be done about the injury. Now, it’s time to triage your patient based on clinical signs that predict the presence or absence of a significant injury.
EMCrit
APRIL 15, 2024
A razor is a rule of thumb that is helpful, although it isn't always correct. In medicine we're familiar with Occam's razor (the rule of parsimony). The cutoff razor states: if a continuous variable is dichotomized using a cutoff, then values near the cutoff provide little information. A simple illustration of the cutoff razor is […] EMCrit Project by Josh Farkas.
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