January, 2022

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HIPAA AND BATTLING PARENTS

Total Medical ComplianceHIPAA

Dealing with a minor’s medical records can be a minefield when a child is from a blended family or the parents have a contentious divorce going. Things get especially sticky when you add in stepparents and grandparents, and when a minor controls all or a portion of their own records. It’s a good time to review the basics. Custody versus Parental Rights: Don’t confuse custody with parental rights.

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EvK RCT | PE-SARD | VTE Tx Update | HEP-COVID | PE Rule Out Pathway

JournalFeed

It’s the JournalFeed Podcast for the week of January 24-28, 2022. We cover the EvK RCT - etomidate vs ketamine for RSI, PE-SARD - predicting major bleed in PE treatment, a major update on antithrombotics for VTE, HEP-COVID - anticoagulation for COVID patients, and a new PE rule out pathway.

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SGEM#358: I Would Do Anything for Septic Olecranon Bursitis But I Won’t Tap That

The Skeptics' Guide to EM

Date: January 25th, 2022 Reference: Beyde et al. Efficacy of empiric antibiotic management of septic olecranon bursitis without bursal aspiration in emergency department patients. AEM January 2022 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. He is also the CME editor for Academic Emergency Medicine. Case: You’re working in your busy freestanding emergency department […] The post SGEM#358: I Would Do Anything for Septic Olecranon Bursitis But I Won’t Tap That fir

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Imaging Case of the Week 491

EMergucate

The following chest x-ray is from an 88 year old who has presented with acute onset left sided chest pain followed by diaphoresis and dyspnoea. Patient is afebrile.

EMS 52
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Vasopressor Nonresponse

Northwestern EM Blog

Written by: Elizabeth Stulpin, MD (NUEM ‘23) Edited by: Aaron Wibberly, MD (NUEM ‘22) Expert Commentary by : Joshua Zimmerman, MD (NUEM ‘17) Non-Response to Vasopressors Shock is defined as a state of cellular and tissue hypoxia resulting in end organ dysfunction. This state may arise due to impaired oxygen delivery to tissues, impaired oxygen utilization by the tissues themselves, increased oxygen consumption, or a combination of these mechanisms.

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Telemedicine: a Solution to the Predicted Physician Shortage?

Advanced Medical Reviews

A new study published by the Association of American Medical Colleges (AAMC) found that the United States could see an estimated shortage of between 37,800 and 124,000 physicians by 2034, including shortfalls in both primary and specialty care. Years before this study was conducted, telemedicine was being utilized to treat patients living in remote communities or areas with a shortage of doctors.

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Select FOAMed EM Cases Summit Videos

Emergency Medicine Cases

A few select videos from EM Cases Summit 2021 have been made FOAMed and available here and on our youtube channel. The latest release is with Dr. Rob Simard who explains the failings of the ACLS protocol for PEA arrest, how PoCUS pulse checks can help us differentiate true PEA from pseudoPEA, and how to integrate this information and our PoCUS skills into the flow of our cardiac arrest management.

EMS 52

More Trending

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Talking About Race in Emergency Medicine

JournalFeed

It’s a special edition of the JournalFeed Podcast. Today, we are talking about race in EM with the authors of a recent op-ed in Annals of Emergency Medicine. We tackle some tough questions about racism and how we can be better allies as EM colleagues. Here are today’s show notes from the authors Cortlyn Brown, Kimberly Brown, Italo Brown, and Rosny Daniel: Allegories on race and racism - TED Talk Mapping Police Violence Maatouk-Bürmann B, Ringel N, Spang J, Weiss C, Möltner A, Riemann U, Langewi

EMS 52
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Ketamine vs Midazolam/ Haloperidol for acute agitation

EMergucate

Original paper here What is this study about Authors hypothesized that given intramuscularly, Ketamine would work quicker (and safer) when … Continue reading →

EMS 52
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MLK Day To Me

Dr. Mike Sevilla

As an Asian-American man, I do not pretend to know what it’s like to be a Black man today. And, I do not pretend to know what it was like to be Dr. Martin Luther King, Jr in the 1950s and 1960s. All I know about that time is what I have seen in television and on the internet. So, on this national holiday, where we, as a nation, are asked to remember this man and his message.

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128. Anaphylaxis- dirty epi's are shaken, not stirred

Board Bombs

Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here: emrapidbombs.supercast.com Welcome to EM Board Bombs Happy Hour. Let’s talk smoke and mirrors in anaphylaxis, why its critical to concentrate on only one treatment that helps these patients, and how to make a dirty Epi drip.

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EM Quick Hits 35 – 10 Best Papers of 2021, Peripartum Cardiomyopathy, Crashing Asthmatic, Febrile Neutropenia, Anaphylaxis update

Emergency Medicine Cases

In this months EM Quick Hits podcast: Ken Milne expertly walks us through the 10 biggest EM papers of 2021, Brit Long on a careful structured approach to Febrile Neutropenia to improve outcomes, Catherine Varner on how not to miss Peripartum Cardiomyopathy, Joe Nemeth on Anaphylaxis update and Anand Swaminathan gives us his approach to the Crashing Asthmatic.

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Hyponatremia

Northwestern EM Blog

Written by: Jim O’Brien, MD (NUEM ‘23) Edited by: David Kaltman, MD (NUEM ‘20) Expert Commentary by : Sarah Dhake, MD (NUEM ‘19) & Josh Waitzman, MD, PhD Expert Commentary Thanks for a great review on hyponatremia by Drs. O’Brien & Kaltman. I’ve recruited the expert insight from one of my favorite colleagues and fellow Northwestern University Feinberg School of Medicine graduate Joshua Waitzman, MD PhD, Instructor of Nephrology at Beth Israel Deaconess Medical Center in Boston, MA.

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Gender Pay Gap | Subsegmental PE | Etomidate or Ketamine for RSI | Ketamine Nebs

JournalFeed

It’s the JournalFeed Podcast for the week of January 10-14, 2022. We cover the gender pay gap in EM leadership, subsegmental PE anticoagulation or not, a point/counterpoint on etomidate or ketamine firstline for RSI, and ketamine nebs for pain control.

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Imaging Case of the Week 489 Answer

EMergucate

The chest x-ray shows presence of pneumomediastinum.

EMS 52
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Remembering The Snow Day

Dr. Mike Sevilla

It’s so interesting, because this photo was taking this very week in 2019, otherwise known as Pre-Pandemic times. I’ve been looking at the forecast over the past couple of days, and some people are saying that for around here, we may expect 12 inches of snow or more. Monday is a holiday for a lot of people out there (not me). But, when snow is forecast like this, it really makes me think back to “back in the day” when I was hoping, as a little kid, for that snow day.

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There is a crazy guy on the street!

MEDEST118

An original post by Mario Rugna Peer reviewed by Minh Le Cong

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Medical Decisions: Some are Easy and Some Not So Much

Stop and Think

Let’s start with the easy decisions: sick patients who are asking for our help. When someone falls and breaks a hip, the decision is easy. You fix it. When someone presents in shock because of AV block and a low heart rate, you place a pacemaker. When someone presents with bacterial infection, you use antibiotics. It gets trickier when we consider preventive interventions.

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SGEM#355: Bigger Isn’t Better When It Comes to Chest Tubes

The Skeptics' Guide to EM

Date: December 28th, 2021 Reference: Kulvatunyou et al. The small (14 Fr) percutaneous catheter (P-CAT) versus large (28–32 Fr) open chest tube for traumatic hemothorax: A multicenter randomized clinical trial. J Trauma and Acute Care Surgery. November 2021. Guest Skeptic: Dr. Chris Root is a second-year resident physician in the Department of Emergency Medicine at the University […] The post SGEM#355: Bigger Isn’t Better When It Comes to Chest Tubes first appeared on The Skeptics Guide to Emerg

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POCUS for PS | Deaths OTC Meds | ED Sepsis Teams | Dispo Early v Late | New ASA Difficult Airway

JournalFeed

It’s the JournalFeed Podcast for the week of January 3-7, 2022. We cover POCUS for pyloric stenosis, deaths from OTC cough medicine in children, ED sepsis teams reduce mortality, dispo times early vs late in your shift, and new ASA 2022 difficult airway guidelines.

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Imaging Case of the Week 490 Answer

EMergucate

Chilaiditi’s Syndrome. The chest x-ray reveals bowel loop interposed between liver and right hemi diaphragm.

EMS 52
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Snowstorm Coming: Calm Down People

Dr. Mike Sevilla

Yes, our weather friends are giving us the heads-up that we may be getting some snow going into early Monday morning. You know what that means? Yes, people just go nuts and crazy for the coming snowstorm or the cute name that they will call this on social media, whether it be “snowpocalypse” or “snowmageddon” or whatever. I don’t want to be all snarky (but I know that’s why you love me) but let me be the first to say (again), “Hey people, it’s January and we live in Ohio.

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The Collapse of the Covid Narrative

Dr. No

As the stain of compulsory vaccination and its dystopian paperwork paraphernalia spreads across many European states, extinguishing the lights of individual freedom, and paving a way for a return to the dark days of totalitarianism, we in Britain, and particularly England, find ourselves standing alone in resisting the clamour for ever tighter controls.

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Episode 65 – Acute Joint Pain

EB Medicine

Interview with author: Rachel Sullivan, MD Why joint pain ? Differential Diagnosis Mono vs Poly Articular Presentation? Figure 1 Infectious, degenerative, autoimmune, crystal deposition, reactive, traumatic Septic Arthritis- Bimodal incidence Risks Septic arthritis is polyarticular in 15% to 20% of cases, and in these cases, the mortality is high Gonococcal Highest risk Commonly affected joints Symptomatic or asymptomatic infection Lyme Arthritis Viral – Zika, chikungunya, human parvovirus B

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Ep 164 Cardiogenic Shock Simplified

Emergency Medicine Cases

What is the preferred order of vasopressors and ionotropes in the management of cardiogenic shock? In which patients would dobutamine be preferred over milrinone and vice versa? How can we best pick up occult cardiogenic shock before it floured shock kicks in? What are the best strategies to efficiently get the patient in cardiogenic shock to definitive care, whether that be the cath lab or the operating room?

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COVID Oral Antivirals EUA Guide

EM Updates

pdf Paxlovid Patient/Caregiver Fact Sheet Paxlovid Healthcare Professionals Fact Sheet Paxlovid FDA Checklist [updated Oct 2022] molnupiravir EUA & patient info

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Imaging Case of the Week 490

EMergucate

The following erect chest x-ray is from a 75 year old with epigastric pain and tenderness. What can be seen?

EMS 52
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Taking A Risk

Dr. Mike Sevilla

I’m going to do something I’ve never done before. I’m going to ask you, the reader, to give me a review on Google. I have to tell you, this is a big risk, because I have no idea what is going to happen here. Why now? Well, let me ask you, how many time have you read the reviews on Amazon before you make a purchase? How about this? How many times have you read the reviews of a doctor before you made a decision whether to pick a new doctor.

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7 steps to missing posterior Occlusion MI, and how to avoid them

Dr. Smith's ECG Blog

This fantastic case and post was written by Jesse McLaren (@ECGcases), edited by Smith Case You’re shown an ECG from a patient in the waiting room with chest pain. What do you think? Sinus bradycardia, normal conduction, normal axis, normal R wave progression, no hypertrophy. There’s primary ST depression in the precordial leads maximal in V3-4, and an inverted T wave in V2.

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42

Dr. No

Those familiar with the Hitch-Hiker’s Guide to the Galaxy will know that the number 42 is the ‘Answer to the Ultimate Question of Life, the Universe, and Everything’; it necessarily follows that it must also be the answer to today’s ultimate question, how to end the covid pandemic. Dr No has spent the New Year break trying to get to the bottom of this cryptic answer.

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Calcium OHCA | NEAR4KIDS | Syncope Calculator | Limit Cardiac Tests | Top Articles 2021

JournalFeed

It’s the JournalFeed Podcast for the week of December 27-31, 2021. We cover calcium for OHCA, NEAR4KIDS, Canadian Syncope Calculator, limiting cardiac testing in low risk patients, and the top articles of 2021.

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SGEM#354: Everybody Walk the Dinosaur and Not Take the MSU

The Skeptics' Guide to EM

Date: December 21st, 2021 Guest Skeptic: Dr. Howard “Howie” Mell began his career as a firefighter / paramedic in Chicago. He became double board certified in Emergency Medicine (EM) and Emergency Medical Services (EMS). Howie also has a Master of Public Health. Reference: Grotta JC et al. Prospective, multicenter, controlled trial of mobile stroke units.

Stroke 52
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Imaging Case of the Week 488 Answer

EMergucate

The left wrist x-ray shows an intra-articular two part fracture of the base of the 5th metacarpal & scaphoid waist … Continue reading →

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Appreciate The Sunrise

Dr. Mike Sevilla

Just another day for a health care worker in America. I was driving to work this morning, and my mind was wandering all over the place thinking about work and life. And, then I turn the corner, and I see the sunrise, and I had to stop. And, sometimes life does that to you. We’re knee deep every day in our usual day-to-day things, and then something happens to just stop you in your tracks.

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Focus On: Pyloric Stenosis

Pediatric Emergency Playbook

Myth: “No olive, no problem” Reality: Rare finding, since we diagnose earlier Pyloric stenosis occurs in young infants because the pyloric sphincter hypertrophies, causing near-complete obstruction of the gastric outlet. More common in boys, preterm babies, first-born. Less common in older mothers. Association with macrolide use. Presentation Young infant arrives with forceful vomiting, but can’t quite get enough to eat “the hungry, hungry, not-so-hippo”.

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Hot off the press. My favourite 2021 Articles

MEDEST118

By Mario Rugna

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EPIC-HR Evaluates Nirmatrelvir-Ritonavir for COVID-19

PulmCCM

Jon-Emile S. Kenny MD [ @heart_lung ] “When she smiles without her teeth in place she looks like a witch. But with them in her mouth she’s very pretty.” -Judy Blume Basic Biology The SARS-CoV-2 genome encodes structural proteins [i.e., spike, envelope, membrane, nucleocapsid] and polyproteins [i.e., pp1a and pp1ab]. When the guts of SARS-CoV-2 spew into a cell, viral mRNA acts as a template for polyprotein inception.