Ken Grauer, MD
JUNE 26, 2023
The ECG in Figure-1 was obtained from a young man with a history of rheumatic heart disease — who presented with “palpitations”. He was hemodynamically stable at the time this tracing was recorded. How would YOU interpret the ECG in Figure-1 ? How would you treat the patient? Figure-1: The initial ECG in today’s case. What is the rhythm? How would you treat the patient?
Pediatric EM Morsels
JUNE 30, 2023
I’m sure you can recall at least several parents who bring their children into the ED for concern of recurrent pneumonias. Often the parents focus on a possible underlying immunodeficiency. Fortunately, most commonly these pneumonias are due to viral infections, and we can often offer reassurances to the parent. The differential could also include aspiration , asthma , and bronchiectasis depending on the patient’s history.
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The Trauma Pro
JUNE 23, 2023
What are common sources of malpractice complaints against nurses? The most common event is medication error. Most people worry about common errors like wrong dose, wrong drug, and wrong route of administration. But one less commonly considered drug-related responsibility is assessment for side effects and toxicity of medications administered. Other common reasons include failure to adequately monitor and assess the patient, and failure to supervise a patient that results in harm.
Don't Forget the Bubbles
JUNE 30, 2023
A PEM adventure It’s time for another PEM adventure. Join us on another journey (with an inbuilt time travel machine) in managing Elsa, a 2-year-old girl who is a HUGE fan of the Disney movie, Frozen. Elsa was found face down in the family pool 20 minutes after last visual contact and was picked up without resuscitation. Emergency Medical Services found her apneic and pulseless.
RebelEM
JUNE 29, 2023
Back on June 1 st , 2023, Swami wrote a blog post on REBEL EM titled, The CT FIRST Trial, Should We Pan-CT After ROSC? This stemmed a lot of discussion in the background between Swami, myself, and Scott. We felt it was worthwhile to record this as a podcast to better flush out some nuanced points. Below you will find some of the points we discussed.
The Bottom Line
JUNE 19, 2023
In adult patients with major trauma, who are at risk for trauma-induced coagulopathy does early administration of 1g of tranexamic acid (TXA) followed by an infusion of 1g over 8 hours, compared with placebo, increase survival with a favourable functional outcome at 6 months?
Science Based Medicine
JUNE 11, 2023
Three new studies tell us what we already knew- vaccine isn't perfect, but it's far safer than the virus for children. The post Three New Studies Show the COVID Vaccines Are Very Safe for Children first appeared on Science-Based Medicine.
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The Trauma Pro
JUNE 6, 2023
In today’s post, I will review the diaphragmatic injury practice guidelines published by the Eastern Association for the Surgery of Trauma (EAST). I will follow this up on Friday with an interesting delayed diaphragm injury case. Diaphragm injury is a troublesome one to diagnose. It is essentially an elliptical sheet of muscle that is doubly curved, so it does not lend itself well to diagnosis by axial imaging.
Don't Forget the Bubbles
JUNE 30, 2023
A PEM adventure Meet Polly, a 6-year-old girl with a penchant for shopping. Besides a few febrile convulsions when she was two, she’s a healthy 6-year-old. Having just bought the most gorgeous pair of red ballet pumps that would go delightfully with the red bow she bought in Harrods last week, she was skipping down Regent’s Street with her nanny. As they crossed the front of Liberty, a huge letter L came plummeting down, crashing in front of her.
RebelEM
JUNE 26, 2023
Background: Hemorrhage is the leading cause of mortality in trauma patients. Interventions such as early application of hemorrhage control, tranexamic acid, reduction of crystalloid fluid administration and balanced ratio blood product transfusion have improved many patients’ outcomes. However, mortality still remains high due to trauma-induced coagulopathy.
St. Emlyn
JUNE 2, 2023
St.Emlyn's - Emergency Medicine #FOAMed New guidelines from @RCollEM and @RCRadiologists finally agree that contrast CT should not be delayed in the critically ill/injured #FOAMed The post Contrast Induced Nephropathy – sense at last. St Emlyn’s appeared first on St.Emlyn's.
Science Based Medicine
JUNE 12, 2023
Last week, an antivaxxer on Substack—where else?—tried to argue that Robert F. Kennedy, Jr. is not antivaccine by encouraging you to judge him by his own words. I agree. You should judge RFK Jr. by his own words, as they show definitively that he has been antivaccine since at least 2005. The post Is Robert F. Kennedy, Jr. antivaccine? Judge him by his own words!
Life in the Fast Lane
JUNE 11, 2023
Neil Long and Chris Nickson AMAX4 Algorithm AMAX4 is a best-practice algorithm for critical care clinicians in anaphylaxis and asthma resuscitation.
Emergency Live
JUNE 28, 2023
An early prototype defibrillator was built by the American surgeon Claude S. Beck at the University of Cleveland in 1974; it saved the life of a 14-year-old boy who suffered ventricular fibrillation during surgery The post Defibrillator, a bit of history appeared first on Emergency Live.
Don't Forget the Bubbles
JUNE 12, 2023
I remember how I felt when. I first watched “ Just a Routine Operation “, – the story of the events that led to the tragic death of Elaine Bromiley. Elaine Bromiley went into hospital for a routine operation. Despite an appropriate pre-operative assessment, the anaesthetists tasked with intubating Elaine found themselves in a Can’t Intubate, Can’t Oxygenate scenario, though they failed to recognise it at the time.
RebelEM
JUNE 22, 2023
Background: The COVID-19 pandemic has been the focus of massive research efforts over the last three years. Our understanding of the disease and effective treatments to reduce mortality have progressed rapidly during this time. However, the medical community is only just starting to understand long-COVID (WHO Definition: the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation).
First 10 EM
JUNE 12, 2023
Can herbs cure sepsis? The EXIT-SEP trial was just published, and demonstrated a decrease in all cause mortality from xuebijing – a product manufactured by a pharmaceutical company from a combination of Carthamus tinctorius flowers (Honghua in Chinese), Paeonia lactiflora roots (Chishao), Ligusticum chuanxiong rhizomes (Chuanxiong), Angelica sinensis roots (Danggui), and Salvia miltiorrhiza roots (Danshen). […] The post Finally, a cure fore sepsis: Herbs appeared first on First10EM.
Science Based Medicine
JUNE 18, 2023
Though calls for "debates" are made by unserious people, unserious people can do serious damage when they are willing to spread disinformation about vaccines, all because a doctor with principles isn't willing to play his part in their absurd theater. The post The Pandemic As Spectacle first appeared on Science-Based Medicine.
Medagadget
JUNE 6, 2023
Researchers at the University of California San Diego have created a wearable ultrasound system that can monitor deep tissues, as far as 16.5 cm (6.5 inches) below the surface of the body. Moreover, the team employed a machine learning algorithm to reduce the noise associated with movement, helping to obtain reliable readings while the wearer goes about their day.
Emergency Live
JUNE 19, 2023
Myocarditis is an inflammation of the heart muscle that affects the middle layer of the heart wall, the muscular tonaca called the myocardium The post Inflammations of the heart: myocarditis appeared first on Emergency Live.
Don't Forget the Bubbles
JUNE 19, 2023
You are asked to see a baby boy in the labour ward. He was born at 38 weeks and 5 days gestational age and weighs 2600 grams. His mother is healthy, but she does mention that her first-born daughter was also small. She weighed 2570 grams at 39 weeks and is now perfectly healthy. The parents are of South-Asian descent. There were no issues during the pregnancy, and estimated fetal growth by ultrasound was constant.
RebelEM
JUNE 14, 2023
Anaphylactic Shock is an acute, life-threatening hypersensitivity disorder, with a generalized, rapidly evolving, multi-systemic allergic reaction (IgE-mediated disorder). If not treated rapidly can become fatal. Scott Weingart, MD put together a manual titled the Resuscitation Crisis Manual , which in short, is composed of two-page protocols for various situations that involve crashing patients.
SheMD
JUNE 18, 2023
It's that time of the year. July 1st is almost here and hospitals around the country will welcome in their new interns. To those starting on the wards as interns, this series is for YOU! We're sharing advice from SheMD authors on how to not only SURVIVE but THRIVE during your intern year. Wishing you all the best next week. You CAN do this! January 1st may be the start of the New Year, but for everyone in the medical field we all know that the year really begins on July 1st.
Greater Sydney Area HEMS
JUNE 25, 2023
In this episode, Senior Staff Specialist Dr Geoff Healy reflects on a formative case with unexpected long term follow-up, and how this has shaped his clinical career as both a physician, and mentor.
Broome Docs
JUNE 20, 2023
Hi All, we are back with another instalment of the Journal Club with Justin Morgenstern. Big news this month is that Justin has just been invited to visit my home shop as the honorary WG Smith Fellow and deliver a series of EBM lectures to the local teams in Western Australia. So we are planning to take this show on th eraod and do some live sessions later in 2023.
Emergency Live
JUNE 14, 2023
Pyelonephritis is an inflammatory disease of the kidney and renal pelvis that can be acute or chronic. The disease is often associated with a more or less extensive infection of the organ parenchyma The post Pyelonephritis: causes, symptoms, diagnosis and treatment appeared first on Emergency Live.
Don't Forget the Bubbles
JUNE 30, 2023
A PEM Adventure Ranulf is a 14-year-old explorer. He has already climbed Ben Nevis in Scotland, visited the Gobi desert (possibly from the comfort of his parents 4 x 4, but who’s judging) and has his bronze D of E nailed. Whilst you were busy managing head injuries and drownings, Ranulf had been out with a group of boys from school this evening. They had been enjoying a celebratory dinner following their safe return from a trip to the Amazon rainforest.
RebelEM
JUNE 1, 2023
Background: Achieving ROSC in out of hospital cardiac arrest (OHCA) is no easy feat but, care doesn’t end with ROSC. Post-ROSC management is nuanced and challenging but helps to ensure good outcomes. Identification of the underlying cause of the cardiac arrest is a critical area of focus in post-arrest care. Although myocardial infarction, dysrhythmias and pulmonary emboli are common pathologies to consider, there are a host of other causes including subarachnoid hemorrhage, trauma and electroly
PEMBlog
JUNE 7, 2023
There are protocols in place that assist highly trained Emergency Medical Service providers in assuring that agitated children are safely transported to their destination. This podcast episode hosted by Brad Sobolewski ( @PEMTweets ) and co-authored by Dennis Ren ( @DennisRenMD ) is all about what prehospital providers should do to get these agitated children safely to the ED.
St. Emlyn
JUNE 7, 2023
St.Emlyn's - Emergency Medicine #FOAMed If you’re working in the UK then you will know that there is currently a shortage of ketamine (I know!). Specifically we are struggling to get hold of the 10mg/ml … Etomidate for RSI induction? St Emlyn’s Read More » The post Etomidate for RSI induction? St Emlyn’s appeared first on St.Emlyn's.
Science Based Medicine
JUNE 4, 2023
My critics lack the courage to accurately quote me. That tells you everything about them and nothing about me. The post Dr. Jay Bhattacharya Responds to Words I Never Said first appeared on Science-Based Medicine.
Emergency Live
JUNE 28, 2023
Even the trachea, like other organs, can become inflamed due to viruses and bacteria. In this case we speak of "tracheitis" The post Tracheitis: symptoms, causes, diagnosis and treatment appeared first on Emergency Live.
Don't Forget the Bubbles
JUNE 14, 2023
This post, from Ben Symon on XXX, is the first of our 2022 DFTB conference. Some tickets are still left for DFTB23 in Adelaide, so sign up while you can. Ben Symon is a pediatric emergency medicine physician. He’s fascinated by the interactions and boundaries between how we interact together as clinicians and with our patients. Kindness is central to our speciality – but it should be central to all of our specialities.
First 10 EM
JUNE 26, 2023
I think the conclusions of the paper are incredibly obvious, and therefore not practice changing, but I worry that a superficial read might lead to misinterpretation, and therefore the paper is probably worth covering. (This is the same research group that published the infamous PESIT study, and all the subsequent misinformation about PE risk in […] The post PE risk in severe exertional dyspnea appeared first on First10EM.
ACEP Now
JUNE 21, 2023
U.S. emergency medicine (EM) residency training length has been a decades-long dilemma: four vs. three years. Two important questions befall educators and residents. First, is three years enough time to become an EM physician? Second, does an additional year add sufficient value to justify the time and expense? To date, the debate has been lively yet largely conceptual.
St. Emlyn
JUNE 13, 2023
St.Emlyn's - Emergency Medicine #FOAMed This post is from Australia and was brought to us by Dr Ben McKenzie. The events that precede this blog are utterly tragic, but from such tragedy there is hope … Just a routine resuscitation. The AMAX4 algorithm for anaphylaxis/asthma. St Emlyn’s Read More » The post Just a routine resuscitation.
Science Based Medicine
JUNE 24, 2023
The amount of energy needed to refute b t is an order of magnitude bigger than that needed to produce it. The post Steve Kirsch and Brandolini’s law first appeared on Science-Based Medicine.
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