The Trauma Pro
NOVEMBER 8, 2024
Patients with severe TBI frequently undergo surgical procedures to remove clot or decompress the brain. Most of the time, they undergo a craniotomy, in which a bone flap is raised temporarily and then replaced at the end of the procedure. But in decompressive surgery, the bone flap cannot be replaced because doing so may increase intracranial pressure.
Ken Grauer, MD
NOVEMBER 1, 2024
I was sent this ECG recording — and asked for my interpretation of the rhythm in Figure-1. I had little clinical information. QUESTIONS: How was I able to guess the probable correct answer in less than 5 seconds? How was I then able to prove that my guess was correct? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ).
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Don't Forget the Bubbles
NOVEMBER 11, 2024
One-liner… Traumatic brain injury (TBI) is a leading cause of mortality and morbidity in paediatric populations, and fever is associated with worse outcomes. Should we aim to prevent fever, or should we cool patients? A 12-year-old boy presents with a significant head injury following a road traffic accident. At the scene, his lowest GCS was 5 (E1V2M2).
Science Based Medicine
NOVEMBER 1, 2024
Any doctor who is unabashedly pro-vaccine has already spoken up about the normalization of anti-vaxx quackery within our ranks. The post If RFK Jr. Turns the CDC Into An Anti-Vaxx Propaganda Outfit, I Don’t Want To Hear a Peep From Some “Respectable” Doctors first appeared on Science-Based Medicine.
Dr. Smith's ECG Blog
NOVEMBER 27, 2024
Pendell and I and the geniuses at Powerful Medical (Producers of the PMCardio Queen of Hearts OMI AI app ) are working on an objective, mathematical definition of hyperacute T-waves , based on real OMI outcomes and hyperacute T-wave annotation that has excellent interrater agreement (between me and Pendell), and it will end up being a logistic regression using these 3 variables: 1) area under the curve (AUC) relative to the QRS size 2) increased symmetry , as defined by time from T-wave onset to
St. Emlyn
NOVEMBER 6, 2024
St.Emlyn's - Emergency Medicine #FOAMed Creating a learning culture in the emergency department (ED) fosters psychological safety, open communication, and continuous improvement. This approach supports team resilience, enhances patient care, and reduces burnout. Learn practical steps to build a strong learning culture in your ED, promoting growth and collaborative excellence in emergency medicine.
RebelEM
NOVEMBER 6, 2024
Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (80%) Demographics Most commonly affects patients between ages 10-20 years old As age increases, elbow dislocation rates tend to d
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The Trauma Pro
NOVEMBER 1, 2024
Every trauma center has a massive transfusion protocol (MTP). But every trauma center also does it entirely differently. Ideally, an MTP is designed with the resources available at the hospital in mind. These may include whole blood, the use of O- vs. O+ blood, the number of units of each product per cooler, the different products in different coolers, and personnel available to move those coolers to the correct locations.
Science Based Medicine
NOVEMBER 8, 2024
Doctors who are concerned about members of our profession enabling powerful anti-vaxx disinformation agents should speak up before it's too late. But its probably too late already. The post Robert Kennedy Jr. & His Doctor Friends May Just Be Getting Started first appeared on Science-Based Medicine.
Sensible Medicine
NOVEMBER 14, 2024
What does our philosophy have to do with RFK Jr and MAHA?
The Bottom Line
NOVEMBER 16, 2024
What’s new in the Critical Care literature – monthly updates
St. Emlyn
NOVEMBER 19, 2024
St.Emlyn's - Emergency Medicine #FOAMed Traditionally, large-bore chest tubes have been standard for managing hemothorax, but smaller tubes are now proving just as effective in stable patients, with added benefits like reduced pain and fewer tube days. This review explores outcomes in drainage efficacy, complication rates, and patient comfort, showing that small-bore thoracostomy may be a reliable alternative for non-emergent cases.
EMCrit
NOVEMBER 15, 2024
Medtwitter was great. We met amazing people and exchanged ideas. There were endless arguments about electrolytes and intubation. But the strength of Medtwitter was never the platform – it was the people. Twitter has been deteriorating for years. For example, the algorithm is horrific, the blocking feature has been largely removed, posts from paid users […] EMCrit Project by Josh Farkas.
First 10 EM
NOVEMBER 11, 2024
In the most recent BroomeDocs podcast, we talk about an attempt to use the IM route to give cardiac arrest victims epinephrine faster. (The podcast and Research Roundups blog post might actually come out next week.) I was skeptical about the outcomes, partly because the evidence that epinephrine helps at all in cardiac arrest is […] The post IV versus IO for cardiac arrest (PARAMEDIC3 and IVIO) appeared first on First10EM.
Science Based Medicine
NOVEMBER 15, 2024
When RFK Jr. does to the U.S. what he did to Samoa, doctors will say they are horrified, that they love vaccines, blah blah blah. But it will be too late. The post If You Sanewashed RFK Jr., Or If You Sanewashed Doctors Who Did, You Own the Next 4 Years first appeared on Science-Based Medicine.
PulmCCM
NOVEMBER 14, 2024
Critically ill patients receiving mechanical ventilation are highly prone to developing severe weakness and long-term disability. Although early mobilization and physical therapy for vented patients would intuitively seem to have indisputable benefits, early mobility programs have failed to consistently show improvements in meaningful patient-centered outcomes (e.g, increased functional independence or exercise ability after ICU discharge).
The Skeptics' Guide to EM
NOVEMBER 30, 2024
Date: November 10, 2024 Reference: Couper et al. The Paramedic 3 Trial: A randomized clinical trial of drug route in out-of-hospital cardiac arrest. October 31, 2024 NEJM Access to the SGEM Podcast episode at this LINK. Guest Skeptic: Missy Carter is a PA currently practicing in critical care after having attended the University of Washington's MEDEX program.
EM Ottawa
NOVEMBER 28, 2024
What do you do when expert nurses tell you they can’t obtain IV access? Do you spend 20 minutes performing an invasive central line? Does your resident finally get two IO EPAs? Or do you save the day with a slick, ultrasound guided IV? Obtaining peripheral ultrasound guided IV access is not only a core […] The post Ultrasound Guided Peripheral IVs appeared first on EMOttawa Blog.
EMCrit
NOVEMBER 28, 2024
I discussed the reasons for migrating to BlueSky here. I've received positive feedback from several FOAMed expats who migrated to Bluesky and enjoy it there. I've also received some questions about getting started on BlueSky, so here is a brief guide to moving into MedSky. [1] Set up your account & profile This is essentially […] EMCrit Project by Josh Farkas.
American Medical Compliance
NOVEMBER 14, 2024
Defined by the World Health Organization as the reluctance or refusal to vaccinate despite the availability of vaccines, vaccine hesitancy is influenced by complex factors including misinformation, cultural beliefs, and fear of adverse effects. To help address this growing concern, pediatric immunization training equips healthcare providers with the skills, knowledge, and empathy necessary to effectively address vaccine hesitancy.
Science Based Medicine
NOVEMBER 22, 2024
Had laptop class doctors been willing to listen to doctors who worked on COVID units, they wouldn't have said so many absurd things. The post Laptop Class Doctors Think Doctors Who Treat Patients Are Lazy, Dumb, Cowardly, Sheep first appeared on Science-Based Medicine.
PulmCCM
NOVEMBER 7, 2024
During cardiac arrest, every second matters (at least potentially). For out-of-hospital cardiac arrest in particular, intravenous access can be difficult to establish, delaying the administration of epinephrine and other drugs and possibly worsening outcomes. Intraosseous (IO) devices—inserted by punching a needle loaded on a trocar into the tibia or femur—can be placed more easily than IV catheters, leading to faster injection of epinephrine.
Dr. Smith's ECG Blog
NOVEMBER 25, 2024
Introductory Angiography Guide To find the guide later, go to the banner at the top of the blog: This blog is dedicated to improving understanding of ECGs in the context of emergency medicine. A substantial proportion of cases discussed include diagnostic angiography. Attaining expertise in angiography requires dedication and practice. What follows is an introduction to angiography -- a guide meant for people with no prior experience interpreting angiograms.
St. Emlyn
NOVEMBER 26, 2024
St.Emlyn's - Emergency Medicine #FOAMed In this podcast, Liz Crowe discusses the effect bad behaviour has on teams and ultimately patient safety. The post Podcast – Bad Behaviour in Teams with Liz Crowe at Tactical Trauma 2024 appeared first on St.Emlyn's.
Life in the Fast Lane
NOVEMBER 7, 2024
Mike Cadogan November 8, 1895 On November 8, 1895 Wilhelm Röntgen, chair of physics at Würzburg, noted an unusual phenomenon, that would change the world of medicine
ACEP Now
NOVEMBER 6, 2024
Native American emergency physicians make up 0.1 percent of physicians in U.S. emergency departments, according to research published in 2020 in Annals of Emergency Medicine. Three Native American emergency physicians in Oklahoma—three of five in the state—discussed with ACEP Now their approach to health care and how their careers in medicine began.
Science Based Medicine
NOVEMBER 16, 2024
It means pertussis and measles outbreaks will be happening under your watch and you'll be held responsible while your boss is an anti-vaxx crank. Enjoy! The post What Does it Mean to Own the Next 4 Years? first appeared on Science-Based Medicine.
The Trauma Pro
NOVEMBER 12, 2024
The Pediatric Readiness Score (PRS) is a new(er) metric that is now required for all US trauma centers verified by the American College Surgeons. There is no specific threshold that must be met, but the value must be reported for review at the time of the site visit. What is the PRS? It is a measure introduced by the National Pediatric Readiness Project.
Sensible Medicine
NOVEMBER 4, 2024
Nearly a thousand news outlets covered the recent publication of the positive results of the STEP-9 trial of semaglutide vs placebo for the treatment of knee pain due to osteoarthritis in patients with obesity. Twitter overflowed with positive messages after the New England Journal of Medicine publication. I am not sold on the trial. STEP-9 had many flaws but one fatal flaw.
St. Emlyn
NOVEMBER 22, 2024
St.Emlyn's - Emergency Medicine #FOAMed This retrospective study explores the link between intra-arrest arterial blood pressure (IBP) and return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA). Analysing data from 80 patients attended by the East Anglian Air Ambulance, it found that higher diastolic blood pressure (DBP) during CPR significantly increased the likelihood of ROSC.
Life in the Fast Lane
NOVEMBER 2, 2024
Mike Cadogan Waiting Room Medicine With exponential Emergency Department over-crowding and spiraling waiting times, the Utopian College has produced a series of guidelines to assist fondling members.
RebelEM
NOVEMBER 25, 2024
Background: In 2018, the BEAM Trial, a small single-center randomized clinical trial, conducted in the emergency department at Hennepin County Medical Center, demonstrated that bougie use significantly increased the first-attempt intubation success rate compared to the endotracheal tube with stylet (98% vs 87% (absolute difference, 11% [95% CI, 7% to 14%]). 1 Conversely, the 2021 BOUGIE trial—a larger, multicenter randomized clinical trial conducted by the same investigators—found no significant
Science Based Medicine
NOVEMBER 10, 2024
Mass purges and prosecutions of scientists have happened before. We shouldn't pretend they can't happen here. The post Dr. Vinay Prasad: “I Don’t Believe in Forgiveness Because in My Opinion These Pieces of S**t Are Still Lying.” first appeared on Science-Based Medicine.
Emergency Medicine Journal
NOVEMBER 21, 2024
Background The WHO recognises patient safety as a serious public health problem. The COVID-19 pandemic affected adult EDs (AEDs) and paediatric EDs (PEDs) differently. We compared the culture of safety in the adult AED and PED before and after the COVID-19 pandemic. Methods A quasi-experimental study was performed. In 2019, we conducted a survey using the Spanish-adapted Hospital Survey on Patient Safety Culture open to all staff (doctors, nurses and paediatric residents) in AED and PED.
The Skeptics' Guide to EM
NOVEMBER 2, 2024
Date: October 29, 2024 Reference: Galili et al. Low dose ketamine as an adjunct to morphine: a randomized controlled trial among patients with and without current opioid use. AEM Oct 2024. Guest Skeptic: Dr. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. He is the Vice Chair of the Emergency Department and Program Director of the EM residency program at Nassau University Medical Center in East Meadow, NY, the safety net hospital for Nassau County.
St. Emlyn
NOVEMBER 24, 2024
St.Emlyn's - Emergency Medicine #FOAMed GLP-1A toxicity: What do emergency clinicians need to know about drugs like Ozempic® and Wegovy®? #FOAMed @stemlyns Greg Yates takes through a paper reporting overdoses in US practice. The post GLP-1A toxicity: What do emergency clinicians need to know about drugs like Ozempic® and Wegovy®? appeared first on St.Emlyn's.
ACEP Now
NOVEMBER 6, 2024
A gravid woman presents to your emergency department (ED). Before you can obtain any history, she gives birth in your waiting room. The neonate is apneic and has a heart rate of 48. How do you stabilize this patient? Neonatal resuscitation is common; 10 percent of the four million newborns in the U.S. each year will require at least some intervention. 1 However, one percent of births will require advanced interventions, including chest compressions, intubation, and medications. 2 These rare scen
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