Mount Sinai EM

NOVEMBER 14, 2022

Intro For this week’s teaching pearl, I wanted to go back and cover a medical pearl. We always hear the word “ECMO” thrown around but I want to today go into a very brief overview of what ECMO is and why it is being used more commonly. I am going to provide the pearl in a Q/A format to make it easier to process. Disclaimer : This is only a very brief overview of ECMO just so everyone at least has a basic understanding of what the technology is and what the circuit looks like.

Shock 130

Shock Wellness 130

PDC Healthcare

NOVEMBER 22, 2022

3 More Efficient Ways to Identify Patients at an ASC According to a recent survey with PDC customers, a majority of Ambulatory Surgery Centers are using a printed label adhered to a paper or plastic wristband as their method of identifying patients. While this method enables them to satisfy the Joint Commission’s Two Patient Identifiers […]. The post 3 More Efficient Ways to Identify Patients at an ASC appeared first on connectID - PDC Healthcare Blog.

Patient Safety 87

Patient Safety 87

EMCrit

NOVEMBER 18, 2022

Lumbar Puncture This seemingly simple procedure seems to be the Achilles's heel or many resus docs! If you have a good baseline knowledge of how to do the lumbar puncture correctly, it is super easy. If you have bad habits, then you will make your poor patient look like a pin cushion. EMCrit Project by Scott Weingart, MD FCCM.

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Total Medical ComplianceHIPAA

NOVEMBER 7, 2022

If you have spent any time on the Internet, you have been asked what you would like a website to do with its cookies. A cookie is information saved by your web browser. Cookies are like flags that allow a website to recognize and remember your device if you return to that site in the future. Some cookies can also keep track of your device over time.

Documentation/Coding 93

Documentation/Coding Wellness 93

33 Charts

NOVEMBER 7, 2022

Peter Drucker, the father of modern day management, inspired a generation of leaders with his quote, “ One cannot manage change. One can only be ahead of it.” This needs to be reconsidered. Because there’s the fantasy of staying ahead of change and then there’s the modern reality. Early in this century technological progress exceeded the system’s ability to keep up.

Leadership 58

Leadership 58

EMergucate

NOVEMBER 7, 2022

Original paper Findings Intranasal topical TXA is associated with a lower rate of need for anterior nasal packing and a shortened stay in the ED Bottom line Topical TXA for epi…

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Mount Sinai EM

NOVEMBER 14, 2022

Intro Raise your hand if you ever struggled obtaining a CSF sample from a Lumbar Puncture. I “virtually” see that most if not all of you at one point in your career struggled with this. This pearl is inspired by an overnight Elmhurst A-side shift I had several months ago with a patient requiring a Lumbar Puncture. I waved off my senior/attending and told them “No worries, I got this.

Ultrasounds 130

Ultrasounds Wellness 130

EMCrit

NOVEMBER 3, 2022

SAH and Hypoxic Encephalopathy. EMCrit Project by NeuroEMCrit Team (Casey & Neha).

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RebelEM

NOVEMBER 30, 2022

Take Home Points Consider the diagnosis of testicular torsion in all patients with acute testicular pain Testicular torsion is a surgical emergency that requires immediate urologic consultation to increase the rate of tissue salvage. History, physical examination and ultrasound are all flawed in making the diagnosis. The gold standard is surgical exploration.

Ultrasounds 52

Ultrasounds Pediatrics Operations EMS 52

American Medical Compliance

NOVEMBER 30, 2022

As health systems continue to mitigate the effects of the COVID-19 pandemic, they must brace for a new threat: the rising rate of healthcare-associated infections (HAIs). For example, Staphylococcus aureus (MRSA) bacteremia (which is resistant to many antibiotics) is infecting an increasing number of patients in healthcare facilities. Tackling the increased rate of HAIs is crucial.

Patient Safety 52

Patient Safety CDC Operations Outcomes 52

Board Bombs

NOVEMBER 27, 2022

Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here: emrapidbombs.supercast.com. Face it, its broken. Your face that is. This epic podcast covers the major facial fractures, when to call a surgeon, and who needs to be seen in emergently in the ED vs outpatient. This is perfect for boards and clinical practice.

Fractures 52

Fractures 52

Dr. Mike Sevilla

NOVEMBER 23, 2022

My father passed away in 2020 right before Thanksgiving, and I admit that holiday time is a difficult time for me. But, what continues to bring be joy are the memories of him carving the turkey every year. For those, who don’t know he was a surgeon who practiced in the Youngstown, Ohio area for years. So, every Thanksgiving, I was impressed by his precision of his turkey carving.

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Dr. Smith's ECG Blog

NOVEMBER 25, 2022

A 30-something male was involved in a single vehicle crash and had multiple injuries. As a routine part of his critical trauma evaluation, he had an ECG recorded: There is an rSR" in V1 and V2, with downsloping ST segment and inverted T-wave which is very similar to a Brugada Type 1 phenocopy. I was shown this ECG and thought that it could perhaps be Brugada, but I was more suspicious for Right Ventricular (RV) myocardial contusion.

EKG/ECG 52

EKG/ECG Fractures Hyperthermia / Hypothermia Wellness 52

Trigger Lab

NOVEMBER 22, 2022

Instructions for the reader: The text contains elements of the little experience I have. It can, therefore, be perfectly questionable, especially the units and data that emerged from literature. All ventilation settings are under medical supervision and approval (for lovers of nursing diagnosis, this is a collaborative problem). Since certain aspects are strongly linked to … Leggi tutto Noninvasive Ventilation: how to start?

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RebelEM

NOVEMBER 28, 2022

BACKGROUND: Direct oral anticoagulants (DOACs) such as rivaroxaban [Xarelto] and apixaban [Eliquis] have become more prevalent in the aging population and are associated with intracranial bleeding at rates up to 4.2%. (Xian 2019) 4-Factor Prothrombin Complex Concentrates (4F-PCC), or K-Centra, is a derivative of human plasma and is explicitly used to reverse vitamin K antagonists such as warfarin and non-specifically in the reversal of DOACs.

Outcomes 52

Outcomes Administration Hospitals EMS 52

Emergency Medicine Cases

NOVEMBER 22, 2022

In this EM Quick Hits podcast: Justin Morgenstern on fluids in pancreatitis, Leeor Sommer on nasal fractures, Christina Shenvi on delirium, Sheldon Cheskes and Rohit Mohindra on Dose VF, and Noor Khatib and Kari Sampsel on intimate partner violence. The post EM Quick Hits 44 Fluids in Pancreatitis, Nasal Fractures, Delirium, DOSE VF, Intimate Partner Violence appeared first on Emergency Medicine Cases.

Fractures 52

Fractures EMS Fluid Resuscitation Resuscitation 52

Medical Law

NOVEMBER 17, 2022

The power of nature is amazing. It’s hard to believe that a plant could be strong enough to damage a concrete sidewalk, but we see it happening all the time. Over time, steadily growing tree roots can extend underneath a sidewalk. As the roots grow and expand, they will eventually disrupt the surface of the sidewalk. This creates substantially uneven surfaces that may cause pedestrians to fall and be seriously injured.

Head Injuries 52

Head Injuries Fractures 52

American Medical Compliance

NOVEMBER 16, 2022

Healthcare worker violence is increasing at an alarming rate, making providers’ jobs of looking after patients incredibly challenging. The pandemic has largely fueled this increase in violence. The uptick in healthcare worker violence has been substantial and affects all types of care providers. Of registered nurses, 44% reported being victims of physical violence, while 68% suffered verbal abuse while on the job.

Hospitals 52

Hospitals 52

Dr. Smith's ECG Blog

NOVEMBER 23, 2022

Case submitted by Rachel Plate MD, written by Pendell Meyers A man in his 70s presented with chest pain which had started acutely at rest and has lasted for 2 hours. The pain was still ongoing at arrival. He also noted a bilateral "odd feeling" in his arms. He stated it was similar to prior heart attacks. He had history of prior MIs and CABG, as well as diabetes, hypertension, and hyperlipidemia.

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EKG/ECG Shock CPR Outcomes 52

EM SIM Cases

NOVEMBER 15, 2022

This case comes from Major Alex Koo. Since leaving the military, Dr. Koo works as an Emergency Physician and Assistant Professor of Emergency Medicine at MedStar Health and Georgetown University. He previously served as Deputy Medical Director at Andersen Simulation Center, the largest simulation center in the US Army as well as the Simulation Director for Madigan Army Medical Center’s Department of Emergency Medicine Residency.

COPD 52

COPD Military Emergency Department EMS 52

RebelEM

NOVEMBER 16, 2022

Take Home Points Methemoglobinemia can result from exposure to a number of different medications. The most common are dapsone and topical anesthetic agents (i.e. benzocaine) Consider the diagnosis in any patient with cyanosis and hypoxia that doesn’t respond to oxygen administration Administer methylene blue to any patient with abnormal vital signs, metabolic acidosis, end organ dysfunction or, a serum level > 25% REBEL Core Cast 90.0 – Methemoglobinemia Click here for Direct Download

Seizures 52

Seizures Administration Airway Management COPD 52

Trigger Lab

NOVEMBER 14, 2022

Oggi abbiamo il piacere di proporre un contributo offerto a Triggerlab da un caro collega, Sergio Calzari, che lavora nella terapia intensiva dell’Istituto Cardiocentro del Ticino, Lugano (CH). Sergio è impegnato nell’umanizzazione delle cure in terapia intensiva e nella ricerca di strumenti in grado di combattere la Post Intensive Care Syndrome (PICS).

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Board Bombs

NOVEMBER 13, 2022

Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here: emrapidbombs.supercast.com. What lurks beneath? Scary, scary infections. Time to change the way you think about Nec/Fas! Sobering stats, key pitfalls, but some really great learning points on this episode. Cite this podcast as: Briggs, Blake.

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The Skeptics' Guide to EM

NOVEMBER 12, 2022

Date: November 10th, 2022 Reference: de-Madaria E et al. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis (WATERFALL). NEJM 2022. Guest Skeptic: Dr. Salim R. Rezaie completed his medical school training at Texas A&M Health Science Center and continued his medical education with a combined Emergency Medicine/Internal Medicine residency at East Carolina University.

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Fluid Resuscitation Resuscitation Emergency Department Shock 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2022

Written by Bobby Nicholson MD, with edits by Meyers A woman in her 50s with past medical history of heart failure, prior stroke, atrial fibrillation on Eliquis, lung cancer in remission, and CKD, presented to the emergency department for evaluation of cough and shortness of breath. EKG was obtained in triage and read as ventricular bigeminy. What do you think?

EKG/ECG 52

EKG/ECG Stroke Emergency Department Wellness 52

Total Medical ComplianceHIPAA

NOVEMBER 10, 2022

HIPAA: True or False: If a practice has a website, a current copy of its HIPAA Notice of Privacy Practices (NPP) must be available there. True. The HIPAA Privacy Rule requires covered entities to post the current version of its NPP at a prominent location on their website. The Office for Civil Rights (OCR) clarified “prominent location” by providing two examples: Through a drop-down menu on the home page.

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Emergency Medicine Cases

NOVEMBER 8, 2022

While most of us have a clear algorithm in our minds for the management of life-threatening hyperkalemia, the same may not be said about the other life-threatening electrolyte abnormalities. In this ECG Cases blog Dr. Jesse MacLaren gives us an approach to potassium, calcium and magnesium abnormalities including risk factor assessment, ECG interpretation and management pearls.

EKG/ECG 52

EKG/ECG EMS 52

Dr. Mike Sevilla

NOVEMBER 8, 2022

Just wanted to encourage everyone to get out there and vote today. I know that the news usually says that it’s always, “The most important election in our lifetime,” at least until the next election. I just read a local news article saying that the local board of elections is only expecting about 60% turnout today. We have got to do better than that.

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Clinical Correlations

NOVEMBER 8, 2022

By Kathryn Hockemeyer Peer Reviewed I caught up with a friend who works in environmental, social, and corporate governance investing during a lull in the COVID-19 pandemic. Seconds into the conversation, he asked, “I hear the.

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EMCrit

NOVEMBER 2, 2022

Finally it is here. EMCrit Project by Scott Weingart, MD FCCM.

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Resuscitation 88

Dr. Smith's ECG Blog

NOVEMBER 13, 2022

Written by Emre Aslanger. Emre is a new Editor of the Blog. He is an interventionalist in Turkey. A 50 something-year-old man with a history of newly diagnosed hypertension and diabetes, for which he did not take any medication, presented a non-PCI-capable center with a vague, but central chest pain. His vitals were normal and his first ECG was as shown below: There is obvious ST segment elevation (STE) in anterior leads.

EKG/ECG 52

EKG/ECG Burns Documentation/Coding Hospitals 52

Ultrasound Gel

NOVEMBER 7, 2022

Another Bonus Cuts author interview - this time with Amy Zhou, Pediatric Emergency Medicine specialist and first author of the recently reviewed article on IVC collapse duration. Zach and Mike ask the hard questions about how this paper came to be and how we should be thinking about the IVC in our pediatric patients. [link] Another Bonus Cuts author interview - this time with Amy Zhou, Pediatric Emergency Medicine specialist and first author of the recently reviewed article on IVC collapse durat

Pediatrics 52

Pediatrics 52

Emergency Medicine Cases

NOVEMBER 8, 2022

Do not let a negative X-ray rule the day! Like almost all medical tests X-rays are far from perfect and should be ordered and interpreted only in the context of a thorough history and physical exam. In this 2nd part of our 2-part series on orthopedic x-rays with Dr. Arun Sayal and Dr. Yatin Chadha we discuss the pitfalls of obtaining and interpreting orthopedic X-rays, when orthopedic X-ray decision tools lead us astray, how understanding the concept of central ray helps dictate how we should or

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Ultrasounds EMS 52

Advanced Medical Reviews

NOVEMBER 7, 2022

It seems like just yesterday summer was on the scene, bringing warm weather, family vacations and an array of outdoor sporting activities. However, winter will be here soon, with the season starting in the Northern Hemisphere on December 21.

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The Skeptics' Guide to EM

NOVEMBER 5, 2022

Date: October 24, 2022 Guest Skeptic: Dr. Damian Roland is a Consultant at the University of Leicester NHS Trust and Honorary Professor for the University of Leicester’s SAPPHIRE group. He specializes in Pediatric Emergency Medicine and is a passionate believer and advocate of FOAMed. Damian is also part of the Don’t Forget the Bubbles team. […] The post SGEM Peds Xtra: Making Research Better, Faster, Stronger first appeared on The Skeptics Guide to Emergency Medicine.

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Research Pediatrics Wellness 52

EB Medicine

NOVEMBER 3, 2022

In this episode, Sam Ashoo, MD, interviews Ami Shah, MD, MPH, and Don Walker, MD, about eye injuries in the pediatric population. Why ocular injuries? Why did you pick this topic? What kind of injuries are included and at what age are they most common? Injury zones and terminology Differential Diagnosis What should we keep in mind when we are confronted with an ocular injury?

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Pediatrics Fractures EMS Outcomes 52

Dr. Smith's ECG Blog

NOVEMBER 11, 2022

Written by Pendell Meyers Family of an elderly woman with many comorbidities called EMS when she suddenly experienced shortness of breath, nausea, vomiting, and near syncope. She was alert and oriented and hypotensive with initial BP 70/50. A 12 lead ECG was obtained by EMS and is shown below: What do you think? There is sinus tachycardia (do not be fooled into thinking this is VT or another wide complex tachycardia!

EKG/ECG 52

EKG/ECG Shock EMS Documentation/Coding 52