December, 2022

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Lisfranc Injury

Mount Sinai EM

Summary Summary The Lisfranc joint is made of the first four metatarsals, cuneiforms and cuboid and associated ligaments A Lisfranc injury is any disruption of the joint The mechanism of injury (axial load on plantarflexed foot, rotational force, crush injury) should increase suspicion for this injury Familiarize yourself with the normal foot x-ray as findings for a Lisfranc injury can be subtle Management depends on the severity of injury and should involve a discussion with your orthopedic sur

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EMCrit RACC Lit Review for December 2022

EMCrit

All the resus/acute critical care literature goodness for December 2022. EMCrit Project by Scott Weingart, MD FCCM.

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Five Best Practices for IV Medication Administration Safety 

PDC Healthcare

Healthcare professionals are faced with many obstacles while administering IV medication to patients, which can lead to medical errors and a risk for patient safety. Nearly 40% of medical errors take place during medication administration as it is one of the most intricate processes for healthcare staff. It is critical to ensure the 5 rights […].

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2022 Highlights: Helping you put Human Understanding into practice

NRC Health

NRC Health appreciates the opportunity to guide you in trends and competitive insights to help you engage your patients and employees to drive loyalty and retention. The post 2022 Highlights: Helping you put Human Understanding into practice appeared first on NRC Health.

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Dental Waterlines Found to Contain Bacteria

American Medical Compliance

A number of dental waterlines have been found to contain waterborne bacteria, infecting children with nontuberculous Mycobacteria (NTM). This caused the Centers for Disease Control and Prevention (CDC) to issue a health advisory on bacteria in the pipes of dental facilities. Dental Waterlines and Infections. Biofilms containing bacteria can easily develop in dental waterlines.

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7d vs 14d of Antibiotics in Afebrile Men with UTI

RebelEM

Background: Urinary tract infection (UTI) is one of the most common reasons for anti-microbial use (Tan, 2016). However, the optimal treatment duration for UTI in men is not well studied, and current practice guidelines are based on historical dogma. One clinical trial demonstrates that afebrile UTI can be treated successfully with antibiotics for seven days in women, but that seven days is inferior to 14 days during short-term follow-up and non-inferior during long-term follow-up (van Nieuwkoop

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How to Land the Best Travel Nursing Job Ever

Core Medical Group

Editor's Note: This post was originally published in April 2017 and has been updated for accuracy and comprehensiveness. These 3 simple lessons will help you land the best travel nursing job ever – whether it’s your first time or fifteenth time!

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157. Alcohol Withdrawal: What are you doing New Year's Eve?

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. Happy Holidays and New Year’s to our listeners! Thank you for what you do for your patients each day. We appreciate you listening. We decided to re-publish one of our most popular episodes from 2022 as a throw-back.

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30-something woman with a HEART score of zero, EDACS of 2, computer "Normal" ECG, and initial troponin < Limit of Detection

Dr. Smith's ECG Blog

I was working in triage very late when a 30 yo previously completely healthy woman walked in with 30 minutes of central chest pressure. This ECG was recorded: The computer called it "Normal" except for "Possible right ventricular conduction delay" What do you think? I immediately recognized an inferior-posterior-lateral OMI. There are hyperacute T-waves in II, III, and aVF.

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ECG of the Week 21st December 2022

EMergucate

This ECG was obtained from a 22 year old man who had taken a polypharmacy overdose 24 hours ago. He had suffered a bradycardic / asystolic arrest and is currently in the intensive care unit.

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WTBS 28 I’m OK, How Are You? How can we innovate our way out of this crisis in EM and cope until we do?

Emergency Medicine Cases

In this month's Waiting to Be Seen blog Dr. Howard Ovens outlines challenges, innovations and coping strategies in the EM Crisis. The post WTBS 28 I’m OK, How Are You? How can we innovate our way out of this crisis in EM and cope until we do? appeared first on Emergency Medicine Cases.

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Discover Interim Healthcare Management

Core Medical Group

The job market has been a whirlwind in recent years, so it’s likely affected you in one way or another if you’re in a management or director-level position within the healthcare industry.

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EMCrit 338 – End of Year Question & Answer Session

EMCrit

Rounding up the questions from the past few months. EMCrit Project by Scott Weingart, MD FCCM.

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Cybersecurity Threats to Health Systems

American Medical Compliance

Cybersecurity threats against healthcare systems have increased since the beginning of the COVID-19 pandemic due to the adoption of new health technologies. During 2020, cyberattacks against health systems increased by forty-seven percent. Adopting stronger security measures will be essential to protecting patient data moving forward. Causes of Increased Cybersecurity Threats.

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See OMI vs. STEMI philosophy in action

Dr. Smith's ECG Blog

by Emre Aslanger Dr. Aslanger is our newest editorial member. He is an interventional cardiologist in Turkey. Dr. Aslanger is also the author of the DIFFOCULT study: Emre K. Aslanger , a, ⁎ Özlem Yıldırımtürk , b Barış Şimşek , c Emrah Bozbeyoğlu , c Mustafa Aytek Şimşek , a Can Yücel Karabay , b Stephen W. Smith , d and Muzaffer Değertekin a DIFOCCULT: DIagnostic accuracy oF electrocardiogram for acute coronary OCClUsion resuLTing in myocardial infarction.

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Ultrasound vs Landmark Subclavians

Ultrasound Gel

This episode has been a long time coming! We're talking ultrasound-guided subclavian central lines, and a lot of people have opinions. Are they better than landmark? What should we teach learners? The GEL team discusses through the lens of this fascinating RCT. [link] [link] This episode has been a long time coming! We're talking ultrasound-guided subclavian central lines, and a lot of people have opinions.

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ECG Cases 38 – ECG Interpretation in Cocaine Chest Pain

Emergency Medicine Cases

Dr. Jesse McLaren discusses some key aspects of cocaine chest pain ECG interpretation in this month's blog including: Patients with cocaine-associated chest pain require benzodiazepines +/- nitroglycerine for symptom relief, aspirin and ECG to look for signs of occlusion and reperfusion. In patients with chest pain + ST elevation, consider false positive STEMI including early repolarization, LVH and Brugada-pattern.

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Pro-MEDIC

The Bottom Line

In adults with an expected ICU stay of > 72 hours, does the provision of enteral melatonin compared to placebo increase the number of delirium-free assessments within 14 days or before ICU discharge?

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EMCrit 339 – Decisions, Decisions, Decisions with Andrew Petrosoniak

EMCrit

Making good decisions is the heart of Emergency Medicine and Critical Care. EMCrit Project by Scott Weingart, MD FCCM.

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156. Aortic Dissection: On a Tear

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. It lives in our nightmares. On this special holiday episode, Blake and Iltifat share the pearls and pitfalls of aortic dissection presentation, diagnosis, and management. You won't want to miss this high yield year's end conclusion.

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SGEM386: Blood on Blood – Massive Transfusion Protocols in Older Trauma Patients

The Skeptics' Guide to EM

Date: December 16th, 2022 Reference: Hohle et al. Massive Blood Transfusion Following Older Adult Trauma: the Effect of Blood Ratios on Mortality. AEM December 2022 Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. She is also the wonderful educator that creates the Paper in a Pic infographics summarizing each SGEM episode.

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Right Bundle Branch Block and Posterior OMI????

Dr. Smith's ECG Blog

This 39 year old patient presents with syncope. What do you think? There appears to be RBBB with excessively discordant ST depression (2-2.5 mm) in V2 and V3, suggestive of RBBB with posterior OMI Whenever you see abnormal ST-T (ST elevation, ST depression, hyperacute T-waves), you MUST look at the entire ECG (rhythm, rate, P-waves, intervals, and QRS) to see if there is some abnormality among these which can explain the ST-T.

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Ep 177 Bronchiolitis – Diagnostic Challenges and Management Pitfalls

Emergency Medicine Cases

In this main episode podcast Anton discusses with world expert and bronchiolitis researcher Dr. Suzanne Schuh, the challenges of the diagnosis and management of bronchiolitis during a time of crisis in pediatric emergency medicine and offers some evidence-based solutions to improving outcomes while minimizing valuable resources, as part of our 'Best of University of Toronto EM' series.

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Pediatric Collab preview: Support employees and deliver better care

NRC Health

The NRC Health 2023 Pediatric Collaborative is truly a can’t-miss experience, with exceptional presentations that will stir innovative ideas. The post Pediatric Collab preview: Support employees and deliver better care appeared first on NRC Health.

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EMCrit 340 – End of Year Round-Up on Surgical Critical Care Tips and Remimazolam with Joe Shiber and Sean Rees

EMCrit

For this last podcast of the year, I had a couple of pieces that were going to become Wees, but I thought I would combine them for synergistic goodness and make this end-of-year podcast. Today, we speak about some tips from a EM Surgical Intensivist and discussion of a brand new sedative, Remimazolam. EMCrit Project by Scott Weingart, MD FCCM.

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Why You Shouldn’t Settle Until You’re 100% Medically Stable

Medical Law

When you’ve suffered serious injuries caused by somebody’s careless behavior, you’ll probably want to resolve the matter quickly. After all, you have other things to focus on — overcoming the trauma, getting back to work, and resuming your daily activities. There’s a natural desire to finalize the legal process and start putting your life back together.

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ECG of the Week 14th December 2022

EMergucate

The following ECG was obtained in a 38 year old Indigenous man with a history of ischaemic cardiomyopathy at a regional hospital. He did not have a history of left bundle branch block previously.

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A man in his 50s with acute chest pain and LVH

Dr. Smith's ECG Blog

Sent by Drew Williams, written by Pendell Meyers A man in his 50s with history of hypertension was standing at the bus stop when he developed sudden onset severe pressure-like chest pain radiating to his neck and right arm, associated with dyspnea, diaphoresis, and presyncope. EMS arrived and administered aspirin and nitroglycerin. He reported several weeks of intermittent chest pain similar to the active pain, worsening over the past 2-3 days, some of them as long as an hour, but all spontaneou

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Does Spine Surgery Have a Role in Low Back Pain? - Clinical Correlations

Clinical Correlations

By: Michael Moore Peer Reviewed “Too many complex back surgeries are being performed and patients are suffering as a result” wrote National Public Radio health science journalist Joanne Silberner in her 2010 article “Surgery May Not.

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REBEL Core Cast 92.0 – Perichondritis

RebelEM

Take Home Points Perichondritis is an infection of the cartilage and connective tissue of the ear Perichondritis can be recognized clinically by erythema, swelling and tenderness of the auricle. The most common organism in perichondritis is P. aeruginosa and antibiotics should be tailored to cover this organism REBEL Core Cast 92.0 – Perichondritis Click here for Direct Download of the Podcast Background Perichondritis may appear to be a simple cellulitis of the ear but, in fact, it repres

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Understanding the Fifth Revolution as a key competitive advantage

NRC Health

Health organizations that are already overwhelmed by challenges must find a way to implement simple but systematic tools that will support a deep transformation from transactions to transcendental relations.  The post Understanding the Fifth Revolution as a key competitive advantage appeared first on NRC Health.

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Influenza

EB Medicine

In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the December 2022 Evidence-Based Urgent Care article on Influenza in Urgent Care. Epidemiology Historical data Since COVID, tracking "influenza-like illness" has been complicated Influenza deaths and age Annual mortality  Outbreaks Transmission Classification Influenza A, B, and C Hemagglutinin and neuraminidase subgroups Antigenic drift and shift Pathophysiology Transmission Incubation Secondary infection H3N2 Vaccines Egg-based,

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155. RSV Overload: High Flow

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. Is your ED crowded? Sick of the RSV? Let’s review with an expert Pediatric EM specialist and our Lead Editor on PEM, Dr. Shad Baab! We will set you straight. Want to experience the greatest in board studying?

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On its way from occlusion to reperfusion (or vice versa), the ECG can be normal or near normal

Dr. Smith's ECG Blog

Written by Pendell Meyers I was reading ECGs in a database (without any clinical information) when I came to this one: What do you think? Seeing only this ECG with no context, I thought this ECG was within normal limits. The upright and large T wave in V1 is unusual, but if it were hyperacute, I did not see reciprocal findings in V6 which would be concerning for LAD OMI pattern (we call that "precordial swirl").

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Carrying Loss During The Holidays

Dr. Mike Sevilla

What a beautiful day here in northeastern Ohio. It was a crisp 39 degrees at Beaver Creek State Park today as we hiked close to sunset. This hike really reminded me of the time when my father was sick two years ago. In the past few weeks, I’ve seen on by feed that there are many of my Facebook friends have experienced loss with the passing of a family member recently.

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SGEM#385: If the Bones are Good, the Rest Don’t Matter – Operative vs Non-Operative Management of Scaphoid Fractures

The Skeptics' Guide to EM

Date: November 30th, 2022 Reference: Johnson et al. One-year outcome of surgery compared with immobilization in a cast for adults with an undisplaced or minimally displaced scaphoid fracture: A meta-analysis of randomized controlled trials. Bone Joint J 2022 Guest Skeptic: Dr.Matt Schmitz is an Orthopaedic Surgeon specializing in Adolescent Sports Medicine and Young Adult Hip Preservation. […] The post SGEM#385: If the Bones are Good, the Rest Don’t Matter – Operative vs Non-Operative Management

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TEAM

The Bottom Line

Early Active Mobilization during Mechanical Ventilation in the ICU @chodgsonANZICRC @TEAMtrialICU. NEJM 2022; 387:1747-58 doi:10.1056/NEJMoa2209083 Clinical Question In mechanically ventilated adult patients does the provision of early mobilisation when compared to standard care increase the number of days alive and out of hospital at 180 days?