Mount Sinai EM
AUGUST 7, 2024
Ultrasound during cardiac arrest has quickly become standard. Initially, data suggested that the use of ultrasound during arrest increased pauses between compressions which worsens outcomes. To decrease time between compressions, many protocols were proposed (see here ). One such protocol that successfully decreased time between compressions is the CASA (Cardiac Arrest Sonographic Assessment) protocol.
The Trauma Pro
AUGUST 16, 2024
And another law to end the first week! Any time I give a pediatric talk, I mention it. This one applies to anyone who takes care of children, and is particularly important to EMS / prehospital providers and emergency physicians. On occasion, medics are called to a home to treat a child in extremis, or occasionally in arrest. Similarly, extremely sick children are often brought to the ED by parents or other caregivers.
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Pediatric EM Morsels
AUGUST 9, 2024
Neonates presenting to the Emergency Department often cause a lot of uncertainty. Is this scalp swelling normal? Is this bloody stool concerning? Are this odd movements part of normal development? Is that umbilical area ok or concerning? Fortunately, we have addressed many neonatal issues in the PedEMMorsels. Obviously, one of the most concerning considerations in neonates is the potential for infection.
Science Based Medicine
AUGUST 26, 2024
This week, Stanford University announced a conference on pandemic policy that features several of the usual suspects who spread misinformation during the COVID-19 pandemic. Truly, Stanford has become the "respectable" academic face of efforts to undermine public health. The post Stanford University will host a conference on pandemic planning featuring the usual (COVID-19) suspects first appeared on Science-Based Medicine.
Sensible Medicine
AUGUST 3, 2024
Last week Adam Cifu and Vinay Prasad offered dueling interpretations of a randomized trial of masking. These posts were read by nearly a hundred thousand readers, and you can read them below. One reader, Ben Recht, a Berkeley Professor, thinks both of them are wrong. This is his column. Sensible Medicine Adam Cifu is Wrong About Masking In a recent post on Sensible Medicine, written on my phone while traveling, I criticized a randomized trial of masking in the BMJ that found Norweigans told to w
EMCrit
AUGUST 26, 2024
We often joke that the right ventricle is the “forgotten ventricle,” but there is a sad truth behind this joke. Recently, there has been increased recognition of the importance of right ventricle failure and systemic congestion within some circles (e.g., nephrologists and resuscitationists). However, overall the right ventricular failure continues to be commonly overlooked.
Dr. Smith's ECG Blog
AUGUST 26, 2024
A 60-something woman with no cardiac history presented with epigastric and right upper quadrant pain after eating spicy food. She had an ECG recorded at triage: What do you think? This was sent to me without any info while I was out and about, and I looked at it on my phone. I responded: "That is a tough one. V2 is very worrisome. But no other leads are.
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Pediatric EM Morsels
AUGUST 2, 2024
It’s never comfortable and is often very distressing to have skin problems and infections, such as intertrigo , folliculitis , panniculitis , omphalitis , or even preseptal or periorbital cellulitis. It’s even more distressing when the skin problem affects the penis. While summer is starting to wind down, and Summer Penile Syndrome is less likely to occur, we must still be vigilant for penile problems that can occur all year long.
Science Based Medicine
AUGUST 31, 2024
I trust you'll have the intellectual integrity to play videos of these speakers. Anything less, would be misinformation and censorship. The post An Open Letter to the President of Stanford, Jonathan Levin: Don’t Censor Drs. Scott Atlas, John Ioannidis, Sunetra Gupta, Marty Marky, Monica Gandhi, Jay Bhattacharya, and Vinay Prasad. Amplify Their Voices. first appeared on Science-Based Medicine.
Sensible Medicine
AUGUST 4, 2024
Editors note: a shortened version of this post was originally submitted to the New England Journal, but it was rejected. Refusing to host debates is why journals will die. By Joseph Marine, MD In a recent NEJM Perspective piece , Drs. Mullen, Topol, and Verghese argue “in support of institutional voices” to take public positions on matters of public controversy “when it concludes that a faculty member’s opinion could cause public harm.” Their essay (ironically publi
Emergency Medicine Cases
AUGUST 19, 2024
We over-admit low risk acute heart failure patients and under-admit high risk heart failure patients. In this podcast we discuss the diagnostic accuracy of various clinical features, lab tests and imaging modalities for acute heart failure, the 3 validated risk stratification tools and a simple approach to PoCUS for the diagnosis and prognostication of acute heart failure in the ED to improve our diagnostic accuracy and disposition decisions for patients with acute heart failure.
Dr. Smith's ECG Blog
AUGUST 2, 2024
Written by Willy Frick A 50 year old man with no medical history presented with acute onset substernal chest pain. His ECG is shown below. Pretty obvious anterior current of injury. This was a machine read STEMI positive OMI. Readers of this blog can easily appreciate the hyperacute T waves in the precordium, clearest in V1-V4. What would you guess is the culprit artery?
The Trauma Pro
AUGUST 27, 2024
Here’s the last one… for now. If you have followed this blog for any period of time, you are aware of the skepticism I bring to bear when I am reading new material or learning of new ideas. Why is this? Because it is very difficult in this day and age to ascertain the veracity of anything we see, hear, or read. This is not new compared to, say, a hundred years ago.
St. Emlyn
AUGUST 1, 2024
St.Emlyn's - Emergency Medicine #FOAMed "Time Critical: Information Light" decision-making is vital in emergency medicine, requiring swift actions with minimal data. However, uncertainty decreases over time as more information becomes available. This model highlights the importance of making high-stakes decisions promptly, avoiding premature or delayed interventions.
Science Based Medicine
AUGUST 21, 2024
It’s interesting to follow the scientific exploration of a new clinical entity in real time. It reveals a lot about how medical science works, and how scientists nibble away at complex problems. This is partly why I have been closely following the story of long COVID as it has unfolded over the last few years. I also see patients with long COVID […] The post More on Long COVID first appeared on Science-Based Medicine.
Sensible Medicine
AUGUST 12, 2024
I would like to live a long life. Surely you do as well. You can improve your chances by eating well, exercising, avoiding smoking and too much alcohol. There is also the matter of luck. The question today is whether modern medical screening can improve on those basic lifestyle choices. People believe it can, obviously. The screening industry is a money-making machine.
Stop and Think
AUGUST 28, 2024
One area continues to dominate my field of cardiology. It is the search for and treatment of ischemic heart disease. Coronary heart disease dominates the minds of patients and doctors alike. Find blockages so they can be fixed before a heart attack or death occurs—goes the thinking. Coronary artery scans are the newest tool. But stress labs run days and weekends.
Dr. Smith's ECG Blog
AUGUST 4, 2024
Written by Pendell Meyers Try first to interpret the ECG without any clinical context: What do you think? Sinus rhythm with abnormal STE in V2-V6, and I, II, aVF. Reciprocal STD in aVR and V1. Most leads with STE have remarkably non-hyperacute, flat T waves. Most would say that there is Spodick's sign. The PR depression in II (and its reciprocal PR elevation in aVR) is probably beyond normal baseline values.
The Trauma Pro
AUGUST 12, 2024
Let’s get started with the Laws of Trauma! After pursuing any discipline for an extended period, one begins to see the common threads and underlying principles of their area of expertise. I’ve been trying to crystallize these for years, and today I’m going to share one of the most basic laws of trauma care. The First Law of Trauma Any anomaly in your trauma patient is due to trauma, no matter how unlikely it may seem.
ACEP Now
AUGUST 12, 2024
Every once in a while, I get a text from a friend of a meme decrying the inevitability of becoming interested in birds as you age. In a way, it’s true; it came out of nowhere for me. And granted it can seem peculiar to the uninitiated. But now that I have been indoctrinated for a couple of years, it has become much more than a hobby to me. I see it as a healthful exercise, a practice in mindfulness.
Science Based Medicine
AUGUST 25, 2024
Dr. Vinay Prasad started treating vaccine side effects as a fate worse than death in February 2021, before these was a COVID vaccine for children. The post Dr. Vinay Prasad Opposed The Pediatric COVID Vaccine Before There Was A Pediatric COVID Vaccine first appeared on Science-Based Medicine.
Life in the Fast Lane
AUGUST 11, 2024
Jeremy Rogers and Chris Moseley High Flow Nasal Cannula
Sensible Medicine
AUGUST 17, 2024
A few years ago, a colleague of mine was applying for, and eventually received, a grant to study lung cancer screening in a vulnerable population. One day, we were having coffee, and she mused. “Look at these 20 year old tech start up people. 8 of them living in a house. Spending day and night coding. All dreaming that they will make it big. It’s sad to watch, knowing how few will succeed.
Dr. Smith's ECG Blog
AUGUST 16, 2024
Written by Pendell Meyers A man in his 60s presented with acute chest pain and normal vital signs. Here is his triage ECG: What do you think? The ECG shows massively hyperacute T waves of LAD OMI, plus WPW. V3-V5 also have the depressed HATW takeoff which qualifies them as the rare de Winter subtype of HATWs. Its hard to measure the STE in I exactly with the moving baseline, but there is almost certainly not enough STE to meet STEMI criteria.
The Trauma Pro
AUGUST 21, 2024
All trauma professionals need to keep up with the current thinking in their field. There are a variety of ways to do this, including lectures, courses, online curricula, meetings, and reading journal articles. The last method requires a bit of skill and patience. Many research papers are dry, long, and hard to read. Quite a few people do not have the patience to wade through them, and get lost in all the details.
ACEP Now
AUGUST 13, 2024
The inclusion of diversity, equity, and inclusion (DEI) principles in undergraduate medical education is considered crucial for creating a just and fair health care system. Though DEI education, including critical race theory and its derivatives, is still a topic of public debate, many industry specialists and educators believe that it forms the foundation of high quality health care practices and the achievement of health equity.
Science Based Medicine
AUGUST 24, 2024
Dr. Jay Bhattacharya and the merging of political pandemic narratives The post Great Barrington Declaration Author Joins COVID-19 Lab Leak-Pushing Group first appeared on Science-Based Medicine.
Emergency Medicine Cases
AUGUST 19, 2024
ECG artifact and lead reversal can mimic tachy-arrhythmia, infarct or Brugada. Learn how to identify these errors to prevent misdiagnosis on this month's ECG Cases with Dr. Jesse McLaren. The post ECG Cases 51 – Artifact and Lead Misplacement appeared first on Emergency Medicine Cases.
Sensible Medicine
AUGUST 16, 2024
I’d been certain that all would be well in medicine in the age of AI. I had been telling myself that the addition of AI to medical practice would be a net positive. AI would assist with some of the drudgery that is part of every doctor’s job. We would also incorporate AI into our decision making. AI would help us read X-rays or pathology specimens.
Dr. Smith's ECG Blog
AUGUST 18, 2024
Written by Pendell Meyers A man in his 70s presented with history of pacemaker presented with shortness of breath with exertion and presyncope. Here is his triage ECG with minimal symptoms: What do you think? The ECG shows pacemaker failure with inability to capture or sense, with either underlying atrial fibrillation or junctional escape rhythm. The QRS shows LVH and there are diffuse ST-T abnormalities likely in part appropriate for the LVH, though memory T waves are also a consideration.
The Trauma Pro
AUGUST 14, 2024
Trauma patients don’t always behave the way we would like. They continually surprise us, sometimes for the better when they recover more quickly and completely than we thought. But sometimes it’s for the worse. They occasionally crash when we think everything is going so well. The crashing patient is in obvious need of help and most trauma professionals know what to do.
American Medical Compliance
AUGUST 27, 2024
According to Rock Health , digital health funding still totaled $15.3 billion in 2022, despite economic challenges. This figure underscores the critical role technology continues to play in healthcare, particularly in advancing access and equity. As healthcare providers, organizations, and policymakers increasingly recognize the persistent disparities in health outcomes across different populations, technology is emerging as a powerful tool to bridge these gaps.
Science Based Medicine
AUGUST 8, 2024
Hypocritical articles on politics and medicine weren't really about politics and medicine, they were a message- the standards we set for you, don't apply to us and everyone knows it. The post The Hypocrisy Is The Point. Doctors Who Said Not To Mix Politics & Medicine. first appeared on Science-Based Medicine.
NRC Health
AUGUST 22, 2024
NRC Health announces the acquisition of leading healthcare rounding technology company Nobl and a new strategic partnership with customer and employee experience management leader Medallia. The post NRC Health announces Nobl acquisition & Medallia partnership to advance healthcare experience innovation appeared first on NRC Health.
Sensible Medicine
AUGUST 11, 2024
When I was a resident, I worked 7 nights of 12 hour shifts alternating with 7 days of 14 hour shifts. The jet lag was like flying to Moscow. I also worked 28 hour shifts Q4 (on paper), which actually ran as high as 32-36 hours (in reality). Often, I was tired. Whether or not residents need to work long hours, and what they do during that time is an open debate.
Dr. Smith's ECG Blog
AUGUST 6, 2024
Written by Magnus Nossen with Edits by Grauer and Smith The ECGs in today’s case are from 3 different patients all presenting with new-onset CP ( Chest Pain ). All ECGs were recorded by EMS, and transferred to a PCI capable center for evaluation. For 2 of the 3 patients — the cath lab was activated based on the ECG. One of the patients was lucky to have expert ECG interpretation by the Queen Of Hearts AI model.
The Trauma Pro
AUGUST 19, 2024
Here’s another one. I’ve seen the clinical problems and poor outcomes that can arise from ignoring it many times over the years. You’ve ordered a CT or a conventional x-ray image. The result comes back in your EMR. You take a quick glance at the summary at the bottom of the report. No abnormal findings are listed. So now, in your own mind and in any sign-outs that you provide, the image is normal.
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