June, 2021

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Journal Jam 18 The Evidence for TXA – Should Tranexamic Acid Be Routine Therapy in the Bleeding Patient?

Emergency Medicine Cases

With the help of a special guest, EBM guru Dr. Ken Milne of the The SGEM, Anton and Justin look at all the various potential indications for TXA and review the available evidence. Should we be using TXA for epistaxis, postpartum hemorrhage, hyphema or hemoptysis? Is it a miracle drug that stops all bleeding? Or has it been drastically overhyped? Was CRASH-2 enough to be definitive, or does the classic EBM mantra of "we need more studies" remain true?

EMS 52
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How Independent Medical Reviews Benefits Patients, Payers and the Health Care System

Advanced Medical Reviews

The Affordable Care Act (ACA) was enacted in 2010 with three primary goals. First, to make affordable health insurance available to more people; second, to expand the Medicaid program to cover all adults with income below 138% of the federal poverty level; and third, to support innovative medical care delivery methods designed to lower the costs of health care generally.

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Who Is Liable for Injuries at a Rental Home?

Medical Law

Airbnb and other vacation rental companies have become an increasingly popular way for people to rent out vacation homes, and more people than ever are flocking to the California coast. With the growing usage of these rental companies, there are more injuries than ever before — and these incidents raise important questions about liability that don’t factor into most vacation plans: if a renter is injured while staying at someone else’s home, who is at fault — the renter or the owner?

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Acute behavioural disturbance

PHEM Cast

Definitions UK definition (RCEM): It describes the sudden onset of aggressive and violent behaviour and autonomic dysfunction, typically in the setting of acute on chronic drug abuse or serious mental illness. Australian definition (NSW Health): Behaviour that puts the patient or others at immediate risk of serious harm and may include threatening or aggressive behaviour, extreme distress, and serious self-harm which could cause major injury or death.

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Tom Jones at 81, sings about aging on his new album

CasesBlog

NPR and Bob Boilen | June 7, 2021: "We're publishing this Tom Jones Tiny Desk (home) concert on his 81st birthday. It's a poignant moment in the life of a singer whose career spans 56 years and more than 100 million records sold; the passing of his wife, Linda, in 2016 after 59 years of marriage was devastating and resulted in the longest break between recordings of his career.

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Scribe Meta-analysis | PCN Allergy Swaps | Post-LP HA | ESBL, CRE, DTR-P | HEART Score Woes

JournalFeed

It’s the JournalFeed Podcast for the week of Jun 21-25, 2021. We cover the benefit of scribes, choosing alternative antibiotics in penicillin allergic patients, how to prevent post-LP headache, treating highly resistant gram-negatives, and more problems with the HEART score.

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OMG, TMI! What does open notes mean for you and your patients?

Downeast Emergency Medicine

This lecture was presented at the 2021 Maine Medical Center Winter Symposium. For more information on the symposium click here. In April 2021, provisions against “information blocking” in the 21st Century Cures Act will take effect. For the first time, patients will have easy digital access to their chart in real time via their patient portal. This change was largely driven by the “Open Notes” movement.

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Tasty Morsels of Critical Care 046 | Abdominal Compartment Syndrome

Emergency Medicine Ireland

Welcome back to the tasty morsels of critical care podcast. This week we’re looking at the other ACS, the surgical ACS, the old abdominal compartment syndrome. This is common, especially in the surgical population and does not always immediately jump. Read More » Welcome back to the tasty morsels of critical care podcast. This week we’re looking at the other ACS, the surgical ACS, the old abdominal compartment syndrome.

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113. Saddle up: Pulmonary Embolism

Board Bombs

Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here: [link] Sometimes when a shift gets tough you just need to saddle up and make a diagnosis…. funny enough saddle PE’s are quite rare…. so let’s dispel the myths and cover what you NEED to know about PEs. Want to experience the greatest in board studying?

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Middlescence = time between adolescence and senescence

CasesBlog

Middlescence is defined as the time between adolescence and senescence. "It is a paradox of life that we do not begin to live until we begin to die. Death begins at thirty, that is, deterioration of the muscle cells sets in." [link] From the video below: Life begins at 40: the biological and cultural roots of the midlife crisis | The Royal Society. In this lecture, Professor Mark Jackson, winner of the 2018 Wilkins-Bernal-Medawar Medal, explores a rich range of historical sources to argue that t

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POCUS Dyspnea | FQ+Aortic Disease | ASA-only Cervical Arterial Dissection? | CARPE DIEM | BASICS RCT

JournalFeed

It’s the JournalFeed Podcast for the week of Jun 14-18, 2021. We cover POCUS for acute dyspnea, risk of fluoroquinolones in known aortic disease, aspirin or oral anticoagulants for cervical arterial dissection, predicting pneumonia severity in children, and endovascular therapy for basilar artery occlusion stroke.

Stroke 52
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Step-by-step Guide to the Independent Medical Review Process

Advanced Medical Reviews

Most businesses have established processes and procedures to ensure employees follow the correct sequence of steps that results in high-quality products or services. Providers of independent medical reviews (IMRs) are no different.

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ECG Cases 22: T-wave INVERSION mnemonic

Emergency Medicine Cases

The differential for T-wave INVERSION includes: Incorrect lead placement, No bundle (RBBB, LBBB), Ventricular hypertrophy (LVH, RVH), Embolism, Reciprocal/refractory/reperfused occlusion MI, Sudden death (ARVD), Iatrogenic (digoxin), Obtunded (eg SAH), and Normal variant. Jesse McLaren runs through 10 cases of patients who present to the ED who have T-wave inversions on their ECGs.

EKG/ECG 52
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The Emergency Department Admitting Team: A Crisis Response to an Unprecedented Surge of Critically Ill Patients During COVID-19

EM Updates

Maimonides Medical Center (MMC) is Brooklyn’s largest hospital, an academic quaternary care center with, in normal times, 711 total beds, 66 intensive care beds, and an Emergency Department that treats approximately 120,000 patients per year. On March 9, the first patient with a novel coronavirus infection was admitted to MMC. At its peak, on April 9, there were 471 patients with confirmed or suspected COVID-19 admitted to the hospital, with 139 patients designated to be occupying a critical car

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Tasty Morsels of Critical Care 045 | Chemical Biological Radiological and Nuclear exposures

Emergency Medicine Ireland

Welcome back to the tasty morsels of critical care podcast. Oh dedicates an entire chapter, number 88 to CBRN issues. While not commonly seen you can rest assured that critical care will be expected to turn up and manage these. Read More » Welcome back to the tasty morsels of critical care podcast. Oh dedicates an entire chapter, number 88 to CBRN issues.

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How to give a talk/present a lecture - by MIT/Patrick Winston

CasesBlog

Some goods points in the video below. Quality = f (K P t) -- explained at beginning: Patrick Winston's How to Speak talk has been an MIT tradition for over 40 years. Offered every January, the talk is intended to improve your speaking ability in critical situations by teaching you a few heuristic rules. 00:16 - Introduction 03:11 - Rules of Engagement 04:15 - How to Start 05:38 - Four Sample Heuristics 10:17 - The Tools: Time and Place 13:24 - The Tools: Boards, Props, and Slides 36:30 - Informi

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Antibiotic Use Sepsis | HEART-EDACS | ED-AWARENESS | Thoracentesis+Coagulopathy | Difficult Airway

JournalFeed

It’s the JournalFeed Podcast for the week of Jun 7-11, 2021. We cover overuse of antibiotics for ED sepsis alerts, HEART or EDACS with hs-cTn 0-1 hour rule outs, ED-AWARENESS - paralysis awareness after RSI, thoracentesis or chest tubes in coagulopathic patients, and a review on managing the difficult airway.

Sepsis 52
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LBBB: Using the (Smith) Modified Sgarbossa Criteria would have saved this man's life

Dr. Smith's ECG Blog

Case submitted and written by Dr. Jesse McLaren (@ECGcases), of Emergency Medicine Cases Reviewed by Pendell Meyers and Steve Smith An 85yo with a history of hypertension developed chest pain and collapsed, and had bystander CPR. The paramedics found the patient with ROSC and a GCS 7, and an ECG showing LBBB with possible lateral ST elevation. The patient was brought to the ED as a possible Code STEMI and was seen directly by cardiology.

EKG/ECG 52
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EM Quick Hits 29 Vasopressor Failure, Asplenic Considerations, Bronchiolitis Update, ICD Electrical Storm, Night Shift Tips

Emergency Medicine Cases

In this month's EM Quick Hits podcast: Anand Swaminathan on vasopressor failure, Brit Long and Michael Gottlieb on aspleic considerations, Sarah Reid on a bronchiolitis update and evolving patterns in the COVID era, Hans Rosenberg and Lindsay Cheskes on ICD electrical storm, Justin Morgenstern on night shift tips. The post EM Quick Hits 29 Vasopressor Failure, Asplenic Considerations, Bronchiolitis Update, ICD Electrical Storm, Night Shift Tips appeared first on Emergency Medicine Cases.

EMS 52
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Not a Stab in the Dark - Mastering the Ultrasound Guided Peripheral IV

Downeast Emergency Medicine

This lecture was presented at the 2021 Maine Medical Center Winter Symposium. For more information on the symposium click here. Key concepts for Ultrasound Guided IV placement LENGTH Always use long IV (1.88 inches) catheters or it will pull out of the vessel. FLASH Do NOT look for flash, you should watch the needle all the way into the vessel to ensure your location.

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Tasty Morsels of Critical Care 044 | Calcium Disorders

Emergency Medicine Ireland

Welcome back to the tasty morsels of critical care podcast. It is with trepidation that I approach any topic that involves the negative feedback loops of endocrine control as I really struggle to keep it all straight in my head, Read More » Welcome back to the tasty morsels of critical care podcast. It is with trepidation that I approach any topic that involves the negative feedback loops of endocrine control as I really struggle to keep it all straight in my head, but today I’m going to t

Sepsis 52
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SGEM#333: Do you gotta be starting something – like tPA before EVT?

The Skeptics' Guide to EM

Date: May 25th, 2021 Guest Skeptic: Dr. Garreth Debiegun is an emergency physician at Maine Medical Center in Portland, ME and clinical assistant professor with Tufts University School of Medicine. He also works at an urgent care and a rural critical access hospital. Garreth is interested in wilderness medicine and is the co-director of the […] The post SGEM#333: Do you gotta be starting something – like tPA before EVT?

Stroke 52
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SpO2 Black Patients | AHA Opioid OHCA | EMS Ped C-spine | CTA Penetrating Neck | Podcasts While Driving

JournalFeed

It’s the JournalFeed Podcast for the week of May 31 - Jun 4, 2021. We cover pulse oximeter inaccuracies in Black patients, the AHA statement on opioid-associated OHCA, EMS predictors of c-spine injury, usefulness of CTA to diagnose aerodigestive tract injury in penetrating neck trauma, and the efficacy of listening to educational podcasts while driving vs with no distractions.

EMS 52
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How to Know If a Pool Is Safe

Medical Law

As the weather heats up, a lot of us are looking forward to fun get-togethers over the summer months. Backyard barbeques, visits to the beach, family road trips, and lots of pool parties. While “going to the pool” conjures up visions of fun with family and friends, it is important for everyone to keep pool safety in mind before going in for that swim.

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Episode 58 – Syncope – An Interview With Dr. James Morris

EB Medicine

EMplify - June 2021 Announcements: The Clinical Decision Making in the Emergency Department conference is June 23-27 live and virtual. More information here: [link] Be on the lookout for an announcement regarding the new EB Medicine app, coming to an App Store near you this summer !! Syncope- An Interview With Dr. James Morris See the EB Medicine Article @ [link] Why syncope?

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Ep157 Neuromuscular Disease for Emergency Medicine

Emergency Medicine Cases

There is a long list of rare neuromuscular diseases. Nonetheless, there are a few that you are likely to see in the ED, that are relevant to Emergency Medicine because they require timely diagnosis and treatment. In this Part 2 of our 2-part series on acute motor weakness with Roy Baskind and George Porfiris, we keep it short and simple by limiting our discussion to the key clinical clues and management strategies of two of the more common acute life-threatening neuromuscular diseases, myastheni

EMS 52
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ECG of the Week 9th June 2021 Interpretation

EMergucate

86 year old male with a background of CRF, PPM and AF presents to ED with SOB Answer Rate: Ventricular … Continue reading →

EKG/ECG 52
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Tasty Morsels of Critical Care 047 | Haemostatic failure

Emergency Medicine Ireland

Welcome back to the tasty morsels of critical care podcast. This week we’ll make a fly by at part of Oh Chapter 100 looking at haemostatic failure. The understanding of the haemostatic system seems a little like the universe at. Read More » Welcome back to the tasty morsels of critical care podcast. This week we’ll make a fly by at part of Oh Chapter 100 looking at haemostatic failure.

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Ischemic ST depression maximal in V1-V4 (vs. V5-V6), even if less than 0.1 millivolt, is specific for Occlusion Myocardial Infarction (vs. subendocardial non-occlusive ischemia)

Dr. Smith's ECG Blog

This is a case from many years ago that I discovered recently. The patient has heart failure as a result of this event. A 50-something man with history only of alcohol abuse and hypertension (not on meds) presented with sudden left chest pain, sharp, radiating down left arm, cramping, that waxes and wanes but never goes completely away. There was SOB at the start and increased work of breathing.

EKG/ECG 52
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SGEM#335: Sisters are Doin’ It for Themselves…Self-Obtained Vaginal Swabs for STIs

The Skeptics' Guide to EM

Date: June 25th, 2021 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and assistant Professor at the University of Calgary. He is also an avid FOAM supporter/producer through various online outlets including TheSGEM. Reference: Chinnock et al. Self-obtained vaginal swabs are not inferior to provider-performed endocervical sampling for emergency department diagnosis of Neisseria gonorrhoeae and Chlamydia […] The post SGEM#335: Sisters are Doin’ It for Themselves…Self-Obtained Vag

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Ludmir – Evolution of Cardiac Critical Care

University of Maryland CC Project

Dr. Jona Ludmir, critical care cardiologist at the Corrigan Minehan Heart Center ICU at Mass General and instructor of medicine at Harvard Medical School presents on the evolution of cardiac critical care. Dr. Jona Ludmir, critical care cardiologist at the Corrigan Minehan Heart Center ICU at Mass General and instructor of medicine at Harvard Medical School presents on the evolution of cardiac critical care.

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"No Doctor Visit Required - Order Your Own Lab Test" - Quest Diagnostics Google Ad

CasesBlog

Quest Labs is actively advertising on Google with "No Doctor Visit Required - Order Your Own Quest® Lab Test". Anyone can order their own lab test at Quest and LabCorp, including test for COVID antibodies, HIV, etc: [link] [link] This is not new, it but it is still not widely utilized in clinical practice. The likely reason is that the cost of the tests must be paid out of pocket as most insurers do not cover it.

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ECG of the Week – 16th June 2021 – Interpretation

EMergucate

You’re reviewing a 44 year old obese patient whose wife has noticed that he is breathing abnormally at night time.

EKG/ECG 52
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Nurses Make Care Happen

ER Nurses

As the slow incremental reforms in the American healthcare system amble forward, within the change lies great opportunity. In seeking to avert the collision course of an aging chronically ill population with a financial burden to maintain the current system, policy makers have had to reflect and discover a hitherto unrealized fact: nurses are the backbone of the health care system.

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Still Alive!

EM Literature of Note

While the blog has become a bit sparse – owing to the demands of a new environment down in New Zealand – I’ve got plenty of new content to share. I’m still writing bimonthly for ACEP Now : Should We Use New Blood Test to Rule Out TBI? Insights from the Pediatric Emergency Care Applied Research Network Then, every month there’s a new Annals of Emergency Medicine Journal Club : Stop the MABness!

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SGEM#334: In My Life there’s been Earache and Pain I don’t know if it’s IBI again – in an Afebrile Infant with Acute Otitis Media

The Skeptics' Guide to EM

Date: June 11th, 2021 Guest Skeptic: Dr. Dennis Ren is a paediatric emergency medicine fellow at Children’s National Hospital in Washington, DC. Reference: McLaren SH, et al. Invasive bacterial infections in afebrile infants diagnosed with acute otitis media. Pediatrics 2021 Case: You are working with a medical student at the emergency department when a 2-month-old boy is […] The post SGEM#334: In My Life there’s been Earache and Pain I don’t know if it’s IBI again – in an Afebrile Infant with A

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Patel – Nutrition Therapy in Critical Illness: Why, When, Where, and What do I Feed my Critically Ill Patient?

University of Maryland CC Project

Dr. Jayshil Patel, MD, Associate Professor of Pulmonary, Critical Care and Sleep Medicine at the Medical College of Wisconsin, discusses nutrition therapy in critical illness. Dr. Jayshil Patel, MD, Associate Professor of Pulmonary, Critical Care and Sleep Medicine at the Medical College of Wisconsin, discusses nutrition therapy in critical illness.

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