The Trauma Pro

OCTOBER 22, 2024

Today’s post is directed to all those prehospital trauma professionals out there. Car crashes account for a huge number of injuries worldwide. About 40% of people involved are trapped in the vehicle. And unfortunately, entrapped individuals are much more likely to die. There are four basic groups (and their category in parentheses) of trapped car occupants : those who can self-extricate or extricate with minimal assistance (self-extrication) individuals who cannot self-extricate due to pai

EMS 264

EMS 264

Ken Grauer, MD

OCTOBER 25, 2024

The ECG in Figure-1 was obtained from a middle-aged man who presented with a 2 week history of progressively increasing CP ( C hest P ain ) with exertion. He had his most severe episode of CP the day before he was seen with this ECG. His CP was much less compared to the day before — but it had not yet completely resolved. An initial Troponin drawn less than 1 hour after the ECG in Figure-1 was recorded was over 10,000.

EKG/ECG 236

EKG/ECG Shock Hospitals 236

Mount Sinai EM

OCTOBER 10, 2024

The Case: A woman in her twenties with no significant medical history presents with one month of progressive frontal headaches radiating to her occiput. Her headaches have been intermittent, however over the past few days she has had a few episodes of vomiting and brief episodes of blurred vision. Her headache is 8/10 currently. Last emesis and blurred vision were both 12 hours prior.

Urgent Care 232

Urgent Care Ultrasounds 232

Sensible Medicine

OCTOBER 20, 2024

In a world where doctors are increasingly treated like cogs in a machine, the question arises: Would you recommend your son or daughter pursue the field? Recently, I saw this poll: I said ‘unsure’, but that is just a fragment of what I think. Here is my answer (leave yours in the comments). My answer is: it depends on who is asking. I would strongly encourage you to pursue medicine if… Your primary goal in a career is using your talents to improve the well being of others.

Wellness 142

Wellness Hospitals 142

Science Based Medicine

OCTOBER 2, 2024

Just recently, in casual conversation, someone commented to me that “they” already have a cure for cancer but are hiding it. This is a claim I frequently encounter. One survey, from 2005, found that 27.3% of those surveyed endorsed this belief. Another survey from 2014 found that 37% of people believe the FDA is suppressing natural cancer cures on behalf of “Big […] The post Conspiracy Thinking And Alternative Medicine first appeared on Science-Based Medicine.

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Dr. Smith's ECG Blog

OCTOBER 20, 2024

Written by Magnus Nossen The patient in today's case is a male in his 70s with hypertension and type II diabetes mellitus. His wife contacted the ambulance service after the patient experienced an episode of loss of consciousness. The syncope lasted about 2-3 minutes according to his wife. He woke up alert and with chest pain which he also had experienced intermittently over the previous few days.

EKG/ECG 132

EKG/ECG Shock Emergency Department Ambulance Services 132

The Trauma Pro

OCTOBER 29, 2024

CT scans are commonly used to aid the workup of patients with blunt trauma. They are occasionally useful in penetrating trauma, specifically when penetration into a body cavity is uncertain, and the patient has no hard signs that would send him or her immediately to the operating room. Is there any role for CT in operative penetrating trauma, after the patient has already been to the OR?

Operations 199

Operations Fractures Radiology Radiology 199

American Medical Compliance

OCTOBER 31, 2024

A survey reveals that falls are the most frequent health issue affecting seniors in long-term care facilities. Interestingly, while 90% of caregivers feel confident in implementing fall prevention measures, only 60% have adequate knowledge to do so effectively. As the aging population grows, so does the demand for specialized healthcare tailored to the unique needs of seniors and individuals with disabilities, posing new challenges and responsibilities for healthcare providers.

Best Practices 105

Best Practices Outcomes Patient Safety Wellness 105

Sensible Medicine

OCTOBER 15, 2024

It is my pleasure to introduce this article by Joseph Marine, MD in response to mandatory masking policies in a number of California hospitals. There is simply no randomized evidence to support these policies, and they make little sense in 2024. I worry about the mental abilities of the public health officers who instituted these policies, and that their actions will further erode trust in public health.

Hospitals 138

Hospitals Wellness 138

Science Based Medicine

OCTOBER 11, 2024

It doesn't bode well for the future that "leaders" of major American institutions look at naked emperors and compliment them on their beautiful clothes. The post The President of Stanford Wants Us To Debate Which Number is Larger, 9 or 133 first appeared on Science-Based Medicine.

Wellness 133

Wellness 133

Dr. Smith's ECG Blog

OCTOBER 3, 2024

This was sent to me from Sam Ghali ( @EM_Resus ) with no other information. I assumed it was a patient with acute chest pain. "What do you think, Steve? Real or just fake?" What do YOU think? It has some inferior ST elevation with some reciprocal ST depression and inverted T in aVL. This usually indicates inferior OMI. My answer: "Fake: pretty certain, but not 100% certain.

EKG/ECG 127

EKG/ECG Wellness 127

The Trauma Pro

OCTOBER 18, 2024

All trauma centers admit some of their patients to nonsurgical services. This usually occurs when patients have medical comorbidities that overshadow their injuries. Unfortunately, the decision-making that goes into balancing the medical versus trauma issues is not always straightforward. The fear is that if trauma patients are inappropriately placed on a nonsurgical service, mortality and morbidity may be higher because their injuries may not receive adequate attention.

Documentation/Coding 147

Documentation/Coding Emergency Department Hospitals 147

EM Ottawa

OCTOBER 31, 2024

Delirium is a medical emergency. It is characterized by acute disturbance of consciousness, with changes in perceptual disturbances and fluctuation of symptoms. Delirium is often the initial manifestation of an underlying acute illness and can be present before fever, tachypnea, tachycardia, or hypoxia. There is an ED prevalence ranging from 7-24%, with increased mortality rates […] The post Delirium revisited appeared first on EMOttawa Blog.

Infectious Diseases 122

Infectious Diseases EMS 122

St. Emlyn

OCTOBER 9, 2024

St.Emlyn's - Emergency Medicine #FOAMed Day one report of the Annual Scientific Conference of the Royal College of Emergency Medicine #RCEMASC #FOAMed @stemlyns The post RCEM ASC 2024. appeared first on St.Emlyn's.

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Sensible Medicine

OCTOBER 16, 2024

Dr. Satel is a bit of a regular here on Sensible Medicine. Today she returns to a topic that she wrote about in January 2023 , changing our organ donation laws to increase organ availability. Adam Cifu Sensible Medicine is a reader-supported publication. If you support our work, consider becoming a free or paid subscriber. What if we could solve the organ donor shortage with a simple tax credit?

Operations 125

Operations Research 125

Science Based Medicine

OCTOBER 18, 2024

WWTI doctors' cared only about infecting unvaccinated children with SAR-CoV-2, and they were willing to blatantly contradict themselves and make things up achieve this goal. The post Dr. Sunetra Gupta Versus Dr. Sunetra Gupta first appeared on Science-Based Medicine.

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Dr. Smith's ECG Blog

OCTOBER 8, 2024

This was sent to me by a reader who wishes to remain anonymous. A lady in her 60s came to the ER with chest discomfort and shortness of breath. She had a history of previous anterior MI treated by primary PCI to the proximal LAD. The first EKG is from 2:30 PM on the day of presentation to the ER. Smith : To me this is a blatantly obvious acute anterior OMI.

EKG/ECG 126

EKG/ECG Documentation/Coding Shock Resuscitation 126

The Trauma Pro

OCTOBER 1, 2024

In this day and age of ride-sharing apps like Uber and Lyft, it is possible to get a cheap ride virtually anywhere there is car service and a smartphone. And, of course, some people have used these services for transportation to the hospital instead of an ambulance ride. What might the impact of ride services on patient transport be for both patient and EMS?

Ambulance Services 130

Ambulance Services EMS Hospitals 130

The Skeptics' Guide to EM

OCTOBER 5, 2024

Date: October 2, 2024 Reference: Paxton et al. Headpulse measurement can reliably identify large-vessel occlusion stroke in prehospital suspected stroke patients: Results from the EPISODE-PS-COVID study. AEM Sept 2024 Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the UMass Chan Medical School – Baystate.

Stroke 113

Stroke EMS Outcomes Research 113

St. Emlyn

OCTOBER 22, 2024

St.Emlyn's - Emergency Medicine #FOAMed This post accompanies the podcast “Simulation for Elite Team Performance,” which was recorded live at the Tactical Trauma 2024 conference in Sundsvall, Sweden. We are grateful to the organizing team […] The post Podcast – Simulation for Elite Team Performance with Andrew Petrosoniak at Tactical Trauma 2024 appeared first on St.Emlyn's.

Emergency Department 112

Emergency Department 112

Sensible Medicine

OCTOBER 2, 2024

This post continues yesterday’s. If you have not read Part I, I suggest you read it first. Adam Cifu Sensible Medicine is a reader-supported publication. Please consider becoming a free or paid subscriber. There was a time when, right or wrong, there was a consensus within medicine regarding what kind of person would make a good doctor. It was believed that being a doctor meant you had to remember a great number of obscure things, and so we designed tests that heavily weighted memorization

Academics 125

Academics Wellness 125

Science Based Medicine

OCTOBER 31, 2024

The organization scapegoated by the lab leak-promoting GOP-led House Covid subcommittee publishes its defense The post EcoHealth Alliance Fights Back first appeared on Science-Based Medicine.

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Dr. Smith's ECG Blog

OCTOBER 15, 2024

This was sent to me by an undergraduate name Hans Helseth, who is an EKG tech, but who is an expert OMI ECG reader. He wrote most of it and I (Smith) edited. A prehospital “STEMI” activation was called on a 75 year old male ( Patient 1 ) with a history of hyperlipidemia and LAD and Cx OMI with stent placement. He arrived to the ED by helicopter at 1507, about three hours after the start of his chest pain while chopping wood around noon.

EKG/ECG 119

EKG/ECG Hospitals Wellness 119

The Trauma Pro

OCTOBER 25, 2024

Earlier this year, I wrote a series of posts on the two commonly used pelvic fracture interventions: preperitoneal packing (PPP) and angioembolization (AE). To sum up, both are equally effective in controlling hemorrhage, but the hospital costs for patients undergoing angioembolization are significantly less. This is probably because there is no need to perform repeated operations to insert and remove the preperitoneal packs when angiography is used.

Fractures 113

Fractures Head Injuries Operations Ultrasounds 113

Life in the Fast Lane

OCTOBER 30, 2024

Casey Parker and James Rippey Ultrasound Case 112 A 30 year old woman who is currently 30 weeks gestation presents to the ED with abrupt, severe right loin pain.

Ultrasounds 111

Ultrasounds 111

American Medical Compliance

OCTOBER 14, 2024

Assisted living facilities are a lifeline for elderly and vulnerable individuals who need care and support in a safe, nurturing environment. Yet, even in these compassionate settings, caregivers often face the challenge of managing aggressive behaviors among residents. Imagine the case of Mrs. Stevens, a once gentle and kind woman who, after the onset of dementia, began exhibiting sudden outbursts of anger.

Wellness 105

Wellness Operations Outcomes 105

Sensible Medicine

OCTOBER 10, 2024

I appreciate this essay for its reframing of our debates about cancer screening; viewing them through an ethical lens. The speculation that we might eventually be able to identify individuals harmed by radiographic screening and how this would alter our approach is both intriguing and alarming. Adam Cifu Sensible Medicine is a reader-supported publication.

Hospitals 121

Hospitals Wellness 121

Science Based Medicine

OCTOBER 4, 2024

Dying of COVID is worse. The post If Dr. Jay Bhattacharya Saw What I Saw, He’d Realize That Being Called “Fringe” Isn’t So Bad After All first appeared on Science-Based Medicine.

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Dr. Smith's ECG Blog

OCTOBER 12, 2024

Written by Bobby Nicholson What do you think of this “STEMI”? A man in his 90s with a history of HTN, CKD, COPD, and OSA presented to the emergency department after being found unresponsive at home. With EMS, patient had a GCS of 3 and was saturating 60% on room air. He improved to 100% with the addition of non-rebreather, however remained altered and was intubated by EMS with ketamine and succinylcholine.

EKG/ECG 119

EKG/ECG Documentation/Coding Emergency Department COPD 119

The Trauma Pro

OCTOBER 11, 2024

I’ve written many posts in the past about the arguments surrounding chest tube size: large bore vs. small bore (pigtail). For the longest time, only a few decent papers were looking into this debate, and subject numbers were small. The best the papers could say was that “small-bore chest tubes are not inferior to large-bore tubes.” Not that this is not the same as saying, “small-bore tubes are better than large-bore tubes.” But finally, after more than ten years, th

Hospitals 113

Hospitals 113

EM Ottawa

OCTOBER 7, 2024

Methodology: 2.5/5 Usefulness: 3.5/5d Gaudreau-Simard M, et al. Ultrasound J. 2024 Feb 22;16(1):15. doi: 10.1186/s13089-023-00352-3. Question and Methods: The authors aimed to determine the test characteristics of point-of-care ultrasonography (POCUS) for detecting hydronephrosis in acute kidney injury. Findings: From 65 patients, POCUS had a sensitivity of 85% (95% CI 71-94%), specificity of 78% (95% CI […] The post Test characteristics of point-of-care ultrasonography in patients with ac

Ultrasounds 110

Ultrasounds 110

RebelEM

OCTOBER 2, 2024

Take Home Points Toxic alcohols generally refer to methanol and ethylene glycol as these substances pose significant metabolic derangement and end-organ damage. Patient who present shortly after ingestion will simply look inebriated – no different than ethanol intoxication. At this point, patients will have an elevated osmolar gap and little to no anion gap.

EMS 108

EMS 108

Sensible Medicine

OCTOBER 28, 2024

The study of the week will take a short break. I head to Curitiba Brazil tomorrow for the Brazilian EP society meeting. I have five lectures. I will be back next week. And there will be plenty of studies to choose from because we are entering the fall season of medical meetings. This week, Sensible Medicine features a guest column from Zachary R. Caverley, a Cardiology Physician Assistant working in the Northwest coast of Oregon.

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Science Based Medicine

OCTOBER 23, 2024

A recent meta-analysis of eye movement desensitization and reprocessing (EMDR) therapy concludes that the evidence “confirms” EMDR is effective in treating depression. It is a great example of the limitations of meta-analysis, and how easy it is to create essentially a false narrative using poor quality research. EMDR was “developed” by Dr.

Research 119

Research 119

Dr. Smith's ECG Blog

OCTOBER 1, 2024

== MY Comment , by K EN G RAUER, MD ( 8/30 /2024 ): == I was sent the ECG shown in Figure-1 — knowing only that the patient was being seen in the ED ( E mergency D epartment ). How would you interpret this tracing? Figure-1: The initial ECG in today's case. MY Initial Thoughts: In my experience — all-too-many emergency providers fail to appreciate the potential contribution that a brief ( 1-to-2 line ) history may convey when interpreting arrhythmias.

EKG/ECG 116

EKG/ECG Shock EMS 116

Emergency Medicine Cases

OCTOBER 1, 2024

In this ECG Cases blog we look at 5 cases of ECGs falsely labeled 'normal'. Can you spot the critical abnormality? Written by Jesse McLaren; Peer Reviewed and edited by Anton Helman. October 2024 Five patients presented with ECGs labeled ‘normal’. Can you use systematic ECG interpretation to identify the [.] The post ECG Cases 51 – ECGs falsely labeled “normal” appeared first on Emergency Medicine Cases.

EKG/ECG 108

EKG/ECG EMS 108

First 10 EM

OCTOBER 21, 2024

I love toxicologists, but it’s time for someone to call them out. (I also love ranting. Let’s see if I can get myself cancelled by a group of physicians that are definitely smarter than me.) I am sick of the anti-science rhetoric. Every time a toxicologist takes the stage at a conference, or grabs the […] The post Toxicology: the excuses must stop appeared first on First10EM.

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