Emergency Live
JANUARY 29, 2024
The Advent of Driverless Ambulances and Their Implications for the Healthcare System Innovation and Development in Driverless Ambulances Driverless ambulances represent a groundbreaking innovation in the field of healthcare. Autonomous driving technology is already finding applications in the transportation of medications and supplies within hospital complexes.
Emergency Medicine Cases
JANUARY 2, 2024
Based on a blend of number of listens, feedback from listeners, website visits and personal faves, EM Cases Best of 2023 Top 10. The post EM Cases Best of 2023 Top 10 appeared first on Emergency Medicine Cases.
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The Skeptics' Guide to EM
JANUARY 6, 2024
Reference: Remick KE, et al. National Assessment of Pediatric Readiness of US Emergency Departments during the Covid-19 Pandemic. JAMA Netw Open. July 2023 Date: Dec 11, 2023 Guest Skeptic: Dr. Rachel Hatcliffe is a pediatric emergency medicine attending at Children’s National Hospital in Washington, DC. Her research focuses on prehospital care of children with anaphylaxis. […] The post SGEM #425: Are You Ready for This?
Ken Grauer, MD
JANUARY 5, 2024
How would YOU interpret the tracing in Figure-1 — that was sent to me without additional information? QUESTIONS: What is the rhythm? Is there AV dissociation? If so — WHY? Clinically — HOW would you approach interpretation of this tracing in optimal time -efficient fashion? Figure-1: The initial ECG in today's case. KEY Clinical Point: If I was the medical provider charged with the care of the patient whose ECG is shown in Figure-1 — I would approach this tracing in the following sequential stag
Pediatric EM Morsels
JANUARY 19, 2024
If you have ever talked with a pediatric emergency medicine physician about some basic tenets of their practice, one of them will inevitably be, “ Never trust a neonate. ” The first few months of life outside the womb can elucidate a myriad of problems that were previously hidden during the prenatal state. We have previously touched on congenital issues like Congenital Adrenal Hyperplasia , Congenital Pulmonary Airway Malformation , Neonatal Leukemia , and of course there is always the Inconso
The Trauma Pro
JANUARY 11, 2024
The pendulum has swung from the use of whole blood in the early 20th century, to component therapy in the 1960s, and now a gradual move toward incorporating whole blood again. More and more papers are being published, and many trauma centers are looking for ways to integrate whole blood into their massive transfusion protocols. Much of the literature has been dedicated to safety and effectiveness, but little has examined thrombotic complications from its use.
Sensible Medicine
JANUARY 2, 2024
I am pleased to introduce Dr. Howard Luks. Howard is an Orthopedic Surgeon in Dobbs Ferry, NY. He authored Longevity Simplified , and works with athletes of all ages—with a focus on metabolic fitness and its role in musculoskeletal health. I’ve never met Howard in real life, but I feel like I know him. He was one of the early adopters of public writing—back in the “blogging” days.
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Emergency Medicine News
JANUARY 31, 2024
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Ken Grauer, MD
JANUARY 13, 2024
The ECG in Figure-1 was obtained from a middle-aged man with known hypertension — who presented to the ED ( E mergency D epartment ) for CP ( C hest P ain ) over the preceding 2-3 days. QUESTIONS: How would YOU interpret the ECG in Figure-1 ? Should you activate the cath lab? If not — What next? Figure-1: The initial ECG in today's case — obtained from a middle-aged man with CP for the past 2-3 days.
Science Based Medicine
JANUARY 8, 2024
The Wellness Company, promoted by Dr. Peter McCullough, is the product of a trend in which antivax doctors have predictably become just quacks. At least in this case, there is an amusing quack fight at the heart of it all. The post The Wellness Company: How antivaccine grift becomes plain old quackery first appeared on Science-Based Medicine.
The Trauma Pro
JANUARY 2, 2024
The use of elevated mean arterial pressure (MAP) to help manage spinal cord injury has been a mainstay of treatment for years. The concept is similar to that used for management of severe traumatic brain injury. The theory is that there may be areas of the brain that are damaged, but not irretrievably so. Increasing MAP should improve perfusion and may protect areas in jeopardy from secondary injury.
EM Ottawa
JANUARY 25, 2024
Mechanical ventilation has a lot of nuance associated with it, but a lot of reference guides focus on care in the ICU. There is certainly a need for more practical application for the ED doc or initial setup of patients on the vent. With both ER and ICU experience, this post acts as a quick […] The post Mechanical Ventilation Basics appeared first on EMOttawa Blog.
First 10 EM
JANUARY 15, 2024
We are once again buried in a wave of viral respiratory illnesses, and much of the burden of illness is still COVID. I did a pretty thorough review of all COVID antiviral therapies in 2022, both on First10EM and on the EMCases Journal Jam, but that was 2 years ago. I think most of us […] The post Paxlovid evidence: still very little reason to prescribe appeared first on First10EM.
Ken Grauer, MD
JANUARY 26, 2024
I was sent the ECG in Figure-1 — without the benefit of any history. QUESTION: What kind of AV block is present in Figure-1 ? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). MY Approach to Today’s Tracing: As always — I favor beginning assessment with a quick look at the long lead rhythm strips at the bottom of the tracing.
RebelEM
JANUARY 29, 2024
Background: Massive pulmonary embolism defined as sustained hypotension (SBP <90mmHg) has a high mortality which is why early recognition and thrombolytic therapy is typically recommended (AHA Class IIA; ESC Class IB) [1]. However, full-dose thrombolytic therapy (Alteplase 100mg (IV) is associated with an increase in bleeding [2]. Because the lungs receive 100% of cardiac output, it has been hypothesized that a lower dose of thrombolytic therapy may still be effective with a better safety
The Trauma Pro
JANUARY 12, 2024
In theory, tiered trauma centers should allow patients with lesser injuries to be treated at lower levels and more severe trauma at higher-level centers. This parallels the resource availability at those centers. In reality, many patients with injuries that seem complex (solid organ, children, and TBI) are transferred due to a “lack of comfort” in taking care of them or the perception that they may deteriorate quickly.
Sensible Medicine
JANUARY 16, 2024
Peter Marks, the director of the Center for Biologics Evaluation and Research at the FDA, and Robert Califf, the commissioner of the FDA published a “Viewpoint” article in JAMA on January 5th: Is Vaccination Approaching a Dangerous Tipping Point. The Viewpoint is short and certainly worth a read – probably before getting further in this essay.
Life in the Fast Lane
JANUARY 15, 2024
Sheralyn Guilleminot and Mike Cadogan Real-World Applications of Artificial Intelligence in Medicine Interview with critical care clinician, and AI enthusiast, Dr Sameer Shaikh on the many ways to use AI to save time and increase efficiency in healthcare
Stop and Think
JANUARY 14, 2024
Since Andrew Foy and I wrote our Case Against Coronary Artery Scans in an academic journal, the test has only increased in popularity. Grin. The imaging test measures the amount of calcium in the coronary arteries. It’s not covered by health insurers, but smart businesspeople have placed the cost at a manageable $100—which is only a fraction of what you’d be billed for a medical grade CT scan.
Ken Grauer, MD
JANUARY 20, 2024
I was sent the tracing shown in Figure-1 — told only that this was a preoperative ECG obtained from an asymptomatic older woman scheduled for non-cardiac surgery. How would YOU interpret this ECG? Would you approve her for surgery if the procedure was nonemergent? Figure-1: Preoperative ECG from an asymptomatic older woman scheduled for non-cardiac surgery.
RebelEM
JANUARY 18, 2024
Background: Sepsis remains one of the leading causes of morbidity and mortality. It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Time to antibiotic therapy (from triage, not from onset of infection) has become a quality metric to improve the time to administration of these medications. In an effort to administer antibiotics earlier, many studies have attempted to give antibiotics in the prehospital setting but the benefit of this int
The Trauma Pro
JANUARY 4, 2024
Venous thromboembolism (VTE) after trauma in adults has generated a considerable body of literature for guidance. However, there is much less information available regarding pediatric trauma. High-risk criteria for pediatric VTE after trauma have recently been released. These criteria have not yet been evaluated prospectively or coupled with the administration of chemoprophylaxis.
EMCrit
JANUARY 11, 2024
Should DSI become the new standard? EMCrit Project by Scott Weingart, MD FCCM.
Don't Forget the Bubbles
JANUARY 29, 2024
A UK-based study found that 4% of admissions to a tertiary paediatric intensive care unit (PICU) over a 10-year period were due to refractory status epilepticus (RSE) – seizures which fail to terminate despite appropriate first and second-line treatments. Of those patients admitted with RSE, a subset will go on to develop super-refractory status epilepticus (SRSE).
Dr. Smith's ECG Blog
JANUARY 20, 2024
Written by Pendell Meyers A man in his late 30s with history of hypertension, tobacco use, and obesity presented to the Emergency Department for acute chest pain which started approximately 3 hours prior to arrival, in the setting of a very stressful situation. The pain radiated down both arms, 10/10 in severity. He stated it did not feel like his prior episodes of reflux.
Stop and Think
JANUARY 31, 2024
Randomized clinical trials are the best way to know what works in medicine. While medical interventions (drugs or devices) remain the same, situations often change. One of the cool things that our Cardiology Trials substack project (Andrew Foy and Mohammad Ruzieh and I are cataloging the seminal trials) is teaching me, is that medications/devices proven effective in trials decades ago, may no longer have benefit now.
RebelEM
JANUARY 25, 2024
Background: Point-of-care ultrasound (PoCUS) is a valuable clinical tool in the assessment of acute dyspnea. It can be used to distinguish between various conditions, including chronic obstructive pulmonary disease (COPD) exacerbation, acute heart failure (AHF), pleural effusion, pulmonary edema, pericardial effusion, pneumothorax, and pneumonia [2,3].
The Trauma Pro
JANUARY 25, 2024
Yesterday, I described how the typical automated oscillometric blood pressure cuff works. We rely on this workhorse piece of equipment for nearly all pressure determinations outside of the intensive care unit. So the obvious question is, “is it accurate?” Interestingly, there are not very many good papers that have ever looked at this! However, this simple question was addressed by a group at Harvard back in 2013.
EMCrit
JANUARY 22, 2024
background: ANTHARTIC trial Prophylaxis against VAP (ventilator associated pneumonia) has is already supported by a few studies in the literature, perhaps most notably the ANTHARTIC trial. That was a multi-center RCT evaluating 48 hours of therapy with ampicillin-sulbactam for patients intubated following cardiac arrest. Antibiotic therapy reduced early-onset VAP, with a trend towards more ventilator-free […] EMCrit Project by Josh Farkas.
Science Based Medicine
JANUARY 29, 2024
A couple of weeks ago, I discussed why antivax quacks' claimed biological mechanisms for COVID-19 vaccine "shedding" reminded me of homeopaths. Confabulation about fantastical scientific mechanisms continues, courtesy of "A Midwestern Doctor." The post Antivax quacks are continuing to make up fantastical biological mechanisms for COVID-19 vaccine “shedding” first appeared on Science-Based Medicine.
PulmCCM
JANUARY 29, 2024
AHA Updates its Cardiac Arrest Guidelines In December 2023, the American Heart Association published a “focused update” to its landmark guidelines for the management of cardiac arrest. PulmCCM is not affiliated with the American Heart Association. Read the document for all the details (it’s not long). Here’s PulmCCM’s take on the new changes.
St. Emlyn
JANUARY 13, 2024
St.Emlyn's - Emergency Medicine #FOAMed Virchester (the home of St Emlyn’s) is a large conurbation that suffers from many of the issues that affect large urban populations in the western world. One part of that […] The post JC: Intubation for the low GCS tox patient. St Emlyn’s appeared first on St.Emlyn's.
Sensible Medicine
JANUARY 22, 2024
Two quick stories as background. I remember caring for an older man who presented with a minor heart attack. We got him squared away easily. I was then struck by his history because more than a decade ago, doctors discovered severe multi-vessel coronary disease and they had recommended bypass surgery. They told him he would die without it. He refused.
The Trauma Pro
JANUARY 22, 2024
The blood pressure cuff is one of those devices trauma professionals don’t give a second thought to. Old timers like me remember using the cuff with a sphygmomanometer and stethoscope to get manual blood pressures. I’ve had to do this twice in recent months on airplanes, and I had forgotten how much work this is. But technology makes things easier for us.
EMCrit
JANUARY 1, 2024
background and general concept My research project in fellowship was the construction of a mathematical model to convert VBG values into ABG values. The fundamental concept for the model was pretty simple: we can approximate the respiratory quotient (RQ) of tissue in the hand as being constant. This indicates that changes in oxygen content and […] EMCrit Project by Josh Farkas.
Science Based Medicine
JANUARY 23, 2024
Many chiropractors continue to claim that vertebral subluxations can affect organ function by interfering with nerve flow in spinal nerves, a view that is scientifically indefensible. The post Chiropractic Subluxation Theory: Science or Gobbledegook? first appeared on Science-Based Medicine.
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