January, 2025

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Direct Oral Anticoagulant (DOAC) Reversal: Part 3

The Trauma Pro

In my last two posts, I reviewed some older papers on the efficacy of Andexxa (andexanet alfa) for the reversal of Factor Xa inhibitor anticoagulants. Those results were not very impressive, especially considering the high cost of this drug. In 2021, an article was published (reference 1) that performed a systematic review of the literature from 2017 to 2020.

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The willful blindness of RFK Jr’s supporters

Science Based Medicine

Shrug, move on and never admit you were wrong The post The willful blindness of RFK Jrs supporters first appeared on Science-Based Medicine.

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Torsade in a patient with left bundle branch block: is there a long QT? (And: Left Bundle Pacing).

Dr. Smith's ECG Blog

By Smith with comments from our electrophysiologist, Rehan Karim. (And of course Ken's comments at the bottom) An elderly obese woman with cardiomyopathy, Left bundle branch block, and chronic hypercapnea presented hypoxic with altered mental status. She was intubated. Bedside cardiac ultrasound showed moderately decreased LV function. CT of the chest showed no pulmonary embolism but bibasilar infiltrates.

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Is RFK Jr to blame for the Samoa measles outbreak? An empirical analysis of published scholarly papers and news stories

Sensible Medicine

Just out, we have a new paper on a provocative question. What factors were blamed for the 2019 Samoa measles outbreak in the peer reviewed literature and news coverage? At the time, and now 5 years later? Subscribe now First, we assembled every single peer reviewed article and mainstream media news story on the Samoa measles outbreak. 163 studies met our criteria.

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Emergency Evidence Updates – December 2024

The Bottom Line

Whats new in the Critical Care literature monthly updates

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Post-Tonsillectomy Hemorrhage: A Three-Pronged Approach

ACEP Now

Its 4 a.m., and youre three hours from the nearest tertiary care center. A young woman, 13 days post-tonsillectomy, comes into your rural emergency department (ED) coughing up blood. On exam, you see bright red blood trickling down her left tonsillar fossa. Her vital signs are normal, except for a heart rate of 115 bpm. Its going to take time to get her to a tertiary center.

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Journal update monthly top five

Emergency Medicine Journal

This month’s update is by the Emergency Department of the University Hospital of Heraklion, Crete, Greece. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlighted each paper’s main findings, key limitations and clinical bottom line.

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Acute chest pain with LBBB and obvious OMI, worsening on serial ECGs, but repeatedly missed by physicians and Marquette 12SL

Dr. Smith's ECG Blog

This was written by Hans Helseth. He just graduated from college. He has no medical training, but he has read this blog for years. He is an ECG tech who hopes to go to medical school. He has never been poisoned by the STEMI/NSTEMI paradigm because he has never been to medical school. Lucky Hans. You don't need to have medical training to recognize OMI on the ECG.

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Seed Oils: Real Harm or Just Another Food Fear Fad?

Sensible Medicine

Two health obsessions that I’ve never really understood are the supposed benefits of vitamin D (for every imaginable ill) and harm of seed oils. Dr. Bobby Dubois thinks a lot about the evidence behind health recommendations on his podcast. His research has led him to a pretty clear opinion about the role of seed oils in health and disease. Attentive Sensible Medicine readers will note that his take is a bit different from that expressed in a recent post.

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Critical Care Evidence Updates – December 2024

The Bottom Line

Whats new in the Critical Care literature monthly updates

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The Death of Critical Thinking in Emergency Medicine

ACEP Now

In recent years, emergency medicine, once the bastion of quick decision making, clinical acumen, and patient-centered care, has been quietly succumbing to a different forcethe slow but steady erosion of critical thinking. The culprit is the increasing reliance on protocolization and the diminishing autonomy of emergency physicians. This shift, intended to standardize care and mitigate error, is paradoxically undermining the very heart of medicinethe doctors ability to think critically, adapt to

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Pre Hospital Extracorporeal CPR (ECPR) in the UK: The Sub30 study

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed This feasibility study described the delivery of ECMO CPR (ECPR) for the first time in the UK The post Pre Hospital Extracorporeal CPR (ECPR) in the UK: The Sub30 study appeared first on St.Emlyn's.

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To Spread Mistrust, Dr. Martin Kulldorff Asks RFK Jr. to do an Unethical, Impossible RCT of Vaccines He Knows Are Safe & Effective

Science Based Medicine

Once again, sheltered laptop-class doctors are treating children's health as a parlor game to advance their political objectives. The post To Spread Mistrust, Dr. Martin Kulldorff Asks RFK Jr. to do an Unethical, Impossible RCT of Vaccines He Knows Are Safe & Effective first appeared on Science-Based Medicine.

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Online QT calculator for wide QRS (LBBB, RBBB, etc.)

Dr. Smith's ECG Blog

(This was created by Arron Pearce ( [link] ) Online QT calculator for wide QRS (LBBB, RBBB, etc.

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A Very Tepid Defense of the Physical Exam

Sensible Medicine

Doctors of a certain age tend to fetishize the physical exam. I think this is because learning the physical exam is an important part of the socialization of the doctor. It is also a skill that doesn’t really wither with time. Though with every passing day I feel more and more like part of the old guard, I can only give the exam a tepid defense.

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These are the ‘Roids you are looking for – Steroids in the ED

EM Ottawa

In the acute care setting, steroids have various usages and indications, but their usage can often be nuanced. From adrenal crises to septic shock, severe community-acquired pneumonia, and even acute pharyngitis, steroids play a pivotal role in managing a variety of conditions encountered in the Emergency Department (ED). However, their use is far from straightforwardbalancing […] The post These are the ‘Roids you are looking for – Steroids in the ED appeared first on EMOttawa

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Is procalcitonin "safe" to guide antibiotic use in patients with sepsis?

PulmCCM

Many randomized trials have tested the biomarker procalcitonin as a guide to de-escalate or stop antibiotic therapy in patients with known or suspected infection. A large proportion have concluded PCT is a safe and effective method to shorten antibiotic courses, including in patients with sepsis. But most such trials have been small, often single-center, and vulnerable to bias due to the unblinded nature of the intervention.

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The EM Expert Mindset – A Female Perspective

Emergency Medicine Cases

Dr. Patricia Lee is an EM physician in Calgary, Alberta and an Assistant Professor at the University of Calgary in the Department of Emergency Medicine. She reached out to me after listening to Episode 200 How EM Experts Think Part 1 as a longtime supporter of EM Cases, to highlight the importance of recognizing challenges that female-identifying EM physicians may face before, during and after ED shifts.

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Defenders of the Great Barrington Declaration Neither Know Nor Care What it Proposed. The Deliberate Erasure of the We Want Them Infected Movement Has Succeeded.

Science Based Medicine

Defenders of the GBD won't tell you what it actually said. I will. The post Defenders of the Great Barrington Declaration Neither Know Nor Care What it Proposed. The Deliberate Erasure of the We Want Them Infected Movement Has Succeeded. first appeared on Science-Based Medicine.

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Neuroimaging Cases 007

Life in the Fast Lane

Michael Gibbs MD Neuroimaging Cases 007 Nail gun injury. First in our Neuroimaging case study series with Teresa Crow , Troy Carnwath, Scott DiMeo, L.

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Robert F. Kennedy Jr. and the Treatment of Drug Addiction

Sensible Medicine

If Robert F. Kennedy Jr. is confirmed as the next secretary of the Department of Health and Human Services, and if he carries out even part of his agenda , he will be a consequential -- and controversial -- cabinet secretary. I am concerned about some of his stances , including his record of objecting to vaccines, but in other areas, starting with addiction, his vision and values could transform lives.

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A 34 yo Man with chest pain and Zero ST Elevation

Dr. Smith's ECG Blog

Written by Hans Helseth A 34 year old man with no known medical history presented to the ED after an hour of chest pain. He described the pain as a mid sternal "burning sensation" and rated it 8.5 out of 10 at onset, but on presentation to the ED, reported that the pain had improved to 4.5. His first EKG is shown below, with a lead II rhythm strip: EKG 1, 1645 A provisder who is looking for STEMI would not see much in this EKG.

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Pre-Hospital Emergency Anaesthesia (PHEA) vs. Emergency Department RSI: A Comparative Study on Trauma Care Timelines and Outcomes

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed How does pre-hospital emergency anaesthesia (PHEA) delivered by Helicopter Emergency Medical Services (HEMS) impacts trauma care timelines compared to emergency department RSI (EDRSI). This retrospective study explores time efficiency, injury severity, and patient outcomes, highlighting the role of HEMS in delivering critical care to severely injured patients in remote locations.

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EM Quick Hits 62 Optimizing RSI Medication Timing, ED Boarding of Older Patients, Prolonged Tourniquet Use, Rural Peer Support Programs, ECG Reciprocal Changes, Nutrition Tips for Shift Workers

Emergency Medicine Cases

On this month's EM Quick Hits podcast: Anand Swaminathan on optimizing RSI medication timing, Brittany Ellison ED boarding challenges in older patients and solutions to ED crowding and flow, Dave Jeromeon managing prolonged tourniquet application, Nour Khatib and Phil Gillick on a rural peer support case, Jesse McLaren on ECG reciprocal changes in acute coronary occlusion, and Melody Ngon practical nutrition tips for shift workers.

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Dr. Jay Bhattacharya Was Nice to Someone During a Debate. That Doesn’t Erase the Consequences of His Misinformation.

Science Based Medicine

This is what it looks like when doctors treat the pandemic as an intellectual parlor game. The post Dr. Jay Bhattacharya Was Nice to Someone During a Debate. That Doesnt Erase the Consequences of His Misinformation. first appeared on Science-Based Medicine.

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Pulse oximeters overestimate O2 saturations in darker-skin patients; FDA acts (again)

PulmCCM

Pulse oximeters for healthcare and consumer use are calibrated on patients with lighter skin. Manufacturers have recognized the devices’ suboptimal performance in darker-skinned patients for decades, but they have faced no serious regulatory or legal pressure to act. In 2013, FDA issued a suggestion that manufacturers test devices on patients “with a range of skin pigmentations.” But the standard was lax: only two darkly pigmented subjects, or 15% of the total pool were needed.

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EM Innovation Collaborative - An interview with Nicholas Stark, MD, MBA & Zaid Altawil, MD

EB Medicine

In this episode, Sam Ashoo, MD interviews Nicholas Stark, MD, MBA & Zaid Altawil, MD about the Emergency Medicine Innovation Collaborative 1. Discussion on EMIC - Overview of the collaborative - Background and formation during the pandemic in late 2021 2. Growth of EMIC - Expansion from three members to over 500 - Focus areas: Education, mentorship, opportunity 3.

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Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest

EM Ottawa

Methodology: 4/5 Usefulness: 4/5 Vallentin MF, et al. N Engl J Med. 2024 Oct 31. doi: 10.1056/NEJMoa2407616. Editorial: The Way to a Patient’s Heart – Vascular Access in Cardiac Arrest Question and Methods: This RCT compared IO vs. IV vascular access in adults with OHCA, using ROSC as a primary outcome. Findings: No significant difference […] The post Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest appeared first on EMOttawa Blog.

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Podcast – Likelihood Ratios: Critical Appraisal Nugget 12

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed Mastering likelihood ratios can transform your diagnostic skills. In this podcast with Rick and Greg, discover how likelihood ratios can enhance decision-making and improve patient care. The post Podcast – Likelihood Ratios: Critical Appraisal Nugget 12 appeared first on St.Emlyn's.

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Variation Exists! Outcomes Exist!

EM Literature of Note

This little article has made the rounds, primarily by those who critique it for its many flaws. However, the underlying themes can still be valid, even if an article has limitations. This is a “there is variation in emergency physician admitting practices” article. Literally every practicing physician working in a hospital environment knows there is a broad spectrum of skill, approach to acute illness, and level of risk-tolerance.

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Well Well Well, We Want Them Infected Doctors Are OK With Censorship After All

Science Based Medicine

Doctors who mourned the loss of a single speech or YouTube video are fine with the the mass censorship of public scientists. The post Well Well Well, We Want Them Infected Doctors Are OK With Censorship After All first appeared on Science-Based Medicine.

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EMCrit 393 – CV-EMCrit – Inotrope Basics Part 1

EMCrit

The basics of inotropes - part 1 EMCrit Project by Scott Weingart, MD FCCM.

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Alkali Exposure

EB Medicine

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the January 2025 Emergency Medicine Practice article, Alkali Exposure: An Evidence-Based Approach to Diagnosis and Treatment Patient Demographics and Case Scenarios: Types of patients prone to alkali exposure Causes and scenarios leading to alkali exposure (e.g., accidental, intentional, social media challenges) Poison control reports and statistics Types and Effects of Exposure: Different types of exposure: ingestion, ocular, dermal Eff

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ECG Pointers: A Dynamic Approach to Tachydysrhythmias Part 4

EMDocs

Authors: Lloyd Tannenbaum, MD (EM Attending Physician, Geisinger Wyoming Valley, PA); Mai Saber, DO (EM Attending Physician, Hackensack University Medical Center, NJ); Rachel Bridwell, MD (EM Attending Physician, Charlotte, NC) // Reviewer: Brit Long, MD (@long_brit) Hello and welcome back to ECG Pointers, a series designed to make you more confident in your ECG interpretations.

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Maintenance of Prehospital Anaesthesia in Trauma Patients: Variability in Practice

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed Explore the variability in maintaining prehospital anaesthesia for trauma patients in this comprehensive summary of a multinational survey. With insights into drug protocols, administration methods, and governance, the article highlights challenges and opportunities for standardisation in prehospital care.

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Get To Know: Joe McLaughlin - Senior Recruiter Permanent Placement

Core Medical Group

Meet senior recruiter from our permanent placement division, Joe McLaughlin. Joe will help you find your dream healthcare job today.

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A Challenge For Dr. Edward Livingston: Defend the Great Barrington Declaration Without Censoring the Great Barrington Declaration

Science Based Medicine

In 2020, the GBD was all about herd immunity via natural immunity. Today, its defenders censor that. The post A Challenge For Dr. Edward Livingston: Defend the Great Barrington Declaration Without Censoring the Great Barrington Declaration first appeared on Science-Based Medicine.

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