Ken Grauer, MD

JULY 29, 2023

The ECG in Figure-1 was obtained from an 18-year old woman — who moments before been resuscitated from out-of-hospital cardiac arrest. QUESTIONS: In light of the above clinical history. How would YOU interpret her post-resuscitation ECG? Does this ECG in Figure-1 provide clue(s) to the etiology of this patient's cardiac arrest? Figure-1: The initial ECG in today's case — obtained following resuscitation from cardiac arrest of an 18-year old woman.

EKG/ECG 370

EKG/ECG Resuscitation Documentation/Coding Hospitals 370

Pediatric EM Morsels

JULY 21, 2023

In emergency medicine, we often use illness scripts and protocols to help drive our decision-making. I recall a shift I had with Dr. Fox while I was early in fellowship ( not so many years ago ). We had just received a young child from EMS who was post-ictal with decreased mentation. Dr. Fox asked me what I wanted to do next to care for the child, and as I calculated his GCS… 7 at the time… I felt somewhat obligated to say that I should intubate the child. “ Less than 8, intubate!

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

Mount Sinai EM

JULY 27, 2023

Fever in the Asplenic Patient Why we care Fever in a patient with impaired splenic function = early sign of sepsis Infections in this population can develop precipitously with very minimal antecedent symptoms, and can become fulminant and fatal within hours of symptom onset DIC can occur early in the course Patient population Anatomic Asplenia (post-splenectomy, congenital asplenia) Functional Asplenia (e.g. sickle cell anemia) Hyposplenia (from atrophy, infarction, engorgement, or infiltration

Sepsis 182

Sepsis Wellness Infectious Diseases 182

RebelEM

JULY 5, 2023

Take Home Points Provider assessment of how the patient looks is extremely important. If it looks and feels like a STEMI clinically, get serial ECGs and consult Cardiology immediately. POCUS has been a phenomenal tool in the management and early diagnosis of a lot of abnormal ECG and chest pain presentations. Isolated elevation in aVR with diffuse ST depressions can be a sign of Left Main occlusion.

EKG/ECG 144

EKG/ECG Sepsis EMS 144

Don't Forget the Bubbles

JULY 5, 2023

Topic Sickle Cell Disease Author Beatrice Zanetti Duration Up to 2 Hours Facilitator Level ST4+ Learner Level Most useful for those in experience seeing paediatric patients regularly. From FY1 + and 5+ nurses on Equipment Required None Outline Pre-reading Basics Case 1: Salmonella osteomyelitis Case 1: Discussion Case 2: Acute painful crisis and Priapism Case 2: Discussion Advanced Case 1: Acute chest syndrome Advanced Case 1: Discussion Advanced Case 2: Stroke in sickle cell disease patient Adv

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Emergency Live

JULY 4, 2023

Telangiectasias are caused by enlarged blood vessels. This condition is much more common than you think and you will probably have come across this problem at least once in your life The post Teleangiectasias: what are they? appeared first on Emergency Live.

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The Skeptics' Guide to EM

JULY 2, 2023

Date: July 1, 2023 Reference: PATCH-Trauma Investigators and ANZICS Clinical Trial Group. Prehospital Tranexamic Acid for Severe Trauma. NEJM 2023. Guest Skeptic: Dr. Salim Rezaie is a community emergency physician in San Antonio, TX. He is the Creator and founder of REBEL EM, a free, critical appraisal blog that tries to cut down knowledge translation gaps of […] The post SGEM#408: Hey, I, Oh I’m Still Alive – Is it due to TXA?

EMS 121

EMS Outcomes Hospitals Research 121

Mount Sinai EM

JULY 21, 2023

Why is this a pearl? We get G-tube dislodgments quite often at Sinai, and they can be an easy patient encounter with a quick note and quick dispo. But they made me so nervous as an intern and early 2! Now I love ‘em and you can love ‘em too! ** GJ-tubes or J-tubes do not get replaced in the ED. Tell me about the PEG tube. Gastrostomy tube (G-tube) or Percutaneous Endoscopic Gastrostomy tube (PEG tube) is a tube placed in the stomach for long-term enteral nutritional support.

EMS 181

EMS Radiology Radiology 181

Science Based Medicine

JULY 2, 2023

Robert F. Kennedy, Jr. has resurrected the antivax claim that the childhood vaccine schedule has never been tested in randomized controlled trials (RCTs) with a saline placebo controls (and therefore the vaccine schedule is unsafe). This is an old and deceptive antivax half-truth that ignores both what constitutes a scientifically valid placebo and the ethical requirements for RCTs.

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St. Emlyn

JULY 2, 2023

St.Emlyn's - Emergency Medicine #FOAMed Zaf Qasim @resusone reviews the UKREBOA trial. No benefit shown, but is this really the end of REBOA in trauma? #FOAMed @stemlyns The post JC: The UK-REBOA trial. Has the balloon popped? St Emlyn’s appeared first on St.Emlyn's.

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Emergency Live

JULY 1, 2023

Water retention is a problem that affects most women. However, most people confuse water retention and cellulite The post Water retention, how to deal with it appeared first on Emergency Live.

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PulmCCM

JULY 3, 2023

Video laryngoscopy was superior to direct laryngoscopy in first-pass success among ED residents and CCM fellows intubating critically ill patients (DEVICE trial). Surprisingly to me, video laryngoscopy (VL) has not consistently been shown to increase first-pass intubation success over direct laryngoscopy (DL) in critically ill patients. Most studies have been small, single center, and only some have favored video.

Airway Management 101

Airway Management Outcomes Hospitals Emergency Department 101

Pediatric EM Morsels

JULY 7, 2023

In the past, we have discussed several causes of Knee Pain in children. Some of those causes are benign (ex, Osgood Schlatter’s Disease ) while others are scary (ex, osteosarcoma ). Evaluating the limping child , though, requires us to ponder not only the common (ex, Toddler’s Fracture ), but also to be vigilant for the severe (ex, Septic Arthritis ).

Dislocations 141

Dislocations Fractures Pediatrics EMS 141

Mount Sinai EM

JULY 30, 2023

TR Pearl: Thyroid Storm Management Endocrine emergency: severe clinical manifestations of thyrotoxicosis Mortality rate of thyroid storm is 10-30% Often precipitated in patients with hx of hyperthyroidism by an acute event such as surgery (thyroid or non-thyroidal surgery), trauma, infection, acute iodine load (including amiodarone), or parturition Risk factor includes irregular use or discontinuation of antithyroid drugs Diagnosing Thyroid Storm : The distinction between severe thyrotoxicosis a

Administration 179

Administration COPD Wellness 179

SheMD

JULY 30, 2023

Disclaimer: This post was written before the COVID-19 pandemic. Some of the interview information may not be relevant during the 2020-2021 & 2021-2022 academic years. Hello premeds! ,, AMCAS , ,, AACOMAS , and ,, TMDSAS all opened in the beginning of May. We are kicking it into high-gear with premeds so they can turn in their medical school applications as soon as they are able.

Academics 104

Academics Leadership Research Wellness 104

Sensible Medicine

JULY 9, 2023

I always tell junior faculty that your contract means little, and, indeed, I found that to be the case, when a mid-career faculty departed and I inherited a third of his lung cancer patients. Yet, like most unexpected clinical changes in my career, I ended up learning unexpected truths. One man taught me about lung cancer screening. He was the most improbable 74 year old.

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Emergency Live

JULY 3, 2023

Schizophrenia comes from the Greek and literally means “separate mind”: those affected struggle to distinguish reality from imagination It is a psychiatric disorder that seriously compromises self-perception. In addition to negatively affecting social relationships and the performance of normal daily activities. This disease also affects perception, memory, attention, learning and emotions.

Psychiatric 119

Psychiatric 119

Science Based Medicine

JULY 5, 2023

Despite the leaked new classification as a "possible" carcinogen, the evidence still shows aspartame is safe. The post Aspartame and Cancer first appeared on Science-Based Medicine.

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Don't Forget the Bubbles

JULY 31, 2023

With millions of journal articles published yearly, it is impossible to keep up. Our team have scoured what’s new (well, mostly new!) in the paediatric literature. One reviewer has returned to an oldie but a goodie to answer a clinical question! Article 1: Does rapid diagnostic testing for Malaria work? Bird C, Hayward GN, Turner PJ, Merrick V, Lyttle MD, Mullen N, Fanshawe TR.

Rapid Diagnostic Testing 98

Rapid Diagnostic Testing Resuscitation Emergency Department Pediatrics 98

PulmCCM

JULY 31, 2023

New Practice Guidelines for Diagnosis and Management of Acute Respiratory Distress Syndrome As mentioned here previously , a group of U.S. and European experts arrived at a consensus of new recommendations for the management of acute respiratory distress syndrome (ARDS), now publishing their guidance in JAMA. The highlights include: A trial of high-flow nasal cannula oxygen was advised before intubating patients.

Shock 97

Shock Documentation/Coding Outcomes Wellness 97

RebelEM

JULY 27, 2023

Background: Current stroke guidelines recommend IV alteplase for patients with acute ischemic stroke presenting within 4.5hrs of symptom onset based on the NINDS and ECASS III publications. Both NINDS and ECASS III excluded patients with mild stroke symptoms but failed to clearly define a threshold for mild stroke. Many patients, however, will have minor strokes (defined as an NIHSS score ≤5).

Stroke 98

Stroke Outcomes EMS Hospitals 98

EM Ottawa

JULY 27, 2023

Acute scrotal pain is a common in emergency departments, comprising ~ 0.5% of all presentations. However, torsion is another very time sensitive diagnosis that is ubiquitous across all ages as seen by this Rosen’s table. Incidence / Epidemiology Unfortunately, epidemiological data is poor. Acute scrotal complaints make up approximately 0.5% of all ED visits […] The post Testicular Torsion appeared first on EMOttawa Blog.

Emergency Department 98

Emergency Department Resuscitation 98

Emergency Live

JULY 3, 2023

Bladder cancer is a malignant transformation of the cells - mainly those called transitional cells - which cover the inner walls of the bladder, the organ responsible for collecting and expelling urine once it has been filtered by the kidneys The post Bladder cancer: what is it? appeared first on Emergency Live.

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ECG Guru

JULY 24, 2023

This is a "classic" ECG of very good quality for you to use in a classroom setting. The Patient: A 57-year-old man who complains of a sudden onset of "sharp" chest pain while on a long bike ride. The pain does not radiate, and nothing makes it worse or better. He is pale, cool, and diaphoretic. His medical history is unknown. The ECG: This ECG could be considered "classic" for an inferior wall ST elevation M.I. caused by occlusion of the right coronary artery.

EKG/ECG 98

EKG/ECG EMS Outcomes 98

Don't Forget the Bubbles

JULY 26, 2023

Topic Cardiology & the ECG Author Anna McCorquodale Duration 1-2 hours Facilitator Level ST4+ level used to seeing children acutely Learner level Anyone involved in initial assessment of children with cardiac symptoms; paediatric trainees, emergency trainees, foundation doctors Outline Pre-reading Basics Case 1 Case 1: Discussion Case 2 Case 2: Discussion Advanced Case 1 Advanced Case 1: Discussion Advanced Case 2 Advanced Case 2: Discussion Quiz Take Home Points Basics (15 mins) with sharin

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

Emergency Medicine Journal

JULY 24, 2023

Background Endotracheal tube (ETT) malposition is frequent in paediatric intubation. The current recommendations for ETT insertion depths are based on formulae that hold various limitations. This study aimed to develop age-based, weight-based and height-based curve charts and tables for ETT insertion depth recommendations in children. Methods In this retrospective single-centre study, we determined the individual optimal ETT insertion depths in paediatric patients by evaluating postintubation ra

Wellness 98

Wellness 98

RebelEM

JULY 26, 2023

Take Home Points Methylxanthines are a drug class that includes caffeine, theophylline, and theobromine. The three main mechanisms that account for the clinical presentation of methylxanthine toxicity are: catecholamine release, adenosine antagonism, and phosphodiesterase inhibition. Beta agonism will lead to hyperlactatemia, hypokalemia, hyperglycemia, and tachycardia.

Seizures 98

Seizures COPD Shock EMS 98

SheMD

JULY 23, 2023

Disclaimer: This post was written before the COVID-19 pandemic. Some of the interview information may not be relevant during the 2020-2021 & 2021-2022 academic years. Now that it’s the heart of interview season for both medical school applicants and residency applicants, I wanted to share some tips on how to answer commonly asked interview questions.

Research 98

Research Academics Hospitals Administration 98

Emergency Live

JULY 4, 2023

The aircraft was carrying five people, prompt rescue, all survived A helicopter, involved in the route between the high altitude refuges Capanna Gnifetti and Regina Margherita on Monte Rosa, crashed in the area of the municipality of Alagna Valsesia. The helicopter was performing its usual service connecting the two refuges, offering tourists and climbers, all […] The post Helicopter crashes on Monte Rosa, no fatalities appeared first on Emergency Live.

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Ziqitza HealthCare Ltd

JULY 21, 2023

Ambulance emergency number It’s heartbreaking to know that millions of emergencies end in the loss of lives. What shakes us is the lack of awareness of ambulance emergency numbers and the affordability of ambulance services. These reasons may sound a little weird in the digital era we are living in, but it’s true. You may argue that one can simply Google for an emergency number when needed.

Ambulance Services 98

Ambulance Services Poisoning Operations Hospitals 98

Don't Forget the Bubbles

JULY 24, 2023

Discitis is an inflammatory condition involving the intervertebral discs and end plates of vertebral bodies. It encompasses a spectrum of conditions that includes discitis , spondylodiscitis , and vertebral osteomyelitis. Discitis is uncommon. However, there is a bimodal peak in children, those under 6 years and adolescents. Neonates can also be affected.

Radiology 98

Radiology Radiology Infectious Diseases Pediatrics 98

EM Ottawa

JULY 17, 2023

Methodology: 2/5 Usefulness: 1/5 Lim P, et al. Eur Heart J Acute Cardiovasc Care. 2022 Jan 12;11(1):2-9. Question and Methods: Does diuresis with single-dose IV furosemide improve hemodynamic parameters and prevent oligo-anuria in normotensive patients with intermediate-risk PE? Multi-centre, placebo-controlled, double-blind trial of furosemide 80mg IV vs. placebo.

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RebelEM

JULY 24, 2023

Background: Rapid Sequence Intubation (RSI) is a procedure fraught with potential complications including hypotension which, in turn, can result in cardiovascular collapse. While there are numerous potential causes of hypotension peri-RSI, induction medications represent an important, modifiable variable. Over the last decade, airway experts have advocated for reduced induction agent dosing to lessen the risk of hypotension particularly in at risk patients.

Resuscitation 98

Resuscitation Outcomes Emergency Department EMS 98

ECG Guru

JULY 14, 2023

ECG 1 is from a 57-year-old male with no prior cardiac disease. He reports acute shortness of breath for 2 days. We see a sinus rhythm with left anterior fascicular block (LAFB) and conspicuous T-wave inversions in the inferior leads and in V1-V6. These are typical ECG changes that may indicate a pulmonary embolism. ECG 2 was taken from the same patient 1 year earlier.

EKG/ECG 98

EKG/ECG 98

Emergency Live

JULY 3, 2023

The incidence of melanoma - until a few years ago considered a rather rare disease - has increased by 4% in the last twenty years, reaching 14.3 cases per 100,000 men and 13.6 cases per 100,000 women The post Melanoma: causes, symptoms, diagnosis and treatment appeared first on Emergency Live.

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ACEP Now

JULY 8, 2023

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.

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98

Don't Forget the Bubbles

JULY 17, 2023

Can’t get enough of Bubble Wrap? The Bubble Wrap Plus is a monthly paediatric journal club reading list from Anke Raaijmakers, working with Professor Jaan Toelen and his team at the University Hospitals in Leuven. This comprehensive list is developed from 34 journals, including major and subspecialty paediatric journals. We suggest this list can help you discover relevant or interesting articles for your local journal club or allow you to keep a finger on the pulse of paediatric research.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98