September, 2022

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EMCrit 332 – Procedural Errors I See at the REANIMATE ECPR Course and How to Place an Intra-Arrest Femoral Arterial Line

EMCrit

Today, the errors and procedural missteps I commonly observe while teaching 100 docs per year how to cannulate for ECMO (but the lessons are not about ECMO, they are about all vascular access in the femoral vessels.). EMCrit Project by Scott Weingart, MD FCCM.

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Is Cocoa the New Aspirin 81? - Clinical Correlations

Clinical Correlations

By Luke Bonanni Peer Reviewed Theobroma, literally “food of gods” in Greek, is an apt description of chocolate. Made from the fermented seeds of the Theobroma cacao tree, chocolate is an immensely popular food, with worldwide.

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Less is More. Again: Speed of IV Fluid Administration in Pancreatitis (WATERFALL Trial)

RebelEM

Background: Standard emergency department management of acute pancreatitis has focused on aggressive hydration, analgesia and investigation for an underlying reversible cause (eg gallstones). Recent evidence has challenged the routine use of aggressive hydration as unnecessary. There are also potential harms to large volume fluid resuscitation including progression of pancreatitis and fluid overload with or without respiratory failure.

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Nasogastric Tube Placement

Ultrasound Gel

New idea alert! Should we be using POCUS to guide nasogastric tube placement? Crazy? Unnecessary, you say? Well listen in to the discussion of this interesting randomized controlled trial designed to answer this burning question. [link] [link] New idea alert! Should we be using POCUS to guide nasogastric tube placement? Crazy? Unnecessary, you say? Well listen in to the discussion of this interesting randomized controlled trial designed to answer this burning question.

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EZIO Drill Recycling

ETM Course

On the ETM Course we teach intraosseous needle insertion using the EZIO system. EZIO essentially has a monopoly on intraosseous access, being used in almost all Emergency Departments and ambulance/pre-hospital systems around Australia and New Zealand. The main downside however is that the proprietary drill is non-rechargeable. These drills cost $380.00 (AUD) each to purchase, and we go through several each year on our courses.

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Ep 174 Is Less More? Saving EM and Traumatic Pneumothorax – Highlights from CAEP 2022

Emergency Medicine Cases

Emergency Medicine has undergone many changes over the last couple of decades and especially during the COVID pandemic. Most of these changes have been very positive, but increasing volumes, staff shortages, aging populations, increasing breadth of responsibilities and better access to more imaging have made some of us question how we should define the scope of our practices.

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EMCrit 333 – The State of the Fluids Show with the EMCrit Core Team

EMCrit

Where are we on Fluids on 2022? EMCrit Project by Scott Weingart, MD FCCM.

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TEG-Guided Resuscitation of Patients with Cirrhosis and Non-Variceal Bleeding

RebelEM

Background: Thromboelastography (TEG) is a reliable, comprehensive non-invasive hemostatic assay that measures the ability of whole blood to form a clot. TEG analyzes the interaction between platelets and the coagulation cascade. It provides highly descriptive, real-time information on clot formation, clot strength, platelet function, and fibrinolysis, which is superior to traditional coagulation tests such as INR, aPTT, and platelet count.

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Expansion of COVID-Era Telehealth Services

American Medical Compliance

On July 27th, 2022, the House implemented a bill to further expand Telehealth services. During the COVID-19 pandemic, most medical providers transitioned into online consultations with patients using Telehealth with the help of Medicare. In an effort to continue the policies, the introduction of this bill will support these services to provide accessible care through 2024.

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The Pros of Interim Healthcare Management: Choosing the Right Career Path for You

Core Medical Group

Before jumping into any career decision, it’s best to weigh the pros and cons given your lifestyle and unique situation. Interim healthcare management could make sense for you now, or it may be an option you tuck away for a different season of life. No matter which category you fall into, understanding this more flexible career path will be helpful as you plan your future.

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Imaging Case of the Week 521

EMergucate

The following coronal CT face slice is from an 8 year old who was elbowed in the face. What radiological sign can be seen? What are the clinical features of this injury in paediatric population?

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EMCrit RACC-Lit Review for September 2022

EMCrit

All of the resuscitation and acute critical care goodness for Sept 2022. EMCrit Project by Scott Weingart, MD FCCM.

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Posterior leads can give false reassurance

Dr. Smith's ECG Blog

A 40-something woman with diabetes and peripheral vascular disease who frequently needs the ED for chronic pain called 911 for sudden severe chest pain. The patient was very agitated and could not hold still. I greeted medics at the door to view the prehospital ECG. Here it is: It is not normal, but there is no specific evidence of Occlusion MI (OMI) There are some Q-waves in inferior and lateral leads (of uncertain age) and there is some "terminal QRS distortion" in inferior leads and V4-V6, bu

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Another Piece of Equipment with Racial Bias

RebelEM

Background: Medical equipment that gives clinicians vital signs or other objective information must be reliable across populations as this data drives medical decisions. Many of these tools were not developed or validated in a racially diverse group of patients. We have already covered issues with pulse oximetry potentially missing hypoxemia in Black patients on REBEL EM ( Link is HERE ).

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147. Caustic ingestions: hide your kids, hide your bleach

Board Bombs

Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here: emrapidbombs.supercast.com. Hide your kids or hide your bleach. Let's talk about a classic tox presentation this week! Cite this podcast as: Briggs, Blake. Episode 147: Caustic Ingestions: hide your kids, hide your bleach. [link] September 18th, 2022.

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SGEM#376: I Wonder Why She Ran Away from the HINTS Exam

The Skeptics' Guide to EM

Date: September 16th, 2022 Reference: Gerlier C, et al. Differentiating central from peripheral causes of acute vertigo in an emergency setting with the HINTS, STANDING and ABCD2 tests: A diagnostic cohort study. AEM 2021 Guest Skeptic: Dr. Peter Johns has been practicing emergency medicine since 1985 and has been passionate about vertigo education for the last two […] The post SGEM#376: I Wonder Why She Ran Away from the HINTS Exam first appeared on The Skeptics Guide to Emergency Medicine.

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Can a Trespasser Injured on Someone’s Property Pursue Compensation for Personal Injuries?

Medical Law

Property owners are required to take reasonable care to ensure that any visitors on their property are kept safe from injuries. If the property owner does not maintain the property in a reasonably safe condition for visitors, they can be held liable if someone is injured on their property. Generally, a property owner must keep their property in a reasonably safe condition for all people who enter their property, regardless of their status.

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ECG of the Week 14 September 2022 Answer

EMergucate

A 64 year old male presents to ED after multiple seizure episodes that day. It was reported that the patient would have 20 seconds of seizure activity and then make a full recovering.

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Myths of Grieving

Dr. Mike Sevilla

For the fall issue of the Ohio Family Physician magazine , I wrote the following essay. The theme of the issue was the topic of Health Myths……. When people typically hear the term “Health Myths” they typically think of things having to do with misinformation on the internet, misinformation about COVID-19, and other ideas. You probably have never thought about health myths following the end of someone’s life.

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REBEL Core Cast 86.0 – Hand Nerve Blocks

RebelEM

REBEL Core Cast 86.0 – Hand Nerve Blocks Click here for Direct Download of the Podcast References: Core Ultrasound: Median Nerve Block Core Ultrasound: Radial Nerve Block Core Ultrasound: Ulnar Nerve Block Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter: @srrezaie ) The post REBEL Core Cast 86.0 – Hand Nerve Blocks appeared first on REBEL EM - Emergency Medicine Blog.

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ECG Cases 35 – ECG Approach to Takotsubo Syndrome

Emergency Medicine Cases

Takotsubo Syndrome is usually triggered by an emotional or physical stress leading to acute catecholaminergic myocardial stunning. The initial ST elevation phase of Takotsubo Syndrome mimics Occlusion MI, can not be distinguished by patient factors or POCUS findings, and requires immediate angiogram. The subsequent phase of Takotsubo Syndrome has T wave inversion in an apical distribution, which can mimic reperfusion, but often has very deep T wave inversions and a very long QT interval.

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Ultrasound-Guided Arthrocentesis

Ultrasound Gel

In our second in the series of Bonus Cuts, Zach and Mike interview the illustrious Ryan Gibbons for his take on arthrocentesis and a discussion of his research in the field. What an exciting joint venture! [link] In our second in the series of Bonus Cuts, Zach and Mike interview the illustrious Ryan Gibbons for his take on arthrocentesis and a discussion of his research in the field.

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Proper Preparation for Mass Casualty Incidents

Northwestern EM Blog

Written by: August Grace, MD (NUEM ‘24) Edited by: Andrew Rogers, MD, MBA (NUEM ‘22) Expert Commentary by : Andra Farcas, MD (NUEM ‘21) Introduction In the setting of trauma, most hospitals are adept at treating and managing patients with a variety of injuries. However, the ability of a hospital to handle a mass casualty incident (MCI) requires a completely different approach and, most importantly, adequate triage and pre-planning.

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Getting Your Flu Shot This Year

American Medical Compliance

Medical experts are proposing that a noticeable increase in flu cases could occur in the United States this year. This means that getting a flu shot this year is extremely important. Flu season has been different from its usual patterns due to COVID-19, meaning this year’s season is likely to be unpredictable. Influenza rates were extremely low in 2021 due to protective measures relating to COVID-19.

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September Check-In

Dr. Mike Sevilla

Happy September! Yes, where has the year gone? And, yes, I realize that is has been a few months since I wrote here. You know how it goes, when a new year starts, you have all kinds of plans to do this and to do that, and then February comes, and then, you get back to the status quo. Why does this happen? Anyway, I was biking riding recently, and I decided that I had to write a post here.

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Heads Up! There is No Association with Improved Outcomes for Head Up CPR: Why We Must Read Past the Abstract

RebelEM

Background: There are only two interventions that have been proven in the medical literature to improved outcomes in cardiac arrest: high-quality CPR and early defibrillation. Over the years, we as a scientific community have worked extensively to find other interventions that improve outcomes. Some look promising (ie eCPR and application of US) while others have been considerably less effective or inconsistent (ie epinephrine and targeted temperature management).

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EM Quick Hits 42 – Subsegmental PE, Trauma Analgesia, Drowning, Polio, Head-up CPR

Emergency Medicine Cases

In this EM Quick Hits podcast: Salim Rezaie on venous thromboembolism recurrence in subsegmental pulmonary embolism, Andrew Petrosoniak on pain management in the polytrauma, Nour Khatib on a rural EM case on management of near-drowning patient, Sara Reid delivers a polio primer, Anand Swaminathan on head-up CPR. The post EM Quick Hits 42 – Subsegmental PE, Trauma Analgesia, Drowning, Polio, Head-up CPR appeared first on Emergency Medicine Cases.

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SGEM#375: Only One versus Two-Dose Dexamethasone for Mild to Moderate Pediatric Asthma Exacerbations

The Skeptics' Guide to EM

Date: August 25th, 2022 Reference: Martin et al. Single-dose dexamethasone is not inferior to 2 doses in mild to moderate pediatric asthma exacerbations in the emergency department. Pediatr Emerg Care. 2022 Guest Skeptic: Dr. Harrison Hayward is a Pediatric Emergency Medicine fellow at Children’s National Hospital. He finished his General Pediatrics residency at Yale-New Haven Hospital.

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Conversation - Artificial Intelligence and EM Coach

EB Medicine

In this episode of EMplify: Conversation, Sam Ashoo, MD talks with Andrew Phillips, MD, MEd, founder of EM Coach , about artificial intelligence and emergency medicine education. EM/Critical care practice - what’s that like? EM Coach - what is it? Artificial Intelligence - What is it and how does EM Coach use it? The algorithm How did you create it?

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REVERSE TRIGGERING

Trigger Lab

Prima di approfondire questa asincronia è necessario comprendere il significato di “entrainment”. In fisica questo termine si riferisce all’allineamento della fase e del periodo di un sistema oscillatorio non lineare, con la fase e il periodo di un input esterno periodico.

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A Report from Barcelona

Stop and Think

Medical meetings have a buzz about them. The bright lights, the masses of people, and in Europe, the different languages. Virtual meetings don’t come close. I just returned from the ESC meeting in Barcelona and have a brief report. The first thing to say is how nice it was to see (and sometimes hug) friends and colleagues from all over the world.

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The ADVOR Trial: Acetazolamide in Acute Decompensated Heart Failure

RebelEM

Background: Patients presenting with acute exacerbations of congestive heart failure are frequently treated with intravenous loop diuretics. Despite being treated with loop diuretics, the problem is many are discharged from the hospital with residual clinical signs of volume overload despite optimal treatment. One option to improve diuresis may be the addition of acetazolamide, however evidence supporting this strategy is sparse.

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ECG of the week 7th September 2022 – Answer

EMergucate

A 85 year old female presents to ED. She has been complaining of nausea and lethargy over the past week. Her GP has recently started her on new medication for her heart.

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SGEM Xtra: A Hero Is Rising – Season#8 Book

The Skeptics' Guide to EM

Date: September 3rd, 2022 Reference: Milne WK, Carpenter CR and Young T. A Hero Is Rising – Season#8 Book Guest Skeptic: Dr. Tayler Young is a first year Family Medicine resident at Queen’s University. Her interests are quality improvement and Free Open Access to Medical Education (FOAMed). This is an SGEM Xtra to announce Season#8 has now been […] The post SGEM Xtra: A Hero Is Rising – Season#8 Book first appeared on The Skeptics Guide to Emergency Medicine.

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Human Trafficking of Children and Adolescents

EB Medicine

In this episode, Sam Ashoo, MD interviews Lela Bachrach, MD, MS, Larissa Truschel, MD, MPH, and Makini Chisolm-Straker, MD, MPH - the authors of the July 2022 PEMP article on Human Trafficking of Children and Adolescents: Recognition and Response in the Emergency Department. Listen to the discussion to hear more about the emergency medicine approach to human trafficking.

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Reflections on undertaking qualitative research in emergency care

RCEM Learning

The post Reflections on undertaking qualitative research in emergency care appeared first on RCEMLearning.

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Chief’s Inquiry Corner – 9/28/22 - Clinical Correlations

Clinical Correlations

Bellevue Outpatient: What is the optimal duration of therapy for bisphosphates in osteoporosis? Bellevue Inpatient: What is the role of aggressive fluid resuscitation in acute pancreatitis? VA Inpatient: What is the treatment for allergic bronchopulmonary aspergillosis?