Ken Grauer, MD

APRIL 20, 2024

The ECG in Figure-1 — was obtained from a 70-ish year old man with episodic CP ( C hest P ain ) over the previous 2-3 days , being awakened from sleep now for a more severe CP episode. QUESTIONS: In view of this history — How would YOU interpret this ECG? Should you activate the cath lab? Figure-1: The initial ECG in today's case. MY Initial Thoughts on Today's CASE: Although it is difficult from the brief history we are given, to determine the true onset of whatever might be happening — the pat

EKG/ECG 432

EKG/ECG Wellness 432

The Trauma Pro

APRIL 26, 2024

In this series, I will review the two major techniques for addressing troublesome bleeding from pelvic fractures. This post will review the evolution of packing techniques and more fully describe the concept of preperitoneal packing. Next, I’ll review an early paper that compared the snippets of information we had to angioembolization. In the last post in the series, I’ll discuss a paper in press that compares the efficacy and hospital charges of the two techniques.

Fractures 147

Fractures Head Injuries Radiology Radiology 147

First 10 EM

APRIL 22, 2024

As mentioned in my most recent review, publication bias has been a major concern when trying to decide whether to prescribe paxlovid. Pfizer rushed to publish their positive study (EPIC-HR), but refused to release the results of a second simultaneous study (EPIC-SR) that was stopped (due to futility) at the exact same time. With the […] The post EPIC-SR: The negative paxlovid data Pfizer has been sitting on appeared first on First10EM.

EMS 135

EMS 135

Sensible Medicine

APRIL 25, 2024

The US FDA is under tremendous political pressure to approve drugs, and indeed they tout the number of approved drugs as a measure of the quality of their work. Unfortunately, you can approve bad drugs. Selenexor is a toxic poison that does not increase survival. Belantumab causes eye damage and had to be pulled from the US market Idelalisib, copanlisib, duvelisib— the entire P13k inhibitor class —may have resulted in increased deaths.

Poisoning 135

Poisoning Outcomes 135

Ken Grauer, MD

APRIL 26, 2024

The ECG in Figure-1 — was obtained on the scene by EMS ( E mergency M edical S ervices ). The patient was a man in his 90s, who ~1 hour earlier, noted the onset of severe CP ( C hest P ain ). He was hemodynamically stable — but clearly distressed with a sense of “impending doom” at the time ECG #1 was recorded. Despite the patient’s age — he was independent, lived alone, had good mental function — and had family support.

EKG/ECG 395

EKG/ECG Resuscitation EMS Wellness 395

The Trauma Pro

APRIL 23, 2024

In the last post, I described the first crucial step in the contemporary management of penetrating neck trauma, control of obvious external hemorrhage. Let’s move on to the nuts and bolts of figuring out what needs to be done about the injury. Now, it’s time to triage your patient based on clinical signs that predict the presence or absence of a significant injury.

Operations 113

Operations Stroke Shock 113

Dr. Smith's ECG Blog

APRIL 24, 2024

Quiz The PM Cardio Queen of Hearts AI model for ECG interpretation from Powerful Medical is still in its early days. Do you think you can outperform the toddler version of the AI model? Version 2.0 will soon be available with four times the training data. The QoH groups ECGs into OMI and NOT OMI. Each category is subdivided into three levels of confidence.

EKG/ECG 118

EKG/ECG 118

Emergency Medicine Cases

APRIL 23, 2024

In this month's EM Quick Hits podcast: Justin Morgenstern on the first RCT of high dose nitroglycerin in SCAPE, Andrew Neill on Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) indications and evidence, Brit Long on indications for CT in suspected diverticulitis, Tahara Bhate on Central Retinal Artery Occlusion (CRAO) and diagnostic error, Matthew McArthur on penicillin allergy labels, myths and penicillin challenges, and Susan Lu on how ED physician personality influences patie

EMS 107

EMS Resuscitation Outcomes Allergic Reactions 107

Science Based Medicine

APRIL 22, 2024

No matter how implausible it is or how weak the evidence for it is, the myth that COVID vaccines cause "turbo cancer" just won't die. Quite the contrary, alas. Antivaxxers are—dare I say?—turbocharging it with bad science. The post COVID-19 vaccine-caused “turbo cancer” nonsense just keeps getting more turbocharged and nonsensical first appeared on Science-Based Medicine.

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Dr. Smith's ECG Blog

APRIL 22, 2024

A 50-something male with hypertension and 20- to 40-year smoking history presented with 1 week of stuttering chest pain that is worse with exertion, which takes many minutes to resolve after resting and never occurs at rest. It is a ssociated with mild dyspnea on exertion. At times the pain does go to his left neck. It was present on arrival at triage but then resolved before bed placement in the ED.

EKG/ECG 116

EKG/ECG Outcomes Ultrasounds Hospitals 116

St. Emlyn

APRIL 25, 2024

St.Emlyn's - Emergency Medicine #FOAMed Part 2 of our podcast on top papers from 2023/24 with @EMManchester and @docb #FOAMed @stemlyns The post Top papers podcast 2023/24. Part 2. St Emlyn’s appeared first on St.Emlyn's.

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Emergency Live

APRIL 26, 2024

Discover the Vital Importance of These Tiny Blood Components What Are Red Blood Cells? They are vital cells that help people to live. The cells called erythrocytes provide oxygen throughout the body. Their unique shape increases the surface area for better breathing. The absence of a nucleus inside means more space for the iron proteins […] The post Red Blood Cells: Pillars of Oxygenation in the Human Body appeared first on Emergency Live.

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Emergency Medicine Journal

APRIL 22, 2024

Cannabinoid hyperemesis syndrome (CHS) is an episodic syndrome of cyclic vomiting in the context of the prolonged use of cannabis. The Royal College of Emergency Medicine Toxicology Special Interest Group has produced guidance to support emergency medicine clinicians with the recognition and treatment of people experiencing CHS. Considerations regarding recognition, investigation and communication are discussed, and recommendations regarding treatment options (which include haloperidol and capsa

Best Practices 98

Best Practices Emergency Department 98

Science Based Medicine

APRIL 21, 2024

"Last year, @WashburneAlex made a bombshell prediction supporting the lab leak theory. New documents released yesterday confirm his prediction." - Dr. Jay Bhattacharya January 2024 The post Science Based Satire: BOMBSHELL NEWS!!! The Virus I Told You Not to Worry About and Worked to Infect You With… CAME FROM A LAB!!! first appeared on Science-Based Medicine.

Documentation/Coding 88

Documentation/Coding 88

St. Emlyn

APRIL 23, 2024

St.Emlyn's - Emergency Medicine #FOAMed This month we hacve two podcasts covering our recent posts on top 10 resuscitation papers. This blog covers the first 5 papers. Part 2 will be out later in the […] The post Top papers podcast 2023/24. St Emlyn’s appeared first on St.Emlyn's.

Resuscitation 109

Resuscitation 109

Emergency Live

APRIL 26, 2024

Discovering the Importance of One of the Four Fundamental Nucleotides for Life What is Guanine? One of the four main building blocks of DNA and RNA is guanine. It’s a special nitrogen-containing compound that pairs with adenine, cytosine, and thymine (or uracil in RNA) to form the genetic code. What makes guanine unique is its […] The post The Essential Role of Guanine in DNA and RNA appeared first on Emergency Live.

Documentation/Coding 98

Documentation/Coding 98

Emergency Medicine Journal

APRIL 22, 2024

Objective We sought to validate the clinical performance of a rapid assessment pathway incorporating the Siemens Atellica IM high sensitivity cardiac troponin I (hs-cTnI) assay in patients presenting to the emergency department (ED) with suspected acute myocardial infarction (AMI). Methods This was a multicentre prospective observational study of adult ED patients presenting to five Australian hospitals between November 2020 and September 2021.

Emergency Department 98

Emergency Department Outcomes EKG/ECG Hospitals 98

Science Based Medicine

APRIL 24, 2024

When patients are diagnosed with cancer, or a terminal illness of any kind, they report that there are a couple of near universal reactions by the people around them. First, everyone has advice for them. Everyone thinks they know what caused their illness and what will cure it. The floodgates of free advice and misinformation open. Everyone also wants them to stay […] The post Don’t Blame the Patient first appeared on Science-Based Medicine.

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Don't Forget the Bubbles

APRIL 22, 2024

You are called to the postnatal ward to review a 22-hour-old infant with feeding difficulties. On examination, two bluish, soft swellings are located medially to the inner canthus on both eyes. The infant is unsettled but has a mild fever. What do you do? What is dacryocystitis? Dacryocystitis is an inflammation of the lacrimal sac. This oval-shaped structure receives tear drainage from the eye and sits in a groove formed by the lacrimal bone and frontal process of the maxilla.

Infectious Diseases 85

Infectious Diseases Sepsis Pediatrics Operations 85

Emergency Live

APRIL 26, 2024

Learn how mammography works and why it is essential for early detection What is Mammography? Mammography is a healthcare imaging method that uses low-dose X-rays to examine breast tissue for any potentially dangerous changes. This check-up is considered the best tool for early detection of breast cancer because it can detect growths and small deposits […] The post Mammography: A Crucial Tool in the Fight Against Breast Cancer appeared first on Emergency Live.

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Emergency Medicine Journal

APRIL 22, 2024

Background Supporting people to quit smoking is one of the most powerful interventions to improve health. The Emergency Department (ED) represents a potentially valuable opportunity to deliver a smoking cessation intervention if it is sufficiently resourced. The objective of this trial was to determine whether an opportunistic ED-based smoking cessation intervention can help people to quit smoking.

Emergency Department 97

Emergency Department Outcomes 97

The Skeptics' Guide to EM

APRIL 20, 2024

Reference: Ramesh S, Ayyan SM, Rath DP, Sadanandan DM. Efficacy and safety of ultrasound-guided erector spinae plane block compared to sham procedure in adult patients with rib fractures presenting to the emergency department: A randomized controlled trial. AEM April 2024 Date: April 19, 2024 Guest Skeptic: Dr. Suchismita Datta. She is an Assistant Professor and Director of […] The post SGEM#437: Don’t Be Fooled by the Meds I Got, I Still Need an ESP Block – For My Rib Fractures first appeared o

Fractures 83

Fractures Ultrasounds Emergency Department CDC 83

EMDocs

APRIL 22, 2024

Authors: Joseph R. Peters, (DO, RDMS, FACOEP, FACEP, FACOI); Carolina Hartje, DO // Reviewed by: Stephen Alerhand, MD; Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Introduction There are an estimated 300,000-600,000 Americans who develop venous thromboembolisms (VTE) each year, including deep venous thromboembolisms (DVT) and pulmonary embolism (PE). 1-3 VTE is responsible for hospitalizing over 250,000 Americans every year, and there are an estimated 100,000 deaths annually associat

Ultrasounds 81

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 81

Emergency Live

APRIL 26, 2024

Earth Day. Red Cross, Valastro: “Conflicts and humanitarian crises endanger the planet’s balance. From CRI, a universal sustainable development, thanks to the youth” “The ongoing conflicts and humanitarian crises, combined with recent health, social, and environmental emergencies, are jeopardizing the balance of our planet and slowing down the commitment made by the 2030 Agenda in […] The post CRI, Valastro: "Conflicts endanger the planet's balance." ap

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Emergency Medicine Journal

APRIL 22, 2024

Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication.

Research 97

Research 97

The Bottom Line

APRIL 26, 2024

Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock Møller JE et al. 2024. NEJM. DOI: 10.1056/NEJMoa2312572 Clinical Question In adults presenting with STEMI and cardiogenic shock does the use of a microaxial flow pump (Impella CP) compared to standard care reduce death from any cause at day 180?

Shock 79

Shock 79

Sensible Medicine

APRIL 22, 2024

I remember when Dr. Gervasio Lamas stunned the world of cardiology when he presented the results of the TACT 1 trial. I chose the verb stun because chelation was way outside the box that contains medical thinking. This was not a drug or a procedure. It is a way to remove heavy metals from the body. And it was practiced not by doctors, but alternative medicine practitioners.

Academics 84

Academics 84

Emergency Live

APRIL 26, 2024

High participation of attendees at the comprehensive theoretical-practical course on airway management During emergency situations, proper airway management is a delicate yet fundamental phase to ensure the patient’s life is out of danger. Airway management represents the foundation of every resuscitative treatment, an essential starting point for every subsequent therapeutic choice.

Airway Management 98

Airway Management Resuscitation 98

RebelEM

APRIL 22, 2024

Background: Hypoxemic respiratory failure is a frequent complicating feature of severe COVID-19 infection. Early in the pandemic, extensive efforts were made to identify the best approach to oxygenation in this group of patients. Best practices settled on aggressive use of non-invasive ventilation (NIV) and delaying invasive mechanical ventilation (IMV) where feasible.

Outcomes 75

Outcomes Best Practices EMS Shock 75

EMDocs

APRIL 20, 2024

We always work hard, but we may not have time to read through a bunch of journals. It’s time to learn smarter. Originally published at JournalFeed , a site that provides daily or weekly literature updates. Follow Dr. Clay Smith at @spoonfedEM , and sign up for email updates here. #1: Should We Use New Duke Criteria for Infective Endocarditis? Spoon Feed This external validation compared the 2023 Duke-International Society for Cardiovascular Infectious Diseases Diagnostic (ISCVID) Criteria aga

Infectious Diseases 75

Infectious Diseases Pediatrics Resuscitation Hospitals 75

Sensible Medicine

APRIL 23, 2024

I love case control studies. When done well, they are simple, relatively easy to perform studies, that can be hugely impactful, usually by suggesting that an exposure is harmful. Case control studies have saved millions of lives, demonstrating the adverse effects of substances such as tobacco smoke, DES, and dexfenfluramine. Case control studies can also mislead us.

Wellness 80

Wellness 80

Emergency Live

APRIL 26, 2024

An in-depth look at the causes, classification, and treatment options of leukemia What is Leukemia? Leukemia is a cancer of the blood cells that begins in the bone marrow. It occurs when abnormal cells grow uncontrollably, outnumbering healthy cells. This disease mainly affects white blood cells and disrupts the normal production of blood cells. Classification […] The post Understanding leukemia: types and treatments appeared first on Emergency Live.

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98

Science Based Medicine

APRIL 25, 2024

Two papers look at the effects of cold water immersion after exercise, with mixed results. The post Cold Water Immersion Not Always Beneficial first appeared on Science-Based Medicine.

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Core Medical Group

APRIL 24, 2024

At CMG, one of our core values is making a difference, something we live out every day both professionally and personally. Each quarter, our leadership team selects a charity for our quarterly donations, directing our efforts towards supporting that cause. We also encourage our employees to utilize their Volunteer Time Off (VTO), allowing them up to 8 hours per calendar year to volunteer with a 501(c)(3) organization of their choice.

Leadership 68

Leadership 68

Taming the SRU

APRIL 23, 2024

Active Shooter Incidents - Mass Casualty Simulation - Climate Change - Hazmat/Decon Active shooter incidents Important to have situational awareness, which is generally defined as knowing what is going on around you Three main tactics for defense in an active shooter situation: Run, hide, and/or fight Run - Evacuation is going to be based on specific circumstances: location of shooter and whether it can be accomplished safely.

Mass Casualty Incidents 59

Mass Casualty Incidents Emergency Department Hospitals 59

Emergency Live

APRIL 26, 2024

National Assembly of the Red Cross. Valastro: “The costs of conflicts are unacceptable: civilians, healthcare personnel, and humanitarian workers are not protected.” 160th anniversary medal to Deputy Minister Bellucci “An important opportunity to reflect on our journey, analyze commitments made, results, and mistakes but above all our priorities, because the action of the Italian Red […] The post CRI National Assembly.

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95

Science Based Medicine

APRIL 26, 2024

Are parents really turning to diapers made using kinesiology tape to help their fussy babies? Of course not. That would be incredibly silly, and profitable. This is satire. The post Science-Based Satire: More Parents Turn to Kinesiology Diapers for Fussy Infants first appeared on Science-Based Medicine.

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