The Trauma Pro
NOVEMBER 12, 2024
The Pediatric Readiness Score (PRS) is a new(er) metric that is now required for all US trauma centers verified by the American College Surgeons. There is no specific threshold that must be met, but the value must be reported for review at the time of the site visit. What is the PRS? It is a measure introduced by the National Pediatric Readiness Project.
Ken Grauer, MD
NOVEMBER 15, 2024
Today's case was contributed by Dr. Magnus Nossen ( from Fredrikstad, Norway ). Dr. Nossen was at his computer — reviewing ECGs from patients recently admitted to his group's hospital service. He came across the ECG shown in Figure-1 — obtained from a woman in her 70s who was admitted to the hospital for new CP ( C hest P ain ). QUESTION: How would YOU interpret the ECG in Figure-1 ?
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Pediatric EM Morsels
NOVEMBER 15, 2024
Seizures are super scary for a parent to witness, but not all seizures mean danger. There is actually a diagnosis of seizures that has “ BENIGN” in the name! Have you ever had that feeling of falling that rapidly wakes you from sleep? While it’s unlikely that you were having Benign Epilepsy with CentroTemporal Spikes (BECTS) seizures or a benign Rolandic seizure, that tenuous state between sleeping and waking is a time when some odd neurologic things can happen, including BECTS.
Science Based Medicine
NOVEMBER 15, 2024
When RFK Jr. does to the U.S. what he did to Samoa, doctors will say they are horrified, that they love vaccines, blah blah blah. But it will be too late. The post If You Sanewashed RFK Jr., Or If You Sanewashed Doctors Who Did, You Own the Next 4 Years first appeared on Science-Based Medicine.
Dr. Smith's ECG Blog
NOVEMBER 14, 2024
This was texted to me by a paramedic while I was out running one day: "54 yo male chest pain started at 1pm. History of diabetes type II and stent placement in 2018. I’m seeing hyperacute T waves III, aVF, down sloping depression I and aVL. Thoughts?" What do you think? I responded: "Definite inferior OMI. And Right Ventricular. Activated the Cath Lab.
Ken Grauer, MD
NOVEMBER 9, 2024
I was asked to interpret the ECG in Figure-1 — told only that this 30-ish year old man had a history of having undergone a number of operations for CHD ( C ongenital H eart D isease ) as a child. QUESTIONS: In Figure-1 — Is the rhythm VT — or — SVT with aberrant conduction — or — potentially neither of these possibilities? IF told that this patient was hypotensive in association with the rhythm in Figure-1 — Does It Matter what the specific etiology of this rhythm is?
First 10 EM
NOVEMBER 11, 2024
In the most recent BroomeDocs podcast, we talk about an attempt to use the IM route to give cardiac arrest victims epinephrine faster. (The podcast and Research Roundups blog post might actually come out next week.) I was skeptical about the outcomes, partly because the evidence that epinephrine helps at all in cardiac arrest is […] The post IV versus IO for cardiac arrest (PARAMEDIC3 and IVIO) appeared first on First10EM.
Emergency Care Today brings together the best content for emergency care practitioners from the widest variety of industry thought leaders.
RebelEM
NOVEMBER 13, 2024
Take Home points : Always suspect an open joint if there is a laceration, regardless of size, the lies over joint CT scan of the affected joint is widely considered to be the standard approach to evaluation but the saline load test may be useful in certain circumstances. Obtain emergency orthopedics consultation for all open joints and administer antibiotics and update tetanus in all patients REBEL Core Cast 131.0 – Traumatic Arthrotomy Click here for Direct Download of the Podcast.
PulmCCM
NOVEMBER 14, 2024
Critically ill patients receiving mechanical ventilation are highly prone to developing severe weakness and long-term disability. Although early mobilization and physical therapy for vented patients would intuitively seem to have indisputable benefits, early mobility programs have failed to consistently show improvements in meaningful patient-centered outcomes (e.g, increased functional independence or exercise ability after ICU discharge).
Taming the SRU
NOVEMBER 13, 2024
sports medicine grand rounds - Rabies Phophylaxis - R2 qi/kt: Acetaminophen overdose - Landmark studies of emergency medicine - R4 Discharge/Transfer/Treat - Pediatric Lecture sports medicine grand rounds WITH dr. gawron Team physicians deal with a variety of medical complaints, including sports-related injuries as well as non-traumatic concerns Case 1: Clavicular Osteomyelitis 18-year-old female athele presented with a soccer injury but developed fevers, erythema, and warmth of the medial clavi
Emergency Medicine Cases
NOVEMBER 12, 2024
In this EM Cases main episode podcast, we tackle the complexities of trauma airway management, including direct trauma to the airway. We discuss indications and timing of intubation, penetrating neck trauma, the head injured patient, the agitated patients and the soiled airway. The critical question is: when should we deviate from, delay or modify RSI, and how do we navigate the unique challenges presented by trauma airways and airway trauma?
Sensible Medicine
NOVEMBER 15, 2024
“What kind of a doctor are you?” “I’m a general internist.” “Like an intern?” Laughing, “Don’t you think I’m too old to be an intern? No, I do general internal medicine, mostly outpatient primary care, but I do some inpatient general medicine as well.” “Oh, so you’re like a GP.” “Sort of… ” Sensible Medicine is a reader-supported publication.
PulmCCM
NOVEMBER 11, 2024
The DanGer-Shock randomized trial allowed interventional cardiologists to breathe a bit easier, knowing that the Impella device resulted in improved survival 6 months after ST-elevation myocardial infarction with cardiogenic shock: The trial also underscored the high risks associated with the Impella device: Many more patients with Impellas required renal replacement therapy (41.9% vs 26.7%).
ECG Guru
NOVEMBER 11, 2024
Sometimes you see an ECG and feel overwhelmed at first. This ECG rhythm strip is challenging at first glance. However, if you take a systematic approach to the analysis, it is usually possible to decipher the case.
Dr. Smith's ECG Blog
NOVEMBER 10, 2024
Written by Pendell Meyers, few edits by Smith A woman in her 70s was woken from sleep by midsternal chest pain radiating to left arm with nausea. EMS arrived and recorded this ECG: What do you think? Queen of hearts explainability image. Overall High confidence OMI. Smith : this is an "Active OMI". The artery is occluded at this point in time. The ECG shows sinus rhythm, normal QRS, and signs of inferoposterolateral OMI.
Sensible Medicine
NOVEMBER 11, 2024
We learn in high school that the purpose of science is to ask and answer questions about nature--through experiments. Scientists don’t know the results of an experiment beforehand, so, any result, negative or positive, adds knowledge. Medical science should work the same way. Medical scientists would design and conduct experiments to answer important questions, say, whether a drug or surgery, improves an outcome.
Science Based Medicine
NOVEMBER 13, 2024
When physicians spread medical misinformation, the potential harm to health is far greater than their direct patient care. And yet, in a recent study, medical boards rarely discipline physicians for spreading misinformation. The JAMA article looked at 3128 medical board disciplinary proceedings involving physicians. Spreading misinformation to the community was the least common reason, at 0.1%.
EMDocs
NOVEMBER 13, 2024
Today on the emDOCs cast with Brit Long, MD ( @long_brit) , we cover the literature on evaluation and management of primary SBP. Episode 110: Primary Spontaneous Bacterial Peritonitis Background: End-stage liver disease with cirrhosis and ascites is a major cause of death worldwide. Primary spontaneous bacterial peritonitis (SBP) is one of the most common infections in those with cirrhosis and ascites.
Taming the SRU
NOVEMBER 11, 2024
R1 Core Content: ms - r4 Capstone : ableism - Ultrasound grand rounds : MSK R1 Core content: multiple sclerosis WITH Dr. boggust MS is a demyelinating disease affecting young people, with females more frequently affected MS can present with a variety of neurologic symptoms. Those affecting the limbs, bladder, bowels and eyes are most common. Evaluation is most commonly with MRI of the brain and spinal cord with and without contrast after exclusion of other life-threatening conditions.
Sensible Medicine
NOVEMBER 9, 2024
I am huge of fan of the The Skeptical Cardiologist, who I will refer to as TSC. His opinions are often ones I hope I would have come to if I was thinking about the same topic. His substack and twitter feed are totally worth following. I read his post last week on Sensible Medicine and agreed with pretty much everything he said. I also was left with a different conclusion.
ECG Guru
NOVEMBER 12, 2024
The answer to the question is relatively simple. A PAC is usually characterized by the occurrence of a premature P wave, if it is conducted it is followed by a premature QRS complex. A PVC is usually a premature beat from the ventricles with a wide QRS komplex. Either there is no P wave before it, or it is not premature, or the P wave is hidden in the QRS complex or follows it.
EMDocs
NOVEMBER 9, 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: Large- or Small-Bore Chest Tubes for Hemothorax? Spoon Feed While there was concern for selection bias in a number of included studies, this systematic review and meta-analysis found that small–bore thoracostomy tub
Dr. Smith's ECG Blog
NOVEMBER 11, 2024
Written by Willy Frick A middle aged man presented for elective outpatient surgery. The following ECG was obtained in the preoperative area. What do you think? The ECG shows sinus rhythm with a rate of about 78 and 2:1 AV conduction along with right bundle branch block and left anterior fascicular block. The PR interval on the conducted beats is prolonged, about 220 ms.
Don't Forget the Bubbles
NOVEMBER 11, 2024
One-liner… Traumatic brain injury (TBI) is a leading cause of mortality and morbidity in paediatric populations, and fever is associated with worse outcomes. Should we aim to prevent fever, or should we cool patients? A 12-year-old boy presents with a significant head injury following a road traffic accident. At the scene, his lowest GCS was 5 (E1V2M2).
Sensible Medicine
NOVEMBER 14, 2024
What does our philosophy have to do with RFK Jr and MAHA?
EMDocs
NOVEMBER 14, 2024
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.
American Medical Compliance
NOVEMBER 14, 2024
Defined by the World Health Organization as the reluctance or refusal to vaccinate despite the availability of vaccines, vaccine hesitancy is influenced by complex factors including misinformation, cultural beliefs, and fear of adverse effects. To help address this growing concern, pediatric immunization training equips healthcare providers with the skills, knowledge, and empathy necessary to effectively address vaccine hesitancy.
EM Ottawa
NOVEMBER 14, 2024
Urine drug (or toxicologic) screens are a fairly standard tool used in addictions, psychiatry and the Emergency Department (ED), often employed to detect substance use in patients presenting with altered mental status, trauma, psychiatric or abnormal behaviour. Yet, the reliance on these screens is fraught with inaccuracies, clinical irrelevance, and significant ethical concerns, particularly from […] The post Blurred Lines: The Ethical Pitfalls of Urine Drug Screens appeared first on EMOt
St. Emlyn
NOVEMBER 14, 2024
St.Emlyn's - Emergency Medicine #FOAMed Emergency medicine is shaped by our ability to respond effectively to both routine cases and extreme, high-stakes incidents. While civilian incidents dominate prehospital care, the intersection of civilian and military […] The post Podcast – Care in the Hot Zone with Claire Park at Tactical Trauma 2024 appeared first on St.Emlyn's.
Life in the Fast Lane
NOVEMBER 15, 2024
James Miers and Daniel Gaetani Procedure: Radial Arterial Line Emergency Procedure: Radial Arterial Line, with a guide made in partnership with a recent publication in Emergency medicine Australasia
EB Medicine
NOVEMBER 15, 2024
In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the November 2024 Emergency Medicine Practice article, Emergency Department Management of Patients With Low Back Pain: A Review of Current Evidence Prevalence and Importance of Back Pain in the ED Differential Diagnosis and Serious Pathologies Patient Expectations and Management Strategies Missed Serious Pathologies and Their Implications Conflicting Evidence and Treatment Protocols Pathologies Causing Low Back Pain Mechanical and Infe
Ultrasound Gel
NOVEMBER 15, 2024
GEL x SCUF back again! This year at the annual meeting of the Society of Clinical Ultrasound Fellowships, the GEL team interviews several up-and-coming leaders in POCUS about a variety of fascinating topics. [link] GEL x SCUF back again! This year at the annual meeting of the Society of Clinical Ultrasound Fellowships, the GEL team interviews several up-and-coming leaders in POCUS about a variety of fascinating topics.
ECG Guru
NOVEMBER 14, 2024
This ECG comes from Germany, where unfortunately recording is still often done at 50 mm/s. Nevertheless, I believe that you can easily recognize the important changes in this ECG, even if you are not familiar with this recording format. The first two beats are the limb leads, the other beats are the precordial leads.
NRC Health
NOVEMBER 14, 2024
In today's episode, Lukas Voss chats with Jennifer Baron, Chief Experience Officer at NRC Health, and Dr. Reg Blaber, EVP and Chief Clinical Officer at Virtua Health. They delve into the concept of "experiences by design" and its crucial role in healthcare. The post Designing the future of healthcare: Elevating patient and staff experience appeared first on NRC Health.
Clinical Correlations
NOVEMBER 12, 2024
By Enoch Jiang Peer Reviewed “Counseled patient on diet and lifestyle.” Over the past few weeks on my Ambulatory Care rotation, this phrase has rapidly shot to the top of my internal gestalt of a prototypical.
Emergency Medicine Cases
NOVEMBER 12, 2024
Dr. Sara Alavian describes some of the challenges of providing palliative care in low-income/low resource settings and offers some simple solutions in this Global EM column. The post Global EM 6 Palliative Care in Low-Resource Settings: Challenges and Solutions appeared first on Emergency Medicine Cases.
ECG Guru
NOVEMBER 14, 2024
Especially in the social media, one sees again and again similar EKGS like the one shown here with the question: What type of AV block is present here? 2nd degree AVB block type I (Wenckebach) or type II (Mobitz)? It is neither one nor the other! Here, a PAC can be seen under the blue arrow, which is not conduced because the AV node is still refractory (the refractory period of the AV node depends on the preceding heart rate).
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