PulmCCM
FEBRUARY 5, 2024
Fever in the ICU: Guideline Update The Society of Critical Care Medicine (SCCM) and the Infectious Diseases Society of America (IDSA) issued an interim update to their 2008 recommendations for the management of fever in the ICU. PulmCCM is not affiliated with SCCM or IDSA. Virtually all the recommendations were based on weak evidence and represent a consensus of expert opinion.
Ken Grauer, MD
FEBRUARY 3, 2024
Today’s patient is an older woman who experienced a number of fainting epiodes over the previous week. No CP ( C hest P ain ). Shortly after arrival in the ED ( E mergency D epartment ) — she suffered a cardiac arrest. The ECG in Figure-1 was obtained following successful resuscitation. Stat Echo — obtained shortly after successful resuscitation revealed anterior wall akinesis.
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The Trauma Pro
FEBRUARY 9, 2024
This case involves an accidental nail gun injury to the neck. The patient is hemodynamically stable, neurologically intact, the airway is patent and not threatened, and there is no apparent hematoma. There is a small puncture near the sternocleidomastoid muscle on the right, fairly high on the neck. The nail is not palpable on either side. And the patient only complains of a little discomfort when he swallows.
Sensible Medicine
FEBRUARY 9, 2024
You can only listen to, or read, what doctors have to say for so long. Today, in our Friday, “reflective writing” slot, an essay from someone in the bed rather than beside it. Adam Cifu Sensible Medicine is a reader-supported publication. If you appreciate our work, consider becoming a free or paid subscriber. After ten days tethered to an IV of cyclosporine, the surgeon explained that he would remove my colon, create a stoma, and hitch a colostomy bag to my abdomen.
Science Based Medicine
FEBRUARY 7, 2024
Wellness influencers are often also conspiracy theorists, as both mindsets rely upon the same underlying methods, motivation, and narrative. The post The Menace of Wellness Influencers first appeared on Science-Based Medicine.
Ken Grauer, MD
FEBRUARY 9, 2024
Imagine the only information provided for the ECG in Figure-1 — is that it was obtained from a 60-year old man with new CP ( C hest P ain ). QUESTIONS: In view of this brief history — How would YOU interpret this ECG in Figure-1 ? Is the cardiac rhythm related to the 12-lead ECG? Figure-1: The initial ECG in today’s case. MY Thoughts on the ECG in Figure-1: The goal of practicing clinicians is to interpret both parts of the tracing in Figure-1 ( = the cardiac rhythm and the 12-lead ECG ) — in an
The Trauma Pro
FEBRUARY 6, 2024
Here’s a very interesting case for you. A construction worker was carrying an object inside a building WHILE HOLDING HIS NAIL GUN! As he passed through the door, his elbow hit the frame and he brushed his neck with the business end of the gun. Guess what happened? He experienced sharp pain, then noted pain every time he swallowed. He checked himself out in the mirror, and there was a small puncture wound in the right side of his neck.
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Science Based Medicine
FEBRUARY 5, 2024
A year ago, I noticed that COVID-19 quacks were touting the "repurposing" of ivermectin to treat cancer. Now, familiar COVID-19 antivaxxers—cough, cough, FLCCC—have turbocharged this quackery. The post COVID-19 antivax quacks are now “repurposing” ivermectin for cancer first appeared on Science-Based Medicine.
First 10 EM
FEBRUARY 8, 2024
Long time readers will know that I generally dislike guidelines. Although there are exceptions, I think that guidelines are often more problematic than helpful. However, I know that many people work in places that have medicolegal structures that leave them feeling completely paralyzed, and unable to practice in the absence of a relevant guideline. The […] The post ACEP says its OK to use topical anesthetics for simple corneal abrasions appeared first on First10EM.
RebelEM
FEBRUARY 8, 2024
Background: Patients with shock frequently present with hypotension. Many of these patients are started on vasopressor and inopressor medications to assist in efforts to normalize blood pressure to help improve organ perfusion. In shocky patients, arterial lines are often used to monitor hemodynamic parameters and inform treatment decisions. However, there is limited data on the benefit of invasive blood pressure monitoring over non-invasive blood pressure monitoring.
Sensible Medicine
FEBRUARY 6, 2024
Two things are clear about the internal medicine residents I get to work with. First, their qualifications are spectacular: academic accolades, research, publications, clinical medicine experiences prior to residency, even real-life professional experiences. When they enter internship, their CVs dwarf those of my residency colleagues (’93 - ’96).
Dr. Smith's ECG Blog
FEBRUARY 9, 2024
Written by Jesse McLaren A 65 year old with a history of atrial flutter, CABG and end-stage renal disease on dialysis presented with 3 days of fluctuating chest pain, which was ongoing at triage. What do you think? Do you need posterior leads? There’s atrial flutter with controlled ventricular response, a non-specific intra-ventricular conduction delay, borderline right axis, normal R wave progression and normal voltages.
First 10 EM
FEBRUARY 5, 2024
In the Rapid Review series, I briefly review the key points of a clinical review paper (which often extends to multiple papers because I can’t help myself). The topic this time: Propofol Related Infusion Syndrome (PRIS). Like many rapid review topics, this was chosen for my own education because I have next to no experience […] The post Propofol Related Infusion Syndrome (PRIS) appeared first on First10EM.
The Bottom Line
FEBRUARY 7, 2024
What’s new in the Critical Care literature – monthly updates
Life in the Fast Lane
FEBRUARY 8, 2024
Sheralyn Guilleminot and Mike Cadogan AI-Assisted Learning and Teaching AI-assisted learning and teaching is an often-overlooked use of artificial intelligence in medicine! Here are 4 ways to do it.
Dr. Smith's ECG Blog
FEBRUARY 6, 2024
Written by Pendell Meyers A teenager was involved in a motor vehicle collision and presented to the Emergency Department via EMS altered and potentially critically ill. He was intubated for altered mental status. Chest trauma was suspected on initial exam. Here is his initial ECG around 1330: What do you think? The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia.
ALiEM
FEBRUARY 9, 2024
How do we best use high-sensitivity cardiac troponin (hs-cTn) to risk stratify patients with symptoms concerning for an acute myocardial infarction (AMI)? The 2022 American College of Cardiology (ACC) pathway provides timely guidance [1]. We help you translate this to your clinical practice, by illustrating with a case. Time to know your hs-cTn better.
EMCrit
FEBRUARY 9, 2024
The acute crit care med rec EMCrit Project by Scott Weingart, MD FCCM.
RebelEM
FEBRUARY 5, 2024
Background: The optimal management of primary, spontaneous pneumothorax (sPTX) remains an area of active debate. The British Thoracic Society recommends the least invasive approach possible. In contrast, the American College of Chest Physicians favors first-line chest tube drainage for any sPTX with an estimated volume of over 20%.(3) A Cochrane systematic review comparing simple aspiration with drainage for adult cases identified several randomized controlled trials of small, heterogeneous po
Emergency Live
FEBRUARY 5, 2024
A comprehensive guide to understanding, preventing, and effectively treating kidney colic. Kidney colic is an acute disorder characterized by intense and sudden pain localized in the lower abdomen or back. This condition mainly occurs due to the presence of kidney stones in the ureter, the thin tube that connects the kidneys to the bladder. These […] The post Kidney colic: prevention and treatment appeared first on Emergency Live.
PEMBlog
FEBRUARY 7, 2024
Just look at the rash – then scroll down to reveal the diagnosis. That’s it. And oh yeah, she did spend time in a hot tub during a recent trip. The nodules on the platter surface of the feet are painful. She is systemically well appearing. It’s Pseudomonas Hot-Foot Syndrome! This malady is characterized by the acute onset in children of exquisitely tender plantar nodules and a benign, self-limited course.
Taming the SRU
FEBRUARY 7, 2024
AirCare - Derm Emergencies - R4 Capstone - Landmarks of EM - Global Health - Toxicology Aircare Grand ROunds WITH Drs. Tillotson and Hinckley Simulation Communication on arrival to a scene is key, both between you and your flight nurse before you enter the ambulance and with the EMS crew Reassessing the potential reasons for shock in a trauma is important to pick up causes that are not initially on your mind initially (blood products for hemorrhage, controlling a significant scalp bleed, relievi
Life in the Fast Lane
FEBRUARY 4, 2024
Oliver Flower EVACUATE: ICH Management Amal Abou-Hamden discusses intracerebral haemorrhage (ICH), and the history of management of surgical management of ICH including the STICH1, STICH2 and EVACUATE trial
Science Based Medicine
FEBRUARY 9, 2024
What did I mean when I said Dr. Kelly Brogan "won the pandemic"? The post Dr. Kelly Brogan Wakes Up to the “Ball Earth Hoax”. What Does This Reveal About Prominent Professors From Prominent Medical Schools? first appeared on Science-Based Medicine.
The Bottom Line
FEBRUARY 7, 2024
What’s new in the Critical Care literature – monthly updates
Taming the SRU
FEBRUARY 5, 2024
Imhotep was an egyptian chancellor and has been credited with the discovery of csf. Metropolitan Museum of Art, CC0, via Wikimedia Commons The ancient Egyptian physician Imhotep is often credited with the discovery of cerebral spinal fluid (CSF) —over 5,000 years ago! (1) However, it wasn’t until the 1890s that purposeful, successful, and safe attempts to access this fluid were documented (2).
ALiEM
FEBRUARY 5, 2024
Welcome to the AIR Toxicology Module! After carefully reviewing all relevant posts in the past 12 months from the top 50 sites of the Digital Impact Factor [1], the ALiEM AIR Team is proud to present the highest quality online content related to related to toxicology in the Emergency Department. 8 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board.
Sensible Medicine
FEBRUARY 5, 2024
Tomorrow over at CardiologyTrials we will describe the CAPRICORN trial of carvedilol vs placebo in patients post myocardial infarction. Carvedilol is now widely accepted for this indication, but CAPRICORN featured a super-interesting twist regarding how we interpret data given pre-experiment choices. Do tune in. (Also, the bad typo in the original e-mail is fixed.
EMDocs
FEBRUARY 7, 2024
Author: Ryan Leone, MSc, Medical Student at Columbia University // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) What’s the issue? Across several sectors, labor strikes and unionization were prominent throughout the last year. Despite a plateau in overall union membership of around 10% in 2023 1 , major labor actions shook the U.S. and gained national attention, including high-profile strikes by the United Auto Workers (UAW), the Screen Actors Guild – American F
The Bottom Line
FEBRUARY 8, 2024
In patients with severe brain injury who require mechanical ventilation, does an early, single dose of ceftriaxone compared with placebo reduce the incidence of early VAP?
Science Based Medicine
FEBRUARY 4, 2024
A man who experienced the pandemic entirely from his laptop, explains what he would have done had he actually done anything. The post Science Based Satire: What I Would Have Done first appeared on Science-Based Medicine.
American Medical Compliance
FEBRUARY 9, 2024
Compliance officers’ responsibilities extend far beyond merely checking boxes and ticking off regulatory requirements. In fact, 61% of the compliance teams from a Thomson Reuters report also work on long-range strategies for their companies by putting regulatory and legislative changes as a top priority. Compliance officers take on a more complex task such as the creation of medical compliance plans for their company’s long-term success.
EMDocs
FEBRUARY 7, 2024
Today on the emDOCs cast with Jess Pelletier and Brit Long, we discuss the GLP-1 agonist craze, complications, and medication compounding. Episode 94: GLP-1 Agonist Complications Background: GLP-1 agonists are used for weight loss and diabetes; include the following: Semaglutide (Wegovy) GLP-1 agonist FDA approved for weight loss by SQ injection Liraglutide (Saxenda) GLP-1 agonist FDA approved for weight loss by SQ injection Semaglutide (Ozempic) GLP-1 agonist FDA approved for type 2 diabetes by
The Skeptics' Guide to EM
FEBRUARY 3, 2024
Reference: Curry SD, et al. Systematic Review of CT Angiography in Guiding Management in Pediatric Oropharyngeal Trauma. Laryngoscope. March 2023 Date: January 30, 2024 Guest Skeptic: Dr. Alexandra (Ali) Espinel is an Associate professor of pediatrics and otolaryngology at Children’s National Hospital and George Washington University. She is also the director of the Pediatric Otolaryngology […] The post SGEM #429: It’s CT Angio, Hi.
Science Based Medicine
FEBRUARY 3, 2024
For once, I beat the alarm clock by a good hour. Anxiety is better than sunrise for becoming and staying awake. I had too many things to do, and neither the time nor the skill set to accomplish them. As the week progressed, I had become increasingly aware that every hour we did not act meant more death and disease—and I could […] The post Skeptics in the Pub.
NRC Health
FEBRUARY 8, 2024
You may not immediately see the connection between running ultramarathons in the mountains and leading a product innovation team, but to Jon Tanner, Product Leader, the parallels are obvious. Both involve setting ambitious goals, overcoming obstacles, and finding fulfillment in testing limits. The post Igniting Human Understanding: Cami Mitelman appeared first on NRC Health.
EMDocs
FEBRUARY 9, 2024
Authors: Adam Roussas, MD, MBA, MSE // Reviewed by: Jamie Santistevan, MD ( @jamie_rae_EMdoc, EM Physician, Presbyterian Hospital, Albuquerque, NM); Manpreet Singh, MD ( @MPrizzleER ); and Brit Long, MD ( @long_brit ) Case A 40-year-old female presents to the emergency department for palpitations and lightheadedness. She has a history of depression on citalopram, migraines on amitriptyline, and was recently prescribed tramadol after she broke her wrist.
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