Ken Grauer, MD
FEBRUARY 15, 2024
The ECG in Figure-1 was obtained from a previously healthy middle-aged man — who presented to the ED ( E mergency D epartment ) for shortness of breath. QUESTIONS: How would YOU interpret the ECG shown in Figure-1 ? Given the irregular irregularity of beats #4-through 17 — Is this a run of AFib ( A trial Fib rillation ) with aberrant conduction? Figure-1: The initial ECG in today's case.
The Trauma Pro
FEBRUARY 16, 2024
Here’s a post from my archive describing a different way to remove the foreign body. This is the technique I used, instead of the standard neck incision. The final incision was just a slight extension of the puncture wound, measuring only 1cm. I was able to grasp the head and pull it out without difficulty. The surprising thing to me was the amount of force I needed to apply to actually pull it out!
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Sensible Medicine
FEBRUARY 15, 2024
It’s been a few years since I first heard about the Galleri test produced by the Menlo Park startup Grail. Galleri is a blood-based screening test for cancer. I think I first heard about it from doctors in concierge practices; next I heard whispers from my own better-off patients who brought me results or asked what I thought of the test. Sensible Medicine is a reader-supported publication.
RebelEM
FEBRUARY 15, 2024
Background: Patients with decreased level of consciousness due to alcohol, drugs, or medications commonly present to the ED. These patients can be at risk of vomiting and aspiration and often prompts clinicians to pursue definitive airway management to avoid pneumonia and other complications. It is unclear, though, if the risks of intubation (including ventilator associated pneumonia) outweighs the benefits.
Dr. Smith's ECG Blog
FEBRUARY 16, 2024
Written by Pendell Meyers A teenager was playing basketball when he suddenly developed palpitations and lightheadedness. He presented soon afterward at the Emergency Department with ongoing symptoms. Mentation and blood pressure were normal. He had no chest pain or shortness of breath. Heart rates on the monitor fluctuated from 180-250 bpm. Here is his triage ECG: What do you think?
EM Ottawa
FEBRUARY 15, 2024
We’re increasingly cognizant of the physiological importance of maintaining specific hemodynamics during resuscitation. Practice patterns vary broadly, so we’ve done a deep dive into the various evidence around the use of ketamine and etomidate in specific clinical scenarios. Physiology of the rapid sequence intubation Rapid sequence intubation (RSI) is the nearly simultaneous administration […] The post Ketamine and Etimodate: Into the Void appeared first on EMOttawa Blog.
Sensible Medicine
FEBRUARY 12, 2024
Academic medicine sometimes gets it right. This is a positive story about a negative trial. Neurologist Hooman Kamel from the Weil Cornell Medical Center in NY had an idea about atrial fibrillation and stroke. Old thinking held that clots formed in the left atrium during periods of irregular rapid fibrillatory activity. Stroke came when these clots moved northward to the brain.
Emergency Care Today brings together the best content for emergency care practitioners from the widest variety of industry thought leaders.
The Trauma Pro
FEBRUARY 13, 2024
We’ve made sure that our victim of the nail gun to the neck did not need an emergent operation. Vitals are stable, there’s no uncontrolled hemorrhage, and the patient is neurologically intact. We’ve imaged him using CT angiography, and the nail does not appear to have injured any vital structures. How do we get it out of there? There are two things that need to be considered: where and how.
Science Based Medicine
FEBRUARY 14, 2024
The Mayo Clinic is a prestigious medical institution with a deserved international reputation. It also promotes rank pseudoscience. It does this, apparently, for all the reasons we have explored here at SBM over the years. I have seen first hand how one or a few true believers can promote so-called alternative medicine at their institutions, meeting little resistance from colleagues and administrators […] The post Mayo Clinic Promotes Reiki first appeared on Science-Based Medicine.
Sensible Medicine
FEBRUARY 16, 2024
It is July 1 st , 1988, Cara’s first day as a medicine intern on my ward team. She meets her existing patients and picks up a new one, Bill. Bill is 35 and has a severe cardiomyopathy. He is waiting a heart transplant but has been having worsening episodes of ventricular tachycardia (VT). He was a direct admission after an electrophysiologic (EP) study.
Emergency Medicine Cases
FEBRUARY 13, 2024
In this month's ECG Cases blog Dr. Jesse McLaren reviews interpretation of the pre-arrest ECG: identifying high risk ECGs requiring empiric treatment like calcium for hyperkalemia, magnesium for long QT, or reperfusion for Occlusion MI; the intra-arrest ECG: identifying pseudo-PEA; and post-arrest ECG: the importance of serial ECGs to reduce false positive STEMI, role of POCUS to help with the differential of diffuse ST depression with reciprocal ST elevation in aVR, and identifying signs of Occ
Dr. Smith's ECG Blog
FEBRUARY 14, 2024
A 41-year-old male who presents to the emergency department with chest pain. Patient reports approximately 2 hours prior to arrival he developed a sharp chest pain that radiates into his left arm and left lower leg. Describes the radiating pain as numbness/tingling. No shortness of breath. No recent travel. No cough. No cardiac history. Here is his ECG: He had a previous ECG on file, from many years prior: What do you think?
NIOSH Science Blog
FEBRUARY 15, 2024
The American Journal of Public Health recently published a special supplement with 15 articles focusing on health worker mental health. This special issue of the journal was sponsored and edited by the National Institute for Occupational Safety and Health (NIOSH) and stems from the health worker mental health initiative from the Centers for Disease Control and Prevention and NIOSH.
First 10 EM
FEBRUARY 12, 2024
Usually, I reserve stand alone blog posts for high quality papers. Usually, garbage science is either ignored, or reserved for brief mentions in the Research Roundups. However, the conclusion of this paper, which states “it is becoming increasingly difficult to justify not making MRI a mandatory part of the clinical assessment of [first episode psychosis]”, […] The post No, you don’t need to order an MRI in first episode psychosis appeared first on First10EM.
Emergency Live
FEBRUARY 16, 2024
Between Climate Change and Health Risks The Zika alarm has brought attention back to the growing concern for vector-borne diseases in Europe, with a particular focus on the risks that the Zika virus poses to the continent. Originally identified in Uganda in 1947, the Zika virus has spread significantly in various regions of the world, […] The post Zika in Europe: an underestimated emergency?
Taming the SRU
FEBRUARY 14, 2024
THE CASE A female in her 20’s presented to the emergency department with concern for oral swelling. She had previously been evaluated at an outside facility for sore throat and was subsequently diagnosed with acute pharyngitis and left tonsillar hypertrophy. She was placed on a course of antibiotics and sent home, however, she continued to have worsening throat pain and edema of her left tonsil with associated difficulty swallowing.
Core Medical Group
FEBRUARY 16, 2024
Introducing Jo Newell, Chief Financial Officer at CoreMedical Group. This feature branches off from our Friday's Finest, where we previously showcased our exceptional recruiters. Now, we're shifting gears to shine a light on our executive team. With a tenure of 15 years at CMG, Jo offers valuable insights on her path into the field and her journey to becoming CFO.
Stop and Think
FEBRUARY 11, 2024
I really don’t like scolds. I have hesitated to write this short piece because it makes me seem like a scold. But I can’t help myself. This week I saw on my Facebook feed a picture celebrating the 500th implant of a preventive cardiac device. The picture featured smiling doctors and super-happy industry reps. The writer expressed happiness that they had helped so many people.
Emergency Live
FEBRUARY 16, 2024
A Free Course for Professionals and Enthusiasts The European Centre for Disaster Medicine (CEMEC), in collaboration with prestigious institutions, announces the launch of the free online course “Forensic Science and Disaster Management” scheduled for February 23, 2024, from 9:00 am to 4:00 pm. A unique opportunity to delve into the world of forensic medicine applied […] The post Discovering forensic science and disaster management appeared first on Emergency Live.
Dr. Smith's ECG Blog
FEBRUARY 12, 2024
A 60-something complained of vomiting, diarrhea overnight, and "bubbles in my chest" that started just prior to calling 911. He had this ECG recorded prehospital: Smith interpretation: There are hyperacute T-waves in III and aVF, and reciprocal STD in aVL with a reciprocally inverted T-wave in aVL. There are also hyperacute T-waves in V3 and V4. There is STD in V1 and V2.
EMDocs
FEBRUARY 15, 2024
Authors: Angela Pikus, MD Emergency Medicine Resident, Atrium Health’s Carolinas Medical Center); Christine Murphy, MD (Emergency Medicine Attending, Medical Toxicologist, Atrium Health’s Carolinas Medical Center) // Reviewed by: Anthony Spadaro, MD (@TSpadaro91, Medical Toxicology Fellow, Rutgers New Jersey Medical School, Newark, NJ); James Dazhe Cao, MD (@JamesCaoMD, Associate Professor of EM, Medical Toxicology, UT Southwestern Medical Center, Dallas, TX); Alex Koyfman, MD (@EMHighAK); Brit
RebelEM
FEBRUARY 12, 2024
Bottom Line Up Top: In selective patients presenting with flank pain, we can diagnose renal colic without a CT scan. There is also a subset of patients that would benefit from IV contrast enhanced CT scanning. Clinical Scenario: A 35-year-old man with no PMH presents with left flank pain, hematuria and history of kidney stones. His vitals are: HR 90, BP 150/90, Temp 98, O2 Sat 99% on RA, RR 18.
Emergency Live
FEBRUARY 16, 2024
The spread of the virus and the importance of prevention In a context characterized by a global increase in temperatures and significant climate change, the alarm for the spread of dengue fever in Europe has become a topic of growing concern for public health. This viral disease, mainly transmitted by mosquitoes of the genus Aedes, […] The post Dengue alarm in Europe: between climate change and new challenges appeared first on Emergency Live.
Emergency Medicine Cases
FEBRUARY 13, 2024
In order fix EM, each of us needs to understand systems issues and systems thinking, and advocate for a better system based on sound systems principles and specific solutions. In this main episode EM Cases podcast Anton is joined by Dr. Alecs Chochinov and Dr. Davie Petrie, two systems thinkers and leaders in EM. They discuss solutions for how to fix EM in 5 spheres: having a coordinated mission, optimizing access points, accountability, disaster preparedness and adaptation/evolution.
Taming the SRU
FEBRUARY 12, 2024
HISTORY OF PRESENT ILLNESS A female in her 30s arrives to the emergency department via emergency medical services. Per report, she called to declare ingestion of an unknown amount of several medications (possibly insulin, antihypertensives, and anticoagulants) in an attempt for self-harm. She initially agreed to be transported to the hospital by ambulance, but jumped from the moving vehicle and was subsequently struck and pinned under the fuselage for 10-15 minutes.
Sensible Medicine
FEBRUARY 13, 2024
Yesterday, someone made an error on the Internet. And I think it was me. Here is a link to my take of the ARCADIA trial. In brief, the trial compared apixaban vs aspirin in patients who had had a stroke of unknown source and evidence of atrial cardiopathy. The trial was stopped early for futility. Recurrent stroke (the primary endpoint) occurred in 40 patients in each group.
Emergency Live
FEBRUARY 15, 2024
We explore how some viruses may be causing cancer diseases and what are the prevention strategies The Connection Between Viruses and Cancer Research has shown that some viruses, known as oncoviruses, can contribute to the development of tumors in various organs of the human body. Among these, the human papillomavirus (HPV) is the most well-known […] The post The invisible link: viruses and cancers appeared first on Emergency Live.
Kings County Downstate EM
FEBRUARY 13, 2024
Co-authors: Taylor Murtaugh MD, Esteban Davila MDWe're back after a quick hiatus for part 2. You can find part 1 here.The Case ContinuedHistory and PhysicalWhen suspecting HCM, the history should focus on overall fitness as well as adverse responses to exertion such as chest pain, shortness of breath, palpitations, and syncope. […] The post Hypertrophic Cardiomyopathy Part 2: Workup and Treatment appeared first on County EM.
Science Based Medicine
FEBRUARY 15, 2024
The controversial and never-proven-effective drug to treat Alzheimer's disease, aducanumab (Aduhelm) has been discontinued. The post Adios Aduhelm first appeared on Science-Based Medicine.
EMDocs
FEBRUARY 13, 2024
Today on the emDOCs cast we have back Rob Orman, MD ( @emergencypdx ). Emergency Physician and founder of Orman Physician Coaching Host of the Stimulus Podcast Learn more at roborman.com Rob and several other amazing clinicians and educators are putting on Awake and Aware , a 3 day conference May 1-3 in Bend Oregon. A 3-day interactive workshop focusing on skills to thrive in your incredibly demanding job (and life).
Emergency Live
FEBRUARY 15, 2024
Politicians, doctors, and experts mobilize on World Day Against Pediatric Cancer The reality of pediatric cancer Pediatric cancer represents a heterogeneous group of oncological diseases that affect children and adolescents. Unlike tumors that develop in adults, pediatric cancers often arise from cells that grow and divide rapidly. These diseases require specific therapeutic approaches tailored to […] The post A united front against cancer in children appeared first on Emergency Live.
ALiEM
FEBRUARY 16, 2024
An 86-year-old man with a past medical history of coronary artery disease, hypertension, hyperlipidemia, chronic kidney disease, COPD, choledocholithiasis requiring ERCP and sphincterotomy 2 years ago presented with five days of feeling unwell. History was limited due to cognitive impairment. His daughter had reported to staff he had been feeling unwell for five days, intermittently having nausea and generalized abdominal pain, subjective fevers, chest pain, and shortness of breath.
Science Based Medicine
FEBRUARY 16, 2024
Newborns are exposed to painful procedures for good reason every day. Treating pain is important in this population, and music might play a role. At least it definitely won't hurt. The post Music for Reducing Pain in Newborns first appeared on Science-Based Medicine.
Dr. Smith's ECG Blog
FEBRUARY 11, 2024
This was a patient with chest pain. The ECG was faxed to a cardiologist. But it was very difficult for him to see. He showed this to me the next day.
Emergency Live
FEBRUARY 16, 2024
A Record Year for the European Company Airbus, the European aerospace giant, closed the financial year of 2023 with record numbers, demonstrating the company’s strength and resilience in a still complex global context. With 735 commercial aircraft delivered and a significant increase in orders, Airbus not only met but exceeded expectations, setting new goals for […] The post Airbus flies high: results and future prospects appeared first on Emergency Live.
NRC Health
FEBRUARY 14, 2024
The NRC Health 2024 Pediatric Collaborative is truly a can’t-miss experience, with exceptional presentations that will stir innovative ideas. Check out a preview of one of the sessions! The post Pediatric Collab Preview | AI and tech: Friend or foe of the healthcare experience? appeared first on NRC Health.
Science Based Medicine
FEBRUARY 10, 2024
“You are here early,” he said. “Yeah. I’m trying to decide what to do about this pump and the seawater cure. So far, my attempts are falling flat.” I told him about the couple pumping water and my lack of success in stopping them from taking the water home. “No surprise,” said Bonham. “Water is supposed to be as safe as mothers” […] The post Skeptics in the Pub.
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