The Trauma Pro

JUNE 13, 2023

For the longest time, one of my pet peeves has been potential conflicts of interest (COI) involving authors on research papers. There is no simple definition of the term “conflict of interest.” However, a simple way to think of it is a situation where one’s personal interests may influence their professional responsibilities. Upton Sinclair said it more simply in a book he was writing in the 1930s: “It is difficult to get a man to understand something when his salary depends up

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Research Academics Operations Hospitals 245

Pediatric EM Morsels

JUNE 16, 2023

The subcutaneous space is a vast region of potential space where things can collect. Sometimes this can be used to our advantage, like when we need to give subcutaneous fluids to a dehydrated patient without an IV, or when we need to give SQ medications for things like Sulfonylurea overdose , Hereditary Angioedema , or DVTs. Sometimes, however, these deeper layers of the subcutaneous space can collect dangerous infections , like Necrotizing Fasciitis.

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Soft Tissue Injuries Dehydration Fractures Operations 152

RebelEM

JUNE 14, 2023

Anaphylactic Shock is an acute, life-threatening hypersensitivity disorder, with a generalized, rapidly evolving, multi-systemic allergic reaction (IgE-mediated disorder). If not treated rapidly can become fatal. Scott Weingart, MD put together a manual titled the Resuscitation Crisis Manual , which in short, is composed of two-page protocols for various situations that involve crashing patients.

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Shock Allergic Reactions Resuscitation EMS 145

Don't Forget the Bubbles

JUNE 12, 2023

I remember how I felt when. I first watched “ Just a Routine Operation “, – the story of the events that led to the tragic death of Elaine Bromiley. Elaine Bromiley went into hospital for a routine operation. Despite an appropriate pre-operative assessment, the anaesthetists tasked with intubating Elaine found themselves in a Can’t Intubate, Can’t Oxygenate scenario, though they failed to recognise it at the time.

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Resuscitation Anaphylaxis Best Practices Operations 145

The Trauma Pro

JUNE 16, 2023

How often have you heard this phrase in a talk or seen it in a journal article: “Maintain a high index of suspicion” What does this mean??? It’s been popping up in papers and textbooks for at least 30 years. And to me, it’s meaningless. You try to figure out that sentence! An index is a number, usually mathematically derived in some way. Yet whenever I see or hear this phrase, it doesn’t apply to anything quantifiable.

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Science Based Medicine

JUNE 11, 2023

Three new studies tell us what we already knew- vaccine isn't perfect, but it's far safer than the virus for children. The post Three New Studies Show the COVID Vaccines Are Very Safe for Children first appeared on Science-Based Medicine.

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Life in the Fast Lane

JUNE 11, 2023

Neil Long and Chris Nickson AMAX4 Algorithm AMAX4 is a best-practice algorithm for critical care clinicians in anaphylaxis and asthma resuscitation.

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Anaphylaxis Best Practices Resuscitation Pediatrics 145

First 10 EM

JUNE 12, 2023

Can herbs cure sepsis? The EXIT-SEP trial was just published, and demonstrated a decrease in all cause mortality from xuebijing – a product manufactured by a pharmaceutical company from a combination of Carthamus tinctorius flowers (Honghua in Chinese), Paeonia lactiflora roots (Chishao), Ligusticum chuanxiong rhizomes (Chuanxiong), Angelica sinensis roots (Danggui), and Salvia miltiorrhiza roots (Danshen). […] The post Finally, a cure fore sepsis: Herbs appeared first on First10EM.

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Sepsis EMS 128

Science Based Medicine

JUNE 12, 2023

Last week, an antivaxxer on Substack—where else?—tried to argue that Robert F. Kennedy, Jr. is not antivaccine by encouraging you to judge him by his own words. I agree. You should judge RFK Jr. by his own words, as they show definitively that he has been antivaccine since at least 2005. The post Is Robert F. Kennedy, Jr. antivaccine? Judge him by his own words!

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Emergency Live

JUNE 14, 2023

Pyelonephritis is an inflammatory disease of the kidney and renal pelvis that can be acute or chronic. The disease is often associated with a more or less extensive infection of the organ parenchyma The post Pyelonephritis: causes, symptoms, diagnosis and treatment appeared first on Emergency Live.

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Don't Forget the Bubbles

JUNE 14, 2023

Can’t get enough of Bubble Wrap? The Bubble Wrap Plus is a monthly paediatric journal club reading list from Anke Raaijmakers, working with Professor Jaan Toelen and his team at the University Hospitals in Leuven. This comprehensive list is developed from 34 journals, including major and subspecialty paediatric journals. We suggest this list can help you discover relevant or interesting articles for your local journal club or allow you to keep a finger on the pulse of paediatric research.

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Pediatrics Point-of-Care Testing Outcomes Hospitals 119

St. Emlyn

JUNE 13, 2023

St.Emlyn's - Emergency Medicine #FOAMed This post is from Australia and was brought to us by Dr Ben McKenzie. The events that precede this blog are utterly tragic, but from such tragedy there is hope … Just a routine resuscitation. The AMAX4 algorithm for anaphylaxis/asthma. St Emlyn’s Read More » The post Just a routine resuscitation.

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Anaphylaxis Resuscitation 123

Science Based Medicine

JUNE 16, 2023

Calling me a "lockerdowner" generates likes and retweets from "free-thinkers", but it doesn't refute anything I wrote. Since you obviously need help, I'd like to give you a clear roadmap to refute my ideas. All you have to do is stand up for your own words and make the affirmative case that the purposeful infection of unvaccinated children and young adults was wise and a net positive.

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Emergency Live

JUNE 13, 2023

Brugada syndrome is a disease that most commonly affects young males in adulthood. The genetic defect is in proteins that control the entry of sodium into the cardiac cell The post Genetic heart disease: Brugada syndrome appeared first on Emergency Live.

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PulmCCM

JUNE 12, 2023

Induced hypothermia after cardiac arrest is also called “active temperature control” or “targeted temperature management.” The treatment became widespread after a trial ( NEJM 2002, n=275) showed large neurologic and survival benefits from hypothermia; however, subsequent trials mostly failed to replicate those findings. A Cochrane review analyzing 12 studies with 3956 participants concluded that: There was no detectable benefit to cooling to temperatures lower than 36 &#

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Hyperthermia / Hypothermia Academics Documentation/Coding Outcomes 102

Taming the SRU

JUNE 12, 2023

In the United States, approximately 4.5 million people are bitten by dogs annually [1]. Although not every person seeks health care for these injuries, the majority of those that do end up in the emergency department. In 2008, this led to greater than 316,000 emergency department (ED) visits and about 9,500 hospitalizations [1]. There are multiple factors to consider when managing dog and mammalian bites in the ED, including closure, prophylactic antibiotic administration, and rabies post-exposu

Infectious Diseases 102

Infectious Diseases Emergency Department Administration Academics 102

St. Emlyn

JUNE 13, 2023

St.Emlyn's - Emergency Medicine #FOAMed The latest from the @stemlyns podcast with the best of the blog from April 2023. #FOAMed @docib and @EMManchester talk about HALO, Blood and the future of #FOAMed The post April 2023 podcast round up. St Emlyn’s appeared first on St.Emlyn's.

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Emergency Live

JUNE 15, 2023

The obstruction or narrowing of the urethra, the channel that allows urine to flow outwards, is called urethral stricture The post Urethral stenosis: definition, causes, symptoms, diagnosis and treatment appeared first on Emergency Live.

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SheMD

JUNE 15, 2023

Currently, I am a neurology resident and neuroscientist at Mayo Clinic in Rochester, MN. As a neurology resident, I conducted my intern year rotating within internal medicine. In less than 2 weeks, I will be a PGY-2 neurology resident. As I reflect over my experience, it has been a year of tremendous excitement and extreme difficulty. I have grown into becoming a more independent physician-scientist.

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Hospitals 98

ALiEM

JUNE 15, 2023

Which cardiotoxic plant is shown? Lily of the valley Moonflower Morning glory Water hemlock White snakeroot Reveal the Answer 1. Lily of the Valley What type of plant is lily of the valley? Lily of the valley ( Convallaria majalis ) is a woodland perennial with a sweet scented, white bell-shaped flower. It blooms from April to June in North America and bears orange-red berries in July [1].

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Poisoning EKG/ECG Hospitals 98

PEMBlog

JUNE 14, 2023

We are in the midst of a staggering mental health crisis. Thousands of children and adolescents spend days at time in Emergency Departments waiting for definitive mental health disposition. This podcast episode hosted by Brad Sobolewski ( @PEMTweets ) and co-authored by Dennis Ren ( @DennisRenMD ) is all about what we should consider when boarding children in the ED for mental health reasons.

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Psychiatric Emergency Department Pediatrics Best Practices 98

Emergency Live

JUNE 10, 2023

The objective examination of the heart includes auscultation, inspection and percussion, but to arrive at a diagnosis the doctor checks the history and may prescribe exams The post Semeiotics of the heart: history in the complete cardiac physical examination appeared first on Emergency Live.

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Stop and Think

JUNE 13, 2023

Before I tell you about two recent (mind-boggling) studies, I want to say thank you for the support. It’s shocking how many have subscribed and supported this newsletter. This will be the first of a two-part series regarding two curious studies. I have built a 30-minute lecture on critical appraisal of medical evidence. I give the talk in seven chapters.

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Outcomes Academics Shock Hospitals 98

EM Ottawa

JUNE 12, 2023

Methodology: 2/5 Usefulness: 3/5 Warstadt NM, et al. BMJ Open Qual. 2022 Jan;11(1):e001624. Questions and Methods: Using a cohort and QI approach, to demonstrate the effectiveness of a multidisciplinary educational intervention and EHR tool to increase sepsis bundle compliance. Findings: Overall EHR tool use increased from 23.3 to 87.2% with an improvement in sepsis bundle […] The post Quality initiative to improve emergency department sepsis bundle compliance through utilisation of an ele

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Sepsis Emergency Department 98

SheMD

JUNE 15, 2023

I wish I really knew how hard it would be. “ It” being these 4 years of my clinical training called residency. Throughout residency everything has been tried including my patience, sanity, mind and marriage. When we are in medical school we are so concerned with graduating and getting to the next step, not realizing that this next step is unlike anything we have ever experienced.

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Hospitals 96

Emergency Live

JUNE 10, 2023

Electrical cardioversion, CVE, is a therapeutic procedure used to restore normal heart rhythm in patients with atrial fibrillation, flutter, or tachycardia and in whom pharmacological cardioversion has failed The post Electrical cardioversion: what it is, when it saves a life appeared first on Emergency Live.

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Eolas Medical

JUNE 12, 2023

It’s been a busy few months at Eolas, and as usual the blog is the first thing to suffer! The good news, though, is that we’ve been busy attending some of the world’s leading health IT events.

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Dr. Smith's ECG Blog

JUNE 15, 2023

Written by Pendell Meyers Both of these cases were sent to me with no information other than adults with acute chest pain. What would be your response? Case 1: Case 2: What if I told you that Case 1 has an abnormal initial troponin, and Case 2 has a normal initial troponin? Case 1 An elderly male presented with chest pain. His vitals were within normal limits except some mild hypertension.

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EKG/ECG Documentation/Coding Outcomes Hospitals 93

Sensible Medicine

JUNE 15, 2023

Over 5000 people have retweeted and over 4 million have seen a new preprint that claims that the shingles’ vaccines reduces the risk of dementia. The vaccine purportedly lowers the risk of shingles by 1 percentage point over 7 years; Apparently, it also lowers the absolute risk of dementia by 5.6% in women (Bigger effect!) and essentially nothing in men, according to this paper.

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Emergency Live

JUNE 10, 2023

Genital prolapse refers to the descent of the pelvic organs through the vaginal canal. To better understand how it happens, it is useful to frame the functioning of the pelvic floor The post What is genital prolapse? appeared first on Emergency Live.

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Taming the SRU

JUNE 11, 2023

Ladde JG, Miller S, Chin K, et al. End-tidal carbon dioxide measured at emergency department triage outperforms standard triage vital signs in predicting in-hospital mortality and intensive care unit admission. Acad Emerg Med 2023; 10.1111/acem.14703 P: 1094 patients, triaged as ESI 2-4, presenting to a single center, Level 1 trauma center in Florida by either lobby or EMS I: EtCO2 Measurement C: Traditional vital signs (HR, BP, RR, SpO2) O: EtCO2 outperformed traditional vital signs in predicti

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Hospitals Emergency Department EMS Outcomes 87

Dr. Smith's ECG Blog

JUNE 11, 2023

Written by Bobby Nicholson MD and Pendell Meyers A man in his 30s presented to the ED for evaluation of chest pain and palpitations. He described it as a "jackhammering" sensation, associated with palpitations, diaphoresis, and shortness of breath, and he stated it started soon after consuming an "energy drink" (product/contents unknown). He stated these symptoms were the same as a prior episode which required cardioversion.

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EKG/ECG Resuscitation Shock EMS 88

Science Based Medicine

JUNE 14, 2023

Beware overblown claims that autonomic testing can help almost anything. The post Dubious Autonomic Nervous System Claims first appeared on Science-Based Medicine.

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Emergency Live

JUNE 10, 2023

Flat foot - from the Latin pes planus - is a dysmorphism that occurs with altered anatomical relationships of the foot, in particular with the characteristic reduction or total disappearance of the plantar arch with consequent enlargement of the support surface of the foot itself The post Let's talk about flat foot: what problems does it cause?

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Taming the SRU

JUNE 14, 2023

Massive upper Gi bleed - electrical storm - waveform capnography - valproic acid toxicity - severe dka Taming the sru WITH dr. diaz Case: Middle aged patient with esophageal varices, recently banded presents for large volume hematemesis in hypovolemic shock. She required MAC line placement, MTP activation and transfusion. She was intubated for airway protection and the decision was made to perform balloon tamponade with placement of a Minnesota Tube.

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Shock CPR Wellness 87

Medagadget

JUNE 12, 2023

The human body has a deep connection with electricity. The transmission of electrical impulses is responsible for the movement of our limbs, the functioning of our organs, and the formation and recall of memories. The signatures of the various electrical signals emanating from our body can be telltale signs of our health, and a jolt of electricity can literally bring us back from the brink of death.

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Sensible Medicine

JUNE 12, 2023

If you have not read part 1 of this series, do that now. It is short. We will wait. NEJM published the ELAN trial in May of this year. Early vs late initiation of oral anticoagulation after an ischemic stroke due to atrial fibrillation. The primary outcome was a composite of lots of bad things—stroke, systemic embolism, intracranial bleeding, extracranial bleeding, and death due to cardiovascular causes.

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Stroke Outcomes 84