Sat.Jun 10, 2023 - Fri.Jun 16, 2023

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Pet Peeve: Conflicts Of Interest

The Trauma Pro

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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Morel-Lavallée Lesion in Children

Pediatric EM Morsels

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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A routine resuscitation

Don't Forget the Bubbles

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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Anaphylactic Shock

RebelEM

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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AMAX4 Algorithm

Life in the Fast Lane

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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Is Robert F. Kennedy, Jr. antivaccine? Judge him by his own words!

Science Based Medicine

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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Boundaries of knowledge

Don't Forget the Bubbles

This post, from Ben Symon on XXX, is the first of our 2022 DFTB conference. Some tickets are still left for DFTB23 in Adelaide, so sign up while you can. Ben Symon is a pediatric emergency medicine physician. He’s fascinated by the interactions and boundaries between how we interact together as clinicians and with our patients. Kindness is central to our speciality – but it should be central to all of our specialities.

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Finally, a cure fore sepsis: Herbs

First 10 EM

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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Three New Studies Show the COVID Vaccines Are Very Safe for Children

Science Based Medicine

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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Just a routine resuscitation. The AMAX4 algorithm for anaphylaxis/asthma. St Emlyn’s

St. Emlyn

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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Genetic heart disease: Brugada syndrome

Emergency Live

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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Bubble Wrap PLUS – June 2023

Don't Forget the Bubbles

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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Pet Peeve: “High Index of Suspicion”

The Trauma Pro

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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A Letter to My Critics: To Refute Me, Stand Up For Your Own Words

Science Based Medicine

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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Urethral stenosis: definition, causes, symptoms, diagnosis and treatment

Emergency Live

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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Issue #4: The Latest in Critical Care, 6/12/23

PulmCCM

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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April 2023 podcast round up. St Emlyn’s

St. Emlyn

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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Mastering Minor Care: Dog Bites

Taming the SRU

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

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Electrical cardioversion: what it is, when it saves a life

Emergency Live

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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Malpractice: Could a Zebra Be Grazing Nearby?

Emergency Medicine News

An abstract is unavailable.

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Tips for Thriving During Intern Year

SheMD

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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ACMT Toxicology Visual Pearl: The Heart Won’t Go On and On

ALiEM

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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Semeiotics of the heart: history in the complete cardiac physical examination

Emergency Live

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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Agitation Podcast Series Episode 5: Management of the child with mental health problems who is boarded in the ED

PEMBlog

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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I am not cynical but these two studies.

Stop and Think

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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The Case Files: A Rare Cause of Syncope

Emergency Medicine News

An abstract is unavailable.

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What is genital prolapse?

Emergency Live

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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Quality initiative to improve emergency department sepsis bundle compliance through utilisation of an electronic health record tool

EM Ottawa

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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Blood Pressure Medications: A Bedtime Story - Clinical Correlations

Clinical Correlations

By Jonah Klapholz Peer Reviewed Telling patients.

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What I Wish I Knew Before Residency

SheMD

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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Let's talk about flat foot: what problems does it cause?

Emergency Live

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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Wellness 911: Stop: The Giving Tree: Model of Medicine

Emergency Medicine News

An abstract is unavailable.

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What's the word on Health IT street?

Eolas Medical

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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Two ECGs texted to me in the same hour. What would you recommend?

Dr. Smith's ECG Blog

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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Vaginismus: causes, symptoms, diagnosis and treatment

Emergency Live

Vaginismus is a conditioned reaction that probably results from the association of pain and fear with attempts at vaginal penetration or even with penetration fantasy alone The post Vaginismus: causes, symptoms, diagnosis and treatment appeared first on Emergency Live.

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Identify this eye exam finding.

University of Maryland Department of Emergency Med

What is this called? What does it indicate? Treatment? ANSWER: Tear Drop pupil. Globe rupture/corneal laceration. Prote.

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EtCO2 vs. Standard Triage Vitals in Predicting In-Hospital Mortality and ICU Admission

Taming the SRU

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