Pediatric EM Morsels

JUNE 2, 2023

Rare diseases are not confined to the pages of a textbook or computer screen. Our patients have varied past medical histories that require us to be well-versed in even the most uncommon disorders (or know where to look things up in a pinch)! Today we are talking about a rare disease called FPIES (food protein induced enterocolitis syndrome) and how you might encounter these patients in the Pediatric Emergency Department.

Dehydration 189

Dehydration Shock Pediatrics Emergency Department 189

RebelEM

MAY 29, 2023

Background: Sepsis can induce numerous physiologic derangements. At the most severe end, this includes endothelial dysfunction leading to increased vascular permeability, abnormal nitric oxide metabolism, and vasodilation (i.e. septic shock). Judicious fluid resuscitation is indicated in patients with signs of hypo perfusion but is often inadequate necessitating the administration of vasoactive medications.

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

St. Emlyn

JUNE 2, 2023

St.Emlyn's - Emergency Medicine #FOAMed New guidelines from @RCollEM and @RCRadiologists finally agree that contrast CT should not be delayed in the critically ill/injured #FOAMed The post Contrast Induced Nephropathy – sense at last. St Emlyn’s appeared first on St.Emlyn's.

Resuscitation 143

Resuscitation 143

Greater Sydney Area HEMS

MAY 30, 2023

In the first in this series, HEMS physician and podcast host Dr Samuel Bulford interviews senior staff specialist Dr Cliff Reid who describes a case that changed his life and set his approach to mission preparation and training on a new trajectory.

Leadership 137

Leadership 137

Emergency Medicine News

MAY 31, 2023

An abstract is unavailable.

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131

RebelEM

JUNE 1, 2023

Background: Achieving ROSC in out of hospital cardiac arrest (OHCA) is no easy feat but, care doesn’t end with ROSC. Post-ROSC management is nuanced and challenging but helps to ensure good outcomes. Identification of the underlying cause of the cardiac arrest is a critical area of focus in post-arrest care. Although myocardial infarction, dysrhythmias and pulmonary emboli are common pathologies to consider, there are a host of other causes including subarachnoid hemorrhage, trauma and electroly

Outcomes 142

Outcomes Resuscitation Hospitals CPR 142

EMCrit

JUNE 1, 2023

Optimization of Emergency Medicine Teams EMCrit Project by Scott Weingart, MD FCCM.

123

123

ALiEM

JUNE 1, 2023

Are you using phenobarbital instead of benzodiazepines as the first-line monotherapy for patients in alcohol withdrawal in the Emergency Department (ED)? If not, you probably should be. Another old drug for a new indication, right? Well not exactly. Phenobarbital is indeed an older and relatively cheap drug (less than $20 per loading dose) that has gained some press recently for the treatment of acute alcohol withdrawal [1-3].

Administration 98

Administration Emergency Department Seizures Hospitals 98

Science Based Medicine

MAY 31, 2023

Why plausibility must play a central role in scientific medicine. The post Why Scientific Plausibility Matters first appeared on Science-Based Medicine.

98

98

Sensible Medicine

MAY 30, 2023

Thank goodness John Ioannidis exists. Inter alia, if it wasn’t for his research, plenty of the work of academic journal editors and science publishers would go unnoticed, through thick and thin. Instead, his meta-research prompts us to question about these professions and about the future of science communication. Two of his very recent papers pushed me to reflect - from my possibly biased point of view (I am a scientific publisher) – on what is an important issue also to those who w

Research 97

Research Academics Wellness 97

Dr. Smith's ECG Blog

MAY 30, 2023

A 50-something man presented in shock with severe chest pain. His prehospital ECG was diagnostic of inferior posterior OMI. The patient was in clinical shock with a lactate of 8. BP was 108 systolic (if a cuff pressure can be trusted) but appeared to be maintaining BP only by very high systemic vascular resistance. He appeared gray in color, with cool skin.

Shock 97

Shock EKG/ECG Academics Stroke 97

ALiEM

MAY 29, 2023

Massive epistaxis is considered a medical emergency that requires immediate attention. Symptoms of massive epistaxis include sudden and heavy bleeding from the nose, difficulty breathing, dizziness, and a rapid heartbeat. If left untreated, it can lead to significant blood loss, shock, airway obstruction, and even death. We report a case of a 50-year-old man with end stage renal disease with massive nasal bleeding from the left nostril, shortness of breath, and confusion.

Blood Transfusions 98

Blood Transfusions Emergency Department Shock Hospitals 98

Science Based Medicine

JUNE 2, 2023

The authors of the Great Barrington Declaration never asked "vulnerable" people if they were on board with their plan to lock them down for month on end, with no backup plan if herd immunity never arrived. They just wanted to impose their will on tens of millions of vulnerable Americans whether they wanted it or not. The post “Their Plan is Incongruent With My Existence” first appeared on Science-Based Medicine.

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97

Sensible Medicine

MAY 31, 2023

The names and various details of the patients presented below have been altered to preserve confidentiality. Permission was obtained for all images used. Some images have been altered to remove any identifying marks and preserve anonymity. Sensible Medicine is a reader-supported publication. If you appreciate our work, consider becoming a free or paid subscriber.

Psychiatric 97

Psychiatric Hospitals Wellness Military 97

Dr. Smith's ECG Blog

MAY 31, 2023

I received the following text message with these 3 EKGs (providers text me ECGs all day every day; most are false positives; many are subtle true positives): "Hi Steve, here are 3 EKGs for you (my colleague's case). A 67 yo f developed chest pain this morning." EKG #1 Followed 15 minutes by this #2 EKG: Then the patient received aspirin and Dilaudid (hydromorphone, same effect as morphine) and the pain went away and there was this 3rd ECG: Smith comment: hydromorphone will make any pain go away

EKG/ECG 96

EKG/ECG Outcomes Academics Wellness 96

Emergency Medicine News

MAY 31, 2023

An abstract is unavailable.

95

95

Science Based Medicine

MAY 30, 2023

The failure of the White House COVID-19 Response Coordinator to, well, coordinate a response to COVID-19 misinformation has left physicians to fight the uphill battle on their own. The post Voices in the Vacuum first appeared on Science-Based Medicine.

Wellness 93

Wellness 93

Sensible Medicine

JUNE 2, 2023

PH is a 55-year-old woman who comes to see me for an initial visit. She says she has lost about 50 pounds over the last year. Over the last few weeks, the most she can eat at one sitting is a spoonful or two of food. Sensible Medicine is a reader-supported publication. If you appreciate our work, consider becoming a free or paid subscriber. René Leriche famously wrote, "Every surgeon carries within himself a small cemetery, where from time to time he goes to pray -- a place of bitterness an

Hospice 93

Hospice Hospitals 93

EMDocs

MAY 31, 2023

Author: Walid Malki, MD ( @Wandering_ER ) // Reviewed by: Brit Long, MD (@long_brit); Alex Koyfman, MD (@EMHighAK) Welcome the Visual Wednesdays, a series that provides focused EM updates with infographics. Please follow us on Instagram to see past, current and future infographics! The post Visual Wednesdays: Septic Shock Management appeared first on emDOCs.net - Emergency Medicine Education.

Shock 91

Shock EMS Sepsis 91

St. Emlyn

MAY 31, 2023

St.Emlyn's - Emergency Medicine #FOAMed Although these terms may be heard more often in a Build-a-Bear factory or a kitchen at Christmas than a Emergency Department, it doesn’t mean they’re any less relevant. What on earth … Packers, Pushers and Stuffers – Drug Concealment in the ED Read More » The post Packers, Pushers and Stuffers – Drug Concealment in the ED appeared first on St.Emlyn's.

Emergency Department 88

Emergency Department 88

EMCrit

MAY 27, 2023

My dear pulmonologists, I have some bad news. Santa Claus isn't real. Neither is “ARDS.” “ARDS” has traditionally been conflated with a specific histopathological form of lung injury: diffuse alveolar damage (DAD). Lectures, chapters, and articles typically juxtapose these two entities, promoting the concept that they're one and the same.

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87

Medagadget

MAY 30, 2023

Researchers at MIT have developed smart sutures with a hydrogel coating that contains sensing and drug delivery components, and could even be used to implant therapeutic cells. The sutures are made using pig tissues that have been decellularized with detergents to reduce the possibility that they could provoke an immune reaction. The surrounding hydrogel layer contains microparticles that can release peptides when enzymes involved in inflammation are present, and other microparticles that allow

Research 84

Research Wellness 84

Emergency Medicine News

MAY 31, 2023

No abstract available

75

75

St. Emlyn

MAY 30, 2023

St.Emlyn's - Emergency Medicine #FOAMed Quick post to highlight the GECCO conference in Edinburgh on June 6th. global health projects, programmes & research: who does what in emergency care? All welcome and looks great. #FOAMed @GECCoUK The post GECCo: UK global health projects, programmes & research – who does what in emergency care?

Research 78

Research 78

Canadian EM

MAY 31, 2023

Hi Folks! The second day of CAEP truly embodied the essence of phrase “Work Hard, Play Hard.” It was a jam-packed day filled with remarkable talks, enlightening presentations, and a thought-provoking plenary by Dr. Heather Patterson on using photography to cope with burnout. To wrap up the day on a high note, we were treated to the highly anticipated annual Docs that Rock concert.

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73

Medagadget

JUNE 1, 2023

Researchers at Florida State University have developed a 3D model that examines how the bacterium Helicobacter pylori moves through viscous fluids. H. pylori can cause gastrointestinal ulcers and even cancer, moving through the intestinal mucus layer to reach the wall of the gut. Using antibiotics can cause side-effects and can contribute to drug resistance, so these researchers are studying how the bacterium navigates through mucus in an effort to find new therapeutic targets with which to disr

Research 79

Research 79

Emergency Medicine News

MAY 31, 2023

No abstract available

75

75

Sensible Medicine

JUNE 1, 2023

A note about the authors: Drs. Alderighi and Rasoini are both practicing physicians in Italy. Dr. Alderighi is a Sensible Medicine editorial board member. We hope you enjoy their essay. In Italy, a debate has emerged regarding the importance of using the feminine suffix “a” at the end of words defining key positions held by women in society, such as “ sindaca ” (major) or “ avvocata ” (lawyer), instead of the conventional masculine suffix “o” ( sin

Research 72

Research Outcomes 72

University of Maryland CC Project

MAY 29, 2023

Anica Law, MD, MS, Assistant Professor of Medicine/Pulmonary Center at the Boston University School of Medicine presents Critical Care Grand Rounds with a lecture entitled "After Our Work Here is Done: Survivorship After the ICU." Anica Law, MD, MS, Assistant Professor of Medicine/Pulmonary Center at the Boston University School of Medicine presents Critical Care Grand Rounds with a lecture entitled “After Our Work Here is Done: Survivorship After the ICU.

67

67

Medagadget

MAY 30, 2023

Researchers at UMass Chan Medical School have developed a small interfering RNA (siRNA) technology that is stable enough for inhalation into the lungs, where it can potentially treat diseases as diverse as asthma, pulmonary fibrosis, and viral infections such as COVID-19. siRNA is not typically stable enough to survive for long in the lungs, but the researchers chemically modified the constituent nucleotides to stabilize the molecules and help them to evade immune destruction.

Research 73

Research Wellness 73

Emergency Medicine News

MAY 31, 2023

No abstract available

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74

EMDocs

JUNE 1, 2023

Welcome back to the “52 in 52” series. This collection of posts features recently published must-know articles. This week we cover the POLAR RCT on hypothermia for neuroprotection in those with severe TBI. Author: Christiaan van Nispen, MD (Resident, Emergency Medicine Physician, San Antonio, TX); B rannon Inman, MD (Chief Resident, Emergency Medicine Physician, San Antonio, TX) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Effect of Early Sustained Prophylactic Hypot

Hyperthermia / Hypothermia 67

Hyperthermia / Hypothermia Outcomes Hospitals Emergency Department 67

Science Based Medicine

MAY 29, 2023

Some of your fans want public health officials to suffer. Should you care? The post Open Letter to a Medical Student Part 2: “It Was Criminal in My Mind” first appeared on Science-Based Medicine.

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65

ECG Guru

MAY 31, 2023

This ECG comes from a 75 yo man who had 2 syncopes in the past few weeks. The 12-lead-EKG at the family doctor showed an inconspicuous finding. Here you can see a section of the patients Holter ECG. There is a very slow junctional escape rhythm. How can this be recognized?

EKG/ECG 64

EKG/ECG 64

University of Maryland Department of Emergency Med

JUNE 2, 2023

The authors of this study retrospectively compared the 10-day mortality rates of patients who were triaged to levels 3-5 on the Scandinavian Ra.

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62

Sensible Medicine

MAY 29, 2023

The NEJM published a paper last week that may change the future of medical evidence. It is seriously important. But today is Memorial Day in the US. It is not time to analyze papers. It is time to remember and honor those who gave their life in the service of this country. I travel a fair amount and one of the moments that I enjoy—no matter how tired—is when the border guard at passport control says…'“welcome home.” It reminds me of something that is easy to take fo

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62

EMDocs

MAY 27, 2023

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: And the Best Shoulder Reduction Award Goes to… Spoon Feed This meta-analysis found Boss-Holzach-Matter/Davos and FARES had the most favorable value for success rates, while both FARES and modified external rotation

Dislocations 61

Dislocations Stroke Operations 61