Ken Grauer, MD
JUNE 2, 2023
I was sent the Holter monitor tracing in Figure-1 — but without the benefit of any clinical information. QUESTIONS: A total of 9 QRS complexes are seen in the 2 simultaneously-recorded monitoring leads. How would YOU interpret the rhythm in Figure-1 ? How many P waves do you see? Why do the QRS complexes of beats #4 and 5 in the bottom lead look different than the other 7 beats?
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.
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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
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.
Don't Forget the Bubbles
MAY 31, 2023
What’s the relationship between COVID-19 and diabetes? May saw the e-publication of the DIMPLES study. Let’s take a deep dive into this paper and its implications for PEM internationally. Ponmani C, Nijman RG, Roland D, Barrett M, Hulse T, Whittle V, Lyttle MD on behalf of PERUKI. Children presenting with diabetes and diabetic ketoacidosis to Emergency Departments during the COVID-19 pandemic in the UK and Ireland: an international retrospective observational study.
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.
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.
Emergency Care Today brings together the best content for emergency care practitioners from the widest variety of industry thought leaders.
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].
Don't Forget the Bubbles
MAY 29, 2023
You are working with your colleagues to assist an 8-year-old with multiple injuries following a high-impact traffic collision. You’re thinking about the next steps and voicing the options; you hear an impatient voice saying, “Are up for this? Should I do it?” from one of the team. What does incivility look like? Whilst not a new concept, incivility is still a widely reported concern within healthcare.
PEMBlog
MAY 31, 2023
When we think of managing agitated patients we think of medicines – but that shouldn’t be our first option. However, medications can be adjuncts to non-pharmacologic means to help keep agitated children safe from harm. This podcast episode hosted by Brad Sobolewski ( @PEMTweets ) and co-authored by Dennis Ren ( @DennisRenMD ) is all about age-appropriate pharmacologic management strategies for agitated children.
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.
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.
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.
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
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.
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.
EMCrit
JUNE 1, 2023
Optimization of Emergency Medicine Teams EMCrit Project by Scott Weingart, MD FCCM.
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.
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
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
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.
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.
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.
Dr. Smith's ECG Blog
JUNE 2, 2023
Written by Pendell Meyers A woman in her 30s with minimal past medical history presented simply stating she was "feeling unwell." Her symptoms started suddenly about 48 hours ago, but had continued to worsen, including epigastric discomfort, nausea, cough, and dyspnea and lightheadedness on exertion. She denied chest pain and denied feeling any palpitations, even during her triage ECG: What do you think?
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.
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?
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
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.
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?
ECG Guru
MAY 27, 2023
This ECG is from an 80-year-old lady who has collapsed or had sycopal episodes several times. The ECG comes from a Holter monitor. She has arterial hypertension and coronary artery disease. The ECG shows a second-degree, Mobitz Type II AV block. In both types of AVB, the PP intervals are usually the same.
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
EMDocs
JUNE 2, 2023
Original podcast posted on PEM Currents – Hosted by Brad Sobolewski ( @PEMTweets ) and co-authored by Dennis Ren ( @DennisRenMD ) This podcast series by PEM Currents is a co-production with the Emergency Medical Services for Children Innovation and Improvement Center (EMSC IIC), whose mission is to minimize morbidity and mortality of acutely ill and injured children across the emergency continuum.
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.
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.
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
Life in the Fast Lane
MAY 28, 2023
Mike Cadogan Eponymous ankle and talus injuries Eponymythology associated with signs, symptoms, investigation and management of ankle and talus injuries, fractures and conditions.
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