Sensible Medicine
NOVEMBER 22, 2024
OK, the title is click bait. Sensible Medicine is a reader-supported publication. I you appreciate our work, consider becoming a free or paid subscriber. I am a great believer in the healthy lifestyle. If Americans lived healthier lives, we would all be in a better place. There would be less obesity, diabetes, and heart disease. We would probably be treating fewer patients for depression, cancer, and addictions.
Stop and Think
NOVEMBER 19, 2024
The OPTION trial compared two strategies to reduce stroke and bleeding after catheter ablation of atrial fibrillation. The current strategy is to continue an anticoagulant medication. The alternative tested in OPTION is to implant a left atrial appendage device—abbreviated as LAAC (left atrial appendage closure). AF ablation is one of the most common procedures in my field.
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St. Emlyn
NOVEMBER 22, 2024
St.Emlyn's - Emergency Medicine #FOAMed This retrospective study explores the link between intra-arrest arterial blood pressure (IBP) and return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA). Analysing data from 80 patients attended by the East Anglian Air Ambulance, it found that higher diastolic blood pressure (DBP) during CPR significantly increased the likelihood of ROSC.
ECG Guru
NOVEMBER 16, 2024
The Patient: Sixty-year-old man with a complaint of severe substernal chest pain. Denies hx of M.I., but reports feeling short of breath on exertion for about a year. Hx of hypertension, but admits he is non-compliant with his medication. Appears pale and diaphoretic, BP 110/68. The ECG: The rhythm is sinus at 62 bpm. The QRS is slightly wide at 110 ms (.11 seconds), but still within normal limits.
Science Based Medicine
NOVEMBER 22, 2024
Had laptop class doctors been willing to listen to doctors who worked on COVID units, they wouldn't have said so many absurd things. The post Laptop Class Doctors Think Doctors Who Treat Patients Are Lazy, Dumb, Cowardly, Sheep first appeared on Science-Based Medicine.
PulmCCM
NOVEMBER 22, 2024
ChatGPT crushed 50 academic attendings and residents in a diagnostic reasoning contest. At the end of 2023, 26 attendings and 24 residents (mostly in internal medicine at Stanford, Beth Israel/Harvard, and the University of Virginia) read clinical case vignettes and were randomized to answer them either with conventional resources like decision support tools (e.g., Google search, UpToDate™), or to use ChatGPT-4.
St. Emlyn
NOVEMBER 19, 2024
St.Emlyn's - Emergency Medicine #FOAMed Traditionally, large-bore chest tubes have been standard for managing hemothorax, but smaller tubes are now proving just as effective in stable patients, with added benefits like reduced pain and fewer tube days. This review explores outcomes in drainage efficacy, complication rates, and patient comfort, showing that small-bore thoracostomy may be a reliable alternative for non-emergent cases.
Emergency Care Today brings together the best content for emergency care practitioners from the widest variety of industry thought leaders.
Science Based Medicine
NOVEMBER 16, 2024
It means pertussis and measles outbreaks will be happening under your watch and you'll be held responsible while your boss is an anti-vaxx crank. Enjoy! The post What Does it Mean to Own the Next 4 Years? first appeared on Science-Based Medicine.
The Bottom Line
NOVEMBER 22, 2024
Quetiapine Versus Haloperidol in the Management of Hyperactive Delirium: Randomized Controlled Trial Zakhary et al. Neurocritical Care; Oct;41(2):550-557. doi:10.1007/s12028-024-01948-w Clinical Question In critically ill patients with delirium, does quetiapine in comparison to haloperidol, reduce the severity of delirium?
Dr. Smith's ECG Blog
NOVEMBER 21, 2024
Written by Pendell Meyers A woman in her 40s presented with acute chest pain and shortness of breath. Vitals were within normal limits. Here is her triage ECG: What do you think? Smith : This is classic for pulmonary embolism (PE). There are 2 key points to making this diagnosis on the ECG: 1) There is T-wave inversion which you might think is due to Wellens' waves, but the patient has active symptoms, so it is not Wellens' sydrome 2) The T-wave inversion in V1-V4 is accompanied by T-wave invers
EMDocs
NOVEMBER 22, 2024
Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. The goal of MMI-LFL is to improve patient safety, educate physicians and reduce the cost and stress of medical malpractice lawsuits. To opt in to the free subscriber list, click here. Stories of med mal lawsuits can save lives.
ALiEM
NOVEMBER 22, 2024
A 13-month-old, full-term male presented due to intermittent emesis over a 3-week period. He and his parents had COVID one week prior to presentation. He had multiple episodes of non-bloody, non-bilious vomit the day before and the day of presentation. Parents noted he had been listless and unable to tolerate food. The mother was also concerned that he was straining to have bowel movements and that a mass was coming out of his bottom on the ride to the hospital.
The Bottom Line
NOVEMBER 22, 2024
Long-term effects of flexible visitation in the intensive care unit on family members’ mental health: 12-month results from a randomized clinical trial JMB de Souza et al. Intensive Care Med (2024); 50:1614–1621. DOI: 10.
Dr. Smith's ECG Blog
NOVEMBER 17, 2024
Written by Willy Frick A 51 year old man with hypertension presented with three hours of acute onset, severe midsternal chest pain associated with two episodes of nausea and vomiting. ECG 1 What do you think? Smith : Inferior leads have subtle ST Elevation with reciprocal STD in aVL. The end of the T-wave in all of II, III, aVF has a rapid downturn, suggesting early T-wave inversion.
EMCrit
NOVEMBER 22, 2024
Experts' guide to the use of the Bougie for Emergency Airway Management EMCrit Project by Scott Weingart, MD FCCM.
EMDocs
NOVEMBER 19, 2024
Authors: Bricey Bayonnet, MD ( EM Resident Physician, Atrium Health’s Carolinas Medical Center, Charlotte, NC); Christine Murphy, MD (EM Attending Physician; Medical Toxicologist, Atrium Health’s Carolinas Medical Center, Charlotte, NC) // Reviewed by: James Dazhe Cao, MD (@JamesCaoMD, Associate Professor of EM, Medical Toxicology, UT Southwestern Medical Center, Dallas, TX); Anthony Spadaro MD, (@TSpadaro91, Fellow in Medical Toxicology, Rutgers NJMS); Alex Koyfman, MD (@EMHighAK); Brit Long, M
The Bottom Line
NOVEMBER 22, 2024
Validating quantitative pupillometry thresholds for neuroprognostication after out‑of‑hospital cardiac arrest. A predefined substudy of the Blood Pressure and Oxygenations Targets After Cardiac Arrest (BOX)‑trial Nyholm. Intensive Care Med 2024; 50:1484–1495. doi.org/10.
Science Based Medicine
NOVEMBER 21, 2024
The FDA is proposing to order the removal of phenylephrine from oral cough and cold remedies. The post FDA poised to reshape the cold remedy aisle first appeared on Science-Based Medicine.
Dr. Smith's ECG Blog
NOVEMBER 19, 2024
These ECGs were texted to me by one of our previous ultrasound fellows, Will Smoot An elderly male arrived via EMS for acute substernal chest pain with radiation to left shoulder and arm that awakened him from sleep at 0030. He took two full strength aspirin prior to EMS arrival. The pain was relieved by one prehospital NTG spray. He arrived at the ED just shy of two hours after onset, pain free.
Taming the SRU
NOVEMBER 18, 2024
Overview Hiccups are one of the most common human reflexes and fascinatingly occur in adults, children, neonates and in utero! The official medical term for hiccups is “singultus” which is derived from the Latin root word singult and means “to catch one’s breath while sobbing”. While there is no established purpose for hiccups in adults, it is hypothesized that its role in utero is to prevent amniotic fluid aspiration and for respiratory muscle and diaphragmatic training prior to delivery.
EM Literature of Note
NOVEMBER 20, 2024
This article regarding the cost of upgrading emergency departments to be “ready” for sick children has been bouncing around in the background since its publication, with some initial lay press coverage. The general concept here is obviously laudable and the culmination of at least a decade of hard work from these authors and the team involved – with the ultimate goal of ensuring each emergency department in the country is capable of caring for critically unwell children.
Science Based Medicine
NOVEMBER 20, 2024
Amid all the shocking and depressing news regarding the future of American healthcare and medicine, at least over the next four years, I thought I would tackle something a bit lighter today. What happens to the brains of astronauts aboard the ISS? Space medicine is a field of study, if fairly niche, and will likely have increasing implications as humanity increases its […] The post Your Brain In Space first appeared on Science-Based Medicine.
Sensible Medicine
NOVEMBER 19, 2024
Posting this article was a no brainer. It is a critical appraisal deep dive by “friend of the stack” David Rind that combines the “letter to the editor” feel that we like so much as well some nice EBM history. Enjoy. Adam Cifu Sensible Medicine is a reader-supported publication. If you appreciate our work, consider becoming a free or paid subscriber.
RebelEM
NOVEMBER 18, 2024
View Course Dates This 2-day course provides an in-depth look at effective surgical airway management techniques that you will actually use in your next emergency airway. There is a unique focus on airway anatomy and imaging combined with one-of-a-kind opportunity to practice the techniques on a large variety of non-embalmed, specially prepared cadavers.
St. Emlyn
NOVEMBER 19, 2024
St.Emlyn's - Emergency Medicine #FOAMed All the best from the blog from August 2024, in our easy to digest podcast. The post September 2024 Round-Up – Patient Experience in the ED, Dirty Adrenaline, and More! appeared first on St.Emlyn's.
The Bottom Line
NOVEMBER 16, 2024
What’s new in the Critical Care literature – monthly updates
ALiEM
NOVEMBER 18, 2024
A 48-year-old male with no significant past medical history presented to the Emergency Department with a left-sided facial rash and associated burning left eye pain that started four days prior. He was seen at an ophthalmology clinic when his symptoms started and given oral valacyclovir which he took for three days without improvement. He also endorsed left-sided facial weakness and diplopia for the last eight days.
RebelEM
NOVEMBER 21, 2024
A parent presents to the ED with their 6-week-old infant for evaluation of a fever. The infant was born full term and has no other symptoms. Physical exam is normal and vital signs are HR is 150 bpm, SpO2 is 99%, and a rectal T is 101.4°F (38.6°C). Blood cultures are sent and lab results from a CBC, procalcitonin, and urinalysis are as follows: WBC: 5,300/µL Hemoglobin: 12.2 g/dL Platelets: 205,000/µL Absolute neutrophil count: 2,600/µL Procalcitonin: 0.14 ng/mL Urinalysis WBC: 50–100/hpf RBC: 0
St. Emlyn
NOVEMBER 19, 2024
St.Emlyn's - Emergency Medicine #FOAMed Traditionally, large-bore chest tubes have been standard for managing hemothorax, but smaller tubes are now proving just as effective in stable patients. Dive in to explore the latest evidence in trauma management and see if small-bore thoracostomy is suitable for your practice’s patient population. The post Small Bore vs Large Bore Thoracostomy for Traumatic Haemothorax. appeared first on St.Emlyn's.
Science Based Medicine
NOVEMBER 19, 2024
Perhaps the neck manipulation was a bit too aggressive. The post A New DC Degree. What the World Needs Now. first appeared on Science-Based Medicine.
First 10 EM
NOVEMBER 18, 2024
Back for another month of interesting, arcane, important, or baffling articles. As we enter the winter in the Northern hemisphere, and I have little interest in heading outside, I will probably spend more time reading, so these write ups might get longer for the next few months. For now, the weather remains fine, golf season […] The post The November 2024 Research Roundup appeared first on First10EM.
Mind The Bleep
NOVEMBER 22, 2024
Introduction to AI Artificial Intelligence (AI) has changed almost every aspect of modern technology, and it is inevitable that we will soon witness its impact on healthcare. It is therefore vital that healthcare professionals (HCPs) have a basic understanding of how AI works and what impact it will have on our future practice. Ways AI is integrated into healthcare : Medical education and teaching e.g.
Broome Docs
NOVEMBER 17, 2024
Palatinus HN, Johnson MA, Wang HE, Hoareau GL, Youngquist ST. Early intramuscular adrenaline administration is associated with improved survival from out-of-hospital cardiac arrest. Resuscitation. 2024 Aug;201:110266. doi: 10.1016/j.resuscitation.2024.110266. Epub 2024 Jun 9. PMID: 38857847 Bottom line: This before and after study demonstrates an association between early IM epinephrine and survival from cardiac arrest.
Don't Forget the Bubbles
NOVEMBER 18, 2024
As you roll into your night shift, getting briefed and handed the urgent pager, you exit the briefing room and go into the hum of the neonatal intensive care unit. The familiar beeps of monitors and the soft cries of a premature infant fill the air, but then—a sharp, unusual beep cuts through. Moments later, a nurse calls, “Doctor, could you check this blood pressure?
The Skeptics' Guide to EM
NOVEMBER 16, 2024
Date: October 28, 2024 Reference: Verma et al. Clinical evaluation of a machine learning–based early warning system for patient deterioration. CMAJ September 2024 Guest Skeptic: Michael Page is currently the Director of Artificial Intelligence (AI) Commercialization at Unity Health Toronto. He leads an AI team intending to improve patient outcomes and healthcare system efficiency.
PEMBlog
NOVEMBER 21, 2024
I am excited to share the recording of the AAP Section on Emergency Medicine Fall Virtual Education Session , originally held on Tuesday, November 19, 2024 focused on delivering timely and actionable feedback, along with strategies to develop and implement sustainable feedback programs. PEM educators shared their experiences and provided practical strategies to strengthen evaluation processes and initiatives in this multidisciplinary, interactive session.
NRC Health
NOVEMBER 21, 2024
Consumers expect always-on connectivity, transparency, and personalization; so, to drive loyalty, the Wexner Medical Center has focused on delivering individualized, high-quality patient experiences while enhancing its digital front door. The post Unleashing innovative marketing insights to connect the dots for patient experience initiatives appeared first on NRC Health.
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