NIOSH Science Blog

NOVEMBER 8, 2023

Despite legislation and improved technology, data from Massachusetts hospitals show that sharps injuries have increased in the operating room (OR) [1]. These injuries place healthcare workers at risk of exposure to bloodborne pathogens (BBPs). There is an urgent need to renew efforts to protect healthcare workers inside the operating room. The Massachusetts data highlight a gap and the need to establish a national surveillance program that would help hospitals develop further measures to prevent

Operations 125

Operations Hospitals 125

Ken Grauer, MD

NOVEMBER 10, 2023

== — CLICK HERE — for a V ideo presentation of this case! Below are slides used in my video presentation. For full discussion of this case — See ECG Blog #220 — == The long lead II rhythm strip shown in Figure-1 was obtained from an 51-year-old man who presented to the ED ( Emergency Department ) with "palpitations" that began 1 hour earlier. HOW would you interpret this tracing?

EKG/ECG 483

EKG/ECG Emergency Department 483

Sensible Medicine

NOVEMBER 10, 2023

The CDC has just reported that more parents than ever are getting vaccine exemptions for their children entering Kindergarten. For many of us who have witnessed the CDC’s repeated blunders with kids COVID19 vaccines, this result is entirely predictable. The CDC has lost the trust of the American people, and it will keep getting worse. First, let me say, I warned them.

CDC 145

CDC Pediatrics Poisoning Hospitals 145

Greater Sydney Area HEMS

NOVEMBER 4, 2023

Airway Registry learning points reflect the challenges described and wisdom shared by Sydney HEMS personnel and guests at the Clinical Governance Airway Registry presentations. Cases are discussed non-contemporaneously, anonymised and amalgamated over a period of time to draw together unifying take-home messages. Details of specific cases are removed and/or changed, such that any similarity to real-life patients or scenarios is coincidental.

Airway Management 144

Airway Management Burns Operations Resuscitation 144

The Trauma Pro

NOVEMBER 10, 2023

My last two posts were dedicated to the use of consultants for your trauma patients. Here are my thoughts on best practices in using their services. Trauma surgeons often rely on consultants to assist in the care of their patients. Orthopedic surgeons and neurosurgeons are some of the more frequent consultants, but various other surgical and medical specialists may be needed.

Documentation/Coding 147

Documentation/Coding Best Practices 147

Ken Grauer, MD

NOVEMBER 4, 2023

You are told that the patient next door is in the regular SVT ( S upra V entricular T achycardia ) rhythm shown in Figure-1. QUESTIONS: Is the rhythm AVNRT or AVRT? Is Adenosine likely to convert this rhythm? Figure-1: How would YOU interpret this ECG? MY Thoughts on the ECG in Figure-1: When faced with a challenging cardiac arrhythmia — It is a "luxury" to have access to a long lead rhythm strip containing 3 simultaneously -recorded leads.

EKG/ECG 422

EKG/ECG Wellness 422

Sensible Medicine

NOVEMBER 5, 2023

Years ago, I was late to a dinner party at a new, trendy downtown restaurant. I had been working as an attending on the bone marrow transplant service, and the day got away from me. I had to take care of a patient who had a serious adverse reaction when she received her stem cell infusion. Another patient was suffering from a catastrophic fungal infection, and graft versus host disease threatened the life of a third.

Hospitals 129

Hospitals Wellness 129

Don't Forget the Bubbles

NOVEMBER 8, 2023

7-year-old Tilly is brought to your emergency department at 11 p.m. by her father. She has had abdominal pain for two days, and it has now moved to the right side. She is obviously uncomfortable. Abdominal pain in children is common, accounting for over 1 in 20 attendances to paediatric emergency departments [1]. Differentiating between self-limiting and surgical conditions can be particularly challenging in younger patients who often present with non-specific symptoms and signs.

Emergency Department 103

Emergency Department Ultrasounds Pediatrics Best Practices 103

EM Ottawa

NOVEMBER 6, 2023

Methodology: 4/5 Usefulness: 4/5 Ma L, et al. Lancet 2023 Jul 1;402(10395):27-40. Question and Methods: Do 6 month outcomes improve after implementation of a goal-directed care bundle that corrects prognostically poor physiological abnormalities (systolic hypertension, fever, hyperglycemia, abnormal anticoagulation) for acute intracranial hemorrhage?

Outcomes 104

Outcomes 104

Sensible Medicine

NOVEMBER 6, 2023

Many doctors believe that closing the left atrial appendage (with a device) will help reduce stroke and bleeding. The idea behind stroke reduction is that occluding the appendage takes away a common area where clots form. The reason for less bleeding is that patients with proper occlusion can often be taken off anticoagulant drugs. These are nice ideas.

Stroke 125

Stroke Outcomes Ultrasounds Wellness 125

Emergency Live

NOVEMBER 10, 2023

Discover Key Hospitals in Addis Ababa for Emergency Care and First Aid Services Addis Ababa, the capital city of Ethiopia, is home to a growing population and a diverse healthcare system. First aid services play a crucial role in providing immediate medical care and initial support to individuals in need of urgent assistance. In this […] The post Which Hospitals in Addis Ababa Have a First Aid Service?

Hospitals 105

Hospitals 105

Dr. Smith's ECG Blog

NOVEMBER 5, 2023

By Magnus Nossen, edits by Grauer and Smith The patient is a 70-something female with DMII, HTN and an extensive prior history of coronary artery disease and myocardial infarctions. She's had multiple PCI procedures. She also has sick sinus syndrome (SSS) and intermittent high grade AV block for which she had a dual chamber pacemaker implanted. On the day of presentation she complained of typical chest pain, and stated it feels like prior MI.

EKG/ECG 104

EKG/ECG Wellness 104

Emergency Medicine Cases

NOVEMBER 7, 2023

You diagnose uncomplicated appendicitis in the ED. The on call General Surgery team wants to wait until the next morning to perform an appendectomy. Is your patient at risk for appendiceal perforation with a delay to surgery? Dr. Rohit Mohindra and Dr. Shelley McLeod analyze the latest RCT that attempts to answer this question, the PERFECT study, on this EM Cases Journal Club.

EMS 102

EMS 102

Broome Docs

NOVEMBER 8, 2023

Controversial title… courtesy of Dr Justin Morgenstern. In this podcast Justin tells me about the evidentiary basis for our modern obsession with clinical decision rules and tools. We discuss the reasons that these tools may seem like a great idea, the reality of practice and how we may be able to do better in the future. So if you have ever used a decision tool in the ED – Wells, Ottawa, PECARN, San Francisco, HEART… or any other acronym you need to stop and have a listen to u

Wellness 102

Wellness 102

Emergency Live

NOVEMBER 7, 2023

Specific protections for wounded and medical personnel according to IHL standards during wars In the context of tragic theaters of war, international humanitarian law (IHL) emerges as a beacon of civilization, offering protection to the defenseless and those working to provide relief and treatment. Health facilities and units, including hospitals, according to IHL, should not […] The post Protecting Hospitals in Armed Conflict: The Directives of International Humanitarian Law appeared firs

Hospitals 105

Hospitals 105

ACEP Now

NOVEMBER 7, 2023

ACEP Calls Out Insurer Abuses During Surprise Billing Congressional Hearing ACEP member Seth Bleier, MD, FACEP, testified in front of the influential House Ways and Means Committee during a public hearing in October to call out insurers and advocate for fixes to the severely flawed implementation of the No Surprises Act. Dr. Bleier raised concerns that the Independent Dispute Resolution process has been virtually inaccessible for smaller practices and called out cases where physician groups were

Leadership 98

Leadership Administration Research Risk Management 98

Science Based Medicine

NOVEMBER 6, 2023

Robert F. Kennedy Jr. gave the keynote speech at the second annual meeting of his antivax organization, Children's Health Defense. Once again, he demonstrated that not only is he still antivax as hell, but that his proposals are even more bizarre than before. Truly, it was a homecoming for him. The post Robert F. Kennedy Jr. comes home to his antivax roots…again first appeared on Science-Based Medicine.

Infectious Diseases 95

Infectious Diseases 95

EMDocs

NOVEMBER 6, 2023

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association 2023 Guideline for managing cardiac arrest or life-threatening toxicity due to poisoning was recently released. This post will focus on the key parts of the guideline that affect ED evaluation and management. Top 10 Take Home Pearls 1. Treatment of cardiac arrest and life-threatening toxicity due to poisoning often requires specialized treatments that most clinicians do not use frequentl

Poisoning 95

Poisoning Hyperthermia / Hypothermia Seizures Administration 95

Emergency Live

NOVEMBER 7, 2023

Exploring the Cutting-Edge Medical Facilities Aboard These Lifesaving Vessels Hospital ships are a beacon of hope in times of disaster, conflict, and humanitarian crises. These seafaring medical facilities are equipped with state-of-the-art technology and skilled medical professionals ready to provide critical care and surgical interventions. In this article, we will explore some of the most […] The post Setting Sail to Save Lives: The World's Most Advanced Hospital Ships appeared fir

Hospitals 105

Hospitals 105

PDC Healthcare

NOVEMBER 9, 2023

Children’s Hospital of Philadelphia Uses Time-Expiring Visitor Badges to Improve Safety and Peace of Mind for Patients, Parents and Employees Visitor identification is vital to the security of all healthcare facilities, but perhaps the most important within children’s hospitals, where vulnerable, young patients are being cared for around the clock. We chatted with Candice Tate, […] The post How Visitor Identification Plays a Vital Role in Security at Children’s Hospitals appeared first on

Hospitals 91

Hospitals Patient Safety 91

Emergency Medicine Cases

NOVEMBER 7, 2023

Key principles and approach to management of both non-massive and massive hemoptysis with Dr. Scott Weingart and Dr. Bourke Tillmann, who answer questions such as: What are the factors to consider in the decision to intubate patients with massive hemoptysis? How can one reliably distinguish hemoptysis from pseudohemoptysis? What is the evidence for tranexamic acid in patients with hemoptysis?

Resuscitation 91

Resuscitation EMS 91

Science Based Medicine

NOVEMBER 9, 2023

There's no evidence flushing coffee into your rectum is safe or effective, despite what you may see on TikTok. The post Coffee enemas: This TikTok trend can be deadly first appeared on Science-Based Medicine.

89

89

Emergency Live

NOVEMBER 9, 2023

Relief in International Waters: Advanced Health Care for Palestinian Civilians International solidarity makes waves and sails aboard the hospital ship Vulcano, which departed Nov. 7 from Civitavecchia (Italy). Its voyage to Cyprus is a humanitarian bridge stretched between Italian shores and the Middle East in turmoil, aiming to provide immediate medical care and relief to […] The post Humanitarian Missions at Sea: The Ship Vulcano at the Vault of the Middle East appeared first on Emergenc

Hospitals 105

Hospitals 105

EMDocs

NOVEMBER 7, 2023

Today on the emDOCs cast with Brit Long, MD ( @long_brit) , we discuss the controversy of antibiotics for patients with uncomplicated diverticulitis. For more on the ED evaluation of diverticulitis, please see Part 1. Episode 89: Antibiotics for Uncomplicated Diverticulitis Background: Previously antibiotics were utilized for all patients with diverticulitis.

Sepsis 89

Sepsis Best Practices Hospitals Outcomes 89

PulmCCM

NOVEMBER 6, 2023

Convalescent plasma for ARDS due to Covid-19 Convalescent plasma, donated by patients after recovering from Covid-19 and distributed by the Red Cross, represented one of the many ethical and policy controversies generated by the pandemic. The therapy was approved for emergency use in 2020 by FDA after an observational study of 10 patients showed likely benefit (yes, 10, which should remind us of our collective desperation).

Blood Transfusions 88

Blood Transfusions Operations Resuscitation Infectious Diseases 88

Don't Forget the Bubbles

NOVEMBER 6, 2023

Starting conversations with stories There’s something about a bookshop – a calm and comforting sense that I am surrounded by stories. The knowledge that within each beautiful book are words, illustrations, and photographs from which I can learn so much. I gently run my fingers over the front cover of a book that I know my daughter will like. Turning it over, I scan the back.

Wellness 86

Wellness 86

Emergency Live

NOVEMBER 6, 2023

Emergency Response Challenged: The SFRS Condemns Attacks and Maintains Community Protection Amidst Firework Frenzy As the skies of Scotland were illuminated with the vibrant displays of Bonfire Night, a darker narrative unfolded on the ground. Firefighters, the very symbols of safety and aid, found themselves under siege, not from the flames they are trained to […] The post Bravery Under Fire: Scottish Firefighters Face Hostile Attacks on Bonfire Night appeared first on Emergency Live.

105

105

EMCrit

NOVEMBER 4, 2023

AHA Guidelines on Critical Care Toxicology EMCrit Project by Scott Weingart, MD FCCM.

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122

Taming the SRU

NOVEMBER 4, 2023

Morbidity & Mortality - Global Health - MAHA - Imaging Decision Rules - BRASH - R4 Capstone Morbidity & Mortality WITH Dr. Yates Foot Infection NSTIs are rare but deadly pathology that need to be considered with any soft tissue infection NSTI is a clinical diagnosis, but there are many imaging and laboratory assessments to help increase clinical suspicion Expedited disposition to the OR for NSTIs under 12 hours from ED presentation significantly decreases mortality Emesis Transaminitis i

Hyperthermia / Hypothermia 84

Hyperthermia / Hypothermia Resuscitation Burns Emergency Department 84

Dr. Smith's ECG Blog

NOVEMBER 9, 2023

A 60-something yo female presented w/ exertional chest pain for 3 days. She had a recent positive stress test about one week ago. Pain was 8/10 and constant. She has been experiencing progressively worsening exertional dyspnea and chest tightness mostly when climbing up flights of stairs since early September. She underwent exercise echocardiogram in mid October where she exercised for nearly 7 minutes on the standard Bruce protocol and had typical anginal pain and shortness of breath.

EKG/ECG 78

EKG/ECG Wellness 78

Emergency Live

NOVEMBER 6, 2023

A Look Back at the Hydrological Emergency That Tested Italy’s Newly Formed Civil Protection and the Role of Volunteers in Disaster Response The 6th of November, 1994, remains etched in the collective memory of Italy, a testament to the country’s resilience and solidarity. On this day, the region of Piemonte faced one of the most […] The post Remembering the Great Flood of 1994: The Watershed Moment in Emergency Response appeared first on Emergency Live.

105

105

ALiEM

NOVEMBER 6, 2023

A 55-year-old female with a history of hyperlipidemia presents after a syncopal episode. She had mild nausea and diarrhea on the morning of presentation but otherwise had no prodromal symptoms before suddenly losing consciousness in a grocery store. Of note, she recalls a similar syncopal episode in the remote past, also preceded by gastrointestinal symptoms at that time.

EKG/ECG 78

EKG/ECG Academics Outcomes Wellness 78

Science Based Medicine

NOVEMBER 8, 2023

Ozone therapy sits in the border zone between science and pseudoscience. The post Ozone Therapy first appeared on Science-Based Medicine.

90

90

RebelEM

NOVEMBER 6, 2023

Background Information: Vasoplegic shock is defined as hypotension with normal or increased cardiac output and can commonly occur in post-cardiac surgery patients having received cardiopulmonary bypass. This dysregulation of vasodilation is associated with a mortality of close to 25%. After catecholamine vasopressors, treatment options include angiotensin II, corticosteroids, methylene blue and hydroxocobalamin.

Shock 72

Shock Administration Academics Hospitals 72

EMDocs

NOVEMBER 4, 2023

Authors: Jacob Kirkland, MD (EM Resident Physician, UTSW – Dallas, TX); Steve Field, DO (Assistant Professor of EM/Attending Physician, UTSW – Dallas, TX) // Reviewed by: Sophia Görgens, MD (EM Fellow Physician, Zucker-Northwell NS/LIJ, NY); Cassandra Mackey, MD (Assistant Professor of Emergency Medicine, UMass Chan Medical School); Alex Koyfman, MD (@EMHighAK) ; Brit Long, MD (@long_brit) Welcome to EM@3AM, an emDOCs series designed to foster your working knowledge by providing an expedited rev

EMS 69

EMS Ultrasounds Emergency Department Infectious Diseases 69

Life in the Fast Lane

NOVEMBER 7, 2023

Michael Gibbs MD Adult Ortho Cases 001 Pelvic ring injuries.

Radiology 111

Radiology Radiology 111

Science Based Medicine

NOVEMBER 10, 2023

Recently published CDC data has revealed an increase in the number of infant deaths in 2022, the first in two decades. The United States continues to struggle with serious healthcare disparities and to lag behind other countries when it comes to keeping young children alive. The post U.S. Infant Mortality Increases for First Time in 20 Years first appeared on Science-Based Medicine.

CDC 71

CDC 71