Emergency Live

JANUARY 24, 2024

A Look at Current Trends in Medical Specialization The field of medicine is constantly evolving, and with it, the need for specialization. In 2024, some medical specializations have stood out for their demand in the healthcare sector. Prominent Specializations According to data from 2023, some medical specializations filled quickly even during the initial allocation period, […] The post The most in-demand medical specialties of 2024 appeared first on Emergency Live.

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Ken Grauer, MD

JANUARY 26, 2024

I was sent the ECG in Figure-1 — without the benefit of any history. QUESTION: What kind of AV block is present in Figure-1 ? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). MY Approach to Today’s Tracing: As always — I favor beginning assessment with a quick look at the long lead rhythm strips at the bottom of the tracing.

EKG/ECG 266

EKG/ECG 266

The Trauma Pro

JANUARY 25, 2024

Yesterday, I described how the typical automated oscillometric blood pressure cuff works. We rely on this workhorse piece of equipment for nearly all pressure determinations outside of the intensive care unit. So the obvious question is, “is it accurate?” Interestingly, there are not very many good papers that have ever looked at this! However, this simple question was addressed by a group at Harvard back in 2013.

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Shock 147

EM Ottawa

JANUARY 25, 2024

Mechanical ventilation has a lot of nuance associated with it, but a lot of reference guides focus on care in the ICU. There is certainly a need for more practical application for the ED doc or initial setup of patients on the vent. With both ER and ICU experience, this post acts as a quick […] The post Mechanical Ventilation Basics appeared first on EMOttawa Blog.

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EMS 141

Critical Care North Hampton

JANUARY 25, 2024

Many thanks to Dr Manoj Wickramsinghe for his review of this fabulous POCUS textbook. He is a trainee in Anaesthesia and ICM, based in Leeds, and one of the CCN editorial team. About the book authors Editors; Hatem Soliman-Aboumarie, Marcelo Haertel Miglioranza, Luna Gargani, Giovanni Volpicelli. The authors and editors of this book include some.

Ultrasounds 140

Ultrasounds 140

Ken Grauer, MD

JANUARY 20, 2024

I was sent the tracing shown in Figure-1 — told only that this was a preoperative ECG obtained from an asymptomatic older woman scheduled for non-cardiac surgery. How would YOU interpret this ECG? Would you approve her for surgery if the procedure was nonemergent? Figure-1: Preoperative ECG from an asymptomatic older woman scheduled for non-cardiac surgery.

EKG/ECG 238

EKG/ECG 238

The Trauma Pro

JANUARY 22, 2024

The blood pressure cuff is one of those devices trauma professionals don’t give a second thought to. Old timers like me remember using the cuff with a sphygmomanometer and stethoscope to get manual blood pressures. I’ve had to do this twice in recent months on airplanes, and I had forgotten how much work this is. But technology makes things easier for us.

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EMCrit

JANUARY 22, 2024

background: ANTHARTIC trial Prophylaxis against VAP (ventilator associated pneumonia) has is already supported by a few studies in the literature, perhaps most notably the ANTHARTIC trial. That was a multi-center RCT evaluating 48 hours of therapy with ampicillin-sulbactam for patients intubated following cardiac arrest. Antibiotic therapy reduced early-onset VAP, with a trend towards more ventilator-free […] EMCrit Project by Josh Farkas.

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Sensible Medicine

JANUARY 26, 2024

What happens to doctors who run unethical clinical trials? Ans: they get praised and promoted In this essay, I am going to explain to you why the recent study CONTACT-2— presented now at a cancer conference— is a problematic trial. Next, I am going to discuss why these trials persist. The reason is that the investigators are rewarded not punished.

Documentation/Coding 116

Documentation/Coding 116

Dr. Smith's ECG Blog

JANUARY 20, 2024

Written by Pendell Meyers A man in his late 30s with history of hypertension, tobacco use, and obesity presented to the Emergency Department for acute chest pain which started approximately 3 hours prior to arrival, in the setting of a very stressful situation. The pain radiated down both arms, 10/10 in severity. He stated it did not feel like his prior episodes of reflux.

EKG/ECG 117

EKG/ECG Documentation/Coding Emergency Department Hospitals 117

First 10 EM

JANUARY 22, 2024

Over the last few years, I have seen a steady increase in the number of non-inferiority trials being published. This makes some sense, as they generally require fewer participants, and are therefore cheaper and easier to run. However, it presents a problem, as most of us (including myself) don’t really understand the statistics being performed, […] The post You don’t understand non-inferiority trials (and neither do I) appeared first on First10EM.

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Don't Forget the Bubbles

JANUARY 24, 2024

Going beyond the algorithm, what can we do when a child is still fitting despite appropriate treatment? Four-year-old Fern is a previously healthy girl who presents with a febrile illness and seizures. Seizure activity did not respond to either first or second-line treatments, so she needed rapid sequence induction and transfer to PICU for ongoing anaesthesia and management.

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Seizures Pediatrics Outcomes Hyperthermia / Hypothermia 109

Sensible Medicine

JANUARY 22, 2024

Two quick stories as background. I remember caring for an older man who presented with a minor heart attack. We got him squared away easily. I was then struck by his history because more than a decade ago, doctors discovered severe multi-vessel coronary disease and they had recommended bypass surgery. They told him he would die without it. He refused.

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Outcomes Research 116

Emergency Live

JANUARY 24, 2024

From the Unification of Italy to the Modern Emergency Management System The Roots of Civil Protection The history of Civil Protection in Italy has its roots in solidarity and civic assistance. Even in post-unification Italy, emergency relief efforts were not considered a priority of the state but rather entrusted to the military and volunteer organizations. […] The post Civil Protection in Italy: a history of solidarity and innovation appeared first on Emergency Live.

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Military 111

EM Ottawa

JANUARY 22, 2024

Methodology: 3.5/5 Usefulness: 4/5 Friedman BW, et al. Neurology. 2023 Oct 3;101(14):e1448-e1454. Question and Methods: This double-blinded RCT of 209 patients presenting to the ED with moderate to severe migraines compared high- to low- dose dexamethasone (16 mg vs 4 mg) on sustained headache relief 48 hours post discharge. Findings: There was no significant difference in sustained […] The post Randomized Trial Comparing Low- vs High-Dose IV Dexamethasone for Patients With Moderate to

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Science Based Medicine

JANUARY 23, 2024

Many chiropractors continue to claim that vertebral subluxations can affect organ function by interfering with nerve flow in spinal nerves, a view that is scientifically indefensible. The post Chiropractic Subluxation Theory: Science or Gobbledegook? first appeared on Science-Based Medicine.

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Emergency Medicine Cases

JANUARY 23, 2024

Olivia Ostrow on the management of button battery ingestions, Brit Long on C difficile infection, Jesse McLaren on an approach to ECG's in the tox patient, Joe Mullally on the identification and treatment of bed bug bites, Andrew Petrosoniak on fibrinogen replacement in bleeding trauma patients, Justin Morganstern on Cold Air for Croup. The post EM Quick Hits 54 Button Battery Ingestion, C. difficile, ECG in Tox, Bed Bugs, Fibrinogen in Trauma, Cold Air for Croup appeared first on Emergency Medi

EMS 103

EMS EKG/ECG Pediatrics 103

Emergency Live

JANUARY 25, 2024

From Its Discovery to Modern Treatment Strategies HIV (Human Immunodeficiency Virus) is a virus that affects the body’s immune system, particularly CD4 T cells, which play a crucial role in fighting infections. If left untreated, HIV can progress and become AIDS (Acquired Immunodeficiency Syndrome), the most advanced stage of HIV infection, characterized by severely damaged […] The post HIV: let's better understand what it is appeared first on Emergency Live.

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EMDocs

JANUARY 23, 2024

Today on the emDOCs cast we cover BRASH syndrome and what you need to know regarding diagnosis and treatment. Episode 93: BRASH syndrome Background: Brash syndrome has 5 components: bradycardia, renal failure, AV nodal blocker, shock, hyperkalemia. Patients at risk of renal insufficiency are the primary population, as well as those on certain medications: AV nodal blockers : any of this class but specifically atenolol, nadolol, labetalol ACE-I and ARBS : increase risk of hyperkalemia and renal d

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Shock Dehydration Sepsis EKG/ECG 88

Science Based Medicine

JANUARY 24, 2024

Despite massive efforts to reduce the disease burden of malaria, it remains a significant cause of disease and death in parts of the world, most notably Sub-Saharan Africa. Now we have a new tool in the fight against malaria – two safe and effective vaccines. Cameroon is just beginning a program to give the vaccine for free to children in four doses […] The post Cameroon Begins First Malaria Vaccine Program first appeared on Science-Based Medicine.

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American Medical Compliance

JANUARY 25, 2024

The year 2024 marks another significant chapter in the healthcare industry’s ongoing battle against infectious diseases, and the numbers speak volumes. The CDC’s FluSurv-NET system, a sentinel network of healthcare facilities, documented over 104,000 flu-related hospitalizations across 13 states during past flu seasons. As healthcare heroes continue their unwavering service on the front lines, the spotlight remains firmly fixed on the importance of personal protective equipment (PP

Infectious Diseases 87

Infectious Diseases PPE CDC Documentation/Coding 87

Emergency Live

JANUARY 25, 2024

An Evolving Landscape of Healthcare Professions The healthcare sector is constantly evolving, and along with it, the professional needs. In 2024, some healthcare roles are emerging as particularly in demand, reflecting the changing requirements of a rapidly transforming industry. Frontline Technicians and Specialists Radiology technicians, laboratory technicians, and healthcare assistants are among the fastest-growing healthcare […] The post Health professions most in demand in 2024 appear

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Radiology Radiology 98

Taming the SRU

JANUARY 24, 2024

Leadership curriculum: recruiting & building a team r4 Case follow-up - r3 small groups Leadership curriculum: recruiting & building a team WITH Drs. fermann and lAfollette The best leaders understand that the critical component to their success as a leader is building a great team around them This involves getting the right people involved in your organization and empowering them to do their job well Recruitment is not a one person job and should involve the entire team recruiting other

Fractures 88

Fractures Leadership Dislocations Resuscitation 88

Science Based Medicine

JANUARY 22, 2024

Wakefield redux? Antivax scientist Byram Bridle just took the "new school" antivax movement old school by implying that COVID-19 vaccines might cause an "epidemic of autism." Everything old is new again, sort of. The post “New school” antivax goes old school as Byram Bridle asks if COVID-19 vaccines will drive an “epidemic” of autism first appeared on Science-Based Medicine.

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Dr. Smith's ECG Blog

JANUARY 23, 2024

This was written by Magnus Nossen The patient is a female in her 50s. She presented with a one week hx of «dizziness» and weakness. She was feeling fine prior to the last seven days. There was no chest pain. She did admit to shortness of breath on exertion. She had no known heart condition. Other than being overweight and having an elevated cholesterol she was healthy.

EKG/ECG 87

EKG/ECG Wellness Pediatrics 87

Emergency Live

JANUARY 26, 2024

A Journey into the Birth and Evolution of Medical Education The School of Montpellier: A Millennial Tradition The Faculty of Medicine at the University of Montpellier, founded in the 12th century, is recognized as the oldest continuously functioning medical school in the world. Its origins date back to 1170 when an initial nucleus of practicing […] The post At the origin of medical practice: the history of early medical schools appeared first on Emergency Live.

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PulmCCM

JANUARY 22, 2024

Targeted temperature management post-cardiac arrest is no more New guidelines from the American Heart Association have effectively ended the two decade era of cooling comatose patients post-cardiac arrest. The new advisement : prevent fevers by keeping core temperature ≤37.5° C; cooling below that is optional. Read on for details. PulmCCM is not affiliated with AHA or ILCOR.

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Hyperthermia / Hypothermia Outcomes Research Hospitals 80

Science Based Medicine

JANUARY 20, 2024

If Dr. Adam Cifu were genuinely concerned about vaccine hesitancy, I would strongly encourage him to learn about the anti-vaccine movement. He'll discover that it is fueled not by a lack of "robust data" on COVID boosters, but rather by exactly the sort of mistrust and anti-vaccine misinformation spread by his own blog and collaborators. The post Dr.

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Dr. Smith's ECG Blog

JANUARY 25, 2024

A 40-something with severe diabetes on dialysis and with known coronary disease presented with acute crushing chest pain. Here is his ED ECG: What do you think? There is a flat and downsloping ST segment in V2 and V3. This could be due to posterior OMI. Is there an old ECG for comparison? Here is the most recent previous ECG: Indeed, there was some normal ST elevation in V2 and V3 , discordant to a relatively deep S-wave which could be due to some LVH.

EKG/ECG 75

EKG/ECG 75

Emergency Live

JANUARY 25, 2024

A Journey Through Innovation and Professional Development Continuous medical education is a key element in keeping healthcare professionals updated on the latest discoveries and practices. In 2024, the educational offerings for doctors and healthcare providers are rich with new developments, ranging from cardiorespiratory emergencies to the cutting-edge applications of artificial intelligence in medicine.

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ALiEM

JANUARY 26, 2024

An 88-year-old female presented to the ER with a chief complaint of cough, vague abdominal pain, and a rash. The patient stated that she was started on Cipro eyedrops 1 or 2 days prior to presentation for a possible eye infection. A day prior to presentation she developed a purple purpuric rash on her lower extremities that gradually progressed up her legs, and was present on her buttocks thighs, and lower legs.

Documentation/Coding 73

Documentation/Coding Academics EMS Hospitals 73

EMDocs

JANUARY 25, 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.

Poisoning 72

Poisoning Documentation/Coding Patient Safety Hospitals 72

RCEM Learning

JANUARY 23, 2024

Prof. Ceri Battle, Honorary Professor in Trauma and Emergency Care and Consultant Critical Care Physiotherapist, Swansea University Applying for a grant during the second wave of a global pandemic, to complete my first multi-centre, randomised controlled trial (RCT) was never going to be my brightest idea. But I wanted to continue with my research work, improving the care of patients with blunt chest trauma.

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Research Wellness Outcomes Documentation/Coding 72

Emergency Live

JANUARY 24, 2024

Understanding, Preventing, and Managing Aneurysm Risk An aneurysm is an abnormal bulge in the walls of an artery, caused by weakness in the arterial wall. It can develop in any artery but is more common in the aorta, the main blood vessel that carries blood from the heart to the rest of the body, and […] The post Aneurysm: a silent threat appeared first on Emergency Live.

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Core Medical Group

JANUARY 23, 2024

Adina Love is a CoreMedical Group travel nurse who lives in Indiana with her husband and two kids. Once a well-paid factory worker who could predict her days down to the hour, Adina’s career took a turn when she experienced a layoff. Having been a hospice volunteer where she ultimately served for 11 years, Adina applied her compassion and commitment to patient care to the next level by diving into nursing school at age 36.

Hospice 72

Hospice Wellness 72

The Skeptics' Guide to EM

JANUARY 20, 2024

Reference: Zaoutis T, et al. Short-course Therapy for Urinary Tract Infections in Children: the SCOUT randomized clinical trial. JAMA Pediatr. Aug 2023 Date: October 30, 2023 Guest Skeptic: Dr. Ellie Hill is a pediatric emergency medicine physician at Children’s National Hospital in Washington, DC and Assistant Professor of Pediatrics and Emergency Medicine at George Washington University […] The post SGEM #427: I Want a Treatment with a Short Course…for Pediatric Urinary Tract Infections first

Pediatrics 71

Pediatrics Anaphylaxis Emergency Department Outcomes 71

Emergency Medicine Journal

JANUARY 22, 2024

Objectives Sympathetic crashing acute pulmonary edema (SCAPE) is a subset of heart failure with a dramatic presentation. The unique physiology of this condition requires a different management strategy from the conventional practice. The trial objective was to compare the efficacy of high-dose and low-dose GTN in patients with SCAPE. Methods This was an open-label randomised control trial conducted in a tertiary care teaching hospital in India from 11 November 2021 to 30 November 2022.

Outcomes 75

Outcomes Hospitals 75