The Trauma Pro
JUNE 6, 2023
In today’s post, I will review the diaphragmatic injury practice guidelines published by the Eastern Association for the Surgery of Trauma (EAST). I will follow this up on Friday with an interesting delayed diaphragm injury case. Diaphragm injury is a troublesome one to diagnose. It is essentially an elliptical sheet of muscle that is doubly curved, so it does not lend itself well to diagnosis by axial imaging.
Ken Grauer, MD
JUNE 6, 2023
== P lease N OTE : After today — No new ECG Blog posts for 2- to -3 weeks. — I will also not be prompt in replying to emails. == All material on this ECG Blog site remains open! The INDEX tab ( in the upper right of each page ) — has linked Contents, listed by subject. So IF you are looking for ECG material — There is plenty on this web site! IF you scroll down a little on the right-hand column of this blog — You'll see a lot of icons.
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Pediatric EM Morsels
JUNE 9, 2023
When we think of severe hemorrhage in children, we typically think about trauma. Maybe injuries to the spleen or kidney come to mind. Perhaps thoughts of pelvic injuries or severe head injury dominate our considerations. Of course, we all have a healthy respect for post-tonsillectomy hemorrhage and we like to talk about Damage Control Resuscitation.
St. Emlyn
JUNE 7, 2023
St.Emlyn's - Emergency Medicine #FOAMed If you’re working in the UK then you will know that there is currently a shortage of ketamine (I know!). Specifically we are struggling to get hold of the 10mg/ml … Etomidate for RSI induction? St Emlyn’s Read More » The post Etomidate for RSI induction? St Emlyn’s appeared first on St.Emlyn's.
The Trauma Pro
JUNE 9, 2023
Diaphragm injury from blunt trauma is uncommon, occurring in only a few percent of patients after high-energy mechanisms. They usually occur on the left side and are more frequently seen after t-bone type car crashes and in pedestrians struck by a car. Blunt diaphragm injury on the right side is very unusual. Even so, it is more easily detected due to obvious displacement of the liver that can be seen on chest x-ray.
Medagadget
JUNE 6, 2023
Researchers at the University of California San Diego have created a wearable ultrasound system that can monitor deep tissues, as far as 16.5 cm (6.5 inches) below the surface of the body. Moreover, the team employed a machine learning algorithm to reduce the noise associated with movement, helping to obtain reliable readings while the wearer goes about their day.
PEMBlog
JUNE 7, 2023
There are protocols in place that assist highly trained Emergency Medical Service providers in assuring that agitated children are safely transported to their destination. This podcast episode hosted by Brad Sobolewski ( @PEMTweets ) and co-authored by Dennis Ren ( @DennisRenMD ) is all about what prehospital providers should do to get these agitated children safely to the ED.
Emergency Care Today brings together the best content for emergency care practitioners from the widest variety of industry thought leaders.
Science Based Medicine
JUNE 4, 2023
My critics lack the courage to accurately quote me. That tells you everything about them and nothing about me. The post Dr. Jay Bhattacharya Responds to Words I Never Said first appeared on Science-Based Medicine.
Medagadget
JUNE 9, 2023
Researchers at George Washington University have created a swallowable capsule containing a video camera that can assist in identifying lesions in the stomach. However, unlike similar devices that have been developed previously, this capsule can drive around the stomach under the control of a clinician. This allows it to thoroughly navigate and screen the entire area to identify any health issues in the stomach mucosa, such as ulcers or bleeding.
ALiEM
JUNE 5, 2023
Which of the following is the most likely explanation for this skin lesion in a worker handling sheep hides? Bacillus anthracis Group A streptococcus Pseudomonas aeruginosa Staphylococcus aureus (Photo credit: CDC/ James H. Steele, Public domain via Wikimedia Commons) Reveal the Answer Answer: 1. Bacillus anthracis This patient has cutaneous anthrax.
Emergency Live
JUNE 9, 2023
Unlike astigmatism, nearsightedness, and farsightedness, presbyopia is not a refractive error. Instead, it is a physiological reduction of the accommodative amplitude and, therefore, of the maximum level of accommodation that an eye corrected for any refractive errors can produce with voluntary effort The post Visual defects, let's talk about presbyopia appeared first on Emergency Live.
RebelEM
JUNE 8, 2023
Background Information: Acute Hypotension is associated with increased morbidity and mortality. Continuous vasopressor infusions have previously been the mainstay of treatment. However, peripherally dosed push dose pressors, (PDPs), are beginning to be administered more frequently for management of acute hypotension. 1-4 The PDPs, phenylephrine and epinephrine, result in vasoconstriction and increased cardiac contractility.
Medagadget
JUNE 8, 2023
The iLet Bionic Pancreas for use by type 1 diabetes patients has been cleared by the FDA and is now available commercially. The device is offered by Beta Bionics , a medtech company based in Massachusetts and California, but the underlying technology originally developed by researchers at Boston University. The system can be paired with a Bluetooth glucose monitor to deliver personalized insulin dosing every five minutes, and calculates doses based on past and current glucose levels and its expe
EM Ottawa
JUNE 5, 2023
Methodology: 4.5/5 Usefulness: 5/5 Beno S, al. CJEM. 2022 Aug;24(5):535-543. Editorial: Reducing overuse of CT imaging in pediatric trauma: a model example of the Model for Improvement. Question and Methods: The aim of this QI project was to reduce unnecessary CT abdomen on pediatric trauma activations who were identified as being low risk of IAI.
Emergency Live
JUNE 8, 2023
The Rovsing maneuver is a maneuver used in medical semiotics to investigate the presence of abdominal pain The post Maneuver and positive or negative Rovsing sign: what are they and what do they indicate? appeared first on Emergency Live.
RebelEM
JUNE 7, 2023
Take Home Points Caustics are substances that injure tissue upon physical contact. Caustic potential is not purely a function of pH. The decision to admit is dependent on the history and physical. Vomiting, drooling, and stridor are concerning. Stridor alone or 2/3 symptoms should warrant admission and gastroenterology consultation for potential endoscopy.
PHARM
JUNE 3, 2023
Photo by Karolina Grabowska on Pexels.com This recent Northern Territory coroners inquest report into the death of a young woman from a pulmonary embolism during hospital care for acute mental health condition highlights the risks of sedation and restraint. She had risk factors for thrombosis and was subjected to multiple episodes of chemical and mechanical restraint leading up to a final admission to Alice Springs Hospital ICU where she was intubated and anaesthetised for aeromedical transfer t
ACEP Now
JUNE 6, 2023
When considering an optimized environment for compassionate patient communication, the chaotic emergency department (ED) probably gives some clinicians pause. EDs, filled with alarms, frequent interruptions, hurried paramedics and consultants, hallway beds, and the looming sense that clinicians are out of time, is rarely thought of as a place for empathetic communication.
Emergency Live
JUNE 9, 2023
Coronary angioplasty is the procedure by which an obstructed blood vessel is dilated using a balloon placed where the problem arises; it is inflated to recreate the space needed for blood to flow The post Heart disease: what are coronary angioplasty, stents and bypasses appeared first on Emergency Live.
RebelEM
JUNE 5, 2023
Background Information: Opioid overdose deaths have been increasing in the past twenty years. The national number of overdose deaths from any opioid has increased 62.5% from 2019 to 2021 (from 48,000 to 81,400 annual deaths), which includes prescription opioids (natural and semi-synthetic opioids and methadone), heroin, and synthetic opioids other than methadone including fentanyl (1).
EM Ottawa
JUNE 8, 2023
Preamble: This Grand Rounds was inspired in part by a conversation I had with Dr. Andrew Petrosoniak during my time at St. Michael’s Hospital where we discussed the growing concern of excessive ED wait times and the limited concerted effort on addressing the waiting experience itself. In this blogpost, we will explore the concept of […] The post Psychology and Science of Waiting appeared first on EMOttawa Blog.
Science Based Medicine
JUNE 5, 2023
Tech bro turned COVID-19 misinformation superspreader and antivaxxer has now fully embraced "old school" vaccine-autism conspiracy theories, demonstrating how anti-COVID-19 vaccine antivaxxers frequently become just antivaxxers. The post Steve Kirsch: How “anti-COVID-19 vaccine” antivax often becomes radicalized and just plain antivaccine first appeared on Science-Based Medicine.
Emergency Live
JUNE 8, 2023
The skin of the abdomen is divided into 9 regions, called abdominals: 3 median (epigastrium, peri-umbilical region and hypogastrium) and 3 lateral (hypochondrium, flank and iliac fossa) The post Abdominal regions: semeiotics, anatomy and contained organs appeared first on Emergency Live.
PDC Healthcare
JUNE 8, 2023
In March of 2023, the U.S. Food and Drug Administration (FDA) published updates to their mammography regulations to facilitate better reporting of information and an improved experience for patients. The announcement means change is imminent for many healthcare providers, who will need to adjust policies and make updates to equipment to be compliant.
Emergency Medicine Cases
JUNE 6, 2023
In this ECG Cases blog we look at 10 patients with shortness of breath, and discuss how the ECG can be used to help diagnose cardiac, respiratory and metabolic emergencies. We discover that for STEMI/OMI vs subendocardial ischemia, we should look for STEMI(-)OMI, subacute OMI, and OMI in the presence of LBBB and RBBB, and consider the differential for diffuse ST depression with reciprocal ST elevation in aVR.
Sensible Medicine
JUNE 5, 2023
Editors note: The writer—me—inverted results of one of the trials used as an example. This post now contains the proper results. Thanks to an astute reader. The NEJM published this month a study on an important medical question that may upend the way we use medical evidence. This has nothing to do with the specific medical question. It has everything to do with how we interpret the results.
Emergency Live
JUNE 8, 2023
If it is the patient's first time performing an electrocardiogram (ECG), the rescuer, doctor, or nurse should explain to the patient - in words appropriate to his/her level of understanding - the steps and usefulness of the electrocardiogram The post Electrocardiogram: initial procedures, ECG electrode placement and some tips appeared first on Emergency Live.
The Skeptics' Guide to EM
JUNE 3, 2023
Date: June3, 2023 Reference: Kotani et al. Etomidate as an induction agent for endotracheal intubation in critically ill patients: A meta-analysis of randomized trials. Journal of Critical Care April 2023 Guest Skeptic: Dr. Amber Gombash is an emergency physician in Concord, NC. Case: You have a critically ill patient that you are preparing to intubate and wonder […] The post SGEM#405: We’re Off To Never-Never Land – But Should We Use Etomidate for the Rapid Sequence Intubation?
Science Based Medicine
JUNE 7, 2023
Monoclonal antibodies are the medical scientific breakthrough you may never have heard of. The post The Monoclonal Antibody Revolution first appeared on Science-Based Medicine.
Medagadget
JUNE 8, 2023
Engineers at the University of Colorado at Boulder have developed a medical microrobot that is powered by acoustic waves. The tiny devices, which are 20 micrometers wide and considerably smaller than the width of a human hair, can move incredibly fast for their size, achieving a speed of 3 millimeters per second. To put this in context, if a microrobot and a cheetah the same size had a race, the microrobot would win comfortably.
Emergency Live
JUNE 8, 2023
Let's talk about hip replacement, and specifically the anterior access approach: in general, this procedure relieves pain and restores mobility in people whose joints have been damaged by trauma or degenerative diseases such as hip arthrosis The post Anterior access hip replacement: an overview of advantages and disadvantages appeared first on Emergency Live.
ACEP Now
JUNE 6, 2023
A 50-year-old female develops chest pain radiating to the neck and left arm. ECG, CXR, and troponin are negative. She is given morphine for pain. Four hours later she develops back pain and bilateral leg paresthesias. CT angiography shows aortic dissection which is treated surgically, but she is left with paraplegia. Notoriously elusive, with a high misdiagnosis rate, thoracic aortic dissection (AD) can mimic many conditions, including acute coronary syndrome (ACS, the most common), gastroesopha
Sensible Medicine
JUNE 6, 2023
Even after 26 years on the Third Coast, I remain at heart a skeptical New Yorker. I think that is why I was quick to embrace the skepticism of critical appraisal when I first learned the skills as a resident. Not to date him, but David Rind was one of the faculty members who first taught me how to critically read the medical literature. In this essay he counsels us on when to moderate our skepticism and recognize that our understanding of an illness or therapy might need to change.
EMDocs
JUNE 7, 2023
Authors: Daniel Escobar, MD (Emergency Physician, Mercy Hospital Northwest Arkansas, Rogers, Arkansas); Ann-Jeannette Geib, MD (Emergency Medicine Attending; Medical Toxicologist, Carolinas Medical Center, Charlotte, NC) // Reviewed by: James Dazhe Cao, MD (@JamesCaoMD, Associate Professor of EM, Medical Toxicology, UT Southwestern Medical Center, Dallas, TX); Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case: A 22-year-old female presents to the Emergency Department (ED) in respirat
Emergency Live
JUNE 8, 2023
In medical semeiotics various abdominal points are known, whose tenderness on palpation and pressure is more or less indicative of appendicitis, often appendicitis (inflammation of the vermiform appendix) The post Point of Morris, Munro, Lanz, Clado, Jalaguier and other abdominal points indicating appendicitis appeared first on Emergency Live.
Dr. Smith's ECG Blog
JUNE 5, 2023
A 40-something male presented by ambulance with one hour of chest pain that was improving after sublingual nitroglycerine and 325 mg of aspirin, chewed. Here is his initial ED ECG: What do you think? I read this ECG without any history as reperfusing inferior and posterior OMI due to the Q-wave in lead III with minimal STE and reciprocal ST depression in V2-V4 (which should never be there).
PulmCCM
JUNE 5, 2023
Corticosteroids for community-acquired pneumonia have been studied with inconclusive results, and expert guidelines currently advise against their use except in patients with refractory septic shock. Only a few trials have tested the utility of steroids for pneumonia in ICU patients; one of the largest and most recent ones enrolling 586 patients at U.S. veterans’ hospitals did not show a mortality reduction from low-dose methylprednisolone.
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