Sat.Jun 29, 2024 - Fri.Jul 05, 2024

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ECG Blog #437 — A 2-Part Answer.

Ken Grauer, MD

I was sent the ECG in Figure-1 — but without the benefit of any history. QUESTIONS: How would YOU interpret this tracing? WHY do I say there is, "A 2-Part Answer?" Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). MY Thoughts on Today's CASE: As important as providing a brief, relevant history is for optimal clinical ECG interpretation — Cases like the one today often prove even more educational, because we are not given any

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Pediatric Cervical Spine Injury Risk Stratification: Rebaked Morsel

Pediatric EM Morsels

It seems like just yesterday ( or maybe ~ a month ago ) when we served up a tasty morsel on the PECARN decision rule for intra-abdominal traumatic injuries in children. Our friends at the PECARN injury group have remained busy this spring with generating more externally validated clinical decision rules. In addition to the recently published low risk intra-abdominal injury validation, we have another new tool to use this summer as school breaks, underdeveloped frontal lobes, and high speeds leav

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10 Things That Will Get You Sued – Part 3

The Trauma Pro

#7. Inappropriate prescribing Most trauma professionals worry about over-prescribing pain medication. But under-prescribing can create problems as well. Uncontrolled pain is a huge patient dissatisfier, and can lead to unwelcome complications as well (think pneumonia after rib fractures). Always do the math and make sure you are sending the right drug in the right amount home with your patient.

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BPAP vs AVAPS for Hypercapnic Respiratory Failure in the ED

RebelEM

Background: Non-invasive positive pressure ventilation (NIPPV) is an effective treatment modality for patients with both hypoxemic or hypercapnic respiratory failure and has been shown to decrease the need for intubation [2]. Continuous positive airway pressure (CPAP) provides a constant positive pressure support throughout the breathing cycle, while bilevel positive airway pressure (BPAP) provides different levels of positive airway pressure during inspiration and expiration.

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Paul Marik: Disparaging chemotherapy in order to sell cancer quackery

Science Based Medicine

Everything old is new once again, as COVID-19 quacks rehash old cancer quack claims that chemotherapy doesn't work in order to sell their preferred cancer quackery. The post Paul Marik: Disparaging chemotherapy in order to sell cancer quackery first appeared on Science-Based Medicine.

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Regular Wide Complex Tachycarida with poor LV function and hypotension. Duration unknown. How to manage?

Dr. Smith's ECG Blog

An older patient with no previous medical history arrived at triage complaining of SOB. Her heart rate was very fast, so we obtained an ECG immediately: ECG: What do you think? There is a regular wide complex tachycardia. The QRS morphology is RBBB with LAFB (tiny r-waves in inferior leads followed by deep S-waves; tiny q-wave in aVL followed by large R-wave; Left axis deviation).

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10 Things That Will Get You Sued – Part 2

The Trauma Pro

#3. You are responsible for the conduct of your staff If the people who work for you treat patients poorly, you may be responsible. It is important that your staff have bedside manner at least as good as yours. #4. Avoiding your patients Some of your patients may need to contact you, either while in the hospital or while at home. Don’t appear to be inaccessible.

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No Benefit to Daily Multivitamin Use

Science Based Medicine

A 20-year analysis of almost 400,000 generally healthy adults shows that vitamins do not help you live longer. The post No Benefit to Daily Multivitamin Use first appeared on Science-Based Medicine.

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Podcast – Eating Disorders in the Emergency Department

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed Learn about how to look after patients with eating disorders in the Emergency Department. Listen to this podcast recorded live at the Premier Conference 2024. The post Podcast – Eating Disorders in the Emergency Department appeared first on St.Emlyn's.

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TXA in Trauma

Taming the SRU

Fouche PF, Stein C, Nichols M, et al. Tranexamic Acid for Traumatic Injury in the Emergency Setting: A Systematic Review and Bias-Adjusted Meta-Analysis of Randomized Controlled Trials. Ann Emerg Med 2024;83(5):435–45. This metanalysis published in May 2024 investigated the use of TXA in severely injured trauma patients. They ultimately included a total of 7 randomized control trials that evaluated TXA use for patients with traumatic injures: 3 of these studies looked at general polytrauma and t

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How to survive a Hurricane: guidelines and useful tips

Emergency Live

Hurricanes pose a real threat to those in affected areas. Knowing what to do and taking the right precautions can mean the difference between life and death Updates from the Caribbean These days people are talking about the powerful Hurricane Beryl, the first recorded Category 4 hurricane at the beginning of the season. It is […] The post How to survive a Hurricane: guidelines and useful tips appeared first on Emergency Live.

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The Most Ignored Study in Cardiac Electrophysiology

Sensible Medicine

In days of old, we placed implantable cardioverter–defibrillators (ICD) in patients who survived cardiac arrest. The problem was that survival of out-of-hospital cardiac arrest was terrible. Smart people then designed studies to place ICDs in patients before they had cardiac arrest. We call this primary prevention. You can’t place ICDs in everyone because the device comes with downsides (infection, inappropriate shocks, anxiety and costs, for instance.

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JC: Systematic review of the Manchester Acute Coronary Scores.

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed Journal Club on the impact of the MACS score in emergency medicine (systematic review). Learn how this tool improves diagnosis and patient outcomes while optimising hospital resources."FOAMed The post JC: Systematic review of the Manchester Acute Coronary Scores. appeared first on St.Emlyn's.

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Grand Rounds Recap 6.26.2024

Taming the SRU

global health journal club - R2 CPC - r1 diagnostics: Pacing - r3 taming the SRu: methemoglobinemia Global health journal club WITH dr. bryant Organophosphate toxicity is much more common in low- and medium-income countries and carries high mortality Abedin et. al performed an RCT in Bangladesh and investigated standard bolus dosing of atropine compared to frequent push-doses of atropine followed by a drip Incremental boluses plus an infusion of atropine was found to have significantly reduced m

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Forest fires: preventing them and fighting them

Emergency Live

With the hot season and the arrival of increasingly higher temperatures, the threat of forest fires returns; vegetation and wildlife at serious risk as well as the civilian population As rescue workers, we know how forest fires pose a dire threat to our environment, the civilian community, and our own safety. With the arrival of […] The post Forest fires: preventing them and fighting them appeared first on Emergency Live.

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Journal Feed Weekly Wrap-Up

EMDocs

We always work hard, but we may not have time to read through a bunch of journals. It’s time to learn smarter. Originally published at JournalFeed , a site that provides daily or weekly literature updates. Follow Dr. Clay Smith at @spoonfedEM , and sign up for email updates here. #1: Re-DOSE VF… DSED for Shock-Refractory VF? Spoon Feed This secondary analysis of the DOSE VF trial found that DSED (dual sequence external defibrillation) was the superior strategy for obtaining ROSC and functional n

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The Saga Continues: Australian Chiropractors Banned from Manipulating Infants…Again?

Science Based Medicine

Those silly Australian chiropractors are at it again, what with all their high jinks and shenanigans and what not. This time they have reinstated a ban on treating babies that they had just gotten rid of. The post The Saga Continues: Australian Chiropractors Banned from Manipulating Infants…Again? first appeared on Science-Based Medicine.

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Behavioral Education Training for Healthcare Providers

American Medical Compliance

The Behavioral Education Training for Healthcare Providers (HCP) aims to fully educate healthcare providers on professional behavior in healthcare settings. Furthermore, training on proper and appropriate behavior within healthcare settings is necessary for a safe and positive work environment. This course offers valuable insight and practical strategies aimed towards achieving the best and safest workplace setting through education on behavioral training for healthcare providers.

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European Civil Protection Pool: member states united in emergency

Emergency Live

The goal: to enable a faster, more coordinated and effective European response to disasters, whether natural or man-made The European Civil Protection Pool (ECPP) is a European Union response to emergencies. Established in 2013, this tool brings together and coordinates the resources of 27 member and participating states, providing rapid and effective assistance in the […] The post European Civil Protection Pool: member states united in emergency appeared first on Emergency Live.

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Acute Pain Management in the Opiate Dependent Person

Sensible Medicine

I am not sure what to call this post. It is an honest and courageous reflection whose life was almost sacrificed, then saved and then damaged by medical care. It is also an account by someone who has taken their life’s experience and used them in caring for others. Adam Cifu Sensible Medicine is a reader-supported publication. If you appreciate our work, consider becoming a free or paid subscriber.

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Microplastics and Global Health

Science Based Medicine

What is a science-based medicine approach to potential public health risks? We write a lot about such risks here, trying to put them into perspective and cut through the hype and sensational headlines. We all have more than enough to worry about without adding unnecessarily to this burden. At the same time, humans have transformed our environment with industry, potentially introducing new […] The post Microplastics and Global Health first appeared on Science-Based Medicine.

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Drugs: the problem, the solution, the interactions!

EM Ottawa

We all know medications can help us feel better and stay healthy but as we are all familiar, sometimes drug interactions can be overlooked and cause significant adverse health outcomes. Drug interactions are common clinical problems that can occur in several different ways and in various settings. The estimated rate of drug interactions occurring in […] The post Drugs: the problem, the solution, the interactions!

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SGEM Xtra: When I’m 64 – Old Fashioned Doctors

The Skeptics' Guide to EM

Date: June 29, 2024 Reference: Herbert L. Fred M.D. (1998) Old-Fashioned Doctors, Hospital Practice. This is an SGEM Xtra episode. I was honoured to be invited by Dr. Fernada Bellolio to the Mayo Clinic and present to the Department of Emergency Medicine. They were kind enough to allow me to speak about any topic. I decided to talk about an article Dr.

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The First10EM monthly wrap-up for June 2024

First 10 EM

The First10EM monthly wrap up is a place for me to share updates about the website, about my academic life, and also interesting content, such as books, podcasts, and other FOAMed, that I have encountered in the prior month. Obviously the format means the focus is mostly on content I have found, but I hope […] The post The First10EM monthly wrap-up for June 2024 appeared first on First10EM.

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Framing Human Understanding for the healthcare experience

NRC Health

Ryan Donohue, a thought leader in healthcare consumerism, will speak at Human Understanding Beyond | HUB 24 in San Diego, August 21–23, about the impact of Human Understanding on the healthcare industry. The post Framing Human Understanding for the healthcare experience appeared first on NRC Health.

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Maryland Infection Control Training for Dental Healthcare Professionals

American Medical Compliance

The Maryland Infection Control Training for Dental Healthcare Providers aims to fully educate dental healthcare providers (DHCP) on how to protect themselves and others and mitigate community transmission of infectious diseases. Furthermore, understanding state regulations and proper procedures can prevent the transmission of infections among patients and DHCP.

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Improving Your Critical Appraisal Skills #6: Decision Analysis

Sensible Medicine

I’ve taken a little break from the “Improving Your Critical Appraisal Skills” series but I’m returning with a few more. These articles are a little treat for our paid subscribers. The first five are here. I must admit, I rarely read decision analyses. That said, I should appreciate them a whole lot more. First, the whole point of a decision analysis is to determine the best course of action when faced with two or more alternatives.

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Chapter 2 of my Paul Wood Lecture

Stop and Think

During my medicine clinic as a resident at Indiana University in the 1990s, I prescribed hormone replacement therapy to post-menopausal women. The goal was not to alleviate post-menopausal symptoms; instead, the goal was prevention of future cardiac events. (I have now developed an allergy to preventive—anything.). Two reasons drove the enthusiasm behind preventive HRT.

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Lab case 447 interpretation

EMergucate

Question 1: • Hb = 76 (between 7 and 9.9) = moderate anaemia. Normal MCH and MCV so we have normochromic anaemia. • WBC = 1.5 (N = 0.9) = mild leukopenia with moderate neutropenia.

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The ETM Course Podcast is back! The Trauma Physician with Chris Bowles

PHARM

We are excited to announce that after a hibernation period, the ETM Course podcast is back! In our first episode of the new podcast we talk to Dr … The ETM Course Podcast is back!

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Thoracostomy Tube Insertion

Life in the Fast Lane

Andy Steval and Chris Moseley Thoracostomy Tube Insertion In this episode of our emergency and critical care procedures series we take a look at how to insert a tube thoracostomy.

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Top 10 Reasons to Choose the Philips HeartStart OnSite AED M5066A

AED Leader

When choosing the suitable automated external defibrillator (AED) for your business, it’s essential to consider various factors such as reliability, ease of use, and effectiveness. One AED that stands out is the Philips HeartStart OnSite AED M5066A. With its advanced features and exceptional performance, the HeartStart OnSite AED is a top choice for businesses looking to ensure the safety of their employees and customers.

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TriCEM is looking for an Assistant Director

The Evolution & Medicine Review

The Triangle Center for Evolutionary Medicine (TriCEM, [link] at Duke University seeks a Postdoctoral Associate to serve as Assistant Director of TriCEM. Applicants must have a Ph.D. and demonstrated experience in evolutionary medicine, scientific communication, and interdisciplinary research.

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Systematic review of the Manchester Acute Coronary Scores.

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed Journal Club on the impact of the MACS score in emergency medicine (systematic review). Learn how this tool improves diagnosis and patient outcomes while optimising hospital resources."FOAMed The post Systematic review of the Manchester Acute Coronary Scores. appeared first on St.Emlyn's.

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Imaging Case of the Week 596

EMergucate

The forearm x-ray is from a child with pain & swelling in the elbow & forearm following a FOOSH injury. Only 1 view could be obtained due to patient being in distress. What can be seen?

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The Top 5 Features to Look for in a Cardiac Science AED Defibrillator

AED Leader

When it comes to ensuring the safety and well-being of your business and its employees, having a reliable automated external defibrillator (AED) is essential. AEDs are life-saving devices that can significantly increase the chances of survival in the event of sudden cardiac arrest. Cardiac Science stands out for its exceptional quality and advanced features among the top brands in the market.

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Postdoc position at Baylor

The Evolution & Medicine Review

Applicants must have a Ph.D. and demonstrated experience in evolutionary medicine, scientific communication, and interdisciplinary research. The postdoc will conduct research in evolutionary medicine, while also working with a program manager to help run TriCEM programming and funding.