Pediatric EM Morsels

JULY 26, 2024

We have discussed many causes of encephalitis and encephalopathy previously (ex, Eastern Equine Encephalitis , Posterior Reversible Encephalopathy , FIRES , Reye’s Syndrome ) and have highlighted the fact that they can be challenging to diagnose early. An irritated brain can lead to such a wide array of symptoms. It is even more challenging when the initial symptoms seem to align with what we perceive as psychiatric concerns.

Psychiatric 269

Psychiatric Seizures Outcomes Pediatrics 269

The Trauma Pro

JULY 23, 2024

Although very few things in medicine are new, I love it when I learn about something I’ve never heard of before. Recently, while reading an autopsy report, I ran across the term “hinge fracture of the skull.” What? Maybe if I were a neurosurgeon, I would have recognized the term. This was the perfect excuse to hit the books (or, more accurately, the internet).

Fractures 264

Fractures 264

Sensible Medicine

JULY 25, 2024

Atle Freithem and colleagues report in the British Medical journal the results of a pragmatic randomized control trial. The take-home message is that wearing a surgical mask for 2 weeks during the winter season of 2023 reduced the spread of self-reported viral illness. According to some, the study proves masks work. First, I commend the authors for running a randomized control trial.

Documentation/Coding 145

Documentation/Coding Academics Research 145

Science Based Medicine

JULY 21, 2024

Actual death is worse than theoretical death. This didn't used to be controversial in medicine. The post Dr. John Ioannidis: Yet Another Doctor Who Treats Theoretical Death From The Vaccine With More Gravity Than Actual Death From COVID first appeared on Science-Based Medicine.

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Dr. Smith's ECG Blog

JULY 21, 2024

Written By Magnus Nossen — with edits by Ken Grauer and Smith. The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chest pain. The pain was 10/10 in intensity radiating bilaterally to the shoulders and also to the left arm and neck. The below ECG was recorded. The ECG shows obvious STEMI(+) OMI due to probable proximal LAD occlusion.

EKG/ECG 122

EKG/ECG Shock Hospitals Sepsis 122

St. Emlyn

JULY 22, 2024

St.Emlyn's - Emergency Medicine #FOAMed Background As I think I have mentioned before, I spend some of my time as a major trauma consultant on the major trauma ward (MTW). You may be shocked to […] The post JC: Evaluation of Lidocaine Patches for Elderly Patients with Rib Fractures: A Feasibility Study appeared first on St.Emlyn's.

Fractures 112

Fractures Shock 112

Sensible Medicine

JULY 22, 2024

I call it therapeutic fashion. Practice patterns. Beliefs. Ways of doing things. Examples: patients with new heart failure get coronary angiography; patients with chest pain without evidence of heart attack get stress tests; certain drugs and devices become favored over generics. The curious thing about many therapeutic fashions is their lack of evidentiary support.

Research 138

Research 138

Dr. Smith's ECG Blog

JULY 25, 2024

This patient was witnessed by bystanders to collapse. They started CPR. EMS arrived and found him in Ventricular Fibrillation (VF). He was defibrillated into VT. He then underwent dual sequential defibrillation into asystole. After 1 mg of epinephrine they achieved ROSC. Total prehospital meds were epinephrine 1 mg x 3, amiodarone 300 mg and 100 mL of 8.4% sodium bicarbonate.

Resuscitation 119

Resuscitation EKG/ECG CPR Shock 119

Don't Forget the Bubbles

JULY 22, 2024

Pre-school wheezers remain a poorly understood cohort of children despite seeing them every day in paediatric EDs. Unfortunately, the number of acute wheeze exacerbations coming through the doors is still rising , but are we equipped to manage these children? In the UK, national guidance advises giving oral prednisolone early when treating paediatric asthma attacks.

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

NRC Health

JULY 23, 2024

Patients, families, and even healthcare team members often walk into medical settings filled with fear—and when they’re scared, they can’t fully grasp the critical information providers are trying to convey. Mindy G. Spigel, RN, MSN, CPXP, will delve into her research on patient and family fear, offering key strategies to alleviate this anxiety at Human Understanding Beyond | HUB 24 in San Diego, August 21–23.

Research 102

Research 102

Emergency Medicine Journal

JULY 22, 2024

Naloxone is a potent opioid receptor antagonist that reliably reverses life-threatening respiratory depression in opioid overdose but can precipitate severe withdrawal in opioid-dependent individuals. 1 Guidelines recommend naloxone specifically for respiratory depression and not for reduced level of consciousness alone, with lower doses recommended in patients who may be opioid-dependent. 2 3 The extent to which such guidelines are applied in practice has received little attention.

Emergency Department 98

Emergency Department Hospitals 98

Dr. Smith's ECG Blog

JULY 23, 2024

I was working at triage when the medics brought this patient who is 65 yo and has had chest pain for 12 hours. They recorded a prehospital ECG at 2112 and said that it was “normal”. It had already been crumpled up and put in the waste basket. So I uncrumpled it: What do you think? You need to click on it to enlarge it to view it well I was suspicious for inferior and posterior OMI (Large T-wave in aVF, slight STE in lead III with inverted T-wave in aVL, and a slightly downsloping ST with negativ

EKG/ECG 115

EKG/ECG Wellness EMS Hospitals 115

Taming the SRU

JULY 25, 2024

Femoral nerve block case review - morbidity & mortality - community practice - r2 Clinical pathologic case - visual diagnosis - when time matters - operational aspects of stroke care Femoral nerve Block Case Review WITH dr. stolz Why do we care about regional anesthesia, specifically femoral nerve blocks? More efficacious than parenteral opioids alone Safer than opioids Decreased delirium Patients have been shown to have improved functional outcomes at 30 days Early pain control matters!

Stroke 97

Stroke Fractures Outcomes Operations 97

Northwestern EM Blog

JULY 22, 2024

Written by : Jilan Shimberg, MD (NUEM ‘26) Edited by : Michael Tandlich, MD (NUEM ‘24) Expert Commentary by : Matthew B Maas, MD MS Expert Commentary Posterior Reversible Encephalopathy Syndrome (PRES) is a potentially catastrophic but frequently overlooked diagnosis. It often coexists in a pathophysiological spectrum with Reversible Cerebral Vasoconstriction Syndrome (RCVS).

Seizures 97

Seizures Documentation/Coding Hospitals 97

Emergency Medicine Journal

JULY 22, 2024

Background The outcomes of patients who call an ambulance but are discharged at scene reflect the safety and quality of emergency medical service (EMS) care. While previous studies have examined the outcomes of patients discharged at scene, none have specifically focused on paramedic-initiated discharge. This study aims to describe the outcomes of adult patients discharged at scene by paramedics and identify factors associated with 72-hour outcomes.

Outcomes 98

Outcomes EMS Hospitals Research 98

ECG Guru

JULY 26, 2024

In order to differentiate supraventricular extrasystoles/tachycardias with aberrant conduction from ventricular extrasystoles/tachycardias, the search for P waves is often very important. Here are some examples of how the P waves can be positioned around the ventricular extrasystoles.

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Taming the SRU

JULY 22, 2024

INDICATIONS Arthrocentesis is a common procedure performed in the Emergency Department, in which a needle is inserted into a joint to withdraw fluid from the joint capsule. This procedure may be performed for diagnostic and/or therapeutic purposes [1]. Diagnostic arthrocentesis is often performed to distinguish between septic arthritis and other common causes of acute monoarthritis including hemarthrosis, crystal arthropathies (gout, psedogout), and autoimmune arthropathies (SLE, RA, etc.) [2].

Ultrasounds 96

Ultrasounds Emergency Department EMS 96

The Skeptics' Guide to EM

JULY 20, 2024

Reference: Gibbs et al. Noninvasive Ventilation for Preoxygenation during Emergency Intubation (The PREOXI trial). NEJM June 2024. Date: July 17, 2024 Guest Skeptic: Dr. Aine Yore is an Emergency Physician, practicing in the Seattle, Washington area for over twenty years. She is the former president of the Washington chapter of ACEP and her career focus outside of clinical practice has been largely devoted to health care policy.

COPD 89

COPD Patient Safety Administration Emergency Department 89

Core Medical Group

JULY 26, 2024

At CoreMedical Group , our QA team is the backbone of your job placement journey. From finding travel nursing and therapy opportunities to getting you started in new locations, our QA experts, alongside your recruiter, ensure everything is top-notch. Whether it’s your first or fifteenth assignment , we’ve got your back with personalized service, helping with applications, licensing, housing, and even some local tips for your new destination.

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RebelEM

JULY 24, 2024

Do you know what the latest evidence in critical care/resuscitation? If this question makes you uncomfortable or you just don’t have time to keep up with the literature, you should sign up for the REBEL Lit Distillery at the ResusX Conference in Philly. Let us help you keep up to date. -Workshop: Sept 17 th , 2024 -Location: Philadelphia, PA -20 to 25 Critical Care/Resuscitation Papers Reviewed -Direct Link: [link] The post The REBEL Lit Distillery at ResusX appeared first on REBEL EM - Emergen

Resuscitation 84

Resuscitation EMS 84

Taming the SRU

JULY 24, 2024

Knack SKS, Scott N, Driver BE, et al. Early Physician Gestalt Versus Usual Screening Tools for the Prediction of Sepsis in Critically Ill Emergency Patients. Ann Emerg Med 2024 Background Sepsis remains an increasingly common emergency department condition that is tied to higher morbidity and mortality across the United States as well as the rest of the world.

Sepsis 89

Sepsis Resuscitation Emergency Department Wellness 89

Science Based Medicine

JULY 24, 2024

Rehabilitation robots, first introduced in the 1990s, are just what they sound like – robotics used to aid in regaining function through rehabilitation following an injury. The idea sounds compelling, and the technology has been advancing steadily. But still we have to ask ourselves the question – do they actually help, and what is the evidence?

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EMDocs

JULY 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.

Documentation/Coding 82

Documentation/Coding Hospitals Patient Safety Emergency Department 82

St. Emlyn

JULY 22, 2024

St.Emlyn's - Emergency Medicine #FOAMed Background I spend some of my time as a major trauma consultant on the major trauma ward (MTW). You may be shocked to hear that an Emergency Medicine doctor such […] The post Lidocaine Patches for Elderly Patients with Rib Fractures: A Feasibility Study appeared first on St.Emlyn's.

Fractures 82

Fractures Shock 82

Critical Care Now

JULY 21, 2024

Reading Time: 3 minutes Article Herman R, Meyers HP, Smith SW, et al. International evaluation of an artificial intelligence-powered electrocardiogram model detecting acute coronary occlusion myocardial infarction. Eur Heart J Digit Health. 2023;5(2):123-133. Published 2023 Nov 28. PMID: 38505483 Cath lab activation based on ST-elevation myocardial infarction (STEMI) criteria relies on outdated data and needs modernization.

EKG/ECG 75

EKG/ECG Emergency Department EMS Wellness 75

ECG Guru

JULY 26, 2024

This is the ECG of a 50-year-old man with a congenital heart defect (we do not have exact details). To interpret an ECG with several different abnormalities, you have to proceed systematically. You can see my comments in the second picture. Perhaps Dawn would like to add something?

EKG/ECG 52

EKG/ECG 52

EMDocs

JULY 20, 2024

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: Does Stress Ulcer Prophylaxis with a PPI Work? Spoon Feed An international, multi-center RCT found that administering pantoprazole to intubated ICU patients lowered the rate of upper GI bleeding compared to placebo.

Emergency Department 75

Emergency Department 75

St. Emlyn

JULY 23, 2024

St.Emlyn's - Emergency Medicine #FOAMed Welcome back to another instalment of our Critical Appraisal Nugget series with Rick Body and Greg Yates here at St Emlyn’s. In our previous podcast, we delved into the concepts […] The post Podcast – Positive and Negative Predictive Values: Critical Appraisal Nugget appeared first on St.Emlyn's.

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Sensible Medicine

JULY 26, 2024

I once had a section chief who was fond of telling me to “make it count twice.” If I was doing work for one part of my job, she suggested that I try to use it for something else. If I worked hard on a lecture for our students, maybe I could turn it into a paper or a workshop to give at a meeting. If research into a patient’s problem raised some interesting questions, maybe I could try to answer these questions as part of a research project.

Academics 52

Academics Research Wellness 52

ECG Guru

JULY 26, 2024

This is the ECG of a 50-year-old man with a congenital heart defect (we do not have exact details). To interpret an ECG with several different abnormalities, you have to proceed systematically. You can see my comments in the second picture. Perhaps Dawn would like to add something?

EKG/ECG 52

EKG/ECG 52

Ziqitza HealthCare Ltd

JULY 26, 2024

A key component of modern healthcare, telemedicine utilizes technology to make medical services accessible despite many barriers and challenges. Telemedicine services make it easier for people to access medical services and treatment and get essential and timely healthcare. Telemedicine is making different medical services available to people virtually.

Telemedicine 52

Telemedicine Ambulance Services Administration Operations 52

Greater Sydney Area HEMS

JULY 25, 2024

Visit the post for more.

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ACEP Now

JULY 25, 2024

ACEP Now has received an APEX Award of Excellence for writing for “Space Medicine: Emergency Physicians Voyage Into the Final Frontier ” (July 2023). You can read the award-winning article. The annual APEX Awards are given by Communication Concepts to recognize excellence in writing, digital content, graphic design, social media, public relations, and marketing.

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Dr. Smith's ECG Blog

JULY 24, 2024

I recently recorded a series of 4 podcasts regarding KEY concepts in ECG interpretation. Easy LINK — [link] — My New E CG P odcasts ( 5/28/2024 ): These podcasts are part of the Mayo Clinic Cardiovascular CME Podcasts Series ( "Making Waves" ) — hosted by Dr. Anthony Kashou. They are found on the Mayo Clinic Cardiovasciular CME site. You can adjust the speed of the recording ( If the speed is "slow" for you — increasing to 1.25 speed should be optimal for you!

EKG/ECG 52

EKG/ECG Wellness 52

Canadian EM

JULY 23, 2024

Your meeting with hospital stakeholders on designing a dashboard to better care for COVID-19 patients who are experiencing homelessness was a resounding success. Everyone was engaged and helped craft a problem statement, KPIs, and OKRs that you then presented to your hospital IT team. Luckily, IT has the bandwidth available to support developing this dashboard—but they need your help through the process.

Hospitals 52

Hospitals Best Practices 52

EMergucate

JULY 23, 2024

The following chest x-ray is from a child with cough & fever. What can be seen?

EMS 52

EMS 52

Total Medical ComplianceHIPAA

JULY 22, 2024

Health and Human Services (HHS) has finalized disincentives for Information Blocking and healthcare providers. Here is a summary: The HHS rule impacts the Merit-based Incentive Payment System (MIPS) by penalizing clinicians who engage in information blocking. MIPS eligible clinicians found to be information blockers by the HHS Office of Inspector General will receive a zero score in the Promoting Interoperability performance category for the year in which the violation occurs.

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