The Trauma Pro

OCTOBER 22, 2024

Today’s post is directed to all those prehospital trauma professionals out there. Car crashes account for a huge number of injuries worldwide. About 40% of people involved are trapped in the vehicle. And unfortunately, entrapped individuals are much more likely to die. There are four basic groups (and their category in parentheses) of trapped car occupants : those who can self-extricate or extricate with minimal assistance (self-extrication) individuals who cannot self-extricate due to pai

EMS 217

EMS 217

Ken Grauer, MD

OCTOBER 25, 2024

The ECG in Figure-1 was obtained from a middle-aged man who presented with a 2 week history of progressively increasing CP ( C hest P ain ) with exertion. He had his most severe episode of CP the day before he was seen with this ECG. His CP was much less compared to the day before — but it had not yet completely resolved. An initial Troponin drawn less than 1 hour after the ECG in Figure-1 was recorded was over 10,000.

EKG/ECG 242

EKG/ECG Shock Hospitals 242

Sensible Medicine

OCTOBER 20, 2024

In a world where doctors are increasingly treated like cogs in a machine, the question arises: Would you recommend your son or daughter pursue the field? Recently, I saw this poll: I said ‘unsure’, but that is just a fragment of what I think. Here is my answer (leave yours in the comments). My answer is: it depends on who is asking. I would strongly encourage you to pursue medicine if… Your primary goal in a career is using your talents to improve the well being of others.

Wellness 127

Wellness Hospitals 127

Science Based Medicine

OCTOBER 24, 2024

Millions of Americans are taking herbal remedies that may be toxic to the liver. The post Widespread Use of Dietary Supplements Linked to Liver Damage first appeared on Science-Based Medicine.

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The Trauma Pro

OCTOBER 25, 2024

Earlier this year, I wrote a series of posts on the two commonly used pelvic fracture interventions: preperitoneal packing (PPP) and angioembolization (AE). To sum up, both are equally effective in controlling hemorrhage, but the hospital costs for patients undergoing angioembolization are significantly less. This is probably because there is no need to perform repeated operations to insert and remove the preperitoneal packs when angiography is used.

Fractures 147

Fractures Head Injuries Operations Ultrasounds 147

Ken Grauer, MD

OCTOBER 19, 2024

The patient whose ECG is shown in Figure-1 — presented with acute dyspnea and hypotension. QUESTION: In Figure-1 — Is the rhythm VT? — How certain are you of your answer? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). == MY Thoughts on the ECG in Figure-1: Although at first glance, the ECG in Figure-1 appears to be wide — this is a false initial impression!

EKG/ECG 286

EKG/ECG Shock 286

Sensible Medicine

OCTOBER 25, 2024

The woman with palpitations. The man with whom you used to joke and trade barbs who now sits silently, absent, while you talk to his wife. The woman whose depression dominates every visit; her depression being the one problem she refuses to address. The man whose joy and charisma makes every visit an absolute pleasure, despite his painful disability about which you can really do nothing.

Urgent Care 103

Urgent Care Wellness 103

Science Based Medicine

OCTOBER 24, 2024

The Free Press = Unherd = Persuasion = Reason = Tablet The post The “Heterodox” Media: Using Groupthink and Misinformation to Inhibit Free Thought first appeared on Science-Based Medicine.

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First 10 EM

OCTOBER 21, 2024

I love toxicologists, but it’s time for someone to call them out. (I also love ranting. Let’s see if I can get myself cancelled by a group of physicians that are definitely smarter than me.) I am sick of the anti-science rhetoric. Every time a toxicologist takes the stage at a conference, or grabs the […] The post Toxicology: the excuses must stop appeared first on First10EM.

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Sensible Medicine

OCTOBER 21, 2024

The story begins in Nottingham UK in 1980. It was a small study at one hospital. But its lessons are large. First the background. I believe the CAST trial (1991) was the most important trial in all of modern medicine. It showed that the common practice of using drugs to suppress rhythm disturbances (anti-arrhythmics) in patients after heart attack (myocardial infarction) led to higher death rates.

Evidence-Based Practice 110

Evidence-Based Practice Shock Outcomes Fractures 110

Emergency Medicine Journal

OCTOBER 23, 2024

Patients who present to the ED usually have their BP measured as part of their routine triage assessment. BP measurements suggesting hypertension (≥140 systolic or ≥90 diastolic 1 ) are a frequent incidental finding, unrelated to the patient’s presenting complaint, but require follow-up. 2 Hypertension is associated with an increased risk of cardiovascular events, so its detection in ED may be an opportunity to initiate further investigations and management. 3 Guidance produced

Emergency Department 98

Emergency Department 98

Science Based Medicine

OCTOBER 23, 2024

A recent meta-analysis of eye movement desensitization and reprocessing (EMDR) therapy concludes that the evidence “confirms” EMDR is effective in treating depression. It is a great example of the limitations of meta-analysis, and how easy it is to create essentially a false narrative using poor quality research. EMDR was “developed” by Dr.

Research 100

Research 100

EM Ottawa

OCTOBER 24, 2024

Precedex (dexmedetomidine) is an alpha-2 adrenergic agonist increasingly used in critical care environments for sedation and anxiolysis. It offers a unique profile of sedation without respiratory depression, making it an attractive option in various clinical scenarios. Historically, it has been used more frequently in the ICU than in Emergency Departments, likely due to provider comfort. […] The post Is there a Precedence for Precedex in the ED?

Emergency Department 92

Emergency Department Resuscitation 92

St. Emlyn

OCTOBER 21, 2024

St.Emlyn's - Emergency Medicine #FOAMed Should we use AP or AL pad position first for defibrillation in VF/VT cardiac arrest. Critical appraisal of an observational study in JAMA suggests a better outcome with AP, but there are many biases in this study. #FOAMed @stemlyns The post JC: AP or AL pad position for first choice shock in VF? appeared first on St.Emlyn's.

Shock 94

Shock Outcomes 94

Dr. Smith's ECG Blog

OCTOBER 24, 2024

Written by Pendell Meyers A woman in her 70s with with multiple medical comorbidities began to have episodes of weakness and pre-syncope off and on for several days, then suffered three episodes of syncope within a few hours. She was brought to an Emergency Department for evaluation. On arrival she was awake, alert, and asymptomatic, with normal vital signs except for heart rate in the low 50s.

EKG/ECG 85

EKG/ECG Emergency Department Hospitals EMS 85

Science Based Medicine

OCTOBER 21, 2024

Ever since recombinant DNA has been used to develop and manufacture vaccines, antivaxxers have portrayed it as evil. This weekend, an antivaxxer decided that fear mongering about SV40 in COVID-19 vaccines wasn't enough. Here we go again. The post “And we’d better not risk another frontal assault. That plasmid’s dynamite.” Antivaxxers vs. plasmid DNA first appeared on Science-Based Medicine.

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Core Medical Group

OCTOBER 25, 2024

This week, CoreMedical Group is celebrating its 25 th anniversary. From beginning its journey in 1999, to thriving today in 2024, CoreMedical Group has grown and flourished.

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Emergency Medicine Cases

OCTOBER 22, 2024

On this month's EM Quick Hits podcast: Kevin Wasko on post-tonsillectomy hemorrhage management, Brit Long on assessment and management of post-CABG surgical incision infections, Anand Swaminathan on evidence, pitfalls and tips on using Bougies, Leah Flannigan on when to suspect vascular injury in patients with low energy mechanism pelvic fractures, Andrew Petrosoniak on debriefing after cases: why, when and how.

Fractures 82

Fractures EMS Resuscitation 82

EMDocs

OCTOBER 25, 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: Hypertensive Crisis Averted…New AHA Statement on Asymptomatic Hypertension Spoon Feed This article emphasizes the difference between hypertensive emergency and asymptomatic elevated blood pressure (BP); while hypert

Emergency Department 69

Emergency Department Outcomes Hospitals 69

EM Literature of Note

OCTOBER 20, 2024

Pharmaceutical development is all about the blockbuster drug. Many of our brightest minds are research scientists and bioinformaticians working at translating in vitro discoveries to improving the lives of human kind. Many of our brightest minds are also working to ensure, even if their drug candidates are – say – a little flawed, there’s a clinical trial design, trial implementation, and post-approval marketing plan to maximize return to shareholders.

Research 80

Research Hospitals 80

ALiEM

OCTOBER 25, 2024

A 64-year-old male with a history of bipolar 1 disorder, PTSD, anxiety, depression, obsessive-compulsive disorder, GERD, and HTN presented to the ED with the chief complaint of foreign body and self-injury. He reported years of sticking sewing needles into his right arm, most recently yesterday. He explained that inserting needles makes him feel better with mild associated pain.

Academics 70

Academics Radiology Radiology 70

The Skeptics' Guide to EM

OCTOBER 19, 2024

Date: October 7, 2024 Reference: Nguyen et al. Comparison of Nebulized Ketamine to Intravenous Subdissociative Dose Ketamine for Treating Acute Painful Conditions in the Emergency Department: A Prospective, Randomized, Double-Blind, Double-Dummy Controlled Trial. Annals of EM 2024. Guest Skeptic: Dr. Brendan Freeman is an emergency medicine physician, assistant professor of emergency medicine, and medical education fellow at Staten Island University Hospital.

Emergency Department 77

Emergency Department EMS Research Outcomes 77

EMDocs

OCTOBER 25, 2024

Today on the emDOCs cast with Brit Long, MD ( @long_brit) , and Rachel Bridwell, MD ( @rebridwell ), we cover corneal abrasions and DRESS. Episode 109: Corneal Abrasion and DRESS Corneal Abrasion Epidemiology Ocular diagnoses comprise 8% of total ED visits with 45% of those being corneal abrasions. Corneal epithelium is easily damaged, however, regenerates quickly with a healing time of 24-48 hours.

Sepsis 66

Sepsis Burns EKG/ECG EMS 66

Mind The Bleep

OCTOBER 22, 2024

What is digital? To a Victorian doctor, the term digital would have referred to the anatomy of our fingers or toes and the nerves and vasculature contained within. This term came from the Latin digitus , which (surprisingly) means finger or toe. A digit has also meant a whole number less than ten for hundreds of years; perhaps they look a bit like fingers.

Documentation/Coding 59

Documentation/Coding Telemedicine Urgent Care Operations 59

ALiEM

OCTOBER 21, 2024

A 5-year-old generally healthy fully immunized boy presented to the ED with worsening left ear redness, swelling, and tenderness that his family noticed the day before presentation. His family had also recently noticed an abrasion over that ear. The patient was on amoxicillin for strep throat, which was diagnosed a week before the onset of his symptoms and was improving.

Academics 67

Academics Wellness 67

ETM Course

OCTOBER 25, 2024

ETM Course Director Andy Buck was lucky enough to be invited to speak on Trauma Education at the fantastic ANZTS Conference in Brisbane this week. If you’re looking for the references from Andy’s talk, you can find them here. Thanks to everyone who came to the presentation and the conference, it’s always great to catch up with like-minded people who have a passion for trauma!

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Don't Forget the Bubbles

OCTOBER 21, 2024

Olivia, 7, has been brought to the emergency department. Over the last couple of weeks, Olivia has been having episodes of rapid blinking and grimacing. They only occur when she’s awake. She does not lose awareness, and her activities are not impaired. Olivia feels she can stop them from happening, but she feels better if she lets them happen. She is otherwise completely well.

Emergency Department 59

Emergency Department Research Hospitals Wellness 59

EB Medicine

OCTOBER 21, 2024

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the October 2024 Pediatric Emergency Medicine Practice article, Elder Abuse and Neglect: Making the Diagnosis and Devising a Treatment Plan in the Emergency Departmen t 00:00 Welcome and Introduction 00:13 Free Subscription for Emergency Medicine Residents 01:05 Introduction to Pediatric Emergency Medicine Practice 01:37 Discussion on Acute Scrotal Pain 02:35 Testicular Torsion: Key Insights 09:50 Differential Diagnosis for Acute Scro

Pediatrics 59

Pediatrics Elder Abuse Risk Management Emergency Department 59

ALiEM

OCTOBER 23, 2024

Ultrasound-guided procedures are difficult enough just identifying the anatomy. Performing a nerve block with the ultrasound in one hand and the needle in the other hand adds extra challenges. The simplest 1-person approach involves attaching a syringe with local anesthetic directly to the end of the procedural needle. A 2-person approach involves attach the syringe to a custom tubing-needle setup such as below.

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Ultrasounds Emergency Department 56

Emergency Live

OCTOBER 25, 2024

Vitamins, minerals and trace elements: half of the world’s population does not have enough To function at its best, our body needs a number of specific “ingredients”, the micronutrients. And, according to a recent study, half of the world’s population does not have enough. What are micronutrients? Micronutrients are substances present in small amounts in […] The post Half the world suffers from nutritional deficiencies appeared first on Emergency Live.

Research 52

Research 52

Mind The Bleep

OCTOBER 25, 2024

Strabismus, commonly referred to as “crossed eyes” or “wandering eyes,” is a visual condition characterised by the misalignment of one or both eyes. This condition can have significant implications for visual acuity and quality of life. Below is a detailed discussion on strabismus, diagnosis, affected populations, treatments, and potential complications, intended to provide medical professionals with a comprehensive understanding of this condition.

Stroke 52

Stroke Pediatrics Outcomes Wellness 52

ECG Guru

OCTOBER 24, 2024

Is there a quick and easy way to screen for limb lead wire misplacement? Today's Expert is Dr Jerry W. Jones, MD, a long-time contributer to the ECG Guru. Dr Jones is known for his Master Classes in Advanced ECG Interpretation and his published texts, Getting Acquainted With Wide Complex Tachycardias, Getting Acquainted With Laddergrams, and Getting Acquainted With Ischemia and Infarction.

EKG/ECG 52

EKG/ECG Wellness 52

Emergency Medicine Journal

OCTOBER 23, 2024

This month’s update is by The Alfred Emergency and Trauma Centre in Victoria, Australia. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper.

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PulmCCM

OCTOBER 23, 2024

Endovascular thrombectomy became standard care for ischemic strokes resulting from large vessel occlusion (LVO) in the anterior cerebral circulation after randomized trials published in the mid-2010s showed improved outcomes with the intervention. Patients with large strokes (as assessed on imaging) were excluded from those trials establishing thrombectomy's benefits, owing to hypothetical risks (such as bleeding or edema) after reperfusion of large areas of dead or damaged brain tissue.

Stroke 52

Stroke Outcomes 52

Mind The Bleep

OCTOBER 22, 2024

Introduction Cardiology is one of the most popular and varied medical specialities. It is a field that combines acute care with long-term patient management, offering a diverse range of subspecialties, including interventional cardiology, adult congenital heart disease, electrophysiology, imaging, and specialist heart failure management. Whether you enjoy working in the high-stakes setting of a cath lab or improving patient outcomes through prevention and rehabilitation, cardiology offers someth

Evidence-Based Practice 52

Evidence-Based Practice Academics Operations Hospitals 52

St. Emlyn

OCTOBER 21, 2024

St.Emlyn's - Emergency Medicine #FOAMed Should we use AP or AL pad position first for defibrillation in VF/VT cardiac arrest. Critical appraisal of an observational study in JAMA suggests a better outcome with AP, but there are many biases in this study. #FOAMed @stemlyns The post AP or AL pad position for first choice shock in VF? appeared first on St.Emlyn's.

Shock 52

Shock Outcomes 52

Emergency Medicine Journal

OCTOBER 23, 2024

Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication.

Research 52

Research 52