The Trauma Pro
JULY 30, 2024
There’s a lot of dogma in trauma care, as well as in the field of medicine generally. The knee dislocation dogma is that the incidence of vascular injury is high (around 50%) with posterior dislocation and somewhat lower with non-posterior dislocation. At least, that’s what I learned way back when. After recently finding myself spouting off those numbers, I wondered if it was really true.
Pediatric EM Morsels
AUGUST 2, 2024
It’s never comfortable and is often very distressing to have skin problems and infections, such as intertrigo , folliculitis , panniculitis , omphalitis , or even preseptal or periorbital cellulitis. It’s even more distressing when the skin problem affects the penis. While summer is starting to wind down, and Summer Penile Syndrome is less likely to occur, we must still be vigilant for penile problems that can occur all year long.
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ETM Course
JULY 31, 2024
In this episode of the ETM Course Podcast we talk to Dr Chris Partyka, Emergency Physician and Prehospital and Retrieval Specialist from Sydney and lead author for the recently published SABRE trial which compared Serratus Anterior Plane Blocks to a standard analgesia package for patients with rib fractures. Also available on Apple Spotify YouTube iHeart Podchaser PlayerFM This was a really well designed and executed study, and the results will be practice changing for anyone who treats trauma p
Sensible Medicine
JULY 28, 2024
In a recent post on Sensible Medicine, written on my phone while traveling, I criticized a randomized trial of masking in the BMJ that found Norweigans told to wear masks for 2 weeks had a lower self-reported rate of cold symptoms from 12% to 9%. A reduction of 3%. In a follow up post , Adam Cifu, my friend and colleague, took me to task. Let me highlight his criticism, and why he is wrong both about the trial, and my Kurt Cobain shirt.
The Trauma Pro
AUGUST 2, 2024
The perimortem C-section (PMCS) is a heroic procedure designed to salvage a viable fetus from a moribund mother. Interestingly, in some mothers, delivery of the fetus results in return of spontaneous circulation. The traditional teaching is that PMCS should be started within 4-5 minutes of the mother’s circulatory arrest. The longer it is delayed, the (much) lower the likelihood that the fetus will survive.
St. Emlyn
AUGUST 1, 2024
St.Emlyn's - Emergency Medicine #FOAMed "Time Critical: Information Light" decision-making is vital in emergency medicine, requiring swift actions with minimal data. However, uncertainty decreases over time as more information becomes available. This model highlights the importance of making high-stakes decisions promptly, avoiding premature or delayed interventions.
Dr. Smith's ECG Blog
AUGUST 2, 2024
Written by Willy Frick A 50 year old man with no medical history presented with acute onset substernal chest pain. His ECG is shown below. Pretty obvious anterior current of injury. This was a machine read STEMI positive OMI. Readers of this blog can easily appreciate the hyperacute T waves in the precordium, clearest in V1-V4. What would you guess is the culprit artery?
Emergency Care Today brings together the best content for emergency care practitioners from the widest variety of industry thought leaders.
First 10 EM
JULY 29, 2024
Gestalt for sepsis? This paper hits two of my biggest pet peeves in medicine. 1) The endless emphasis on rushing to hit treatment targets in sepsis or otherwise and 2) the assumption that decision instruments must be better than basic clinical judgment. I am aware, therefore, that my interpretation is more likely to be biased, […] The post Gestalt is better than decision tools for identifying sepsis appeared first on First10EM.
Science Based Medicine
JULY 29, 2024
On Friday, JAMA Health Forum published a study that is just more evidence that public health interventions against COVID-19 saved lives. The post As imperfect as they are, public health interventions save lives first appeared on Science-Based Medicine.
St. Emlyn
JULY 30, 2024
St.Emlyn's - Emergency Medicine #FOAMed Listen to the podcast recorded live at the Premier Conference 2024. The post Podcast – Button Battery Ingestion appeared first on St.Emlyn's.
Sensible Medicine
JULY 29, 2024
Let’s think today about one of evidence-based medicine’s biggest blind spots: the study of policies. Drugs, devices and treatment strategies often face the challenge of randomized trials. Yet policies mostly escape this challenge. It seems all a policy needs is a strong champion and plausibility. Yet the failure of the hospital readmission penalty policy and sepsis protocols expose the risks of implementing a policy because it sounds good.
Emergency Medicine Cases
JULY 30, 2024
In this month's EM Quick Hits podcast: Andrew Petrosoniak on the role of vasopressors in the hemorrhaging trauma patient, Megan Landes on providing HIV PEP and PrEP in the ED, Justin Morgenstern & George Kovacs on the PREOXI trial and evidence for pre-oxygenation with NIPPV before intubation in RSI, Brit Long on recognition and management of blast crisis in the ED, and Leah Flanagan & Liam Loughrey on the rise of nitrous oxide toxicity.
Science Based Medicine
JULY 31, 2024
Over the last few decades there has been a steady infiltration of acupuncture into Western mainstream medicine. It is not unreasonable to conclude that acupuncture’s journey from an exotic Eastern practice to a fringe treatment to mainstream acceptance has been complete. Knowledgeable proponents of science based medicine (SBM) who remain skeptical of acupuncture now find themselves on the fringe.
EM Ottawa
AUGUST 1, 2024
Social media headlines and evolving literature have highlighted the abysmal life expectancy of emergency room doctors. For example, Dr. Ken Milne, the creator behind The Skeptics Guide to Emergency Medicine, recently shared this post on sobering life-expectancy data for ER physicians. In this post, we delve into the contributing factors to the increased mortality […] The post Is Shift Work Shortening your Life?
Sensible Medicine
JULY 31, 2024
Hi everyone. It is John. I am pleased to once again feature writer and economist Elizabeth Fama, PhD , who delved into the evidence underpinning the recommendation to place babies on their back to sleep. Her critical appraisal is a tour de force in everything we love here at Sensible Medicine. I had no idea how weak the evidence was for this recommendation.
ECG Guru
JULY 30, 2024
The ECG shows an example of a patient with bradycardia/tachycardia syndrome. Initially, a sinus rhythm with a heart rate of approx. 70 bpm is seen. This is followed by my sinus arrest of just under 3000 ms, followed by a junctional escape beat (no preceding P wave, QRS remains narrow). After a further pause of just under 2000 ms, 2 sinus node beats follow, which merge into a sinus tachycardia or atrial tachycardia (heart rate approx. 120 bpm here).
Science Based Medicine
AUGUST 1, 2024
Opponents of birth control don't object to condoms because they think they don't work, and Dr. Vinay Prasad doesn't object to masks because he thinks they don't work. The post Dr. Adam Cifu Should Recognize, Dr. Vinay Prasad Will Never Admit Measures to Limit Viruses “Work” first appeared on Science-Based Medicine.
Kings County Downstate EM
JULY 30, 2024
Author: Dante Robinson, MDEditor: Esteban Davila, MDCase:A 77-year-old male with a history of hypertension and diabetes is brought into the ED by EMS after being found unresponsive. According to the patient’s daughter, the patient had been growing weak and complaining of pain on urination along with urinary frequency. While en […] The post AV Dissociation and Complete AV Block: What’s the Difference?
Sensible Medicine
JULY 30, 2024
A pretty good portion of what we post on Sensible Medicine could be considered critical appraisal of the medical literature. Whether it is John Mandrola’s Study of the Week column, my “Improving Your Critical Appraisal Skills” articles, or Vinay Prasad calling out articles that contend something other than what they actually show, this is clearly an interest of ours.
ECG Guru
JULY 27, 2024
Why is the pause after the PVCs relatively long? We see a sinus arrhythmia in the rhythm strip. The ventricular extrasystoles penetrate the AV node retrogradely and reset the sinus rhythm, which then restarts.
Science Based Medicine
AUGUST 2, 2024
Measles cases are increasing. Kids and even many adults are at risk of injury and death from this vaccine-preventable illness that should be a historical footnote. The post Measles 2024: ‘Merica, are you okay? first appeared on Science-Based Medicine.
The Skeptics' Guide to EM
JULY 27, 2024
Reference: Knack et al. Early Physician Gestalt Versus Usual Screening Tools for the Prediction of Sepsis in Critically Ill Emergency Patients. Ann Emerg Med 2024 Date: July 25, 2024 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called www.First10EM.com Case: Your hospital is running Morbidity and Mortality (M&M) rounds after a few recent cases in which the diagnosis of sepsis was identified late, and antibiotics were delayed.
St. Emlyn
AUGUST 1, 2024
St.Emlyn's - Emergency Medicine #FOAMed "Time Critical: Information Light" decision-making is vital in emergency medicine, requiring swift actions with minimal data. However, uncertainty decreases over time as more information becomes available. The post Optimal Timing for Life-Saving Procedures in Critical Care: Finding the Goldilocks Moment appeared first on St.Emlyn's.
NRC Health
JULY 30, 2024
Imagine navigating the complexities of modern healthcare, constantly adapting to new challenges while striving to provide an exceptional patient experience. This is the journey of Katie Arnett and Janet Hall from UK King’s Daughters. They will share their inspiring story and valuable lessons learned at Human Understanding Beyond | HUB 24 in San Diego, August 21–23.
EMCrit
JULY 29, 2024
Is THAM the better bicarb? Find out in this jam-packed episode in the acid base series. EMCrit Project by Scott Weingart, MD FCCM.
AENJ: Current Issue
JULY 31, 2024
Objective: This quality improvement initiative was conducted to determine if a provider in triage and split flow model could decrease the length of stay (LOS) of discharged patients seen in a community hospital emergency department (ED). Background: Extended LOSs within the ED lead to delays in the care of patients, increase the number of patients who leave without being seen by a provider, decrease patient satisfaction, and cause a loss of revenue for health care organizations.
Emergency Live
AUGUST 2, 2024
The startup Inspire has developed a fleet of drones capable of operating autonomously, monitoring fires Smart drones for effective monitoring Thanks to an innovative system called M.A.R.S. (Multiple Airdrone Response System), Inspire has developed a fleet of drones capable of operating autonomously, Monitoring fires in real time and providing fire fighters with crucial information to […] The post Drones for the fire service: the Inspire revolution appeared first on Emergency Live.
Clinical Correlations
AUGUST 1, 2024
By Johain Ounadjela Peer Reviewed I still remember filling out the application form for my driver’s license at the Redwood City, California Department of Motor Vehicles. I was 16 years old and ready to zoom around.
Taming the SRU
JULY 31, 2024
morbidity and mortality - faculty case follow-up - R4 Capstone - high-risk, low prevalence diseases in pediatrics morbidity and mortality WITH dr. moulds Syncope Complete heart block is a rare but important cause of syncope P waves outnumbering QRS complexes should clue to you to high grade heart block Triage EKGs are often obtained to screen for cardiac ischemia, but bradycardia or tachycardia require a closer look to evaluate for underlying arrhythmias Checklists can aid in EKG interpretation
AENJ: Current Issue
JULY 31, 2024
The purpose of this case study on local anesthetic systemic toxicity (LAST), a potentially life-threatening complication of local anesthetic, is to ensure that emergency nurse practitioners (ENPs) are knowledgeable on this disease process. Local anesthetics are used frequently, often daily, by ENPs, as well as multiple other health care providers for various procedures.
Emergency Live
AUGUST 2, 2024
The importance of knowing how to handle medical emergencies aboard small and large vessels With the onset of the summer season, the sea fills up with recreational sailing and motor boats, and on all of them a significant number of people are embarked. Crews, if we want to call them that, mostly composed of people […] The post First Aid at Sea: Essential for Safety During Navigation appeared first on Emergency Live.
Canadian EM
JULY 30, 2024
It’s a night shift, quieter than usual, though you wouldn’t say so out loud. As if the thought is enough to tempt fate, EMS rolls by. You got no patch, no heads up. “Car accident, just outside the hospital,” a paramedic calls as the patient is transferred onto the trauma stretcher. All you hear are unintelligible moans. All you see is blood streaming from a severely injured face.
ECG Guru
JULY 30, 2024
The first 3 beats are sinus node beats, all have the same morphology of the P wave. This is followed by a PAC, which is conducted via the fast pathway in the AV node. The next PAC is conducted via the slow pathway, then the AV nodal reentry tachycardia (slow/fast) starts. The retrograde P waves are visible at the end of the QRS complex in the lower lead K3.
AENJ: Current Issue
JULY 31, 2024
The aim of the Research to Practice column is to enhance the research critique abilities of both advanced practice registered nurses and emergency nurses (RNs), while also aiding in the translation of research findings into clinical practice. Each column focuses on a specific topic and research study. In this article, we used two patient scenarios as a framework to delve into the 2023 secondary analysis of Papp and Emerman’s study on “Disparities in Emergency Department Naloxone and Buprenorphin
Emergency Live
AUGUST 1, 2024
Researchers have created an interface that directly connects the prosthesis to the patient’s nervous system A landmark for rehabilitation medicine. Research by a group of researchers from the Massachusetts Institute of Technology (MIT), in collaboration with the Brigham and Women’s Hospital, The first bionic leg controlled exclusively by the brain. How does the new prosthesis […] The post The first bionic leg controlled by the brain appeared first on Emergency Live.
Emergency Medicine Cases
JULY 30, 2024
As a profession, we suck at compassion as it is trained out of us through medical school and beyond. Compassion in not simply innate; like any behaviour, it can be learned through deliberate practice. There is evidence that compassion may improve morbidity and/or mortality in patients after trauma, cardiac events, cancer, diabetes, back pain, migraine headache and other conditions, prevent physician burnout and reduces rates of medical error, reduce the rates of patient complaints and litigation
ECG Guru
JULY 30, 2024
The ECG shows an example of a patient with bradycardia/tachycardia syndrome (also called sick sinus syndrome). Initially, a sinus rhythm with a heart rate of approx. 70 bpm is seen. This is followed by sinus arrest of just under 3000 ms, followed by a junctional escape beat (no preceding P wave, QRS remains narrow). After a further pause of just under 2000 ms, 2 sinus node beats follow, which merge into a sinus tachycardia or atrial tachycardia (heart rate approx. 120 bpm here).
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