Sat.Jul 27, 2024 - Fri.Aug 02, 2024

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Vascular And Nerve Injury After Knee Dislocation

The Trauma Pro

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.

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Pediatric Balanitis and Balanoposthitis

Pediatric EM Morsels

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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As imperfect as they are, public health interventions save lives

Science Based Medicine

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.

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Adam Cifu is Wrong About Masking

Sensible Medicine

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.

Research 123
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Optimal Timing for Life-Saving Procedures in Critical Care: Finding the Goldilocks Moment

St. Emlyn

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.

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ETM Podcast – The SABRE Trial – Chris Partyka

ETM Course

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

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Acupuncture and Evidence Based Medicine

Science Based Medicine

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.

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More Trending

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Anterior OMI. What does the angiogram show?

Dr. Smith's ECG Blog

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?

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The Peri-Mortem C-Section

The Trauma Pro

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.

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Measles 2024: ‘Merica, are you okay?

Science Based Medicine

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.

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Yes, we should definitely study that!

Sensible Medicine

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.

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Gestalt is better than decision tools for identifying sepsis

First 10 EM

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.

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Podcast – Button Battery Ingestion

St. Emlyn

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.

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Dr. Adam Cifu Should Recognize, Dr. Vinay Prasad Will Never Admit Measures to Limit Viruses “Work”

Science Based Medicine

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.

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A New Series on the "Back to Sleep" Recommendation to Reduce SIDS

Sensible Medicine

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.

Research 101
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Evidence Mounting for the Green Whistle

Emergency Medicine News

An abstract is unavailable.

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EM Quick Hits 58 – HIV PEP and PrEP, PREOXI Trial, Blast Crisis, Nitrous Oxide Poisoning, Vasopressors in Trauma

Emergency Medicine Cases

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.

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Is Shift Work Shortening your Life?

EM Ottawa

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?

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Long-Term Outcomes in Patients Using Protocol-Directed Active Surveillance for Prostate Cancer

Sensible Medicine

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.

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Why Does No One Care about the Crisis in Rural Emergency Medicine?

Emergency Medicine News

An abstract is unavailable.

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SSS

ECG Guru

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).

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AV Dissociation and Complete AV Block: What’s the Difference?

Kings County Downstate EM

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?

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SGEM#448: More than A Feeling – Gestalt vs CDT for Predicting Sepsis

The Skeptics' Guide to EM

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.

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Aortic Dissection is a Difficult Diagnosis, Despite Widespread CTA Usage

Emergency Medicine News

An abstract is unavailable.

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EMCrit 380 – Acid Base Part VIII – Tris-Hydroxymethyl Aminomethane (THAM) for Acidosis

EMCrit

Is THAM the better bicarb? Find out in this jam-packed episode in the acid base series. EMCrit Project by Scott Weingart, MD FCCM.

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PVCs with VA conduction

ECG Guru

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.

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Optimal Timing for Life-Saving Procedures in Critical Care: Finding the Goldilocks Moment

St. Emlyn

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.

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GRACE-4 as a Call to Action

Emergency Medicine News

An abstract is unavailable.

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More ENP Resources!

AENJ: Current Issue

An abstract is unavailable.

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What Matters is How You Use it

Sensible Medicine

At risk of sounding like a broken record (and sounding old by using this cliché), little about Sensible Medicine makes me happier than when a reader disagrees with one of us and writes a cogent retort. It is best when the reader disagrees with Vinay or John rather than me. Adam Cifu On July 14 th , Dr. Vinay Prasad published an opinion piece titled “ When the Patient is in the Room, Stop Typing Your Note ” He argued that it disconnects the doctor from the visit, and keeps the do

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Uncover innovative solutions to enhance the healthcare experience

NRC Health

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.

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PECARN Can Minimize Imaging for Pediatric Spinal Injuries

Emergency Medicine News

An abstract is unavailable.

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A Case of Cardioversion and Management of Atrial Flutter in the Emergency Department

AENJ: Current Issue

No abstract available

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ToxCard: PNU (Vacor)

EMDocs

Authors: Rosa Malloy Post (@postponemyloanz, Emergency Medicine Resident, Atrium Health’s Carolinas Medical Center); Christine Murphy, MD (Emergency Medicine Attending, Medical Toxicologist, Atrium Health’s Carolinas Medical Center) // Reviewed by: Christopher Counts, MD (Medical Toxicology Fellow, Rutgers New Jersey Medical School, Newark, NJ); Cynthia Santos, MD (Emergency Medicine Attending, Medical Toxicologist, Rutgers New Jersey Medical School); James Dazhe Cao, MD (@JamesCaoMD, Associate

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Drones for the fire service: the Inspire revolution

Emergency Live

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.

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Imaging Case of the Week 596 Answer

EMergucate

Monteggia fracture-dislocation.

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Emergency Department Length of Stay: A Community Hospital Initiative

AENJ: Current Issue

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.