Sat.Sep 24, 2022 - Fri.Sep 30, 2022

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EMCrit 333 – The State of the Fluids Show with the EMCrit Core Team

EMCrit

Where are we on Fluids on 2022? EMCrit Project by Scott Weingart, MD FCCM.

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Is Cocoa the New Aspirin 81? - Clinical Correlations

Clinical Correlations

By Luke Bonanni Peer Reviewed Theobroma, literally “food of gods” in Greek, is an apt description of chocolate. Made from the fermented seeds of the Theobroma cacao tree, chocolate is an immensely popular food, with worldwide.

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Less is More. Again: Speed of IV Fluid Administration in Pancreatitis (WATERFALL Trial)

RebelEM

Background: Standard emergency department management of acute pancreatitis has focused on aggressive hydration, analgesia and investigation for an underlying reversible cause (eg gallstones). Recent evidence has challenged the routine use of aggressive hydration as unnecessary. There are also potential harms to large volume fluid resuscitation including progression of pancreatitis and fluid overload with or without respiratory failure.

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Nasogastric Tube Placement

Ultrasound Gel

New idea alert! Should we be using POCUS to guide nasogastric tube placement? Crazy? Unnecessary, you say? Well listen in to the discussion of this interesting randomized controlled trial designed to answer this burning question. [link] [link] New idea alert! Should we be using POCUS to guide nasogastric tube placement? Crazy? Unnecessary, you say? Well listen in to the discussion of this interesting randomized controlled trial designed to answer this burning question.

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EMCrit RACC-Lit Review for September 2022

EMCrit

All of the resuscitation and acute critical care goodness for Sept 2022. EMCrit Project by Scott Weingart, MD FCCM.

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Imaging Case of the Week 522

EMergucate

The pelvic x-ray is from a 35 year old with right hip pain following fall from a height.

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EZIO Drill Recycling

ETM Course

On the ETM Course we teach intraosseous needle insertion using the EZIO system. EZIO essentially has a monopoly on intraosseous access, being used in almost all Emergency Departments and ambulance/pre-hospital systems around Australia and New Zealand. The main downside however is that the proprietary drill is non-rechargeable. These drills cost $380.00 (AUD) each to purchase, and we go through several each year on our courses.

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Debriefing in the ED

Northwestern EM Blog

Written by: Diana Halloran (NUEM ‘24) & Andrew Long (NUEM ‘25) Edited by: Nick Wleklinski (NUEM ‘22) Expert Commentary by : John Bailitz, MD Introduction The Emergency Department is a challenging work environment for a variety of reasons. It is not surprising that unpredictable work hours mixed with frequent interactions with patients undergoing physical and emotional trauma can cause spillover into the personal lives of ED staff.

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TEG-Guided Resuscitation of Patients with Cirrhosis and Non-Variceal Bleeding

RebelEM

Background: Thromboelastography (TEG) is a reliable, comprehensive non-invasive hemostatic assay that measures the ability of whole blood to form a clot. TEG analyzes the interaction between platelets and the coagulation cascade. It provides highly descriptive, real-time information on clot formation, clot strength, platelet function, and fibrinolysis, which is superior to traditional coagulation tests such as INR, aPTT, and platelet count.

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Imaging Case of the Week 520 Answer

EMergucate

There is cardiomegaly and enlargement of left atrium as evidenced by splaying of the carina & double right heart border.

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Expansion of COVID-Era Telehealth Services

American Medical Compliance

On July 27th, 2022, the House implemented a bill to further expand Telehealth services. During the COVID-19 pandemic, most medical providers transitioned into online consultations with patients using Telehealth with the help of Medicare. In an effort to continue the policies, the introduction of this bill will support these services to provide accessible care through 2024.

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Chief’s Inquiry Corner – 9/28/22 - Clinical Correlations

Clinical Correlations

Bellevue Outpatient: What is the optimal duration of therapy for bisphosphates in osteoporosis? Bellevue Inpatient: What is the role of aggressive fluid resuscitation in acute pancreatitis? VA Inpatient: What is the treatment for allergic bronchopulmonary aspergillosis?

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No Dizzy Answers | Hemoptysis, So What?

JournalFeed

The JournalFeed podcast for the week of Sept 19-23, 2022. These are summaries from just 2 of the 5 article we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member. No Dizzy Answers Spoon Feed We cannot rely on neuroimaging (CT, CTA, MRI or MRA) alone to effectively rule out stroke in patients presenting to the ED with acute dizziness or vertigo.

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Imaging Case of the Week 521 Answer

EMergucate

The coronal CT image shows orbital blow out fracture.

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Journal Club - Racism is a Public Health Problem

Downeast Emergency Medicine

Ijeoma Oluo, author of "So You Want to Talk About Race" Background In the United States, racism is a critical public health problem, permeating everyday systems including educational and health care systems; criminal justice and legal systems; financial, housing, and economic systems; environmental issues and beyond to create differential health outcomes that adversely affect Black, Indigenous, and other people of color.

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SGEM#377: You Don’t Have to “AcT” that Way – TNK for Acute Ischemic Stroke?

The Skeptics' Guide to EM

Date: September 20th, 2022 Reference: Menon et al. Intravenous tenecteplase compared with alteplase for acute ischaemic stroke in Canada (AcT): a pragmatic, multicentre, open-label, registry-linked, randomised, controlled, non-inferiority trial. The Lancet 2022 Guest Skeptic: Professor Daniel Fatovich is an emergency physician and clinical researcher based at Royal Perth Hospital, Western Australia.

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Lab Case 380 answers

EMergucate

From the archive Question 1: Hb = 48 g/L, that is severe life threatening anaemia. WCC =14.

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Lab case 380

EMergucate

An 82 year old man presents to your ED after a syncopal episode. He complains of abdominal pain and diarrhoea. On examination he has a heart rate of 105/min and a BP of 95/65.

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