Sensible Medicine
OCTOBER 10, 2024
I appreciate this essay for its reframing of our debates about cancer screening; viewing them through an ethical lens. The speculation that we might eventually be able to identify individuals harmed by radiographic screening and how this would alter our approach is both intriguing and alarming. Adam Cifu Sensible Medicine is a reader-supported publication.
The Trauma Pro
OCTOBER 11, 2024
I’ve written many posts in the past about the arguments surrounding chest tube size: large bore vs. small bore (pigtail). For the longest time, only a few decent papers were looking into this debate, and subject numbers were small. The best the papers could say was that “small-bore chest tubes are not inferior to large-bore tubes.” Not that this is not the same as saying, “small-bore tubes are better than large-bore tubes.” But finally, after more than ten years, th
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Dr. Smith's ECG Blog
OCTOBER 10, 2024
Written by Pendell Meyers A man in his early sixties with no significant medical history (including a "negative cardiac workup a few years ago" for unclear indication) called 911 for acute chest pain constantly for the past 5 hours. EMS arrived and recorded vital signs within normal limits and the following ECG during active pain: EMS1 @ 0157: What do you think?
Mount Sinai EM
OCTOBER 10, 2024
Many of us–myself included–often find ourselves spending more time on our smartphones than we intend to. One recent survey showed that 57% of Americans feel addicted to their smartphones. Another survey finds that millennials and gen z feel the most addicted. Earlier this year, Dr. Vivek Murthy, the U.S. Surgeon General, called for a warning label on social media platforms in a New York Times guest essay.
Science Based Medicine
OCTOBER 10, 2024
Accumulated evidence does not demonstrate that elderberry has meaningful beneficial effects. The post Elderberry (What is it good for) first appeared on Science-Based Medicine.
Ken Grauer, MD
OCTOBER 10, 2024
I was sent the ECG shown in Figure-1 — told only that the patient was a middle-aged man with septicemia. QUESTIONS: Is this rhythm too fast to be sinus tachycardia? Are flutter waves hidden within the QRS and T waves? Are we seeing the retrograde P waves of AVNRT? Is this ATach ( A trial T achycardia )? Figure-1: The initial ECG in today's case. MY Thoughts on Today’s CASE: In my opinion — none of the above answers are optimal to describe the rhythm in Figure-1.
Dr. Smith's ECG Blog
OCTOBER 8, 2024
This was sent to me by a reader who wishes to remain anonymous. A lady in her 60s came to the ER with chest discomfort and shortness of breath. She had a history of previous anterior MI treated by primary PCI to the proximal LAD. The first EKG is from 2:30 PM on the day of presentation to the ER. Smith : To me this is a blatantly obvious acute anterior OMI.
Emergency Care Today brings together the best content for emergency care practitioners from the widest variety of industry thought leaders.
Science Based Medicine
OCTOBER 11, 2024
It doesn't bode well for the future that "leaders" of major American institutions look at naked emperors and compliment them on their beautiful clothes. The post The President of Stanford Wants Us To Debate Which Number is Larger, 9 or 133 first appeared on Science-Based Medicine.
ACEP Now
OCTOBER 10, 2024
Every two years, Americans go to the polls to choose our representatives in Congress and at the state level. Few of the candidates vying to represent us have truly walked in our shoes as emergency physicians. However, seven emergency physicians—some incumbents and a few newcomers—are hoping to represent their communities in Washington, D.C. ACEP Now reached out to Drs.
EM Ottawa
OCTOBER 7, 2024
Methodology: 2.5/5 Usefulness: 3.5/5d Gaudreau-Simard M, et al. Ultrasound J. 2024 Feb 22;16(1):15. doi: 10.1186/s13089-023-00352-3. Question and Methods: The authors aimed to determine the test characteristics of point-of-care ultrasonography (POCUS) for detecting hydronephrosis in acute kidney injury. Findings: From 65 patients, POCUS had a sensitivity of 85% (95% CI 71-94%), specificity of 78% (95% CI […] The post Test characteristics of point-of-care ultrasonography in patients with ac
Mount Sinai EM
OCTOBER 11, 2024
A peritonsillar abscess (PTA) is an abscess in the peritonsillar space between the tonsillar capsule, superior constrictor, and palatopharyngeus muscles. If on your initial primary survey, you have concern for airway compromise: drooling, stridor, hypoxia, sniffing position, increased work of breathing, or tripoding–secure the airway. It may be a difficult intubation.
Broome Docs
OCTOBER 6, 2024
Welcome to a special edition of the Journal Club with Justin. This month we recorded live with a bunch of fantastic Broome junior doctors. Justin gate-crashed our local journal club to share his approach to “reading a paper” ( Video version here) and then we dived into a bunch of new papers… and one really old one. Thanks to Drs Emily Wishart, Josh Briotti and Will Arnott who were brave enough to join the chaos and unscripted nerd fest that we put on every month or two.
The Skeptics' Guide to EM
OCTOBER 5, 2024
Date: October 2, 2024 Reference: Paxton et al. Headpulse measurement can reliably identify large-vessel occlusion stroke in prehospital suspected stroke patients: Results from the EPISODE-PS-COVID study. AEM Sept 2024 Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the UMass Chan Medical School – Baystate.
Life in the Fast Lane
OCTOBER 7, 2024
Jeremy Rogers and Mike Cadogan Blood Gas Interpretation The blood gas is used to rapidly assess ventilatory function and identify acid-base disorders – and will also generally provide point-of-care testing of a number of values such as electrolytes, blood glucose and haemoglobin.
PulmCCM
OCTOBER 8, 2024
Particle Health, a health tech startup, sued Epic Systems in federal court for the Southern District of New York, accusing the giant EHR vendor of monopolistic behavior outlawed by the Sherman Act. The allegations arose from a business dispute between the two firms dating back months. Besides providing insight into Epic’s business practices, the lawsuit will shine a spotlight on the intense but largely secret battle for control of patient data in healthcare.
EMDocs
OCTOBER 8, 2024
Today on the emDOCs cast Brit Long interviews Zachary Aust on the use of a mental model for patients with unexplained sinus tachycardia. Episode 108: Unexplained Sinus Tachycardia Mental Model Background: When a patient in the ED has sinus tachycardia our job as emergency physicians is to identify and treat of the underlying pathology. This is done with a HPI, review of systems, physical exam, and as indicated further diagnostic studies.
St. Emlyn
OCTOBER 9, 2024
St.Emlyn's - Emergency Medicine #FOAMed Day one report of the Annual Scientific Conference of the Royal College of Emergency Medicine #RCEMASC #FOAMed @stemlyns The post RCEM ASC 2024. appeared first on St.Emlyn's.
EB Medicine
OCTOBER 11, 2024
In this special episode Sam Ashoo, MD interviews Ryan Johnson, Pharm. D. who shares strategies to address the recent IV fluid shortage caused by Hurricane Helene. 00:00 Introduction and Episode Overview 01:10 Meet Ryan Johnson: Clinical Pharmacist 02:06 Role of Clinical Pharmacists in Emergency Medicine 05:03 IV Fluid Shortage: Causes and Impact 05:56 Institutional Strategies to Mitigate IV Fluid Shortages 14:52 Provider-Level Solutions for Fluid Conservation 22:11 Pharmacy and Nursing Staff Rol
PulmCCM
OCTOBER 7, 2024
Midodrine A 75-year-old woman seems to have recovered from septic shock, but each time her norepinephrine infusion is reduced from 0.05 to 0.04 mcg/kg/min, her mean arterial pressure falls below 65 mm Hg. Midodrine is started at 10 mg orally t.i.d. Later, the patient’s daughter asks the physician, “What is that new medicine Mom’s on?
EMCrit
OCTOBER 5, 2024
When you need to temporize orbital compartment syndrome, there is markedly easier way than Lateral Cantholysis EMCrit Project by Scott Weingart, MD FCCM.
St. Emlyn
OCTOBER 10, 2024
St.Emlyn's - Emergency Medicine #FOAMed I’m back at the Sage in Gateshead for day 2 of the conference. David Williams and William Rutherford lectures. These are two prestigious named lectures at ASC. Dr John Ryan […] The post RCEM ASC conference 2024. Day 2. appeared first on St.Emlyn's.
EB Medicine
OCTOBER 7, 2024
In this episode, Dr. Julia Draper shares her firsthand account of managing a crisis during a hurricane in Asheville, North Carolina. As the area faced unprecedented flooding, Dr. Draper describes the challenges faced at Mission Hospital, including loss of power and water. She details the innovative solutions the hospital implemented and highlights the tireless efforts of staff during a natural disaster of this magnitude. 00:00 Introduction to Dr.
EM Literature of Note
OCTOBER 9, 2024
This exploration of LLMs in the emergency department is a bit unique in its conceptualization. While most demonstrations of generative AI applied to the ED involve summarization of records, digital scribing, or composing discharge letters, this attempts clinical decision-support. That is to say, rather than attempting to streamline or deburden clinicians from some otherwise time-intensive task, the LLM here taps into its ability to act as a generalized prediction engine – and tries its hand at p
Science Based Medicine
OCTOBER 7, 2024
Antivax is more ideology and conspiracy than science. The recent accusation that antivax influencers are running "limited hangouts" as part of "controlled opposition helps illustrate this characteristic, in which the insufficiently radical are portrayed as useful idiots for the enemy or even heretics. The post Antivax as ideology: “Limited hangouts” run by “controlled opposition” first appeared on Science-Based Medicine.
St. Emlyn
OCTOBER 6, 2024
St.Emlyn's - Emergency Medicine #FOAMed All the best from the blog from July 2024, in our easy to digest podcast. The post Podcast – July 2024 Round-Up appeared first on St.Emlyn's.
First 10 EM
OCTOBER 7, 2024
How much blood people need in their body is an ongoing question. Physicians have moved beyond the days of removing blood from their patients, but we still aren’t totally sure when we are supposed to put blood back in. Most studies suggest we should transfuse less, but there are specific populations who, at least theoretically, […] The post Liberal or restrictive transfusion in brain injury (The HEMOTION trial) appeared first on First10EM.
Don't Forget the Bubbles
OCTOBER 7, 2024
Electrical injuries can range from something minor that needs no medical input to tetany of respiratory muscles through to cardiac arrest secondary to dysrhythmia (VF, VT or asystole). Up to 5% of burns occur secondary to electrical injuries, and this rises to 27% in developing countries. There are two periods of peak incidence in children – under six years and adolescents aged between 13-18 years.
Science Based Medicine
OCTOBER 9, 2024
The 2024 Nobel prize in physiology or medicine goes to two researchers, Victor Ambros and Gary Ruvkun, for their work on microRNA. They began their research in the same lab in the late 1980s as postdoctoral fellow, and then continued to collaborate after they each started their own labs. Their research involves a key question about multicellular life.
Sensible Medicine
OCTOBER 7, 2024
I spend a fair amount of time on Mondays showing problem trials. Such studies have great educational value. But so do hugely positive trials—experiments that truly advance the field. One trial in 1999 transformed the care of patients with heart failure. Doctors were doubtful of the drug before the trial. Heart failure due to a weak heart muscle was a terrible condition at that time.
Dr. Smith's ECG Blog
OCTOBER 6, 2024
This patient had the onset of chest pain 24 hours before arrival to the ED. An ECG was recorded immediately at triage and, at this hospital, the Queen of Hearts is routinely used to determine cath lab activation. Here is that ECG: Original ECG What do you think? There is ST depression maximal in V1-V4, which is diagnostic of posterior OMI. There is some ST Elevation and slightly hyperacute T-wave in V6.
Don't Forget the Bubbles
OCTOBER 10, 2024
With millions of journal articles published yearly, it is impossible to keep up. This time the team from Bristol Royal Children’s Hospital ED tell us what is new in the world of paediatric literature… Led by Dr John Coveney a Paediatric Emergency Medicine Trainee in Bristol who has revived The Journal Club at Bristol Royal Children’s Hospital ED on a monthly basis.
Stop and Think
OCTOBER 8, 2024
I wrote yesterday over at Sensible Medicine about the RALES (circa 1999) trial of spironolactone vs placebo in patients with heart failure. Patients treated in the spironolactone arm had an 11% lower rate of death. The number needed to save a life with this daily inexpensive pill was a mere 9—a massive effect size. The thing about the 1990s era of cardiology is that there were lots of hugely positive trials similar to RALES.
EMDocs
OCTOBER 10, 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.
EM Ottawa
OCTOBER 10, 2024
We often talk about PoCUS for first-trimester bleeding. Is there an IUP? NDIUP? IDK? Yet one of the most common questions patients ask is; “Can you see the heartbeat?” While measuring fetal heart rate is not always our top priority, I’m here to convince you of the following: Measuring it still has clinical value. […] The post PoCUS Pearl – Measuring Fetal Heart Rate appeared first on EMOttawa Blog.
ALiEM
OCTOBER 7, 2024
A 52-year-old female with a past medical history of hypertension and prediabetes presented to the emergency department with double vision that started one day prior to arrival. She stated that her double vision improved when she closed one eye. She denied trauma, headache, neck pain, dizziness, dysphagia, numbness, tingling, weakness, or gait instability.
Taming the SRU
OCTOBER 7, 2024
Venous thromboembolism (VTE) is the number one cause of mortality in pregnant patients, and therefore it is critical for emergency physicians to understand how to appropriately work up and manage this condition. The diagnostic pathway has key differences from the general population given the risks of radiation to the fetus and the physiologic changes associated with pregnancy that naturally make these patients higher risk.
Thinking Critical Care
OCTOBER 5, 2024
Here, Sara Crager takes a few minutes to discuss the hemodynamic interfaces with me. Over the next months, I’ll be picking the brains of my co-authors for the fantastic angles they can all bring to our “Trilogy in 4 Parts” (creative title by of course @EMnerd) which we all feel can be a really useful mental model for both learners and veterans and even better for patients!
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