Sat.Aug 03, 2024 - Fri.Aug 09, 2024

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ECG Blog #442 — And then the Patient Arrested.

Ken Grauer, MD

I was sent the ECG shown in Figure-1 — told only that that this middle-aged woman noted chest tightness and nausea an hour earlier. QUESTIONS: How would YOU interpret the ECG in Figure-1 ? — IF told that this patient arrested shortly after ECG #1 — Does this change your interpretation? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original EC G using PMcardio ).

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Ultrasound in Cardiac Arrest

Mount Sinai EM

Ultrasound during cardiac arrest has quickly become standard. Initially, data suggested that the use of ultrasound during arrest increased pauses between compressions which worsens outcomes. To decrease time between compressions, many protocols were proposed (see here ). One such protocol that successfully decreased time between compressions is the CASA (Cardiac Arrest Sonographic Assessment) protocol.

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Congenital Syphilis

Pediatric EM Morsels

Neonates presenting to the Emergency Department often cause a lot of uncertainty. Is this scalp swelling normal? Is this bloody stool concerning? Are this odd movements part of normal development? Is that umbilical area ok or concerning? Fortunately, we have addressed many neonatal issues in the PedEMMorsels. Obviously, one of the most concerning considerations in neonates is the potential for infection.

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McSwain’s Laws Of Trauma

The Trauma Pro

I’m going to be (re)sharing the laws of trauma over the next few posts. I’ve identified a total of eleven over the past 12 years, and I wanted to share them with you. But first, I’d like to share another trauma surgeon’s observations. Dr. Norman McSwain was an icon in trauma surgery during the early years of my career. I knew Norm for decades and literally grew up reading about his advancements and accomplishments.

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How conspiracy theories like COVID-19 “lab leak” harm science and public health

Science Based Medicine

Ever since COVID-19 first emerged in 2020, evidence-free claims that it had arisen due to a "lab leak" have proliferated. A recent paper argues that this conspiracy theory has been very harmful to science. I argue that it's more than just lab leak that is harmful. The post How conspiracy theories like COVID-19 “lab leak” harm science and public health first appeared on Science-Based Medicine.

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Morning Report on Febrile Seizures

PEMBlog

Recently, I had the opportunity to present a morning report to the residents and medical students at Cincinnati Children’s, focusing on the topic of febrile seizures. The session was highly engaging, with a lot of interest from the audience, as febrile seizures are a common but often frightening experience for families. During the presentation, we covered a range of topics, including the definition and incidence of febrile seizures, their causes, and how to manage and counsel families when their

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When Population Health and Individual Health Clash

Sensible Medicine

First some background from my clinic. Here is how the conversation goes: Patient: “Doc, should I take this cholesterol drug that my primary care doctor prescribed?” Me: “What did your risk score come out as?” Patient: “What?” It stuns me how few doctors use the pooled cohort equation to guide use of primary prevention treatments.

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The Hypocrisy Is The Point. Doctors Who Said Not To Mix Politics & Medicine.

Science Based Medicine

Hypocritical articles on politics and medicine weren't really about politics and medicine, they were a message- the standards we set for you, don't apply to us and everyone knows it. The post The Hypocrisy Is The Point. Doctors Who Said Not To Mix Politics & Medicine. first appeared on Science-Based Medicine.

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Common Infection Control Mistakes and How to Avoid Them

American Medical Compliance

More than a million hospitalized patients each year acquire healthcare-associated infections (HAIs) while being treated for other health conditions. Despite rigorous training and established protocols, mistakes in infection control can still occur, leading to severe consequences, including the spread of healthcare-associated infections (HAIs). In this blog, we will explore common infection control mistakes and provide practical tips on how to avoid them, helping to create a safer healthcare envi

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Intranasal ketorolac in renal colic

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed Is intranasal ketorolac an option for analgesia in renal colic. A review of a paper from the Annals of Emergency Medicine. The post Intranasal ketorolac in renal colic appeared first on St.Emlyn's.

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What does this ECG show?

Dr. Smith's ECG Blog

Written by Pendell Meyers Try first to interpret the ECG without any clinical context: What do you think? Sinus rhythm with abnormal STE in V2-V6, and I, II, aVF. Reciprocal STD in aVR and V1. Most leads with STE have remarkably non-hyperacute, flat T waves. Most would say that there is Spodick's sign. The PR depression in II (and its reciprocal PR elevation in aVR) is probably beyond normal baseline values.

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What I Read Last Week

Sensible Medicine

I’ve got a pretty stable approach to reading the medical literature. I even have a talk, “keeping up on the literature.” I have the JAMA, NEJM, and JAMA IM email me their TOC. I then use my other “media” – NYT, NPR, twitter, office chatter – to find other articles I should be reading. Last week, there were no articles that changed my practice but there were a few that I found interesting.

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The Role of Leadership in Creating a Safe Workplace Environment 

American Medical Compliance

According to OSHA’s report , hospitals pose significant hazards, including the risk of violence, making them among the most hazardous workplaces. Effective leaders understand that prioritizing safety not only protects employees from harm but also enhances productivity. More importantly, it boosts morale and overall business success. In this blog, we will delve into the critical role that leadership plays in promoting safety.

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Cessation of Smoking Trial in the Emergency Department (COSTED): A Critical Appraisal

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed Background Smoking is a leading cause of preventable morbidity and mortality worldwide. In the words of the packaging: ‘Smoking Kills’ If we could persuade more people to give up, it […] The post Cessation of Smoking Trial in the Emergency Department (COSTED): A Critical Appraisal appeared first on St.Emlyn's.

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46 year old with chest pain develops a wide complex rhythm -- see many examples

Dr. Smith's ECG Blog

Written by Colin Jenkins and Nhu-Nguyen Le with edits by Willy Frick and by Smith A 46-year-old male presented to the emergency department with 2 days of heavy substernal chest pain and nausea. He reported a history of “Wolf-Parkinson-White” and “heart attack” but said neither had been treated. These diagnoses were not found in his medical records nor even a baseline ECG.

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Travel Healthcare Destinations: Hot states and Hidden Gems

Core Medical Group

Choosing your next travel assignment is like picking a new adventure. It’s not just about the job - it’s about the location, the experience, and the memories you’ll create along the way! Sure, most of us dream of landing that first contract on a sunny beach in Hawaii or in the snow-capped Rockies, but sometimes the real gems are found in places you might not expect.

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Grand Rounds Recap 7.31.24

Taming the SRU

Capacity Management - Sports medicine grand rounds - introduction to bedside teaching - skin adhesives - hypertensive emergency - ultrasound qa review - how to give a presentation capacity management WITH Dr. lane Emergency Department flow can be characterized as Input - Throughput - Output In the ED, we do not have much control over patient input or output, but we do have control over patient throughput Simulation modeling was used in our Emergency Department to determine our threshold for “at

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Podcast – June 2024 Monthly Round Up – Nebulised Ketamine, Risky Intubations, Better Presentations, DSED, Preoxygenation and more

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed The latest St Emlyn's monthly podcast with all the best from the blog in June 2024. The post Podcast – June 2024 Monthly Round Up – Nebulised Ketamine, Risky Intubations, Better Presentations, DSED, Preoxygenation and more appeared first on St.Emlyn's.

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Journal Feed Weekly Wrap-Up

EMDocs

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: Keith Wrenn Always Said, “Presyncope IS Syncope.” He Was Right Spoon Feed This systematic review found that approximately 4%-27% of patients presenting to the ED with presyncope experienced serious outcomes within a

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Churnalism: Summarized on Video

Sensible Medicine

Vinay and I started talking about and writing about churnalism about 5 years ago. He gets full credit for the term, which I initially resisted but later embraced. We thought we’d be able to write a book about churnalism – sort of a follow-up to Ending Medical Reversal – but that book was not meant to be. When Sensible Medicine got off the ground, it seemed like a perfect home for the chapters we had already written and a place to put ongoing coverage of the topic.

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Rotating Around the Cuff of Shoulder Injuries

EM Ottawa

Shoulder injuries are a common yet complex presentation in emergency medicine, presenting a unique challenge due to the intricate anatomy and diverse range of potential pathologies, where imaging may not always be helpful. In this post, we will explore the various aspects of shoulder injuries from a clinical standpoint to help your bedside assessment; focusing […] The post Rotating Around the Cuff of Shoulder Injuries appeared first on EMOttawa Blog.

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A pathway to patient connection and team collaboration

NRC Health

In his upcoming presentation at HUB24, Dr. Beeson will outline a tested method for systemic skill-building that targets team engagement and patient experience goals. The post A pathway to patient connection and team collaboration appeared first on NRC Health.

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EMCrit RACC Lit Review – August 2024

EMCrit

All the RACC Lit goodness for Aug 2024 EMCrit Project by Scott Weingart, MD FCCM.

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Toxicology Answer: the Lionfish, a Dangerous, Non-Native Invader

ACEP Now

Lionfish ( Pterois species) are members of the family Scorpaenidae, which includes lionfish ( Pterois ), scorpionfish ( Scorpaena ), and stonefish ( Synanceia ). They also are commonly called butterfly cod, firefish, peacock lionfish, and turkeyfish in some places. They deliver one of the most painful stings a human can receive from a marine creature.

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Japan trembles: powerful earthquake shakes Kyushu

Emergency Live

The earthquakes were felt in Miyazaki and Kagoshima prefectures, numerous buildings have been damaged Japan trembles: a powerful earthquake shakes The island of Kyushu in southern Japan has been shaken by a violent earthquake of magnitude 7.1, an earthquake that has put to the test the resilience of a nation accustomed to living with similar […] The post Japan trembles: powerful earthquake shakes Kyushu appeared first on Emergency Live.

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ITIM Prehospital Trauma Evening – Wed 18th Sept

Greater Sydney Area HEMS

Register now for the ITIM Prehospital Trauma Evening, hosted by Sydney HEMS. Wed 18th Sept 2024, 1630-2000 In person at Bankstown Aerodrome or via Livestream – REGISTRATION ESSENTIAL FOR FACE-TO-FACE ATTENDANCE The NSW Institute of Trauma and Injury Management proudly presents the Pre-Hospital Trauma Evening in collaboration with the NSW Ambulance Service.

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Hospital in the Home (HITH)

SCGH ED

Here is some information regarding the developing SCGH HITH Service: Team: Admission Criteria: Exclusion Criteria: HITH Catchment Areas (yellow and orange areas): Investigation/Mx in HITH: Referrals: Date implemented – 08/2024Review date – ?12/2024Author – Wheeler / Liz Feher (Geriatrics) / Hung Do Nguyen (General Medicine) The post Hospital in the Home (HITH) appeared first on Charlie's ED.

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A pathway to patient connection and team collaboration

NRC Health

In his upcoming presentation at HUB24, Dr. Beeson will outline a tested method for systemic skill-building that targets team engagement and patient experience goals. The post A pathway to patient connection and team collaboration appeared first on NRC Health.

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Heat stroke: a serious risk for the liver

Emergency Live

Among the affected organs, the liver is particularly sensitive to increased body temperature The heat waves of these days, increasingly frequent and intense, risk being very harmful for our body. Besides causing the most well-known headaches, nausea and dizziness, they can have very serious consequences, especially on the liver. “Heat stroke” lethal for our body […] The post Heat stroke: a serious risk for the liver appeared first on Emergency Live.

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Medical Music Mondays: Time is Testicle

PEMBlog

Time is testicle! Acute scrotal pain must be evaluated promptly in the ED. You’ll see swelling, extreme pain, sidling testis, and absent cremaster reflex. You’ve got 4 to 6 hours at most to get the patient to surgery. Time is testicle! Also yacht rock. Lyrics [Verse] Pain started suddenly Testicle twists freely Side lying swollen now Cremaster gone, holy cow!

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Which physicians generate the most complaints of unprofessional behavior?

PulmCCM

In the 1980s and 1990s, physicians and PhD colleagues at Vanderbilt University published papers establishing associations between patients’ complaints about feeling disrespected and their subsequent malpractice lawsuits. Further work explored the interconnections between unprofessional behavior, patient complaints, and malpractice risk.

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How Do You Diagnose and Treat Thoracic Outlet Syndrome?

Pediatric Education

Patient Presentation Within the span of one week, a pediatrician encountered two teenage females who had come to clinic for other problems but who had the diagnosis of thoracic outlet syndrome. One had already had surgery and the other was planned within the next month. He thought this was unusual and didn’t remember seeing anyone with this problem for several years.

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Emergency services in the event of collapse: serious shortage of doctors in Ancona

Emergency Live

Long waiting times and overcrowding are putting a strain on the regional hospital in Ancona, Torrette The regional hospital in Ancona, Torrette, is facing a serious crisis in its emergency room. Long waiting times, overcrowding and the transfer of patients to other facilities are putting a strain on patients and health care staff, and have […] The post Emergency services in the event of collapse: serious shortage of doctors in Ancona appeared first on Emergency Live.

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Thinking Critical Care - Untitled Article

Thinking Critical Care

We are excited to announce this year’s evolution of our H&R conference, the Hospitalist & Resuscitationist VExUS and Doppler Masterclass ! This exclusive event, produced in collaboration with Flosonics Medical, will take place on September 28th, 2024 , in Toronto , Ontario, Canada This masterclass is designed for those who seek a deep dive into the cutting-edge techniques of venous congestion, Doppler ultrasound, and fluid resuscitation.

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Oversedation practices fueled by Covid continue post-pandemic

PulmCCM

Minimizing sedation is a touchstone of critical care for patients requiring invasive mechanical ventilation. Systematic efforts to reduce sedation (e.g., limiting continuous infusions and prioritizing daily interruptions) are strongly associated with reduced duration of ventilation and shorter ICU stays and are recommended in critical care guidelines.

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Too Much UFH | What & Why of PE Treatment

JournalFeed

The JournalFeed podcast for the week of July 29 – August 2, 2024. These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member. Thursday Spoon Feed : This retrospective study found increased use of unfractionated heparin (UFH) relative to low-molecular weight heparin (LMWH) and direct oral anticoagulants (DOACs) over time, despite guidelines recommending LMWH or DOACs as first-line treatment for most p

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Weather Alert: Prepare for an Emergency

Emergency Live

Civil protection has issued a high critical weather alert, especially in the northern regions A wave of bad weather is hitting our country, requiring careful preparation by all, especially the rescuers and emergency workers. The Civil Protection Department has issued a high critical weather alert, reporting a worsening of weather conditions with cloud cover, hail […] The post Weather Alert: Prepare for an Emergency appeared first on Emergency Live.

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