The Trauma Pro
OCTOBER 29, 2024
CT scans are commonly used to aid the workup of patients with blunt trauma. They are occasionally useful in penetrating trauma, specifically when penetration into a body cavity is uncertain, and the patient has no hard signs that would send him or her immediately to the operating room. Is there any role for CT in operative penetrating trauma, after the patient has already been to the OR?
Ken Grauer, MD
NOVEMBER 1, 2024
I was sent this ECG recording — and asked for my interpretation of the rhythm in Figure-1. I had little clinical information. QUESTIONS: How was I able to guess the probable correct answer in less than 5 seconds? How was I then able to prove that my guess was correct? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ).
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Science Based Medicine
NOVEMBER 1, 2024
Any doctor who is unabashedly pro-vaccine has already spoken up about the normalization of anti-vaxx quackery within our ranks. The post If RFK Jr. Turns the CDC Into An Anti-Vaxx Propaganda Outfit, I Don’t Want To Hear a Peep From Some “Respectable” Doctors first appeared on Science-Based Medicine.
EM Ottawa
OCTOBER 31, 2024
Delirium is a medical emergency. It is characterized by acute disturbance of consciousness, with changes in perceptual disturbances and fluctuation of symptoms. Delirium is often the initial manifestation of an underlying acute illness and can be present before fever, tachypnea, tachycardia, or hypoxia. There is an ED prevalence ranging from 7-24%, with increased mortality rates […] The post Delirium revisited appeared first on EMOttawa Blog.
The Trauma Pro
NOVEMBER 1, 2024
Every trauma center has a massive transfusion protocol (MTP). But every trauma center also does it entirely differently. Ideally, an MTP is designed with the resources available at the hospital in mind. These may include whole blood, the use of O- vs. O+ blood, the number of units of each product per cooler, the different products in different coolers, and personnel available to move those coolers to the correct locations.
Dr. Smith's ECG Blog
OCTOBER 27, 2024
This was submitted by a paramedic, Hailey Kennedy A late 50s male called 911 following 2 hours of chest pain that started while working at his desk. He reported the crushing chest pain radiated down his left arm. Pt took an antacid with no relief and decided to call at the request of his wife. Here is his EMS ECG: What do you think? This was sent to me with no clinical information, and my initial impression viewing it on my phone was "It’s a tricky one.
Life in the Fast Lane
OCTOBER 30, 2024
Casey Parker and James Rippey Ultrasound Case 112 A 30 year old woman who is currently 30 weeks gestation presents to the ED with abrupt, severe right loin pain.
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First 10 EM
OCTOBER 28, 2024
As with everything that comes out of the PECARN group, this is a huge study, and is therefore one that everyone needs to know about. That being said, despite working in two very busy community hospitals with a high percentage of pediatrics visits, c-spine injuries are just not an issue I struggle with. I have […] The post The PECARN c-spine rule could cause a lot of harm appeared first on First10EM.
Dr. Smith's ECG Blog
OCTOBER 31, 2024
This case was sent by an old residency friend, Kirk Lufkin. He works in a small hospital in Northern Michigan. Case A 61 year old female. hypertension no other past history presented with 30 minutes of fluctuating non-radiating heaviness in chest, with diaphoresis and nausea. VS normal. No cardiac past history. Here is her ECG: What do you think? There are inferior hyperacute T-waves (diagnostic of inferior OMI), with 1) reciprocal ST depression in aVL, 2) a reciprocally inverted hyperacute T-wa
Science Based Medicine
OCTOBER 31, 2024
The organization scapegoated by the lab leak-promoting GOP-led House Covid subcommittee publishes its defense The post EcoHealth Alliance Fights Back first appeared on Science-Based Medicine.
PulmCCM
OCTOBER 28, 2024
Inflammation is implicated in acute myocardial infarction in at least two ways: Inflamed plaques are more likely to rupture and produce coronary occlusion. A robust and potentially damaging inflammatory response occurs after reperfusion with coronary stenting. It has been estimated that inflammation resulting from the reperfusion injury could produce as much as half of the eventual myocardial damage, significantly contributing to disability and death post-MI.
NRC Health
OCTOBER 28, 2024
Addressing workplace violence is an important element of the CMO role at health systems and hospitals, this associate CMO says. The post How CMOs can combat workplace violence appeared first on NRC Health.
American Medical Compliance
OCTOBER 31, 2024
A survey reveals that falls are the most frequent health issue affecting seniors in long-term care facilities. Interestingly, while 90% of caregivers feel confident in implementing fall prevention measures, only 60% have adequate knowledge to do so effectively. As the aging population grows, so does the demand for specialized healthcare tailored to the unique needs of seniors and individuals with disabilities, posing new challenges and responsibilities for healthcare providers.
Sensible Medicine
OCTOBER 28, 2024
The study of the week will take a short break. I head to Curitiba Brazil tomorrow for the Brazilian EP society meeting. I have five lectures. I will be back next week. And there will be plenty of studies to choose from because we are entering the fall season of medical meetings. This week, Sensible Medicine features a guest column from Zachary R. Caverley, a Cardiology Physician Assistant working in the Northwest coast of Oregon.
Dr. Smith's ECG Blog
OCTOBER 30, 2024
Smith Introduction: Saddleback ST Elevation is often an OMI mimic, so one needs to scrutinize these ECGs!! Written by Magnus Nossen Below are ECGs from six different patients. All of the patients contacted EMS due to acute onset chest pain. Imagine you get these ECGs in real time and you are asked whether or not the cath lab should be activated? All ECGs in this case have saddleback ST elevation.
NRC Health
OCTOBER 28, 2024
Addressing workplace violence is an important element of the CMO role at health systems and hospitals, this associate CMO says. The post How CMOs can combat workplace violence appeared first on NRC Health.
EMDocs
OCTOBER 29, 2024
Authors: Rachel Bridwell, MD (EM Attending Physician; Tacoma, WA), Katey DG Osborne, MD (EM Attending Physician; Tacoma, WA) // Reviewed by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (@long_brit, EM Attending Physician, San Antonio, TX) Welcome to emDOCs revamp! This series provides evidence-based updates to previous posts so you can stay current with what you need to know.
Sensible Medicine
NOVEMBER 1, 2024
Nick Arroyo is a 65-year-old man without medical problems. He feels well and sees a primary care doctor every three years or so. He had a chest CT for lung cancer screening because he smoked a pack-a-day for 50 years and heard a radio advertisement that said that lung cancer screening would be helpful. The scan detected a 1 cm nodule. A PET scan was positive, and a biopsy diagnosed it as small cell lung cancer.
Taming the SRU
OCTOBER 28, 2024
Pneumomediastinum is defined as the presence of air in the mediastinum after rupture of air-filled structures such as the esophagus or trachea, or small parts of the lung such as alveoli. This can occur spontaneously or after trauma. Pneumomediastinum is often benign and self limited. However, in more serious cases it can require close monitoring and sometimes surgical intervention.
St. Emlyn
OCTOBER 26, 2024
St.Emlyn's - Emergency Medicine #FOAMed This article reviews a recent study on the use of Tranexamic Acid (TXA) in traumatic brain injury (TBI) patients with intracranial hemorrhage (ICH), focusing on prehospital care. The study, a subgroup analysis from the Prehospital TXA for TBI Trial, compared different TXA dosing regimens and found that a 2-g TXA bolus significantly reduced 28-day mortality compared to placebo.
ALiEM
NOVEMBER 1, 2024
A 67-year-old male with a past medical history of CHF, MI, hypertension, and diabetes presented to the ED with complaints of headache, chest pain, and dyspnea for the past four days. He stated that he has been without his medications for the past few months due to cost. He denied any past surgical history. He stated that he primarily presented because he felt like “my blood pressure is high” Additional Images Physical Exam Cardiovascular : Tachycardic, 2+ pedal edema bilaterally Re
The Bottom Line
OCTOBER 26, 2024
Restrictive vs Liberal Transfusion Strategy in Patients With Acute Brain Injury @fabio_taccone. JAMA. 2024. PMID: 39382241 Clinical Question In patients with acute brain injury, does a liberal, compared to a restrictive strategy of blood transfusion, improve neurological outcomes at 180 days?
Taming the SRU
OCTOBER 31, 2024
Georgette N, Michelson K, Monuteaux M, Eisenberg MA. Development of a New Screening Tool for Pediatric Septic Shock. Ann Emerg Med 2024; Big Picture Current screening tools for pediatric septic shock and sepsis are highly specific but lack sensitivity. This study substituted age adjusted vital sign measures and a pediatric shock index into currently existing pediatric sepsis scoring systems to create the qPS4.When utilizing a cut off of ≧ 2 points, the qPS4 was highly sensitive and specific, and
St. Emlyn
OCTOBER 30, 2024
St.Emlyn's - Emergency Medicine #FOAMed All the best from the blog from August 2024, in our easy to digest podcast. The post August 2024 Round-Up – Goldilocks Moments, Nasal Analgesia, and Public Health in the ED appeared first on St.Emlyn's.
ALiEM
OCTOBER 28, 2024
A 2-year, 11-month-old female with a history of constipation was brought to the ED by her mother for abdominal pain. The mother noticed that the patient’s abdomen had been enlarging for months. When they visited the pediatrician several months ago, the pediatrician also noticed a mildly enlarged abdomen but the patient was asymptomatic at that time.
RebelEM
OCTOBER 30, 2024
Take Home Points Early diagnosis: erythema and warmth of the skin surrounding the umbilicus isn’t normal. Get labs, start abx and get the patient admitted Consult peds surgery on all of these patients as progression to nec fast, while uncommon, is devastating If the patient appears toxic or has systemic symptoms, the simply omphalitis has progressed and aggressive treatment including surgery is likely indicated REBEL Core Cast 130.0 – Omphalitis Click here for Direct Download of the Podcas
ACEP Now
OCTOBER 29, 2024
On a busy day shift in the emergency department, our seasoned triage nurse comes to me after I finish caring for a hallway patient, “Hey, can you come see this guy in the triage room? His vitals are fine…”. Seemingly unsure, she pauses, “I’m getting an interpreter, and I think he has belly pain, but something just doesn’t seem right.” Coming into triage, I see a young man—Georgian-speaking—bracing himself with a hand against the wall and holding his lower abdomen.
Thinking Critical Care
OCTOBER 26, 2024
These are without a doubt some of the hidden gems of any boutique conference. At H&R we’ve always had a great time with these, time for instructors to pass on some really actionable, hands-on skills to a small group of really motivated clinicians. BJJ or Self-Defense for Humans & Health Care Workers – we feel that BJJ is a natural companion to medicine.
EM Ottawa
OCTOBER 28, 2024
Methodology: 4/5 Usefulness: 4/5 Geraghty LE, et al. N Engl J Med. 2024 May 30;390(20):1885-1894. doi: 10.1056/NEJMoa2402785. Question and Methods: Study aimed to determine if video laryngoscopy improves first-attempt intubation success in neonates compared to direct laryngoscopy through a randomized controlled trial. Findings: 74% first pass success with video laryngoscopy and 45% with direct laryngoscopy […] The post Video versus Direct Laryngoscopy for Urgent Intubation of Newborn Infa
Clinical Correlations
NOVEMBER 1, 2024
By Chloe Fong Peer Reviewed The correlation between vitamin deficiency and alcohol use disorder (AUD) has been well documented in the literature, with a study from 1963 finding that 70% of patients admitted to the hospital.
Emergency Live
OCTOBER 31, 2024
The Umberto Veronesi Foundation has launched a research project dedicated to lung cancer Lung cancer, a formidable opponent, is finally meeting stronger resistance thanks to the relentless work of the scientific community. The Umberto Veronesi Foundation, at the forefront of the fight against cancer, has launched an ambitious five-year research project specifically dedicated to lung […] The post New hope against lung cancer: the revolution of the Veronesi Foundation appeared first on Emerg
Thinking Critical Care
OCTOBER 26, 2024
( version francaise ci-dessous ) At our hospital, typical of community hospital intensive care units that do not have an extensive structure of junior and senior trainees who generally staff the university hospitals after hours, medical coverage depends on collaboration between nurses and intensive care doctors as well as their emergency room colleagues.
PulmCCM
OCTOBER 30, 2024
A majority of patients with significant strokes experience fever within the first week after their vascular injury. The presence, intensity, and persistence of fevers are associated with worse outcomes after strokes of any type. For example: Patients with ischemic strokes who develop fever within the first 24 hours have more than double the risk of death, compared to patients without fevers.
ACEP Now
OCTOBER 29, 2024
Our patient is a 33-year-old male with spastic quadriparesis due to cerebral palsy with chronic indwelling suprapubic catheter (SPC) who presented to the emergency department (ED) due to concern for Foley catheter obstruction. The patients’ mother has attempted to flush the SPC multiple times unsuccessfully at home. The catheter was reportedly due for an exchange the following week.
Emergency Live
OCTOBER 30, 2024
Art and sport offer powerful tools to improve quality of life and slow disease progression Parkinson’s is not just a disease, it’s a life-changing challenge. Tremor, stiffness, slow movements: symptoms that deeply mark the daily life of those affected. But research does not stop and new avenues open up, offering patients more hope. A holistic […] The post Beyond Medicine: Art and Sport, New Weapons against Parkinson’s appeared first on Emergency Live.
Mind The Bleep
OCTOBER 29, 2024
Chemical burns are a unique subset of burns that require specialised management due to the nature of the substances involved. Proper initial management is critical to prevent further tissue damage and systemic complications. The majority of acid burns cause coagulative necrosis and cytotoxicity leading to skin and mucosal changes that limit deeper injury.
EMergucate
OCTOBER 28, 2024
This VBG was from a young girl with sever gastroenteritis (Vomiting and diarrhoea) for 3 days. PH = 7.52, that is moderate alkalaemia. pCO2 = 21 mmHg. So, we have respiratory alkalosis.
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