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I was sent the ECG in Figure-1 — without the benefit of any history. Is this VT? What is the 1st thing — that YOU would do? Figure-1: I was sent this ECG without any history. Is this VT? MY Thoughts on Today’s CASE: As tempting as it might be to reach for the defibrillator on seeing the ECG shown in Figure-1 — My initial reaction was different. At 1st glance , my impression from seeing ECG #1 — was that the rhythm is very fast and irregular — with a highly variable QRS morphology — and, without
I’ve covered the problem of performing MRI on patients with external fixators. This is typically a problem that arises in head-injured patients with extremity or pelvic fixators for concomitant fractures. MRI is an indispensable tool for the evaluation of head, spine, and soft tissue trauma. However, a great deal of effort is required to ensure that any patient scheduled for this test is “MRI compatible.
Imagine if your car mechanic took $10,000 a year from Michelin tires for “consulting” and then tended to recommend their tires over Pirelli — even if the latter are on sale or better quality or both. Imagine if your Governor took campaign contributions from Panera bread and then strangely exempted Panera bread from the new minimum wage law.
Background: The REVERT Randomized Controlled Trial demonstrated the superiority of the modified valsalva maneuver (MVM) over the standard valsalva maneuver (VM) in re-establishing normal sinus rhythm (NSR) in patients with PSVT (Appelboam 2015). MVM exaggerates venous return to the heart and increases vagal outflow by elevating the patient’s legs.
Speaker: Simran Kaur, Co-founder & CEO at Tattva.Health
AI is transforming clinical trials—accelerating drug discovery, optimizing patient recruitment, and improving data analysis. But its impact goes far beyond research. As AI-driven innovation reshapes the clinical trial process, it’s also influencing broader healthcare trends, from personalized medicine to patient outcomes. Join this new webinar featuring Simran Kaur for an insightful discussion on what all of this means for the future of healthcare!
I recently recorded a series of 4 podcasts regarding KEY concepts in ECG interpretation. Easy LINKS — tinyurl.com/KG-ECG-Podcasts — [link] — Other ECG Audio PEARLS I previously made for my ECG Blog can be found in the right column of each page on this blog just below this icon — under, "ECG Audio PEARLS". My New E CG P odcasts ( 5/28/2024 ): These podcasts are part of the Mayo Clinic Cardiovascular CME Podcasts Series ( "Making Waves" ) — hosted by Dr.
Call me slow. I’ve subconsciously seen those capital letters in drug names for years. But I never really paid attention or thought much about them. For whatever reason, I just now realized that they are EVERYwhere! So I decided to investigate. Technically, they are called tall man letters. Here are some examples: Certain parts of the drug name are capitalized to highlight differences from a drug with similar spelling.
Regardless of the reason for a primary care visit in the United States, patients are routinely asked how often they feel “hopeless” or "like a failure” These questions come from the PHQ-9. The PHQ-9 has since been validated and is now widely used to screen for depression. Since the United States Preventive Services Task Force (USPSTF) first recommended depression screening 22 years ago, the practice has become standard in primary care despite an absence of evidence.
Regardless of the reason for a primary care visit in the United States, patients are routinely asked how often they feel “hopeless” or "like a failure” These questions come from the PHQ-9. The PHQ-9 has since been validated and is now widely used to screen for depression. Since the United States Preventive Services Task Force (USPSTF) first recommended depression screening 22 years ago, the practice has become standard in primary care despite an absence of evidence.
Once the diagnosis of nontraumatic subarachnoid hemorrhage (SAH) has been made, our job is not done. Mortality in SAH patients can be up to 30% even without neurological deficit. Paying attention to the time-sensitive details of ED management of SAH patients can have a significant impact on their outcome. In this second part of our 2-part podcast series on subarachnoid hemorrhage with Dr.
An elderly dialysis patient presented with chest pain. She has poor LV function. Previous echo 4 months ago (confirmed with ED bedside echo): The estimated left ventricular ejection fraction is 30%. Severely decreased LV function. Regional wall motion abnormality-inferior, inferolateral, septum, anterolateral, anterior and apex, lateral. Here is her ECG: Regular Wide Complex Tachycardia.
We have previously discussed the many pharmaceutical advertisements published by the New England Journal of Medicine, thinly disguised as science, such as the original open label uncontrolled look at andexanet alfa. (Connolly 2019) At that point, I concluded that andexanet alfa should clearly not be used (although our pharmacies didn’t listen and wasted a lot […] The post Andexanet alfa: expensive and harmful?
St.Emlyn's - Emergency Medicine #FOAMed This JC from St Emlyn's looks at a paper from SJTRM and explores the association between first-pass success (FPS) during pre-hospital intubation and 30-day mortality in patients treated by Finnish helicopter emergency medical services (HEMS). The post JC: Is First Pass Success an important outcome in PHEA research?
In this month’s PTM Journal Club, we explored the most recent literature on trauma care in the pre-hospital setting. If you missed last months PTM Journal Club, make sure to check-it out by clicking HERE. Ketamine vs Morphine for Out-Of-Hospital Traumatic Pain Background and Objectives Inadequate analgesia is a common challenge in the out-of-hospital treatment […] The post PTM Journal Club: Trauma Care appeared first on EMOttawa Blog.
Written by Jesse McLaren, with a very few edits by Smith A 60-year-old presented with chest pain. The ECG did not meet STEMI criteria, and the final cardiology interpretation was “ST and T wave abnormality, consider anterior ischemia”. But are there any other signs of Occlusion MI? There’s only minimal ST elevation in III, which does not meet STEMI criteria of 1mm in two contiguous leads.
Efficient autoclave processes are essential for maintaining sterile environments in healthcare settings. Unfortunately, the autoclave process can often be time-consuming and resource-intensive if not managed properly. That’s why finding simple yet effective ways to streamline and enhance this process can make a significant difference in both operational efficiency and patient care quality.
Take Home Points: Posterior epistaxis is a rare, life-threatning presentation. The key is in identifying and rapidly gaining control with a posterior pack or foley catheter. These patients often require surgical intervention so get ENT to the bedside and admit to a place with a higher level of monitoring. REBEL Core Cast 123.0 – Posterior Epistaxis Click here for Direct Download of the Podcast.
Written by Pendell Meyers Two patients with acute chest pain. Do either, neither, or both have OMI and need reperfusion? Patient 1: Patient 2: Patient 1: A man in his 40s with minimal medical history presented with acute chest pain radiating to his R shoulder. Triage ECG: Click here to sign up for Queen of Hearts Access Three serial troponins were all undetectable.
Reference: Borgundvaag et al. Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-4): Alcohol use disorder and cannabinoid hyperemesis syndrome management in the emergency department. AEM May 2024 Date: May 22, 2024 Dr. Bjug Borgundvaag Guest Skeptic: Dr. Bjug Borgundvaag is the Founding Director of the Schwartz/Reisman Emergency Medicine Institute (SREMI), at Sinai Health System.
Understanding Multiple Sclerosis: Understanding the Disease Multiple sclerosis (MS) is a chronic disease in which the immune system attacks nerve fibers in the brain and spinal cord. MS affects the myelin sheath that covers nerve fibers, resulting in a variety of different effects in terms of neurological symptoms. Among the most common outcomes are vision […] The post World Multiple Sclerosis Day appeared first on Emergency Live.
Clinical introduction An octogenarian presented to the hospital post-fall from a bed, sustaining left facial and chest bruises without consciousness loss. He had diabetes, hypertension, stroke and atrial fibrillation, and was on aspirin 100 mg and edoxaban 30 mg daily. Vital signs were stable. Examination showed left periorbital swelling and anterior thoracic bruising.
Authors: Alena Hoover, MD (EM Resident Physician, ACMC/Oak Lawn, IL); Thaer Ahmad, MD (EM Attending Physician, Oak Lawn, IL) // Reviewed by: Sophia Görgens, MD (EM Physician, Northwell, NY); Cassandra Mackey, MD (Assistant Professor of Emergency Medicine, UMass Chan Medical School); Brit Long, MD (@long_brit) Welcome to EM@3AM, an emDOCs series designed to foster your working knowledge by providing an expedited review of clinical basics.
For most of history, medical diagnosis came through a series of chaotic steps. Patients experienced a string of studies, samples, and images coupled with a doctor’s judgment offering a best-guess answer. Or, in many cases, just a guess. Increasingly, diagnosis is being be reduced to simple transactions. Clean point-of-care testing based on molecular and marker diagnosis.
Record Heat in New Delhi At this moment, the city of New Delhi is experiencing an exceptional drought, with temperatures reaching increasingly higher records month by month. Since the beginning of May, maximum temperatures have been steadily rising at the Mungeshpur weather station, reaching 52.3 degrees Celsius. This peak has raised alarm and shown severe […] The post Extreme Heatwave in New Delhi appeared first on Emergency Live.
Today on the emDOCs cast with Brit Long, MD ( @long_brit) , we cover part 2 of acute chest syndrome. Episode 101: Acute Chest Syndrome Part 2 Background SCD is an autosomal recessive condition that results in the formation of hemoglobin S (HbS). HbS has reduced solubility in the setting of hypoxia, leading to sickling of the RBCs. Other causes of sickling: acidosis, dehydration, inflammation, infection, fever, and blood stasis.
Workplace violence impacts the mental health and wellbeing of the healthcare workforce. The negative outcomes not only affect the healthcare worker but can trickle down to patient safety and satisfaction. It is important that healthcare institutions implement workplace violence prevention programs that benefit the entire healthcare workforce. This blog post highlights current efforts across government and industry to address this critical issue.
How Drones Are Transforming Search and Rescue Operations The development of drone technologies has brought about a change in search and rescue operations. Devices have been equipped with advanced technologies: expanding thermal cameras with artificial intelligence. This is greatly increasing the efficiency and effectiveness of rescue missions. Today’s article shows how drones are revolutionizing the […] The post Rescue Drones: Technological Revolution appeared first on Emergency Live
Written by Magnus Nossen, with some edits by Smith This ECG was transmitted electronically by EMS for evaluation. The patient is a 70 something female with chest discomfort and dyspnea. How would you interpret the ST changes seen in this ECG? Will you accept this patient for emergent coronary angiogram based on the ECG changes? Does the ECG represent STEMI-negative OMI findings?
Shortness of breath is one of the most common complaints presenting to emergency departments. Although the etiology is varied, in this post we will examine one specific cause – pleural effusions – in addition to management of pleural effusions with the thoracentesis procedure. Overview - what is a pleural effusion and how can i fix it? The pleural cavity is a potential space between the lung and chest wall.
Welcome to the June edition of the Journal Club for 2024. Justin and I discuss 7 papers covering a range of topics from securing IVCs in kids to intubating in space and the use of religious sham artifacts in middle-age, French “psychiatry” Yep, it was a strange month on the pod! Enjoy. Articles linked below and podcast available on your favourite player or YouTube over at the First10EM channel.
How AI and AR Are Revolutionizing Rescue Operations Rescue operations are crucial for saving lives in emergency situations. In recent years, the advent of advanced technologies like artificial intelligence and augmented reality has significantly increased the efficiency and quality of these operations. This technological development not only speeds up response times but also improves the […] The post Innovations in Rescue: Technologies that Save Lives appeared first on Emergency Live.
Hearkening back to my former life as the chair of an Institutional Review Board: you do not promise or imply a potential for benefit to clinical trial participants. Why? Because clinical trials aren’t designed to benefit participants. Participants may be randomized to the “standard of care” arm. The trial drug may not have any improvement in efficacy over the “standard of care” Worse, the trial drug may, in fact, have greater toxicity than the current options.
The First10EM monthly wrap up is a place for me to share updates about the website, about my academic life, and also interesting content, such as books, podcasts, and other FOAMed, that I have encountered in the prior month. Obviously the format means the focus is mostly on content I have found, but I hope […] The post The First10EM monthly wrap-up for May 2024 appeared first on First10EM.
Dr. Howard Ovens reflects on the role of leader in the EM in this 2nd part of a 2-part Waiting to Be Seen blog series on EM leadership. He touches on mentoring, being committed, aligning with patients' interests, being a role model and a few quick takes on some controversial issues in EM. The post WTBS 30 Lessons on Emergency Medicine Leadership: The Role of The Leader appeared first on Emergency Medicine Cases.
The Importance of Ongoing and Quality Training For first responders, advanced and continuous training is essential to maintain high skills and provide effective responses to emergencies. Through such training, they can not only update previously acquired techniques but also learn about new technologies and innovate their methods of use. Specialized Training Programs A wide range […] The post Advanced Training for Rescue Professionals appeared first on Emergency Live.
JD is a 67-year-old man admitted with a community acquired pneumonia and a small parapneumonic effusion. The medical team admits him and performs a diagnostic thoracentesis, the results of which reveal a complicated parapneumonic effusion (pH = 7.11). A thoracic surgery consultation is called for a chest tube to be placed. Sensible Medicine is a reader-supported publication.
Methodology: 4/5 Usefulness: 3.5/5 Carson JL, et al. N Engl J Med. 2023 Dec 28;389(26):2446-2456. doi: 10.1056/NEJMoa2307983. Questions and methods: This multicenter, open-label, RCT of 3604 patients with MI with anemia compared 30-day all-cause mortality and recurrent nonfatal MI between liberal vs restrictive transfusion thresholds. Findings: There was no significant difference in 30-day all-cause mortality […] The post Restrictive or Liberal Transfusion Strategy in Myocardial Infarctio
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