Sensible Medicine

NOVEMBER 23, 2024

It is my pleasure to introduce this article by Joseph Marine, MD. Mr. Marine has 10 sensible suggestions for reform at the NIH. I love them all, but particularly #3, 6, and 8, which I have railed about for years. Vinay Prasad, MD MPH The NIH needs reform The recent news that Dr. Jayanta Bhattacharya is being considered for the post of Director of the National Institutes of Health (NIH) was received with enthusiasm by many of us who opposed the US pandemic response.

Infectious Diseases 138

Infectious Diseases Research Leadership Academics 138

Ken Grauer, MD

NOVEMBER 23, 2024

I was sent the ECG shown in Figure-1 — told only that that it was from an acutely ill patient on a ventilator, who was being evaluated for bradycardia. His providers thought this rhythm was complete AV block. QUESTIONS: How would you interpret the ECG in Figure-1 ? Is the rhythm complete AV block? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ).

EKG/ECG 407

EKG/ECG Documentation/Coding 407

EM Ottawa

NOVEMBER 28, 2024

What do you do when expert nurses tell you they can’t obtain IV access? Do you spend 20 minutes performing an invasive central line? Does your resident finally get two IO EPAs? Or do you save the day with a slick, ultrasound guided IV? Obtaining peripheral ultrasound guided IV access is not only a core […] The post Ultrasound Guided Peripheral IVs appeared first on EMOttawa Blog.

Ultrasounds 116

Ultrasounds 116

Dr. Smith's ECG Blog

NOVEMBER 27, 2024

Pendell and I and the geniuses at Powerful Medical (Producers of the PMCardio Queen of Hearts OMI AI app ) are working on an objective, mathematical definition of hyperacute T-waves , based on real OMI outcomes and hyperacute T-wave annotation that has excellent interrater agreement (between me and Pendell), and it will end up being a logistic regression using these 3 variables: 1) area under the curve (AUC) relative to the QRS size 2) increased symmetry , as defined by time from T-wave onset to

EKG/ECG 112

EKG/ECG Research Outcomes Wellness 112

St. Emlyn

NOVEMBER 26, 2024

St.Emlyn's - Emergency Medicine #FOAMed In this podcast, Liz Crowe discusses the effect bad behaviour has on teams and ultimately patient safety. The post Podcast – Bad Behaviour in Teams with Liz Crowe at Tactical Trauma 2024 appeared first on St.Emlyn's.

Patient Safety 103

Patient Safety 103

Sensible Medicine

NOVEMBER 24, 2024

Marty Makary, an editorial board member of Sensible Medicine, is up for FDA commissioner. In honor of that, we reprint one of his essays. Elsewhere I have a short piece on how the media coverage of him has been biased, and why I support his nomination. In the piece below Marty was correct that there is no data to support year over year COVID boosters, and I, like most Americans, don’t get them.

CDC 110

CDC Research 110

EMCrit

NOVEMBER 28, 2024

I discussed the reasons for migrating to BlueSky here. I've received positive feedback from several FOAMed expats who migrated to Bluesky and enjoy it there. I've also received some questions about getting started on BlueSky, so here is a brief guide to moving into MedSky. [1] Set up your account & profile This is essentially […] EMCrit Project by Josh Farkas.

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St. Emlyn

NOVEMBER 24, 2024

St.Emlyn's - Emergency Medicine #FOAMed GLP-1A toxicity: What do emergency clinicians need to know about drugs like Ozempic® and Wegovy®? #FOAMed @stemlyns Greg Yates takes through a paper reporting overdoses in US practice. The post GLP-1A toxicity: What do emergency clinicians need to know about drugs like Ozempic® and Wegovy®? appeared first on St.Emlyn's.

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Sensible Medicine

NOVEMBER 25, 2024

When a clinical trial is published, people are relieved. The researchers did the work, analyzed the data, published the report and surely feel a sense of completion. Clinicians are relieved because we have more evidence to use in patient care. The question is how certain we should be about the trial’s result. In April, I covered the work of Dena Zeraatker , from McMaster University, who elegantly showed that there were thousands of ways to analyze data from observational studies.

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Research Outcomes 105

Science Based Medicine

NOVEMBER 29, 2024

Dr. Zubin Damania praised and promoted RFK Jr.-loving doctors. We criticized these doctors and corrected their factual errors. See the difference? The post ZDoggMD on RFK Jr.’s Rise: “I’m Talking About Like These Science Based Medicine Guys” first appeared on Science-Based Medicine.

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American Medical Compliance

NOVEMBER 29, 2024

Continuous Glucose Monitoring (CGM) technology is transforming the approach to diabetes care for healthcare providers, including endocrinologists, diabetes educators, and nurses, as well as for the patients they support. Unlike traditional methods that rely on periodic fingerstick tests, CGM offers real-time insights into glucose levels, trends, and fluctuations, empowering proactive management and improving patient outcomes.

Outcomes 79

Outcomes Wellness Operations Pediatrics 79

Don't Forget the Bubbles

NOVEMBER 27, 2024

Imagine this – a six-week-old infant with a fever of 38.3⁰C presents to your emergency department. They look well and, apart from fever, have no other symptoms. There are no sick contacts at home. Although they look well, you don’t want to miss a serious diagnosis, so what do you do? You’ve so many questions. Which of the many febrile infant clinical decision tools should you use?

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Outcomes Wellness Hospitals Emergency Department 76

Sensible Medicine

NOVEMBER 29, 2024

PR is an 82-year-old woman who is brought to the emergency room after “an episode.” During her first 12 hours in the hospital, she saw an emergency medicine resident and attending, a neurology resident and attending, and finally an internal medicine intern and resident who were covering the “night-float” shift. By the time these last two met her, she was pretty well wiped out, so the case they presented to us, her admitting team, was mostly cobbled together from the other

Seizures 76

Seizures Hospitals Wellness 76

Science Based Medicine

NOVEMBER 23, 2024

If you associate yourself with Sensible Medicine, you are anti-vaccine no matter how you describe yourself. The post Any Doctor Who Enabled RFK Jr. In Any Way Is Anti-Vaccine No Matter How They Describe Themselves first appeared on Science-Based Medicine.

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EM Literature of Note

NOVEMBER 25, 2024

Following on the success of Toy Story 2, Inside Out 2, and Avatar 2, we have WOMAN-2, yet another trial featuring emergency medicine’s third-favorite medication: tranexamic acid. However, where those sequels succeeded, WOMAN-2 is more like Miss Congeniality 2 – the one we’re not going to talk about again. But, don’t take it from me – take it from the ChatGPT Agent I created!

Research 79

Research Outcomes Administration Wellness 79

Dr. Smith's ECG Blog

NOVEMBER 29, 2024

Written by Willy Frick A young woman with a history of paroxysmal nocturnal hemoglobinuria presented with acute substernal chest pain. Five days prior, she had a similar presentation to a different hospital. She underwent coronary angiography which showed thrombotic occlusion of an RPL branch s/p aspiration thrombectomy. The report describes heavy plaque in the proximal RCA by IVUS, but no lesions in the previously occluded RPL branch and no stent was deployed.

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EKG/ECG Hospitals Documentation/Coding 66

Sensible Medicine

NOVEMBER 26, 2024

The disparities in health outcomes in the US, most notably between black and white, is appalling. It is an effect of our country’s original sin, compounded by hundreds of years of racism. Whether you examine specific health issues -- COVID , gun violence , cardiovascular death – or overall mortality , the differences are repugnant, embarrassing, and heart breaking.

Research 107

Research Outcomes CDC Hospitals 107

First 10 EM

NOVEMBER 25, 2024

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 (or now quarter). Obviously the format means the focus is mostly on content I have found, […] The post The First10EM monthly wrap-up for autumn 2024 appeared first on First10EM.

Academics 75

Academics 75

Don't Forget the Bubbles

NOVEMBER 29, 2024

It’s a busy day in the paediatric ED. A worried parent rushes in carrying a toddler who’s just had a gulp from an unlabelled bottle in the garage. The child looks unsettled but otherwise fine—for now. “It was just a bit of the stuff we use for cleaning the car windscreen,” the parent says. You smell the faint odour of alcohol on the child’s breath A quick mental note: methanol poisoning?

Poisoning 62

Poisoning Forensics Seizures Outcomes 62

The Skeptics' Guide to EM

NOVEMBER 23, 2024

Date: November 13, 2024 Reference: Lee WH, et al. Study of Pediatric Appendicitis Scores and Management Strategies: A Prospective Observational Feasibility Study. Academic Emergency Medicine. Dec 2024 Guest Skeptic: Dr. Dennis Ren is a pediatric emergency medicine physician at Children’s National Hospital in Washington, DC. He’s also the host of SGEMPeds.

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Pediatrics Sepsis Academics Emergency Department 74

EMDocs

NOVEMBER 23, 2024

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: Could Paralyzing Before Sedatives Increase First Pass Success? Spoon Feed This study utilized Bayesian analysis and found that when paralytic medications were administered before sedatives during ED intubation, the

Administration 70

Administration 70

Board Bombs

NOVEMBER 29, 2024

You've survived Thanksgiving, now survive managing a pediatric airway obstruction by foreign body. This case will make you wish your in-laws came back to visit for Christmas. Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind at here. Cite this podcast as: Briggs, Blake; Husain, Iltifat. 241.

Pediatrics 52

Pediatrics 52

Don't Forget the Bubbles

NOVEMBER 25, 2024

A 7-week-old baby presents to the Emergency Department (ED) with a one-day history of coryza and cough. Parents have recorded a temperature of 38°C at home. In triage, she is noted to be alert and feeding well. Her initial observations show a temperature of 38.2°C, HR 152 bpm, RR 45/min, and oxygen saturation 97% in room air. You perform a viral swab test at ED which comes back positive for SARS-CoV-2.

Point-of-Care Testing 67

Point-of-Care Testing Outcomes Wellness Emergency Department 67

JournalFeed

NOVEMBER 29, 2024

The JournalFeed podcast for the week of Nov 25-29, 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. Monday Spoon Feed : This secondary analysis of 2 RCTs found no significant difference between rocuronium or succinylcholine on first attempt success or severe complications in critically ill patients undergoing endotracheal intubation.

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Dr. Smith's ECG Blog

NOVEMBER 23, 2024

An elderly woman presented with one day of chest and right arm pain, and also abdominal pain. There was associated tingling and numbness in the right hand and generalized weakness, worse on the right side. A triage ECG was recorded: Smith : there is widespread artifact, except in lead III. Since lead III is not artifactual, one can deduce that t he artifact is caused by movement of the right arm electrode, so that electrode should be moved and the ECG re-recorded.

EKG/ECG 63

EKG/ECG 63

RebelEM

NOVEMBER 25, 2024

Background: In 2018, the BEAM Trial, a small single-center randomized clinical trial, conducted in the emergency department at Hennepin County Medical Center, demonstrated that bougie use significantly increased the first-attempt intubation success rate compared to the endotracheal tube with stylet (98% vs 87% (absolute difference, 11% [95% CI, 7% to 14%]). 1 Conversely, the 2021 BOUGIE trial—a larger, multicenter randomized clinical trial conducted by the same investigators—found no significant

Outcomes 59

Outcomes Emergency Department Operations Hospitals 59

Sensible Medicine

NOVEMBER 28, 2024

A few years ago, meeting on zoom, Vinay had an improbable idea: What if we worked together on a single substack. The idea was Sensible Medicine — a place to debate ideas in biomedicine, to host debates, to tell stories from the trenches, to dissect articles. What would a substack look like that featured not just one voice, or two voices, but a range of voices in medicine.

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The Evolution & Medicine Review

NOVEMBER 26, 2024

Ongoing selection for adaptation to high altitude Ye, S., Sun, J., Craig, S. R., Di Rienzo, A., Witonsky, D., Yu, J. J., Moya, E. A., Simonson, T. S., Powell, F. L., Basnyat, B., Strohl, K. P., Hoit, B. D., & Beall, C. M. (2024).

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EMergucate

NOVEMBER 25, 2024

72 year-year-old man with history of type II DM and has a single kidney. Presented with 2 weeks of diarrhoea. He has been in bed for 2 weeks. Unresponsive. Last proper meal was 2 weeks ago.

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AED Leader

NOVEMBER 25, 2024

California is leading the way in public safety with a new law that could save countless lives during cardiac emergencies. Effective January 1, 2017, the state’s Health and Safety Code 19300 mandates that certain high-occupancy buildings must install Automated External Defibrillators (AEDs). This legislation reflects a growing recognition of how crucial AEDs are in improving survival rates for sudden cardiac arrest (SCA).

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CPR Documentation/Coding Shock Hospitals 52

PEMBlog

NOVEMBER 25, 2024

The Kocher criteria can help you rule out a septic hip. Transient Synovitis is a much better diagnosis. It used to be called Toxic Synovitis, but that name was too scary so it got changed. Lyrics In a kid with hip pain I’ve got to explain The Kocher criteria And using your brain Cannot bear weight A fever complaint White count 12K ESR 40 today I’ve they’ve got all four The hips septic for sure But if they have none Then show them the door Note: CRP of >2.5 can replace ESR>40, but it was

Infectious Diseases 52

Infectious Diseases 52

Board Bombs

NOVEMBER 23, 2024

We have a short attention span in the ED….so it’s okay to defer hyponatremia to the real nerds (psst internal medicine). But there are a few indications when we need to jump into action to save the day. Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind at here. Cite this podcast as: Briggs, Blake. 240.

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JournalFeed

NOVEMBER 23, 2024

The JournalFeed podcast for the week of Nov 18-22, 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. Monday Spoon Feed : Most of the time, targeting a hemoglobin threshold of 7 – 8 g/dL in critically-ill patients is recommended, with acute coronary syndrome as the exception to the rule.

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EMergucate

NOVEMBER 24, 2024

The supine chest x-ray shows left sided deep sulcus sign (lucency diving deep into left upper quadrant) indicative of a … Continue reading →

EMS 52

EMS 52

Core Ultrasound

NOVEMBER 29, 2024

In this video tutorial, we provide a detailed guide to operating the Sonosite LX ultrasound machine. Designed for both beginners and those familiar with ultrasound technology, this demonstration will walk you through the essential features and functions of this device. You’ll learn how to power it on, optimize image quality, navigate the user interface, save and review images, and utilize its advanced settings to improve your workflow. > The post 5 Minute Sono – Sonosite LX Machine Basics

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Ultrasounds Operations 52

EM Ottawa

NOVEMBER 29, 2024

Methodology: 3.5/5 Usefulness: 3.5/5 CMAJ. 2023 Dec 3;195(47):E1614-E1621. de Wit K, et al. doi: 10.1503/cmaj.230634. Question and Methods: The Falls Decision Rule was derived to identify older adults with fall who do not require CT to rule out intracranial bleeding, using logistic regression. Findings: The rule demonstrated 98.6% sensitivity and 20.3% specificity for detecting significant […] The post Derivation of the Falls Decision Rule to exclude intracranial bleeding without head CT

Head Injuries 40

Head Injuries 40

Stop and Think

NOVEMBER 28, 2024

Just a short note to say thank you to those who follow this Substack. I am grateful to have readers. It’s Thanksgiving here and it is nice that my brain gets a holiday. Peace be with you all. JMM Stop and Think is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

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