Ken Grauer, MD
SEPTEMBER 22, 2023
The ECG in Figure-1 — was obtained from a middle-aged man with palpitations and shortness of breath. He was hemodynamically stable at the time this tracing was recorded. How would YOU interpret the ECG in Figure-1 ? Is there evidence of a recent or ongoing acute MI? What might you do first? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ).
Pediatric EM Morsels
SEPTEMBER 22, 2023
To celebrate the end of trauma season ( is it ever really over? ), we here at the Ped EM Morsels Bakery have cooked up a morsel to remind you that pediatric trauma can be even more difficult than you think. Never fear. As our fearless leader likes to say: “children are not aliens, but they are a special population with unique anatomy and physiology.” Children compensate for blood and volume loss very well… until they don’t.
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First 10 EM
SEPTEMBER 18, 2023
Transfusion seems like the simplest intervention in medicine. The patient is losing blood, so let’s put some back in. Not much more complicated than an oil change. Sure, you need to use a specific brand, but as long as the system is topped up, everything should run just fine. Therefore, when someone (to be left […] The post Massive hemorrhage: a very deep dive appeared first on First10EM.
RebelEM
SEPTEMBER 21, 2023
Bottom Line Up Top: Troponins should not be routinely sent in patients presenting with SVT. Rarely, they may be necessary if the patient has concerning ischemic symptoms that persist after conversion to sinus rhythm. Clinical Scenario: A 44-year-old man presents with palpitations that started 45 minutes ago. He has no medical problems and denies any prior similar symptoms.
The Trauma Pro
SEPTEMBER 21, 2023
Here’s another abstract with a promising title that suffers from low subject numbers. Whole blood is the new darling of trauma resuscitation. Assembling a unit of whole blood from the components it was broken down into produces an inferior product from the standpoint of resuscitation. It makes sense from a coagulation standpoint, but there are a few pesky issues that need to be considered, such as antibody titers.
Dr. Smith's ECG Blog
SEPTEMBER 19, 2023
Case submitted by anonymous. Written by Smith. Ken's piece at the bottom is excellent. A 50-something presented with s udden onset palpitations 8 hrs prior while sitting at desk at work. He had concurrent sharp substernal chest pain that resolved, but palpitations continued. Over past 3 months, he has had similar intermittent episodes of sharp chest pain while running, but none at rest.
Sensible Medicine
SEPTEMBER 16, 2023
Recently, I saw a tweet from World Lung Conference. A presenter lamented differences in Lung cancer screening rates by race. Black and Hispanic patients had lower rates of lung cancer CT screening than whites, and the speaker argued that we needed targeted efforts to improve this disparity. But lung cancer screening doesn't work, as I described in a prior post.
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The Trauma Pro
SEPTEMBER 20, 2023
Until the last few years, massive transfusion in trauma consisted of component therapy, an admixture of packed red cells, plasma, and platelets. Whole blood transfusion is making inroads again, but it is used in a minority of centers. Of the three components, platelets have classically required different handling than the others. They are generally kept at room temperature, while the red cells and plasma are kept very cold to preserve their shelf life.
Dr. Smith's ECG Blog
SEPTEMBER 22, 2023
This ECG was texted to me with no other information. I assumed the presentation was consistent with acute MI. What did I say? "OMI. Activate the cath lab." The T-waves in V2-V6 are diagnostic. It does, in fact, the STE meets STEMI criteria since there is 1 mm of in V4 and V5. There is also some non-diagnostic STE in inferior leads. There is zero reciprocal ST depression. 50% of LAD OMI have zero reciprocal ST depression!
The Bottom Line
SEPTEMBER 22, 2023
Extracorporeal Life Support in Infarct-Related Cardiogenic Shock Thiele H. NEJM 2023; Online ahead of print. doi:10.1056/NEJMoa2307227 Clinical Question In patients presenting with acute myocardial infarction complicated by cardiogenic shock undergoing revascularisation, does the early unselected application of extracorporeal life support reduce mortality from any cause at day 30?
Sensible Medicine
SEPTEMBER 18, 2023
Let’s do a thought experiment about the tricuspid valve. The TCV controls blood flow from the right atrium to the right ventricle. Background : A common TCV problem occurs when the leaflets don’t close properly during systole and there is too much regurgitation of blood back to the right atrium. We call this TR or tricuspid regurgitation.
Emergency Live
SEPTEMBER 21, 2023
Extrication Training Centre in Casiglion Fiorentino: First Dedicated Centre for Rescue Worker Training up and running In the heart of STRASICURAPark, in Casiglion Fiorentino (Arezzo), is a state-of-the-art centre, ready to welcome visitors, experts and rescue professionals specialised in a delicate branch of emergencies: the extrication of victims from crashed vehicles.
St. Emlyn
SEPTEMBER 22, 2023
St.Emlyn's - Emergency Medicine #FOAMed Does the age of your emergency physician influence survival rates? It appears so with more mortality the older the clinician. Why might this be? #FOAMed @stemlyns The post JC: How old is your doctor? St Emlyn’s appeared first on St.Emlyn's.
Medagadget
SEPTEMBER 19, 2023
Researchers at Nanyang Technological University in Singapore have developed a tiny, flexible battery that is intended for use in smart contact lenses. The device is as thin as the human cornea and can be charged by a saline solution, which is particularly useful in the eye, as it is full of salty tears. When the battery-equipped smart lens is not in use, such as at night, then it can be stored in a saline solution, helping to further recharge the battery.
EM Ottawa
SEPTEMBER 21, 2023
Emergency medicine is a fast-paced realm where paramedics and medical professionals must make split-second decisions that often mean the difference between life and death. In this high-stakes environment, understanding and respecting patient preferences while upholding ethical principles are paramount. This article delves into the crucial role of paramedics in ensuring patients’ choices are honoured and […] The post BHP Corner: Respecting Patient Preferences appeared first on EMOttaw
Emergency Live
SEPTEMBER 21, 2023
Arson fires: the role of arsonists, economic interests and rescuers We have now seen several fires that have created various disasters: some of these remain world-famous precisely because of the number of hectares burned, the number of victims or their famous circumstances. It is always a drama that has to be dealt with day after […] The post Arson fires: some of the most common reasons appeared first on Emergency Live.
PulmCCM
SEPTEMBER 21, 2023
Blood pressure often rises during acute ischemic strokes, in what is widely held to be a natural protective mechanism: increased blood pressure pushes more blood through and around stenotic blood vessels into areas of injured, oxygen-starved brain. This process is hypothesized to reduce further ischemic injury that would occur if blood pressure were to remain at baseline.
Medagadget
SEPTEMBER 19, 2023
Researchers at ETH Zurich have developed an insulin delivery system that relies on music as a trigger. The unusual technology is based on calcium ion channels that typically reside in the cell membrane. Such channels are sensitive to mechanical deformation and these researchers discovered that sound waves will activate the channels. When insulin-producing cells are genetically modified to express this channel, they will experience an influx in calcium ions when music is played close by, promptin
Taming the SRU
SEPTEMBER 22, 2023
Prekker, M. E. et al. Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults. N. Engl. J. Med.389, 418–429 (2023). Clinical Question: Does video laryngoscopy increase the likelihood of first attempt tracheal intubation with compared to direct laryngoscopy? Background More than 1.5 million adults undergo tracheal intubation outside of the operating room each year in the United States.
Emergency Live
SEPTEMBER 19, 2023
CRI National First Aid Competitions: the challenge of volunteers in 17 emergency simulations In the beautiful setting of the medieval village of Caserta Vecchia, the 28th edition of the Italian Red Cross National First Aid Competitions was held. This event represented an extraordinary opportunity for hundreds of volunteers from all corners of Italy, who competed […] The post Lombardy triumphs in the Italian Red Cross National First Aid Competition 2023 appeared first on Emergency Live.
PulmCCM
SEPTEMBER 17, 2023
The Centers for Disease Control and Prevention formally called on hospitals to develop robust sepsis care programs to systematically identify and treat sepsis, track outcomes, and improve care delivery. The guidance comes as a series of recommendations dubbed the Hospital Sepsis Program Core Elements , along with an “assessment tool” that functions as a sort of checklist for compliance.
Medagadget
SEPTEMBER 20, 2023
Researchers at the Terasaki Institute in Los Angeles have developed a new method to create 3D printed muscle constructs with enhanced muscle cell alignment and maturation. The technique involves creating microparticles loaded with insulin-like growth factor (IGF) using a microfluidic platform. Then, these particles are included in a bioink that also incorporates myoblast cells and a gelatin-based hydrogel.
Sensible Medicine
SEPTEMBER 22, 2023
I’ve managed to keep up the every other week Friday Reflection for 58 weeks. A very busy month almost led me to miss this deadline, and then my mother came to the rescue. My mom died 4 years ago. At the time I packed away her journals and albums, unable to imagine getting rid of any of them. During the last couple of weeks, for the same reasons I failed to write a reflection this week, I dove into her files.
Emergency Live
SEPTEMBER 22, 2023
Dangerous sinkholes: how to recognise them and what to do in an emergency Even if our world can be said to be invaded by concrete and plastic, it is difficult to call it even completely solid. In areas where we do not often see floods or tornadoes, there can instead be problems that come from […] The post Sinkholes: what they are, how they form and what to do in an emergency appeared first on Emergency Live.
Dr. Smith's ECG Blog
SEPTEMBER 17, 2023
Written by Magnus Nossen MD, peer reviewed and edits by Smith, Meyers, Grauer A 60 something previously healthy female smoker sought medical attention after 2-3 days of intermittent chest discomfort. The chest discomfort was described as sharp. Episodes lasting 5-30 minutes. On the day of presentation she experienced another episode of chest discomfort accompanied by vomiting and throat pain.
Medagadget
SEPTEMBER 19, 2023
Researchers at the University of Colorado Anschutz Medical Campus have developed a technique that may spot the very early signs of Alzheimer’s disease, years before symptoms arise. The method may alert patients and clinicians to an increased risk of the disease, potentially allowing them to take steps to slow the disease progression. The method involves using a simple EEG headband while sleeping.
Life in the Fast Lane
SEPTEMBER 19, 2023
Chris Groombridge and James Miers Thoracotomy Emergency Procedure: Thoracotomy. Possibly the most terrifying emergency procedure, but also one which carries a high chance of saving a life.
Emergency Live
SEPTEMBER 18, 2023
The latest findings on forecasting and prevention, how to predict and counter an earthquake event How many times have we asked ourselves this question: is it possible to predict an earthquake? Is there any system or method to stop such events? There are various tools to predict some dramatic event and there are also some […] The post Earthquakes: is it possible to predict them?
Taming the SRU
SEPTEMBER 21, 2023
Driver, B. E., Trent, S. A., Prekker, M. E., Reardon, R. F. & Brown, C. A. Sedative Dose for Rapid Sequence Intubation and Postintubation Hypotension: Is There an Association? Ann. Emerg. Med. (2023) doi:10.1016/j.annemergmed.2023.05.014. Clinical Question: Does the dose of etomidate or ketamine play a role in post-intubation hypotension? Background Rapid sequence intubation (RSI) is frequently performed under emergent conditions in acutely ill patients.
Medagadget
SEPTEMBER 20, 2023
Researchers at RMIT in Australia have developed a drug-free approach to kill bacteria and fungi that can infect surfaces on medical implants. Such pathogens can cause serious and difficult-to-treat infections around medical implants, sometimes requiring the removal of the implant. In addition, many microbes are increasingly resistant to common antibiotics, highlighting the need for drug-free approaches.
Science Based Medicine
SEPTEMBER 20, 2023
It's not as complicated as you may think. The post Why Is American Healthcare So Expensive? first appeared on Science-Based Medicine.
Emergency Live
SEPTEMBER 20, 2023
AI and IoT Revolutionize Medical Delivery with Drones: Insights from IEEE SPA Conference 2023 In a captivating session at the IEEE SPA Conference 2023, Giuseppe Tortora unveiled a visionary talk titled “AI and IoT for Future Generation of Medical Delivery with Drones.” Held at the esteemed Polytechnic University of Poland, this conference delved into the […] The post Drones for medical deliveries: is the future already here?
St. Emlyn
SEPTEMBER 19, 2023
St.Emlyn's - Emergency Medicine #FOAMed Top 10 papers from 2022-2023 for the SASEM 2023 conference in Jeddah. The post SASEM 2023. Top 10 papers. St Emlyn’s appeared first on St.Emlyn's.
Core Medical Group
SEPTEMBER 20, 2023
Meet Jalen, an enthusiastic Allied Recruiter at CoreMedical Group, whose journey in healthcare recruiting began shortly after she graduated with a degree in health management and policy from the University of New Hampshire. From her early college days, Jalen's commitment to making a difference in healthcare was clear. While initially drawn to clinical aspects, she discovered the profound impact of non-clinical elements, fueling her passion for recruitment, which eventually led her to CoreMedical
Science Based Medicine
SEPTEMBER 19, 2023
Burning Man. It is more than a rained out festival in the desert. The post Spontaneous Human Combustion. A Sort of Narrative Review. first appeared on Science-Based Medicine.
Emergency Live
SEPTEMBER 22, 2023
Green Camps: a learning opportunity on road safety for young people With the Green Camps in Manfredonia and Varese, the first phase of the “Safety on the Road” project, a valuable initiative promoted by the Red Cross in cooperation with Bridgestone EMIA, has come to a successful end. These camps represented an important learning opportunity […] The post 5,000 students involved in the 'Safety on the Road' project appeared first on Emergency Live.
Sensible Medicine
SEPTEMBER 19, 2023
This week, I talk with Andrew Foy, who is an academic cardiologist at Penn State University in Hershey, PA. Andrew is one of the smartest voices in medicine today. We start with the REMEDIAL trial, published recently in JAMA. Ablation vs Meds. Primary endpoint—depression and anxiety. One of the main issues was the control arm—namely that there was no sham control.
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