The Trauma Pro

DECEMBER 19, 2023

In my last post, I discussed the growing number of choices for plasma replacement. Today I’ll look at some work that was done that tried to determine if any one of them is better than the others when used for the massive transfusion protocol (MTP). As noted last time, fresh frozen plasma (frozen within 8 hours, FFP) and frozen plasma (frozen within 24 hours, FP) have a shelf life of 5 days once thawed.

Military 147

Military Hospitals Resuscitation 147

Sensible Medicine

DECEMBER 18, 2023

Good morning all. This Monday, I take a day off. For the study of the week, Vinay Prasad contrasts the different recommendations on the treatment of childhood obesity. The USPSTF or United States Preventive Services Task Force is an independent volunteer panel of experts in disease prevention and evidence-based medicine. They are as close to neutral judges of medical evidence as it gets.

Pediatrics 142

Pediatrics Documentation/Coding Burns Academics 142

Don't Forget the Bubbles

DECEMBER 18, 2023

“Okay team, we’ve been following the APLS algorithm for 30 minutes and have considered all reversible causes. This child has been in cardiac arrest for at least an hour and none of the interventions we have carried out have made a difference. The blood gas is incompatible with life. I think we should stop resuscitation. Does anyone have any objections?

Resuscitation 130

Resuscitation Outcomes CPR Hospitals 130

ECG Guru

DECEMBER 18, 2023

If a wide complex tachycardia occurs, the probability is very high that it is a ventricular tachycardia (approx. 80%, in patients with a previous myocardial infarction (.) approx. 90%). Here we see a broad complex tachycardia that looks like an RBBB + LAFB, which is regular. In this constellation, 3 causes must be considered: 1. fascicular tachycardia from the left posterior fascicle of the left tawara fascicle (QRS width usually only around 130 ms, but sometimes significantly longer). 2.

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The Trauma Pro

DECEMBER 22, 2023

As I was browsing through my journal list this week, I ran into an interesting title for an article that is currently in press. “The use of radio-opaque markers is medical dogma” Catchy, especially since I love writing about dogma vs what is really supported by the literature. The author questions the justification of this practice and posits that there are risks to extrapolating information based on radiographs with markers placed by the trauma team.

Operations 250

Operations Outcomes 250

Life in the Fast Lane

DECEMBER 18, 2023

Neil Long Button Battery Update 3.0 Want to know the latest on button battery management, prevention and immediate care? Look no further than our latest tox offering.

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125

Dr. Smith's ECG Blog

DECEMBER 19, 2023

This is written by Willy Frick, an amazing cardiology fellow in St. Louis. [link] A 62 year old man with a history of hypertension, type 2 diabetes mellitus, and carotid artery stenosis called 911 at 9:30 in the morning with complaint of chest pain. He described it as "10/10" intensity, radiating across his chest from right to left. EMS obtained the following vital signs: pulse 50, respiratory rate 16, blood pressure 96/49.

EKG/ECG 121

EKG/ECG EMS Wellness Operations 121

Science Based Medicine

DECEMBER 18, 2023

On Friday, CNN host Kasie Hunt interviewed antivax presidential candidate Robert F. Kennedy, Jr. Although she did better than most journalists confronting him for his past antivax statements in that she played a clip of one of his antivax statements, she clearly hadn't anticipated his response, which should have been very predictable given that he's been using it for at least 15 years.

CDC 115

CDC 115

Sensible Medicine

DECEMBER 21, 2023

Over the last week, a debate has simmered between the pages of my Substack , Sensible Medicine, and the Sensible Medicine podcast, which you can watch here. Sensible Medicine Mandrola and Prasad are back Listen now 4 days ago · 60 likes · 18 comments · Vinay Prasad and John Mandrola Briefly put the argument is: Yes, of course, medicine would benefit from more large, well done randomized studies, and better epidemiologic evidence, but this is expensive, costly, requires coordinatio

Pediatrics 109

Pediatrics Wellness 109

Emergency Live

DECEMBER 22, 2023

The Latest Innovations in First Aid Presented at CMEF Life-Saving Innovations Rhino Rescue, a leading company in the field of first aid equipment, recently unveiled a series of groundbreaking products at the China International Medical Equipment Fair (CMEF), a prominent global event in the medical devices industry. Among these, the ADV-PRO pneumothorax needle stood out […] The post Rhino Rescue: Life-Saving Innovations in Emergency Response appeared first on Emergency Live.

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First 10 EM

DECEMBER 18, 2023

This is a guest post by Dr. Ross Prager. It was actually the first blog post on a new FOAMed project – SimpleSage – and I asked to cross-post it here because I think that, based on the quality, readers of First10EM will almost certainly be interested in following this new evidence based medicine project. […] The post How to create a focused and answerable research question appeared first on First10EM.

Research 112

Research 112

Dr. Smith's ECG Blog

DECEMBER 22, 2023

This is a case I had quite a while back. The patient with no prior cardiac history presented in the middle of the night with acute chest pain, and had this ECG recorded during active pain: I did not see any ischemia on this electrocardiogram. It does not look entirely normal, since there are some nonspecific STT abnormalities, such as flattening of the T waves in aVL.

EKG/ECG 106

EKG/ECG Outcomes 106

SheMD

DECEMBER 21, 2023

Work life balance —it is a phrase we are hearing everywhere. It seems our entire society is overworked, tired and trying to find a way out. In reality the concept seems nebulous. What does it mean to be balanced? Can one really have true balance? Today Dr. Anne Slater joins us on the blog to discuss how to find balance or get back to equilibrium in your life.

Emergency Department 104

Emergency Department Hospitals Wellness 104

Emergency Live

DECEMBER 20, 2023

Understanding the Causes, Symptoms, and Prevention Techniques to Address Hernia Symptoms and Causes of Hernia Hernia is a common condition that occurs when an organ or tissue protrudes through a weakness in the surrounding muscle or tissue. It can present as a visible bulge and cause symptoms such as pressure, dull pain, or discomfort. Some […] The post Preventing Hernia: Strategies and Innovations appeared first on Emergency Live.

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111

Mind The Bleep

DECEMBER 19, 2023

Diabetic Ketoacidosis (DKA) is a medical emergency caused by uncontrolled Type 1 Diabetes Mellitus (T1DM). It is quite common for children with undiagnosed T1DM to present as DKA, and for these patients to present acutely unwell. Therefore, it’s important to be able to recognise the presentation and start appropriate management. Epidemiology The frequency of DKA at clinical onset of diabetes varies by location, but is approximately 15-75%.

Dehydration 98

Dehydration Fluid Resuscitation Shock Resuscitation 98

Life in the Fast Lane

DECEMBER 17, 2023

Oliver Flower The Power of Words: Language and Death Victoria Whitfield and Louise Sayers discuss the importance of effective communication from health professionals to patients and their families

Resuscitation 98

Resuscitation 98

ECG Guru

DECEMBER 20, 2023

A sustained VT is a ventricular rhythm with a frequency of more than 100 beats per minute that usually lasts at least 30 seconds or must be terminated earlier due to hemodynamic instability. We see here a wide complex tachycardia with a frequency of approx. 105-110 beats per minute that lasts for a good minute. It begins with a premature QRS complex without a premature P wave.

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Emergency Live

DECEMBER 19, 2023

Understanding the Link between Diet, Physical Activity, and Diabetes Risk The Global Impact of Diet and Physical Activity on Diabetes Diabetes, one of the most common and rapidly growing chronic diseases worldwide, is strongly influenced by lifestyle factors such as diet and physical activity. Research conducted by Tufts University revealed that in 2018, approximately 14.1 […] The post Diabetes and Lifestyles: A Global Correlation appeared first on Emergency Live.

Research 111

Research 111

St. Emlyn

DECEMBER 18, 2023

St.Emlyn's - Emergency Medicine #FOAMed In this bumper double edition Simon and Iain chat through all the recent content on the St Emlyn’s blog site, including a review of CRYOSTAT-2 and the DAShED study, a … November 2023 podcast St Emlyn’s Read More » The post November 2023 podcast St Emlyn’s appeared first on St.Emlyn's.

EMS 96

EMS 96

Emergency Medicine Cases

DECEMBER 19, 2023

In this part 1 or our 2-part podcast series on wrist injuries Dr. Arun Sayal and Dr. Matt DiStefano answer such questions as:when should we suspect a DRUJ injury, why is it important to pick up DRUJ injuries in the ED, and how does it change our management? Why is the lateral x-ray view so important in picking up commonly missed wrist injuries? When it comes to distal radius fractures, how are Colles vs Barton's vs Smith's fractures managed differently in the ED?

Fractures 94

Fractures EMS 94

EMDocs

DECEMBER 19, 2023

Today on the emDOCs cast, we have a special guest, Alexis Koda, core faculty at the Nazareth Emergency Medicine Residency program in Philadelphia, PA. Alexis takes us through marine envenomations and trauma. Episode 91: Marine Envenomation and Trauma Major Marine Trauma Shark Bites Tend to be neurovascular injury and tissue loss Death from hemorrhage Don’t chew—result in tearing injuries Treatment of Major Marine Trauma Remove from water Control bleeding Supportive management Radiographs for fo

Poisoning 92

Poisoning Seizures Anaphylaxis Burns 92

Emergency Live

DECEMBER 22, 2023

Intensive Rescue Efforts and Climatic Challenges in Northwestern China Devastating Impact of the Earthquake and Initial Response The recent earthquake in northwestern China, one of the deadliest since 2014, has resulted in a tragic toll of over 130 casualties, with 113 people perishing in Gansu province and 18 in Qinghai province. In Gansu, more than […] The post Earthquake in China: Latest Updates appeared first on Emergency Live.

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Sensible Medicine

DECEMBER 20, 2023

I am not an artificial intelligence skeptic or pessimist. I am confident that AI will improve healthcare, and I look forward to seeing how. I’ve been following the general conversations and have been particularly interested in AI’s potential to improve diagnostic performance. Two good reads are here and here. I do not think that we can yet really imagine how we will incorporate AI into our practice in five or ten years.

Wellness 89

Wellness Hospitals 89

ECG Guru

DECEMBER 20, 2023

A sustained VT is a ventricular rhythm with a frequency of more than 100 beats per minute that usually lasts at least 30 seconds or must be terminated earlier due to hemodynamic instability. We see here a wide complex tachycardia with a frequency of approx. 105-110 beats per minute that lasts for a good minute. It begins with a premature QRS complex without a premature P wave.

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Emergency Medicine Cases

DECEMBER 20, 2023

In this ECG Cases Dr. Jesse McLaren delves into ECG interpretation in toxicology and the poisoned patient using his HEARTS approach in 7 case examples. Heart rate/rhythm: consider antidotes for brady/tachy-arrhythmias, and for sinus tachycardia consider fluids for vasodilation and benzodiazepines for agitation. Electrical conduction and axis: consider sodium bicarb for QRS > 100 especially if RBBB or terminal rightward shift, and magnesium for QTc> 500.

EKG/ECG 82

EKG/ECG Poisoning EMS 82

Emergency Live

DECEMBER 22, 2023

From Telegraphy to Digital, the Story of a Universal Signal The Birth of SOS The story of the “SOS” distress signal begins in the early 20th century. Germany was the first country to adopt the SOS, known as the Notzeichen, in 1905. It was then recognized internationally when the first International Radiotelegraph Convention, held in […] The post SOS: Distress Signal and Its Historical Evolution appeared first on Emergency Live.

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105

Taming the SRU

DECEMBER 20, 2023

Key History and Physical Exam When gathering a history on a patient with a dislodged G-tube, it’s important to obtain certain key pieces of information about the placement and history of the tube. Whether through direct query of the patient or chart review, the clinician should identify the date of tube placement in order to determine whether the tract is mature enough to attempt bedside replacement.

Pediatrics 80

Pediatrics Emergency Department EMS Outcomes 80

Science Based Medicine

DECEMBER 21, 2023

There are no homeopathic eye drops approved by the FDA. The post FDA: Don’t use homeopathic eye drops first appeared on Science-Based Medicine.

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88

EMDocs

DECEMBER 20, 2023

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. The goal of MMI-LFL is to improve patient safety, educate physicians and reduce the cost and stress of medical malpractice lawsuits. To opt in to the free subscriber list, click here. Stories of med mal lawsuits can save lives.

Patient Safety 77

Patient Safety Wellness 77

Emergency Live

DECEMBER 22, 2023

How a sedentary lifestyle can increase the risk of developing cancer Correlation between Sedentary Life and Cancer A 2014 meta-analysis examined data from over 68,000 cancer cases and found that prolonged sedentary behaviors, such as watching TV or sitting for work, are associated with an increased risk of colon, endometrial, and lung cancer. An 8% […] The post Sedentary Lifestyle and Cancer Risk: A Concerning Connection appeared first on Emergency Live.

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105

Taming the SRU

DECEMBER 18, 2023

Key History and Physical Exam After determining your patient has a clear indication for foley placement, it’s important for the clinician to determine if the patient has any history or conditions that increase the difficulty of foley insertion (See Table 1 below). Knowing before attempts whether you anticipate the catheterization will be challenging allows the clinician to appropriately plan methods, gather supplies, and call for help if needed.

Emergency Nursing 77

Emergency Nursing EMS Emergency Department Ultrasounds 77

Science Based Medicine

DECEMBER 20, 2023

Some thoughts as we complete our 15th year of science-based medicine. The post SBM in 2023 first appeared on Science-Based Medicine.

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American Medical Compliance

DECEMBER 21, 2023

Providing healthcare is undeniably one of the most promising and rewarding ventures in today’s business landscape. This is because of the rapidly growing global population and aging demographic. As featured in Companies Market Cap, the top 10 publicly traded healthcare companies have revenue of $39 billion to $359 billion as of 2023. This shows that there’s a continual focus on health and wellness.

Best Practices 71

Best Practices Telemedicine Wellness 71

Emergency Live

DECEMBER 22, 2023

An Overview of Relief Difficulties and the Human Rights Situation Humanitarian Situation and Relief Challenges Afghanistan is facing a severe humanitarian crisis, exacerbated by climate change, a sharp economic decline, and restrictions imposed by the Taliban, which directly affect the ability to provide humanitarian aid. In 2023, approximately 28 million people in Afghanistan rely on […] The post Humanitarian Crisis in Afghanistan: Challenges and Conditions of Women appeared first on Emer

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105

ALiEM

DECEMBER 18, 2023

A 19-year-old female with a past medical history of epilepsy presented to the emergency department for evaluation of rash and fever. Two days prior to presentation she began to experience fevers with a Tmax of 103°F. One day before presentation she developed a rash that began on her face and slowly spread down her body, now involving her palms. The patient endorsed associated pruritus and cervical lymphadenopathy with the rash.

Academics 70

Academics Emergency Department Wellness 70

Sensible Medicine

DECEMBER 22, 2023

As many of you know, I have long argued (unsuccessfully until now) for a placebo-controlled trial of AF ablation. One group gets the ablation; the other gets a placebo or sham procedure. This way we can sort out the placebo-resistant effect of the ablation. Finally, here is the first report of one. Dr. Malcolm Finlay is an electrophysiologist at St Bartholomew hospital in London UK and primary investigator of the study.

Hospitals 66

Hospitals 66

Emergency Medicine Journal

DECEMBER 22, 2023

Clinical introduction A 96-year-old woman presented to the ED with a 3-day history of fever and facial redness. She had dementia and was constantly scratching her face with itching. On examination, her body temperature was 38.2℃ The erythema was tender and confined to her face and ears. Laboratory tests showed an absolute neutrophil count of 10,900/μL and a C reactive protein level of 115 mg/L.

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