Sat.Jun 01, 2024 - Fri.Jun 07, 2024

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ECG #433 — Which Lead Convinced Me?

Ken Grauer, MD

The ECG in Figure-1 was obtained from a previously healthy older man — who presented to the ED ( E mergency D epartment ) with new but atypical CP ( C hest P ain ) for several hours. QUESTIONS: Given this history — How would YOU interpret this ECG? Which lead is the most concerning? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ).

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Prehospital: What’s The Best Chest Seal For Sucking Chest Wounds?

The Trauma Pro

The treatment of a “sucking chest wound” in the field has typically been with application of some type of occlusive dressing. Many times, a generic adhesive dressing is applied, typically the same kind used to cover IV sites. This is quick, easy, cheap, and readily available in the ambulance. But there is a danger that this could result in development of tension pneumothorax, because the dressing not only keeps air from getting in but also keeps any buildup of pneumothorax from getti

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ReBaked Morsel on Asthma Control – The 2020 NIH Asthma Management Guidelines

Pediatric EM Morsels

Knowing how to manage a severe asthma exacerbation in the ER is a vital ingredient to being a successful ER doctor, but what about the more mild cases? The kids with a history of wheezing that are at the start of a viral URI but not yet in the midst of an exacerbation? What recommendations should we be giving these families? Lucky for us, in 2020 there were some updates made to the NIH Asthma Management Guidelines and we’re going to discuss which ones can help us in the Emergency Department!

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Anthony Fauci failed during the coronavirus response

Sensible Medicine

The first two weeks of March 2020 were jolting. Governments read the Imperial College London report (modeling a million deaths in the US), watched horrifying scenes in Bergamo (a city with median age in the 80s fyi), and collectively embraced policies that had no precedent in human history: The global closing of borders, schools, business, and the use of the police state to enforce this lockdown.

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PulmCrit: MidaKet for procedural sedation in critical illness

EMCrit

intro: the challenge of procedural sedation in critical illness Procedural sedation for critically ill patients is a minefield for several reasons: Patients are already physiologically unstable. Procedures are emergent (a factor widely associated with greater complications). Time constraints often prevent a complete pre-anesthetic evaluation (e.g., medical history and laboratory studies may be unknown).

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The Andexxa Showpiece

EM Literature of Note

Every so often a masterclass performance arises in the medical literature. A performance transcending the boundaries of what was once thought possible. A shining exemplar of human achievement. This is a trial, published in the New England Journal of Medicine , with the following features: Conducted by an institute sponsored by pharma. Designed by the first author, a consultant for pharma, and two employees of pharma.

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Normal angiogram one week prior. Must be myocarditis then?

Dr. Smith's ECG Blog

Written by Magnus Nossen The patient in todays case is a 50 year old male. He has a medical hx notable for hypertension, hyperlipidemia and previous tobacco use disorder. The patient presented due to chest pain that was typical in nature, retrosternal and radiating to the left arm and neck. He denied any exertional chest pain. The below ECG was recorded.

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EMCrit Wee – Controlled Automated Reperfusion of the Whole Body (CARL) ECPR / ECLS Yields Amazing Results

EMCrit

Today, we talk about a paper that showed impressive neurologically intact survival for all-rhythms presenting in cardiac arrest, both OHCA and IHCA. It uses a new set of strategies and technologies called CARL. The Paper Treatment of Refractory Cardiac Arrest by Controlled Reperfusion of the Whole Body: A Multicenter, Prospective Observational Study Supplemental Material […] EMCrit Project by Scott Weingart, MD FCCM.

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Fire Brigade vehicles: a detailed analysis

Emergency Live

An Overview of Emergency Vehicles The Fire Brigade is equipped with a wide array of specialized vehicles capable of handling various emergency situations. These vehicles cater to different operational needs, allowing operators to be as efficient and safe as possible during interventions. From fire engines to cranes, amphibious vehicles, and vehicles for chemical and radioactive […] The post Fire Brigade vehicles: a detailed analysis appeared first on Emergency Live.

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Chest pain with serial ECGs – can you guess the sequence?

Dr. Smith's ECG Blog

Written by Jesse McLaren A 45-year-old presented with 24 hours of intermittent chest pain. Below are serial ECGs focusing on the inferior leads and aVL. Can you guess the sequence? First, what’s the interpretation of each ECG on its own? #1 There’s T wave inversion in III/aVF and a taller T wave in aVL and V2. On it’s own this is nonspecific, but in the right context this could be diagonal occlusion (if active chest pain) or infero-posterior reperfusion (if resolved chest pain). #2 Normal ECG #3

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The MATE ACT Mandate

Life in the Fast Lane

Sunayana Samantaray and Mike Cadogan The MATE ACT Mandate The Medication Access and Training Expansion (MATE) Act went into effect late 2023.

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Research Roundup (June 2024)

First 10 EM

Back again with another month’s worth of interesting, inane, or sometimes important emergency medicine literature. As always, podcast version on BroomeDocs or YouTube. Obviously, GCS 8 doesn’t mean intubate Freund Y, Viglino D, Cachanado M, Cassard C, Montassier E, Douay B, Guenezan J, Le Borgne P, Yordanov Y, Severin A, Roussel M, Daniel M, Marteau […] The post Research Roundup (June 2024) appeared first on First10EM.

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Innovation in Emergency: The SEUAM Project

Emergency Live

A Revolution in Cardiac Emergency Aerospace is proving to be an unexpected ally in the fight against sudden cardiac arrest. Thanks to the experimental project SEUAM (Sanitary Emergency Urban Air Mobility), developed by SIS118 in collaboration with various partners, including the aerospace consortium CALTEC and prominent academic institutions like the Campus Biomedical University of Rome […] The post Innovation in Emergency: The SEUAM Project appeared first on Emergency Live.

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Grand Rounds Recap 5.22.24

Taming the SRU

Air care grand rounds - top 10 air care cases of the year - r3 small groups - r4 capstone air care grand rounds: too sick to transport? with Dr. Susan Wilcox Increasing regionalization due to: Growth of specialty centers Increasing development of healthcare systems Hub-and-spoke models Development of ECMO, trauma, transplant, and stroke centers The higher the acuity of the centers, the higher the acuity of the patient that needs to get there.

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JC: Is nebulised ketamine an option in the ED?

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed Journal club review of an RCT on the use of nebulised ketamine use in the emergency department. Yet another route for ketamine? Or maybe not?? #FOAMed @stemlyns The post JC: Is nebulised ketamine an option in the ED? appeared first on St.Emlyn's.

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Overly optimistic design dooms many large randomized trials to failure

PulmCCM

Academic medicine is a tough business. Conceiving and conducting large randomized controlled trials is an expensive, time-consuming undertaking, requiring intense competition for funding and collaboration by dozens or hundreds of collaborators and facilitators. In an era of diminishing public funding, meaningful clinical research is becoming even more difficult.

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Robbery of Medicines at Naples Polyclinic: investigation underway

Emergency Live

A 1.4 million euro heist puts strain on healthcare system Last week, the pharmacy of the University Hospital “Federico II”, commonly known as the Policlinico of Naples, was raided by multiple gangs of thieves. Newspapers reported on the robbery and the pharmacy reopening after the weekend, on Monday morning, with an empty warehouse and stolen […] The post Robbery of Medicines at Naples Polyclinic: investigation underway appeared first on Emergency Live.

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Pertussis Cases are Rising Sharply in 2024

Science Based Medicine

As the pandemic "winds down", cases of whooping cough are on the rise in dramatic fashion. The post Pertussis Cases are Rising Sharply in 2024 first appeared on Science-Based Medicine.

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Podcast – April 2024 Monthly Round Up – Bougies, cardiac arrest, trauma, sepsis, race and medicine, and choosing with intention

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed The latest St Emlyn's podcast with discussion about Bougies, cardiac arrest, trauma, sepsis, race and medicine and choosing with intention The post Podcast – April 2024 Monthly Round Up – Bougies, cardiac arrest, trauma, sepsis, race and medicine, and choosing with intention appeared first on St.Emlyn's.

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A Social Science Perspective on Masking

Sensible Medicine

I know, I know, what can possibly be left to say on this topic? I feel like this piece by Dr. Scales is a good place to leave it as it totally recontextualizes the discussion in an interesting way. It is a little longer than many of our pieces but I think it is worth it. You now have my promise that I will never post about COVID and Masking again on Sensible Medicine.

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Emergency Numbers in the World: Differences and Operation

Emergency Live

An Introduction to Emergency Numbers Emergency numbers are a critical institution to ensure a quick and organized response to emergencies, but they vary significantly from country to country. This reflects both different emergency service structures and specific local needs. While some countries use a single number for any type of emergency, in others there are […] The post Emergency Numbers in the World: Differences and Operation appeared first on Emergency Live.

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Yet another example of how “new school” anti-COVID vaccine antivaxxers have become just antivaxxers now

Science Based Medicine

Dr. Pierre Kory and the pseudomous Substacker known as A Midwestern Doctor provide two more examples of how "anti-COVID" antivax has now become just antivax. The post Yet another example of how “new school” anti-COVID vaccine antivaxxers have become just antivaxxers now first appeared on Science-Based Medicine.

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SGEM#441: Searching Searching for the best Clinical Decision Rule to Detect Pediatric C-Spine Injury

The Skeptics' Guide to EM

Reference: Tavender E, et al. Triage tools for detecting cervical spine injury in paediatric trauma patients. Cochrane Database Syst Rev. 2024 Date: May 29, 2024 Guest Skeptic: Dr. Caleb Ward is a pediatric emergency medicine attending and Associate Professor of Pediatrics and Emergency Medicine at Children’s National Hospital and The George Washington School of Medicine and Health Sciences in Washington, DC.

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Meet Joe: A Passionate Recruiter Connecting Nurses with Their Perfect Roles

Core Medical Group

Joe is a Senior Recruiter in the Permanent Placement Division at CoreMedical Group, with over 2.5 years of experience. Known for being personable and easy to talk to, Joe enjoys fishing, watching sports, and spending time with his son. Joe is dedicated to connecting nurses with their perfect placement!

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WHO Approves a Four-Year Plan for Global Health

Emergency Live

11.1 Billion Dollars to Tackle Global Health Challenges During the World Health Assembly in Geneva, delegates approved a four-year plan worth 11.1 billion dollars to improve global health. The plan, called the Fourteenth General Programme of Work (GPW14), will cover the period 2025-28 and focuses on six strategic objectives. Program Focus: Climate Change and Health […] The post WHO Approves a Four-Year Plan for Global Health appeared first on Emergency Live.

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ToxCard: Osmol Gap – Part 2

EMDocs

Authors: Travis Mok, MD (@tkcm01 on Threads, Emergency Medicine Resident, Rutgers New Jersey Medical School); Cynthia Santos, MD (Emergency Medicine Attending, Medical Toxicologist, Rutgers New Jersey Medical School) // Reviewed by: Anthony Spadaro, MD (@TSpadaro91, Medical Toxicology Fellow, Rutgers New Jersey Medical School, Newark, NJ); James Dazhe Cao, MD (@JamesCaoMD, Associate Professor of EM, Medical Toxicology, UT Southwestern Medical Center, Dallas, TX); Alex Koyfman, MD (@EMHighAK); Br

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What are “Adaptogens”?

Science Based Medicine

The multi-billion dollar “snake oil” industry is nothing if not good at marketing. This is probably because this is not one or even a small number of companies, but likely thousands of companies and millions of individuals crowdsourcing many different marketing strategies. Those that work tend to prosper and proliferate, spawning variations.

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Why should I take these medications?

Sensible Medicine

My one disappointment with Sensible Medicine, as we near the end of our second year, is that we don’t have more people writing from a patient perspective. I wrote one piece and Kristin Inciardi published a great one, but that is about it. Thus, I was thrilled to receive this one from John Horwitz. I am not sure what I should call it, a prose poem maybe?

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Tragedy in Uttar Pradesh: dozens die of heat-related deaths

Emergency Live

India, Devastating Heatwave: Dozens Dead During Elections On June 1st, the final day of voting in the general elections in India, the northern state of Uttar Pradesh became the stage for a tragic mix of democracy and tragedy. With soaring temperatures, 58 people lost their lives due to the heat, including 33 election personnel, showcasing […] The post Tragedy in Uttar Pradesh: dozens die of heat-related deaths appeared first on Emergency Live.

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CCR24 and CCR Down Under

Life in the Fast Lane

Chris Nickson CCR24 and CCR Down Under Don't miss out on the livestream for the upcoming CCR24 meeting. and registrations for CCR Down Under have opened!

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Collagen Supplementation: Hype and Hope

Science Based Medicine

Collagen is an expensive protein supplement - nothing more. The post Collagen Supplementation: Hype and Hope first appeared on Science-Based Medicine.

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H&R2025 – The Hospitalist & The Resuscitationist, Montreal, May 21-24, 2025. #HR25

Thinking Critical Care

A few words about it… HR2025 is about putting it all together. We’ve been talking about the venous side for a long time and it has been fantastic seeing how much it has taken off – at least in the #medtwitter #foamed community. There’s enough data out there to show a real clinical utility of consciously examining the venous compartment. This applies to any hospitalized patients, whether in the ED, the wards or the ICU, so that’s why this year, the H and the R will spend the first day

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Flooding in Germany: Victims and Damage

Emergency Live

Bavaria Underwater: Devastating Floods Over the weekend, southern Germany was hit by disastrous floods that caused extensive damage and loss of lives. Torrential hailstorms and heavy rains ravaged many communities, killing a firefighter in an accident and drowning two other individuals. Tragedy in Pfaffenhofen an der Ilm A 42-year-old firefighter lost his life in the […] The post Flooding in Germany: Victims and Damage appeared first on Emergency Live.

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Journal Feed Weekly Wrap-Up

EMDocs

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: What’s the Best Target in the Neck for US Guided Central Access Spoon Feed This was a network meta-analysis of 13 randomized controlled trials comparing 5 different central venous catheterization (CVC) approaches.

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Trust No One, Believe Nothing, Pre-Oxygenation is Key

EM Ottawa

Your patients need you to start rethinking what you know about pre-oxygenation. The peri-intubation period is a physiologically hazardous time; when we feel forced to act in critical situations, we often try to speed things up and cut corners. We hope to convince you, with an abundance of evidence, that taking the time to perfectly […] The post Trust No One, Believe Nothing, Pre-Oxygenation is Key appeared first on EMOttawa Blog.

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CICM Second Part Exam Practice SAQs 06062024

Intensive Blog

As prepared by Chris Nickson, here are the practice written questions from a recent CICM Second Part exam practice session at The Alfred ICU, with recommended reading from LITFL.com Critical Care Compendium and other FOAM sources: Q1. You are asked by an oncologist to talk to a competent patient with terminal cancer and pneumonia, who has a life expectancy of <3 months based on expert medical consensus opinion.

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Osimertinib: news for the treatment of lung cancer

Emergency Live

Effectiveness of Osimertinib in NSCLC Lung Cancer: A Revolutionary Study Results presented at the recent American Society of Clinical Oncology (ASCO) congress in Chicago have promised better prospects for patients with non-small cell lung cancer. According to the findings of the LAURA study, osimertinib reduces the risk of disease progression or death by 84% among […] The post Osimertinib: news for the treatment of lung cancer appeared first on Emergency Live.

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