The Skeptics' Guide to EM

DECEMBER 21, 2024

Date: December 15, 2024 Guest Skeptics: Dr. Chris Carpenter, Vice Chair of Emergency Medicine at Mayo Clinic. Today, were sleighing through the holiday season with a special episode filled with statistical cheer, a dash of skepticism, and a hint of eggnog-flavoured nerdiness. This is an SGEM Xtra like the one we did on What I Learned from Top Gun. Its fun to mix it up and not do a structured critical appraisal of a recent publication and have a more philosophical chat.

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Outcomes Research Ultrasounds 97

RebelEM

DECEMBER 23, 2024

Background: Sickle cell disease (SCD) affects an estimated 300,000 infants born worldwide each year and has a total estimated prevalence of 100,000 in the United States alone ( Piel 2017 ). Within this population, over 90% of healthcare encounters are due to painful vaso-occlusive episodes (VOE) ( Kidwell 2021 ). VOE is often complicated by hypovolemia, making fluid administration a common intervention ( Lovett 2017 ).

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Fluid Resuscitation Resuscitation Documentation/Coding Outcomes 122

Science Based Medicine

DECEMBER 27, 2024

The time to start speaking out to defend vaccines from RFK Jr. is now. The post Dr. Marty Makary, What Are You Going To Do If RFK Jr. Demands That Revoke Approval For Vaccines? first appeared on Science-Based Medicine.

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St. Emlyn

DECEMBER 23, 2024

St.Emlyn's - Emergency Medicine #FOAMed David Purkarthofer reviews the highlights from the fantastic EuSEM conference held in Copenhagen earlier this year. #FOAMed @stemlyns The post EuSEM 2024 in review appeared first on St.Emlyn's.

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EMCrit

DECEMBER 27, 2024

All things stabilizing tamponade and performing pericardiocentesis EMCrit Project by Scott Weingart, MD FCCM.

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Northwestern EM Blog

DECEMBER 23, 2024

Written by: Chezlyn Patton, MD, (NUEM 27) Edited by: David Adler, MD (NUEM 25) Expert Commentary by : Melissa Marinelli, MD Expert Commentary Doctors in the ER are under intense time pressure to see many patients quickly and make hundreds of decisions over the course of a single shift. This actually fosters a natural honing of communication skills, because rapport must be developed quickly with anyone who walks through the door.

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Science Based Medicine

DECEMBER 22, 2024

If pro-RFK Jr. propaganda wins the day, I am confident we will soon find out a tough truth- MAHA is all about RFK and has everything to do with vaccines. The post Dr. Joseph Marine: MAHA is More Than RFK and Has Little to do With Vaccines first appeared on Science-Based Medicine.

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EMDocs

DECEMBER 23, 2024

Authors: Molly Rinkevich, PharmD, PGY2 EM Pharm Resident (Geisinger Wyoming Valley, Wilkes Barre, PA); Howard Rainey, DO (Geisinger Medical Center, Danville, PA); Drew Schmucker, PharmD (Geisinger Wyoming Valley, Wilkes Barre, PA); Lloyd Tannenbaum, MD (APD, Geisinger Wyoming Valley, Wilkes Barre, PA) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case: Its 3 am on a busy shift and EMS rolls in with a 67-year-old male coming in from home with a history of ischemic card

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EKG/ECG Wellness Shock EMS 63

EMCrit

DECEMBER 23, 2024

All the literature goodness for December 2024 EMCrit Project by Scott Weingart, MD FCCM.

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Mind The Bleep

DECEMBER 27, 2024

Im currently in my third year of working in a rural district general hospital Accident and Emergency Department, and one of the things that has struck me most is the use of pre-hospital medicine. Being in an area where it can take an hour and a half to get to the us, as the nearest trauma unit, really puts into perspective the need to have people trained to a level where they can provide immediate aid to people within the Golden Hour.

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Hospitals Ambulance Services Operations Teamwork 52

St. Emlyn

DECEMBER 27, 2024

St.Emlyn's - Emergency Medicine #FOAMed Intraosseous (IO) access is essential in prehospital emergency care when intravenous access is challenging. A Danish retrospective cohort study of over 5,000 patients found fewer than five cases of osteomyelitis, no osteonecrosis or compartment syndrome, and no complications in children. Despite a high mortality rate (60% at 180 days) potentially underestimating long-term risks, the study's robust design supports IO access as a generally safe and effe

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JournalFeed

DECEMBER 21, 2024

The JournalFeed podcast for the week of Dec 16-20, 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 article breaks down patient selection, setup, special considerations, and step-by step instructions to manage awake intubations, a rarely utilized but essential technique in emergency airway management.

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Airway Management 52

PulmCCM

DECEMBER 27, 2024

"Covert consciousness," hyperglycemia guideline update, reviews on midodrine, antipsychotics, steroids, delirium, more

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Mind The Bleep

DECEMBER 23, 2024

Introduction Thyroid Eye Disease (TED) is an autoimmune disease characterised by extraocular muscle swelling and orbital fat expansion 1. It affects approximately 50,000 people in the UK, most commonly occurring in those diagnosed with Graves disease, although a minority of cases do affect euthyroid or hypothyroid patients 1,2. Symptoms may include lid retraction , proptosis , watery eyes and double vision 3.

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St. Emlyn

DECEMBER 26, 2024

St.Emlyn's - Emergency Medicine #FOAMed Does early exercise after blunt chest trauma make a difference? Find out when we review the ELECT trial. #FOAMed @stemlyns The post EarLy Exercise in blunt Chest wall Trauma: A multi-centre, parallel randomised controlled trial (ELECT2 Trial) appeared first on St.Emlyn's.

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EMergucate

DECEMBER 22, 2024

The following knee x-rays are from an adult who has knee pain & swelling after a twisting injury to the … Continue reading →

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EMS 52

ECG Guru

DECEMBER 21, 2024

This strip shows normal sinus rhythm at a rate of 95 bpm. The isoelectric line shows the effects of the patient's breathing. Placing the limb electrodes on the limbs rather than on the chest will eliminate this artifact.

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EKG/ECG 52

Emergency Medicine Cases

DECEMBER 23, 2024

In this Global EM post we provide examples of Global EM partnerships and tools for developing these partnerships to foster global solidarity in improving emergency medicine as a specialty and help EM societies not only strengthen their systems but also enhance global health outcomes. The post Global EM 7 Global Emergency Medicine Partnerships appeared first on Emergency Medicine Cases.

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EMS Outcomes 52

St. Emlyn

DECEMBER 23, 2024

St.Emlyn's - Emergency Medicine #FOAMed Day 1 review from the London Conference 2024 with Zaf Qasim. Also check out our podcasts from the same conference on our podcast channel. #FOAMed The post Talking trauma – London Trauma Conference Day 1 appeared first on St.Emlyn's.

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Board Bombs

DECEMBER 22, 2024

Ho ho hold still! Lets talk about the 3 major complications that can happen with procedural sedation in the ED. All is Calm, Until Its Not. 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. 244. Sleigh the Complications: Sedation pitfalls.

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Pediatric Education

DECEMBER 22, 2024

PediatricEducation.org is taking a holiday break and will return on January 6, 2025. We appreciate your continued patronage and wish everyone a happy and safe holiday season and all the best in the New Year. In the meantime, please take a look at the different Archives and Curriculum Maps listed at the top of the page. Happy Holidays, Donna DAlessandro and Michael DAlessandro, curators.

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PEMBlog

DECEMBER 23, 2024

The Emergency Department never closes – not even on Christmas Day. This song reminds us all that the ED is always open, and that we are there for our patients during the holidays. But we still miss our families… Lyrics When Ive got to work on Christmas Ill tell you what Ill do I will treat all sorts of problems Cough and cold and strep and flu Ill unwrap a diagnosis With a test or three I will splint a buckle fracture like I trim a tree If your child is sick on Christmas We will neve

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Fractures Emergency Department 52

St. Emlyn

DECEMBER 27, 2024

St.Emlyn's - Emergency Medicine #FOAMed Intraosseous (IO) access is essential in prehospital emergency care when intravenous access is challenging. This Danish retrospective cohort study supports IO access as a generally safe and effective procedure in critical care situations. The post What’s the long term complication rate of intraosseous access?

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Broome Docs

DECEMBER 22, 2024

Welcome back to the pre-Xmas edition of the Broomedocs & First10EM Journal club. This month we cover a few out-of-hospital arrest trials. More PECARN goodness and we answer the question: are ants better doctors than human doctors? There is a bunch more – so have a listen or watch us on Youtube feed below. You can read all the papers on the links in the show notes right here.

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Blood Transfusions Hospitals Outcomes Emergency Department 52

Ken Grauer, MD

DECEMBER 21, 2024

I was sent the ECG shown in Figure-1 initially without the benefit of any history? How would you interpret this tracing? What is YOUR differential diagnosis of this tracing? Figure-1: The initial ECG in today's case. ( To improve visualization I've digitized the original ECG using PMcardio ). == The Obvious Concern: I immediately realized the reason that I was sent this tracing: ==> there is ST elevation in the anterior chest leads!

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EKG/ECG Wellness 245

The Trauma Pro

DECEMBER 24, 2024

In the previous post, I reviewed some basic information on DOAC reversal. Five years ago, it was costly and questionably effective. So what has happened in the meantime? In this post, I’ll review a big trial the pharma company was excited about and make a few comments. ANNEXA-I Study This study sought to evaluate the hemostatic effect of Andexanet administration in patients taking a Factor Xa inhibitor who suffered an intracranial hemorrhage.

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Stroke Administration Outcomes 203

Dr. Smith's ECG Blog

DECEMBER 27, 2024

Submitted anonymously, written by Willy Frick A man in his 70s with a history of remote MI (details unavailable) and prior stent placement presented to cardiology clinic for routine follow up. He complained of days to weeks of palpitations and dyspnea. His clinic ECG is shown. What do you think? In an elderly patient complaining of palpitations, we have an ECG with heart rate 140 bpm.

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EKG/ECG Hospitals Sepsis Documentation/Coding 122

Sensible Medicine

DECEMBER 25, 2024

Recently, at the American Society of Hematology and concurrently published in the New England Journal was a randomized controlled trial of treating smoldering myeloma. The investigators congratulated themselves and said there's a new standard of care. But the reality is the trial has fatal flaws, and reflects the failures of our field. Smoldering myeloma is an interesting disease.

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Academics Research Wellness 109

First 10 EM

DECEMBER 23, 2024

Another month, another set of articles. Perhaps some are useful. Perhaps some will guide your practice. At least one should completely blow your mind. More research was needed Taccone FS, Rynkowski Bittencourt C, Mller K, Lormans P, Quintana-Daz M, Caricato A, Cardoso Ferreira MA, Badenes R, Kurtz P, Sndergaard CB, Colpaert K, Petterson L, Quintard […] The post The December 2024 Research Roundup appeared first on First10EM.

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Research EMS 102

EMDocs

DECEMBER 21, 2024

We always work hard, but we may not have time to read through a bunch of journals. Its 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: Early Shock Better VF Outcomes in OHCA Spoon Feed For every minute of delay to shock in ventricular fibrillation (VF) arrest, the proportion of successful first shocks decreases by 6%.

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Shock Outcomes Hospitals 77

Dr. Smith's ECG Blog

DECEMBER 23, 2024

Written by Willy Frick A woman in her 70s is hospitalized with undifferentiated shock after being found down at home. Her family had not heard from her and called EMS. Paramedics found her bradycardic, hypotensive, and tachypneic. She was resuscitated and admitted to ICU for presumed sepsis. Several days into hospitalization, she continued to have occasional episodes of sinus rhythm and sinus bradycardia with periods of Mobitz I AV block and 2:1 block.

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EKG/ECG Shock Ultrasounds Sepsis 115

Sensible Medicine

DECEMBER 23, 2024

When you read the PLATO trial in the NEJM , nothing seems awry. It was a comparison of ticagrelor vs clopidogrel as the second antiplatelet drug (added to aspirin) in more than 18,000 patients who were having an acute coronary syndrome (most often an MI). The primary endpoint of CV death, MI or stroke occurred in 9.8% in the ticagrelor arm vs 11.7% of those on clopidogrel.

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Stroke Documentation/Coding Research Wellness 103

Emergency Medicine Cases

DECEMBER 23, 2024

Which elements of your current pre-shift preparation contribute most to your mental clarity and performance, and what new practices might further optimize your readiness? With interruptions shown to increase task errors and decision fatigue, how can you strike a balance between being approachable to colleagues and safeguarding your focus for patient care?

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Resuscitation EMS 65

Mind The Bleep

DECEMBER 22, 2024

With IMT interviews fast approaching, we have partnered with Optimise Interviews to publish free resources for anyone who has interviews upcoming! They have provided the below video and article for Mind the Bleep users. This resource contains top tips for the IMT clinical station, delivered by past Dr Balrik Kailey – Cardiology ST6 and Cardiology Lead at Optimise Interviews.

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Documentation/Coding EKG/ECG Wellness 59

Dr. Smith's ECG Blog

DECEMBER 22, 2024

Written by Willy Frick A man in his early 40s with BMI 36, hypertension, and a 30 pack-year smoking history presented with three days of chest pain. It started while he was at rest after finishing a workout. He described it as a mild intensity, nagging pain on the right side of his chest with nausea and dyspnea. It woke him the next day and radiated into his back.

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Urgent Care EKG/ECG Wellness 69

Sensible Medicine

DECEMBER 26, 2024

Last Friday, I received two emails: One was from MedPageToday promoting an article titled Public Health Experts Decry Louisiana's Ban on Vaccine Promotion. The second was from medical center leadership alerting staff that masks are now, again, required for all patient care interactions. Sensible Medicine is a reader-supported publication. If you appreciate our work, and want to receive and comment on all posts, consider becoming a free or paid subscriber.

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Leadership 83

PulmCCM

DECEMBER 23, 2024

Severe acute hypoxemic respiratory failure (AHRF) is today treated with high-flow nasal cannula oxygen or noninvasive ventilation, in an attempt to forestall the need for intubation and mechanical ventilation. It’s uncertain which method of respiratory support is superior, or in which situations. AHRF can result from many different illnesses: viral or bacterial pneumonia, cardiogenic or noncardiogenic pulmonary edema, exacerbations of chronic lung disease, and more.

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Outcomes Hospitals 52