Ken Grauer, MD
FEBRUARY 23, 2024
The ECG in Figure-1 was obtained from a previously healthy man in his 40s — who presented to the ED ( E mergency D epartment ) with new-onset CP ( C hest P ain ) that awakened him from sleep. ECG #1 was recorded ~90 minutes after the patient was awakened from sleep. He was still having CP. QUESTIONS: In view of this history — How would YOU interpret the ECG in Figure-1 ?
The Trauma Pro
FEBRUARY 20, 2024
Let’s look at an uncommon scenario that crops up from time to time. Most seasoned trauma professionals have seen this one a time or two: An elderly male is driving on a sunny afternoon, and crashes his car into a highway divider at 25 miles per hour. EMS responds and notes that he has a few facial lacerations, is awake but confused. They note some possible facial asymmetry and perhaps a bit of upper extremity weakness.
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Dr. Smith's ECG Blog
FEBRUARY 22, 2024
Written by Pendell Meyers A woman in her 30s called EMS for acute symptoms including near-syncope, nausea, diaphoresis, and abdominal pain. EMS arrived and found her to appear altered, critically ill, and hypotensive. An ECG was performed: What do you think? Extremely wide complex monomorphic rhythm just over 100 bpm. The QRS is so wide and sinusoidal that the only real possibilities left are hyperkalemia or Na channel blockade.
Sensible Medicine
FEBRUARY 22, 2024
Last week I wrote about Grail’s Galleri test; a test marketed as a single blood test that screens for 50 cancers. Last week’s article outlined my pretty dim view of the test. I referenced a Wall Street Journal Opinion piece, Who’s Afraid of Early Cancer Detection? One answer to the question posed by the WSJ piece is: me. Sensible Medicine is a reader-supported publication.
RebelEM
FEBRUARY 19, 2024
Background: Use of vasopressors is a common practice to support hemodynamics and optimization of tissue perfusion in patients presenting with shock. Historically the administration of vasopressors was restricted to central venous catheters (CVC) due to concerns for local tissue injury resulting from vasoconstriction if extravasation occurred from a peripheral IV.
The Trauma Pro
FEBRUARY 23, 2024
Kids are frequent flyers when it comes to abdominal injury, with about 15% of their injuries involving this anatomic area. Solid organ injuries, mainly the liver and spleen, are the most prevalent ones. The American Pediatric Surgical Association (APSA) published a practice guideline way back in 2000 that outlined a consistent way to care for children with solid organ injuries.
Dr. Smith's ECG Blog
FEBRUARY 20, 2024
A 20-something type, 1 diabetic presented by EMS with altered mental status. Blood pressure was 117/80, pulse 161, Resp 45, SpO2 100 on oxygen. Here is the 12-lead ECG: Wide complex tachycardia What do you think? The providers thought that this wide QRS was purely due to (severe) hyperkalemia. They treated with 4 ampules (200 mL) of bicarb and 1 gram of calcium gluconate.
Emergency Care Today brings together the best content for emergency care practitioners from the widest variety of industry thought leaders.
First 10 EM
FEBRUARY 19, 2024
Nail bed injuries aren’t quite common enough to cause the same debates as TXA, or IV antibiotics, or tPa, but talk to 10 different emergency doctors and you are likely to get 10 different opinions about the management of these injuries. Therefore, even though the NINJA study doesn’t answer the most important question (in my […] The post The NINJA trial: Do you replace the fingernail after nail bed repair?
Sensible Medicine
FEBRUARY 20, 2024
SPRINT is a large randomized trial that has changed practice and led many providers to lower blood pressure beyond prior targets. Here is the conclusion of the paper: But is this trial reliable? I always say that a clinical trial can only change your practice if the control arm is your practice. SPRINT messed this up. The trial didn’t just target less than 140 in the control arm — it did something beyond this.
Broome Docs
FEBRUARY 22, 2024
Welcome to the first episode for 2024 – and we have a range of papers covering the big life threatening issues to the tiniest pinky finger injuries and a lot in between. There is something for everyone in here! We try to answer a few questions that you may have not even pondered such as: should all Psych patinets get an MRI? Should you replace fingernails on crushed digits?
Science Based Medicine
FEBRUARY 23, 2024
The authors of the GBD advised and influenced many politicians at the highest level. They claim to have delineated many practical policies to protect the vulnerable, and they said it would’ve been possible, certainly. So an obvious question emerges. Why didn’t they protect the vulnerable? The post The Great Barrington Declaration Wasn’t a Plan For Public Health Officials.
Emergency Live
FEBRUARY 23, 2024
How Artificial Intelligence is Transforming Operating Rooms The integration of artificial intelligence (AI) in surgery is marking the beginning of a revolution in the medical field, promising to enhance the precision, safety, and efficiency of surgical procedures. AI, through machine learning and extensive data analysis, is developing robust predictive algorithms that assist surgeons in pre-operative […] The post The cutting edge of surgery: the integration of AI appeared first on Emergenc
Sensible Medicine
FEBRUARY 21, 2024
This is the second guest post from Dr. Bienen—a veterinarian whose research focuses on zoonotic disease and associated policies. She recently left the OHSU-Portland State University School of Public Health in Portland, Oregon to work in her biomedical editing and writing business, C3 Science. I learned a lot from this discussion. JMM Many discussions about the importance of breastfeeding suffer from 1) overlooking the most interesting and rigorous research on breast milk and breastfeeding
Greater Sydney Area HEMS
FEBRUARY 20, 2024
Obtaining access in shocked trauma patients can be notoriously difficult due to circulatory collapse. Those who are shocked, shut down with limited or no other options for peripheral access require central access. The cohort of patients that require this intervention in the pre-hospital setting are likely to be the most critically unwell patients we encounter.
Trigger Lab
FEBRUARY 17, 2024
A cura di Enrico Bulleri Nei pazienti affetti da insufficienza respiratoria, il drive e lo sforzo respiratorio risultano spesso elevati. Le cause possono includere fattori quali dolore, ansia, delirio, inadeguata assistenza ventilatoria e dispnea [1,2].
Emergency Live
FEBRUARY 22, 2024
A 14-year-old boy becomes a hero after saving a man from a heart attack thanks to acquired skills In an increasingly aware society of the importance of preparation in emergency situations, the story of a young boy who saved the life of a 65-year-old man suffering from a heart attack highlights the essentiality of first […] The post When TV saves lives: a teenager's lesson appeared first on Emergency Live.
Dr. Smith's ECG Blog
FEBRUARY 18, 2024
Written by Willy Frick A woman in her 90s with a history of end stage renal disease and complete heart block status post dual chamber pacemaker presented from home with acute onset dyspnea. ECG is shown below. What do you think? The ST and T wave abnormalities jump off the page, but let's set that aside just for a moment to review the tracing systematically.
Science Based Medicine
FEBRUARY 19, 2024
Over the weekend, NBC News aired a story on whole body MRI scans. Although it did include the usual cautions about false positives and the harm they cause, the caution was diluted by the story's focus a rare case of a woman who had a brain tumor detected. Overall, it was false balance that reminded me of vaccine/autism stories 20 years ago. The post False balance in an NBC news story on whole body MRI scans first appeared on Science-Based Medicine.
Life in the Fast Lane
FEBRUARY 21, 2024
Sheralyn Guilleminot and Franz Wiesbauer Making a medical podcast using AI AI can work for Spotify's music DJ, so we wondered if it can also work for a cardiology podcast intended for clinicians. Here are the pros and cons we discovered.
Emergency Live
FEBRUARY 22, 2024
An analysis of the latest data and impacts on public health from pollution The latest images provided by the Copernicus satellite network leave little room for interpretation: the Po Valley, a productive hub and the beating heart of the Italian economy, is among the most polluted regions in the world. Exceedances of fine particulate matter […] The post The fog that kills: smog in the Po Valley appeared first on Emergency Live.
EM Ottawa
FEBRUARY 22, 2024
Lacerations are a common presenting complaint to emergency department. In 2013, in the United States there were 7 million visits to the emergency department (ED) for lacerations making up a total of 5.2% of ED visits(1). Let’s review some of the evidence (or lack thereof) surrounding laceration repair so that we can be better at […] The post Lacerations: The secrets they don’t want you to know appeared first on EMOttawa Blog.
American Medical Compliance
FEBRUARY 17, 2024
Ensuring the safety and well-being of both patients and staff is paramount. With the Occupational Safety and Health Administration (OSHA) setting standards to protect workers from occupational hazards, healthcare organizations face unique challenges in maintaining compliance due to the complexity of their operations and the diverse array of risks inherent in patient care.
EMDocs
FEBRUARY 20, 2024
Welcome to the emDOCs Videocast – please subscribe to our YouTube channel. These videos will cover post summaries, take homes on clinical condition, and EBM/guideline literature updates. Today we look at the WATERFALL trial and hypertriglyceridemic pancreatitis. The post emDOCs Videocast: EBM Update – Pancreatitis appeared first on emDOCs.net - Emergency Medicine Education.
Emergency Live
FEBRUARY 23, 2024
From Alzheimer’s to ALS, an analysis of diseases for which research is still seeking answers The landscape of incurable diseases presents a picture as varied as it is challenging for patients, their families, and the global medical community. While medical science has made giant strides in early diagnosis and symptomatic treatment of many conditions, some […] The post Diseases with no way out: a journey through the deadliest conditions appeared first on Emergency Live.
Taming the SRU
FEBRUARY 22, 2024
M&M - Arterial Lines - Fat Embolism Syndrome - CPC Morbidity & Mortality WITH Dr. Finney Case 1: MVC AMA, especially in pediatrics, is a high-risk disposition that requires thorough discussion and documentation Approach pediatric blunt abdominal trauma with a thorough physical exam and consider decision making tools when applicable Case 2 & 3: Found down and Hypoglycemia Renal replacement therapy & bicarb drips can be useful in management of severe metabolic acidosis in the setti
Science Based Medicine
FEBRUARY 18, 2024
We shouldn't "give a s**t" about COVID. Instead, we should care deeply about strangers who still "give a s**t" about COVID. They need to be publicly mocked and shamed over and over again. The post Science Based Satire: Sure, COVID Is Killing 1,500 Americans Per Week, But I Saw a Stranger Wearing a Mask…OUTSIDE! first appeared on Science-Based Medicine.
EMDocs
FEBRUARY 20, 2024
Welcome to the emDOCs Videocast – please subscribe to our YouTube channel. These videos will cover post summaries, take homes on clinical condition, and EBM/guideline literature updates. Today we focus on pancreatitis. Fluids in Pancreatitis #1 : de-Madaria E, Buxbaum JL, Maisonneuve P, et al; ERICA Consortium. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis.
Emergency Live
FEBRUARY 21, 2024
Detailed analysis of interventions in case of accidents on Italian highways Highway accidents represent one of the main challenges for road safety in Italy, requiring an effective and coordinated emergency response. This article explores the complex intervention system activated in case of highway accidents, outlining the roles of the main actors involved and the procedures […] The post Dynamics and protocols of highway rescue in Italy appeared first on Emergency Live.
Emergency Medicine Journal
FEBRUARY 20, 2024
Background Andexanet alfa was approved in 2018 for reversal of direct oral anticoagulants but due to issues of cost and access, four-factor prothrombin complex concentrate (4F-PCC) continues to be used for this indication. The objective of this study is to evaluate outcomes of reversal with these agents in patients with isolated traumatic brain injuries (TBI).
Science Based Medicine
FEBRUARY 19, 2024
This is going to be a mostly reference free blog entry. Mostly a rambling opinion about my biases and opinions about science. And you know what they say about opinions. I seem to fret an inordinate amount about adjectives. So often they do not belong in front the nouns found here at the blog. I remain a touch annoyed at the need […] The post More Unneeded Adjectives first appeared on Science-Based Medicine.
EMDocs
FEBRUARY 22, 2024
Authors: Katey DG Osborne, MD (EM Attending Physician: Tacoma, WA) and Rachel Bridwell, MD (EM Attending Physician: Tacoma, WA) // Reviewed by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital); Brit Long, MD (@long_brit, EM Attending Physician, San Antonio, TX) Welcome to emDOCs revamp! This series provides evidence-based updates to previous posts so you can stay current with what you need to know.
Emergency Live
FEBRUARY 23, 2024
Let’s explore the crucial role of emergency call operators in coordinating rescue efforts In a world where every second counts in emergency situations, the operators who answer rescue calls play a fundamental, often underestimated role in the emergency response system. They are the first line of contact between the public and emergency services, acting as […] The post Calm voice in the storm: the invisible heroes of emergencies appeared first on Emergency Live.
Taming the SRU
FEBRUARY 23, 2024
Clinical pathologic case presentation - r1 diagnostics/therapeutics: Lumbar punctures - AIRWAY GROUND ROUNDS- r4 capstone - r3 taming the sru - ultrasound grand rounds Clinical pathologic case presentation WITH Drs. Rodriguez and benoit Syncope accounts of 3-4% of pediatric visits to the ED Seizures, drug/alcohol intoxication, and breath holding spells are common mimics Neurocardiogenic syncope (aka vagal event) is the most common cause of syncope in otherwise healthy children Yet, cardiac arrhy
ALiEM
FEBRUARY 20, 2024
What agent would most likely be responsible for these ECG findings? Cyclobenzaprine Digoxin Flecainide Sotalol Reveal the Answer 3. Flecainide Background [1-3] Flecainide is a class IC antiarrhythmic that binds to the voltage-gated sodium channel of the myocardium, slowing depolarization and prolonging phase 0 of the action potential. In toxicity, bradydysrhythmias, AV nodal blockade, ventricular tachycardia, and rate-dependent QRS widening occur.
PEMBlog
FEBRUARY 22, 2024
Newborn infants need intramuscular injections of Vitamin K in order to produce critical clotting factors. If they don’t get it they can have potentially life threatening bleeding. This is a podcast episode that reviews Vitamin K Deficient Bleeding AKA Hemorrhagic disease of the newborn. @PEMTweets on… sigh “X” (Twitter) My Instagram My Mastodon account @bradsobo Listen [link] Subscribe References American Academy of Pediatrics, Committee on Fetus and Newborn.
Emergency Live
FEBRUARY 18, 2024
The Role of AFP in Modern Medicine Alpha-fetoprotein (AFP) is more than just a protein; it serves as a sentinel in the early diagnosis and monitoring of significant medical conditions. Primarily produced by the yolk sac and fetal liver during embryonic development, this plasma protein takes on the role of the fetal analog of serum […] The post AFP: a marker in early diagnosis appeared first on Emergency Live.
The Bottom Line
FEBRUARY 23, 2024
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