Sat.Apr 15, 2023 - Fri.Apr 21, 2023

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ECG Blog #375 — At Least 3 Major Findings.

Ken Grauer, MD

The ECG in Figure-1 was obtained from a 50-year old man — who presented to the ED ( E mergency D epartment ) with new-onset CP ( C hest P ain ). QUESTIONS: There are at least 3 principal findings on this ECG — some of which deal with a possible “culprit” artery and / or the location of whatever is going on. How many of these findings can YOU identify?

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How Good is Ultrasound at Diagnosing PTA?

RebelEM

Background: The increased utility and accessibility of point-of-care ultrasound (POCUS) has allowed clinicians the freedom to rethink their diagnostic approach for many common diseases, including peritonsillar abscess (PTA). Clinical evaluation may prove difficult since many PTA and peritonsillar cellulitis symptoms overlap. Physical examination is approximately 75% sensitive and 50% specific for identifying PTA.

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PulmCrit wee- When guidelines disagree: neuroprognostication post cardiac arrest

EMCrit

Recently, two sets of guidelines for neuroprognostication following cardiac arrest were released – almost simultaneously. In a perfect world, two evidence-based guidelines based on the same evidence would be the same. But of course, this isn't actually the case. The guidelines differ significantly. The Neurocritical Care Society guidelines recommended this general approach:(36949360) Meanwhile, the Canadian […] EMCrit Project by Josh Farkas.

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Neonatal Resus for the Pre-Hospital Non-Neonatologist

Greater Sydney Area HEMS

It is a rare but confronting situation where a pre-hospital and retrieval medicine team are presented with a sick newborn. At one of our recent education days we heard Dr Mark Russell and Dr Mark Newcombe deliver excellent presentations of cases which they had been involved in, involving resuscitative hysterotomy and neonatal resuscitation respectively.

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Mechanical Power

Trigger Lab

La genesi o il peggioramento del VILI rappresenta il risultato indesiderato di una complessa interazione tra forze meccaniche che agiscono sulle strutture polmonari, dipendendo certamente dalle impostazioni del ventilatore, ma anche dalle caratteristiche dell’apparato respiratorio e dall’interazione paziente-ventilatore.

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AID-ICU

The Bottom Line

In patients in the ICU with delirium, does haloperidol compared with placebo, increase the number of days alive and out of the hospital at 90 days?

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50 year old with acute chest pain, with ‘normal’ ECG and falling troponin

Dr. Smith's ECG Blog

Written by Jesse McLaren, with comments from Smith A 50-year old patient on the medical wards developed acute chest pain, with an ECG labeled (see computer interpretation at the top) and confirmed as normal. What do you think? There’s normal sinus rhythm, normal conduction, normal axis, normal R wave progression, and normal voltages. Lead aVL jumps out as abnormal because there is a discordant T wave inversion and mild ST depression.

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More Trending

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Why Perinatal Psychiatry?

SheMD

Trying to figure out what kind of doctor you should become? Wondering which specialty you should choose? Then SheMD's Why Specialty Series is perfect for you! We're bringing you female physicians sharing WHY they chose their specialty. Today's post is on why Dr. Haynes chose perinatal psychiatry and why it is a great field. I found perinatal psychiatry almost by accident.

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Emergency Evidence Updates – March 2023

The Bottom Line

What’s new in the Critical Care literature – monthly updates

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A prophylactic treatment for hemophilia that you should know about

PEMBlog

A special thanks to Dr. Cristina Tarango, director of the Hemophilia Treatment Center at Cincinnati Children’s and Lisa Littner, Project Manager at Cincinnati Children’s who helped me research and write this post. …and it’s called Hemlibra (Emicizumab) Why this med is important and why kids are on it? Emicizumab (Hemlibra) was approved in 2018 for routine bleeding prophylaxis in hemophilia A with or without inhibitors.

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Education Day – Wed 26th Apr, 2023

Greater Sydney Area HEMS

Visit the post for more.

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Three “Fundamentals First” priorities that can differentiate a healthcare system

NRC Health

As technology-driven innovation becomes routine across the healthcare ecosystem, a human-focused approach can be a great differentiator. The post Three “Fundamentals First” priorities that can differentiate a healthcare system appeared first on NRC Health.

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CJEM Visual Abstract – Just the facts: POCUS assessment for deep vein thrombosis

Canadian EM

In this issue, we collaborated with the CJEM team to present “Just the facts: POCUS assessment for deep vein thrombosis”​1​ in a visual abstract format. Deep vein thrombosis is a diagnosis that can be notoriously difficult to risk stratify and diagnose in a timely manner in the ED. There are multiple contributing factors, including variability of presentation and the availability of timely ultrasound (the mainstay of diagnosis).

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Fearsome Foliage - An Overview of Toxic Plants

Taming the SRU

Spring has sprung. and so have many species of toxic plants! Poison centers across the United States receive over 100,000 reports of exposures to toxic plants annually. The most common reported effects of these exposures are skin irritation and gastrointestinal symptoms. The majority of ingestion cases occur in pediatric patients and are often minor due to low quantities of exposure.

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Antibiotics are not needed in uncomplicated diverticulitis

First 10 EM

In a lecture series entitled “Get off the fence”, in which I discuss practice changing evidence based medicine, I have discussed the role of antibiotics in diverticulitis multiple times this year. Although I have discussed the topic previously on First10EM, I wanted to provide a quick summary of the most important publications as a quick […] The post Antibiotics are not needed in uncomplicated diverticulitis appeared first on First10EM.

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Human Understanding Beyond | HUB23 Preview: Dr. Sarah Lazarus

NRC Health

At HUB23, you’ll find expanded, dynamic programming focused on bringing impact to your organization. The post Human Understanding Beyond | HUB23 Preview: Dr. Sarah Lazarus appeared first on NRC Health.

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Compare these two ECGs. Do either, neither, or both show anything important?

Dr. Smith's ECG Blog

One case sent by Dr. Sean Rees MD, written by Pendell Meyers, other case by Sam Ghali and Steve Smith Take a look at these two ECGs below from two patients in the ED, first without any clinical context. Full case details and outcomes are below. Case 1: Case 2: Case 1: What do you think? This was sent to Dr. Smith by SamGhali (@EM_RESUS) with zero other info.

EKG/ECG 52
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Asking Patients About Their Habits Should Be Part of the Medical History - Clinical Correlations

Clinical Correlations

By Mercedes Fissore-O’Leary Peer Reviewed I. It is his youngest’s birthday today. His oldest is in the military, like he was. Except he served in the navy, in Vietnam. He has a birthday.

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Overview of the AHA Essential 8 for Heart Health

AED Leader

The American Heart Association’s Essential 8™ provides an excellent checklist for improving cardiovascular health and reducing the principal risk factors for cardiovascular disease, heart attack, cardiac arrest, and stroke. Originally developed in 2010 as “Life’s Simple 7,” the American Heart Association’s construct has been updated to “Life’s Essential 8.” The updated construct includes sleep guidelines Read More "Overview of the AHA Essential 8 f

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SAEM Clinical Images Series: My Eye Looks Different

ALiEM

A 29 year-old-male with a past medical history of left eye enucleation secondary to a gunshot wound several years prior presents to the Emergency Department (ED) for blurry vision, redness, and concern for a deformity to his right eye. The patient states symptoms started 2-3 months ago and he initially thought symptoms were due to allergies and recalls rubbing his eye a lot.

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SheMD Journal Club: Gender Bias in Resident Assessment in Graduate Medical Education

SheMD

Here at sheMD, we believe in the importance of practicing Evidence-Based Medicine. We believe the same principles apply to discussing Gender and Medical Education. Therefore, we are bringing you an entire Journal Club series! Our series will focus on foundational and new literature within the gender and medicine space. This post contains affiliate links.

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Imaging Case of the Week 547 Answer

EMergucate

Deep Sulcus Sign. There is a supine pneumothorax on the right as evidenced by a deep sulcus sign.

EMS 52
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172. Altitude sickness: Mountains and Viagra

Board Bombs

Mountains and Viagra. We promise they’re related here (no puns). Are you wearing your Patagonia? Good we thought so. Vest or jacket is acceptable by us. We’re covering a classic board question on EM tests. If you have any interest in wilderness medicine, here’s your chance to shine. Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here: emrapidbombs.supercast.com Mountains and Viagra.

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Ketamine ICP Safety | Bougie First

JournalFeed

The JournalFeed podcast for the week of April 10-14, 2023. These are summaries from just 2 of the 5 article we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member. Ketamine ICP Safety Spoon Feed This retrospective study of thirty-three pediatric patients with severe traumatic brain injury (sTBI) demonstrated no increase in intracranial pressure (ICP) after administration of ketamine.

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Ketamine vs opiates for pediatric pain management

University of Maryland Department of Emergency Med

Multiple modalities are available for pain control in the pediatric setting. Ketamine has recently been introduced into the prehosp.

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Imaging Case of the Week 548 Answer

EMergucate

The knee x-ray shows a small curvilinear bony avulsion adjacent to the lateral tibial plateau implying a Segond fracture.

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Critical Care Evidence Updates – March 2023

The Bottom Line

What’s new in the Critical Care literature – monthly updates

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How is Osgood-Schlatter Apophysitis Treated?

Pediatric Education

Patient Presentation A 14-year-old female came to clinic with a history of bilateral knee pain. She noticed more pain when she was playing late winter volleyball and had added 3 times/week indoor soccer practice to get ready for the spring high school season. The pain was symmetric and would worsen during the practices and improve after stopping practice and with ice.

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Association of an Emergency Critical Care Program With Survival and Early Downgrade Among Critically Ill Medical Patients in the Emergency Department

University of Maryland Department of Emergency Med

CCM recently published Stanford's experience with their Emergency Critical Care Program (ECCP), an ED based intensivist consultation/management mo.

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Imaging Case of the Week 549

EMergucate

The neck x-rays are from a 6-year-old with neck pain, difficulty swallowing following a recent bout of upper respiratory tract … Continue reading →

EMS 52
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Forkhead box O3 protein (FOXO3) genes and longevity

CasesBlog

Approximately 25–32% of the overall variation in adult lifespan is accounted for by genetic differences that become particularly important for survival after the age of 60. Forkhead box O3 protein (FOXO3) is a transcription factor involved in the regulation of genes involved in many cellular processes, including DNA repair, tumor suppression, immune function, and resistance to oxidative stress.

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SGEM#400: A little Bit of Heart and Sports Related Sudden Cardiac Arrest in Women

The Skeptics' Guide to EM

Date: April 12, 2023 Reference: Weizmann et al. Incidence of Cardiac Arrest During Sports Among Women in the European Union. JACC November 2022 Guest Skeptic: Dr. Susanne (Susy) DeMeester is an Emergency Physician practicing at St Charles Medical Center in Bend, Oregon. She has been very involved with EMRAP’s CorePendium as the cardiovascular section editor.