Ken Grauer, MD

AUGUST 18, 2023

This patient was seen in the office — and during his exam, was found to have an “irregular heart beat”. He was not symptomatic with the ECG shown in Figure-1. How would YOU interpret this ECG? As the primary care clinician — What would YOU do? Extra Credit ( which is a HINT to the Answer! ): How many beats are recorded on the ECG in Figure-1 ? Figure-1: The initial ECG in today’s case. ( To improve visualization — I've digitized the original ECG using PMcardio ).

EKG/ECG 195

EKG/ECG Dehydration Wellness 195

Pediatric EM Morsels

AUGUST 18, 2023

When you read the Morsel on Perichonditis of the ear last week ( or perhaps the Plantar Puncture Morsel from many many many weeks ago ) you may have objected because of the mention that, when indicated, fluroquinolones are safe in children. Some of you may have thought to yourself “first the AAP allows tetracycline ( Rocky Mountain Spotted Fever ) and now they allow fluoroquinolones use in children… what next?!

Pediatrics 130

Pediatrics Infectious Diseases Seizures Hospitals 130

The Trauma Pro

AUGUST 15, 2023

My series on the massive transfusion protocol (MTP) continues! Today, I’ll provide some tips on the logistics of your MTP. MTP logistics include details such as who will be delivering the blood, what actually goes in each cooler, what ratios should be used, limitations imposed by the use of frozen plasma, and documentation. I’ll discuss details about ratios and FFP in the next Trauma MedEd newsletter.

Documentation/Coding 130

Documentation/Coding Best Practices Resuscitation Administration 130

Mount Sinai EM

AUGUST 13, 2023

Background Hip fractures are a very frequent presentation, even in non trauma centers. Usually affects senior patients with comorbidities, and it’s associated with high morbidity and mortality. Adequate pain control, and early surgical treatment and mobilization are the main goals of hip fracture treatment; to reduce complications including infections, DVT and delirium.

Fractures 100

Fractures Dislocations Operations Ultrasounds 100

EM Ottawa

AUGUST 17, 2023

Drug rashes are fairly common, but like much of dermatology, diagnostic clarification can be hard to achieve. Here, we present a standardized approach to drug rashes in the Emergency Department. Differential Diagnosis Clinical Approach Assessment History Distribution and progression, recent exposures, new meds Physical Exam Dangerous features: abnormal vital signs; […] The post Drug Rashes appeared first on EMOttawa Blog.

Emergency Department 98

Emergency Department Allergic Reactions 98

Emergency Live

AUGUST 18, 2023

Let's talk about cardiac arrhythmia. The heart is a muscle whose basic task is to circulate blood throughout the body The post Cardiac arrhythmia: causes, symptoms, diagnosis and treatment appeared first on Emergency Live.

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The Trauma Pro

AUGUST 18, 2023

Let’s continue with my series on the massive transfusion protocol (MTP). I’ll continue today with information on deactivating and analyzing your MTP. Deactivation. There are two components to this: recognizing that high volume blood products are no longer needed, and communicating this with the blood bank. As bleeding comes under surgical control, and CBC and clotting parameters (and maybe TEG/ROTEM) normalize, the pace of transfusion slows, and ultimately stops.

Administration 100

Administration Operations Hospitals Wellness 100

RebelEM

AUGUST 14, 2023

Background: Could Xuebijing (XBJ) catalyze a paradigm shift in sepsis management? XBJ is an herbal compound used in China to manage various inflammatory and infectious processes in recent years, including sepsis. 2-6 It is an herbal preparation comprising a blend of five herbs: Carthami Flos, Paeoniae Radix Rubra, Angelicae Sinensis Radix, and Salviae Miltiorrhizae. 2,5,6 Professor Jinda Wang developed it based on traditional Chinese medicine principles to combat infection and inflammation. 4 XB

Sepsis 98

Sepsis Outcomes Administration EMS 98

Emergency Live

AUGUST 14, 2023

The Valsalva manoeuvre (MV), named after the physician Antonio Maria Valsalva, is a forced compensation manoeuvre of the middle ear, mainly used in medicine, especially in the field of cardiology, but also in the field of diving The post Semeiotics of heart failure: the Valsalva Manoeuvre (tachycardia and vagus nerve) appeared first on Emergency Live.

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Science Based Medicine

AUGUST 14, 2023

Last week, the Ohio State Medical Board suspended the medical license of Dr. Sherri Tenpenny, a longtime antivax quack. The only question is: What took them so long, and why did it take the pandemic for them to act? Also, is there less to this action than meets the eye? The post The Ohio State Medical Board has finally suspended the medical license of antivax quack Sherri Tenpenny first appeared on Science-Based Medicine.

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Don't Forget the Bubbles

AUGUST 13, 2023

Topic Febrile Seizures Author Lakshmi Shenoy Duration Up to 2 hrs Facilitator Level Senior trainee/ANP equivalent + Learner level Most useful for those experience seeing paediatric patients regularly: FY1+, band 5+ nurses Equipment Required None Outline Pre-reading Basics Case: generalized tonic-clonic seizure Generalized tonic-clonic seizure: Discussion Case: simple febrile seizure Simple febrile seizure: Discussion Advanced Case: complex febrile seizure Complex febrile seizure: Discussion Adva

Seizures 97

Seizures Pediatrics Dehydration Radiology 97

RebelEM

AUGUST 16, 2023

Take Home Points REBEL Core Cast 106.0 – Nerve Block Basics Click here for Direct Download of the Podcast Resources REBEL EM: Local Anesthetic Systemic Toxicity Sono in Staten Blog: [link] Core Ultrasound: [link] POCUS Atlas: [link] Highland Ultrasound : [link] Post Created By: Billy Caputo MD Post Peer Reviewed By: Anand Swaminathan MD, MPH (Twitter @EMSwami ) The post REBEL Core Cast 106.0 – Nerve Block Basics appeared first on REBEL EM - Emergency Medicine Blog.

Ultrasounds 93

Ultrasounds EMS 93

PDC Healthcare

AUGUST 17, 2023

Key Takeaways from a Recent Pharmacy Survey PDC surveyed 6,400 Hospital Pharmacy Managers and Directors to get feedback on their priorities and challenges. Below we explore the results and key takeaways of the PDC survey, along with some helpful tips for pharmacy professionals. Top Concerns Among Hospital Pharmacists The top concerns identified by pharmacists were […] The post Inside Look at What’s Keeping Hospital Pharmacists Up at Night appeared first on connectID - PDC Healthcare Blog.

Hospitals 92

Hospitals Patient Safety Documentation/Coding 92

First 10 EM

AUGUST 14, 2023

This is a guest post by Dr. Julia Dmytryshyn. Julia completed medical school at the University of Toronto and is now a 2nd year Family Medicine resident at the University of Toronto. She is the co-creator of the popular medical education podcast series The Vulva Diaries. Her areas of interest include emergency medicine and women’s […] The post Miscarriage (Mis)management part 1: Evaluation and Diagnosis appeared first on First10EM.

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ACEP Now

AUGUST 15, 2023

Emergency medicine is stressful. There are charged moments of powerful highs and lows. In one shift, you may achieve return of spontaneous circulation in a college student with a massive pulmonary embolism, who will survive neurologically intact. The next shift you may feel inadequate as you realize the antibiotics you prescribe will never be picked up by your patient.

Emergency Department 90

Emergency Department Military Resuscitation Wellness 90

Science Based Medicine

AUGUST 18, 2023

RSV is a terrible infection that puts thousands of kids in the hospital every year and can be deadly. We will soon have a safe and effective way to prevent many of these severe cases, but it won't be easy to get shots into arms this season. The post Nirsevimab is Great News for Infants, Caregivers, and Exhausted Pediatricians first appeared on Science-Based Medicine.

Hospitals 86

Hospitals 86

EM Literature of Note

AUGUST 18, 2023

We do love to give out opiates in the emergency department. Kidney stone? Opiates. Broken arm? Opiates. Gunshot wound? Opiates. Sore throat? Dexamethasone. And opiates. So of course we’re here with opiates for your back pain. In this modern day, we are far, far more judicious than in times of yore, back when pharma had lobbied for pain to become the “fifth vital sign” But, nonetheless, those patients who are struggling to manage despite non-opiate analgesia frequently end up wi

Emergency Department 84

Emergency Department Wellness 84

Core Medical Group

AUGUST 18, 2023

In the fast-moving space of healthcare staffing, connecting the right professionals with critical roles requires tactfulness and expertise. With almost two years of experience to his credit, Zac has proven himself a seasoned authority in Allied healthcare recruitment.

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Sensible Medicine

AUGUST 14, 2023

Regular readers know the deal about medical studies. In the simplest sense, you randomize patients to two treatments. Random assignment (mostly) balances the known and unknown factors. You declare an endpoint before the experiment and then report that endpoint. There may be secondary endpoints, but the focus is always on the primary endpoint. I will first present the trial in question without any specifics.

Outcomes 82

Outcomes 82

Science Based Medicine

AUGUST 16, 2023

Heat related deaths are on the rise. What can we expect? The post Heat A Growing Public Health Problem first appeared on Science-Based Medicine.

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EMDocs

AUGUST 12, 2023

Authors: Jacob Kirkland, MD (EM Resident Physician, UTSW – Dallas, TX); Steve Field, DO (Assistant Professor of EM/Attending Physician, UTSW – Dallas, TX) // Reviewed by: Sophia Görgens, MD (EM Physician, Northwell, NY); Cassandra Mackey, MD (Assistant Professor of Emergency Medicine, UMass Chan Medical School); Alex Koyfman, MD (@EMHighAK) Welcome to EM@3AM, an emDOCs series designed to foster your working knowledge by providing an expedited review of clinical basics.

EMS 69

EMS Fractures Operations Ultrasounds 69

University of Maryland Department of Emergency Med

AUGUST 18, 2023

Splenic injury treatment depends on the grade of injury. In general, grades 1 and 2 are non-operatively managed. Grades 4 and.

Operations 71

Operations 71

Sensible Medicine

AUGUST 15, 2023

Dr. Ostacher and I last wrote together on Sensible Medicine asking why we treat Zoloft and Ritalin so differently ? It is a pleasure to collaborate with him again. We here at Sensible Medicine are a bit obsessed with the seven deadly sins. We first reworked them in our discussion of churnalism. Here we suggest that, thanks to pharma, maybe the sins are not that deadly anymore.

Documentation/Coding 74

Documentation/Coding 74

Science Based Medicine

AUGUST 15, 2023

Denying reality and substituting his own worked for Adam Savage. Not so much as an approach to COVID. The post I Reject Your Medical Reality and I Substitute Death first appeared on Science-Based Medicine.

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EMDocs

AUGUST 17, 2023

Welcome back to the “52 in 52” series. This collection of posts features recently published must-know articles. Today we look at the CENSER trial. Author: Mackenzie Prendergast, DO (EM resident physician, San Antonio, TX); Brannon L Inman, MD (Critical Care Fellow, Orlando, FL) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Early Use of Norepinephrine in Septic Shock Resuscitation: A Randomized Trial AKA the CENSER Trial Clinical question: In patients with suspected

Sepsis 67

Sepsis Shock Resuscitation Fluid Resuscitation 67

University of Maryland Department of Emergency Med

AUGUST 18, 2023

In a study looking at 80 blunt trauma patients that died within 1 hour of arrival to a trauma center who underwent a noncontrast post mortem CT.

66

66

ALiEM

AUGUST 18, 2023

A middle-aged man with a past medical history of hypertension and tobacco use disorder presented to the Emergency Department after evaluation by an ophthalmologist. He complained of ten days of a right-sided headache and three days of diplopia. He denied eye pain, pain with eye movements, photophobia, and vision loss. Physical Exam Vitals : Temp 98.4 °F (36.9 °C); BP 122/72; Pulse 90; Resp 16; SpO2 100% Neuro : Ptosis, “down and out” deviation and pupil dilation of the right eye were noted.

Academics 52

Academics Emergency Department 52

Science Based Medicine

AUGUST 17, 2023

A new paper documents COVID-19 medical misinformation shared by US physicians on social media The post Examining COVID-19 misinformation propagated by US physicians first appeared on Science-Based Medicine.

Documentation/Coding 78

Documentation/Coding 78

Intensive Blog

AUGUST 17, 2023

Everything ECMO 046: Bleeding and ECMO Author: Dr Zoe Guo Peer reviewers: Dr Paddy Joyce The bedside nurse alerts you to a new haemoglobin drop from 90 to 70g/L for a patient who is day 3 on V-A ECMO post cardiac arrest. You suspect a bleeding complication. Q1. How common is a bleeding complication during an ECMO run? Show answer Clinical overt bleeding is the most common complication of ECMO, affecting nearly 60% of patients during ECMO treatment.

Blood Transfusions 52

Blood Transfusions Operations Wellness 52

University of Maryland Department of Emergency Med

AUGUST 18, 2023

The authors of this paper suggest the following changes, supported by evidence, to the management of traumatic cardiac arrest: 1. &nbs.

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67

SheMD

AUGUST 17, 2023

Are you in medical school or heading to medical school and wondering what to expect? Dr. Erin Carlquist is discussing being a woman in medical school and how to thrive as a medical student! She shares the 10 THINGS she wish she knew before starting medical school today on the blog. ⁠ ⁠ The ten things I wish I could go back and tell this little baby student-doctor Bascom (my maiden name) in this picture before I started medical school at this time 10 years ago: 1.

Burns 52

Burns Radiology Radiology Wellness 52

Emergency Live

AUGUST 16, 2023

Pemphigus is an autoimmune bullous dermatosis of the skin and mucous membranes characterised by disruption of the cell adhesion mechanisms of the epidermis, particularly the desmosomes The post Pemphigus: causes, symptoms, diagnosis and treatment appeared first on Emergency Live.

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52

ACEP Now

AUGUST 17, 2023

Philadelphia offers rich history, but it is also a food lover’s dream and a cultural cornucopia. While visiting for the ACEP Scientific Assembly, you will have the chance to attend some of the best educational sessions in emergency medicine in a city that offers unique, diverse experiences. This guide will help you take advantage of all the City of Brotherly Love has to offer.

Ultrasounds 52

Ultrasounds EMS Hospitals 52

NRC Health

AUGUST 17, 2023

The whole goal of my art is that when you come up and actually take the time to look and understand, you can find more details. The post HUB23: Jayce Hall’s art Inspires people to look closer, listen more appeared first on NRC Health.

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52

RebelEM

AUGUST 17, 2023

A 24-year-old woman presents to the emergency department with persistent severe pain in her right thigh following a direct blow during a soccer match 2 weeks ago. She is participating in an important tournament, so she has been attempting to continue playing. However, she reports difficulty and pain with walking and feels a hard lump in the affected area.

EMS 52

EMS Fractures Emergency Department 52

Emergency Live

AUGUST 17, 2023

Cerebral palsy is one of the neurological disorders and mainly affects the motor skills of the child The post Cerebral palsy: what it is and what causes it appeared first on Emergency Live.

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52

Don't Forget the Bubbles

AUGUST 16, 2023

The ABC approach to bedbugs for the first contact clinician A bed bug infestation can leave your patients feeling lousy. This 5-minute blog will give you the tools to help your patients scratch that itch for good. What are bed bugs? Bed bugs are small brown insects ( Cimex hemipterus or Cimex letularius ) that feed on human blood. It only takes a handful to infest a new location, creating a vast colony.

Anaphylaxis 52

Anaphylaxis Pediatrics Wellness 52