The Trauma Pro

MAY 19, 2023

The serial hemoglobin (Hgb) determination. We’ve all done them. Not only trauma professionals, but other in-hospital clinical services as well. But my considered opinion is that they are not of much use. They inflict pain. They wake patients up at inconvenient hours. And they are difficult to interpret. So why do them? I’m reposting this mini-series on serial hemoglobin draws in light of a new paper that was published in the Journal of Trauma Nursing.

Fractures 130

Fractures Hospitals Wellness 130

RebelEM

MAY 18, 2023

Background: IV fluids are part of the standard resuscitation bundle in septic shock, however it is unclear if they provide a significant benefit. These patients can have a vasodilated vascular bed and the initial use of fluids is hypothesized to serve two purposes: Augmenting the macrovascular system (stroke volume and cardiac output) and augmenting the microvascular perfusion (capillary blood flow).

Sepsis 105

Sepsis Shock Resuscitation Outcomes 105

ALiEM

MAY 19, 2023

A heavy alcohol drinker, who is well known to your Emergency Department, presents with altered mental status, except that he looks different this time. He looks really bad, stating that he has been vomiting blood. He is hypotensive. He then vomits a copious amount of blood right in front of you. You intubate the patient and initiate the massive transfusion protocol, but everything you pour into him seemingly comes right back out.

Emergency Department 98

Emergency Department Ultrasounds Wellness EMS 98

PEMBlog

MAY 15, 2023

Syncope is described as a brief loss of consciousness and postural tone caused by transient global cerebral hypoperfusion. It is followed by a complete recovery. An estimated 80% of pediatric syncope is due to autonomic (vasovagal or neurocardiogenic) syncope. Our role as providers is to identify the patients who have a life-threatening etiology to their syncope.

Pediatrics 97

Pediatrics EKG/ECG Emergency Department Burns 97

The Trauma Pro

MAY 17, 2023

The Rural Trauma Team Development Course (RTTDC) was introduced by the American College of Surgeons (ACS) to improve the care of trauma patients in rural communities. It is a staple of education for Level III and IV trauma centers in rural areas. Like everything else, most courses were shut down by the COVID-19 pandemic. Conemaugh Memorial Medical Center in Johnstown, Pennsylvania, polled its local referral hospitals and discovered that the majority felt a significant need for continuing, in-per

Administration 100

Administration Hospitals 100

RebelEM

MAY 15, 2023

You are working in a rural ED, and an older woman from a local assisted care facility arrives via ambulance in obvious respiratory distress. EMS is able to tell you that she is currently being treated for pneumonia. The patient is on a nonrebreather mask, and vital signs on arrival are BP 110/50 mm Hg, HR 120 bpm, RR 40/min, T 98.6°F (37°C), and SpO2 86%.

EMS 98

EMS Documentation/Coding Resuscitation 98

EM Ottawa

MAY 18, 2023

Welcome Back to BHP Corner For those who are new to this segment of the EMOttawa Blog, here’s a little refresher. In the Base Hospital Program (BHP) Corner, we aim to review interesting and evolving topics, as they pertain to the prehospital/paramedicine world. Advances, reviews, and changes to Ontario and local practices, you name […] The post BHP Corner – Out of Hospital Discharge: Pearls and Pitfalls appeared first on EMOttawa Blog.

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Hospitals EMS 97

First 10 EM

MAY 15, 2023

The Beers criteria (named after Dr. Beers and not your Friday night escapades) is a guideline to help guide safe prescribing practices in the geriatric population. Polypharmacy and medication side effects are a common, and generally under-recognized, reason for patients to present to the emergency department. Adverse events and drug interactions should almost always be […] The post Beers criteria for potentially inappropriate medication use in older adults appeared first on First10EM.

Emergency Department 81

Emergency Department 81

PEMBlog

MAY 17, 2023

Most children who present to Pediatric Emergency Departments these days with mental health concerns – including agitation – have a known psychiatric problem or diagnosis. Furthermore, the connection between physical and functional symptoms is inextricably linked in many patients. Why then do we persist with the “is it medical/organic or psych” question?

Psychiatric 80

Psychiatric Pediatrics Emergency Department Best Practices 80

Canadian EM

MAY 18, 2023

In this issue, we collaborated with CJEM team to present “Emergency department crowding negatively influences outcomes for adults presenting with chronic obstructive pulmonary disease”​1​ in a visual abstract format. In the ED, patients with respiratory pathology present on a shiftly basis. A majority of these patients are affected by chronic obstructive pulmonary disease (COPD).

COPD 75

COPD Emergency Department Outcomes Resuscitation 75

Don't Forget the Bubbles

MAY 17, 2023

Can’t get enough of Bubble Wrap? The Bubble Wrap Plus is a monthly paediatric journal club reading list from Anke Raaijmakers, working with Professor Jaan Toelen and his team at the University Hospitals in Leuven. This comprehensive list is developed from 34 journals, including major and subspecialty paediatric journals. We suggest this list can help you discover relevant or interesting articles for your local journal club or allow you to keep a finger on the pulse of paediatric research.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

Science Based Medicine

MAY 17, 2023

Using AI systems for pattern recognition in early diagnosis of dementia shows the potential of this tool. The post AI as a Diagnostic Tool first appeared on Science-Based Medicine.

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EMCrit

MAY 17, 2023

More on burnout with an expert. EMCrit Project by Scott Weingart, MD FCCM.

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Sensible Medicine

MAY 19, 2023

CB is a 72-year-old woman with macrocytosis and otherwise normal cell counts. After an unrevealing evaluation, her internist referred her to a hematologist. Hematologist: “You won’t believe this, CB, the patient you referred to me, she has megakaryocytic dysplasia with 5q and 12p deletions and the TP53 mutation.” Internist: “I have no idea what that means, can you explain it to me?

Wellness 52

Wellness Hospitals 52

AED Leader

MAY 19, 2023

Dying in your sleep might seem like a peaceful way to go, but if you’ve still got a lot of life left to live, it can be helpful to understand the main causes of sudden nocturnal death and things you can do to prevent it. It’s important to note that whether your interest in the Read More "Top Main Causes for Dying in Your Sleep" The post Top Main Causes for Dying in Your Sleep appeared first on AEDs for Sale | Buy Defibrillators and Accessories.

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Science Based Medicine

MAY 15, 2023

Antivaccine activists and quacks often weaponize legitimate concerns about industry conflicts of interest in medicine into the "shill gambit," in which they accuse critics and defenders of science-based medicine of being in the pay of big pharma. However, the rise of physician-influencers and, in particular, Substack show that not all conflicts of interest are from industry or even financial.

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SheMD

MAY 18, 2023

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.

Academics 52

Academics Pediatrics Outcomes Hospitals 52

Sensible Medicine

MAY 15, 2023

As always, we at Sensible Medicine appreciate the support from our readers. We are surprised and grateful. JMM Let’s start by leaving out the disease and treatment. This randomized controlled trial was simple and elegant. One group received an active drug (an inexpensive generic), the other group received placebo. The primary endpoint required no judging—alive or dead at 60 days.

Outcomes 52

Outcomes Wellness 52

Dr. Smith's ECG Blog

MAY 18, 2023

This case was provided by Steven Souchtchenko, a recent graduate of our Hennepin Healthcare EM/IM residency (i.e., a former trainee of mine). Case A 45 yo man with no previous cardiac history presented to an ED not associated with a cath lab. He complained of jaw pain radiating to left shoulder for 6 hours. He stated he had had a brief similar episode the evening prior.

EKG/ECG 52

EKG/ECG EMS 52

Science Based Medicine

MAY 19, 2023

To advocates of Feelings Based Medicine, there is no difference between criticizing someone's ideas and attacking them personally. The post Might “Vitriolic Attacks” Against Emily Oster Rival COVID’s Carnage? first appeared on Science-Based Medicine.

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Clinical Correlations

MAY 18, 2023

By Hadley Greenwood Peer Reviewed Medications originally developed as agents to treat type 2 diabetes have been making headlines for their use as weight loss drugs, even in individuals without diabetes. The medical community has known.

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NRC Health

MAY 18, 2023

Our partners at Phoenix Children’s share how grassroots efforts helped to define and drive patient experience priorities and build alignment throughout the organization. The post The Power of the board in DEI endeavors: Children’s Minnesota appeared first on NRC Health.

Pediatrics 52

Pediatrics 52

PulmCCM

MAY 17, 2023

This is to all of you who took a chance and pledged subscriptions or subscribed to help bring PulmCCM back. And especially to those who wrote notes along with their pledges saying such nice things supporting Jon and my efforts in building the site. Writing for PulmCCM has usually felt rewarding for its own sake but it’s also been very solitary.

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Science Based Medicine

MAY 16, 2023

Anything new regarding stroke and chiropractic neck manipulation? The post The Good. The Bad. The Ugly. first appeared on Science-Based Medicine.

Stroke 77

Stroke 77

EM Ottawa

MAY 17, 2023

Methodology: 3/5 Usefulness: 3/5 O’Rielly CM, et al. Can J Cardiol. 2023 Mar;39(3):304-310. doi: 10.1016/j.cjca.2022.12.028. Question and Methods: The authors conducted a systematic review to identify and synthesize prognostic performance of chest pain risk scores amongst patients with negative primary ACS events, as defined by high sensitivity troponin assays.

Emergency Department 52

Emergency Department 52

ALiEM

MAY 17, 2023

The 2023 Emergency Medicine Match was an unprecedented year that took many of us in the education community by surprise. There were 132 (46%) EM residency programs with at least one unfilled PGY-1 position, and there were 554 (18.4%) overall unfilled EM positions. Dr. Sara Krzyzaniak (EM program director at Stanford) hosts this important episode with Dr.

EMS 52

EMS 52

Mind The Bleep

MAY 16, 2023

Definition BRUEs are a scary event for any parent, characterised by the following: At least one of: Central colour change (cyanosis/pallor) Abnormal tone (hyper-/hypotonic) Abnormal breathing (irregular/reduced/apnoea) Altered level of consciousness Occurring in infants (<12 months of age) Lasting for <1 minute Resolves without intervention, typically prior to assessment No apparent medical cause BRUE is a description of the event, not a diagnosis.

Basic Life Support 52

Basic Life Support Seizures CPR Wellness 52

Science Based Medicine

MAY 14, 2023

A article published in The Atlantic implored people to take detransitioners seriously but did so by perpetuating non-evidence-based tropes that harm both detransitioners and transgender people The post Detransition, Retransition, and What Everyone Gets Wrong first appeared on Science-Based Medicine.

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Dr. Smith's ECG Blog

MAY 16, 2023

Sent by Dan Singer MD, written by Meyers, edits by Smith A man in his late 30s presented with acute chest pain and normal vitals except tachycardia at about 115 bpm. Here is his triage ECG: What do you think? Dr. Singer sent this to me with just the information: "~40 year old with acute chest pain". I immediately responded: "cool fake! Not OMI. Do you have a prior?

EKG/ECG 52

EKG/ECG Stroke Documentation/Coding Outcomes 52

Cook County EM Blog

MAY 15, 2023

Figure 1: Initial EKG The Case: 45-year-old Spanish speaking male with no known past medical history presented to the ED with 2-3 hours of severe back pain and throat pain. The pain started at rest with no specific aggravating or alleviating factors. The patient reported having similar intermittent episodes in the past, but this occurrence was more severe and persistent.

EKG/ECG 52

EKG/ECG Documentation/Coding Wellness 52

Mind The Bleep

MAY 16, 2023

Introduction Infantile haemangioma (IH) are commonly known as “strawberry naevi”. IH are the most common benign vascular skin tumours in children. They are caused by proliferation of the vascular endothelium. They are usually not present at birth, but the precursor lesions (flat pale or pink macules) may be present soon after birth. IH rapidly proliferate in the first few weeks of life.

Administration 52

Administration Wellness Emergency Department 52

Board Bombs

MAY 14, 2023

Lemierre’s Syndrome? Sacrébleu! This is a nasty, rare complication of pharyngitis, but it’s much more common than Rheumatic fever. Let’s nail the diagnosis and treatment on this nasty F. necrophorum infection. Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here: emrapidbombs.supercast.com.

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American Medical Compliance

MAY 15, 2023

The Health Insurance Portability and Accountability Act (HIPAA) became law in 1996. It establishes a set of national standards to protect the privacy and security of individuals’ health information. The law applies to covered entities. These include healthcare providers, health plans, and healthcare clearinghouses, as well as their business associates.

Administration 52

Administration Wellness 52

SheMD

MAY 14, 2023

Dr. Karen Tran-Harding joins us on the blog to discuss how we often "fail" in medicine when we are striving for perfection, but how those "failures" are actually opportunities for growth and do NOT make us a FAILURE as a physician. In fact, if we approach them correctly, they will make us stronger physicians in the long run. This post contains affiliate links.

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OB/GYN Radiology Radiology Pediatrics 52

Mind The Bleep

MAY 16, 2023

Kawasaki Disease is a clinical diagnosis that requires prompt recognition and management. It is an acute illness with inflammation of small and medium-sized blood vessels throughout the body, in particular, the coronary arteries. Kawasaki disease was previously known as mucocutaneous lymph node syndrome. It was first described in Japan in 1967 by Dr Tomisaku Kawasaki (a Paediatrician). 80% of cases occur in children younger than 5 years old with a peak incidence between 1- 2 years.

Administration 52

Administration Shock EKG/ECG 52

Sensible Medicine

MAY 14, 2023

Recently, I had dinner with a friend and colleague visiting San Francisco for the SWOG (Southwest oncology group) conference. SWOG is a cooperative group-- nominally a collection of academic doctors who are supposed to run trials as a counterweight to pharma; guided by doing what is best for patients not profits. My colleague attended these sessions dutifully.

Academics 52

Academics Wellness Research 52

Maria Yang, MD

MAY 14, 2023

Artwork by Pascal Campion Since my last post , I have recovered from illness, though spasms of coughing still occasionally overtake me. Other circumstances have changed, too, that have highlighted to me the importance of spending time with people we love. American culture often focuses on becoming financial millionaires when becoming time millionaires is vastly more important.

Psychiatric 52

Psychiatric 52