2024

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The VIP Syndrome In Healthcare (Very Important Person)

The Trauma Pro

The VIP syndrome occurs in healthcare when a celebrity or other well-connected “important” person receives a level of care that the average person does not. This situation was first documented in a paper published in the 1960s, which noted that VIP patients have worse outcomes. Who is a VIP? It may be a celebrity. A family member. Or even a colleague.

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Rebaked: Inborn Errors of Metabolism presenting in the ED

Pediatric EM Morsels

Often our job requires us to consider the presence of needles of significant illness in the haystack of nonspecific symptoms. With the help of our favorite geneticist , Dr. Liz Baker, we will dive into the haystack headfirst and find those needles. Hopefully, without getting poked. Let’s consider Inborn Errors of Metabolism Presenting in the ED : Inborn Errors of Metabolism: Basics Common Presentations, Uncommon Kiddos For the child with lethargy, vomiting, acidosis, hypoglycemia , organom

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ECG Blog #419 — The Cause of ECG #1?

Ken Grauer, MD

I was sent the 2 ECGs shown in Figure-1 — which were recorded from an elderly man whose heart beat "has been irregular for years". No clear history for recent chest pain — but the patient "has not been well" for the previous week. Regarding the 2 ECGs in Figure-1 : ECG #1 is the initial tracing obtained at the scene by the EMS ( E mergency M edical S ystems ) team — in association with an alert but markedly hypotensive patient.

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Communic8: Eight Universal Leadership Lessons from the Children’s Emergency Department

Don't Forget the Bubbles

The Childrens Emergency Department is a busy, challenging, and dynamic environment. The skills needed to deliver the best possible outcomes for children and young people are multifaceted and constantly evolving. They involve a mixture of clinical, communication, and leadership traits. Having recently moved from a leadership position within the Childrens Emergency Department to a more system-based role involving children of all ages, its apparent to me how transferable my experiences on the shop

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Nirsevimab (Beyfortus): is universal prophylaxis for RSV warranted?

Sensible Medicine

Dharini Bhammar, PhD, MBBS, is a respiratory physiologist and evidence enthusiast. As a new mum, her pediatrician recommended the RSV monoclonal antibody for her baby. After reviewing the evidence, she declined it. We are excited to share her clearly written argument as an excellent example of evidence translation. Core concepts discussed include effect size, net benefit and the external validity of clinical trials.

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What makes a T-wave Hyperacute? And: 30 Examples of Hyperacute T-waves, 10 in each of 3 myocardial territories.

Dr. Smith's ECG Blog

Pendell and I and the geniuses at Powerful Medical (Producers of the PMCardio Queen of Hearts OMI AI app ) are working on an objective, mathematical definition of hyperacute T-waves , based on real OMI outcomes and hyperacute T-wave annotation that has excellent interrater agreement (between me and Pendell), and it will end up being a logistic regression using these 3 variables: 1) area under the curve (AUC) relative to the QRS size 2) increased symmetry , as defined by time from T-wave onset to

EKG/ECG 133
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Building a Learning Culture in the ED: Why It Matters and How to Make It Happen.

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed Creating a learning culture in the emergency department (ED) fosters psychological safety, open communication, and continuous improvement. This approach supports team resilience, enhances patient care, and reduces burnout. Learn practical steps to build a strong learning culture in your ED, promoting growth and collaborative excellence in emergency medicine.

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Elbow Dislocations

RebelEM

Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (80%) Demographics Most commonly affects patients between ages 10-20 years old As age increases, elbow dislocation rates tend to d

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Health Care Worker Unionization Uncommon, But Sometimes Necessary

ACEP Now

Medical training is a difficult task. As residents and fellows, we move wherever the Match sends us, endure grueling hours, and sacrifice time with loved onesall in pursuit of becoming the best doctors we can be and delivering excellent patient care. But we should not have to sacrifice our own well-being in the process. In Washington, D.C., more than 450 residents and fellows employed by George Washington University (GW) spent the past 15 months fighting for our first contract.

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Addressing Vaccine Hesitancy Through Pediatric Immunization Training 

American Medical Compliance

Defined by the World Health Organization as the reluctance or refusal to vaccinate despite the availability of vaccines, vaccine hesitancy is influenced by complex factors including misinformation, cultural beliefs, and fear of adverse effects. To help address this growing concern, pediatric immunization training equips healthcare providers with the skills, knowledge, and empathy necessary to effectively address vaccine hesitancy.

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The Role Of Postop CT Scan In Penetrating Trauma

The Trauma Pro

CT scans are commonly used to aid the workup of patients with blunt trauma. They are occasionally useful in penetrating trauma, specifically when penetration into a body cavity is uncertain, and the patient has no hard signs that would send him or her immediately to the operating room. Is there any role for CT in operative penetrating trauma, after the patient has already been to the OR?

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Mycoplasma Pneumonia in Children

Pediatric EM Morsels

Its been a BIG year for Mycoplasma! If your EDs have been anything like ours, youve been seeing more patients with Mycoplasma Pneumonia than you expected. Many kids are presenting to the ED for failure of outpatient antibiotic therapy of community acquired pneumonia, only to find out thats because they werent on the right meds! Let’s debrief on this atypical bug.

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ECG Blog #422 — Was Clubbing an ECG Hint?

Ken Grauer, MD

I was sent the ECG in Figure-1 — with the following history: The patient is a young man in his early 20s — who presents to the ED ( E mergency D epartment ) because of SOB ( S hortness O f B reath ) that had been ongoing for several hours. No chest pain. He reports a number of similar previous episodes over the past few years ( although apparently has not been formerly evaluated for this ).

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Targeted Temperature Management in Paediatric Traumatic Brain Injury

Don't Forget the Bubbles

One-liner… Traumatic brain injury (TBI) is a leading cause of mortality and morbidity in paediatric populations, and fever is associated with worse outcomes. Should we aim to prevent fever, or should we cool patients? A 12-year-old boy presents with a significant head injury following a road traffic accident. At the scene, his lowest GCS was 5 (E1V2M2).

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Delirium revisited

EM Ottawa

Delirium is a medical emergency. It is characterized by acute disturbance of consciousness, with changes in perceptual disturbances and fluctuation of symptoms. Delirium is often the initial manifestation of an underlying acute illness and can be present before fever, tachypnea, tachycardia, or hypoxia. There is an ED prevalence ranging from 7-24%, with increased mortality rates […] The post Delirium revisited appeared first on EMOttawa Blog.

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EM Quick Hits 61 TEE in Cardiac Arrest, Nebulized Ketamine, Cellulitis Update, SQ Insulin for DKA, Medicolegal DDx Documentation Tips

Emergency Medicine Cases

On this month's EM Quick Hits podcast: Ross Prager on TEE in cardiac arrest, Justin Morgenstern on nebulized ketamine for analgesia in the ED, Hans Rosenberg & Krishin Yadav on standardizing cellulitis management, Mathew McArther on latest studies on subcutaneous insulin protocols in DKA, Jennifer C. Tang on documenting differential diagnoses medicolegal tips.

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Difficult Airway Society Meeting 2024

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed Explore key takeaways from the DAS 2024 meeting, including airway management in obstetrics, ethics of training, challenges in critical care, and international practices. Insights tailored for emergency and anaesthesia professionals. The post Difficult Airway Society Meeting 2024 appeared first on St.Emlyn's.

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EM@3AM: Murine Typhus

EMDocs

Authors: Grant Gerstner, DO (EM Resident Physician, San Antonio, TX); Kyle Smiley, MD (EM Resident Physician, San Antonio, TX) // Reviewed by: Sophia Görgens, MD (EM Physician, BIDMC, MA); 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.

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But Can You Just PO?

Taming the SRU

Fluid management in the Emergency Department (ED) is crucial in the adequate resuscitation of the acutely ill and decompensating patient. Patients present to the ED with hypovolemia secondary to a plethora of causessome requiring IV fluid resuscitation and others requiring none. Considering the nationwide IV fluid shortage, judicious use of fluids is imperative.

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How to Best Inspect, Protect, and Dress Wounds in the Emergency Dept.

ACEP Now

This is the second visit in two weeks for an elderly gentleman who is concerned about his legs being red and swollen. During the first visit, he was diagnosed with cellulitis and placed on cephalexin. Today, he notes worsening swelling and a blister forming near his left ankle. The pain makes it difficult for him to ambulate unassisted through his home.

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Training Healthcare Personnel to Better Serve Seniors and Disabled Patients

American Medical Compliance

A survey reveals that falls are the most frequent health issue affecting seniors in long-term care facilities. Interestingly, while 90% of caregivers feel confident in implementing fall prevention measures, only 60% have adequate knowledge to do so effectively. As the aging population grows, so does the demand for specialized healthcare tailored to the unique needs of seniors and individuals with disabilities, posing new challenges and responsibilities for healthcare providers.

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Incidental Appendectomy During Trauma Laparotomy?

The Trauma Pro

The debate over incidental appendectomy has waxed and waned over the years. And for the most part, it has nearly permanently waned in general surgical cases for now. But every once in a while, I am asked about incidental appendectomy during trauma laparotomy. Is it a good idea? What reasons could there possibly be for doing it? In the old days, we would frequently do an incidental appendectomy because… well, just because we were there.

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Post-Tonsillectomy Hemorrhage: ReBaked Morsel

Pediatric EM Morsels

Previously, we covered Post-Tonsillectomy Hemorrhage and how we hope that “all bleeding eventually stops: ideally, by means that we have imposed rather than by exhaustion of the patient’s RBC resources.” Since the original morsel ( way back in 2012 ), the literature has shown that there are a few extra ingredients that we can add to our morsel recipe when we care for children with post-tonsillectomy hemorrhage.

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ECG Blog #451 — Premature Closure.

Ken Grauer, MD

I was sent the ECG shown in Figure-1 — told only that the patient was a middle-aged man with septicemia. QUESTIONS: Is this rhythm too fast to be sinus tachycardia? Are flutter waves hidden within the QRS and T waves? Are we seeing the retrograde P waves of AVNRT? Is this ATach ( A trial T achycardia )? Figure-1: The initial ECG in today's case. MY Thoughts on Today’s CASE: In my opinion — none of the above answers are optimal to describe the rhythm in Figure-1.

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SGEM#460: Why Do I Feel Like, Somebody’s Watching Me – CHARTWatch to Predict Clinical Deterioration

The Skeptics' Guide to EM

Date: October 28, 2024 Reference: Verma et al. Clinical evaluation of a machine learning–based early warning system for patient deterioration. CMAJ September 2024 Guest Skeptic: Michael Page is currently the Director of Artificial Intelligence (AI) Commercialization at Unity Health Toronto. He leads an AI team intending to improve patient outcomes and healthcare system efficiency.

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Lifestyle, Statins, or Both?

Sensible Medicine

The study of the week will take a short break. I head to Curitiba Brazil tomorrow for the Brazilian EP society meeting. I have five lectures. I will be back next week. And there will be plenty of studies to choose from because we are entering the fall season of medical meetings. This week, Sensible Medicine features a guest column from Zachary R. Caverley, a Cardiology Physician Assistant working in the Northwest coast of Oregon.

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The PECARN c-spine rule could cause a lot of harm

First 10 EM

As with everything that comes out of the PECARN group, this is a huge study, and is therefore one that everyone needs to know about. That being said, despite working in two very busy community hospitals with a high percentage of pediatrics visits, c-spine injuries are just not an issue I struggle with. I have […] The post The PECARN c-spine rule could cause a lot of harm appeared first on First10EM.

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JC: Small versus Large-Bore Thoracostomy for Traumatic Hemothorax.

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed Traditionally, large-bore chest tubes have been standard for managing hemothorax, but smaller tubes are now proving just as effective in stable patients, with added benefits like reduced pain and fewer tube days. This review explores outcomes in drainage efficacy, complication rates, and patient comfort, showing that small-bore thoracostomy may be a reliable alternative for non-emergent cases.

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emDOCs Podcast – Episode 110: Primary Spontaneous Bacterial Peritonitis

EMDocs

Today on the emDOCs cast with Brit Long, MD ( @long_brit) , we cover the literature on evaluation and management of primary SBP. Episode 110: Primary Spontaneous Bacterial Peritonitis Background: End-stage liver disease with cirrhosis and ascites is a major cause of death worldwide. Primary spontaneous bacterial peritonitis (SBP) is one of the most common infections in those with cirrhosis and ascites.

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Intraosseous vs intravenous access: which is better during resuscitation?

PulmCCM

During cardiac arrest, every second matters (at least potentially). For out-of-hospital cardiac arrest in particular, intravenous access can be difficult to establish, delaying the administration of epinephrine and other drugs and possibly worsening outcomes. Intraosseous (IO) devices—inserted by punching a needle loaded on a trocar into the tibia or femur—can be placed more easily than IV catheters, leading to faster injection of epinephrine.

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Coronary Angiography Guide by Willy Frick -- Everything you ever wanted to know about the Cath Lab

Dr. Smith's ECG Blog

Introductory Angiography Guide To find the guide later, go to the banner at the top of the blog: This blog is dedicated to improving understanding of ECGs in the context of emergency medicine. A substantial proportion of cases discussed include diagnostic angiography. Attaining expertise in angiography requires dedication and practice. What follows is an introduction to angiography -- a guide meant for people with no prior experience interpreting angiograms.

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Empathy’s Role in Managing Aggression in Assisted Living 

American Medical Compliance

Assisted living facilities are a lifeline for elderly and vulnerable individuals who need care and support in a safe, nurturing environment. Yet, even in these compassionate settings, caregivers often face the challenge of managing aggressive behaviors among residents. Imagine the case of Mrs. Stevens, a once gentle and kind woman who, after the onset of dementia, began exhibiting sudden outbursts of anger.

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Giving TXA Via An Intraosseous Line?

The Trauma Pro

Seriously injured patients frequently develop coagulopathy, which makes resuscitation (and survival) more challenging. A few years ago, the CRASH-2 study lent support for using tranexamic acid (TXA) in select trauma patients to improve survival. This drug is cheap and has antifibrinolytic properties that may be beneficial if given for life-threatening bleeding within 3 hours of initial injury.

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Rebaked Morsel: Pediatric Buckle and Greenstick Forearm Fractures

Pediatric EM Morsels

Trauma season is at hand and like all other pediatric emergency departments in the country, we find our ED breaking ( pun intended ) at the seams with orthopedic injuries. We see all different flavors of upper extremity injuries. Yes, we’re talking about your clavicular , proximal humeral, supracondylar, lateral condylar , scaphoid and metacarpal fractures.

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ECG Blog #411 — Is it Wenckebach?

Ken Grauer, MD

How would YOU interpret the tracing in Figure-1 — that was sent to me without additional information? QUESTIONS: What is the rhythm? Is there AV dissociation? If so — WHY? Clinically — HOW would you approach interpretation of this tracing in optimal time -efficient fashion? Figure-1: The initial ECG in today's case. KEY Clinical Point: If I was the medical provider charged with the care of the patient whose ECG is shown in Figure-1 — I would approach this tracing in the following sequential stag

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Ocular POCUS and ICP elevation

Mount Sinai EM

The Case: A woman in her twenties with no significant medical history presents with one month of progressive frontal headaches radiating to her occiput. Her headaches have been intermittent, however over the past few days she has had a few episodes of vomiting and brief episodes of blurred vision. Her headache is 8/10 currently. Last emesis and blurred vision were both 12 hours prior.

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Inhalation Injuries: The Answers You’ve Been LUNGing For

EM Ottawa

Inhalational injuries are a critical yet often overlooked aspect of trauma care, with far-reaching consequences in emergency medicine. These injuries can arise from various sources, including thermal injuries from fires, recreational activities such as smoke exposure during camping or outdoor events, and chemical inhalation in both industrial and household settings.

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