EM Ottawa

OCTOBER 5, 2023

Do you remember when every newborn under 30 days with a fever needed an LP/admission/blood cultures? Well. times are a little different but its nuanced. The goal of this update is to provide a practical update in pediatric emergency medicine to the average Canadian adult or community emergency clinician. We will review the following three […] The post Little People, Big Updates: Updates in Pediatric Emergency Medicine appeared first on EMOttawa Blog.

Pediatrics 130

Pediatrics Wellness Seizures Resuscitation 130

Emergency Live

DECEMBER 5, 2023

The benefits and challenges in the digital age: the telemedicine revolution in emergency care Telemedicine is playing an increasingly significant role in emergency care, revolutionizing the way care is delivered. The ability to conduct remote medical consultations has opened up new opportunities for faster and more efficient response to medical emergencies.

Telemedicine 122

Telemedicine 122

The Skeptics' Guide to EM

DECEMBER 16, 2023

Reference: Punches et al. Patient Perceptions of Microaggressions and Discrimination Towards Patients During Emergency Department Care. AEM Dec 2023 Date: December 14, 2023 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and assistant Professor at the University of Calgary. He is also an avid FOAM supporter/producer through various online outlets including TheSGEM.

Emergency Department 119

Emergency Department Research Outcomes 119

Ken Grauer, MD

SEPTEMBER 22, 2023

The ECG in Figure-1 — was obtained from a middle-aged man with palpitations and shortness of breath. He was hemodynamically stable at the time this tracing was recorded. How would YOU interpret the ECG in Figure-1 ? Is there evidence of a recent or ongoing acute MI? What might you do first? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ).

EKG/ECG 438

EKG/ECG Wellness 438

Pediatric EM Morsels

SEPTEMBER 22, 2023

To celebrate the end of trauma season ( is it ever really over? ), we here at the Ped EM Morsels Bakery have cooked up a morsel to remind you that pediatric trauma can be even more difficult than you think. Never fear. As our fearless leader likes to say: “children are not aliens, but they are a special population with unique anatomy and physiology.” Children compensate for blood and volume loss very well… until they don’t.

Shock 300

Shock Pediatrics Dislocations Hyperthermia / Hypothermia 300

The Trauma Pro

DECEMBER 22, 2023

As I was browsing through my journal list this week, I ran into an interesting title for an article that is currently in press. “The use of radio-opaque markers is medical dogma” Catchy, especially since I love writing about dogma vs what is really supported by the literature. The author questions the justification of this practice and posits that there are risks to extrapolating information based on radiographs with markers placed by the trauma team.

Operations 264

Operations Outcomes 264

Mount Sinai EM

AUGUST 20, 2023

Causes Inadvertent intravascular injection (even without exceeding max dose) Overdose (with single or multiple doses) Absorption from a vascular area Prevention Calculate max dose, considering comorbidities Direct US guidance, use saline to improve needle tip visualization Add epinephrine when possible. Epi decreases the systemic absorption of LA by reducing local blood flow, also if inadvertently injected IV will provoke tachycardia that can be seen on the monitor.

Seizures 238

Seizures Shock Outcomes 238

Science Based Medicine

DECEMBER 11, 2023

A new study is making the rounds in the antivax crankosphere. The study found that the modified mRNA used in the Pfizer vaccine can cause a frame shift (to be explained) that results in the production of proteins besides the intended spike protein. The findings are, as you probably guessed, a big nothingburger compared to how they are being spun. The post Do mRNA vaccines produce harmful “junk proteins” that “gunk up” the cell and cause unintended “off-target” immune responses?

Documentation/Coding 145

Documentation/Coding 145

Don't Forget the Bubbles

OCTOBER 30, 2023

Read between the lines. No matter where we are or what type of medicine we practice, it is likely that we all were told at one point that we were expected to be lifelong learners. This is important as medical knowledge is constantly evolving. Dr. David Sackett, the father of evidence-based medicine, once said: I The traditional way to stay current is by reading the relevant scientific literature.

Research 144

Research Outcomes 144

Greater Sydney Area HEMS

NOVEMBER 4, 2023

Airway Registry learning points reflect the challenges described and wisdom shared by Sydney HEMS personnel and guests at the Clinical Governance Airway Registry presentations. Cases are discussed non-contemporaneously, anonymised and amalgamated over a period of time to draw together unifying take-home messages. Details of specific cases are removed and/or changed, such that any similarity to real-life patients or scenarios is coincidental.

Airway Management 144

Airway Management Burns Operations Resuscitation 144

EM Ottawa

OCTOBER 12, 2023

I was in the OR for the first day of my anesthesia rotation when suddenly the pain hit me. It was in my left flank, radiating to my back — so much pain I could hardly think. A flurry of tests later, my ultrasound showed good doppler flow, and my lab work was pristine. I had […] The post Experiential learning with a TWIST: Ovarian Torsion appeared first on EMOttawa Blog.

Ultrasounds 144

Ultrasounds EMS 144

The Bottom Line

JUNE 19, 2023

In adult patients with major trauma, who are at risk for trauma-induced coagulopathy does early administration of 1g of tranexamic acid (TXA) followed by an infusion of 1g over 8 hours, compared with placebo, increase survival with a favourable functional outcome at 6 months?

Administration 145

Administration Outcomes Shock 145

RebelEM

MAY 25, 2023

I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. In the initial management of trauma resuscitation there are 4 key principles that should be followed: Control bleeding Restore tissue perfusion Minimize iatrogenic injury from resuscitation itself Promote hemostasis In this blog post I will summarize the lecture and the evidence for each of these principles… MINIMIZE IATROGENIC INJURY PERMISSIVE HYPOTENSION Maintaining a lower blood pressure than physiol

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

Ken Grauer, MD

DECEMBER 29, 2023

QUESTION: HOW would YOU interpret the ECG in Figure-1 — if no clinical information was provided? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). = The H ISTORY in T oday's C ASE: The patient in today's case is a teenager who presented to the ED ( E mergency D epartment ) in cardiac arrest after electrocution.

EKG/ECG 426

EKG/ECG Resuscitation Hospitals Wellness 426

Pediatric EM Morsels

NOVEMBER 3, 2023

Imported Malaria , like all imported tropical illnesses, is a Tale of Two Cities. The infection was unknowingly obtained while enjoying a delightful holiday and then brought back in transit to a country where it is not endemic. In these non-endemic countries, we need to always be attentive to patient’s history of recent travel to correctly identify any concerns related to their recent travel.

Seizures 278

Seizures Pediatrics CDC Infectious Diseases 278

The Trauma Pro

JUNE 6, 2023

In today’s post, I will review the diaphragmatic injury practice guidelines published by the Eastern Association for the Surgery of Trauma (EAST). I will follow this up on Friday with an interesting delayed diaphragm injury case. Diaphragm injury is a troublesome one to diagnose. It is essentially an elliptical sheet of muscle that is doubly curved, so it does not lend itself well to diagnosis by axial imaging.

Operations 259

Operations Wellness 259

Mount Sinai EM

OCTOBER 2, 2023

Let’s talk about large bore/central vascular access! We’ll review different kinds, their different names, and when to use them! Of note outside the scope of this review: how to insert each of these – I think this is better learned by watching videos, watching others, & doing with guidance. This is also by no means a comprehensive vascular access guide – this is a framework to highlight three commonly used types of central lines in the ED.

Resuscitation 231

Resuscitation Fluid Resuscitation Administration Shock 231

Sensible Medicine

NOVEMBER 30, 2023

Three recent events tell us that US healthcare is doomed. First, health care premiums have risen to new heights. Second, Medicare has agreed to pay for GRAIL cancer screening as part of coverage with evidence development and third, many doctors protested Cigna’s denial of coverage for a double lung transplant for stage IV lung cancer, leading the insurer to agree to cover it.

Research 145

Research Radiology Radiology Administration 145

Science Based Medicine

DECEMBER 4, 2023

On Thursday, Steve Kirsch gave his long-hyped talk about "record-level data" from New Zealand that supposedly demonstrates that COVID-19 vaccines have killed more than 10 million people worldwide. His "analysis" of illegally obtained data from a "whistleblower" was so ridden with false assumptions and rookie errors that even some antivaxxers couldn't accept it.

CDC 145

CDC 145

Don't Forget the Bubbles

JUNE 30, 2023

A PEM adventure It’s time for another PEM adventure. Join us on another journey (with an inbuilt time travel machine) in managing Elsa, a 2-year-old girl who is a HUGE fan of the Disney movie, Frozen. Elsa was found face down in the family pool 20 minutes after last visual contact and was picked up without resuscitation. Emergency Medical Services found her apneic and pulseless.

Hyperthermia / Hypothermia 145

Hyperthermia / Hypothermia Military CPR EKG/ECG 145

Life in the Fast Lane

JUNE 11, 2023

Neil Long and Chris Nickson AMAX4 Algorithm AMAX4 is a best-practice algorithm for critical care clinicians in anaphylaxis and asthma resuscitation.

Anaphylaxis 145

Anaphylaxis Best Practices Resuscitation Pediatrics 145

First 10 EM

SEPTEMBER 18, 2023

Transfusion seems like the simplest intervention in medicine. The patient is losing blood, so let’s put some back in. Not much more complicated than an oil change. Sure, you need to use a specific brand, but as long as the system is topped up, everything should run just fine. Therefore, when someone (to be left […] The post Massive hemorrhage: a very deep dive appeared first on First10EM.

143

143

EM Ottawa

SEPTEMBER 7, 2023

According to WHO and CDC: more than nine people die every minute from injuries or violence, and 5.8 million people die every year. It is the leading cause of death in people 1-44 years of age in developed countries (unintentional injuries, homicide, suicide). The most common cardiac rhythm in Traumatic Cardiac Arrest (TCA) is pulseless electrical […] The post Traumatic Cardiac Arrests appeared first on EMOttawa Blog.

CDC 142

CDC Resuscitation 142

RebelEM

MAY 29, 2023

Background: Sepsis can induce numerous physiologic derangements. At the most severe end, this includes endothelial dysfunction leading to increased vascular permeability, abnormal nitric oxide metabolism, and vasodilation (i.e. septic shock). Judicious fluid resuscitation is indicated in patients with signs of hypo perfusion but is often inadequate necessitating the administration of vasoactive medications.

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

Ken Grauer, MD

OCTOBER 6, 2023

The ECG in Figure-1 was obtained from a middle-aged woman who presented with "palpitations". Of note — she has a history of untreated hyperthyroidism. QUESTIONS: How would YOU interpret the rhythm in Figure-1 ? Can you explain the atrial activity in this rhythm strip? Figure-1: The initial long lead II rhythm strip in today's case. MY Approach to the Rhythm in Figure-1: As per ECG Blog #185 — I favor the P s, Q s, 3 R Approach for interpretation of the cardiac rhythm — beginning with whichever o

EKG/ECG 409

EKG/ECG 409

Pediatric EM Morsels

JUNE 30, 2023

I’m sure you can recall at least several parents who bring their children into the ED for concern of recurrent pneumonias. Often the parents focus on a possible underlying immunodeficiency. Fortunately, most commonly these pneumonias are due to viral infections, and we can often offer reassurances to the parent. The differential could also include aspiration , asthma , and bronchiectasis depending on the patient’s history.

Ultrasounds 281

Ultrasounds Pediatrics Operations EMS 281

The Trauma Pro

JUNE 23, 2023

What are common sources of malpractice complaints against nurses? The most common event is medication error. Most people worry about common errors like wrong dose, wrong drug, and wrong route of administration. But one less commonly considered drug-related responsibility is assessment for side effects and toxicity of medications administered. Other common reasons include failure to adequately monitor and assess the patient, and failure to supervise a patient that results in harm.

Documentation/Coding 246

Documentation/Coding Administration 246

Mount Sinai EM

AUGUST 23, 2023

Today is a 2 parter: 1) The Supraorbital (+supratrochlear) block for forehead lacs and 2) Comments on decision-making TNF at Ethyl’s 84th and 2nd again, 8 PM TLDR: The Supraorbital block will save you time and make your life easier/patient happier – WATCH THE 3 MIN VID ; We are DECISION MAKERS – make decisions, learn from them, READ THE ATTACHMENT, get amped THE SUPRAORBITAL/TROCHLEAR FOREHEAD BLOCK A must-have in your Elmhurst tool belt.

EMS 183

EMS 183

Sensible Medicine

NOVEMBER 10, 2023

The CDC has just reported that more parents than ever are getting vaccine exemptions for their children entering Kindergarten. For many of us who have witnessed the CDC’s repeated blunders with kids COVID19 vaccines, this result is entirely predictable. The CDC has lost the trust of the American people, and it will keep getting worse. First, let me say, I warned them.

CDC 145

CDC Pediatrics Poisoning Hospitals 145

Science Based Medicine

NOVEMBER 13, 2023

Over the weekend, Jeffrey Tucker, founder of the Brownstone Institute, crowed about how the Great Barrington Declaration and its recommendation of a "natural herd immunity" approach to the pandemic changed everything three years ago. Unfortunately, as the John Snow Project pointed out last week, the "natural herd immunity" approach has done what could be irreparable damage to public health science and, more importantly, the political and social will to promote public health practices not just fo

Infectious Diseases 145

Infectious Diseases Research 145

Don't Forget the Bubbles

NOVEMBER 27, 2023

Four-year-old Ed is being resuscitated for presumed Invasive Group A Streptococcal Sepsis from tonsilitis. He presented tachycardic and hypotensive with a capillary refill time of 5 seconds. After 40ml/kg of IV 0.9% NaCl, his HR came down a little, but the effect was short-lived. He has an HR of 190/min, and his BP is 85/35 mmHg. The CRT is unchanged.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

Critical Care North Hampton

OCTOBER 9, 2023

We’ve been busy again to bring you the fastest review of GE’s new offering. The VScan SL probe is due to be released and we were lucky enough to get our hands on this fab device. Was it as good as its sister device, the VSCan Air? Take a look at our 3-person review. Below.

Ultrasounds 141

Ultrasounds 141

St. Emlyn

JUNE 2, 2023

St.Emlyn's - Emergency Medicine #FOAMed New guidelines from @RCollEM and @RCRadiologists finally agree that contrast CT should not be delayed in the critically ill/injured #FOAMed The post Contrast Induced Nephropathy – sense at last. St Emlyn’s appeared first on St.Emlyn's.

Resuscitation 143

Resuscitation 143

Dr. Smith's ECG Blog

OCTOBER 21, 2023

A 70 something male presented in severe respiratory distress. The patient had altered mental status and so he was prepared for intubation. Before intubation, he became hypotensive. On the monitor patient had wide-complex tachycardia. The following 12-lead was obtained: What do you think? Differential is ventricular tachycardia versus supraventricular tachycardia with aberrancy versus sinus tachycardia with a aberrancy.

EKG/ECG 141

EKG/ECG COPD 141

RebelEM

SEPTEMBER 21, 2023

Bottom Line Up Top: Troponins should not be routinely sent in patients presenting with SVT. Rarely, they may be necessary if the patient has concerning ischemic symptoms that persist after conversion to sinus rhythm. Clinical Scenario: A 44-year-old man presents with palpitations that started 45 minutes ago. He has no medical problems and denies any prior similar symptoms.

EKG/ECG 143

EKG/ECG Sepsis EMS Outcomes 143

Ken Grauer, MD

AUGUST 4, 2023

The long lead II rhythm strip shown in Figure-1 — was obtained from a previously healthy 30-year old woman, who presented with new abdominal pain. Her vital signs were stable — and she did not have an acute abdomen. QUESTIONS: Is there complete AV block? If not — How would YOU interpret this rhythm? What is unusual about this conduction disturbance?

EKG/ECG 370

EKG/ECG Academics Resuscitation Wellness 370

Pediatric EM Morsels

AUGUST 4, 2023

In the age of Ozempic, everyone seems to be losing weight! This seems to have had an overall positive benefit on the health of many. Losing weight is a good thing, until it is a bad thing! Too much of a good thing is a bad thing. Of course, there can be many complications of rapid weight loss including gallstones , malnutrition , and electrolyte imbalances.

Pediatrics 246

Pediatrics Burns Operations Ultrasounds 246