Ken Grauer, MD
DECEMBER 12, 2024
I was sent the ECG in Figure-1 initially told only that it was obtained from an older man with palpitations. The cardiology team thought the rhythm was an SVT ( S upra V entricular T achycardia ) with QRS widening as a result of aberrant conduction. QUESTION: Do YOU agree that the rhythm is consistent with an SVT , in which there is QRS widening because of aberrancy?
Pediatric EM Morsels
DECEMBER 20, 2024
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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The Trauma Pro
DECEMBER 17, 2024
Anyone who takes care of blunt trauma has seen the Morel-Lavallee lesion (M-L). Heres an obvious one because its acute: The M-L lesion is essentially a closed degloving injury in which the skin remains intact. The subcutaneous tissue is sheared off of the underlying fascia, and typically blood accumulates in the potential space that is created. This picture shows a less acute lesion; the bruising and ecchymosis on the surface have resolved.
Science Based Medicine
DECEMBER 6, 2024
Doctors who gushed over RFK Jr. made their bed, and they'll lie in it. The post Dr. Vinay Prasad Sabotaging RFK Jrs Confirmation Will Increase Vaccine Hesitancy & Doctors Criticizing RFK Jr. Paved the Way for His Ascendancy first appeared on Science-Based Medicine.
EMCrit
DECEMBER 1, 2024
John Holcomb, author of the PROPPR trial, on massive transfusion in 2024 EMCrit Project by Scott Weingart, MD FCCM.
St. Emlyn
DECEMBER 9, 2024
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.
Dr. Smith's ECG Blog
DECEMBER 3, 2024
This was written by one of our fine residents, who will soon be an EMS fellow: Michael Perlmutter Case A mid-50s male came to the ED with a burning sensation that was acutely worse while at home. He had recently returned from overseas travel where these symptoms had been intermittently bothersome over the preceding weeks and had been attributed to heartburn.
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The Trauma Pro
DECEMBER 6, 2024
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.
Science Based Medicine
DECEMBER 3, 2024
Yesterday, Dr. David Gorksi invited us to come up with questions for Senators to ask our future public health leaders. Here are mine. The post Questions For Senators to Ask Drs. Marty Makary and Jay Bhattacharya first appeared on Science-Based Medicine.
Emergency Medicine Cases
DECEMBER 3, 2024
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.
First 10 EM
DECEMBER 2, 2024
Despite being widely talked about in glowing terms, the original WOMAN trial was clearly negative, with no benefit in their primary outcome, and no change in all cause mortality, and therefore no hint of benefit. (There is a lot of confusion about what disease specific mortality means when this paper is discussed, but it only […] The post WOMAN-2: TXA has no role in postpartum hemorrhage appeared first on First10EM.
Dr. Smith's ECG Blog
DECEMBER 6, 2024
A 50-something man presented with worsening severe exertional chest pain which was just resolving as he had an ECG recorded in triage. Time zero. Are the T-waves in leads I and II hyperacute? Hard to tell. How can we know? By the evolution of the ECG! Watch what happends as the heart recovers from its episode of ischemia. The T-waves deflate, demonstrating that the first one was indeed hyperacute. 2 hours T-waves in lead II are significant smaller In lead I not much difference Troponins returned
The Bottom Line
DECEMBER 11, 2024
Whats new in the Critical Care literature monthly updates
The Trauma Pro
DECEMBER 20, 2024
A new class of anticoagulants, the direct oral anticoagulants (DOACs), were introduced in 2010. I started writing about them more than five years ago and was initially pessimistic about their safety profile in patients with head injuries. However, reversal agents and/or protocols were introduced, and the literature has borne out the fact that they appear to be safer than the old stand-by warfarin.
EM Literature of Note
DECEMBER 4, 2024
The emergency department is a place of risk and errors. Those who work in the ED are acutely aware of this, and it conjures up tremendous cognitive pressures on staff every shift. Every ED clinician knows the most benign-appearing triage complaint may obfuscate lurking catastrophe. The vision changes that are actually an acute aortic dissection. A sore shoulder that is necrotizing fasciitis.
EMDocs
DECEMBER 1, 2024
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.
Emergency Medicine News
DECEMBER 1, 2024
No abstract available
St. Emlyn
DECEMBER 2, 2024
St.Emlyn's - Emergency Medicine #FOAMed Uncover the truth about alcohol poisoning. Find out how toxic alcohols can be ingested accidentally or intentionally and the serious consequences they can have with a focus on Emergency medicine management. #FOAMed @stemlyns The post Toxic alcohol poisoning: What do we know about fomepizole, methanol and ethylene glycol?
Don't Forget the Bubbles
DECEMBER 2, 2024
Merry Christmas and Season’s Greetings! With millions of journal articles published yearly, it is impossible to keep up. An international team joining DFTB Bubble Wrap from Aghia Sophia Childrens Hospital ED , Athens, Greece, tell us what is new in thepaediatric literature Led by Spyridon Karageorgos, a Paediatrician enthusiastic about Paediatric Emergency Medicine, reducing antibiotic use in paediatric patients, and Medical Education.
The Trauma Pro
DECEMBER 3, 2024
In my last post, I described the Pediatric Readiness Score and its components. Today, I’ll explain why maintaining a high score may benefit your trauma center and what it costs to do so. Research groups at the Oregon Health Sciences University and the University of Utah combined multiple data sources to estimate current levels of ED pediatric readiness, the cost to achieve it, the number of pediatric deaths in emergency departments, and the number of potential lives saved if readiness is m
Thinking Critical Care
DECEMBER 8, 2024
Every resus doc needs to have a holistic approach to shock – MAP and forward flow simply isn’t enough. Here, Matt and I chat a bit about recent things we’ve heard in the world around us, as well as how we use and see the use of the interface concept. Don’t forget to come up your game at #HR25!!!
EMDocs
DECEMBER 6, 2024
Authors: Haley Dusek, MD (Emergency Medicine Resident, Carolinas Medical Center ); Erik Fisher, MD (Emergency Medicine Attending/Medical Toxicologist, Carolinas Medical Center) // Reviewed by: Anthony Spadaro, MD (@TSpadaro91, Medical Toxicology Fellow, Rutgers New Jersey Medical School, Newark, NJ); James Dazhe Cao, MD (@JamesCaoMD, Associate Professor of EM, Medical Toxicology, UT Southwestern Medical Center, Dallas, TX); Alex Koyfman, MD (@EMHighAK); and Brit Long, MD (@long_brit) Case: A 27-
Emergency Medicine News
DECEMBER 1, 2024
No abstract available
Science Based Medicine
DECEMBER 20, 2024
If RFK Jr. "researches" vaccines, he will certainly "discover" they cause autism. It's possible that this "research" will be used as justification to revoke authorization for vaccines. That's always been the endgame. The post Trusting RFK Jr. to Research Vaccines is Like Trusting a Hungry Python to Babysit a Kitten first appeared on Science-Based Medicine.
St. Emlyn
DECEMBER 10, 2024
St.Emlyn's - Emergency Medicine #FOAMed A podcast with some of the highlights from the London Trauma Conference 2024 The post Podcast – Reflections from the London Trauma Conference 2024: Insights and Inspiration appeared first on St.Emlyn's.
Core Medical Group
DECEMBER 3, 2024
This year's Core Cares Wrapped is here! See how our team has given back in 2024 and how we practiced this fundamental value this year.
RebelEM
DECEMBER 4, 2024
Take Home points : If the patient is low risk with CHA 2 DS 2 -VASc (men < 2, women < 3), cardioversion is safe up to 48 hours from onset. In higher risk patients, we should reserve cardioversion unless there is clear onset less than 12 hours or the patient has been anticoagulated for 3 weeks. Consider anticoagulation in every patient with atrial fibrillation whether they are cardioverted or referred.
EMDocs
DECEMBER 18, 2024
Authors: Kyler Osborne (EM-3 Resident Physician; Tacoma, WA); Katey DG Osborne, MD (EM Attending Physician; Tacoma, WA); Rachel Bridwell, MD (EM Attending Physician; Charlotte, NC) // Reviewed by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (@long_brit, EM Attending Physician) Welcome to emDOCs revamp!
Don't Forget the Bubbles
DECEMBER 16, 2024
Over the last decade, there has been a concerning decline in childhood vaccination rates in the UK. This has been mirrored in many parts of the world. This trend, exacerbated by the COVID-19 pandemic, has led to a resurgence of vaccine-preventable diseases such as measles and pertussis. Once on the brink of eradication, these diseases now pose significant public health risks, especially to vulnerable groups like infants, young children, and the immunocompromised.
St. Emlyn
DECEMBER 16, 2024
St.Emlyn's - Emergency Medicine #FOAMed The blog highlights the updated 2024 guidelines from the Royal College of Radiologists (RCR) on imaging in pediatric trauma. It emphasizes critical changes from the previous 2014 guidelines, focusing on the judicious use of imaging to minimize ionizing radiation exposure in children. Key updates include algorithms for blunt trauma, penetrating trauma, and blast injuries.
Emergency Medicine Cases
DECEMBER 3, 2024
In this month's ECG Cases Jesse McLaren takes us through 6 cases highlighting important mirror concepts in ECG interpretation including: which leads are reciprocal to each other, how to identify which is the main ST/T change and which is the mirror, reciprocal changes highlighting subtle inferior, lateral and posterior OMI, ST elevation in aVR as a mirror to widespread ST depression and more.
Taming the SRU
DECEMBER 17, 2024
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.
EMDocs
DECEMBER 11, 2024
Heres another case from Medical Malpractice Insights Learning from Lawsuits , a monthly email newsletter for ED physicians. The goal of MMI-LFL is to improve patient safety, educate physicians and reduce the cost and stress of medical malpractice lawsuits. To opt in to the free subscriber list, click here. Stories of med mal lawsuits can save lives.
Emergency Medicine News
DECEMBER 1, 2024
No abstract available
ACEP Now
DECEMBER 17, 2024
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.
Dr. Smith's ECG Blog
DECEMBER 16, 2024
Which patient needs a CT Scan? Case 1: 20-something woman with chest pain Case 2: 50-something man with chest pain Case 1 A 20-something yo woman presented in the middle of the night with severe crushing chest pain. It had begun 4 hours before arrival and was initially dull, but became severe and "unbearable" 2 hours prior to arrival. She was a walk-in at triage.
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