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.

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Outcomes 191

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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CDC Seizures Pediatrics EMS 130

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.

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Research 77

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!

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Seizures Emergency Department Hyperthermia / Hypothermia EMS 61

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.

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Head Injuries Administration Hospitals 113

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.

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Mass Casualty Incidents Pediatrics Outcomes 64

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.

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Dehydration Fluid Resuscitation Administration Resuscitation 52

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.

Infectious Diseases 59

Infectious Diseases Documentation/Coding Pediatrics CDC 59

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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Ultrasounds EKG/ECG Operations Emergency Department 65

First 10 EM

DECEMBER 16, 2024

Antibiotic resistance is an existential problem. Optimizing sepsis care, including the appropriate length of antibiotic therapy, is an important goal. So should we be willing to allow an increase in mortality to reduce total antibiotic use, as the ADAPT-Sepsis non-inferiority design seems to imply? The paper Dark P, Hossain A, McAuley DF, Brealey D, Carlson […] The post Killer antibiotic stewardship strategy?

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Sepsis EMS 65

RebelEM

DECEMBER 17, 2024

Bottom Line Up Top: There doesnt appear to be a morbidity or mortality benefit to treating fever in sepsis and fever may have a protective effect. Only treat fever if it causes the patient distress. Clinical Scenario: A 45-year-old woman presents with cough and shortness of breath. Vitals are BP 114/42, HR 138, T 102.1, Sat 93% on RA. The patient is alert and oriented and has no other complaints.

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Sepsis Shock EMS Emergency Department 55

EMCrit

DECEMBER 14, 2024

All thing for HyperAngulated Blade Mastery EMCrit Project by Scott Weingart, MD FCCM.

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NRC Health

DECEMBER 20, 2024

As AI continues to proliferate in the healthcare industry, health IT vendors are testing the waters with an emerging use case: understanding patient experience data. The post Is AI the key to understanding patient experience data? appeared first on NRC Health.

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PulmCCM

DECEMBER 20, 2024

PREOXI, BLING III, ASTER, ANNEXA, GRECO, plus reviews on PPIs, TRALI, nutrition, more

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Total Medical ComplianceHIPAA

DECEMBER 16, 2024

With the upcoming holidays and many family gatherings, one of the most important ways to protect yourself and loved ones is performing frequent hand hygiene. Good hand hygiene protects against sickness and disease such as the flu, respiratory syncytial virus (RSV), COVID-19, and other respiratory illnesses. Hand hygiene has been known to be the single most critical measure for reducing transmitting organisms (infectious agents) to patients and to each other.

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Hospitals 52

The Bottom Line

DECEMBER 15, 2024

Early Restrictive vs Liberal Oxygen for Trauma Patients Arleth. JAMA 2024. doi: 10.1001/jama.2024.25786 Clinical Question In adult patients experiencing blunt or penetrating trauma does an early restrictive oxygen strategy compared to a liberal oxygen strategy reduce death and/or major respiratory complications within 30 days?

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ALiEM

DECEMBER 20, 2024

A 3-year-old male with a history of severe atopic dermatitis presented for facial rash and hand pain. Mom had been applying Aquaphor and Vaseline several times a day. On the day of presentation, he woke up with a new rash over his face and hands which prompted the ED visit. He is up to date on childhood immunizations and is not prescribed any oral medications.

Infectious Diseases 52

Infectious Diseases Pediatrics Academics Emergency Department 52

Science Based Medicine

DECEMBER 17, 2024

Reality. Doesn't care what you think. The post Reality first appeared on Science-Based Medicine.

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Life in the Fast Lane

DECEMBER 18, 2024

Kevin Ostrowski and James Miers Procedure: Lateral Canthotomy Today we cover lateral canthotomy and cantholysis, with a guide made in partnership with a recent publication in Australasian Emergency Care

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The Bottom Line

DECEMBER 17, 2024

High-Flow Nasal Oxygen vs Noninvasive Ventilation in Patients with Acute Respiratory Failure RENOVATE and BRICNet Authors. JAMA 2024. doi: 10.1001/jama.2024.26244 Clinical Question In adult patients with acute respiratory failure does the use of high-flow nasal oxygen compared to noninvasive ventilation reduce the rate of endotracheal intubation or death at 7 days?

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ALiEM

DECEMBER 16, 2024

A 12-year-old male with a history of autism spectrum disorder and chronic sinusitis presented for forehead swelling. His mother reported that she noticed progressive forehead swelling for about one month. She had followed up with the patients pediatrician and ENT and was given oral cephalexin and fluticasone nasal spray which did not make any changes in his symptoms.

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Pediatrics Academics Wellness Infectious Diseases 52

PulmCCM

DECEMBER 18, 2024

Danger-Shock, video vs. DL, PROPHY-VAP, ENRICH, MARVEL, C.

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Shock 52

The Skeptics' Guide to EM

DECEMBER 14, 2024

Reference: Sanchez-Pinto, L.N., et al. Development and Validation of the Phoenix Criteria for Pediatric Sepsis and Septic Shock. JAMA 2024. Guest Skeptic: Prof. Damian Roland is a Consultant at the University of Leicester NHS Trust and Honorary Professor for the University of Leicesters SAPPHIRE group. He specializes in Paediatric Emergency Medicine and is a passionate believer and advocate of FOAMed.

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Sepsis Pediatrics Shock Hospitals 55

EM Ottawa

DECEMBER 19, 2024

Point-of-care ultrasound (PoCUS) for lower extremity deep vein thrombosis (DVT) remains a skill with significant variability in local practice. While some physicians perform DVT scans regularly, others rarely incorporate PoCUS into their workflow. Regardless of your current practice pattern, its always helpful to refresh your knowledge with these key dos and donts of DVT PoCUS. […] The post Mastery of DVT PoCUS appeared first on EMOttawa Blog.

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Ultrasounds 52

Dr. Smith's ECG Blog

DECEMBER 20, 2024

Written by Willy Frick with edits by Ken Grauer An older man with a history of non-ischemic HFrEF s/p CRT and mild coronary artery disease presented with chest pain. He said he had had three episodes of chest pain that day while urinating. The following ECG was obtained in the emergency department during active chest pain. ECG 1 What do you think? There is a lot going on in this ECG.

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EKG/ECG Wellness Emergency Department Shock 57

Sensible Medicine

DECEMBER 16, 2024

Sensible Medicine aims to give public voice to critical appraisal that is rejected by medical journals. I see two important messages in Dr. Rassi’s appraisal: one is the specific mistakes that this trial could lead to regarding treatment of patients with Chagas cardiomyopathy but the more important message is what it says about scientific conduct and publishing.

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Shock Hospitals Outcomes Research 52

PulmCCM

DECEMBER 16, 2024

This review was first published in October 2024; it is updated here with important new results from the SAHARA trial (English et al NEJM 2024) , with a series of (rough) meta-analyses of recent data. -Ed. When deciding whether to transfuse red blood cells to critically ill patients with anemia, less is more, generally speaking. Because transfusion can be harmful, current practice is to usually restrict it in the ICU to patients with hemoglobin less than 7 g/dL.

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Blood Transfusions Stroke Wellness 52

EM Ottawa

DECEMBER 18, 2024

Methodology: 4/5 Usefulness: 2/5 McMullan JT, et al. Ann Emerg Med. 2024 Oct;84(4):363-373. doi: 10.1016/j.annemergmed.2024.04.018. Question and Methods: This out of hospital, placebo-controlled, blinded, parallel group RCT compared reduction in pain scores between Fentanyl + IN Placebo and Fentanyl with IN Ketamine. Findings: There was no significant difference in reduction of pain scores or adverse […] The post Out-of-Hospital Intranasal Ketamine as an Adjunct to Fentanyl for the Treatme

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Hospitals 52

EMergucate

DECEMBER 15, 2024

The following elbow x-ray is from an adolescent who has pain & swelling in the elbow after a fall on outstretched hand. What can be seen?

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EMS 52

Board Bombs

DECEMBER 14, 2024

Who needs a sleep medicine fellowship when you can perform procedural sedations as an EM physician? Let's cover fundamental tips and tricks of this core competency of EM! Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind at here. Cite this podcast as: Briggs, Blake; Husain, Iltifat. 243.

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EMS 52

JournalFeed

DECEMBER 14, 2024

The JournalFeed podcast for the week of Dec 9-13, 2024. These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member. Monday Spoon Feed : A post-hoc analysis of 3 studies conducted in Europe (PROPER, MODIGLIANI, TRYSPEED) analyzed patients with a high pretest probability for PE based on Wells or revised Geneva score and found that using D-dimer alone would have missed 0 PEs, but this strategy is not re

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Outcomes Wellness 52

St. Emlyn

DECEMBER 17, 2024

St.Emlyn's - Emergency Medicine #FOAMed All the best from the blog from October 2024, in our easy to digest podcast, including toxicology and cardiac arrest pearls The post Ep 254 – Monthly Round Up October 2024 – Toxicology, Cardiac Arrest and more appeared first on St.Emlyn's.

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Emergency Department 53

SCGH ED

DECEMBER 18, 2024

Here are some algorithms to assist in the management patients who present with cardiac arrest related to trauma – that is suspected to be resulting from either hypovolaemic shock, obstructive shock or neurogenic shock. Note – In the case of an isolated traumatic brain injury (TBI): “in the absence of other injuries, such patients should […] The post Traumatic Cardiac Arrest appeared first on Charlie's ED.

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Shock 52

Total Medical ComplianceHIPAA

DECEMBER 16, 2024

The U.S. Department of Health and Human Services (HHS) has issued the Final Privacy Rule to support reproductive health care and the protection of related health information under the Health Insurance Portability and Accountability Act (HIPAA). This amendment was designed to strengthen privacy and security for individuals seeking reproductive health care.

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Administration Operations 52

Core Ultrasound

DECEMBER 17, 2024

Ultrasound is a powerful tool that can significantly enhance patient care during cardiac arrest. In Part 1 of this lecture, we break down how ultrasound can be effectively utilized in three key areas: identifying reversible causes, assisting in critical procedures, and guiding resuscitation. RUSH exam Courses The post Cardiac Arrest Update 2024 (Part 1) first appeared on Core Ultrasound.

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Ultrasounds Resuscitation 40

St. Emlyn

DECEMBER 18, 2024

St.Emlyn's - Emergency Medicine #FOAMed The holiday season, a time typically marked by joy and celebration, presents unique challenges for those working in emergency and intensive care units. This is a reminder of a podcast from 2016, where Liz Crowe discusses how to navigate the complexities of grief and gratitude during this time of year. The post Podcast – Grief at Christmas appeared first on St.Emlyn's.

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EM Ottawa

DECEMBER 18, 2024

Methodology: 3.5/5 Usefulness: 2/5 Gravel J, et al. Ann Emerg Med. 2024 Nov;84(5):490-499. doi: 10.1016/j.annemergmed.2024.05.005. Question and Methods: The authors aimed to validate the Sick Kids algorithm for distinguishing bacteremia from contaminants in pediatric ED patients with positive blood cultures. Findings: The algorithms sensitivity and specificity were 100% and 11% respectively; suspicion for osteoarticular infection, […] The post Validation of the Hospital for Sick Children A

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Hospitals Pediatrics Infectious Diseases 52