Ken Grauer, MD
DECEMBER 28, 2024
I was sent the ECG in Figure-1 told only that the patient was an older adult who reported dizziness with activity. QUESTIONS: What is the rhythm? ( HINT: There are at least 4 important findings that should be noted ). Is there AV block? Figure-1: The initial ECG in today's case. ( To improve visualization I've digitized the original ECG using PMcardio ).
Sensible Medicine
DECEMBER 28, 2024
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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Emergency Medicine Journal
DECEMBER 30, 2024
The authors are an Emergency Physician and a Midwife on board the Geo Barents, Médecins Sans Frontières’ search and rescue ship in the Central Mediterranean Sea. Médecins Sans Frontières depends on private donations to support its work— www.msf.org.uk We are handed a little girl, maybe 3-year old and wrapped tight in winter clothes.
PulmCCM
DECEMBER 30, 2024
PEERLESS, ABC-SEPSIS, IV vs IO, BALANCE, FAST, SAHARA, TESLA/LASTE, Epic sued, ChatGPT vs MDs, more
PEMBlog
DECEMBER 30, 2024
Guess who’s back? Back again. Epi Pen. Jab a friend. Give that EpiPen even if you think it might possibly be anaphylaxis! Lyrics His palms are sweaty, knees weak, arms are heavy, He’s allergic, it’s anaphylaxis already. He’s chokin’, his throat’s closin’, hives all over, IgE mediated, peanut exposure Mucosa swollen, he’s gaspin’ for breath, Heart poundin’ like a drum, he’s scared to death. multi system reaction, puking and wheezin
Sensible Medicine
DECEMBER 29, 2024
An introduction to oncology for medical students
Emergency Medicine Journal
DECEMBER 30, 2024
We would like to thank the author for their comments. We would be happy to provide some further explanation regarding the questions and comments regarding our paper. 1 A correction has now been issued for points (2) and (3). (1) In regards to the cost discrepancy of andexanet alfa, we cited and referenced the correct cost of the medication as of 2019, at the time of the study.
Emergency Care Today brings together the best content for emergency care practitioners from the widest variety of industry thought leaders.
The Skeptics' Guide to EM
DECEMBER 28, 2024
Date: December 26, 2024 Reference: Steinhauser S et al. Emergency department staff compassion is associated with lower fear of enacted stigma among patients with opioid use disorder. AEM December 2024 Guest Skeptic:Dr. Suchismita Datta. She is anAssistant Professor and Director of Research in theDepartment of Emergency Medicine at the NYU Grossman Long Island Hospital Campus.
Dr. Smith's ECG Blog
DECEMBER 29, 2024
Dizziness is so unlikely to be OMI without an obvious ECG, that I am going to pretend that this patient presented with chest pain. The PMCardio Queen of Hearts app asks you, before giving an interpretation of OMI ("STEMI-Equivalent"), whether the patient's clinical presentation is high risk for OMI. If no, then she will tell you that the case is outside of the intended use group.
Emergency Medicine Journal
DECEMBER 30, 2024
In a recent article by Sadek et al ( Sadek E, et al. Emerg Med J 2024; 41: 162 – 7 ), we noted several incorrect statements and respectfully ask the authors to correct the following points: In the introduction of their article (Sadek et al , p163), 1 Sadek et al 1 stated the following: "The costs of low dose and high dose of andexanet alfa are approximately $29 040 and $58 080, respectively.
Sensible Medicine
DECEMBER 30, 2024
The debate of the week on social media centered on the role of immigrants working on US visa programs. Dr Ashish Jha posted on X an observational study in the BMJ that he co-authored, which found that international medical graduates outperformed US doctors. The flawed study offers many lessons in critical appraisal. First a note on Dr. Jha, whom I have not met and mean no malice.
Science Based Medicine
DECEMBER 30, 2024
One of many shameful incidents in the life of antivax activist Robert F. Kennedy Jr. was his promotion of anti-MMR fear mongering during a measles epidemic in Samoa. Now that he could become HHS Secretary, his apologists are frantically trying to gaslight you. Here's how. The post Gaslighting RFK Jr.s role in the deadly Samoan measles outbreak first appeared on Science-Based Medicine.
EM Updates
DECEMBER 29, 2024
Depending on how you count, I’ve now been doing emergency medicine for 20 years. This is how I see patients. The protocol below does not apply to resuscitation patients. For resuscitation patients, see The First Five Minutes of Resuscitation. I apply this protocol to just about every patient. When you are systematic, you don’t miss stuff.
Emergency Medicine Journal
DECEMBER 30, 2024
Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication.
JournalFeed
DECEMBER 28, 2024
The JournalFeed podcast for the week of Dec 23-27, 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: In patients presenting with an abdominal gunshot wound with clear indications for operative intervention, a preoperative CT provides no additional benefit and frequently misses injuries.
EMDocs
DECEMBER 28, 2024
Authors: Evan Carlen, MD (EM Resident Physician, Mizzou Columbia, MO); Jessica Pelletier, DO, MHPE (Assistant Professor of EM/Assistant Residency Director, Mizzou Columbia, MO) // Reviewed by: Sophia Grgens, MD (EM Physician, BIDMC, MA); Cassandra Mackey, MD (Assistant Professor of Emergency Medicine, UMass Chan Medical School); Brit Long, MD (@long_brit) Welcome to EM@3AM, an emDOCs series designed to foster your working knowledge by providing an expedited review of clinical basics.
Maria Yang, MD
DECEMBER 29, 2024
Guys, were getting to the end of this project! Weve made it to the last three instances (14, 15, and 16) of the word mental in Project 2025. (I still need to return to the third instance; that will follow soon.) This will also be a short post because theres not much to analyze in these last three instances. The 14th instance of the word mental in Project 2025 is on page 879, in the closing section about the FTC: Conservative approaches to antitrust and consumer protection continue to trust marke
Emergency Medicine Journal
DECEMBER 30, 2024
This month’s update is by the Aberdeen Royal Infirmary Emergency Department in Scotland. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper.
Emergency Medicine Journal
DECEMBER 30, 2024
Clinical Introduction A 13-year-old girl fell while horseback riding and landed on her right shoulder. She experienced immediate pain and swelling over her right shoulder. On clinical examination, a skin dimple was noted over the bruised area of her swollen right shoulder ( figure 1 ). The ‘badge area’ sensation and distal neurovascular status were normal.
Emergency Medicine Journal
DECEMBER 30, 2024
Trauma and emergency care is a national priority in Uganda due to the high burden of injury, impacting a primarily young and rural population. With a significant gap in qualified emergency medicine professionals, a need exists to rapidly upskill the current health workforce and to strengthen access to learning for non-specialist emergency care providers nationally.
Emergency Medicine Journal
DECEMBER 30, 2024
Background On-scene improvised and interim decontamination protocols in the Initial Operational Response to chemical incidents aim for rapid intervention to minimise injury before specialist capabilities arrive. This study examines the effectiveness of UK improvised and interim protocols conducted in sequence. Method A simulant with methyl salicylate (MeS) in vegetable oil and a fluorophore was applied to participants’ shoulders, arms and legs.
Emergency Medicine Journal
DECEMBER 30, 2024
Background Pulse oximetry measures oxygen saturation non-invasively by using differential absorption of infrared signals which are dependent on the oxyhaemoglobin:deoxyhaemoglobin ratio. We tested the hypothesis that pulse oximetry error in measurements of blood oxygen saturations may be associated with blood haemoglobin levels. Methods The study design was an observational study of all adult patients admitted to a large teaching hospital with suspected or confirmed COVID-19 infection from Febru
Emergency Medicine Journal
DECEMBER 30, 2024
Introduction Emergency doctors routinely face uncertainty—they work with limited patient information, under tight time constraints and receive minimal post-discharge feedback. While higher uncertainty tolerance (UT) among staff is linked with reduced resource use and improved well-being in various specialties, its impact in emergency settings is underexplored.
Emergency Medicine Journal
DECEMBER 30, 2024
Background Patients with traumatic out-of-hospital cardiac arrest (t-OHCA) require on-scene airway management to maintain tissue oxygenation. However, the benefits of prehospital endotracheal intubation remain unclear, particularly regarding neurological outcomes. Therefore, this study aimed to evaluate the association between prehospital intubation and favourable neurological outcomes in patients with t-OHCA.
Emergency Medicine Journal
DECEMBER 30, 2024
Clinical introduction A 65-year-old man presented to the ED after experiencing syncope during a flight. On arrival, his vital signs were stable, including normal oxygen saturation while breathing ambient air. Physical examination revealed normal respiration, the absence of a heart murmur and no lower extremity oedema. Laboratory examination, chest radiography and electrocardiography were unremarkable.
Emergency Medicine Journal
DECEMBER 30, 2024
Background Calls to emergency departments (EDs) from ambulances to alert them to a critical case being transported to that facility that requires a special response (‘pre-alerts’) have been shown to improve outcomes for patients requiring immediate time-critical treatment (eg, stroke). However, little is known about their usefulness for other patients and the processes involved in ED responses to them.
Emergency Medicine Journal
DECEMBER 30, 2024
Background Ambulance clinicians use pre-alerts to inform receiving hospitals of the imminent arrival of a time-critical patient considered to require immediate attention, enabling the receiving emergency department (ED) or other clinical area to prepare. Pre-alerts are key to ensuring immediate access to appropriate care, but unnecessary pre-alerts can divert resources from other patients and fuel ‘pre-alert fatigue’ among ED staff.
Emergency Medicine Journal
DECEMBER 30, 2024
Background Ambulance clinicians use pre-alert calls to inform emergency departments (EDs) about the arrival of critically ill patients. However, there is variation in guidance between local ambulance service policies in terms of what should be pre-alerted and how pre-alerts should happen. We conducted a national online survey to understand the use of ambulance pre-alerts and to inform recommendations for practice and guidance.
Emergency Medicine Journal
DECEMBER 30, 2024
Introduction Stress and burnout are prevalent among emergency department (ED) staff in the UK. The concept of well-being interventions for ED staff is a growing area of interest and research worldwide. Various interventions are described in the literature, yet little is known about the experience of ED staff in the UK of interventions designed to support their well-being.
Emergency Medicine Journal
DECEMBER 30, 2024
Background The Emergency Department(ED) team need to make sense of an ever-changing dynamic environment. The stories people tell about everyday occurrences are central to how sense-making occurs. These stories also contribute to organisational culture, with the frequently told narratives maintaining organisational identity and shaping behaviour. By capturing stories in the ED, valuable insights can be gained into organisational culture and identity.
Emergency Medicine Journal
DECEMBER 30, 2024
Does your emergency department (ED) feel like a constant battle? Has the function of your ED been destroyed by external forces? It might strike the reader as extreme to use words related to battle regarding current working conditions in EDs but for most of us this is probably not far from the truth. When you think about battles, you think about frontline casualties (an irony given the origins of emergency medicine (EM)) and how there must be sacrifice for the majority to succeed.
Emergency Medicine Journal
DECEMBER 30, 2024
Happy New Year and welcome to the first primary survey for the Emergency Medicine Journal of 2025. I hope there was an opportunity to rest over the holiday period and for those that were working, thank you. A new year brings us straight into another exciting edition of the journal. This month, the journal brings a prehospital extravaganza of papers, along with global health and staff well-being.
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