December, 2023

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SGEM#422: And It was all Yellow-Nasal Discharge and Antibiotics in Pediatric Sinusitis

The Skeptics' Guide to EM

Reference: Shaikh N, et al. Identifying children likely to benefit from antibiotics for acute sinusitis: a randomized clinical trial. JAMA July 2023 Date: October 17, 2023 Guest Skeptic: Dr. Alasdair Munro is a clinical research fellow specializing in pediatric infectious disease at the University of Southampton. He is currently involved with clinical trials of vaccines […] The post SGEM#422: And It was all Yellow-Nasal Discharge and Antibiotics in Pediatric Sinusitis first appeared on The Skep

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Ep 189 Commonly Missed and Mismanaged Wrist Injuries

Emergency Medicine Cases

In this part 1 or our 2-part podcast series on wrist injuries Dr. Arun Sayal and Dr. Matt DiStefano answer such questions as:when should we suspect a DRUJ injury, why is it important to pick up DRUJ injuries in the ED, and how does it change our management? Why is the lateral x-ray view so important in picking up commonly missed wrist injuries? When it comes to distal radius fractures, how are Colles vs Barton's vs Smith's fractures managed differently in the ED?

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SAEM Clinical Images Series: Rapidly Spreading Rash

ALiEM

A 19-year-old female with a past medical history of epilepsy presented to the emergency department for evaluation of rash and fever. Two days prior to presentation she began to experience fevers with a Tmax of 103°F. One day before presentation she developed a rash that began on her face and slowly spread down her body, now involving her palms. The patient endorsed associated pruritus and cervical lymphadenopathy with the rash.

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GAPBAC | Materials from Oct 31, Nov 1 meeting posted

American Ambulance Association

This content is for AAA members only. Please either Log In or Join! The post GAPBAC | Materials from Oct 31, Nov 1 meeting posted appeared first on American Ambulance Association.

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Lightning rounds #35: Brain death updates, with Ariane Lewis and Matthew Kirschen

Critical Care Scenarios

Discussing the new 2023 AAN/AAP/CNS/SCCM Pediatric and Adult Brain Death/Death by Neurologic Criteria Consensus Practice Guideline, with the joint first authors: Dr. Ariane Lewis, neurointensivist, professor of neurology and neurosurgery at NYU Langone, director of neurocritical care, and chair of the Langone ethics committee, and Dr. Matthew Kirschen, pediatric neurointensivist and associate director of pediatric … Continue reading "Lightning rounds #35: Brain death updates, with Ariane Lewis a

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Episode 191: Rapid Atrial Fibrillation

Core EM

We go over the treatment of rapid atrial fibrillation (afib with RVR). Hosts: Brian Gilberti, MD Jonathan Kobles, MD [link] Download Leave a Comment Tags: Cardiology Show Notes Understanding AF with RVR Categories General AF with RVR: Definition and basic understanding. Rapid AF with Pre-excitation: Characteristics and complications. Chronic AF in Critical Illness: Identification and special considerations.

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SGEM#423: Where is the Love? Microaggression in the Emergency Department

The Skeptics' Guide to EM

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.

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SAEM Clinical Images Series: Enigmatic Traumatic Hip Pain

ALiEM

An 84-year-old female presented with a chief complaint of right hip pain after a fall 12 hours prior to presentation. The patient reported a history of falls resulting in shoulder, rib, and left hip fractures in the past. The patient stated that upon getting out of bed, she took 4-5 steps, lost her balance, and fell backward onto the bedroom floor. She denied loss of consciousness.

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VA Issues Notice on Delay of Special Modes of Transportation Final Rule

American Ambulance Association

This content is for AAA members only. Please either Log In or Join! The post VA Issues Notice on Delay of Special Modes of Transportation Final Rule appeared first on American Ambulance Association.

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Episode 68: Liver transplant with Meera Gupta

Critical Care Scenarios

We learn about liver transplant with Dr. Meera Gupta, transplant surgeon at the University of Kentucky Healthcare Transplant Center, and surgical director of the Kidney and Pancreas Transplant Program. We discuss eligibility, triage, the peri-operative course, and important post-op complications. Find us on Patreon here! Buy your merch here! Takeaway lessons We learn about liver transplant with Dr.

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Imaging Case of the Week 572 Answer

EMergucate

The portable chest x-ray shows evidence of pneumoperitoneum. The patient had a perforated sigmoid diverticulitis which resulted in profound pneumoperitoneum.

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SGEM#424: Ooh-Ooh, I Can’t Wait – To Be Admitted to Hospital

The Skeptics' Guide to EM

Reference: Roussel et al. Overnight stay in the emergency department and mortality in older patients, JAMA Intern Med 2023 Date: December 18, 2023 Guest Skeptic: Dr. Chris Carpenter, Vice Chair of Emergency Medicine at Mayo Clinic. Case: An 85-year-old patient (Ms. McG) presents to your emergency department (ED) after being found by family on the […] The post SGEM#424: Ooh-Ooh, I Can’t Wait – To Be Admitted to Hospital first appeared on The Skeptics Guide to Emergency Medicine.

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PulmCrit: New ARDS guidelines reveal a shambolic state of affairs

EMCrit Project

Within the past year, two major societies have released guidelines on ARDS: the ATS (American Thoracic Society) and the ESICM (European Society of Intensive Care Medicine). Don’t be fooled by their names – both of these organizations are fundamentally international in scope. Some authors on the ATS document were from Europe, and similarly some authors […] EMCrit Project by Josh Farkas.

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SAEM Clinical Images Series: Bulge in the Belly

ALiEM

A 45-year-old male status-post right nephrectomy secondary to a renal mass presented to the emergency department with right-sided flank pain. He endorsed low-grade intermittent right-sided flank pain since the nephrectomy one year prior, associated with an increasingly enlarging mass extending laterally from his right abdomen. Over the course of the past several days, the mass had become larger and more painful.

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EMS Profiles | Meet Michele Bracken

American Ambulance Association

Michele Bracken Training Officer Wendover Ambulance West Wendover, NV Share on: Facebook | Instagram | X | LinkedIn How did you come to be in EMS? I had a good […] The post EMS Profiles | Meet Michele Bracken appeared first on American Ambulance Association.

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When ROSC feels wrong

Don't Forget the Bubbles

“Okay team, we’ve been following the APLS algorithm for 30 minutes and have considered all reversible causes. This child has been in cardiac arrest for at least an hour and none of the interventions we have carried out have made a difference. The blood gas is incompatible with life. I think we should stop resuscitation. Does anyone have any objections?

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Lab case 431 interpretation

EMergucate

Answers: Question 1: PH = 7.58, that is severe alkalaemia. pCO2 = 20 mmHg, so we have respiratory alkalosis. Next we need to calculate the compensation.

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SGEM Xtra: Open Label Placebo

The Skeptics' Guide to EM

Date: November 20, 2023 Reference: Jones et al. Time to reflect on open-label placebos and their value for clinical practice. PAIN October 2023 Guest Skeptic: Dr. Caitlin Jones is a Postdoctoral Research Associate at Sydney University’s institute for Musculoskeletal Health. Her research evaluates the benefits and harms of treatments for musculoskeletal conditions with a particular […] The post SGEM Xtra: Open Label Placebo first appeared on The Skeptics Guide to Emergency Medicine.

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TIRBO 51: Critical care problems are syndromes

Critical Care Scenarios

The core disorders of critical care are mostly syndromes, not diseases. What should this mean to us? The core disorders of critical care are mostly syndromes, not diseases. What should this mean to us?

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SAEM Clinical Images Series: Penile Lesion with a Poor Prognosis

ALiEM

A 49-year-old male presented to the emergency department of an academic hospital with the chief concern of penile pain. Prior medical history is notable for end-stage renal disease on hemodialysis three times per week, but the patient has not been dialyzed in the past four days, hypertension, insulin-dependent diabetes mellitus, heart failure with reduced ejection fraction (59% two months prior), seizure disorder, prior pulmonary embolism (eight months prior), a left nephrectomy seven months ago

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GAO | Roll Out of IDR Process for Out-of-Network Claims Has Been Challenging

American Ambulance Association

Private Health Insurance: Roll out of Independent Dispute Resolution Process for Out-Of-Network Claims Has Been Challenging GAO-24-106335Published: Dec 12, 2023. Publicly Released: Dec 12, 2023. Jump To […] The post GAO | Roll Out of IDR Process for Out-of-Network Claims Has Been Challenging appeared first on American Ambulance Association.

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Button Battery Update 3.0

Life in the Fastlane

Neil Long Button Battery Update 3.0 Want to know the latest on button battery management, prevention and immediate care? Look no further than our latest tox offering.

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Lab case 432

EMergucate

84 year old man with history of asthma and COPD presented with acute shortness of breath. His venous blood gases showed the following: PH = 7.

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SGEM Xtra: Doctor, Doctor – We Need More Family Doctors

The Skeptics' Guide to EM

Date: December 12, 2023 Reference: OCFP News. More Than Four Million Ontarians Will Be Without a Family Doctor by 2026. Nov 7, 2023 Guest Skeptic: Dr. Mahaleh Mekalai Kumanan attended Dalhousie University for her undergraduate studies, Master of Health Administration degree and medical school before completing her residency at the University of Western Ontario.

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TIRBO #50: Never do anything once

Critical Care Scenarios

If you produce academic work, use the research to produce multiple products. Once is a waste. If you produce academic work, use the research to produce multiple products. Once is a waste.

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First10EM Journal Club: December 2023

Broome Docs

Welcome to another episode of the Emergency Medicine Journal Club with Dr Justin Morgenstern. This month we cover a bunch of papers that look at a lot of topics and try to answer questions such as: Can I push Keppra safely? Does BP management in haemorrhagic stroke matter? How good is my intuition about PE diagnosis? Is it a good idea to keep geriatric patients in the ED overnight?

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NHTSA Request for Information: Emergency Medical Services Education Agenda 2050

American Ambulance Association

From Regulations.Gov NHTSA published a request for information on October 13, 2023, seeking comments from all sources (public, private, government, academic, professional, public interest groups, and other interested parties) on […] The post NHTSA Request for Information: Emergency Medical Services Education Agenda 2050 appeared first on American Ambulance Association.

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AI Prompting Techniques

Life in the Fastlane

Sheralyn Guilleminot and Mike Cadogan AI Prompting Techniques 4 AI Prompting Techniques to Help You Stay Ahead in Medicine. AI prompting techniques are the key to using artificial intelligence efficiently and getting usable output.

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Imaging Case of the Week 575

EMergucate

The CT abdomen image is from an adolescent female patient with gradually worsening lower abdominal swelling and difficulty passing urine.

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A young woman with palpitations. What med is she on? With what medication is she non-compliant? What management?

Dr. Smith's ECG Blog

Written by Pendell Meyers A woman in her 20s with connective tissue disorder and history of aortic root and valve repair presented with palpitations. Here is her triage ECG: What do you think? Atrial flutter with 2:1 conduction. The atrial flutter rate is approximately 200 bpm, with 2:1 AV conduction resulting in ventricular rate almost exactly 100 bpm.

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JC: Selective aortic arch perfusion. St Emlyn’s

St. Emlyn's

St.Emlyn's - Emergency Medicine #FOAMed We generally try and review studies that are close to use in practice. but occasionally we spot something that is just interesting and which might give us a clue as … JC: Selective aortic arch perfusion. St Emlyn’s Read More » The post JC: Selective aortic arch perfusion. St Emlyn’s appeared first on St.Emlyn's.

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ECG Pointers: STEMI Equivalents from the American College of Cardiology

EMDocs

Authors: Genevieve Pentecost, MD (@genpentecost, Emergency Medicine Resident, Washington University School of Medicine in St Louis) and Aaron Lacy, MD (@AaronLacyMD, Assistant Professor of Emergency Medicine, Washington University School of Medicine in St Louis) // Reviewed by: Jamie Santistevan, MD (EM Physician, Presbyterian Hospital, Albuquerque, NM); Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Introduction Welcome back to ECG Pointers from emDOCS.

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Podcast | EMS One-Stop | Resuscitating EMS through trend analysis

American Ambulance Association

43 min PLAY The road ahead: Resuscitating EMS through trend analysisEMS One-Stop Government Listen on Apple Podcasts Collecting and communicating the big EMS news of 2023 The American Ambulance Association […] The post Podcast | EMS One-Stop | Resuscitating EMS through trend analysis appeared first on American Ambulance Association.

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5 Minute Sono – Fetal Heart Rate

Core Ultrasound

In this video, we guide you through the steps of using M-mode on a point-of-care ultrasound machine to accurately assess the fetal heart rate.

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Imaging Case of the Week 576 Answer

EMergucate

The chest x-ray shows left pleural based opacity protruding into the lung field with a reverse D appearance.

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Occlusion myocardial infarction is a clinical diagnosis

Dr. Smith's ECG Blog

Occlusion myocardial infarction is a clinical diagnosis Written by Willy Frick (@Willyhfrick). Willy is a cardiology fellow with a keen interest in the ECG in OMI. A woman in her late 70s presented with left arm pain. The arm pain started the day prior when she was at the dentist's office for a root canal. Her systolic blood pressure at the dentist was over 200 mm Hg.

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Adverse childhood experiences

Don't Forget the Bubbles

Adverse Childhood Experiences (or ACEs, for short) are no new thing, but only in recent decades have we come to realise the scope of their impact on children and the adults they become. ACEs can broadly be defined as traumatic events occurring before age eighteen. What counts as an ACE is open for interpretation, with the official domains liable to change.

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