Sat.Jun 08, 2024 - Fri.Jun 14, 2024

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SGEM#442: I’m on the Right Track Baby I Was Born This Way

The Skeptics' Guide to EM

Reference: Kruse et al. Systematic Review, Quality Assessment, and Synthesis of Guidelines for Emergency Department Care of Transgender and Gender-diverse People Recommendations for Immediate Action to Improve Care. WJEM December 2023 Date: May 30, 2024 Guest Skeptic: Dr. Kay Dingwell is a rural emergency physician working in Prince County, PEI with a special interest in gender-affirming care and improving the care of trans and gender-diverse patients.

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From Collision to Clarity: PECARN cervical spine injury prediction rule for injured children

ALiEM

For years, adult literature has provided clear guidelines for cervical spine imaging through the NEXUS and Canadian C-spine Rule (CCR) tools. These have been invaluable in helping clinicians decide when to image the neck in trauma patients. Similarly, the Pediatric Emergency Care Applied Research Network (PECARN) has developed robust tools for assessing blunt head trauma in children.

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Acute Transverse Myelitis in Children

Pediatric EM Morsels

Ooooo the infamous chief complaint of “ weakness ” ……. We just love those don’t we? Although neurological complaints may not be a crowd’s favorite, it is one we must become comfortable with. Timely recognition and treatment can be life-improving and life-saving! So, with that goal in mind, let us digest another delicious morsel on weakness – Acute Transverse Myelitis in Children : Acute Transverse Myelitis in Children: Basics Rare, non-compressive, inflammatory condition of the spinal cord

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CMS GADCS: Labor Costs Webinar Recording

American Ambulance Association

CMS recently posted an updated Medicare Ground Ambulance Data Collection System (GADCS) webinar on Labor Costs on their Ambulance Events webpage. The post CMS GADCS: Labor Costs Webinar Recording appeared first on American Ambulance Association.

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Lightning rounds 41: Respiratory therapy with Keith Lamb

Critical Care Scenarios

We explore the profession of respiratory therapy in the US, including their role and training and how to optimize our clinical relationships, with Keith Lamb (@kdlamb1), RRT, RRT-ACCS, FAARC, FCCM. Keith is an RT at the University of Virginia in Charlottesville, working clinically in neuro/surgical/trauma critical care, who has been active in research and has … Continue reading "Lightning rounds 41: Respiratory therapy with Keith Lamb" We explore the profession of respiratory therapy in the US,

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BiPAP for preoxygenation (the PREOXI trial)

First 10 EM

Preparation for intubation, appropriate preoxygenation, and preventing peri-intubation arrests has been one of my core topics for conference talks. My initial airway series emphasized “optimizing the basics” and carefully considering “is this patient ready for intubation?”. My “RSI and then they die” lecture is by far my most watched video on YouTube.

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ECG of the Week 12th June 2024

EMergucate

You are looking after a 60-year-old male who has presented with left-sided chest pain and dyspnoea.

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EMCrit 377 – Breaking News – The PREOXI Trial changes everything about Preoxygenation for Intubations in the Critically Ill

EMCrit Project

the PREOXI trial validates what I have been saying for 15 years about preoxygenation for the critically ill patient EMCrit Project by Scott Weingart, MD FCCM.

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Ten Tips for Better Presentations – Part 1

St. Emlyn's

St.Emlyn's - Emergency Medicine #FOAMed Presentation skills - what are they and why do we need to have them? This post covers the things to consider before you even open any presentation software. The post Ten Tips for Better Presentations – Part 1 appeared first on St.Emlyn's.

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lab case 445 interpretation

EMergucate

Answers: Ph = 7.51, that is mild alkalaemia. HCO3 = 47.5 mmol/L. So, we have metabolic alkalosis.

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Prehospital "Altered mental status and hypotension due to probable DKA" (everyone must know this ECG diagnosis)

Dr. Smith's ECG Blog

A patient presented with hypotension and altered mental status and presumption of DKA. As the medics arrived, they handed me this ECG: What medication did I call for IMMEDIATELY when I saw this? This is obviously severe hyperkalemia and the patient is near cardiac arrest. The medics had no idea. I called for 2 grams of Calcium Chloride. There was no IV access, so we obtained intraosseous (IO) access, but she arrested before we could give her all the calcium.

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Paxlovid doesn’t work for long COVID either (The STOP-PASC trial)

First 10 EM

As we have covered multiple times before, the evidence for paxlovid is heavily conflicted and mostly negative. There is very little reason to be using this agent clinically. However, despite an utter lack of evidence, many people have held out hope that paxlovid might be the miracle cure for the nebulous long COVID syndrome (referred […] The post Paxlovid doesn’t work for long COVID either (The STOP-PASC trial) appeared first on First10EM.

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Paediatric Emergency Medicine – Premier Conference – Day 1

St. Emlyn's

St.Emlyn's - Emergency Medicine #FOAMed Discover the highlights of Day 1 at the Premier conference on Paediatric Emergency Medicine. The post Paediatric Emergency Medicine – Premier Conference – Day 1 appeared first on St.Emlyn's.

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Lab case 446

EMergucate

The following blood gases results were given to a doctor to sign, explain the findings PH = 7.

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How to Hyperoxygenate Before Suctioning

SSCOR

Hypoxia is one of the most common suctioning complications. It’s also preventable in most scenarios. Hyperoxygenate a patient before suctioning to reduce the risk of hypoxia as well as other suctioning complications. Here’s what you need to know about the process.

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The Expert Witness re-visits a chest pain Malpractice case using the Queen of Hearts

Dr. Smith's ECG Blog

This case was posted by Eric Funk ( [link] ) , editor of the Expert Witness Newsletter , on his site. Here is the case on his site. He has graciously allowed me to repost it here. It is a case he presented several years ago, but then want to re-visit in light of the Queen of Hearts AI system. Don't miss his analysis and assessment of the Queen of Hearts AI OMI ECG bot -- that assessment is at the very bottom of the post.

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JC: Does the outcome from refractory VF differ from recurrent VF in DOSE-VF patients?

St. Emlyn's

St.Emlyn's - Emergency Medicine #FOAMed This secondary analysis of the DOSE VF trial highlights double sequential external defibrillation (DSED) as a superior strategy over standard and vector change defibrillation for refractory ventricular fibrillation (RVF) in out-of-hospital cardiac arrest, improving survival rates and neurological outcomes significantly.

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REBEL Core Cast 124.0 – Hyperinsulinemia Euglycemia Therapy

REBEL EM

Take Home Points Management of severe beta-blocker and calcium-channel blocker toxicity should occur in a stepwise fashion: potential gastric decontamination, multiple lines of access, judicious fluids, calcium, glucagon, and vasopressors as needed. Initiation of high dose insulin therapy requires a tremendous amount of logistical and cognitive resources as it requires cross-disciplinary collaboration and is prone to mismanagement.

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EM@3AM: Traumatic Iritis

EMDocs

Authors: Eliza Szybka, DO (EM Resident Physician, Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn IL); Michael Cirone, MD (@mcironeMD, Assistant Program Director, Advocate Christ Medical Center, Oak Lawn IL) // Reviewed by: Sophia Görgens, MD (EM Physician, Northwell, NY); 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

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Palpitations while awaiting CABG

Dr. Smith's ECG Blog

Written by Willy Frick A 57 year old man with was admitted to the hospital with chest pain. He underwent coronary angiography which showed severe multivessel disease, and he agreed to proceed with workup for CABG. Overnight, his cardiac telemetry showed the following: Telemetry Sample 1 What do you think? The rhythm terminated before it could be captured on 12-lead.

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Short Oral Antibiotic Therapy for Pediatric Febrile Urinary Tract Infections: A Randomized Trial

EMOttawa

Methodology: 3.5/5 Usefulness: 2.5/5 Montini G, et al. Pediatrics. 2024 Jan 1;153(1):e2023062598. Question and Methods: This multicenter, parallel-group randomized controlled trial intended to determine the non-inferiority of a 5-day versus 10-day course of oral clavulin for treating of febrile urinary tract infections (fUTI) in children. Findings: The primary outcome of recurrence of UTI within 30 […] The post Short Oral Antibiotic Therapy for Pediatric Febrile Urinary Tract Infections:

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Nebulised GTN in the ED

Life in the Fastlane

Kane Guthrie Nebulised GTN in the ED Nebulised GTN in the ED.

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Medical Malpractice Insights: “Sign right here and you’re good to go”

EMDocs

Here’s 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.

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Recognizing the Unseen Heroes: Dispatchers and Their Vital Role

First Responders Foundation

When an emergency strikes, the swift coordination of services can mean the difference between life and death. Integral to this process, yet often overshadowed by the more visible presence of first responders, are the emergency dispatchers. Dispatchers serve as the critical first point of contact and play a vital role in orchestrating the complex dance of emergency response with calm precision.

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What Is the 3-3-2 Rule for Predicting Difficult Airways?

SSCOR

Predicting difficult airways is key to successful intubation , and can minimize psychological and physical trauma to patients. Patients with difficult airways face higher morbidity and mortality rates because intubation may be delayed or even impossible. A simple mnemonic device can help you quickly assess a patient’s airway and respond appropriately.

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Does the outcome from refractory VF differ from recurrent VF in DOSE-VF patients?

St. Emlyn's

St.Emlyn's - Emergency Medicine #FOAMed This secondary analysis of the DOSE VF trial highlights double sequential external defibrillation (DSED) as a superior strategy over standard and vector change defibrillation for refractory ventricular fibrillation (RVF) The post Does the outcome from refractory VF differ from recurrent VF in DOSE-VF patients?

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Emergency Physician Empowers Children to Read

ACEP Now

Nick Vasquez, MD, FACEP, gets to see the impact of social determinants of health every day in the emergency department. Like most in our specialty, he wants to help solve problems. He’s spent 12 years in this place “of inquiry and service,” as he calls it, trying to understand some of the root causes of health inequities. Dr. Vasquez honed in on one piece of the puzzle that he’s now passionate about trying to change: childhood literacy.

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How do Carbohydrates affect Diabetes?

Paramedics World

When you consume carbohydrates, your body converts most of them into glucose, which increases your blood sugar. The effect of these foods on your blood sugar levels depends on the… The post How do Carbohydrates affect Diabetes? appeared first on Paramedics World.

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Abdominal Imaging Cases 027

Life in the Fastlane

Kyle Cunningham MD and Michael Gibbs MD Abdominal Imaging Cases 027 June 2024 Adult Abdominal imaging cases and interpretation with Kylee Brooks, Parker Hambright, Alexis Holland, William Lorenz, Brent Mathews and Kyle Cunningham

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Necrotising Enterocolitis

Don't Forget the Bubbles

Welcome to your first day with the neonates! Upon arriving for your initial shift, you set down your bag, and shortly after, you’re asked to evaluate Baby A. Baby A, a preterm infant, appears to be faring well for the moment—requiring minimal respiratory support, on full feeds, without IV access, and generally in an okay condition. However, their nurse expresses concern, noting that they seem a bit “off.” Upon examination and reviewing their observations, everything appears okay.

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Why Performance Chasing Is an Investing Error

ACEP Now

Question I’m now eligible for my 401(k), and I need to pick which mutual funds to invest my contributions into. I’m not sure exactly how to do this, but I can see which ones had the best returns over the last one, three, and five years, so I just thought I’d put all my money into the top two or three of them so I’m diversified. Is that the right approach?

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What if your system adopted the recommendation that a computer "normal" ECG need not be shown to the doctor?

Dr. Smith's ECG Blog

Written by Pendell Meyers with edits by Smith. Sent by anonymous A man in his 40s with no previous heart disease presented within 30 minutes of onset of acute chest pain that started while exercising. There was associated shortness of breath and left arm radiation. This Triage ECG (ECG #1) was recorded on a chest pain patient at triage at 1906 (top highest quality image, bottom photo including computer algorithm interpretation): "Sinus rhythm, normal ECG" (This was performed on a Mortara machine

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LITFL Update 029

Life in the Fastlane

Kane Guthrie and Mike Cadogan LITFL Update 029 Update 028. Sending you FOAMed content from around the globe. Latest trends and best articles so that you stay top of your field.

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Tasty Morsels of Critical Care 082 | Carbon Monoxide Poisoning

Emergency Medicine Ireland

Welcome back to the tasty morsels of critical care podcast. We’re going to cover a bit of an environmental/tox topic today and look at carbon monoxide poisoning from Oh’s manual chapter 83 on burns. I have previously covered this on the old tasty morsels of EM series back when i was doing my EM fellowship exams. As you no doubt remember from school chemistry classes, carbon monoxide is a colourless, odourless, tasteless gas produced when combustion occurs with insufficient oxygen.

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Interhospital Transfer Capabilities Still Pose Major Issues

ACEP Now

Transferring patients from one ED to another hospital is an established part of emergency medicine practice. Patients who need inpatient services do not match the index hospitals’ capabilities, or the patient requests such a transfer, or the hospital has no available inpatient space. The rate of transfers was stable for many years, typically around 2 percent.

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emDOCs Podcast – Episode 102: Hypocalcemia in Trauma and the Diamond of Death

EMDocs

Today on the emDOCs cast with Brit Long, MD ( @long_brit) , we look at hypocalcemia in trauma and the diamond of death. Episode 102: Hypocalcemia in Trauma and the Diamond of Death Why is hypocalcemia in trauma something we should know about? Previous triad of death = hypothermia, acidosis, and coagulopathy. All are associated with critical illness and severe hemorrhage.

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Readers Respond: Ethical Issues in Interhospital Transfers of ED Patients

ACEP Now

A national physician on-call data center where hospital on-call lists are published and categorized by location would be of great value in locating the appropriate available hospital and physician. —Curtis Brown, MD. FACEP Who is liable when the ED is over capacity, boarders (admitted but not bedded) are using ED space and staff, and a patient is alleged to have come to harm?

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