2022

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Stop the Bleed

Chicago EMT Training

Learning how to stop the bleed and procuring the materials to do so is an inexpensive insurance policy. Especially if you're in an area that is prone to gun violence. You don't need a license or permit to carry these things. You never know when you'll need it or someone around you may need it. [link] First up is the Tourniquet. There are a few varieties that have been heavily tested.

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ECG of the Week 21st December 2022

EMergucate

This ECG was obtained from a 22 year old man who had taken a polypharmacy overdose 24 hours ago. He had suffered a bradycardic / asystolic arrest and is currently in the intensive care unit.

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WTBS 28 I’m OK, How Are You? How can we innovate our way out of this crisis in EM and cope until we do?

Emergency Medicine Cases

In this month's Waiting to Be Seen blog Dr. Howard Ovens outlines challenges, innovations and coping strategies in the EM Crisis. The post WTBS 28 I’m OK, How Are You? How can we innovate our way out of this crisis in EM and cope until we do? appeared first on Emergency Medicine Cases.

EMS 130
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SGEM#385: If the Bones are Good, the Rest Don’t Matter – Operative vs Non-Operative Management of Scaphoid Fractures

The Skeptics' Guide to EM

Date: November 30th, 2022 Reference: Johnson et al. One-year outcome of surgery compared with immobilization in a cast for adults with an undisplaced or minimally displaced scaphoid fracture: A meta-analysis of randomized controlled trials. Bone Joint J 2022 Guest Skeptic: Dr.Matt Schmitz is an Orthopaedic Surgeon specializing in Adolescent Sports Medicine and Young Adult Hip Preservation. […] The post SGEM#385: If the Bones are Good, the Rest Don’t Matter – Operative vs Non-Operative Management

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Camera Measures Blood Pressure with Quick Look

Medgadget

At the University of South Australia, researchers designed a system that allows them to measure a patient’s blood pressure with a camera. The camera visualizes the patient’s forehead and focuses on two regions in particular to optically determine photoplethysmographic signals that AI algorithms then convert to blood pressure data. The researchers tested their system in 25 volunteers, and so far it has proven to be approximately 90% as accurate as traditional pressure cuff measurements.

OR 145
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EMCrit 335 – APRV TCAV for Lung Rescue Made Simple with Rory Spiegel

EMCrit Project

Every Resus doc should be able to crash a patient on to APRV for lung rescue. EMCrit Project by Scott Weingart, MD FCCM.

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REBEL Cast Ep111: The PREPARE II Trial – Fluid Bolus Prior to Intubation?

REBEL EM

Background: Some of the feared complications of endotracheal intubation include hypotension, cardiac arrest, and death (cardiovascular collapse). These complications can result from numerous causes including medication-induced vasodilation and decreased venous return to the heart due to increased intrathoracic pressure from positive pressure ventilation.

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30-something woman with a HEART score of zero, EDACS of 2, computer "Normal" ECG, and initial troponin < Limit of Detection

Dr. Smith's ECG Blog

I was working in triage very late when a 30 yo previously completely healthy woman walked in with 30 minutes of central chest pressure. This ECG was recorded: The computer called it "Normal" except for "Possible right ventricular conduction delay" What do you think? I immediately recognized an inferior-posterior-lateral OMI. There are hyperacute T-waves in II, III, and aVF.

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Episode 94: Better CPR at the end of the year with Josh Lupton and Ken Milne

The Overrun Podcast

We end the year with 2 great interviews about cardiac arrest. Josh Lupton is a physician in Oregon who found in 2021 that there might be an ideal number of rescuers for OHCA. Hint: It's more than you think. Then Ken Milne joins us from the S keptics Guide to Emergency Medicine to discuss whether heads-up CPR with a commercial device is ready for prime time.

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First Responder Grief During the Holidays

First Responder Wellness

This article is courtesy of Patrick McCurdy, Retired Sergeant/Deputy. — “I sat with my anger long enough until she told me her real name was grief.” C.S. Lewis It was Christmas Eve. We were looking for a domestic violence assault suspect. It was a pretty bad assault, and we were determined to find him. Everyone inside of the house said that he had run away, but there were no tracks in the fresh snow, and a K9 confirmed that there was no scent trail.

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Holiday Wellness

First Responders Wellness Center

HOLIDAYS & GET TOGETHERS Being a first responder comes with many challenges, one of which is navigating the holidays. Being home for the holidays is not always an option. So, if you do have to work, consider realistic plans that can be easily accomplished. Communication with your family and your work during this time will be the key. Ensure you are reasonable with your time and capabilities.

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ECG of the Week 14th December 2022

EMergucate

The following ECG was obtained in a 38 year old Indigenous man with a history of ischaemic cardiomyopathy at a regional hospital. He did not have a history of left bundle branch block previously.

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ECG Cases 38 – ECG Interpretation in Cocaine Chest Pain

Emergency Medicine Cases

Dr. Jesse McLaren discusses some key aspects of cocaine chest pain ECG interpretation in this month's blog including: Patients with cocaine-associated chest pain require benzodiazepines +/- nitroglycerine for symptom relief, aspirin and ECG to look for signs of occlusion and reperfusion. In patients with chest pain + ST elevation, consider false positive STEMI including early repolarization, LVH and Brugada-pattern.

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SGEM#382: Don’t Go Chasing Waterfalls to Treat Pancreatitis

The Skeptics' Guide to EM

Date: November 10th, 2022 Reference: de-Madaria E et al. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis (WATERFALL). NEJM 2022. Guest Skeptic: Dr. Salim R. Rezaie completed his medical school training at Texas A&M Health Science Center and continued his medical education with a combined Emergency Medicine/Internal Medicine residency at East Carolina University.

ALS 130
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Magnetic Microrobots Assist with Root Canal Treatment

Medgadget

Researchers at the University of Pennsylvania have developed a microrobot system that can help with biofilm disruption, drug delivery, and sample retrieval, all within the restrictive space of the root canal. It can be difficult for dentists to know if they have removed all the infectious material when performing a root canal, and failure to do so will typically result in an infection reoccurring.

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PulmCrit – Myth-busting the conditional nephrotoxicity of piperacillin-tazobactam

EMCrit Project

Most medical myths arose decades ago, prior to the era of modern evidence-based medicine. When investigating the origin story of those myths, we wind up reading grainy old papers from the 1950s. Surely, we think, such myths wouldn’t arise today – not in our shiny, interconnected, science-based, hyper-argumentative medical world. Unfortunately, new myths do continue […].

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Pro-MEDIC

The Bottom Line

In adults with an expected ICU stay of > 72 hours, does the provision of enteral melatonin compared to placebo increase the number of delirium-free assessments within 14 days or before ICU discharge?

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Does Spine Surgery Have a Role in Low Back Pain? - Clinical Correlations

Clinical Correlations

By: Michael Moore Peer Reviewed “Too many complex back surgeries are being performed and patients are suffering as a result” wrote National Public Radio health science journalist Joanne Silberner in her 2010 article “Surgery May Not.

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See OMI vs. STEMI philosophy in action

Dr. Smith's ECG Blog

by Emre Aslanger Dr. Aslanger is our newest editorial member. He is an interventional cardiologist in Turkey. Dr. Aslanger is also the author of the DIFFOCULT study: Emre K. Aslanger , a, ⁎ Özlem Yıldırımtürk , b Barış Şimşek , c Emrah Bozbeyoğlu , c Mustafa Aytek Şimşek , a Can Yücel Karabay , b Stephen W. Smith , d and Muzaffer Değertekin a DIFOCCULT: DIagnostic accuracy oF electrocardiogram for acute coronary OCClUsion resuLTing in myocardial infarction.

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REBEL Core Cast 92.0 – Perichondritis

REBEL EM

Take Home Points Perichondritis is an infection of the cartilage and connective tissue of the ear Perichondritis can be recognized clinically by erythema, swelling and tenderness of the auricle. The most common organism in perichondritis is P. aeruginosa and antibiotics should be tailored to cover this organism REBEL Core Cast 92.0 – Perichondritis Click here for Direct Download of the Podcast Background Perichondritis may appear to be a simple cellulitis of the ear but, in fact, it repres

EMS 52
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Snow ambulance and snow rescue: news from the Stem world

Stem EMS

Every year around 30.000 individuals are involved in an accident on ski slopes, of which almost 1.500 need help, care, or hospitalization. Not to mention almost 20 fatalities on ski slopes every year. L'articolo Snow ambulance and snow rescue: news from the Stem world proviene da Stem Ems.

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Creating and Keeping Healthy New Year’s Resolutions

First Responder Wellness

After the flurry and liveliness of holiday festivities comes a time for quiet reflection, as many look back on this past year and prepare for the next. This desire to continue improving oneself as we make our New Year’s resolutions is a healthy intention. It is admirable to make goals for ourselves continually, but when these goals become too unrealistic, we can set ourselves up to feel anxiety and disappointment if we do not achieve them.

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ECG of the Week 7th December 2022

EMergucate

Paramedics ring through to say that they are 10 minutes away with a 65 year old man who has a heart rate of approximately 170 with a thready pulse and a systolic blood pressure of 90.

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Ep 177 Bronchiolitis – Diagnostic Challenges and Management Pitfalls

Emergency Medicine Cases

In this main episode podcast Anton discusses with world expert and bronchiolitis researcher Dr. Suzanne Schuh, the challenges of the diagnosis and management of bronchiolitis during a time of crisis in pediatric emergency medicine and offers some evidence-based solutions to improving outcomes while minimizing valuable resources, as part of our 'Best of University of Toronto EM' series.

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What You Can Learn From How EMS Professionals Process Failure

Gold Cross Ambulance Service

Despite our best efforts, things don’t always work out exactly as we had hoped 100 percent of the time. That’s especially true in the field of emergency response. Learning to process failure is a very important skill to have as an EMS professional, because if we can’t learn and grow from failures, future patients will be worse off. The same can be said for the average individual.

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AR Headset Helps Surgeons Place Implants: Interview with Louie Vogt of Enovis Surgical

Medgadget

Enovis , a medtech company based in Delaware formerly known as DJO, recently announced the launch of ARVIS (Augmented Reality Visualization and Information System), an augmented reality technology that is designed to assist surgeons during implant placement in the hip and knee. The hands-free technology consists of an eyepiece that is mounted on a surgical helmet that provides the surgeon with real-time information about the position of an implant with respect to patient anatomy.

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EMCrit 331 – Awareness after Resus RSI and ICU Paralysis – It is Unacceptable!!!

EMCrit Project

It is unacceptable to have the rates of Awareness during Paralysis seen in a recent ED sedation study--We are better than this. EMCrit Project by Scott Weingart, MD FCCM.

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TEAM

The Bottom Line

Early Active Mobilization during Mechanical Ventilation in the ICU @chodgsonANZICRC @TEAMtrialICU. NEJM 2022; 387:1747-58 doi:10.1056/NEJMoa2209083 Clinical Question In mechanically ventilated adult patients does the provision of early mobilisation when compared to standard care increase the number of days alive and out of hospital at 180 days?

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Episode 121: PEC Journal Volume 26 Number 4

Prehospital Emergency Care Podcast

Happy Thanksgiving! As you slowly recover from stuffing yourself with turkey and getting ready for Christmas, check out this latest PEC podcast where we cover the Prehospital Emergency Care Journal Volume 26 Number 4. In this episode we cover manuscripts like: Comparison of Four Methods of Paramedic Continuing Education in the Management of Pediatric Emergencies & A Standardized Formulary to Reduce Pediatric Medication Dosing Errors: A Mixed Methods Study Click here to download today!

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Right Bundle Branch Block and Posterior OMI????

Dr. Smith's ECG Blog

This 39 year old patient presents with syncope. What do you think? There appears to be RBBB with excessively discordant ST depression (2-2.5 mm) in V2 and V3, suggestive of RBBB with posterior OMI Whenever you see abnormal ST-T (ST elevation, ST depression, hyperacute T-waves), you MUST look at the entire ECG (rhythm, rate, P-waves, intervals, and QRS) to see if there is some abnormality among these which can explain the ST-T.

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Short Course Antibiotics for Peds CAP: A Systematic Review and Meta-Analysis

REBEL EM

Background: There is a shifting paradigm with persuasive evidence favoring a shorter duration of antibiotics for outpatient management of community-acquired pneumonia (CAP) in children. The SAFER and CAP-IT trials found that short-course antibiotic therapy was not inferior to standard duration therapy. The SCOUT-CAP Trial found that short-course antibiotic therapy was superior to standard therapy.

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5 Benefits of Mindfulness in EMS

On Time Medical Transportation

Mindfulness yes it sounds great in theory, but did you know that practicing this skill can have very real and practical benefits in EMS? Mindfulness is the state of being conscious or aware of something. It can also refer to focusing awareness on the present moment, while calmly acknowledging our feelings, thoughts, and sensations without being overly reactive or overwhelmed.

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Managing Acute Psychosis Emergencies

The Overrun

Whether it be at a college party or in the nursing home at 3 AM, managing an acute psychosis patient is something EMTs and Paramedics encounter with frequency during their tenure. A college student under the influence of mind-altering drugs and an elderly person suffering from sequelae of brain disease can be very similar sometimes… who knew! Today I wanted to talk about acute psychosis , a term that describes a patient’s mental disconnection from reality due to a various array of conditions.

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Imaging Case of the Week 533 Answer

EMergucate

The pelvic x-ray shows: Right iliac wing fracture Right acetabular fracture Right inferior pubic ramus fracture Diastasis of the pubic … Continue reading →

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Journal Jam 21 Laceration Management – Does Timing of Closure, Irrigation, Gloves Type, Eversion Matter?

Emergency Medicine Cases

In this Journal Jam podcast Anton and Justin welcome special guest Dr. Haley Cochrane. We dive deep into the evidence for timing of closure and infection rate, fluid choice, volume and pressure of irrigation of lacerations, glove type and infection rate, how eversion of wound edges effects cosmetic outcomes and much more. You might be surprised to discover that the evidence for many things we do for lacerations that are considered "standard of care", is either weak or non-existent.

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A Novel Method for Heat Stroke Treatment Using a Body Bag

Handtevy

There are 2 types of heat stroke: ➊ Non-exertional (think elderly patient) ➋ Exertional (think athlete) Both need immediate cooling, by EMS ideally. But how can we do this effectively in the field? “Can someone bring me the body bag?” A case study was just published involving an 87-year-old woman found unconscious in a parking lot an oral temperature of 40◦C (104◦F) and an altered mental status.

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Device Measures Hemoglobin More Accurately in Dark Skin

Medgadget

Researchers at the University of Texas at Arlington, in collaboration with Shani Biotechnologies, a local firm, have created a point-of-care device that can accurately measure hemoglobin levels and perform pulse oximetry in individuals with dark skin. At present, methods to determine hemoglobin levels at the point of care, such as pulse oximetry, are inaccurate in individuals with higher levels of melanin in their skin, and there is a clear need to develop alternatives that work for everyone.