February, 2023

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SGEM#392: Shock Me – Double Sequential or Vector Change for OHCAs with Refractory Ventricular Fibrillation?

The Skeptics' Guide to EM

Date: February 7, 2023 Reference: Cheskes et al. Defibrillation Strategies for Refractory Ventricular Fibrillation. NEJM 2022 Guest Skeptic: Dr. Sean Moore is an emergency physician working in Kenora Ontario, where he is Chief of Staff at Lake of the Woods District Hospital, Northern Medical Director for the Ornge air medical transport program and associate medical director with CritiCall […] The post SGEM#392: Shock Me – Double Sequential or Vector Change for OHCAs with Refractory Ventricular F

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Ep 179 Hand Injuries – Finger Tip Injuries, Jersey Finger, PIP Dislocations, Metacarpal Fractures, Thumb Injuries, Tendon Lacerations

Emergency Medicine Cases

ED recognition and management of some commonly missed or mismanaged hand inuries including finger tip avulsions and amputations, nailbed injuries, PIP dislocations, metacarpal fractures, hand tendon lacerations, Stener lesions, Seymour fractures, mallet fingers, jersey fingers, skier's thumb, Bennet fractures and Rolando fractures with masters Dr. Arun Sayal and Dr.

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paper of the week

EMergucate

Effect of a Diagnostic Strategy Using an Elevated and Age-Adjusted D-Dimer Threshold on Thromboembolic Events in Emergency Department Patients With … Continue reading →

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Fracture identification and Hematoma blocks

Core Ultrasound

In this intro video, we demonstrate the use of ultrasound imaging to identify fractures. Ultrasound-guided fracture identification is a minimally invasive technique that allows for quick and accurate diagnosis of fractures, without the need for radiation or contrast agents. Additionally, it can be used during reductions to assist in identification of adequate alignment without the need for a C-arm!

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Tiny Patch for Cardiac Ultrasound Imaging

Medgadget

Engineers at the University of California San Diego have developed a wearable ultrasound system for cardiac imaging. The postage stamp-sized patch can be worn on the skin of the chest and uses AI and ultrasound waves to perform advanced imaging of the heart. The technology can even be worn to perform cardiac ultrasound imaging during exercise. Each patch can be worn for up to 24 hours, and provides information on how much blood the heart is pumping, a key metric in detecting and appraising a var

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TIRBO #29: Understanding blood transfusion

Critical Care Scenarios

A review of the basics of blood donation, storage, typing, screening, matching, and transfusion. Transfusion medicine series at Critical Concepts Find us on Patreon here! Buy your merch here! A review of the basics of blood donation, storage, typing, screening, matching, and transfusion. Transfusion medicine series at Critical Concepts Find us on Patreon here!

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SGEM#394: Say Bye Bye Bicarb for Pediatric In-Hospital Cardiac Arrest

The Skeptics' Guide to EM

Reference: Cashen K, Reeder RW, Ahmed T, et al. Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. Pediatric Crit Care Med. 2022 Date: February 15, 2023 Guest Skeptic: Dr. Carlie Myers is Pediatric Critical Care Attending at Cincinnati Children’s Hospital Medical Center.

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Lab case 399 Interepretation

EMergucate

Question 1: PH = 7.43 that is with in normal range, more toward alkalotic spectrum HCO3 = 39.9, that is elevated so we have metabolic alkalosis. Next we need to check the compensation process.

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Large Joint Arthrocentesis and Injection

Core Ultrasound

Joint pain is a fairly common complaint and accurately identifying fluid (or lack thereof) can be difficult and frustrating without POCUS! In this video I show you how to identify joint effusions (including shoulder, knee and hip effusions) and how to use ultrasound to accurately stick a needle in it to either drain that fluid or to aspirate it.

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3D Bioengineered Skin Grafts Fit Complex Anatomy

Medgadget

Researchers at Columbia University’s Irving Medical Center have developed a method to create three-dimensional bioengineered skin grafts. To date, bioengineered skin is typically created in flat sheets. However, these are difficult to fit to complex anatomy, such as the hand, and so these researchers have designed a more sophisticated technique that combines laser scanning, 3D printing, and cell culture to create seamless three dimensional skin grafts.

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Lightning rounds #25: FailureFest! (Why we’re bad and so are you)

Critical Care Scenarios

A candid discussion of our flaws, mistakes, weaknesses, and errors, and a look at why it’s important to reflect on these things in medicine, acknowledge them, and try to improve. Find us on Patreon here! Buy your merch here! A candid discussion of our flaws, mistakes, weaknesses, and errors, and a look at why it’s important to reflect on these things in medicine, acknowledge them, and try to improve.

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SGEM#393: You Down with APP, Yeah You Know Me

The Skeptics' Guide to EM

Date: February 17, 2023 Reference: Gettel et al. Rising high-acuity emergency care services independently billed by advanced practice providers, 2013 to 2019. AEM Feb 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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Journal Club 2 – Diltiazem Dosing in Atrial Fibrillation with Rapid Ventricular Response

Emergency Medicine Cases

Is low dose diltiazem as effective and safer than standard dose diltiazem for rate control in patients with atrial fibrillation with rapid ventricular response? Dr. Rohit Mohindra and Dr. Shelley McLeod critically appraise the latest study on diltiazem dosing and deliver a research methodology hot take on this month's EM Cases Journal Club. The post Journal Club 2 – Diltiazem Dosing in Atrial Fibrillation with Rapid Ventricular Response appeared first on Emergency Medicine Cases.

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Imaging Case of the Week 543

EMergucate

The elbow x-ray is from an adult patient with pain, swelling & inability to move their elbow after a fall on outstretched hand. What can be seen?

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Knee aspiration and Injection

Core Ultrasound

Peer reviewed by Ben Smith, MD 1/31/23 Basic Knee Exam MSK Basics Courses

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Ingestible Sensor Reveals Gastric Motility

Medgadget

Researchers at MIT have developed an ingestible sensor that can reveal gastrointestinal motility issues, such as gastroparesis and gastroesophageal reflux disease. The technology is intended for use as an easy at-home method to diagnose such issues, which typically require more invasive and inconvenient procedures, such as endoscopy or X-ray imaging.

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TIRBO #28: How I set PEEP

Critical Care Scenarios

A review of the methods of PEEP setting, including stress index, PV loops, esophageal manometry, and PEEP tables, and finally my preferred method of driving pressure trials. Find us on Patreon here! Buy your merch here! A review of the methods of PEEP setting, including stress index, PV loops, esophageal manometry, and PEEP tables, and finally my preferred method of driving pressure trials.

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SGEM#391: Is it Time for a Cool Change (Hypothermia After In-Hospital Cardiac Arrest)?

The Skeptics' Guide to EM

Date: February 1, 2023 Reference: Wolfrum et al. Temperature Control After In-Hospital Cardiac Arrest: A Randomized Clinical Trial. Circulation. September 2022 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called www.First10EM.com Case: You are working an overnight shift at a small rural hospital.

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JJ 23 Laceration Aftercare – Dressings, Antibiotics, Improving Cosmesis, Preventing Infection

Emergency Medicine Cases

In this Part 3 of our 3-part podcast series on management of lacerations Dr. Haley Cochrane joins Anton and Justin to explore laceration aftercare and the evidence for keeping wounds dry or wet, wound dressings, topical antibiotics, prophylactic oral antibiotics, Vitamin E oil, aloe vera cream and UV protection with regards to cosmetic outcomes and infection rates.

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ECG of the Week 1 February 2023 – Interpretation

EMergucate

ECG of the Week 1 February 2023 – Interpretation The patient is in sinus rhythm with a rate of approximately … Continue reading →

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EMCrit 344 – Sleep for the Weary II – General Sleep Stuff

EMCrit Project

All things Sleep--you will add years to your life if you sleep well, so the time investment to listen to this podcast may be well worth it EMCrit Project by Scott Weingart, MD FCCM.

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Wearable Device Senses When Vocal Fatigue Sets in

Medgadget

Researchers at Northwestern University have developed a wearable that can detect when someone is talking or singing, and tallies this information up to provide a warning when the wearer might be at risk of vocal fatigue. Overusing your voice in a short space of time can lead to vocal fatigue and even injury. This technology is useful for patients with vocal disorders, but also for people who rely on their voices a lot, such as singers, politicians, and teachers.

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Episode 56: Resuscitation psychology with Dan Dworkis

Critical Care Scenarios

Discussing the psychology of emergency response, team dynamics, and debriefing with Dan Dworkis, MD, PhD, FACEP. He’s the Chief Medical Officer at the Mission Critical Team Institute, a board-certified emergency physician, and an assistant professor of emergency medicine at the Keck School of Medicine of USC where he works at LAC+USC. He performed his emergency … Continue reading "Episode 56: Resuscitation psychology with Dan Dworkis" Discussing the psychology of emergency response, team dynamic

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INCEPTION

The Bottom Line

In patients with refractory out-of-hospital cardiac arrest (OHCA) and an initial ventricular arrhythmia, does extracorporeal cardiopulmonary resuscitation (ECPR), as compared with conventional CPR (CCPR), improve survival with a favourable neurologic outcome

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EM Quick Hits 46 – Wilderness Medicine, Bowel Prep Hyponatremia, Non-Convulsive Status Epilepticus, Morel Lavallee Lesions, Pacemaker ECGs, Loans vs Investing

Emergency Medicine Cases

In this EM Quick Hits podcast: Justin Hensley and Aaron Billin on Wilderness Medicine, Elisha Targonsky on Bowel Prep Hyponatremia, Brit Long on Non-Convulsive Status Epilepticus, Andrew Petrosoniak on Morel Lavallee Lesions, Jesse McLaren on Pacemaker ECGs and Matt Poyner on paying off loans vs investing. The post EM Quick Hits 46 – Wilderness Medicine, Bowel Prep Hyponatremia, Non-Convulsive Status Epilepticus, Morel Lavallee Lesions, Pacemaker ECGs, Loans vs Investing appeared first on

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Imaging Case of the Week 540 Answer

EMergucate

The wrist x-ray shows At first glance, the frontal wrist x-ray reveals a radial styloid fracture.

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PEC Ep. 124 Vol 26 No 5

Prehospital Emergency Care Podcast

Hello PEC Podcast listeners! In this episode of the PEC podcast, we cover the Prehospital Emergency Care Journal Volume 26 Number 5 with our original PEC Podcast crew; Phil Moy, Scott Goldberg, Jeremiah Escajeda, and Joelle Donofrio-Odmann! We discuss such articles as: Secondary Traumatic Stress in Emergency Services Systems (STRESS) Project: Quantifying and Predicting Compassion Fatigue in Emergency Medical Services Personnel & EMS Experience Caring and Communicating with Patients and Fam

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Automated Feeding Platform to Study Mosquito Disease Transmission

Medgadget

A team at Rice University has developed an automated feeding platform for mosquitoes that allows researchers to test different types of repellent and investigate mosquito-borne disease transmission. Traditionally, such mosquito research would require human volunteers or animal subjects for the mosquitos to feed on, but this is obviously inconvenient and a little distasteful.

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What are these hyperacute T waves, with STE and T-wave inversion in aVL, and STD in inferior leads?

Dr. Smith's ECG Blog

I was reading EKGs on the system and came across this one: What do you think? This is diagnostic of hyperkalemia. HyperK can result in all sorts of pseudoSTEMI or pseudoOMI patterns, including ST elevation, ST depression, and large T-waves. These T-waves are tall but have a narrow base and a corresponding flat ST segment (see lead V4). Also, there are no definite P-waves and this is another result of hyperkalemia.

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Top 10 Best EMT Knives and Rescue Tools

EMT Training Station

A proper EMT knife is much more than a blade with a star of life on it. Rescue tools help a first responder gain quick access or assess a patient during trauma or medical emergencies. A proper EMT knife is also a rescue tool. This article has put together a list of such items. These items range from a battery-operated pulse oximeter to a monster multi-tool with 16 instruments in 1.

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EM Cases Summit Video Streaming Package Now Available

Emergency Medicine Cases

If you missed The EM Cases Summit '23, no worries, we've got you covered! All the main stage talks of both the 2023 and 2021 Summits are now available for video streaming, on your own time, for a limited time only thru emcasessummit.com. Plus you get the 2023 and 2021 eBooks summarizing the talks as a bonus. New EM Cases swag too. The post EM Cases Summit Video Streaming Package Now Available appeared first on Emergency Medicine Cases.

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Head injury, ED Anaesthetics Simulation

EMergucate

Simulation report 2/2/23 Interdisciplinary SIM ED/ Anaesthetics Summery: Head injury requiring intubation post agitation and seizure, ambulance called by police … Continue reading →

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REBEL Core Cast 96.0 – Acute Vision Loss I

REBEL EM

Take Home Points: Suspect glaucoma in any patient with an acute change in vision and get an intraocular pressure measurement First line treatment in acute angle closure glaucoma is a topical beta blocker Consider giant cell arteritis in patients with unilateral headache, jaw claudication and change in vision Don’t wait for the biopsy to start steroids in giant cell arteritis as this therapy is vision saving REBEL Core Cast 96.0 – Acute Vision Loss I Click here for Direct Download of the Po

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Raman-Based Urine Sensor Detects Cancer Metabolites

Medgadget

Researchers at the Korea Institute of Materials Science (KIMS) creaetd a Raman-spectroscopy-based urine test that can detect metabolic compounds that are produced by pancreatic and prostate cancers, potentially allowing for rapid and convenient cancer screening. The technology consists of a paper strip onto which a urine sample can be added. The paper contains ‘coral-shaped’ structures that assist in amplifying the optical signal of cancer metabolites in the urine when the paper strip is illumin

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A man in his 40s with epigastric pain and ST Elevation

Dr. Smith's ECG Blog

Case submitted by Magnus Nossen MD, written by Pendell Meyers A previously healthy man in his 40s presented to the ED with epigastric abdominal pain off and on for several days. Vitals were within normal limits. It is unclear whether he had active pain at the time of the first ECG: What do you think? Here is PM Cardio's Queen of Hearts interpretation (AI ECG interpretation trained by Meyers, Smith, and PM Cardio team using thousands of cases and their outcomes): The output number ranges from 0 t

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Get New Resources to Educate Patients About COVID-19 Treatments

The Vocal CORD

We have new resources to help you speak with your patients about COVID-19 treatments. These free print and digital materials are available for ACEP members to use to help educate patients about: Who is at increased risk for severe illness from COVID The availability of COVID treatments The importance of getting treated early These resources include information from the U.S.

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Episode 96: Chief John Moon and Freedom House EMS

The Overrun Podcast

We had an amazing talk with Chief John Moon, (ret) of Pittsburgh EMS and Freedom House Ambulance, one of the first paramedics in the United States. If you don't know the story of Freedom House, you should. Before Seattle, Miami, and yes, even Squad 51, Freedom House was providing bleeding-edge care to the citizens of the Hill and greater Pittsburgh, in a world where they were not regarded as equals in emergency services or healthcare.

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