August, 2022

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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.

OR 133
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Lethal Blockade

EMS 12-Lead

Acute LAD occlusion in the setting of Right Bundle Branch Block and Left Anterior Fascicular Block. Case Review: [link] Key features of Right Bundle Branch Block: In general, there is no ST elevation throughout the 12 Lead ECG. RBBB has expected slight ST depression, with T wave inversion, in V1-V3 when discordant to a positive R' wave. A possible normal variant is lateral ST elevation (i.e., I/aVL/V5/V6) with bulky T waves when subsequent to a large, slurred S wave.

Coronary 130
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ECG of the Week 31 August 2022 – Answer

EMergucate

A 81 year old male presents to a regional ED with chest pain for the last 4 hours.

ED 130
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Ep 173 Febrile Infant – Risk Stratification and Workup

Emergency Medicine Cases

In this main episode podcast on ED risk stratification and workup of the febrile infant, recorded at the CAEP 2022 Conference in Quebec City with Dr. Brett Burstein and Dr. Gary Joubert, we answer such questions as: Which febrile infants require lumbar puncture? How accurate is procalcitonin in identifying low risk febrile infants? What is the difference between serious bacterial infection (SBI) and invasive bacterial infection (IBI) and why is this important in the work up of the febrile infant

EMS 130
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SGEM Xtra: Are tPA Stroke Trials Really Fragile?

The Skeptics' Guide to EM

Date: August 18th, 2022 Reference: Munn et al. Fragility Index Meta-Analysis of Randomized Controlled Trials Shows Highly Robust Evidential Strength for Benefit of The post SGEM Xtra: Are tPA Stroke Trials Really Fragile? first appeared on The Skeptics Guide to Emergency Medicine. Date: August 18th, 2022 Reference: Munn et al. Fragility Index Meta-Analysis of Randomized Controlled Trials Shows Highly Robust Evidential Strength for Benefit of <3 Hour Intravenous Alteplase.

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IBNCC – Approach to CNS infection

EMCrit Project

This chapter explores some general aspects of neurological infectious diseases, including important historical features and high-risk groups. It also includes a more general discussion of lumbar puncture performance and interpretation. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes. EMCrit Project by Josh Farkas.

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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.

OR 133

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Imaging Case of the Week 518

EMergucate

The ankle x-rays are from a 10 year old with injury following fall from a trampoline. What can be seen?

EMS 130
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ECG Cases 34 – ECG Interpretation in Aortic Dissection

Emergency Medicine Cases

Which patients with ECG evidence of coronary occlusion require a CT scan to rule out aortic dissection? What are the range of ECG findings in acute aortic dissection and how do they change management? Dr. Jesse McLaren guides us through 9 cases to answer these and other questions on ECG interpretation in aortic dissection. The post ECG Cases 34 – ECG Interpretation in Aortic Dissection appeared first on Emergency Medicine Cases.

Coronary 130
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Lightning rounds #19: How to write a journal article

Critical Care Scenarios

Continuing the discussion from last Lightning Rounds about presenting at conferences, Brandon and Bryan chat about writing for peer-reviewed journals: why, how, and the process from choosing co-authors to choosing journals to navigating the submission. Continuing the discussion from last Lightning Rounds about presenting at conferences, Brandon and Bryan chat about writing for peer-reviewed journals: why, how, and the process from choosing co-authors to choosing journals to navigating the submis

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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.

ICU 100
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Smart Socks Help Prevent Falls Among At-Risk Patients

Medgadget

Researchers at the Ohio State University Wexner Medical Center have tested the PUP (Patient is Up) Smart Socks, developed by a medtech company called Palarum , in their ability to reduce falls among at-risk patients. The socks contain pressure sensors that alert caregivers when a patient is attempting to stand up. This can include situations such as a patient getting out of bed to go to the toilet.

OR 127
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In Review: LBBB and Sgarbossa Criteria

EMS 12-Lead

It's back to the basics! Take a seat and relax as the maestro, Tom Bouthillet, guides us through a stepwise approach to assessing Left Bundle Branch Block-- especially in the nefarious context of Occlusive Myocardial Infarction.

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Imaging Case of the Week 517 Answer

EMergucate

The pelvic x-ray shows an avulsion fracture of anterior superior iliac spine (ASIS avulsion).

EMS 130
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EM Quick Hits 41 – IO Limitations, Missed Ectopic Pregnancy, Bronchiolitis O2 Monitoring, DRE in Cauda Equina Syndrome, Withdrawal of Life Sustaining Care

Emergency Medicine Cases

In this EM Quick Hits podcast: Anand Swaminathan on limitations and practical tips on intraosseus access,Tahara Bhate QI corner on missed ectopic pregnancy, Sarah Reid from EM Cases Summit on oxygen saturation monitoring in bronchiolitis and management of infant gastro-esophageal reflux, Brit Long on the value of rectal exam in diagnosis of cauda equina syndrome, Hans Rosenberg & Ariel Hendin on withdrawal of life-sustaining care in the ED.

EMS 130
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SGEM#374: Bad Habits – Medications for Opioid Use Disorder in the Emergency Department

The Skeptics' Guide to EM

Date: August 23rd, 2022 Reference: Schoenfeld et al. “Just give them a choice”: Patients’ perspectives regarding starting medications for opioid use disorder in the ED. AEM August 2022 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. […] The post SGEM#374: Bad Habits – Medications for Opioid Use Disorder in the Emergency Department fir

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TIRBO #16: Are PAs as good as doctors?

Critical Care Scenarios

How do PAs and other APPs compare with physicians in the clinical context? How do PAs and other APPs compare with physicians in the clinical context?

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Fingertip Sensor Measures Lithium Levels in Sweat

Medgadget

Researchers at UCLA have developed a fingertip sensor that can rapidly provide data on the levels of lithium in the body. Used as a treatment for bipolar disorder and depression, lithium requires very accurate and sensitive dosing, with too little providing no therapeutic benefit but slightly too much potentially leading to unwanted side-effects. At present, the most common method to assess lithium levels involves a blood draw and subsequent lab testing, which is inconvenient and cumbersome.

ACS 115
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What Lies Beneath

EMS 12-Lead

David Didlake Firefighter / Paramedic Acute Care Nurse Practitioner @DidlakeDW Expert commentary and peer review by Dr. Jesse McLaren @ECGcases [link] [link] This case was kindly submitted by Dr. Paco Dardon (@PacoDardon), and it’s a privilege to present it as a formal review due to the many pathophysiological, and electrophysiological, phenomenon at play.

E-9-1-1 130
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Imaging Case of the Week 517

EMergucate

The pelvic x-ray is from a 15 year old footie player with sudden pain in the right hip during a … Continue reading →

EMS 130
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Ep 172 Syncope Simplified with David Carr

Emergency Medicine Cases

In this main episode podcast, Dr. David Carr joins Anton to give us his simplified approach to syncope based solely on history, physical and ECG to help guide disposition decisions. We answer questions such as: What features have the best likelihood ratios to help distinguish syncope from seizure? What key clinical features on history and physical exam can help us distinguish orthostatic and reflex syncope from the more sinister cardiac syncope?

EMS 130
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SGEM Xtra: The SGEM Goes to Eleven – for Kids

The Skeptics' Guide to EM

Date: August 7th, 2022 Host Skeptic: Dr. Dennis Ren is a pediatric emergency medicine attending at Children’s National Hospital in Washington, DC. You might remember him from the SGEM episodes on febrile infants, aseptic meningitis, and community acquired pneumonia. This is an SGEM Xtra episode. Season 10 is coming to an end. We want to thank all our listeners […] The post SGEM Xtra: The SGEM Goes to Eleven – for Kids first appeared on The Skeptics Guide to Emergency Medicine.

OR 100
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Episode 50: Rib fractures and surgical plating with Ron Barbosa

Critical Care Scenarios

We look at the rib fracture patient requiring ICU admission, including a discussion of surgical repair, with Dr. Ron Barbosa (@rbarbosa91), Portland trauma surgeon and SICU director at Legacy Emmanual Medical Center. Takeaway lessons Algorithms and protocols for admitting disposition exist but are generally poorly predictive. ICU admission in rib fracture patients is still most … Continue reading "Episode 50: Rib fractures and surgical plating with Ron Barbosa" We look at the rib fracture patien

ICU 100
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Bioengineered Cornea Restores Sight

Medgadget

Scientists at Linköping University in Sweden have developed a collagen-based corneal implant that can restore sight to blind patients with corneal disease. The breakthrough could pave the way for such patients to receive effective treatment for corneal disease without requiring a corneal transplant from a human donor. There is a shortage of donor corneas, so creating an off-the-shelf alternative could be very useful.

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Something Winter This Way Comes

EMS 12-Lead

David Didlake Acute Care Nurse Practitioner Firefighter / Paramedic @DidlakeDW A 50 y/o Male was taking his dog for a leisurely stroll through the park when he suddenly experienced new onset chest discomfort. He waited for it to subside, but after 30 minutes of persistence he called 911. EMS personnel found him seated on a bench, uncomfortable, but without gross distress.

MICU 130
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ECG of the Week – 17th August 2022 – Interpretation

EMergucate

You are reviewing the ECG of a man who has had an intermittent history of chest pain during exercise. His PMH includes being an active smoker but he has no other cardiac risk factors.

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PulmCrit Hot Take – Acetazolamide plus furosemide for decongestion of heart failure (ADVOR trial)

EMCrit Project

Historically, many patients admitted with congestion due to heart failure have been treated with furosemide monotherapy. However, a strategy of furosemide monotherapy has numerous drawbacks: Furosemide tends to stimulate production of dilute urine, leading to a greater amount of water loss than sodium loss. Predominant loss of water may cause loss of volume from the […].

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Non-Sterile Gloves for Suturing Traumatic Lacerations?

REBEL EM

Background: Traumatic lacerations presenting to the emergency department are, by definition, contaminated (ie non-sterile). Standard management involves irrigation, local anesthesia, closure and tetanus update if required. The existing literature has never shown benefit to sterile gloves in these types of injuries if we irrigate and clean the site appropriately.

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Littmann Classic II Stethoscope Parts

EMT City

I know that this is a long-shot with the volume of traffic on here anymore, but what the hell, I'll ask. Does anyone know of a source for obtaining the ring that goes around diaphragm bell of the Classic II? I don't need an entire kit. I just need to replace the ring. Thanks.

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Wearable Tracks Mental States

Medgadget

Researchers at New York University have created a wearable system that can measure electrodermal activity, a property of the skin that is influenced by mental states, such as stress or excitement. The system is called Multimodal Intelligent Noninvasive brain state Decoder for Wearable AdapTive Closed-loop arcHitectures (MINDWATCH) and it can assess electrodermal activity by measuring skin conductance.

OR 111
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PEC podcast: Episode 117 Deep Dive of Prehospital perspectives on End of Life OMD

Prehospital Emergency Care Podcast

PEC podcast Deep Dive In this episode our PEC Podcast team talks in detail about the manuscript: Prehospital Providers’ Perspectives about Online Medical Direction in Emergency End-of-Life Decision with the authors: Michael Waldrop MD Clinical Instructor of Emergency Medicine Albany Medical College & Brian Clemency DO Professor of Emergency Medicine State University of New York at Buffalo Click here to download it today!

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Imaging Case of the Week 516 Answer

EMergucate

The mortise view of ankle shows a faint vertical lucency through the distal tibial epiphysis.

EMS 130
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NeuroEMCrit – 31 #NeuroPostItPearls

EMCrit Project

A multiplicity of neuro tips. EMCrit Project by Casey Albin.

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The EvK Trial: Ketamine vs Etomidate for Rapid Sequence Intubation

REBEL EM

Background: The use of ketamine and etomidate for induction in rapid sequence intubation is heavily debated. The Ketased Trial (Jabre 2009) reported no significant difference between the two induction agents. However, recently the National Emergency Airway Registry reported ketamine is associated with more-frequent hypotension than etomidate in critically ill patients (Mohr 2020).

MICU 52
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Prehospital Ketamine Use in Pediatrics

Handtevy

The primary focus of the study was to understand the characteristics of pediatric patients who received ketamine during EMS transports and to assess the effectiveness, dosing deviations, and potential adverse outcomes. Background: Ketamine, developed in 1962, has been widely used for pediatric sedation in emergency departments before painful procedures.

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EEG Caps for Brain Organoids

Medgadget

Researchers at Johns Hopkins University have created tiny EEG caps for brain organoids. The team was inspired by full size EEG caps that are used to measure brain activity in human patients. Previously, the Hopkins researchers were forced to use flat electrode arrays that were originally designed to take recordings from cell monolayers, but applying a flat surface to a round organoid only results in measurements from a handful of cells that make full contact.

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Risk of vibrations in the ambulance. How to reduce secondary damage for transport

Stem EMS

One of the most complex and at the same time least treated topics during the training courses for rescuers is undoubtedly the secondary damage for transport, i.e. all the alterations […] L'articolo Risk of vibrations in the ambulance. How to reduce secondary damage for transport proviene da Stem Ems.