September, 2022

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Ep 174 Is Less More? Saving EM and Traumatic Pneumothorax – Highlights from CAEP 2022

Emergency Medicine Cases

Emergency Medicine has undergone many changes over the last couple of decades and especially during the COVID pandemic. Most of these changes have been very positive, but increasing volumes, staff shortages, aging populations, increasing breadth of responsibilities and better access to more imaging have made some of us question how we should define the scope of our practices.

EMS 130
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Imaging Case of the Week 521

EMergucate

The following coronal CT face slice is from an 8 year old who was elbowed in the face. What radiological sign can be seen? What are the clinical features of this injury in paediatric population?

EMS 130
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SGEM#376: I Wonder Why She Ran Away from the HINTS Exam

The Skeptics' Guide to EM

Date: September 16th, 2022 Reference: Gerlier C, et al. Differentiating central from peripheral causes of acute vertigo in an emergency setting with the HINTS, STANDING and ABCD2 tests: A diagnostic cohort study. AEM 2021 Guest Skeptic: Dr. Peter Johns has been practicing emergency medicine since 1985 and has been passionate about vertigo education for the last two […] The post SGEM#376: I Wonder Why She Ran Away from the HINTS Exam first appeared on The Skeptics Guide to Emergency Medicine.

ALS 130
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Early Reperfusion

EMS 12-Lead

Coronary thrombosis is a dynamic process of platelet aggregation and subsequent coagulation. During spontaneous reperfusion -- whether via thrombolysis, or recruitment of collateral circulation -- there exists characteristic ST/T changes on the ECG.

Coronary 130
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Lightning rounds #20: Being efficient

Critical Care Scenarios

Brandon and Bryan chat about tricks and methods of increasing efficiency and getting things done at work. Brandon and Bryan chat about tricks and methods of increasing efficiency and getting things done at work.

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Motion Sensors to Detect Age-Related Disease

Medgadget

Researchers at the University of Bern in Switzerland have developed a motion tracking system that is intended to assist in detecting age-related disease in elderly people. The system could be installed in someone’s home or in assisted-living facilities, and consists of a series of motion sensors that can monitor for signs of unusual movement. The system can inform caregivers if an emergency arises, such as a fall, which can be detected when someone does not return to their bed at night or is sta

OR 115
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ECG Cases 35 – ECG Approach to Takotsubo Syndrome

Emergency Medicine Cases

Takotsubo Syndrome is usually triggered by an emotional or physical stress leading to acute catecholaminergic myocardial stunning. The initial ST elevation phase of Takotsubo Syndrome mimics Occlusion MI, can not be distinguished by patient factors or POCUS findings, and requires immediate angiogram. The subsequent phase of Takotsubo Syndrome has T wave inversion in an apical distribution, which can mimic reperfusion, but often has very deep T wave inversions and a very long QT interval.

OR 130

More Trending

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SGEM#375: Only One versus Two-Dose Dexamethasone for Mild to Moderate Pediatric Asthma Exacerbations

The Skeptics' Guide to EM

Date: August 25th, 2022 Reference: Martin et al. Single-dose dexamethasone is not inferior to 2 doses in mild to moderate pediatric asthma exacerbations in the emergency department. Pediatr Emerg Care. 2022 Guest Skeptic: Dr. Harrison Hayward is a Pediatric Emergency Medicine fellow at Children’s National Hospital. He finished his General Pediatrics residency at Yale-New Haven Hospital.

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In Review: Lead Placement

EMS 12-Lead

Accurate lead placement is invaluable, and makes a significant impact on appropriate care trajectory, or misdiagnosis with unnecessary utilization of resources. A common finding associated with V1 / V2 malposition is P wave inversion, and rSr’ QRS with T wave inversion -- potentially leading clinicians to suspect Brugada pattern, for example, when no such entity exists.

Coronary 130
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TIRBO #18: Mastering dilation

Critical Care Scenarios

A deep dive into dilation during Seldinger techniques, such as central line placement: tips, pitfalls, and pearls. A deep dive into dilation during Seldinger techniques, such as central line placement: tips, pitfalls, and pearls.

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Surface Coating Rapidly Kills Pathogens, Lasts Months

Medgadget

A team at the University of Michigan has developed a coating for frequently touched surfaces that can rapidly kill a wide array of pathogens, including MRSA and SARS-CoV-2. The technology incorporates polyurethane that contains crosslinked compounds from essential oils with wide-spectrum anti-microbial action. The researchers fine-tuned the crosslinking process so that the oils were available to kill microbes but not sufficiently free to evaporate rapidly.

OR 111
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EM Quick Hits 42 – Subsegmental PE, Trauma Analgesia, Drowning, Polio, Head-up CPR

Emergency Medicine Cases

In this EM Quick Hits podcast: Salim Rezaie on venous thromboembolism recurrence in subsegmental pulmonary embolism, Andrew Petrosoniak on pain management in the polytrauma, Nour Khatib on a rural EM case on management of near-drowning patient, Sara Reid delivers a polio primer, Anand Swaminathan on head-up CPR. The post EM Quick Hits 42 – Subsegmental PE, Trauma Analgesia, Drowning, Polio, Head-up CPR appeared first on Emergency Medicine Cases.

CPR 130
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ECG of the week 7th September 2022 – Answer

EMergucate

A 85 year old female presents to ED. She has been complaining of nausea and lethargy over the past week. Her GP has recently started her on new medication for her heart.

ED 130
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SGEM Xtra: A Hero Is Rising – Season#8 Book

The Skeptics' Guide to EM

Date: September 3rd, 2022 Reference: Milne WK, Carpenter CR and Young T. A Hero Is Rising – Season#8 Book Guest Skeptic: Dr. Tayler Young is a first year Family Medicine resident at Queen’s University. Her interests are quality improvement and Free Open Access to Medical Education (FOAMed). This is an SGEM Xtra to announce Season#8 has now been […] The post SGEM Xtra: A Hero Is Rising – Season#8 Book first appeared on The Skeptics Guide to Emergency Medicine.

OR 130
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EMCrit 332 – Procedural Errors I See at the REANIMATE ECPR Course and How to Place an Intra-Arrest Femoral Arterial Line

EMCrit Project

Today, the errors and procedural missteps I commonly observe while teaching 100 docs per year how to cannulate for ECMO (but the lessons are not about ECMO, they are about all vascular access in the femoral vessels.). EMCrit Project by Scott Weingart, MD FCCM.

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Episode 51: Resuscitating and deresuscitating with hypertonic saline, with Sean Barnett

Critical Care Scenarios

We explore the controversial area of using hypertonic saline to support hemodynamics, protect the kidneys, and facilitate diuresis in the critically ill patient. Our guest is Dr. Sean Barnett, hypertonic aficionado and nephrologist with a focus in critical care. Takeaway lessons The furosemide stress test in the shocked patient is a useful means to assess … Continue reading "Episode 51: Resuscitating and deresuscitating with hypertonic saline, with Sean Barnett" We explore the controversial area

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Pneumatic Assistive Device for People with Disabilities

Medgadget

Researchers at Rice University have developed a pneumatic assistive device for people with disabilities. The technology includes an air pump that is mounted in the wearer’s shoe, providing pneumatic power with each step. This power is stored in a wearable belt that includes an “arm” that can reach out and grip items when activated. The device may be very practical for people with arm weakness who struggle to lift objects.

OR 109
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Is Cocoa the New Aspirin 81? - Clinical Correlations

Clinical Correlations

By Luke Bonanni Peer Reviewed Theobroma, literally “food of gods” in Greek, is an apt description of chocolate. Made from the fermented seeds of the Theobroma cacao tree, chocolate is an immensely popular food, with worldwide.

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Imaging Case of the Week 520 Answer

EMergucate

There is cardiomegaly and enlargement of left atrium as evidenced by splaying of the carina & double right heart border.

EMS 130
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Less is More. Again: Speed of IV Fluid Administration in Pancreatitis (WATERFALL Trial)

REBEL EM

Background: Standard emergency department management of acute pancreatitis has focused on aggressive hydration, analgesia and investigation for an underlying reversible cause (eg gallstones). Recent evidence has challenged the routine use of aggressive hydration as unnecessary. There are also potential harms to large volume fluid resuscitation including progression of pancreatitis and fluid overload with or without respiratory failure.

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EMCrit 333 – The State of the Fluids Show with the EMCrit Core Team

EMCrit Project

Where are we on Fluids on 2022? EMCrit Project by Scott Weingart, MD FCCM.

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TIRBO #17: Being cool is a privilege

Critical Care Scenarios

Ruminations on nursing post-nominals, understated wealth, and how it’s easiest to not show your power when you already plenty of it. Ruminations on nursing post-nominals, understated wealth, and how it’s easiest to not show your power when you already plenty of it.

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Face Mask Detects Respiratory Viruses, Alerts User

Medgadget

Scientists at Shanghai Tongji University in China have created a face mask that can alert the wearer to the presence of respiratory viruses in the surrounding environment, including the viruses behind COVID-19 and influenza. The mask includes aptamers, which are short sequences of DNA or RNA that can bind to protein targets. When viral particles bind to the aptamers, ion-gated transistors boost the signal so that the mask can sensitively detect small amounts of virus.

OR 108
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Episode 90: What the actual Rhode Island (Redux)?!

The Overrun Podcast

In August 2022 two EMT-Cardiacs in Rhode Island found themselves in a situation that resulted in their suspensions. In this episode, the gang discusses the swiss cheese model of failure, and what we can do as an industry to improve systems and providers to ensure that we treat parents and newborns properly in the field. #DoBetter In August 2022 two EMT-Cardiacs in Rhode Island found themselves in a situation that resulted in their suspensions.

EMT 52
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Imaging Case of the Week 520

EMergucate

The following chest x-ray is from a 40-year-old febrile patient with chronic renal failure. What can be noticed?

EMS 130
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TEG-Guided Resuscitation of Patients with Cirrhosis and Non-Variceal Bleeding

REBEL EM

Background: Thromboelastography (TEG) is a reliable, comprehensive non-invasive hemostatic assay that measures the ability of whole blood to form a clot. TEG analyzes the interaction between platelets and the coagulation cascade. It provides highly descriptive, real-time information on clot formation, clot strength, platelet function, and fibrinolysis, which is superior to traditional coagulation tests such as INR, aPTT, and platelet count.

FFP 52
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EMCrit Wee – Sleep Part 1 – Shift Work Strategies with Mike and Mike from Wild Health

EMCrit Project

Sleep for Shift Workers--this info may add years to your life and keep you performing optimally. EMCrit Project by Scott Weingart, MD FCCM.

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PEC podcast: Ep. 118 Vol 26 No 3

Prehospital Emergency Care Podcast

Fall is here! While you're enjoying the brisk morning walks, check out our latest podcast where we cover the PEC journal Volume 26 Number 3. In this episode, we cover fascinating manuscripts like Assessment of Fall-Related Emergency Medical Service Calls and Transports after a Community-Level Fall-Prevention Initiative Joint Statement on Lights & Siren Vehicle Operations on Emergency Medical Services Responses Click here to download today!

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3D Printed Tablets for Controlled Drug Release

Medgadget

Researchers at the University of the Basque Country have developed a technique that allows them to 3D print pharmaceutical tablets using different types of starch. By modifying the types of starch used and the shape of the tablets, the team can fine-tune drug release to be either rapid or slow. This includes full release of the encapsulated drug in as little as ten minutes to as long as six hours, providing significant scope to address a wide variety of therapeutic situations.

OR 108
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Posterior leads can give false reassurance

Dr. Smith's ECG Blog

A 40-something woman with diabetes and peripheral vascular disease who frequently needs the ED for chronic pain called 911 for sudden severe chest pain. The patient was very agitated and could not hold still. I greeted medics at the door to view the prehospital ECG. Here it is: It is not normal, but there is no specific evidence of Occlusion MI (OMI) There are some Q-waves in inferior and lateral leads (of uncertain age) and there is some "terminal QRS distortion" in inferior leads and V4-V6, bu

STEMI 52
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Imaging Case of the Week 519

EMergucate

The following abdominal x-ray is from a 45-year-old with abdominal pain & vomiting. What can be seen?

EMS 130
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Another Piece of Equipment with Racial Bias

REBEL EM

Background: Medical equipment that gives clinicians vital signs or other objective information must be reliable across populations as this data drives medical decisions. Many of these tools were not developed or validated in a racially diverse group of patients. We have already covered issues with pulse oximetry potentially missing hypoxemia in Black patients on REBEL EM ( Link is HERE ).

ALS 52
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EMCrit RACC-Lit Review for September 2022

EMCrit Project

All of the resuscitation and acute critical care goodness for Sept 2022. EMCrit Project by Scott Weingart, MD FCCM.

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EZ-IO® Emergency Burr Hole for Epidural Hematoma

Handtevy

ATTENTION: DO NOT TRY THIS AT HOME What would do if you had a 17-year old with a post-traumatic epidural hematoma herniating right in front of you with the closest Trauma center an hour away? A study published in The Journal of Emergency Medicine titled “Complete Neurologic Recovery After Emergency Burr Hole Placement Utilizing EZ-IO® for Epidural Hematoma” sheds light on an innovative approach to treat post-traumatic epidural hematoma (EDH) in emergency settings.

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Microfluidic Device Mimics Embryonic Heartbeat to Stimulate Stem Cell Development

Medgadget

Scientists at the University of New South Wales in Australia have developed a method to produce human blood stem cell precursors from human pluripotent stem cells. The method may have use in treating cancer patients who require high doses of such blood stem cells to help replenish endogenous populations that have been destroyed by chemotherapy. The researchers exploited the tendency of cells to respond to mechanical stimuli and cultured the pluripotent stem cells in a microfluidic device that mi

OR 106
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Great Time to Be a Medical Assistant: Demand and Rising Salaries

NHCPS Save a Life

National Medical Assistant Week is fast approaching (Oct 19-23). It’s time to celebrate the tremendous contribution of Medical Assistants to patient care. And we’ll also take a look at: Career paths, pay, and job outlook for 2022 What’s driving Medical Assistant demand…and will it continue? What it takes to be a Medical Assistant How Medical […] The post Great Time to Be a Medical Assistant: Demand and Rising Salaries appeared first on SaveaLife.com.

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Lab case 380

EMergucate

An 82 year old man presents to your ED after a syncopal episode. He complains of abdominal pain and diarrhoea. On examination he has a heart rate of 105/min and a BP of 95/65.

ED 100