ALiEM
APRIL 12, 2023
Ever finally step away from a busy resuscitation and someone stops you for peripheral IV access? You set up everything, have the patient positioned, and then notice there is no sterile ultrasound gel. No gel? No problem. The trick is to eliminate anything of poor acoustic impedance between the ultrasound probe and the patient’s skin. Trick of the Trade 1.
Emergency Medicine Cases
APRIL 11, 2023
How can we use the awareness of complications to identify false positive STEMI and Occlusion MI that doesn’t meet classic STEMI criteria, and consider specific treatment? Dr. Jesse McLaren reviews the complications of MI through 10 ECG cases and how they alter management. The post ECG Cases 41 – STEMI, Occlusion MI Complications appeared first on Emergency Medicine Cases.
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The Skeptics' Guide to EM
APRIL 8, 2023
Date: April 4th, 2023 Reference: Vaughan and Browne. Reconfiguring emergency and acute services: time to pause and reflect. BMJ Qual Saf. 2023 Apr Guest Skeptics: Dr. Louella Vaugh is an internist practising as a hospitalist physician at an academic centre in London, UK with a special interest in smaller, rural and remote healthcare. Her main job […] The post SGEM Xtra: This is My Life – Centralization of Rural Emergency Healthcare first appeared on The Skeptics Guide to Emergency Medicine.
Pediatric EM Morsels
APRIL 28, 2023
Pediatric x-rays are challenging. Of course, we want children to grow, but those darn growth plates really make interpretation of their films difficult !! We have previously discussed how the surrounding ligaments and tendon are often stronger than the weakest part of the child’s bone necessitating our vigilance when addressing the pediatric extremity complaint (ex, Ankle Pain , Elbow Injury , Supracondylar Fractures ).
EMergucate
APRIL 16, 2023
The neck x-rays are from a 6-year-old with neck pain, difficulty swallowing following a recent bout of upper respiratory tract … Continue reading →
EMCrit Project
APRIL 27, 2023
The precise utilization of ABG, VBG, and pulse oximetry remains controversial. Unfortunately, there is little high-level evidence investigating whether these interventions affect patient outcomes (for example, there is precious little evidence to support most of the target values that we're chasing after). This chapter attempts to explore the strengths, weaknesses, and indications for various techniques. […] EMCrit Project by Josh Farkas.
ALiEM
APRIL 14, 2023
Welcome to the AIR Procedures Module! After carefully reviewing all relevant posts in the past 12 months from the top 50 sites of the Social Media Index, the ALiEM AIR Team is proud to present the highest quality online content related to related to procedures in the Emergency Department. 6 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board.
Paramedicine Now brings together the best content for paramedicine professionals from the widest variety of thought leaders.
The Skeptics' Guide to EM
APRIL 22, 2023
Date: April 20, 2023 Reference: Franklin D, et al. Effect of early high-flow nasal oxygen vs standard oxygen therapy on length of hospital stay in hospitalized children with acute hypoxemic respiratory failure: the PARIS-2 randomized clinical trial. JAMA 2023 Guest Skeptic: Dr. Michael Falk is a Pediatric Emergency Medicine attending at Mount Sinai Medical Center […] The post SGEM #401: Hey Ho!
Pediatric EM Morsels
APRIL 7, 2023
There are many conditions that we would like to think belong only to the “ adult patient problem DDx; ” however, as we have discussed several times previously, pediatric patients can experience many “adult conditions” (see, Aortic Dissection , Kidney Stones , and Cholecystitis ). Those conditions usually have a substantial risk factor and one of the most risky of risk factors is Sickle Cell Disease !
EMergucate
APRIL 11, 2023
Answers: Ph = 7.56, that is alkalaemia Both HCO3 and pCO2 are low. So, most likely we have combined metabolic and respiratory alkalosis.
REBEL EM
APRIL 26, 2023
Take Home Points Alcoholic Ketoacidosis (AKA) can present with significant acidemia (pH < 7.00). Despite the significant acidemia, patients with AKA can remain alert and lucid despite their severe metabolic derangement. Relying on urine ketones for diagnosis can be misleading, as acetoacetate is the primary ketone detected in the urine but not the most common ketone generated in AKA.
ALiEM
APRIL 10, 2023
The patient is a 3-month-old, full-term male who presents with a rash on his head. The rash started one day prior to presentation on his forehead and spread to the rest of his head. Today, it developed a central clearing with surrounding redness. He has a history of sensitive skin since birth with patches of eczema and cradle cap. He treats these with Aquaphor and Honest Co.
Emergency Medicine Cases
APRIL 24, 2023
Does the addition of dexamethasone to ketorolac improve pain scores in patients suffering from renal colic? Find out through this critical appraisal of a recent RCT on this EMC Journal Club. The post Journal Club 3 – Dexamethasone and Ketorolac in Acute Renal Colic appeared first on Emergency Medicine Cases.
The Skeptics' Guide to EM
APRIL 29, 2023
Date: April 26, 2023 Reference: Han et al. The effect of telemental versus in-person mental health consults in the emergency department on 30-day utilization and processes of care. AEM April 2023 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. He is also the CME editor for Academic Emergency Medicine. Case: You are moonlighting at the Veterans […] The post SGEM#402: Call Me – On the Telemental Health Line first appeared on The Skeptics Guide to Emergency Medicine.
Critical Care Scenarios
APRIL 26, 2023
We look at stress (Takotsubo) cardiomyopathy in the setting of critical illness, with Dr. Vincent Sorrell. Dr. Sorrell is a cardiologist at the University of Kentucky, where he helped develop the Advanced Cardiovascular Imaging Program, and is current Acting Chief of both the Division of Cardiovascular Medicine and the Gill Heart and Vascular Institute.
EMergucate
APRIL 16, 2023
The knee x-ray shows a small curvilinear bony avulsion adjacent to the lateral tibial plateau implying a Segond fracture.
REBEL EM
APRIL 17, 2023
Background: The increased utility and accessibility of point-of-care ultrasound (POCUS) has allowed clinicians the freedom to rethink their diagnostic approach for many common diseases, including peritonsillar abscess (PTA). Clinical evaluation may prove difficult since many PTA and peritonsillar cellulitis symptoms overlap. Physical examination is approximately 75% sensitive and 50% specific for identifying PTA.
ALiEM
APRIL 17, 2023
A 29 year-old-male with a past medical history of left eye enucleation secondary to a gunshot wound several years prior presents to the Emergency Department (ED) for blurry vision, redness, and concern for a deformity to his right eye. The patient states symptoms started 2-3 months ago and he initially thought symptoms were due to allergies and recalls rubbing his eye a lot.
Emergency Medicine Cases
APRIL 11, 2023
In this episode, Dr. Roy Baskind and Dr. Ahmit Shah answer such questions as: when is an opening pressure on LP required? When should we pull the trigger on ordering a CT venogram in the patient with unexplained headache? Which older patients who present with headache require an ESR/CRP? How do the presentations of cerebral venous thrombosis (CVT) and idiopathic intracranial hypertension (IIH) compare and contrast?
EMCrit Project
APRIL 15, 2023
Recently, two sets of guidelines for neuroprognostication following cardiac arrest were released – almost simultaneously. In a perfect world, two evidence-based guidelines based on the same evidence would be the same. But of course, this isn't actually the case. The guidelines differ significantly. The Neurocritical Care Society guidelines recommended this general approach:(36949360) Meanwhile, the Canadian […] EMCrit Project by Josh Farkas.
Critical Care Scenarios
APRIL 5, 2023
What does bacteremia mean to you? A brief overview of how this affects the picture of an infected patient. What does bacteremia mean to you? A brief overview of how this affects the picture of an infected patient.
EMergucate
APRIL 2, 2023
The pelvic X-ray shows. Ischial tuberosity avulsion fracture on the left side. This is due to hamstring pull.
Medgadget
APRIL 18, 2023
Researchers at MIT have developed lipid nanoparticles that are highly efficient at delivering mRNA therapies to lung cells. Getting therapeutic agents into the lungs can be challenging, but there are a variety of medical challenges that could be addressed by efficiently targeting lung cells with nanoparticle technologies. These latest particles are highly efficient at delivering mRNA which can then encode therapeutically useful proteins in the lungs.
REBEL EM
APRIL 5, 2023
REBEL Core Cast 99.0 – Bundle Branch Blocks Click here for Direct Download of the Podcast Cardiac Conduction System (LITFL) Definition: Interruption of the normal conduction system leading to aberrant conduction and an abnormal QRS morphology Anatomy: At the AV node, conduction splits into the right and left bundle branches. The left bundle branch is composed of anterior and posterior branches.
Dr. Smith's ECG Blog
APRIL 29, 2023
A 50-something with no previous cardiac history and no risk factors presented to the ED with acute chest pain (pressure) that radiated to the left arm. An ECG was immediately recorded: Computer read: Normal ECG What do you think? There is ST depression in V1-V3. We showed that this is diagnostic of OMI (of the posterior wall). Moreover, there is ST elevation in V6 (which is getting close to the location of posterior lead V7).
EMCrit Project
APRIL 3, 2023
(Blogitorials are short, informal blogs that are written in the spirit of a tweetorial). Stress hyperglycemia is an everyday occurence in the ICU, but we hardly know how to treat it. I've been waiting years for this topic to be clarified… but I've realized that such clarity will probably never be reached. Why? The traditional […] EMCrit Project by Josh Farkas.
Critical Care Scenarios
APRIL 19, 2023
When scooching a patient in the bed can make a difference. When scooching a patient in the bed can make a difference.
EMergucate
APRIL 3, 2023
The following chest x-ray is from a critically unwell patient. What can be seen? Answer will be posted later.
Medgadget
APRIL 3, 2023
Researchers at the Terasaki Institute for Biomedical Innovation in Los Angeles have developed a gelatin-based surgical sealant. The sealant is thermoresponsive, meaning that it will rapidly form a semi-solid bolus when it reaches body temperature. It is also bioadhesive, adhering to slippery, wet surfaces in the body with relative ease. The researchers achieved this by incorporating caffeic acid, a substance that is naturally found in coffee and olive oil, into the gelatin gel, which helped to i
NHCPS Save a Life
APRIL 28, 2023
It is crucial for healthcare providers who are new to the Advanced Cardiac Life Support (ACLS) algorithm to understand the difference between pulseless electrical activity and asystole. ACLS is a set of protocols and interventions used to treat patients in cardiac arrest or other life-threatening medical emergencies. PEA and asystole are both types of cardiac […] The post PEA vs Asystole: Understanding the Key Differences appeared first on SaveaLife.com.
Dr. Smith's ECG Blog
APRIL 25, 2023
This was sent to me by a partner: "Curious what you think of this one we had overnight. Healthy male under 25 years old with a pretty good story for acute onset crushing chest pain relieved with nitro. He had another episode the day before after exerting himself. No pericardial effusion on ultrasound." What do you think? First, many on Twitter said "Pericarditis".
EMCrit Project
APRIL 25, 2023
CAR-T cell therapy is rapidly expanding as a miraculous therapy for numerous malignancies. However, it also causes a variety of unique and severe side-effects, which frequently cause ICU admission. This chapter explores current approaches to complications including CRS (cytokine release syndrome), HLH (hemophagocytic lymphohistiocytosis), and ICANS (immune effector cell-associated neurotoxicity syndrome).
First 10 EM
APRIL 24, 2023
I’ve gone in depth into the topic of steroids for pneumonia previously. (Also covered on the EM Cases Journal Jam.) At the time, despite some promising point estimates, I thought that the evidence was too weak to suggest regular use of steroids for community acquired pneumonia. In that write up, I did mention a number […] The post Steroids for pneumonia (CAPE COD and ESCAPe) appeared first on First10EM.
EMergucate
APRIL 25, 2023
Facial x-ray view is from an adult patient who has been punched in the face. What can be noticed?
Medgadget
APRIL 25, 2023
Researchers at Chalmers University of Technology in Sweden have developed a microfluidic system to test the effects of electrical stimulation in wound healing. The researchers hope that their experiments might lead to new medical devices that can assist with chronic wounds. Their microfluidic chip contains artificial skin that contains a layer of cells which the researchers can ‘wound’ and then apply an electrical charge to.
Ingenious
APRIL 21, 2023
Missing the final 2nd FSX due to other obligations at home (owner being sick) Malpi was eager to attend the final Review Meeting in Brussels on the 4th of April 2023 and meet the Project Officer (PO) and old friends within the INGENIOUS project. For this important trip, it was necessary to dress up, smell good, and look sharp and prepared. Polar bears ( SBFF ) have learned the hard way never to travel on the same day to events/meetings so Malpi travelled the day before, contemplating over what w
Dr. Smith's ECG Blog
APRIL 21, 2023
Written by Jesse McLaren, with comments from Smith A 50-year old patient on the medical wards developed acute chest pain, with an ECG labeled (see computer interpretation at the top) and confirmed as normal. What do you think? There’s normal sinus rhythm, normal conduction, normal axis, normal R wave progression, and normal voltages. Lead aVL jumps out as abnormal because there is a discordant T wave inversion and mild ST depression.
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