Pediatric EM Morsels
JULY 28, 2023
Authors: Drs. Kendra Jackson and Rebecca Raffler While we’ve gotten to snack on a Morsel on this subject before , new guidelines and research surrounding DKA and cerebral edema have come to light since the first go ‘round! Thankfully, Dr. Fox wasn’t too “ salty” when we asked to rehydrate this topic. Rates of type 1 diabetes have increased since the COVID-19 pandemic.
ALiEM
JULY 22, 2023
You have a severely dehydrated patient with a peripheral IV line, requiring urgent fluid resuscitation. However, the crystalloid fluids are not flowing freely. Multiple attempts were made to place this line with the latest having a flash of blood return and a smoothly flowing saline flush. You can not seem to find your pressure infusion cuff to squeeze the IV bag and accelerate fluid administration.
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The Skeptics' Guide to EM
JULY 22, 2023
Date: July 21, 2023 Reference: Prekker et al. Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults. NEJM 2023 Guest Skeptic: Dr. Jeff Jarvis is the Chief Medical Officer and System Medical Director for the Metropolitan Area EMS Authority in Fort Worth, Texas, also known as MedStar. He is board certified in both Emergency Medicine […] The post SGEM#410: Do You See What I See?
EMS 12-Lead
JULY 24, 2023
David Didlake Acute Care Nurse Practitioner Firefighter / Paramedic (ret) @DidlakeDW Expert commentary and peer review by Dr. Steve Smith [link] @smithECGBlog A 57 y/o Female with PMHx HTN, HLD, DM, and current use of tobacco products, presented to the ED with chest discomfort. She described it as tightness, centralized, and associated with both dyspnea and diaphoresis.
American Ambulance Association
JULY 24, 2023
Register Now: National EMS Advisory Council Meeting August 9-10 The National EMS Advisory Council (NEMSAC) will host a hybrid meeting on Wednesday, August 9, 2023, at 1:00 pm ET, […] The post NEMSAC | Meeting August 9-10 appeared first on American Ambulance Association.
ALiEM
JULY 24, 2023
Dr. Sara Krzyzaniak (EM program director at Stanford) hosts this episode with Dr. Michelle Lin (ALiEM/UCSF) featuring all-star guests Dr. Alexis Pelletier-Bui (EM associate program director at Cooper University Hospital) and Dr. Elizabeth Werley (EM program director at Penn State Hershey). Both our guests serve as key representatives on behalf of the EM specialty on the AAMC ERAS Supplemental Application Working Group and provide you with a sneak peek behind what is coming for the totally revamp
EMergucate
JULY 27, 2023
The chest x-ray shows presence of pneumomediastinum as indicated on the image. There is no obvious pneumothorax.
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Don't Forget the Bubbles
JULY 24, 2023
Discitis is an inflammatory condition involving the intervertebral discs and end plates of vertebral bodies. It encompasses a spectrum of conditions that includes discitis , spondylodiscitis , and vertebral osteomyelitis. Discitis is uncommon. However, there is a bimodal peak in children, those under 6 years and adolescents. Neonates can also be affected.
REBEL EM
JULY 24, 2023
Background: Rapid Sequence Intubation (RSI) is a procedure fraught with potential complications including hypotension which, in turn, can result in cardiovascular collapse. While there are numerous potential causes of hypotension peri-RSI, induction medications represent an important, modifiable variable. Over the last decade, airway experts have advocated for reduced induction agent dosing to lessen the risk of hypotension particularly in at risk patients.
EMergucate
JULY 27, 2023
The frontal chest x-ray shows a cavity with fluid level projected over the right dome of diaphragm.
Medgadget
JULY 25, 2023
Engineers at the Federal University of Espirito Santo in Brazil have developed smart pants that can non-intrusively track physical movements and provide updates to caregivers if the people they’re taking care of are showing signs of distress. This application could be very useful for people who are monitoring elderly patients in healthcare facilities.
EM Literature of Note
JULY 22, 2023
The results of this paper are hardly surprising, since the witnessed phenomenon – “anchoring bias” – exists as defined. However, it’s always fun to see it demonstrated objectively. In this little piece of research, authors collated four years of encounters to Veterans Affairs emergency departments in the U.S. and parsed out the triage reason between “congestive heart failure” versus all others.
REBEL EM
JULY 26, 2023
Take Home Points Methylxanthines are a drug class that includes caffeine, theophylline, and theobromine. The three main mechanisms that account for the clinical presentation of methylxanthine toxicity are: catecholamine release, adenosine antagonism, and phosphodiesterase inhibition. Beta agonism will lead to hyperlactatemia, hypokalemia, hyperglycemia, and tachycardia.
EMergucate
JULY 27, 2023
The chest x-ray is technically inadequate. AP view has magnified the cardiac shadow.
Medgadget
JULY 25, 2023
Scientists at the City University of Hong Kong have developed a coating for wearable technologies that can help to dissipate heat, reducing the chances of skin burns and increasing the life of such devices. Electronic devices can generate heat, but this can be problematic for wearables that are in constant contact with the skin. The heat may be uncomfortable, may overheat the device itself, and could even cause skin burns.
EM Literature of Note
JULY 23, 2023
It is safe to say the honeymoon phase of large language models has started to fade a bit. Yes, they can absolutely pass a medical licensing examination when given carefully constructed prompts. The focus now turns to practical applications – like, in this example, using ChatGPT to write an entire scientific paper for you! There is no reason to go through the details of the paper, the content, the findings, or any aspect of fruit and vegetable consumption.
EMDocs
JULY 22, 2023
We always work hard, but we may not have time to read through a bunch of journals. It’s time to learn smarter. Originally published at JournalFeed , a site that provides daily or weekly literature updates. Follow Dr. Clay Smith at @spoonfedEM , and sign up for email updates here. #1: Macrolides and Long-Term Survival in ICU Patients with Community-Acquired Pneumonia Spoon Feed Empiric macrolide therapy was associated with improved six and twelve-month survival among ICU patients with community-a
EMergucate
JULY 25, 2023
The chest x-ray is from a 6 year old with asthma exacerbation. What can be seen?
Medgadget
JULY 24, 2023
Researchers at the National University of Singapore have created a wound sensor patch that measures various wound biomarkers that can indicate would healing. Chronic wounds are an ongoing problem for many patients, and developing new ways to monitor and treat these painful lesions would be very useful. This battery-free wound patch contains five colorimetric sensors that change color in response to various wound biomarkers.
EM Literature of Note
JULY 27, 2023
Platelets are the good little minions of hemostasis. In their absence, invasive procedures develop additional risk, ranging from minimal to clinically important, and the mitigation strategy ranges from avoidance, the alternative procedural techniques, to prophylactic platelet transfusions. Platelets, like any blood product, are associated significant risks, not limited to acute lung injury, transfusion-related circulatory overload, allergic reactions, and more.
University of Maryland Department of Emergency Med
JULY 26, 2023
"The normal value for the Böhler angle is between 25° and 40° 1. Although there is wide variation between individua.
EMergucate
JULY 27, 2023
The chest x-ray shows a hyperinflated right lung field.
Medgadget
JULY 25, 2023
Engineers at the University of Sydney have developed a photonic radar that allows them to monitor breathing rates without the need to attach equipment to a patient’s skin. Wired or more invasive systems may not be suitable for everyone – for instance, burn patients with damaged skin or infants with a tiny body surface area may not be able to avail of such systems.
The Bottom Line
JULY 28, 2023
In haematology or ICU patients with platelet counts between 10,000 and 50,000 per mm3, is receiving no prophylactic platelets non inferior compared to the administration of 1u platelets in order to reduce the risk of catheter-related bleeding?
University of Maryland Department of Emergency Med
JULY 24, 2023
Background: Prior evidence1,2 has suggested that early “pan-scan” after ROSC provides clinically-relevant informat.
EMergucate
JULY 23, 2023
39-year-old lady with history of gestational diabetes x2. This patient stopped eating due to mood disturbances.
Dr. Smith's ECG Blog
JULY 27, 2023
This 29 year old African American patient was found down, unconscious, not breathing and was given 2 mg of intranasal naloxone by a bystander. He then received bag-valve-mask ventilations for several minutes until he became responsive. He had a prehospital ECG that was worrisome to the medics, so they called me to see him at the door. On arrival to the ED, the patient was diaphoretic, tachycardic. and had dilated pupils.
ESO
JULY 25, 2023
The National Emergency Response Information System (NERIS) is set to replace NFIRS by Q1 of 2025 – marking the biggest change to emergency response standard in the last 50 years. Its goal is to establish new standards that match the modern fire service and give departments access to data in a quicker, more efficient process. On July 13, 2023, the U.S.
Clinical Correlations
JULY 23, 2023
By Mikaela Belsky Peer Reviewed As I walked out of Bellevue, I plugged in my headphones and clicked shuffle. Minutes later, I passed a friend who was confused.
University of Maryland Department of Emergency Med
JULY 22, 2023
Evaluating trauma patients at Level 3 or 4 centers, rural hospitals, and non-trauma centers is difficult. Understanding the amount of work-.
Dr. Smith's ECG Blog
JULY 26, 2023
This patient presented with vertigo and had an ECG recorded What do you think? I saw this and was worried about inferior OMI due to some subtle STE in III with very worrisome reciprocal findings in aVL. But the well-formed Q-wave and the presence of a normal T-wave in inferior leads led me to believe this was Old Inferior MI with persistent ST Elevation, otherwise known as inferior LV aneurysm.
Emergency Medicine Education
JULY 26, 2023
This is an observational study among patients presenting to 3 EDs with Seizure and they found approximately 12 % of patients had some neuroimaging findings!
Don't Forget the Bubbles
JULY 26, 2023
Topic Cardiology & the ECG Author Anna McCorquodale Duration 1-2 hours Facilitator Level ST4+ level used to seeing children acutely Learner level Anyone involved in initial assessment of children with cardiac symptoms; paediatric trainees, emergency trainees, foundation doctors Outline Pre-reading Basics Case 1 Case 1: Discussion Case 2 Case 2: Discussion Advanced Case 1 Advanced Case 1: Discussion Advanced Case 2 Advanced Case 2: Discussion Quiz Take Home Points Basics (15 mins) with sharin
University of Maryland Department of Emergency Med
JULY 25, 2023
In a recent study of emergency physicians (EPs) who left the workforce between 2013 and 2020, authors sought to investigate their age and nu.
Dr. Smith's ECG Blog
JULY 22, 2023
Written by Pendell Meyers A man in his 70s with no cardiac history presented with acute weakness, syncope, and fever. He denied chest pain or shortness of breath. An ECG was performed in the ED at 1554: Original image unavailable, this is the only recorded scanned ECG available. See below for PM Cardio digitized version of this. PM Cardio digitized version.
EMDocs
JULY 26, 2023
Authors: Whitney Ficker, MD (Pediatric Emergency Medicine Fellow, Atrium Health’s Carolinas Medical Center); Christine Murphy, MD (Emergency Medicine Attending, Medical Toxicologist, Atrium Health’s Carolinas Medical Center) // Reviewed by: James Dazhe Cao, MD (@JamesCaoMD, Associate Professor of EM, Medical Toxicology, UT Southwestern Medical Center, Dallas, TX); Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case: A 13-month-old male presents to the Emergency Department (ED) with his
REBEL EM
JULY 27, 2023
Background: Current stroke guidelines recommend IV alteplase for patients with acute ischemic stroke presenting within 4.5hrs of symptom onset based on the NINDS and ECASS III publications. Both NINDS and ECASS III excluded patients with mild stroke symptoms but failed to clearly define a threshold for mild stroke. Many patients, however, will have minor strokes (defined as an NIHSS score ≤5).
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