Sat.Dec 03, 2022 - Fri.Dec 09, 2022

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ECG of the Week 7th December 2022

EMergucate

Paramedics ring through to say that they are 10 minutes away with a 65 year old man who has a heart rate of approximately 170 with a thready pulse and a systolic blood pressure of 90.

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Journal Jam 21 Laceration Management – Does Timing of Closure, Irrigation, Gloves Type, Eversion Matter?

Emergency Medicine Cases

In this Journal Jam podcast Anton and Justin welcome special guest Dr. Haley Cochrane. We dive deep into the evidence for timing of closure and infection rate, fluid choice, volume and pressure of irrigation of lacerations, glove type and infection rate, how eversion of wound edges effects cosmetic outcomes and much more. You might be surprised to discover that the evidence for many things we do for lacerations that are considered "standard of care", is either weak or non-existent.

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Camera Measures Blood Pressure with Quick Look

Medgadget

At the University of South Australia, researchers designed a system that allows them to measure a patient’s blood pressure with a camera. The camera visualizes the patient’s forehead and focuses on two regions in particular to optically determine photoplethysmographic signals that AI algorithms then convert to blood pressure data. The researchers tested their system in 25 volunteers, and so far it has proven to be approximately 90% as accurate as traditional pressure cuff measurements.

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Episode 54: The critically ill patient with pulmonary hypertension, with Ray Foley

Critical Care Scenarios

We look at the patient with known pulmonary hypertension admitted for new issues like sepsis and pneumonia, and how they differ from our usual bread and butter, with help from Dr. Raymond Foley, director of the medical ICU and the pulmonary/critical care fellowship at UConn Health, as well as director of their pulmonary vascular disease … Continue reading "Episode 54: The critically ill patient with pulmonary hypertension, with Ray Foley" We look at the patient with known pulmonary hypertension

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ECG of the Week 30th November 2022 – Interpretation

EMergucate

ECG of the Week 30th November 2022 – Interpretation This ECG was used to illustrate how a systematic approach ensures … Continue reading →

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EMC Journal Club 1 – Does Treating Fever Make A Difference?

Emergency Medicine Cases

In this first EMC Journal Club (where we take the "boring" out of journal clubs and deliver clear, concise, practical practice changing critical appraisal knowledge based on an Emergency Medicine journal article that may have passed your radar - not too detailed and not too brief), Dr. Rohit Mohindra, an Emergency Physician at North York General in Toronto and SREMI researcher works his critical appraisal magic on the article "Fever therapy in febrile adults: systematic review with meta-analyses

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SGEM #384: Take Me Out Tonight, I Don’t Want to Perforate My Appendix Alright

The Skeptics' Guide to EM

Date: November 16th, 2022 Reference: Lipsett SC, Monuteaux MC, Shanahan KH, et al. Nonoperative Management of Uncomplicated Appendicitis. Pediatrics 2022 Guest Skeptic: Dr. Angelica DesPain is an Assistant Professor of Pediatrics and a pediatric emergency medicine physician at the Baylor College of Medicine Children’s Hospital of San Antonio in San Antonio, TX.

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Imaging Case of the Week 531

EMergucate

The following foot x-rays are from a 50 year old with plantar flexion injury to their foot and inability to … Continue reading →

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Creating and Keeping Healthy New Year’s Resolutions

First Responder Wellness

After the flurry and liveliness of holiday festivities comes a time for quiet reflection, as many look back on this past year and prepare for the next. This desire to continue improving oneself as we make our New Year’s resolutions is a healthy intention. It is admirable to make goals for ourselves continually, but when these goals become too unrealistic, we can set ourselves up to feel anxiety and disappointment if we do not achieve them.

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TEAM

The Bottom Line

Early Active Mobilization during Mechanical Ventilation in the ICU @chodgsonANZICRC @TEAMtrialICU. NEJM 2022; 387:1747-58 doi:10.1056/NEJMoa2209083 Clinical Question In mechanically ventilated adult patients does the provision of early mobilisation when compared to standard care increase the number of days alive and out of hospital at 180 days?

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65 year old with syncope and a 'normal' ECG: discharge home?

Dr. Smith's ECG Blog

A 65 year old with diabetes presented with a syncopal episode while sitting, associated with weakness but no chest pain or shortness of breath. Vital signs were normal and first ECG was labeled as normal by the computer and confirmed by the treating emergency physician and cardiology over-read. What do you think? There’s normal sinus rhythm, normal conduction, normal axis, normal R wave progression, and normal voltages with J waves from early repolarization.

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Lab case 388 interpretation

EMergucate

Question 1: PH = 7.55, that is moderate alkalaemia. pCO2 = 26 mmHG (<40), so we have respiratory alkalosis.

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Short Course Antibiotics for Peds CAP: A Systematic Review and Meta-Analysis

REBEL EM

Background: There is a shifting paradigm with persuasive evidence favoring a shorter duration of antibiotics for outpatient management of community-acquired pneumonia (CAP) in children. The SAFER and CAP-IT trials found that short-course antibiotic therapy was not inferior to standard duration therapy. The SCOUT-CAP Trial found that short-course antibiotic therapy was superior to standard therapy.

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Teenage Heartbreak

EMS 20/20

Maybe don't overthink the cover art, but do Chris and Spence finally argue about what to do about a really, really sick pediatric patient? Stir the oxygen tanks as the guys try and solve Houston's problem, and check our Facebook and Instagram for the EKG's associated with this episode! Maybe don't overthink the cover art, but do Chris and Spence finally argue about what to do about a really, really sick pediatric patient?

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Are these Hyperacute T-waves?

Dr. Smith's ECG Blog

I received this ECG in a text message, with the message: "Hey, these look like hyperacute T waves to me, what do you think? It’s an intubated septic nursing home patient." "Here is her old ECG:" What do you think? Here is my response: "There is something wrong with this ECG. It might be another case of pulse tapping artifact. Change the location of the limb Electrodes and repeat the EKG.

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Lab case 389

EMergucate

25-year-old police academy student brought to ED due to collapse in training.

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Classic Journal Club: TXA for Epistaxis

Silk City Blog

Written by Amanda Hall, DO This post first appeared on REBEL EM Background: Epistaxis is a common ailment experienced by millions worldwide. While most of these cases can be managed by patients at home, some will require medical attention. Initial interventions include local pressure, ice, and forward head positioning for persistent bleeds. When simple maneuvers fail, we proceed to topical agents such as lidocaine with epinephrine, oxymetazoline, anterior nasal packing, and electrical or chemica

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Tasty Morsels of Critical Care 067 | The pulmonary artery catheter

Emergency Medicine Ireland

Welcome back to the tasty morsels of critical care podcast. Today we are going to do our best to charm the yellow snake of the intensive care unit and cover the pulmonary artery floatation catheter. Like a lot, indeed practically all of these topics, I do not in any way consider myself to have great expertise in the topic but I have had to upskill as much as I possibly can in lieu of the typical mis spent youth doing cardiac anaesthesia that most of my colleagues have had.

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Novel prompt for hemmoragic shock resuscitation

University of Maryland Department of Emergency Med

This paper outlines a training course by Hartford Hospital for general surgery and emergency medicine residents. Their goal was to assess pre-a.

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Critical Care Evidence Updates – November 2022

The Bottom Line

What’s new in the Critical Care literature – monthly updates

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Exercise intensity and cardiovascular mortality

University of Maryland Department of Emergency Med

"The Tortoise and the Hare" fable has been used as a metaphor for the epidemiological differences between slower, low-intensity exercise ve.

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Extubation to Noninvasive Ventilation vs High Flow Nasal Cannula

University of Maryland Department of Emergency Med

Although extubation has historically been the purview of critical care, as ED lengths of stay continue to worsen, and as we see more and mo.

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Predicting 30 day readmission in rib fracture patients

University of Maryland Department of Emergency Med

In this retrospective chart review, 3720 admitted trauma patients with rib fractures were looked at for 30 day readmission. 206 patients i.

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Follow up to Trauma Center Accessibility

University of Maryland Department of Emergency Med

In follow-up to last week’s pearl regarding the inequitable distribution of trauma care, there were a few more thoughts: 1.&nbsp.

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Use of Serratus Anterior plane block for posterior rib fractures

University of Maryland Department of Emergency Med

The use of a serratus anterior plane nerve block has previously been described as effective for anterior and lateral rib fracture pain co.

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