Sat.May 06, 2023 - Fri.May 12, 2023

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Closed Head Injury – PECARN for < 3 Months: Rebaked Morsel

Pediatric EM Morsels

We all know that Gravity Works ! While this fact can adversely affect anyone, it offers the greatest challenge for those who cannot protect themselves , like children less than 3 months of age ! We last pondered this in 2011 Morsel , just a couple years after PECARN head injury data was published. Since that time there have been several studies externally validating the PECARN rule in all age groups and in multiple different countries.

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SSM Strategies for Success

High Performance EMS

I am pleased to announce the availability of my latest paperback book. As a consultant working with agencies across the nation that are representative of many distinct models of service, as well as being an EMS provider and a chief fire officer myself, I feel highly invested in the process to improve strategic dispatch and deployment decisions. It is my unique collective experience gained over more than 13 years of consultation and experimentation that is shared through these pages.

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ECG Cases 42 – Approach to ECG Interpretation in Patients with Chest Pain: OMI, False Positive & Negative STEMI & Other Causes

Emergency Medicine Cases

In this ECG Cases blog we look at 10 cases of patients with chest pain, including false positive STEMI, false negative STEMI, and other causes to help hone your ECG interpretation skills in time-sensitive cases where those very ECG skills might save a life. The post ECG Cases 42 – Approach to ECG Interpretation in Patients with Chest Pain: OMI, False Positive & Negative STEMI & Other Causes appeared first on Emergency Medicine Cases.

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Core Ultrasound Image Review, Episode 20!

Core Ultrasound

At long last, Core Ultrasound Image Review episode #20! In this episode, we discuss median nerve blocks, fibroids, pneumonia, pleural effusions, CRAO, AAA, abscesses, endocarditis, DVTs, CVC confirmation and gallstones. Check out the YT for the full video! CUIR #19 CUIR #18 CUIR #17 The post Core Ultrasound Image Review, Episode 20! first appeared on Core Ultrasound.

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Imaging Case of the Week 552

EMergucate

The chest x-ray is from a patient with severe dyspnoea. Patient has a past history of chronic airway obstruction.

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SGEM Xtra: I’m So Excited – But Don’t Call It Excited Delirium

The Skeptics' Guide to EM

Date: April 25, 2023 Reference: Walsh et al. Revisiting “Excited Delirium”: Does the Diagnosis Reflect and Promote Racial Bias? WJEM 2023 Guest Skeptic: Dr. Brooks Walsh is a former paramedic, and is currently an emergency physician in the Bridgeport Hospital, Yale-New Haven Health in Connecticut. This is an SGEM Xtra episode. Brooks reached out to me recently to see […] The post SGEM Xtra: I’m So Excited – But Don’t Call It Excited Delirium first appeared on The Skeptics Guide to Emergency Medi

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Ep 182 STIs: Cervicitis, Vulvovaginitis and Urethritis Emergency Recognition and Management

Emergency Medicine Cases

In this Part 1 or our two-part podcast series on STIs we discuss a general approach to cervicitis, vulvovaginitis and urethritis, elucidate some key historical features, debate who needs a pelvic exam in the ED, understand who needs what testing, debate self swabs vs physician taken swabs, dig into some specific under-recognized organisms like Mycoplasma Genitalium, figure out who needs what kind of empiric treatment, sexual partner treatment and which discharge instructions are key.

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Lightning rounds #27: Our favorite FOAM

Critical Care Scenarios

Bryan and Brandon share their favorite podcasts, blogs, social media, and other online channels for medical education. Podcasts Blogs/websites Twitter accounts So, with Twitter, we could post all day and still leave a bunch of people out. Here are a few…the best way to find good Twitter followers is to start with these and see … Continue reading "Lightning rounds #27: Our favorite FOAM" Bryan and Brandon share their favorite podcasts, blogs, social media, and other online channels for medical ed

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Lab case 404 interpretation

EMergucate

PH = 7.395, that is within normal range. pCO2 = 42 mmHg, Normal for venous blood gases ( Normal pCO2 is 40 mmHg for arterial blood and 48 mmHg for venous). HCO3 = 25 mmol/L.

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Ep 182 STIs: Cervicitis, Vulvovaginitis and Urethritis Emergency Recognition and Management

Emergency Medicine Cases

In this Part 1 or our two-part podcast series on STIs we discuss a general approach to cervicitis, vulvovaginitis and urethritis, elucidate some key historical features, debate who needs a pelvic exam in the ED, understand who needs what testing, debate self swabs vs physician taken swabs, dig into some specific under-recognized organisms like Mycoplasma Genitalium, figure out who needs what kind of empiric treatment, sexual partner treatment and which discharge instructions are key.

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Implanted Ultrasound Lets Chemo Access Brain

Medgadget

Researchers at Northwestern University have trailed an implanted ultrasound device in patients, which is used in combination with microbubbles to transiently open pores in the blood brain barrier, allowing chemo drugs to enter. We have reported on this technique before as a lab-based concept (see flashbacks below), but this is the first time that it has actually been trialed in human patients, in this case patients with glioblastoma, a difficult to treat brain cancer.

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Return Encounters in Emergency Department Patients Treated with Phenobarbital Versus Benzodiazepines for Alcohol Withdrawal

REBEL EM

Background: The emergency department is frequently visited by patients suffering from symptomatic alcohol withdrawal, and the traditional management has been dominated by repeated doses of benzodiazepines. 1, 2 Phenobarbital has been studied as an alternative or adjunct to benzodiazepines with encouraging results, but primarily among inpatient services. 3, 4 Much of the appeal of phenobarbital lies in its ability to stave off severe alcohol withdrawal symptoms days after administration, without

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Learning about human factors in the emergency department

Don't Forget the Bubbles

In May 2022, Holly and Joe, two students on the joint QMUL and DFTB PEM MSc , created video presentations on human factors. We’ve incorporated some of our favourite elements from their presentations in this blog post. You’re in the paediatric emergency department, typing some notes for the child you’ve just discharged. You’re just about aware of the tannoy in the background.

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ECG Cases 42 – Approach to ECG Interpretation in Patients with Chest Pain: OMI, False Positive & Negative STEMI & Other Causes

Emergency Medicine Cases

In this ECG Cases blog we look at 10 cases of patients with chest pain, including false positive STEMI, false negative STEMI, and other causes to help hone your ECG interpretation skills in time-sensitive cases where those very ECG skills might save a life. The post ECG Cases 42 – Approach to ECG Interpretation in Patients with Chest Pain: OMI, False Positive & Negative STEMI & Other Causes appeared first on Emergency Medicine Cases.

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Chest Wearable Provides Key Heart Measurements

Medgadget

Researchers at the University of Texas at Austin have developed a new chest wearable that can obtain both electrocardiogram and seismocardiogram data from the underlying heart. While basic ECG can be monitored via smart watches, no other wearable combines it with seismocardiography, which would conventionally be obtained by listening to the heart using a stethoscope.

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Lab case 405

EMergucate

60 year-year-old man with history of DM and x-smoker but not known to have COPD.

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Lessons Learned from the Silicon Valley Bank Meltdown

ACEP Now

Question I was shocked to see bank runs in March 2023. I thought those went away after regulatory changes in the Great Depression. What takeaway should there be from the troubles that Silicon Valley Bank (SVB) and other banks had during March 2023? Answer In March 2023, depositors of SVB engaged in a classic “bank run” that resulted in the Federal Deposit Insurance Corporation (FDIC) stepping in and putting the bank into receivership.

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Shifting the Paradigm: Can We Manage Mechanically Ventilated Patients with Occult Traumatic Pneumothorax Conservatively?

REBEL EM

Background: Clinically significant pneumothoraces in patients on mechanical ventilation can be dangerous as positive pressure ventilation can cause an increase in intrapleural pressure and trigger tension physiology. Occult pneumothoraces are those not suspected clinically or not evident on plain radiographs but later identified on computerized tomography (CT) imaging.

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Wearable Ultrasound Measures Tissue Stiffness Under Skin

Medgadget

Researchers at the University of California San Diego have developed a wearable ultrasound patch that is intended to provide information on the stiffness of underlying tissues as deep as 4 cm below the surface of the skin. The patch consists of a flexible 16 x 16 ultrasonic array with a silver-epoxy composite backing layer that is designed to absorb excessive vibrations.

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Rocuronium ?1.5 mg/kg versus >1.5 mg/kg and inadequate paralysis in prehospital and retrieval intubation: A retrospective study Clare Hayes-Bradley MBBS

EMergucate

Rocuronium ≤1.5 mg/kg versus >1.

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A 30-something woman with intermittent CP, a HEART score of 2 and a Negative CT Coronary Angiogram on the same day

Dr. Smith's ECG Blog

This was sent by a colleague. A 34 yo woman with a history of HTN, h/o SVT s/p ablation 2006, and 5 months post-partum presented with intermittent central chest pain and SOB. She had one episode of pain the previous night and two additional episodes early on morning the morning she presented. Deep breaths are painful and symptoms come and go. She had one BP that was measured at 160/120, uncertain when and what the BP was at other moments.

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REBEL Core Cast 101.0 – Imaging in Renal Colic

REBEL EM

Take Home Points Many patients with renal colic require a CT scan. Diagnostic imaging should focus on eliminating concerning mimics; not on clinching the diagnosis of renal colic. POCUS and radiology department US are important modalities in evaluation of renal colic. REBEL Core Cast 101.0 – Imaging in Renal Colic Click here for Direct Download of the Podcast References Moore CL et al.

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Immunotherapy Implant to Treat Pancreatic Cancer

Medgadget

Researchers at Houston Methodist have developed an implant that can provide localized and sustained release of immunotherapies to treat pancreatic cancer. Their device is tiny, at approximately the size of a grain of rice, and they have termed it a “nanofluidic drug-eluting seed” Pancreatic cancer is particularly difficult to treat, and current therapies have problems penetrating the tumor while resulting in significant side-effects elsewhere in the body.

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Thalassaemia

Don't Forget the Bubbles

1-year-old Ruby presents with pallor and faltering growth. She is of Asian origin and has a family history of thalassaemia. Her blood tests show a microcytic anaemia. What do you do next? Thalassaemias are inherited blood disorders that can cause anaemia. Usually, haemoglobin, comprised of four globin chains and a haem group, carry oxygen around the body.

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A man in his 70s with acute chest pain and paced rhythm.

Dr. Smith's ECG Blog

Sent by Pete McKenna M.D. Edits by Meyers and Smith A man in his 70s with PMH of hypertension, hyperlipidemia, type 2 diabetes, CVA, dual-chamber Medtronic pacemaker, presented to the ED for evaluation of acute chest pain. Triage ECG: What do you think? This is diagnostic of proximal LAD occlusion. This is a huge anterolateral OMI. Deadly. I cannot be anything else.

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8 Pitfalls in Recognition and Management of Acetaminophen Toxicity

ACEP Now

About one billion doses of acetaminophen are taken safely per annum, and 60 million people in the U.S. take acetaminophen on a weekly basis. 1,2 With such enormous popularity it is no surprise that each year there are 56,000 emergency department (ED) visits, 2,600 hospitalizations, and 500 deaths in the U.S. related to acetaminophen toxicity. 2 Some cases of acetaminophen toxicity are simple to recognize and manage, such as an intentional single recent ingestion of a large number of regular-rele

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Capsule Delivers Electrical Current to Stomach for Appetite

Medgadget

Researchers at MIT have developed an ‘electroceutical’ capsule that is designed to be swallowed and which will deliver a small electrical current to the stomach wall. The device contains an external electrode that wraps around its exterior and small grooves that draw liquid away from the electrode and help it to contact the stomach wall.

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Is this a STEMI?

University of Maryland Department of Emergency Med

52 yo M with chest pain and shortness of breath, ECG as shown, do you activate cath lab? The posterior descending artery (PDA) s.

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EMCrit RACC Lit Review – May 2023

EMCrit Project

all the lit goodness. EMCrit Project by Scott Weingart, MD FCCM.

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By the Numbers: Emergency Medical Technician Shortages

ACEP Now

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.

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Knitted Glove Massages the Hand to Treat Edema

Medgadget

A team of medical engineers at Cornell University has developed a knitted glove that is designed to treat hand edema, where fluid accumulation leads to swelling in the hands. The condition can make it difficult for patients to perform daily activities, and current treatment often involves receiving a manual edema massage performed by a trained healthcare worker.

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LetterSTEMI Problems

EMS 20/20

Check out 90 Seconds: The Epic Story of Eli Beer! Support EMS 20/20 by purchasing through our affiliate links below: Amazon: [link] ArtScroll (Publisher): [link] Pitter patter! New episode out TODAY! Chris hops on a bus driven by Spencer headed to struggle street when it comes to a wonky ECG. To STEMI or not to STEMI? Can Chris get it right, or is he 10-ply?

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Time to Amiodarone and Survival Rate

Emergency Medicine Education

NEJM study in 2016 showed no survival benefits or favorable neurological outcome regarding use of Amiodarone vs Lidocaine vs placebo in OHCA. In a recent publication by Acad Emerg Med , a post hoc analysis of original study was done and the authors found time to Amiodarone in OHCA could be associated with better survival to discharge if it was given within 8 minutes.

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Forensic Evaluation of Motor Vehicle Accidents

ACEP Now

Case A 35-year-old male is brought to the emergency department (ED) following a single-motor-vehicle collision in which two people were ejected and pronounced dead at the scene. The patient was not ejected but was found sitting outside of the vehicle and seems to be intoxicated. He is completely amnestic to the events of the accident. EMS reports starring and significant damage to the windshield and show you a picture (Figure 1).

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Brain Decoder Spells Out Thoughts

Medgadget

Researcher scientists at the University of Texas at Austin have developed a brain decoding technology that combines an fMRI scanner and artificial intelligence, similar to well-known AI systems such ChatGPT or Bard. The technology can spell out our thoughts in text form, but more importantly may allow patients who cannot otherwise communicate, such as those experiencing significant paralysis, to communicate their thoughts.

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Use of delayed sequence induction in trauma pateints

University of Maryland Department of Emergency Med

Delayed sequence intubation can be valuable in the agitated, combative trauma patients who will not tolerate pre-intubation pre-oxygenation. &n.

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Real patient scenario videos

EMT City

Improve your EMS skills with a course about real patient scenarios! There will be a new scenario every week. Enroll in if you're interested!

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