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Date: June3, 2023 Reference: Kotani et al. Etomidate as an induction agent for endotracheal intubation in critically ill patients: A meta-analysis of randomized trials. Journal of Critical Care April 2023 Guest Skeptic: Dr. Amber Gombash is an emergency physician in Concord, NC. Case: You have a critically ill patient that you are preparing to intubate and wonder […] The post SGEM#405: We’re Off To Never-Never Land – But Should We Use Etomidate for the Rapid Sequence Intubation?
In this ECG Cases blog we look at 10 patients with shortness of breath, and discuss how the ECG can be used to help diagnose cardiac, respiratory and metabolic emergencies. We discover that for STEMI/OMI vs subendocardial ischemia, we should look for STEMI(-)OMI, subacute OMI, and OMI in the presence of LBBB and RBBB, and consider the differential for diffuse ST depression with reciprocal ST elevation in aVR.
When we think of severe hemorrhage in children, we typically think about trauma. Maybe injuries to the spleen or kidney come to mind. Perhaps thoughts of pelvic injuries or severe head injury dominate our considerations. Of course, we all have a healthy respect for post-tonsillectomy hemorrhage and we like to talk about Damage Control Resuscitation.
The venom from this pictured snail shares a primary mechanism of action with what other deadly toxin? Alpha-latrotoxin Botulinum toxin Bufotoxin Tetanus toxin Sarin Reveal the Answer Answer: 3. Botulinum toxin The cone snail contains alpha-conotoxin which is a potent nicotinic receptor antagonist similar to botulinum toxin and can cause muscular paralysis.
On this month's EM Quick HIts podcast: Anand Swaminathan on EVT for large vessel occlusion strokes, Sarah Reid on picking up intussusception, Andrew Petrosoniak on 5 Penetrating Trauma Tips, Peter Toth on using a slit lamp to manage skin foreign body hack, Nour Khatib and Jonathan Wallace on CT Radiation Risk and Matt Poyner on setting up an emergency fund.
Researchers at the University of California San Diego have created a wearable ultrasound system that can monitor deep tissues, as far as 16.5 cm (6.5 inches) below the surface of the body. Moreover, the team employed a machine learning algorithm to reduce the noise associated with movement, helping to obtain reliable readings while the wearer goes about their day.
We chat about why people get burned out in medicine, how to weigh the pros and cons of our work, and the right perspective on job satisfaction. We chat about why people get burned out in medicine, how to weigh the pros and cons of our work, and the right perspective on job satisfaction.
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We chat about why people get burned out in medicine, how to weigh the pros and cons of our work, and the right perspective on job satisfaction. We chat about why people get burned out in medicine, how to weigh the pros and cons of our work, and the right perspective on job satisfaction.
Background Information: Acute Hypotension is associated with increased morbidity and mortality. Continuous vasopressor infusions have previously been the mainstay of treatment. However, peripherally dosed push dose pressors, (PDPs), are beginning to be administered more frequently for management of acute hypotension. 1-4 The PDPs, phenylephrine and epinephrine, result in vasoconstriction and increased cardiac contractility.
Researchers at George Washington University have created a swallowable capsule containing a video camera that can assist in identifying lesions in the stomach. However, unlike similar devices that have been developed previously, this capsule can drive around the stomach under the control of a clinician. This allows it to thoroughly navigate and screen the entire area to identify any health issues in the stomach mucosa, such as ulcers or bleeding.
When considering an optimized environment for compassionate patient communication, the chaotic emergency department (ED) probably gives some clinicians pause. EDs, filled with alarms, frequent interruptions, hurried paramedics and consultants, hallway beds, and the looming sense that clinicians are out of time, is rarely thought of as a place for empathetic communication.
Welcome back to the “52 in 52” series. This collection of posts features recently published must-know articles. This week we cover the EXTEND trial looking at thrombolysis up to 9 hours after stroke onset. Author: Christiaan van Nispen, MD (Resident, Emergency Medicine Physician, San Antonio, TX); B rannon Inman, MD (Chief Resident, Emergency Medicine Physician, San Antonio, TX) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Thrombolysis Guided by Perfusion Imaging up
The iLet Bionic Pancreas for use by type 1 diabetes patients has been cleared by the FDA and is now available commercially. The device is offered by Beta Bionics , a medtech company based in Massachusetts and California, but the underlying technology originally developed by researchers at Boston University. The system can be paired with a Bluetooth glucose monitor to deliver personalized insulin dosing every five minutes, and calculates doses based on past and current glucose levels and its expe
A 40-something male presented by ambulance with one hour of chest pain that was improving after sublingual nitroglycerine and 325 mg of aspirin, chewed. Here is his initial ED ECG: What do you think? I read this ECG without any history as reperfusing inferior and posterior OMI due to the Q-wave in lead III with minimal STE and reciprocal ST depression in V2-V4 (which should never be there).
Original podcast posted on PEM Currents – Hosted by Brad Sobolewski ( @PEMTweets ) and co-authored by Dennis Ren ( @DennisRenMD ) This podcast series by PEM Currents is a co-production with the Emergency Medical Services for Children Innovation and Improvement Center (EMSC IIC), whose mission is to minimize morbidity and mortality of acutely ill and injured children across the emergency continuum.
Take Home Points Caustics are substances that injure tissue upon physical contact. Caustic potential is not purely a function of pH. The decision to admit is dependent on the history and physical. Vomiting, drooling, and stridor are concerning. Stridor alone or 2/3 symptoms should warrant admission and gastroenterology consultation for potential endoscopy.
Engineers at the University of Colorado at Boulder have developed a medical microrobot that is powered by acoustic waves. The tiny devices, which are 20 micrometers wide and considerably smaller than the width of a human hair, can move incredibly fast for their size, achieving a speed of 3 millimeters per second. To put this in context, if a microrobot and a cheetah the same size had a race, the microrobot would win comfortably.
Author: Ramya Kondaveeti, MD (EM Resident Physician, ACMC/Oak Lawn, IL); Thaer Ahmad, MD (EM Attending Physician, Oak Lawn, IL) // Reviewed by: Sophia Görgens, MD (EM Resident Physician, Zucker-Northwell NS/LIJ, NY); Cassandra Mackey, MD (Assistant Professor of Emergency Medicine, UMass Chan Medical School); Brit Long, MD (@long_brit) Welcome to EM@3AM, an emDOCs series designed to foster your working knowledge by providing an expedited review of clinical basics.
Background Information: Opioid overdose deaths have been increasing in the past twenty years. The national number of overdose deaths from any opioid has increased 62.5% from 2019 to 2021 (from 48,000 to 81,400 annual deaths), which includes prescription opioids (natural and semi-synthetic opioids and methadone), heroin, and synthetic opioids other than methadone including fentanyl (1).
A 50-year-old female develops chest pain radiating to the neck and left arm. ECG, CXR, and troponin are negative. She is given morphine for pain. Four hours later she develops back pain and bilateral leg paresthesias. CT angiography shows aortic dissection which is treated surgically, but she is left with paraplegia. Notoriously elusive, with a high misdiagnosis rate, thoracic aortic dissection (AD) can mimic many conditions, including acute coronary syndrome (ACS, the most common), gastroesopha
Engineers at Ecole Polytechnique Fédérale de Lausanne (EPFL) in Switzerland have developed a new technology that can provide temperature feedback for amputees using a prosthetic limb. Excitingly, the device makes it feel as if the temperature sensation is experienced in the phantom limb, providing a realistic experience of touching something cold or hot with the missing limb.
This past May, Firefighters and EMS Fund Executive Director, Jane Porter had the honor of attending the 2023 FAMA/FEMSA Hill Day event in Washington, D.C. as a member of FEMSA (Fire and Emergency Manufacturers and Services Association). Firefighters and EMS Fund has participated in this event as members of FEMSA since 2019. Over the course […] The post Firefighters and EMS Fund Attends Hill Day in Washington, D.C. appeared first on Firefighters and EMS Fund.
If you’re wondering about the hype with chatbots in medicine, perhaps it’s because they’re nothing new: the first medical chatbot, after all, was developed back in 1964. Using a simple pattern-matching and reflection script entitled DOCTOR, the ELIZA program simulated a Rogerian psychotherapist. Even this basic initial experiment evoked unique responses from those interacting with the software, and a new field of human-computer interaction was born.
Researchers at the Ohio State University Wexner Medical Center have developed a medical device that is intended to improve patient safety during cardiac ablation procedures to treat atrial fibrillation (AFib). At present, the esophagus can lie very near to the target tissue during cardiac ablation, leading to esophageal injury in many patients. This device is advanced down the esophagus and applies gentle suction to the esophageal wall to move the esophagus gently to one side, away from the abla
A 50-something presented with acute chest pain. Here is her ED ECG. It was texted to me while I was out and about. He wrote: "Steve, what do you think about hyperacute T waves in this? 54-year-old female with CP. I initially interpreted as normal, but I am second-guessing myself, since she is hanging out in triage with me." What do you think, Dear Reader?
Although the treatment of community acquired pneumonia (CAP) is bread-and-butter emergency medicine, several guidelines and landmark studies have called for fairly big changes in clinical practice. 1–4 Two recommendations deserve particular attention. Importantly, recommendations include significantly narrowing the use of antibiotics that cover methicillin resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa ( P. aeruginosa ), even in severe pneumonia.
Scientists at Purdue University have developed a urine test for early-stage Parkinson’s disease. The technology involves isolating extracellular vesicles of neural origin from urine samples and then assessing the proteins within the vesicles to detect biomarkers of the disease. The researchers have called their technology “EVtrap” (Extracellular Vesicles total recovery and purification) and it involves using magnetic beads to concentrate extracellular vesicles in urine, before subsequent proteom
If you’ve been reading about trauma care in the last few years, you have undoubtedly seen something about the use of whole blood in trauma resuscitation. Born out of military medicine experience, we are starting to see civilian EMS programs both air and ground starting to use this treatment to save lives from traumatic injury and massive hemorrhage.
For nearly two years, ACEP has been fighting to ensure that the federal government’s implementation of the No Surprises Act has been in accordance with Congressional intent. Using every channel available on the federal, state, regulatory and legal channels, we have pushed for comprehensive policy and the fair implementation of those policies. Despite our gains on the policy side, the implementation of the law continues to be problematic.
A few years ago, several of our Australian and/or New Zealand members were involved in a major wildfire in Australia, that lasted for weeks. My question is, did the smoke cause orange skies and major air pollution reports downwind from the fires, hundreds of miles/kilometers away like the North Eastern United States is now being subjected to? I only ask, as for the roughly last 48 hours, my New York City is having the worst unhealthy air pollution we've had, since 1965-1966.
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