Sat.Apr 01, 2023 - Fri.Apr 07, 2023

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Sickle Cell Disease and Stroke

Pediatric EM Morsels

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 !

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Imaging Case of the Week 546 Answer

EMergucate

The pelvic X-ray shows. Ischial tuberosity avulsion fracture on the left side. This is due to hamstring pull.

EMS 130
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TIRBO #32: Approaching bacteremia

Critical Care Scenarios

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.

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PulmCrit Blogitorial – Why we will never know how to manage stress hyperglycemia

EMCrit Project

(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.

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REBEL Core Cast 99.0 – Bundle Branch Blocks

REBEL EM

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.

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Imaging Case of the Week 547

EMergucate

The following chest x-ray is from a critically unwell patient. What can be seen? Answer will be posted later.

EMS 130
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Gelatin-Based Surgical Sealant for Rapid Sealing Inside the Body

Medgadget

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

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The Debate Over Volunteer Fire Training: Fire Union Files Complaint After Town Official’s Suggestion

Firefighters and EMS Fund

The fire union in a small Massachusetts town, Manchester-by-the-Sea, has filed a complaint after a town official suggested that police officers train as volunteer firefighters. The suggestion has sparked a debate about the benefits and drawbacks of combining fire and police departments and training officers to serve in both roles. On the one hand, proponents […] The post The Debate Over Volunteer Fire Training: Fire Union Files Complaint After Town Official’s Suggestion appeared firs

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Imaging Case of the Week 545 Answer

EMergucate

The chest X-ray shows. Right upper lobe collapse.

EMS 130
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RBBB and LAFB. Is it trifascicular block? The complexities of Wenckebach, with Ken Grauer analysis.

Dr. Smith's ECG Blog

This patient presented with complications of his dialysis fistula. Medical history: History of Ischemic Heart Disease History of Congestive Heart Failure Diabetes Mellitus requiring treatment with insulin Pre-operative serum creatinine >2 mg/dL He had this ECG recorded: What do you think? There is AV 2nd degree AV Block (Mobitz I, Wenckebach) with RBBB and LAFB The physicians recognized the RBBB and LAFB, but not the Wenckebach.

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First10EM Journal Club: April 2023

Broome Docs

We are back with the long-windiest and borderline funny Emergency Medicine journal club to date. Justin and I are covering some big new trials, some old and unusual papers and a few that just might change your practice. As always the links to the papers are in the write up below and you definitely should read them rather than believe a couple of nerds amusing themselves upon the internet.

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15 of the Best Gifts You Can Give Your EMT or Paramedic

EMT Training Station

In the fast-paced and high-stress world of emergency medical services, EMTs and paramedics consistently go above and beyond to save lives and provide comfort to those in need. These unsung heroes work tirelessly, often sacrificing their own well-being to make a difference in the lives of others. With this in mind, it’s essential to show our appreciation and support for these incredible individuals.

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Lab case 401 interpretation

EMergucate

Answers: Question 1: pH 7.62 that is moderate to severe alkalaemia HCO3 36mmol/L, so we have metabolic alkalosis.

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Formula for Hypernatremia Correction: How to Derive it?

K.S. Chew

Do you find it difficult to grasp the concept of hypernatremia correction and how to calculate the amount of water deficit in patients? This video breaks down the formula using a simple and relatable analogy – diluting a bowl of salty soup!

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70-year-old with acute chest pain, STEMI negative: just an old infarct?

Dr. Smith's ECG Blog

Submitted by Dr. Dennis Cho (@DennisCho), written by Jesse McLaren A 70-year-old with no cardiac history presented with 2 hours of chest pain radiating to the neck, associated with shortness of breath. What do you think? There’s normal sinus rhythm, first-degree AV block, normal axis and voltages. R wave progression is abnormal: there are Q waves in aVL/V2-3 and loss of R wave in V2.

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En Route: Hardcover Edition

Ambulance Driver Files

En Route: A Paramedic’s Stories of Life, Death and Everything In Between is now available in hardcover! Remember, if you’d like personalized and signed copies of my books, click one of the book covers on the right sidebar!

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Lab case 402

EMergucate

70-year-old diabetic man presented with vomiting. His venous blood gases showed the following: PH = 7.

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Intranasal Dexmedetomidine Use in Pediatric Patients for Anxiolysis in the Emergency Department

University of Maryland Department of Emergency Med

Background: Intranasal dexmedetomidine has seen usage in the anesthesia and sedation realms over the past few years, with an increasing interest in usage in t.

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I was reading EKGs on the system and came across this one.

Dr. Smith's ECG Blog

I was reading EKGs on the system and came across this one. I am always looking for EKGs that show either subtle OMI or OMI mimics. Which did I think this was? I suspected that this was a mimic. It is hard to say why. There is "inferior" ST depression, reciprocal to high lateral ST Elevation. The precordial leads have ST Elevation but also high voltage and look like possible LVH.

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The OMI Quizzes

Dr. Smith's ECG Blog

There are 4 quizzes here on OMI ECG diagnosis: Beginner Novice Intermediate Advanced The first link on the page is to an ECG guide as a primer on OMI ECG diagnosis. These quizzes were written by Gregory Yates (an "FY 2 doctor" in the UK), Maddy Kahle (who is just finishing her 4th year of medical school at the U of MN), and aided by Romi Lee (another U of MN med student).

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Steroids in Severe CAP

University of Maryland Department of Emergency Med

Background: The use of steroids in pneumonia has long been controversial with conflicting data, and the recent ESCAPe randomized controll.

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Treatment of lower back pain without opioids

University of Maryland Department of Emergency Med

Acute lower back pain is a very common emergency department presenting complaint. Over the last several years there has been impetus to.