The Skeptics' Guide to EM

SEPTEMBER 9, 2023

Reference: Snelling et al. Ultrasonography or radiography for suspected pediatric distal forearm fractures. New England Journal of Medicine June 2023 Date: July 19, 2023 Guest Skeptic: Dr. Casey Parker is a Rural Generalist that includes in his practice emergency medicine, anesthesia, and critical care. He is also a fully-fledged ultrasonographer. Casey currently splits his time […] The post SGEM#415: Buckle Down for some Ultrasound to Diagnosis Distal Forearm Fractures first appeared on The Ske

Critical Care 310

Critical Care ALS ED Emergency Department 310

Emergency Medicine Cases

SEPTEMBER 12, 2023

In this ECG Cases blog Dr. Jesse MacLaren guides us through 10 cases of patients who present with generalized weakness or acute neurologic symptoms and discusses how to look for ECG signs of dysrhythmias, electrolyte emergencies, acute coronary occlusion, and demand ischemia in patients with generalized weakness and in patients with neurologic symptoms, to consider predisposing factors like LVH; seizure-like activity from cardiac syncope; TIA/CVA embolic sources like atrial fibrillation or LV th

Coronary 296

Coronary OR EMS 296

ALiEM

SEPTEMBER 15, 2023

A 64-year-old Caucasian male with a history of alcohol use disorder and tobacco use disorder presents with painless bilateral hand contractures that have been worsening for the past several months. He denies any recent trauma, fever, chills, or decreased sensation. The patient works as a construction worker. Physical Exam Vitals : BP 143/83 ; HR 94; RR 18; T 98.6°F; O2 saturation 98% on room air Musculoskeletal : He has bilateral palmar contractures proximal to the fourth digits.

OR 152

OR 152

Critical Care Scenarios

SEPTEMBER 13, 2023

We discuss the nuts and bolts of urinary infection with an obstructing stone with Ashley Winter (@AshleyGWinter), board certified urologist with a fellowship in male and female sexual medicine, and chief medical officer of Odela Health. Find us on Patreon here! Buy your merch here! Takeaway lessons We discuss the nuts and bolts of urinary infection with an obstructing stone with Ashley Winter ( @AshleyGWinter ), board certified urologist with a fellowship in male and female sexual medicine, and

OR 130

OR 130

REBEL EM

SEPTEMBER 14, 2023

Background: Cardiogenic shock develops in up to 10% of patients with acute myocardial infarction (AMI) and carries a 30 day mortality rate around 50%. Revascularization of the culprit lesion remains one of the few established treatments though there are numerous other unproven modalities including extracorporeal life support (ECLS). Many centers have attempted ECLS to achieve hemodynamic stabilization in this group of patients.

Life Support 137

Life Support Coronary CPR ICU 137

Emergency Medicine Cases

SEPTEMBER 12, 2023

On this month's EM Quick Hits podcast: Anand Swaminathan on the role of methylene blue in septic shock, Nour Khatib on jaw dislocation reduction techniques, Hans Rosenberg on a phenotypic approach to Crohn's disease emergencies, Gil Yehudaiff on evidence based analgesics in renal colic, Brit Long on the importance of inhaled steroids for asthma, and Andrew Petrosoniak on the "lethal diamond" in polytrauma patients and the current state of hypocalcemia in bleeding trauma patients.

EMS 217

EMS 217

ALiEM

SEPTEMBER 11, 2023

A 29-year-old female with a past medical history of migraine headaches presented to the emergency department (ED) for several hours of bilateral eye pain, redness, and decreased visual acuity. The patient is a contact lens wearer. The night prior to presentation at 18:00, the patient inserted her contacts that she had washed and soaked in a hydrogen peroxide (H2O2) cleaning solution.

Emergency Department 152

Emergency Department ED OR 152

Don't Forget the Bubbles

SEPTEMBER 13, 2023

The Choosing Wisely ® campaign is an initiative that promotes collaborative conversations between clinicians and families to safely avoid unnecessary and potentially harmful tests. The American Academy of Paediatrics Section on Emergency Medicine (AAP SOEM) created a list of five key recommendations for Paediatric Emergency Medicine after a structured review process and expert consensus opinion.

E-9-1-1 131

E-9-1-1 Emergency Department ALS OR 131

Dr. Smith's ECG Blog

SEPTEMBER 15, 2023

I came to work one day and one of my partners said, "Hey, Steve, we had a STEMI this afternoon!" I said, "Cool, can I see the ECG?' Of course he said: "Yes, it was a 60 year old diabetic with Chest pain." So he showed me the ECG recorded in triage: What did I say? "That is not a STEMI. That is Arterial Pulse Tapping Artifact (APTA)." He said: "What?

STEMI 129

STEMI Coronary 129

ACEP Now

SEPTEMBER 11, 2023

Ben Mattingly, MD, tries to live by the adage, “One should be adventurous and daring, but not reckless.” The challenge is that the line between adventurous and reckless is often paper-thin. Take, for example, his recent expedition to Nepal to summit Mount Everest. When he arrived at the base camp, he found out three rope-fixing sherpas had just been killed in the famously dangerous Khumbu Icefall.

126

126

American Ambulance Association

SEPTEMBER 13, 2023

This content is for AAA members only. Please either Log In or Join! The post GAPBAC | AAA Comment Letter on Final Recommendations appeared first on American Ambulance Association.

Ambulance 100

Ambulance OR 100

First 10 EM

SEPTEMBER 11, 2023

This is a guest post by Dr. Lanujan Kaneswaran. Lanujan is a second-year Family Medicine resident at the University of Toronto. He has a background in medical health informatics and machine learning. His areas of interest include artificial intelligence and machine learning in medicine, and health equity through advocacy and technology. When managing atrial fibrillation […] The post Can we use D-dimer to assess for left atrial clot in atrial fibrillation?

123

123

EMergucate

SEPTEMBER 11, 2023

Answers: Question 1 answer: PH = 7.315, that is mild acidaemia. pCO2 = 48 mmHg. For venous blood, pCO2 level up to 48 mmHg is considered normal (40 for arterial blood).

100

100

Don't Forget the Bubbles

SEPTEMBER 11, 2023

5-year-old Willow arrives in the ED at 3 a.m. Her mum says she has been waking up screaming on the last few nights, clutching her vulval area and saying it hurts. Her parents have noticed she is scratching her bottom a lot, too, and they’ve had an email from school saying there are cases of threadworms in the reception class. Threadworms ( Enterobius vermicularis , also known as pinworms or seatworms) are the most common helminthic infection in the Western World.

OR 116

OR ED 116

EM Literature of Note

SEPTEMBER 11, 2023

Well, PRISMS demonstrated unfavorable results. MARISS tried to ascertain predictors of poor outcome in mild stroke, and intravenous thrombolysis was not associated with an effect on the primary outcome. Now, again, we examine thrombolysis in “mild” stroke, in this case, NIHSS ≤3 – and fail. Like MARISS, this is a retrospective dredge of patients selected by the treating clinicians to receive either intravenous thrombolysis or, in this case, dual-antiplatelet therapy with clopidogrel

OR 112

OR 112

Medgadget

SEPTEMBER 12, 2023

Researchers at the University of Washington School of Medicine have developed a method to create stem cell-derived organoids that can produce tooth enamel proteins. The breakthrough could pave the way for lab grown enamel that can be used in dental repairs and may even allow for living fillings or completely new living teeth that can be implanted into a patient’s jaw.

OR 106

OR 106

REBEL EM

SEPTEMBER 13, 2023

Take Home Points: Airway management is paramount; expect a challenging intubation and consider controlling the airway early if there is apparent airway compromise. Understanding the cause of angioedema (mast cell vs. bradykinin mediated) helps dictate directed management. Urticaria and pruritus = MAST CELL mediated, which is treated like a standard allergic reaction.

Frozen Plasma 105

Frozen Plasma Allergic Reaction FFP Plasma 105

EMergucate

SEPTEMBER 11, 2023

32-year-old man presented to ED with an exacerbation of his asthma. On 3L O2, his arterial blood gases showed the following: PH = 7.

ED 100

ED 100

Broome Docs

SEPTEMBER 9, 2023

This month I am back on the SGEM podcast – this time on the all new Paeds section with Dr Dennis Ren. In this episode we do a deep dive into the BUCKLED trial that looked at the use of bedside ultrasound vs. plain film X-rays for the initial investigation of paediatric forearm fractures. This is a really neat Australian trial run by my friend Dr Peter Snelling and friends in Queensland.

ED 114

ED 114

Medgadget

SEPTEMBER 14, 2023

Researchers at the University of California San Francisco have developed a brain computer interface that can lets someone with severe paralysis communicate with both speech and facial expressions, in the form of a digital avatar. The breakthrough advances what has been possible, with previous brain computer interface systems providing speech only, and allows people to communicate more completely, encompassing facial expressions, which are an important aspect of natural communication.

OR 99

OR 99

Dr. Smith's ECG Blog

SEPTEMBER 10, 2023

Sent by anonymous, edited by Pendell Meyers A man in his 50s with history only of hypertension presented with acute chest pain that started 45 minutes prior to presentation while doing yard work. It radiated to both shoulders and both upper extremities, and there was shortness of breath and diaphoresis as well. He reported a normal stress test a few years ago.

E-9-1-1 78

E-9-1-1 ACS STEMI Coronary 78

EMDocs

SEPTEMBER 9, 2023

Authors: Jacob Kirkland, MD (EM Resident Physician, UTSW – Dallas, TX); Stephen Field, DO (Assistant Professor of EM/Attending Physician, UTSW – Dallas, TX) // Reviewed by: Sophia Görgens, MD (EM Physician, Northwell, NY); Cassandra Mackey, MD (Assistant Professor of Emergency Medicine, UMass Chan Medical School); Alex Koyfman, MD (@EMHighAK) ; 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 ba

EMS 78

EMS ED ALS Emergency Department 78

EMCrit Project

SEPTEMBER 10, 2023

The explosion follow-up on the AMAX4 protocol for crashing anaphylaxis and asthma with Ben McKenzie [@amax4] EMCrit Project by Scott Weingart, MD FCCM.

71

71

Medgadget

SEPTEMBER 14, 2023

Researchers at the Harvard Wyss Institute have developed a technique that lets clinicians to characterize and monitor melanoma. The system involves using a microneedle patch that can draw deep interstitial fluid into itself through a series of penetrating hyaluronic acid needles. The needles can later be dissolved to release the biomarkers into a test tube before analysis, using a highly sensitive technique called Simoa, to detect individual biomarker protein molecules.

99

99

Dr. Smith's ECG Blog

SEPTEMBER 12, 2023

A 40 year old with nonspecific symptoms including dizziness. What do you notice about the ECG? There is a very short QT interval. This is often found in hypercalcemia. See Ken Grauer's comments below for detail. Thus, the patient's chemistry was done and revealed ionized hypercalcemia of 6.3 mg/dL (normal 4.4 - 5.2) Followup: he was found to have hyperparathyroidism == MY Comment , by K EN G RAUER, MD ( 9/12 /2023 ): == Today's ECG is remarkable for an uncommon but important finding that we peri

Defibrillator 68

Defibrillator OR 68

EMDocs

SEPTEMBER 15, 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: How to Spot Ischemia in RBBB Patients Spoon Feed In non-ischemic right bundle branch block (RBBB) ECGs, we expect discordant ST depression and T wave inversions in leads V1-V3.

Emergency Medical Services 61

Emergency Medical Services Coronary Emergency Department EMS 61

NAEMSP

SEPTEMBER 14, 2023

Article by Veronica “Vee” Smith, MD Case It’s 11 o’clock in the morning on a sunny autumn day. Your radio alerts you about a mass casualty event and you are then dispatched to what turns out to be a school shooting. The estimated casualty count is over 20 with an unknown number of injured victims on the scene, their ages are estimated to range from 5-58 years of age.

Emergency Department 52

Emergency Department ED OR 52

Medgadget

SEPTEMBER 14, 2023

Researchers at the National University of Singapore have developed a highly sensitive pressure sensor that can provide haptic feedback for surgeons using laparoscopic tools or for use in robotic grippers as part of robotic surgical systems. The technology is inspired by the surface of the lotus leaf, which is extremely sensitive to the pressure exerted by tiny drops of water and will repel them.

OR 93

OR 93

Ambulance Driver Files

SEPTEMBER 13, 2023

On April 14, 2023 I suffered a life-threatening massive pulmonary embolus. I had a DVT that I had ignored/rationalized for nearly a year that turned out to extend from my mid-calf to lower thigh, and on April 14 a big chunk of it broke loose and tried to kill me. I had major clots in.

Ambulance Driver 52

Ambulance Driver Ambulance 52

ACEP Now

SEPTEMBER 13, 2023

Answer: The correct answer is retropharyngeal abscess (d). A retropharyngeal abscess (RPA) is an uncommon but serious life-threatening infection that results from a purulent infection in the retropharyngeal space. It may be seen in all ages but most commonly occurs in children aged two to five years. A retropharyngeal abscess usually occurs after an antecedent viral upper respiratory illness that results in a suppurative cervical adenitis that then extends to involve the retropharyngeal space.

OR 52

OR 52

Stem EMS

SEPTEMBER 11, 2023

The Congrès National des Sapeurs-Pompiers de France is an unmissable event. Let’s discover its origins. The history: The goal is to gather together in order to ensure that the rights […] L'articolo National Firefighters Congress 2023 proviene da Stem Ems.

Firefighter 52

Firefighter EMS 52

Medgadget

SEPTEMBER 12, 2023

Researchers at Stanford University have developed a new type of cancer therapy. The technology targets mucins, sugar-coated proteins that help cancer cells to metastasize and avoid the immune system. In particular, mucins enable cancer cells to survive free-floating as they travel through the blood during metastasis and can also trick immune cells into assuming that the cancer cell is not a threat.

90

90

The FllightBridge ED

SEPTEMBER 11, 2023

September 11, 2001, and the Mental Health of First Responders The tragic events of September 11, 2001, have left an indelible mark on the world’s…

First Responder 52

First Responder 52

ACEP Now

SEPTEMBER 13, 2023

A confluence of challenges is renewing the urgency to address one of emergency medicine’s seemingly intractable issues: boarding in the emergency department. On September 27, ACEP will convene a national summit on emergency department boarding in its Washington, DC office. Congressional representatives, federal and state government officials, regulatory leaders, health care stakeholder groups, and patient advocates are expected to attend the day-long discussion.

ED 52

ED Emergency Department OR 52

University of Maryland Department of Emergency Med

SEPTEMBER 11, 2023

When patients fail simple respiratory support therapies like nasal cannula or non-rebreather, it is often a point of debate whether to mo.

OR 58

OR 58

Medgadget

SEPTEMBER 12, 2023

Researchers at the University of Edinburgh have developed a new method to create multilayered tubes from cells. The technique could be very useful for recreating multilayered tubular constructs that are found in the body, such as the intestines and blood vessels. Accurately modeling such complex structures in the lab could open new doors in terms of medical research and may even pave the way for bioengineered intestinal or vascular constructs that are suitable for implantation in human patients.

OR 82

OR 82

EMCrit Project

SEPTEMBER 11, 2023

Another amazing lecture from Cliff Reid EMCrit Project by Scott Weingart, MD FCCM.

68

68