Sat.Jul 15, 2023 - Fri.Jul 21, 2023

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Glasgow Coma Scale in Children

Pediatric EM Morsels

In emergency medicine, we often use illness scripts and protocols to help drive our decision-making. I recall a shift I had with Dr. Fox while I was early in fellowship ( not so many years ago ). We had just received a young child from EMS who was post-ictal with decreased mentation. Dr. Fox asked me what I wanted to do next to care for the child, and as I calculated his GCS… 7 at the time… I felt somewhat obligated to say that I should intubate the child. “ Less than 8, intubate!

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EM Quick Hits 50 Normal Unenhanced CT Renal Colic DDx, Perichondritis, Magnesium in Pediatric Asthma, Steroids for Pneumonia, OMI Cath Lab Activation

Emergency Medicine Cases

On this month's EM Quick Hits podcast David Carr on differential diagnosis of normal unenhanced CT renal colic, Leeor Sommer on recognition and management of perichondritis and auricular abscess, Suzanne Schuh on IV magnesium sulphate for pediatric asthma, Jess McLaren on Occlusion MI ECG interpretation requiring cath lab activation and Justin Morgenstern on update on steroids for pneumonia.

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ALiEM AIR Series | Infectious Disease 2023 Module

ALiEM

Welcome to the AIR Infectious Disease Module! After carefully reviewing all relevant posts in the past 12 months from the top 50 sites of the Social Media Index, the ALiEM AIR Team is proud to present the highest quality online content related to related to infectious diseases in the Emergency Department. 6 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board.

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Perez and Finstad Push Medic to Paramedic Provision

American Ambulance Association

This content is for AAA members only. Please either Log In or Join! The post Perez and Finstad Push Medic to Paramedic Provision appeared first on American Ambulance Association.

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Characteristics Associated With Serious Self-Harm Events in Children and Adolescents Mert Sekmen,a,b Carlos G. Grijalva, MD, MPH,c Yuwei Zhu, MD, MS,d Derek J. Williams, MD, MPH,a,b James A. Feinstein, MD, MPH,e Justine C. Stassun, MA,a,b Jakobi A. Johnson, BS,a,b Yasas C. Tanguturi, MBBS, MPH,f James C. Gay, MD, MMHC,g James W. Antoon, MD, PhD, MPHa,b

EMergucate

Characteristics Associated With Serious Self-Harm Events in Children and Adolescents Mert Sekmen,a,b Carlos G.

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Journal Club 4 PoCUS or X-ray for Distal Forearm Fractures

Emergency Medicine Cases

You are working the ambulatory section of your ED and evaluating a 6-year boy with a possible distal radius injury. He lives with autism spectrum disorder and is uncomfortable in X-ray rooms, and you wonder if there is a role for PoCUS to help exclude a fracture. With expert clinical commentary by Dr. Arun Sayal and Research Methodology Hot Take by Dr.

OR 130
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Mismatch: Why were there so many unfilled emergency medicine residency positions in 2023?

ALiEM

The Study In an Annals of Emergency Medicine paper , Preiksaitis et al. sought to identify program factors associated with unfilled post-graduate year 1 (PGY-1) emergency medicine (EM) positions in the 2023 Match [1]. The authors completed a cross-sectional, observational study using National Residency Matching Program (NRMP) data and examined 9 variables as potential predictors of unfilled PGY1 positions using regression analyses [2].

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Episode 63: Understanding dialysis, with Paul Adams

Critical Care Scenarios

We dive into when to initiate renal replacement therapy, the modalities, settings, and physics involved, troubleshooting problems, and more, with Dr. Paul Adams, a dual-trained nephrologist and intensivist at the University of Kentucky. Find us on Patreon here! Buy your merch here! Takeaway lessons We dive into when to initiate renal replacement therapy, the modalities, settings, and physics involved, troubleshooting problems, and more, with Dr.

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Papilloedema

Don't Forget the Bubbles

Olivia, a previously well 13-year-old girl, is referred to the paediatric ED from the Ophthalmology ED. She went to the optician today to get a new pair of glasses. When they examined her and found that she had enlarged optic discs, they sent Olivia to the ophthalmology ED. The Ophthalmology SHO agreed and referred Olivia to you. They had explained to Olivia and her parents that she needed urgent neuroimaging as the enlarged optic discs could be a sign of a brain tumour.

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REBEL Cast Ep120: Etomidate vs Ketamine for RSI in the ED?

REBEL EM

Background: Standard rapid sequence intubation (RSI) in the emergency department involves administration of an induction agent and a neuroblocking agent in quick succession. RSI inherently carries with it risks of complications such as post-intubation hypotension and cardiac arrest in the most extreme cases. It is possible that the induction agent used could play an important role on hemodynamic effects in critically ill adults.

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AAA Encourages CMS to Consider Revised Innovation Model for Treatment in Place

American Ambulance Association

Washington, DC— While the Centers for Medicare & Medicaid Services (CMS) has decided to end the Emergency Triage, Treat, and Transport (ET3) Model two years early on December 31, 2023, […] The post AAA Encourages CMS to Consider Revised Innovation Model for Treatment in Place appeared first on American Ambulance Association.

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Critical anaphylaxis and asthma: The AMAX4 algorithm

First 10 EM

I have written about the resuscitation of anaphylaxis and asthma before. However, I was forwarded the AMAX4 algorithm for the patient with asthma or anaphylaxis who is either unconscious or requiring assisted ventilation, and I think it is an important addition for our sickest patients. The heartbreaking backstory to this algorithm and website, created by […] The post Critical anaphylaxis and asthma: The AMAX4 algorithm appeared first on First10EM.

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Bubble Wrap PLUS – July ’23

Don't Forget the Bubbles

Can’t get enough of Bubble Wrap? The Bubble Wrap Plus is a monthly paediatric journal club reading list from Anke Raaijmakers, working with Professor Jaan Toelen and his team at the University Hospitals in Leuven. This comprehensive list is developed from 34 journals, including major and subspecialty paediatric journals. We suggest this list can help you discover relevant or interesting articles for your local journal club or allow you to keep a finger on the pulse of paediatric research.

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Lab Case 412 interepretation

EMergucate

Question 1: PH = 7.31 That is mild acidosis PCO2 = 61, that is high (>40). So, we have respiratory acidosis.

OR 100
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7/27 CMS Ambulance Open Door Forum

American Ambulance Association

From CMS on July 19, 2023 The next CMS Ambulance Open Door Forum scheduled for: Date: Thursday, July 27, 2023 Start Time: 2:00pm-3:00pm PM Eastern Time (ET); Please dial-in at […] The post 7/27 CMS Ambulance Open Door Forum appeared first on American Ambulance Association.

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A young man with tachycardia. Should We Try Adenosine?

Dr. Smith's ECG Blog

A young man presented with weakness and fever. His pulse was 186. An ECG was recorded: What do you think? There is a regular narrow complex tachycardia. Thus, it is supraventricular tachycardia. It is important to remember that SVT includes Sinus Tachycardia! That is why I like to call re-entrant SVT "Paroxysmal" SVT, or PSVT). The sinus node is "supraventricular" and in young people it can beat VERY fast.

OR 90
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EMCrit Wee – The Physiology of Oxygenation with Alex of Deranged Physiology

EMCrit Project

So we used a mean guy on twitter to spur a discussion on Oxygenation Physiology and talk about when PaO2s are necessary and you can't use the pulse ox (hint: not often). My discussant is Alex Yartsev. EMCrit Project by Scott Weingart, MD FCCM.

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Stiff and Tough Hydrogel for Cartilage Repair

Medgadget

Researchers at the University of British Columbia have developed a protein-based hydrogel that is highly adapted for articular cartilage repair. A major challenge in creating biomaterial therapies to repair damaged articular cartilage is matching the mechanical properties of this highly specialized tissue. Cartilage is very tough, resisting breaking under force, but also very stiff, meaning that it resists being bent or deformed.

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Rule Expanding Electronic Submission Requirements for Injury & Illness Data for High Hazard Employers

American Ambulance Association

This content is for AAA members only. Please either Log In or Join! The post Rule Expanding Electronic Submission Requirements for Injury & Illness Data for High Hazard Employers appeared first on American Ambulance Association.

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Large bowel obstruction: ED presentation, evaluation, and management

EMDocs

Authors: Christopher Whiting, MD (EM Resident Physician, University of Vermont) and Joseph Kennedy (EM Attending Physician, University of Vermont) // Reviewed by: Joshua Lowe (EM Attending Physician, USAF), Marina Boushra (EM-CCM Attending Physician, Cleveland Clinic Foundation); Brit Long, MD (@long_brit) Case A 57-year-old man with a past medical history of hypertension and tobacco use presents to the emergency department (ED) with five days of abdominal pain.

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Don’t Become Obsolete: The EM Physician’s Fight Against Procedural Decay

REBEL EM

INTRODUCTION You’re moonlighting in a remote access hospital. EMS radios in for a burn patient and to anticipate a difficult airway. You can hear the tension in their voice. They’re rolling up now. The patient is horribly burned. She was smoking with her home O2 on and has severe mixed partial and full thickness burns to the chest, neck, face, and airway.

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AI-Powered Pain Relief: Interview with Claire Smith, VP at Nevro

Medgadget

Nevro , a medtech company based in California, has developed the HFX iQ spinal cord stimulation system, which is intended to treat chronic pain. While spinal cord stimulators can be very useful in controlling certain types of chronic pain, at present, patients must attend with their clinician to obtain adjustments to their stimulator. This is inconvenient for both patient and clinician alike.

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2023 Stars of Life Nominations Are OPEN!

American Ambulance Association

Honor YOUR Stars in Washington, DC The American Ambulance Association’s Stars of Life program celebrates the contributions of ambulance professionals who have gone above and beyond the call of duty […] The post 2023 Stars of Life Nominations Are OPEN! appeared first on American Ambulance Association.

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ToxCard: Organic Mercury Poisoning

EMDocs

Authors: Ariana Trautmann, MD (Emergency Medicine Resident, Carolinas Medical Center, Charlotte, NC), Ann-Jeannette Geib, MD (Emergency Medicine Attending; Medical Toxicologist, Carolinas Medical Center, Charlotte, NC) // Reviewed by: James Dazhe Cao, MD (@JamesCaoMD, Associate Professor of EM, Medical Toxicology, UT Southwestern Medical Center, Dallas, TX); Alex Koyfman, MD (@EMHighAK); and Brit Long, MD (@long_brit) Case : A 48-year-old female presents to the ED for months of progressively wor

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Fall Recap

EM Literature of Note

It is the long, cold dark here in Christchurch – improved dramatically by leaving for the U.S. for four weeks! Firstly, the blog may be making a bit of a comeback – the ugly demise of Twitter seems to necessitate a better method of knowledge translation, such as blog posts that can be replicated across whichever platform is progressing towards dominance.

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Nanomagnet Patch Measures Muscle Movements

Medgadget

Researchers at UCLA have developed a wearable patch that can measure muscle movements in underlying tissues. The patch contains nanomagnets, and movements in underlying muscles can deform the resulting magnetic fields, creating an electric current. This both provides a readable signal for the system, and also means that the system is self-powered and does not require a battery.

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ED handoff of pediatric patients by EMS

University of Maryland Department of Emergency Med

Ineffective handoff communications have been shown to occur in up to 80% of medical errors. Previous studies have shown that up to 1/3 o.

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ABA President Interviewed on FOX Weather

American Burn Association

Categories Advocacy Burn News MAC Spotlight Media Member Services Organization News Prevention Quality Care Research Return to News & Activities ABA President Robert Cartotto, MD, shares information and tips for keeping children safe on hot playgrounds and preventing contact burns during outdoor activities on hot days on FOX Weather.

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Episode 101: Death Notifications with Steph Leather

The Overrun Podcast

We're bad at notifying families what's happening during a cardiac arrest event. We're even worse on ourselves. The average person may see 3 or 4 dead people in their lives and EMS workers often see that many in a shift. The Overrun's new team member Steph Leather, a national speaker on death notifications and a director of a clinical psychology practice takes us through the steps to make death notifications easier on ourselves and on families of our patients.

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Robotic Glove Helps Stroke Patients Relearn Dexterity

Medgadget

Researchers at Florida Atlantic University have developed a soft robotic glove that can assist stroke patients to relearn how to perform dexterous tasks with their hands. The glove contains soft actuators that helps patients to move their fingers as they perform tasks, and sensors that help to create tactile sensations. So far, the researchers have focused on using the gloves to assist patients to play music.

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On Scene: An Excerpt

Ambulance Driver Files

It was often said that I had no brakes on my Dare Car, and today’s shopping trip proved it. I was browsing the maternity section at Lane Bryant, and not for clothes for Mary. Thus far, Operation Impregnation had produced zero results, but I vowed to soldier on and do my part in the procreation.

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ABA Future of Burn Care Quality: Paper Now Available

American Burn Association

Categories Advocacy Burn News MAC Spotlight Media Member Services Organization News Prevention Quality Care Research Return to News & Activities The American Burn Association (ABA) has released American Burn Association Strategic Quality Summit 2022: Setting the direction for the future in the Journal of Burn Care & Research (JBCR). This paper summarizes goals and outcomes from last year’s Strategic Quality Summit (SQS).

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A Letter From Chris Dillie

ESO

Dear Colleagues, After investing my heart and soul into ESO for almost two decades, I’ve decided to transition from CEO to Executive Board Chair at the start of July. First and foremost, I would like to express my deepest gratitude for the trust and support so many of you have shown me throughout the years. It has been an absolute honor to lead ESO, and I am truly humbled by the opportunity to have supported an industry I deeply care about.

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CRISPR-Cas13 Test Inexpensively and Rapidly Reveals HIV Viral Load

Medgadget

Scientists at Penn State have developed an assay that lets them to directly measure HIV viral load in a drop of blood. The technology is also faster and less expensive than current approaches. At present, RT-PCR is typically used to assess HIV levels in a patient’s blood, requiring genetic material to be amplified before it can be measured. This is time-consuming and does not provide a direct measurement of viral loads, but rather a close estimate.

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Racial and Ethnic Differences in Emergency Department Wait Times for Patients with Substance Use Disorder

University of Maryland Department of Emergency Med

Substance use disorder is now known to be a function of brain disease and not a moral failure. Patients with substance use disorder ar.

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Emergency Evidence Updates – June 2023

The Bottom Line

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

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Methany and the Frog

EMS 20/20

In this week's episode, Spencer tells Chris a tale about meth, altered levels of consciousness, and maybe even child protective services. Also, frogs. In this week's episode, Spencer tells Chris a tale about meth, altered levels of consciousness, and maybe even child protective services. Also, frogs.

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