Afleveringen
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Cardiac arrest care hinges on high‑quality CPR, but pulse checks remain a stubborn source of interruptions — often longer than the recommended 10 seconds and repeated every two minutes. What if we could detect ROSC without ever pausing compressions? This diagnostic accuracy study evaluates whether femoral arterial Doppler waveforms obtained during active CPR can predict arterial line pulsatility at the next pulse check. Join Dr. Qin as she reviews how well Doppler‑detected pulsatility and anterograde flow signal true cardiac activity — and whether ultrasound could offer a future where pulse checks no longer slow us down.
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Diabetic ketoacidosis is a familiar ED diagnosis, but the best fluid strategy is still up for debate. Many of us default to the traditional one‑bag system, even though it can be slow to adjust and prone to glucose swings. This new meta‑analysis compares one‑bag versus two‑bag DKA management across adults and children, examining hypoglycemia rates, time to resolution, and operational impact. Join Dr. Knudsen-Robbins as she breaks down what the evidence shows — and whether the two‑bag fluid system truly offers a clinical edge for treatment.
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Zijn er afleveringen die ontbreken?
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Point‑of‑care echo is fast, powerful—and famously operator‑dependent. Most of us rely on quick visual impressions because precise measurements take time we often don’t have. This new study puts three automated, real‑time AI tools to the test, comparing their ejection fraction, VTI, and IVC assessments against an expert’s read. Join Dr. Sookdeo as she breaks down how well the algorithms performed and what this could mean for the future of bedside echo.
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Documentation load is a major driver of burnout in emergency medicine, and the ED’s pace only intensifies the pressure. Ambient AI scribes offer a hands‑free way to capture encounters and ease charting—but how often are these tools actually used, and do they meaningfully change documentation time? Join Dr. Kopel as she unpacks what early use reveals about the promise and limitations of AI‑generated documentation in emergency care.
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Survival after out‑of‑hospital cardiac arrest hinges often on getting an AED to the patient within minutes - but in most communities (especially more rural areas), that simply doesn’t happen fast enough. First responders often arrive too late, and bystanders rarely have immediate access to a device. This study explores whether pairing first responders with strategically deployed AED‑carrying drones could finally make 5‑minute defibrillation a reality. Join Dr. Boyer as he breaks down what this model suggests about the future of rapid OHCA response.
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Ground-level falls are a leading reason older adults get head CTs in the ER, largely because current rules treat age > 65 as a risk factor by itself. Yet many emergency physicians question whether that’s always necessary for well-appearing patients. A new systematic review and meta-analysis in Annals of Emergency Medicine digs deeper, asking: what other factors truly predict intracranial hemorrhage after ground-level falls? Join Dr. Snyder as she explores the findings, limitations, and what they mean for everyday practice.
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Tranexamic acid (TXA) is an anti-fibrinolytic that may reduce hemorrhage and improve survival in trauma. While early studies raised safety concerns, newer evidence supports its use in select patients. Join Dr. Segev as he reviews key TXA trials and highlights the updated EAST guidelines on pre-hospital and in-hospital administration.
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Gastrointestinal bleeding is a frequent and potentially life-threatening presentation in the ED. With CT angiography increasingly being used as a first-line diagnostic tool, are we improving detection or simply overusing imaging? Join Dr. Guillaume as she discusses this recent JAMA Network Open study examining trends in CTA utilization for GI bleeding and whether rising scan rates are truly leading to better diagnostic yield.
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Pyelonephritis is a commonly treated diagnosis in the emergency department. With resistance rates climbing to the first-line recommended fluoroquinolones and Bactrim, are other antibiotics appropriate in treating pyelonephritis? Join Dr Gabor as she discusses this article and its treatment recommendations for outpatient pyelonephritis with cephalosporins and how it compares to treatment with the more traditional fluoroquinolones / bactrim route.
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Septic shock remains a leading cause of pediatric mortality, but the choice of first-line vasoactive agent has long been debated. Dr Newton, a PGY-3, discusses this single-center retrospective cohort study comparing epinephrine and norepinephrine as initial infusions in children with septic shock. While the primary kidney outcome (MAKE30) showed no difference, epinephrine was linked to higher 30-day mortality in propensity-matched analysis. The findings are hypothesis-generating and highlight the need for prospective pediatric trials.
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In the ED, your words can be as powerful as your meds. In this episode, PGY-3 Dr Kotel unpacks the science of placebo and nocebo, showing how communication shapes patient outcomes—and how small shifts in framing, empathy, and reassurance can turn talk into treatment.
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Lung-protective ventilation (LPV), characterized by low tidal volumes and appropriate PEEP, is a cornerstone in managing patients with acute respiratory distress syndrome (ARDS). However, its application in patients with severe acute brain injury raises concerns. The potential for lung protective ventilation to increase intracranial pressure due to hypercapnia and elevated PEEP levels necessitates a closer examination of its safety and efficacy in this unique patient population.
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Many clinical decision rules exclude elderly patients from the derivation cohorts. So the question remains unanswered do all elderly patients need cervical spine CTs in the setting of trauma? What if they have no symptoms? This recap of a journal club article explores the incidence of significant cervical spine fractures in elderly patients.
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It is well known that ultrasound has exploded in its application in both diagnostics and procedures and has ultimately revolutionized the way we practice medicine. With its growing use, more and more providers are comfortable using ultrasound for both identification of anatomy/pathology and to guide procedures that were previously only done with landmarks. While having the skills to perform landmark guided procedures is incredibly important, there is much value in being able to visually confirm anatomy to avoid procedure complications, especially when landmarks are difficult to palpate / identify in certain individuals. This recap of a recent journal club article covers a paper looking into the use of POCUS to help perform cricothyrotomy.
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More than 1.5 million critically ill adults undergo tracheal intubation each year in the United States. Hypoxemia is a common and serious complication during tracheal intubation in critically ill adults, occurring up to 10-20% of intubations in the emergency department (ED) or intensive care unit (ICU). Hypoxemia increases the risk of cardiac arrest and death. The effect of preoxygenation with noninvasive ventilation, as compared with preoxygenation with an oxygen mask, on the incidence of hypoxemia during tracheal intubation is uncertain. In this breakdown of a Journal Club article, Dr de Castro will cover a recent paper comparing NIPPV to oxygen mask only during preoxygenation for intubation.
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Severe trauma is the leading cause of death worldwide for adults younger than 50 years of age. Acute traumatic life support (ATLS) guidelines endorse early and aggressive usage of supplemental oxygen in patients with severe trauma, at least until abnormalities of airway or breathing can be safely ruled out. However, unclear target concentration, duration or saturation goals often leads to hyperoxemia. Emerging studies in the intensive care unit (ICU) setting suggest that liberal supplemental oxygen therapy and hyperoxemia is associated with increased mortality. Limited evidence in the trauma population suggests similar outcomes.
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We know that the d-dimer can be a helpful test for patients who have a low pre-test probability of pulmonary embolism. But can the test be pushed into use for higher risk patients? Will it still have useful negative predictive value or will we risk missing too many PEs?
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Can a nitro slurry help with food bolus impaction? Glucagon and effervescent beverages have limited evidence for benefit. Can an old drug used in a new way help these patients?
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Current screening tools for pediatric septic shock and sepsis are highly specific but lack sensitivity. This study substituted age adjusted vital sign measures and a pediatric shock index into currently existing pediatric sepsis scoring systems to create the qPS4.When utilizing a cut off of ≧ 2 points, the qPS4 was highly sensitive and specific, and identified pediatric septic shock far sooner into a patient's course.
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There is a wide variation in practice, particularly in obtaining neuro-imaging in patients presenting with vertigo. Many patients are imaged and subjected to a longer length of stay, and on the other side of the coin, some patients with serious pathology fall through the cracks. The authors of this study set out to create a risk score to apply to patients who present to the ED with vertigo which would identify the patients at risk for serious pathology (which they defined as stroke, TIA, vertebral artery dissection, or brain tumor).
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