EM Had a Bad Match – Let’s Talk About That

Education

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An unprecedented 555 unfilled positions in the 2023 emergency medicine (EM) match were less likely a result of wavering interest in our specialty and more due to surging interest after the COVID pandemic (in 2021) and financial pressures within healthcare, resulting in a proliferation of training positions.

Source
The Emergency Medicine Match: Is the Sky Falling or Is This Just Growing Pains? Ann Emerg Med. 2023 Aug 4:S0196-0644(23)00576-0. doi: 10.1016/j.annemergmed.2023.07.004. Epub ahead of print.

How to Manage Blast Injuries

Critical Care, EMS, Trauma

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Blast injuries combine common polytrauma mechanisms – blunt, penetrating, burns – with the unique pathophysiology of blast wave injuries, and mass casualty scenarios. While rare, these patients are resource-intensive, prone to delayed yet rapid clinical deterioration, and carry high morbidity and mortality.

Source
High risk and low prevalence diseases: Blast injuries. Am J Emerg Med. 2023 Aug;70:46-56. doi: 10.1016/j.ajem.2023.05.003. Epub 2023 May 5.

DOACs and Diapers? Direct Oral Anticoagulants in Pediatrics

Pediatrics, Pharmacy/Pharmacology, Venous Thromboembolism

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Treatment with direct oral anticoagulants (DOACs) in pediatric patients appears to reduce venous thromboembolism (VTE) recurrence compared to standard of care, with no difference in major bleeding or serious adverse events. Prophylaxis with DOACs was comparable to standard of care and was associated with a nonsignificant reduction in VTE.

Source
Efficacy and safety of direct oral anticoagulants in the pediatric population: a systematic review and a meta-analysis. J Thromb Haemost. 2023 Jul 20:S1538-7836(23)00573-1. doi: 10.1016/j.jtha.2023.07.011. Epub ahead of print.

How to Spot Ischemia in RBBB Patients

Cardiology

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In non-ischemic right bundle branch block (RBBB) ECGs, we expect discordant ST depression and T wave inversions in leads V1-V3. ST segment elevation, or even an isoelectric ST segment, in these leads is abnormal and should make us concerned for ischemia. See below.

Handy EMS OHCA Handoff Checklist

EMS, Resuscitation

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In this video review, information contained in out-of-hospital cardiac arrest (OHCA) patient handoffs was highly variable, which is an area for quality improvement and standardization. Try this checklist!

Source
Emergency Medical Services handoff of patients in cardiac arrest in the Emergency Department: A retrospective video review study of duration and details of handoff. Resuscitation. 2023 Aug;189:109834. doi: 10.1016/j.resuscitation.2023.109834. Epub 2023 May 16.

Do We Need to Reconsider the Word… Need?

Critical Care, Ethics, Practice of EM

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Need in medicine describes what is missing and the necessary corrective action (i.e. you need a transfusion), but this wording allows little latitude for discussion with patients and families. However, saying, “Can we talk about what this means and what to do next?” allows for dialogue without presuming the desired course of action.

Source
Reconsidering the Language of Serious Illness. JAMA. 2023 Aug 15;330(7):587-588. doi: 10.1001/jama.2023.11409.

Does Suicide Risk Screening…Actually Reduce Suicide?

ED Operations, Psychiatry

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Depression screening (with varying forms of intervention) reduces depression symptoms in follow up, and the screening tools are fairly accurate. Suicide screening (with various interventions) does not reduce suicidal ideation or suicide attempts and may actually increase attempts, though the evidence is very limited.

Source
Depression and Suicide Risk Screening: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2023 Jun 20;329(23):2068-2085. doi: 10.1001/jama.2023.7787.

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