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ECG Blog #482 — This Patient got Morphine

Ken Grauer, MD

== P lease N OTE : After today No new ECG Blog posts for 3- to -4 weeks. I will also not be prompt in replying to emails. == All material on this ECG Blog site remains open! The INDEX tab ( in the upper right of each page ) has linked Contents, listed by subject. So IF you are looking for ECG material There is plenty on this web site! And IF you look at the TOP of every page in this blog You'll see a Menu of Tabs that link to a variety of blog features, including my ECG podcasts, Audios &a

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The Guy in Room 20

Sensible Medicine

On a recent shift, I received sign-out for Room 20, a 46 year old man with a history of schizophrenia as well as alcohol and cannabis abuse. He came to us from a nursing home where he lives. He accidentally set his room on fire with a cigarette, prompting the nursing home to kick him out for being a risk to the facility. Although he had no acute medical issues, he was sent to the emergency department so “the health care system” could find him a new home.

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Imaging in paediatric trauma- what’s new?

Don't Forget the Bubbles

Its the first week of your new placement in the Emergency Department of a Paediatric Major Trauma Centre. Youve just finished discharging your third case of flu that day when the red phone rings a 14-year-old child has been stabbed in the chest and is severely injured. The nurse in charge has input out a major trauma alert, and the consultant has asked you to request the relevant bloods and imaging after the primary survey.

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US Probe: An Abundance of Artifacts

EMDocs

Author: Jonathan Warren, MD (Clinical Ultrasound and EMS Fellow, Department of Emergency Medicine , Harbor-UCLA Medical Center) and Lilly Bellman, MD (Pediatric POCUS Director, San Francisco Emergency Medicine Associates, California Pacific Medical Center) // Reviewed By: Steve Field, MD; Brit Long, MD (@long_brit) Case: A 41 year old male presents to the ED with right upper quadrant pain that worsens after eating.

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Bridging Innovation & Patient Care: The Growing Role of AI

Speaker: Simran Kaur, Co-founder & CEO at Tattva.Health

AI is transforming clinical trials—accelerating drug discovery, optimizing patient recruitment, and improving data analysis. But its impact goes far beyond research. As AI-driven innovation reshapes the clinical trial process, it’s also influencing broader healthcare trends, from personalized medicine to patient outcomes. Join this new webinar featuring Simran Kaur for an insightful discussion on what all of this means for the future of healthcare!

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IV iron improved postsurgical anemia in RCT

PulmCCM

Anemia is the norm in critically ill patients. Over the past 25 years, critical care has shifted from a normalization heuristic to a restrictive, anemia-tolerant approach to transfusion. Hemoglobin levels less than 8 g/dL are common and usually left alone. There’s good evidence this approach doesn’t increase mortality: But much less is known about how severe anemia may impact long-term functional recovery after critical illness.

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SGEM#475: Break on Through to the Other Side – Management of Clinical Scaphoid Fractures

The Skeptics' Guide to EM

Reference: Cohen et al; SUSPECT study group. Can we avoid casting for suspected scaphoid fractures? A multicenter randomized controlled trial. J Orthop Traumatol. 2025 Date: May 1, 2025 Guest Skeptic: Dr. Matt Schmitz is an orthopedic surgeon specializing in Adolescent Sports Medicine and Young Adult Hip Preservation. He practices at the Rady Childrens Hospital in San Diego and is Professor of Orthopedics at UC San Diego.

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Intern Core Content: Disorders of the Adrenal Glands

Taming the SRU

The adrenal system allows our bodies to respond to physiologic stressors and to regulate multiple metabolic processes within the body. Disorders of the adrenal axis can be chronic in onset, causing subacute or subclinical presentations, or acute, leading to frank clinical presentations that need to be managed more emergently by ER physicians. Recognition and diagnosis of these disorders can be difficult as the presenting symptoms are often subtle and nonspecific, making it all the more important

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Hollar For Holters | Intubate The EBM Way

JournalFeed

The JournalFeed podcast for the week of May 12-16, 2025. These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member. Monday Spoon Feed : Short-term ambulatory cardiac monitoring has diagnostic usefulness, although limited, in patients discharged from the emergency department.

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ECG of the week 14/5/2025

EMergucate

A 33yr old male presents with exertional chest pain, his ECG is below: What is the specific finding and concern … Continue reading →

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Thinking About Canada? An Overview for International Medical Graduates and UK Doctor’s Planning to Work in Canada

Mind The Bleep

Whether you’re chasing a better work-life balance , lucrative opportunities, scenic landscapes or a new clinical challenge, Canada is becoming an increasingly attractive destination for international medical graduates (IMGs), especially UK doctors. Canada offers multiple pathways for to work in Canada either as an attending (consultant) doctor or entering into a residency (training) program.

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Procedure: Nail bed repair

Life in the Fast Lane

James Miers and Hasan Sarwar Procedure: Nail bed repair Emergency Procedure, instruction and discussion: nail bed repair - a deceptively simple injury that can lead to permanent nail deformity if managed incorrectly

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NFTI: A Nifty Tool To Replace The Cribari Grid?

The Trauma Pro

In my last post, I reviewed using the Cribari grid to evaluate over- and under-triage at your trauma center. This technique has been a mainstay for over a decade, but it has shortcomings. The most important one is that it relies only on the Injury Severity Score (ISS) to judge whether some type of mistriage occurred. As you know, the ISS is usually calculated after discharge, so it can only be applied after the fact.

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EM@3AM: Systematic Approach to Massive Hemorrhage and Nuances in Special Patient Populations

EMDocs

Authors: Matt Treasure, DO (EM Resident Physician, Christus Spohn/Texas A&M University College of Medicine, Corpus Christi, TX); Rogelio Trey Martinez, DO, MPH (EM Resident Physician, Christus Spohn/Texas A&M University College of Medicine); Justin Hacnik, MD (EM Attending Physician, Christus Spohn/Texas A&M University College of Medicine, Corpus Christi, TX); J.D.

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Compartment Pressure Measurement: Using the Stryker Method

Northwestern EM Blog

Written by: Melissa Kubacki, MD, MS (NUEM 26) Edited by: Jalea Moses, MD (NUEM 24) Expert Commentary by : Matt Levine, MD Introduction: Compartment syndrome is a cant miss diagnosis for any painful extremity examinationespecially in those with any traumatic mechanism. Having a high clinical index of suspicion along with the skills to accurately measure compartment pressures, while in the emergency department, could save a limb.

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Tricuspid Valve Interventions and its Dubious Evidence

Sensible Medicine

I have a great (and sad) story to tell today. It’s about hubris and the need for proper control arms in device trials. The reason control arms popped in my head was an unusually candid editorial in JAMA regarding the management of tricuspid regurgitation. The authors criticize the evidence base underpinning the new push to intervene on the tricuspid valve.

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Ep 204 High Risk Pulmonary Embolism Management

Emergency Medicine Cases

There are many nuances in the management of patients with pulmonary embolism in cardiac arrest, peri-arrest or simply in shock: We need to optimize oxygenation and airway management, hemodynamic support, acid/base management, thrombolysis and/or catheter-directed therapies that Anton dives into with guest experts Dr. Lauren Westafer, Dr. Bourke Tillmann and Dr.

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The Hybrid OR For Trauma

The Trauma Pro

A hybrid operating room is a special OR suite that allows advanced imaging to be carried out simultaneously with one or more additional operative procedures. Its that simple. It contains specialized imaging equipment, including fluoroscopy and infusion equipment for radiographic dye administration. Some also contain CT and/or MRI capabilities, but the shielding required for these makes them rare.

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A woman in her 60s with acute chest pain and shortness of breath

Dr. Smith's ECG Blog

Written by Pendell Meyers A woman in her 60s had acute chest pain and shortness of breath. EMS arrived and recorded this ECG (no baseline ECG available): What do you think? Sinus rhythm, RBBB, and anterolateral OMI pattern with concordant STE in V2, inappropriate STD (precordial swirl pattern) in V5 anv V6, HATW in I and aVL, with reciprocal STD and negative HATW in III and aVF.

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Critical Care Evidence Updates – April 2025

The Bottom Line

Whats new in the Critical Care literature monthly updates

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GLP what?!

Critical Care North Hampton

Discover the perioperative risks of GLP-1 drugs like semaglutide, focusing on delayed gastric emptying and aspiration during anaesthesia.

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EMCrit 1:1 Nursing 001 – An Easy Case of Sepsis

EMCrit

Our first episode uses a simple case to act as touch-point for a discussion of resus nursing in the ED. EMCrit Project by Scott Weingart, MD FCCM.

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Giving Feedback that Sticks and Receiving it With Purpose

EM Ottawa

The importance and efficacy of feedback as an educational tool is well established within medical education literature, with widespread consensus that it is essential for learner development.(1) Reflecting this, the Accreditation Council for Graduate Medical Education (ACGME) designates feedback as an essential and required aspect of resident training across all specialties.

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A young man with a 'pathologic' ECG

Dr. Smith's ECG Blog

Written by Magnus Nossen The patient in today's case is a young adult male who has had annual cardiological follow-ups due to a pathological ECG. His previous studies include annual Holter monitoring for palpitations and biennial echocardiograms. The Holter recordings and echocardiograms were unremarkable. The patient contacted EMS for chest pain and had the following ECG recorded.

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Emergency Evidence Updates – April 2025

The Bottom Line

Whats new in the Critical Care literature monthly updates

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Travel Nursing: How Long Does It Really Take to Start?

Core Medical Group

How long does it take to become a travel nurse? Learn how many years of college you need, degree requirements, and the fastest path to travel nursing.

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PulmCrit Letter to the Editor: Things we do for no reason: Checking QTc on hospitalized adult patients before IV ondansetron administration

EMCrit

I'm writing a letter to the editor in response to a recent article in the Journal of Hospital Medicine. I'm posting it here rather than submitting it to the journal to avoid burying it behind a paywall (and because I have the attention span of an intensivist hopped up on lots of coffee). First, I […] EMCrit Project by Josh Farkas.

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How Not to Get Fooled by the Medical Literature - Part 2: Observational Studies

Sensible Medicine

The most common question we get asked is: is there a course on how to become better at critically reading medical research. Here it is! This is the second of 9 videos that we recorded as part of a course on clinical appraisal, and there will be many more to come. This and future videos will be made available as a thank you to paid subscribers.

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Test Characteristics of Emergency Medicine-Performed Point-of-Care Ultrasound for the Diagnosis of Acute Cholecystitis: A Systematic Review and Meta-analysis

EM Ottawa

Methodology: 4/5 Usefulness: 3.5/5 Wilson SJ, et al. Ann Emerg Med. 2024 Mar;83(3):235-246. doi: 10.1016/j.annemergmed.2023.09.005. Questions and Method:To determine the diagnostic accuracy of emergency physician performed point of care ultrasound (POCUS) for acute cholecystitis diagnosis compared to final diagnosis as per surgical pathology, discharge diagnosis or radiology performed ultrasound.

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Parkinson's, Myasthenia Gravis, and MS in the ED

EB Medicine

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the May 2025 Emergency Medicine Practice article, Emergency Department Management of Patients With Complications of Chronic Neurologic Disease: Parkinson Disease, Myasthenia Gravis, and Multiple Sclerosis Parkinson's Disease Importance of maintaining medication schedule for Parkinson's patients Strategies for ensuring patients receive their medications promptly Overview of Carbidopa Levodopa's mechanism of action Myasthenia Gravis Descr

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Hello WOrld

EMDocs

Hello World The post Hello WOrld appeared first on emDocs.

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Serve or Swerve – what will Mervyn say?!

Critical Care North Hampton

Join Professor Mervyn Singer at SOA25 Congress to explore 40 years of ICU evolution, discussing breakthroughs and ongoing challenges.

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Diseases Just Learned: Part 2

Sensible Medicine

Following up with another 35 “diseases just learned.” Please look back to last week’s intro if you are just coming to this series. Like Part I, this is a gift to our paid subscribers. This Substack is reader-supported. If you appreciate our work, consider becoming a free or paid subscriber.

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Paediatric Cardiovascular Examination

Mind The Bleep

It is very common that we perform a cardiovascular examination in paediatrics, particularly in babies, but we will often leave out key steps which would be expected in a clinical exam setting.

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Pre-Hospital and Retrieval Medicine (PHRM) Education Day – 25th June 2025

Greater Sydney Area HEMS

Visit the post for more.

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NRC Health’s Jennifer Baron Named One of 2025’s Top Women Chief Experience Officers

NRC Health

NRC Health is proud to celebrate our Chief Experience Officer Jennifer Baron for being named one of Women We Admires Top 50 Women Chief Experience Officers of 2025. The post NRC Healths Jennifer Baron Named One of 2025s Top Women Chief Experience Officers appeared first on NRC Health.

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Enteral Nutrition in the ICU and Wards: Review

PulmCCM

Nutrition is complex, and so it should not be surprising that the data on nutritional support in hospitalized patients represent something of a paradox. A relatively robust evidence base suggests strongly that an assertive approach to nutrition can save lives in hospitalized patients who are malnourished or at risk. However, in the most severely ill patients, the choice of nutritional support and the number of calories delivered have shown no significant effect on outcomes.