Ken Grauer, MD

JUNE 14, 2024

The ECG in Figure-1 — was obtained from a middle-aged man who presented to the ED ( E mergency D epartment ) in cardiac arrest. ROSC ( R eturn O f S pontaneous C irculation ) was obtained — and ECG #1 was recorded. In view of this history — How would YOU interpret the ECG in Figure-1 ? Should you activate the cath lab? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ).

EKG/ECG 372

EKG/ECG Wellness Hospitals 372

The Trauma Pro

JUNE 14, 2024

A bucket-handle injury is a relatively uncommon complication of blunt trauma to the abdomen. It only occurs in a few percent of patients, but is much more likely if they have a seat belt sign. The basic pathology is that the bowel mesentery (small bowel of sigmoid colon) gets pulled away from the intestinal wall. This injury is problematic because it may take a few days for the bowel itself to die and perforate.

Operations 147

Operations Radiology Radiology Hospitals 147

Pediatric EM Morsels

JUNE 14, 2024

Ooooo the infamous chief complaint of “ weakness ” ……. We just love those don’t we? Although neurological complaints may not be a crowd’s favorite, it is one we must become comfortable with. Timely recognition and treatment can be life-improving and life-saving! So, with that goal in mind, let us digest another delicious morsel on weakness – Acute Transverse Myelitis in Children : Acute Transverse Myelitis in Children: Basics Rare, non-compressive, inflammatory condition of the spinal cord

Pediatrics 141

Pediatrics EMS Outcomes 141

Science Based Medicine

JUNE 14, 2024

A doctor who actually treated COVID patients said at the start of the pandemic, "Just because they are young doesn’t mean they aren’t vulnerable." The post Dr. Jay Bhattacharya: “An Infection Is A Severe Problem For Older Populations, and Also For People Who Have Certain Chronic Conditions. For Younger Populations Under 70, It’s Much Milder.” first appeared on Science-Based Medicine.

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Sensible Medicine

JUNE 14, 2024

A few weeks ago, I wrote a “ Friday Reflection ” inspired by the quotation: “Regard for power implies disregard for those without power…” The line came from Robert Caro’s 1974 epic biography, The Power Broker: Robert Moses and the Fall of New York. I got carried away and offered up the quote to our readers as a prompt for an essay.

Wellness 106

Wellness Research 106

St. Emlyn

JUNE 14, 2024

St.Emlyn's - Emergency Medicine #FOAMed This secondary analysis of the DOSE VF trial highlights double sequential external defibrillation (DSED) as a superior strategy over standard and vector change defibrillation for refractory ventricular fibrillation (RVF) in out-of-hospital cardiac arrest, improving survival rates and neurological outcomes significantly.

Outcomes 103

Outcomes Hospitals Resuscitation 103

Dr. Smith's ECG Blog

JUNE 14, 2024

Written by Willy Frick A 57 year old man with was admitted to the hospital with chest pain. He underwent coronary angiography which showed severe multivessel disease, and he agreed to proceed with workup for CABG. Overnight, his cardiac telemetry showed the following: Telemetry Sample 1 What do you think? The rhythm terminated before it could be captured on 12-lead.

EKG/ECG 74

EKG/ECG Wellness Hospitals 74

ACEP Now

JUNE 14, 2024

Nick Vasquez, MD, FACEP, gets to see the impact of social determinants of health every day in the emergency department. Like most in our specialty, he wants to help solve problems. He’s spent 12 years in this place “of inquiry and service,” as he calls it, trying to understand some of the root causes of health inequities. Dr. Vasquez honed in on one piece of the puzzle that he’s now passionate about trying to change: childhood literacy.

Operations 52

Operations Emergency Department Research 52

Mind The Bleep

JUNE 14, 2024

Anatomy of a Slit Lamp Biomicroscope The slit lamp consists of: An illumination arm which offers a range of settings to facilitate examining the eye. This swivels on a pivot to allow for the light beam to illuminate the eye from different angles. A viewing arm with a binocular microscope. A joystick which allows both fine and gross horizontal displacement of the slit lamp on the table; twisting the top of the joysticks allows for vertical displacement of the slit lamp.

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ACEP Now

JUNE 14, 2024

Question I’m now eligible for my 401(k), and I need to pick which mutual funds to invest my contributions into. I’m not sure exactly how to do this, but I can see which ones had the best returns over the last one, three, and five years, so I just thought I’d put all my money into the top two or three of them so I’m diversified. Is that the right approach?

Wellness 52

Wellness 52

ACEP Now

JUNE 14, 2024

Transferring patients from one ED to another hospital is an established part of emergency medicine practice. Patients who need inpatient services do not match the index hospitals’ capabilities, or the patient requests such a transfer, or the hospital has no available inpatient space. The rate of transfers was stable for many years, typically around 2 percent.

Emergency Department 52

Emergency Department Operations Hospitals Leadership 52

ACEP Now

JUNE 14, 2024

Aware of growing discourse among emergency physicians about physician unionization, the ACEP Board of directors spent some time at its April meeting discussing what role—if any—ACEP could play. Although not committed to implementation of either, the Board discussed possible options including providing support to members who want to unionize themselves and considering partnership with one or more established unions.

Sexual Assault 52

Sexual Assault Seizures Documentation/Coding EMS 52

ACEP Now

JUNE 14, 2024

Chronic obstructive pulmonary disease (COPD) is a chronic disease of the lungs caused by inflammatory and structural changes of the small airways and parenchyma of the lungs that result in chronic airflow obstruction and gas trapping. In 2019, the global prevalence of COPD was estimated to be 10.3 percent, and COPD is responsible for about three million deaths per year globally. 2,17 COPD is diagnosed by spirometry with a forced expiratory volume in one second to forced vital capacity (FEV1/FVC)

COPD 52

COPD Hospitals Emergency Department Outcomes 52

ACEP Now

JUNE 14, 2024

Ischemic priapism is not uncommonly encountered in the emergency department (ED) and essentially results in a compartment syndrome of the penis. Thus, time is erectile tissue. The prolonged erection in ischemic priapism leads to tissue edema and ultimately necrosis of the corpus cavernosa, with irreversible damage occurring after 24 hours. The best chance to reduce long-term sequelae is through rapid detumescence.

Emergency Department 52

Emergency Department Pediatrics Research 52