Ken Grauer, MD
MARCH 29, 2023
The ECG in Figure-1 is from a man in his 30s — who overall has been healthy, except for a history of "intermittent palpitations" that he has had since childhood. Episodes typically last less than 2 minutes — but this time, he presented to the ED ( E mergency D epartment ) because of ongoing symptoms lasting a number of hours. The patient consumed alcohol at a party the night before.
Pediatric EM Morsels
MARCH 31, 2023
Children love to trick us! Sometimes it is all in good fun and other times it is quite serious! They like to pretend to be well when they are truly sick ( remember to check that Cap Refill and to never trust a Neonate! ) and they often show us “odd” findings that are really normal (ex, Growth Plates, Primitive Reflexes ). They like to keep us on our toes so much, that even their cervical bones can deceive us.
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Mount Sinai EM
MARCH 20, 2023
Sickle cell disease affects ~ 100,000 people in the US. Though pain is the most common ED presentation for patients with SCD, we should always consider life-threatening emergencies in this devastating and complicated disease. Acute Chest Syndrome ACS is the leading cause of morbidity and mortality in patients with SCD. It’s caused by sickling in the pulmonary vasculature, leading to a cycle of hypoxia, vaso-occlusion, and consequently more hypoxia.
EMCrit
MARCH 21, 2023
Steroid is worthless for pneumonia! Wait, a new study shows it's beneficial! Hang on, a fresh meta-analysis shows that steroid it's useless! And wait, here's a fresh NEJM study showing mortality benefit!! This feels like a roller coaster. What's going on here? Several factors may explain this: Steroid is beneficial, but only in a subset […] EMCrit Project by Josh Farkas.
NIOSH Science Blog
MARCH 15, 2023
Employers can play a vital role in suicide prevention. Historically, suicide, mental health, and well-being have been underrepresented in workplace health and safety efforts, but this is changing. In some European countries, there are workplace standards for workplace psychosocial hazards that put workers at risk for suicide. Additionally, in France, employers have been made accountable for toxic workplaces and management practices that contributed to worker suicides.[1] Some of the latest workp
NRC Health
MARCH 22, 2023
NRC Health is named to Becker’s 'top places to work in healthcare' list for 2023. The post NRC Health named to Becker’s ‘top places to work in healthcare’ list appeared first on NRC Health.
Ken Grauer, MD
MARCH 23, 2023
The 12-lead ECG and long lead II rhythm strip shown in Figure-1 — was obtained from a previously healthy, elderly woman who collapsed in the hospital parking lot. She underwent cardiopulmonary resuscitation for VT/VFib — with ROSC ( R eturn O f S pontaneous C irculation ) following defibrillation and treatment with Epinephrine and Amiodarone. A series of cardiac arrhythmias were seen during the course of her resuscitation — including the interesting arrhythmia shown in the long lead II of Figure
Emergency Care Today brings together the best content for emergency care practitioners from the widest variety of industry thought leaders.
Mount Sinai EM
MARCH 20, 2023
Trauma is the leading cause of non-obstetric death in pregnant women. MVAs and intimate partner violence account for most cases. Let’s first discuss the physiological changes to consider when managing a pregnant patient in a trauma. AIRWAY : Progesterone: floppier airway with more edema Predict a more difficult tube Decreased esophageal tone and -> higher risk for aspiration Decompress early with NG or OG tube BREATHING : Increase in respiratory drive -> hyperventilation -> chronic r
EMCrit
MARCH 17, 2023
A new format of ED Critical Care perfectly suited to rural environments EMCrit Project by Scott Weingart, MD FCCM.
Mind The Bleep
MARCH 22, 2023
Introduction Clinical Definition An open fracture is when the broken bone breaks through the skin or any other body cavity that is open to the outside, including those through the rectum or vagina. Classification Gustilo and Anderson Classification 1,2 Type Wound Size Contamination Fracture Arterial injury requiring repair Soft Tissue Coverage 1 < 1cm Minimal Minimal None Adequate – local 2 1-10cm Moderate Moderate None Adequate – local 3A >10cm Extensive Severe None Adequate
NRC Health
MARCH 29, 2023
In this episode we are joined by Toya Gorley, Improvement Advisor at NRC Health and Dr. Elizabeth Paskas, Senior Vice President, Chief Patient Experience Officer at Hackensack Meridian Health as they discuss the Fundamentals First mentality and how it has impacted health systems. The post Hackensack Meridian Health & NRC Health: Fundamentals First appeared first on NRC Health.
Ken Grauer, MD
MARCH 18, 2023
The ECG in Figure-1 was obtained from a man in his mid-60s — who presented with new chest pain. Should the cath lab be activated? Figure-1: T he initial ECG in today’s case. Should the cath lab be activated? MY Thoughts on the Initial ECG: The rhythm in ECG #1 — is sinus at ~70/minute. All intervals ( PR, QRS, QTc ) are normal. There is no chamber enlargement.
Total Medical ComplianceHIPAA
MARCH 15, 2023
With the pandemic drawing to a close in May , many employers are requiring their workers to return to the physical workplace. Patients that are afraid that their medical situation makes that return too risky at this time are requesting a letter from the doctor preventing that return. If the doctor believes this to be valid, they generate the letter.
Dr. Smith's ECG Blog
MARCH 31, 2023
This was sent to me by a friend. It is from a 50-something with chest pain: What do you think? This was marked as "Not a STEMI" by the physicians. It is not a STEMI, but it is diagnostic of an LAD OMI (Occlusion MI). There is subtle ST Elevation in V1-V4 and hyperacute T-waves in V2-V6. There is also subtle but diagnostic INFERIOR ST Elevation, with reciprocal ST Depression in aVL.
EMCrit
MARCH 25, 2023
Hayden Richards is a communications maven. EMCrit Project by Scott Weingart, MD FCCM.
Dr. Mike Sevilla
MARCH 30, 2023
A cheeseburger really is not healthy, right? Well, in a recent news report , a survey claimed that the food chain Whataburger (we have no restaurants around here) has the “healthiest” cheeseburger in America. The wildly popular food website called Mashed (they have 25 monthly readers worldwide) reached out for my comment on this. You can probably guess what I said about it.
American Medical Compliance
MARCH 30, 2023
After the COVID-19 pandemic, there has been a greater importance in implementing proper infection control protocols, such as identifying cases of infections and supplying proper personal protective equipment (PPE) to emergency medical workers. All medical facilities must establish and follow proper infection control guidelines due to the high potential of exposure to infectious materials and patients that healthcare personnel face.
Ken Grauer, MD
MARCH 7, 2023
You are given this ECG to review. No history is provided — except knowing that this patient was seen in the ED ( E mergency D epartment ). QUESTION: Is there a potential problem with this ECG? Figure-1: The initial ECG in today's case. == N OTE : Many of us are charged with reviewing ECGs that have been interpreted by other clinicians — often without the benefit of much ( or any ) history.
NRC Health
MARCH 30, 2023
Compliment Sharing is a new digital solution to address burnout and boost morale among frontline care teams. The post NRC Health energizes healthcare organizations with digital solution to ease burnout for care teams appeared first on NRC Health.
Dr. Smith's ECG Blog
MARCH 30, 2023
= My Comment by K EN G RAUER, MD ( 3/30 /2023 ): = The ECG in Figure-1 was sent to me without the benefit of any history. I thought the rhythm illustrated a number of essential concepts for clinicians dedicated to Emergency Care. Do YOU know what the rhythm is? IF this arrhythmia is puzzling to you — READ ON! I illustrate how to make the diagnosis within less than 15 seconds.
Stop and Think
MARCH 28, 2023
There is this idea that one of the main problems with US healthcare is that our system is set up to profit from sick care. This comment from my friend Dr. David Albert captures the idea: Martha, as you well know, we have a sick care system not a well care system that doesn't make $ from wellness but from caring for the sick. Not sure it will change (Trillions of dollars at stake).
Dr. Mike Sevilla
MARCH 30, 2023
Over the past three years, we have learned a lot about getting COVID infections, and being re-infected with the COVID virus. Looking back, there is a lot that we know now that we did not know previously. Thanks to CNET for reaching out to me to comment on this for their story “ What to know about getting COVID again (and again) in 2023.” I encourage you to click on the article and to check out my comments.
American Medical Compliance
MARCH 30, 2023
OSHA (Occupation Safety and Health Administration) views workplace violence as a major occupational risk. In response to this risk, OSHA may install additional safety standards to combat workplace violence. Over the last decade, the number of workplace violence instances has grown significantly. These instances have continued to increase as a result of the COVID-19 pandemic.
Emergency Medicine Cases
MARCH 28, 2023
Dr. Nav Sahsi gives us a quick primer on Doctors Without Borders, explains the difference between humanitarian work and development work and describes the motivation, personal skills, education, time commitment and flexibility required for humanitarian work for all those with an interest in Global EM. The post Global EM 3 So you want to be a humanitarian doctor?
Cook County EM Blog
MARCH 28, 2023
The Case: The patient is a 61-year-old male with non-insulin dependent diabetes, hypertension, coronary artery disease status post CABG in 2019 who presented with blurry vision of the left eye after being hit on the face with a blunt object by his roommate approximately ten days prior to presentation. The patient reports that over the past year his roommate had been abusing him physically.
NRC Health
MARCH 28, 2023
Check out the latest spring highlights on how we put Human Understanding® into practice The post Partnering for progress: Our spring highlights in healthcare innovation appeared first on NRC Health.
Ultrasound Gel
MARCH 27, 2023
Virtual reality ultrasound?! It is here, and it might be a valuable educational tool. Special host Shawn Sethi, usual but still somewhat special host Mike, and definitely special guest ultrasound educator Suean Pascoe discuss the available evidence and their own perspectives on this innovative technology. [link] Virtual reality ultrasound?! It is here, and it might be a valuable educational tool.
AED Leader
MARCH 27, 2023
Heart palpitations may come on after eating certain foods or you may have heart palpitations for another reason, such as dehydration, low electrolyte levels, pregnancy, anxiety, anemia, thyroid issues, or an underlying heart disease or arrhythmia like atrial fibrillation. While experiencing heart palpitations after eating is fairly common and is usually not dangerous, an irregular Read More "10 Foods You Should Avoid if You Have Heart Palpitations" The post 10 Foods You Should Avoid if You Have
JournalFeed
MARCH 25, 2023
The JournalFeed podcast for the week of March 20-24, 2023. These are summaries from just 2 of the 5 article we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member. Cochrane Anti-Maskers Spoon Feed In this Cochrane review, hand-hygiene programs reduce the incidence of clinical acute respiratory illness (ARI), while masking probably does not provide additional benefit.
Emergency Medicine Cases
MARCH 28, 2023
In this month's EM Quick Hits podcast: Anand Swaminathan on 3-pronged approach to aortic dissection management, Jonathan Wallace on rural practice tips for glue removal and ESP block for renal colic, Sara Gray on everything you need to know about High Flow Nasal Cannula but were afraid to ask, Maria Ivankovic on reducing the duration of antibiotic therapy for uncomplicated common bacterial infections, Tahara Bhate on handover and learner oversight on QI corner and Kerstin De Wit on the ADJUST-UN
The Skeptics' Guide to EM
MARCH 25, 2023
Date: March 22, 2023 Reference: Hilsden et al. Point of care biliary ultrasound in the emergency department (BUSED) predicts final surgical management decisions. Trauma Surg Acute Care Open 2022 Guest Skeptic: Dr. Casey Parker is a Rural Generalist that includes in his practice emergency medicine, anesthesia, and critical care. He is also now a fully-fledged “sonologist”.
NRC Health
MARCH 27, 2023
NRC Health is proud to host and participate in several special events you won’t want to miss this spring! The post Spring’s healthcare events you don’t want to miss—come see us! appeared first on NRC Health.
Core Ultrasound
MARCH 24, 2023
Examining the Utility of Cardiac Ultrasound During Cardiac Arrest Peer reviewed by Ben Smith, MD 3/23/23 RWMA R Heart TEE Cardiac POCUS can be dramatically useful and life-saving in cardiac arrest. I like to think about it in three different broad categories: Procedural, identifying reversible causes, and guiding therapy. This video isn’t a discussion regarding its utility for procedures or diagnosing reversible causes, but it is talking about how maybe the echo pulse check is not the best way t
Trigger Lab
MARCH 23, 2023
I deal with a complex and recent subject that is of great importance in monitoring patients afflicted with ARDS: the Patient Self-Inflicted Lung Injury (P-SILI). The objectives of this piece are divided into two parts: DEFINING P-SILI Over the past 20 years, several important aspects concerning ARDS patients have been emphasized.
RebelEM
MARCH 23, 2023
Background information : Alcohol has potentiating effects on the inhibitory GABA neurotransmission system and inhibitory effects on the excitatory glutamate neurotransmission system. Chronic alcohol use causes changes to preserve homeostasis, and when the stimulus is removed, alcohol withdrawal results due to decreased inhibition via the GABA system and increased excitation via the glutamate system.
Dr. Smith's ECG Blog
MARCH 20, 2023
Submitted by Dr. Caio Aguiar from Brazil, written by Pendell Meyers It is immensely rewarding to receive these emails, like I received from Dr. Aguiar last week: "Last year I had a couple of lessons with you while on my internship. I finished my residency of Emergency Medicine and I’m working at a great Emergency Department here in Brazil. Since then, I started looking for OMI EKG findings and not just STEMI.
Cook County EM Blog
MARCH 20, 2023
Image 1: X-ray AP and and lateral thumb views A 42-year-old right hand dominant male with no known past medical history presents with pain in his right thumb. He works as a painter and was using an industrial paint sprayer when he injected a water-based paint into his right distal thumb pad. He states he had significant pain initially, but it quickly settled to a dull throbbing.
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