Ken Grauer, MD

JULY 29, 2023

The ECG in Figure-1 was obtained from an 18-year old woman — who moments before been resuscitated from out-of-hospital cardiac arrest. QUESTIONS: In light of the above clinical history. How would YOU interpret her post-resuscitation ECG? Does this ECG in Figure-1 provide clue(s) to the etiology of this patient's cardiac arrest? Figure-1: The initial ECG in today's case — obtained following resuscitation from cardiac arrest of an 18-year old woman.

EKG/ECG 370

EKG/ECG Resuscitation Hospitals Documentation/Coding 370

Pediatric EM Morsels

JULY 28, 2023

Authors: Drs. Kendra Jackson and Rebecca Raffler While we’ve gotten to snack on a Morsel on this subject before , new guidelines and research surrounding DKA and cerebral edema have come to light since the first go ‘round! Thankfully, Dr. Fox wasn’t too “ salty” when we asked to rehydrate this topic. Rates of type 1 diabetes have increased since the COVID-19 pandemic.

Fluid Resuscitation 246

Fluid Resuscitation Pediatrics Resuscitation Dehydration 246

Mount Sinai EM

JULY 27, 2023

Fever in the Asplenic Patient Why we care Fever in a patient with impaired splenic function = early sign of sepsis Infections in this population can develop precipitously with very minimal antecedent symptoms, and can become fulminant and fatal within hours of symptom onset DIC can occur early in the course Patient population Anatomic Asplenia (post-splenectomy, congenital asplenia) Functional Asplenia (e.g. sickle cell anemia) Hyposplenia (from atrophy, infarction, engorgement, or infiltration

Sepsis 187

Sepsis Infectious Diseases Wellness 187

The Skeptics' Guide to EM

JULY 2, 2023

Date: July 1, 2023 Reference: PATCH-Trauma Investigators and ANZICS Clinical Trial Group. Prehospital Tranexamic Acid for Severe Trauma. NEJM 2023. Guest Skeptic: Dr. Salim Rezaie is a community emergency physician in San Antonio, TX. He is the Creator and founder of REBEL EM, a free, critical appraisal blog that tries to cut down knowledge translation gaps of […] The post SGEM#408: Hey, I, Oh I’m Still Alive – Is it due to TXA?

EMS 126

EMS Hospitals Outcomes Research 126

Science Based Medicine

JULY 2, 2023

Robert F. Kennedy, Jr. has resurrected the antivax claim that the childhood vaccine schedule has never been tested in randomized controlled trials (RCTs) with a saline placebo controls (and therefore the vaccine schedule is unsafe). This is an old and deceptive antivax half-truth that ignores both what constitutes a scientifically valid placebo and the ethical requirements for RCTs.

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Emergency Live

JULY 4, 2023

Telangiectasias are caused by enlarged blood vessels. This condition is much more common than you think and you will probably have come across this problem at least once in your life The post Teleangiectasias: what are they? appeared first on Emergency Live.

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RebelEM

JULY 5, 2023

Take Home Points Provider assessment of how the patient looks is extremely important. If it looks and feels like a STEMI clinically, get serial ECGs and consult Cardiology immediately. POCUS has been a phenomenal tool in the management and early diagnosis of a lot of abnormal ECG and chest pain presentations. Isolated elevation in aVR with diffuse ST depressions can be a sign of Left Main occlusion.

EKG/ECG 119

EKG/ECG Sepsis EMS 119

Mount Sinai EM

JULY 30, 2023

TR Pearl: Thyroid Storm Management Endocrine emergency: severe clinical manifestations of thyrotoxicosis Mortality rate of thyroid storm is 10-30% Often precipitated in patients with hx of hyperthyroidism by an acute event such as surgery (thyroid or non-thyroidal surgery), trauma, infection, acute iodine load (including amiodarone), or parturition Risk factor includes irregular use or discontinuation of antithyroid drugs Diagnosing Thyroid Storm : The distinction between severe thyrotoxicosis a

COPD 185

COPD Administration Wellness 185

SheMD

JULY 30, 2023

Disclaimer: This post was written before the COVID-19 pandemic. Some of the interview information may not be relevant during the 2020-2021 & 2021-2022 academic years. Hello premeds! ,, AMCAS , ,, AACOMAS , and ,, TMDSAS all opened in the beginning of May. We are kicking it into high-gear with premeds so they can turn in their medical school applications as soon as they are able.

Academics 104

Academics Research Leadership Wellness 104

Science Based Medicine

JULY 5, 2023

Despite the leaked new classification as a "possible" carcinogen, the evidence still shows aspartame is safe. The post Aspartame and Cancer first appeared on Science-Based Medicine.

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Emergency Live

JULY 1, 2023

Water retention is a problem that affects most women. However, most people confuse water retention and cellulite The post Water retention, how to deal with it appeared first on Emergency Live.

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PulmCCM

JULY 3, 2023

Video laryngoscopy was superior to direct laryngoscopy in first-pass success among ED residents and CCM fellows intubating critically ill patients (DEVICE trial). Surprisingly to me, video laryngoscopy (VL) has not consistently been shown to increase first-pass intubation success over direct laryngoscopy (DL) in critically ill patients. Most studies have been small, single center, and only some have favored video.

Hospitals 105

Hospitals Airway Management Resuscitation Ultrasounds 105

Pediatric EM Morsels

JULY 7, 2023

In the past, we have discussed several causes of Knee Pain in children. Some of those causes are benign (ex, Osgood Schlatter’s Disease ) while others are scary (ex, osteosarcoma ). Evaluating the limping child , though, requires us to ponder not only the common (ex, Toddler’s Fracture ), but also to be vigilant for the severe (ex, Septic Arthritis ).

Dislocations 144

Dislocations Fractures Pediatrics EMS 144

Mount Sinai EM

JULY 21, 2023

Why is this a pearl? We get G-tube dislodgments quite often at Sinai, and they can be an easy patient encounter with a quick note and quick dispo. But they made me so nervous as an intern and early 2! Now I love ‘em and you can love ‘em too! ** GJ-tubes or J-tubes do not get replaced in the ED. Tell me about the PEG tube. Gastrostomy tube (G-tube) or Percutaneous Endoscopic Gastrostomy tube (PEG tube) is a tube placed in the stomach for long-term enteral nutritional support.

EMS 186

EMS Radiology Radiology 186

St. Emlyn

JULY 2, 2023

St.Emlyn's - Emergency Medicine #FOAMed Zaf Qasim @resusone reviews the UKREBOA trial. No benefit shown, but is this really the end of REBOA in trauma? #FOAMed @stemlyns The post JC: The UK-REBOA trial. Has the balloon popped? St Emlyn’s appeared first on St.Emlyn's.

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Sensible Medicine

JULY 9, 2023

I always tell junior faculty that your contract means little, and, indeed, I found that to be the case, when a mid-career faculty departed and I inherited a third of his lung cancer patients. Yet, like most unexpected clinical changes in my career, I ended up learning unexpected truths. One man taught me about lung cancer screening. He was the most improbable 74 year old.

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Emergency Live

JULY 3, 2023

Schizophrenia comes from the Greek and literally means “separate mind”: those affected struggle to distinguish reality from imagination It is a psychiatric disorder that seriously compromises self-perception. In addition to negatively affecting social relationships and the performance of normal daily activities. This disease also affects perception, memory, attention, learning and emotions.

Psychiatric 118

Psychiatric 118

PulmCCM

JULY 31, 2023

New Practice Guidelines for Diagnosis and Management of Acute Respiratory Distress Syndrome As mentioned here previously , a group of U.S. and European experts arrived at a consensus of new recommendations for the management of acute respiratory distress syndrome (ARDS), now publishing their guidance in JAMA. The highlights include: A trial of high-flow nasal cannula oxygen was advised before intubating patients.

Shock 98

Shock Outcomes Documentation/Coding Wellness 98

Science Based Medicine

JULY 31, 2023

A report in The Washington Post last week revealed just how badly state medical boards have been failing when dealing with physicians spreading COVID-19 misinformation and using quackery to prevent and treat the disease. None of this is anything new, unfortunately. The pandemic has merely stress tested state medical boards, and most have failed because of political choices made long ago.

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ECG Guru

JULY 24, 2023

This is a "classic" ECG of very good quality for you to use in a classroom setting. The Patient: A 57-year-old man who complains of a sudden onset of "sharp" chest pain while on a long bike ride. The pain does not radiate, and nothing makes it worse or better. He is pale, cool, and diaphoretic. His medical history is unknown. The ECG: This ECG could be considered "classic" for an inferior wall ST elevation M.I. caused by occlusion of the right coronary artery.

EKG/ECG 98

EKG/ECG EMS Outcomes 98

Emergency Medicine Journal

JULY 24, 2023

Background Endotracheal tube (ETT) malposition is frequent in paediatric intubation. The current recommendations for ETT insertion depths are based on formulae that hold various limitations. This study aimed to develop age-based, weight-based and height-based curve charts and tables for ETT insertion depth recommendations in children. Methods In this retrospective single-centre study, we determined the individual optimal ETT insertion depths in paediatric patients by evaluating postintubation ra

Wellness 98

Wellness 98

SheMD

JULY 23, 2023

Disclaimer: This post was written before the COVID-19 pandemic. Some of the interview information may not be relevant during the 2020-2021 & 2021-2022 academic years. Now that it’s the heart of interview season for both medical school applicants and residency applicants, I wanted to share some tips on how to answer commonly asked interview questions.

Research 98

Research Academics Hospitals Ultrasounds 98

Emergency Live

JULY 3, 2023

Bladder cancer is a malignant transformation of the cells - mainly those called transitional cells - which cover the inner walls of the bladder, the organ responsible for collecting and expelling urine once it has been filtered by the kidneys The post Bladder cancer: what is it? appeared first on Emergency Live.

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RebelEM

JULY 24, 2023

Background: Rapid Sequence Intubation (RSI) is a procedure fraught with potential complications including hypotension which, in turn, can result in cardiovascular collapse. While there are numerous potential causes of hypotension peri-RSI, induction medications represent an important, modifiable variable. Over the last decade, airway experts have advocated for reduced induction agent dosing to lessen the risk of hypotension particularly in at risk patients.

Resuscitation 98

Resuscitation Outcomes EMS Emergency Department 98

Ziqitza HealthCare Ltd

JULY 21, 2023

Ambulance emergency number It’s heartbreaking to know that millions of emergencies end in the loss of lives. What shakes us is the lack of awareness of ambulance emergency numbers and the affordability of ambulance services. These reasons may sound a little weird in the digital era we are living in, but it’s true. You may argue that one can simply Google for an emergency number when needed.

Ambulance Services 98

Ambulance Services Poisoning Hospitals Operations 98

ECG Guru

JULY 30, 2023

Complex ECGs like this one have to be approached systematically. Firstly, we can see a normal sinus rhythm. A is the first beat of a wide complex tachycardia. This must be a ventricular tachycardia. Although there is a P-wave before the first beat of the tachycardia, it is not premature. Therefore, there is no SVT with aberrant conduction. The first beat of the tachycardia looks different from the subsequent beats because there is a fusion beat present.

EKG/ECG 98

EKG/ECG 98

ACEP Now

JULY 8, 2023

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.

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PEMBlog

JULY 14, 2023

The case A self-proclaimed dance team superstar presents after injuring her foot at a regional competition. She tried to finish the routine after landing awkwardly. But was having difficulty bearing weight. She applied ice overnight and despite ibuprofen is still in pain, and presents to the ED the next day.On her exam the neruovascular exam is normal, and she has pain along the proximal edge of the 5th metatarsal.

Fractures 98

Fractures Pediatrics 98

Emergency Live

JULY 1, 2023

Also called trapeziometacarpal osteoarthritis, rhizarthrosis is a particular form of osteoarthritis that affects the carpometacarpal joint of the hand The post Rhizarthrosis: definition, causes, symptoms, diagnosis and treatment appeared first on Emergency Live.

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Life in the Fast Lane

JULY 26, 2023

Pramod Chandru Network Five: Emergency Medicine Case Series Network Five Emergency Medicine Case 1 discussing an interesting case of a patient who presents with chest pain and pre-syncope.

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Ziqitza HealthCare Ltd

JULY 15, 2023

Prevention of Road Accidents Misfortunes one can endure- they come from outside, they are accidents. Every year, approximately 1.5 lakh people die on Indian roads, which translates, on average, into 1130 accidents and 422 deaths every day or 47 accidents and 18 deaths every hour. Nowadays, road crashes are the biggest challenge of our life. Road accidents not only take lives but also leave survivors with life-long chronic injuries and disabilities.

Ambulance Services 98

Ambulance Services Operations 98

ECG Guru

JULY 14, 2023

ECG 1 is from a 57-year-old male with no prior cardiac disease. He reports acute shortness of breath for 2 days. We see a sinus rhythm with left anterior fascicular block (LAFB) and conspicuous T-wave inversions in the inferior leads and in V1-V6. These are typical ECG changes that may indicate a pulmonary embolism. ECG 2 was taken from the same patient 1 year earlier.

EKG/ECG 98

EKG/ECG 98

ACEP Now

JULY 7, 2023

Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. 1 Ventricular tachycardia (VT) and ventricular fibrillation (VF) represent the most common initial rhythms for patients presenting to the ED in out-of-hospital cardiac arrest, as well as for patients who develop cardiac arrest while in the ED. 2,3 In general, patients who develop cardiac arrest with an initial r

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Resuscitation Shock Hospitals Stroke 98

EB Medicine

JULY 5, 2023

In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the July 2023 Emergency Medicine Practice article, Diagnosing and Treating Pericarditis and Myocarditis in the Emergency Department Epidemiology Nomenclature Etiology Differential diagnosis Prehospital care ED history and physical Diagnostics ECG Labs Imaging (X-ray, CT, US, MRI) Treatment Special populations COVID-19 Athletes MIS-C In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the July 2023 Emergency Medicine Practice a

EKG/ECG 98

EKG/ECG Emergency Department 98

Emergency Live

JULY 2, 2023

If you have blurred vision, the cause could be failing eyesight and you may need new glasses. The reasons, however, could also be others! In fact, if the blurred vision is persistent, it may also be a sign of other health problems: let's see what they are and when it is a good idea to contact your doctor and have a more thorough examination The post Blurred vision?

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Canadian EM

JULY 25, 2023

A 50-year-old female presents to your ER with a chief complaint of palpitations. A 12-lead ECG shows supraventricular tachycardia at a rate of 165 bpm, and she is put on telemetry. She is clinically stable. You attempt the modified Valsalva maneuver with no effect. You explain that you will have to give her medication to bring her heart rhythm back to normal.

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EKG/ECG 97

Science Based Medicine

JULY 17, 2023

Late last week, RFK Jr. endured some hilariously bad press about an NYC press event at which two of his supporters argued over climate change, one with lots of farts. However, the fart jokes soon gave way to darker side of the fundraise, a Q&A in which RFK Jr. shared an antisemitic conspiracy theory claiming that COVID-19 might have been "targeted" against Caucasians and Blacks, while sparing Jews and the Chinese.

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