Ken Grauer, MD

SEPTEMBER 13, 2024

I was sent the ECG shown in Figure-1 — being told only that providers on the case suspected AFib ( A trial Fib rillation ) with RBBB ( R ight B undle B ranch B lock ) aberrancy. QUESTIONS: Is the wide tachycardia that is seen best in the chest leads, too irregular to be VT ( V entricular T achycardia )? — How certain are YOU of your answer? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). == PEARL # 1: Before reviewing my a

EKG/ECG 248

EKG/ECG Wellness 248

The Trauma Pro

SEPTEMBER 13, 2024

There are basically four indications, two absolute and two relative : Absolute #1 : entrapped extremity with a lengthy extrication and a physiologically impaired patient who does not respond to fluids. In this case, there is occult blood loss in other areas that is killing your patient, and they need to get out quickly for definitive management. Absolute #2 : entrapped extremity with a lengthy extrication and an unstable physical environment.

203

203

Dr. Smith's ECG Blog

SEPTEMBER 7, 2024

A 70-something y.o. male presents to triage with shortness of breath. He reports significant chest pain at the base of his scapula on the right side along with new shortness of breath. ECG 1 at time zero EARLY REPOLARIZATION ABNORMAL ECG ED final official overread: "early repol vs hyperacute T, minimal changes from previous (previous shown below)" What do YOU think?

EKG/ECG 116

EKG/ECG Research Wellness 116

Emergency Medicine Cases

SEPTEMBER 10, 2024

On this month's EM Quick Hits podcast: Ian Chernoff on the often elusive diagnosis of traumatic coronary artery dissection, Anand Swaminathan on proper use of insulin in DKA and in hyperkalemia, Brit Long and Hans Rosenberg on mesenteric ischemia pearls and pitfalls in diagnosis and management, Dave Jerome on recognition and management exercise-associated hyponatremia and heat illness and Jesse McLaren on the Queen of Hearts AI model in helping identify occlusion MI on ECG.

EMS 114

EMS EKG/ECG 114

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!

Outcomes

American Medical Compliance

SEPTEMBER 9, 2024

In assisted living, one of the most critical aspects of resident care is the prevention and management of skin issues. For instance, one of the most common risk factors associated with the development of pressure ulcers is being 70 years of age or older. Skin health is not only a matter of comfort and well-being but also a key indicator of a resident’s overall health status.

Teamwork 105

Teamwork Best Practices Outcomes Wellness 105

Life in the Fast Lane

SEPTEMBER 11, 2024

James Miers and John Mackenzie Procedure: Pericardiocentesis Emergency Procedure: Pericardiocentesis. one of the most difficult and risky emergency procedures, but one you already have the ultrasound and line skills to perform well.

Ultrasounds 103

Ultrasounds Wellness 103

First 10 EM

SEPTEMBER 9, 2024

Welcome back to another research roundup. This edition doesn’t have any immediate practice changers, but I think there are some very important topics. Enjoy. The BroomeDocs podcast: [link] The BroomeDocs podcast on YouTube: (I am on vacation, so this will probably be inserted later.) In a surprise to no one who reads First10EM, clinical judgment […] The post The September 2024 Research Roundup appeared first on First10EM.

Research 95

Research Sepsis EMS 95

EMDocs

SEPTEMBER 7, 2024

Author: Iosif Davidov, MD (EM/IM/CC/Ethics Fellow at North Shore/LIJ Northwell Health System) // Reviewed by: Sophia Görgens, MD (EM Physician, BIDMC, MA); Cassandra Mackey, MD (Assistant Professor of Emergency Medicine, UMass Chan Medical School); Alex Koyfman, MD (@EMHighAK) Welcome to EM@3AM, an emDOCs series designed to foster your working knowledge by providing an expedited review of clinical basics.

EMS 95

EMS Fluid Resuscitation Resuscitation Radiology 95

Life in the Fast Lane

SEPTEMBER 12, 2024

Mark Corden Funtabulously Frivolous Friday Five 360 Funtabulously Frivolous Friday Five 360 - Just when you thought your brain could unwind, enter the medical trivia of FFFF.

97

97

Taming the SRU

SEPTEMBER 12, 2024

Weakness is a common, though sometimes vague, presenting symptom in the ED. Neuromuscular (NM) weakness can have various causes, ranging from common and relatively easy to diagnose conditions (such as strokes and trauma) to less common and more difficult to diagnose ones (such as vascular pathologies, infections, autoimmune diseases, and neoplasms).

Stroke 92

Stroke 92

EB Medicine

SEPTEMBER 13, 2024

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the September 2024 Emergency Medicine Practice article, Elder Abuse and Neglect: Making the Diagnosis and Devising a Treatment Plan in the Emergency Department Introduction and Announcements Elder Abuse and Neglect: An Overview Risk Factors and Reporting Pre-Hospital and Emergency Department Considerations Screening Tools and Physical Examination Documentation and Disposition Cultural Considerations and Future Directions Conclusion an

Elder Abuse 91

Elder Abuse Emergency Department Documentation/Coding Hospitals 91

Sensible Medicine

SEPTEMBER 10, 2024

I am a proud American and an avowed capitalist. I am sure that Adam Smith’s “invisible hand of the free market” maximizes social benefits. Capitalism has its flaws – the concentration of wealth and environmental degradation among others -- but no other system is as good at organizing societies and improving standards of living.

Wellness 90

Wellness 90

Core Medical Group

SEPTEMBER 12, 2024

At CoreMedical Group , our QA team is the backbone of your job placement journey. From finding travel nursing and therapy opportunities to getting you started in new locations, our QA experts, alongside your recruiter, ensure everything is top-notch. Whether it’s your first or fifteenth assignment , we’ve got your back with personalized service, helping with applications, licensing, housing, and even some local tips for your new destination.

89

89

PulmCCM

SEPTEMBER 8, 2024

The emergency department isn’t the right place to start a conversation about end-of-life and hospice care. And most emergency physicians would agree they aren’t the right ones to start it.

Hospice 89

Hospice Emergency Department 89

Don't Forget the Bubbles

SEPTEMBER 11, 2024

This post accompanies Andy Tagg’s talk for Grand Rounds for RU OK Day I have a confession to make to you all. And I know this is a safe space, so here it goes… I am burnt out. I have been a doctor for half of my life, and my journey to burnout has been a 25-year slow burn that began the day I graduated. I had always wanted to be a doctor, and only now do I recognise my parents’ sacrifices to get me to where I am today.

Burns 88

Burns Hospitals Emergency Department Wellness 88

EM Literature of Note

SEPTEMBER 13, 2024

Every year, we have our peak of respiratory viruses – traditionally influenza, respiratory syncytial virus, and their accompanying lessor demons. These are each awful, of course, in their own way from a patient- and parent-oriented standpoint, but they’re also quite awful at the population level, overburdening limited pediatric and emergency department resources.

Emergency Department 87

Emergency Department Pediatrics Administration Wellness 87

Sensible Medicine

SEPTEMBER 13, 2024

PJ is a 53-year-old woman referred for a consultative visit. For the last 12-18 months she has been suffering from fatigue, headache, joint pain, and rashes. She has been seeing a primary care internist and has had consultations with a neurologist, a dermatologist, and a rheumatologist. She presents with a folder of records and codes for outside EMRs.

Psychiatric 74

Psychiatric Radiology Radiology Documentation/Coding 74

Dr. Smith's ECG Blog

SEPTEMBER 9, 2024

Written by Willy Frick A 40 year old woman was at home cooking when she developed chest pain. She took an oxycodone and called EMS. Her presenting ECG is shown below: ECG 1 What do you think? I sent this to Drs. Meyers and Smith and the response was: "I’m quite confident that this is OMI." Here is the Queen's verdict with explainability: She sees OMI with low confidence.

EKG/ECG 67

EKG/ECG Operations Wellness Ultrasounds 67

ALiEM

SEPTEMBER 13, 2024

A 32-year-old male with no significant past medical history presented to the emergency department (ED) from an outside hospital for further management of right eye pain and vision loss sustained after he was struck by a metal wire while at work. The patient presented to an outside “eye doctor” and was told to go to the nearest hospital for evaluation.

Emergency Department 64

Emergency Department Academics Fractures Hospitals 64

RebelEM

SEPTEMBER 9, 2024

A newborn boy presents to the emergency department shortly after a home delivery. The mother had routine prenatal care and reports that he was due in 2 days. The patient appears term and vigorous but is in respiratory distress and gasping for air. His heart rate is 80 bpm. What percent of oxygen should you initially use while providing positive pressure ventilation to this patient?

Resuscitation 58

Resuscitation Emergency Department Pediatrics EMS 58

Sensible Medicine

SEPTEMBER 12, 2024

Sensible Medicine is excited to publish this rejected letter to the editor of the journal JACC-HF. Our excitement comes from a) the specific lessons about the design of clinical trials, and b) we love being a place where strongly argued but contrary viewpoints can be read. The specifics concern Chagas cardiomyopathy, which is caused by Trypanosoma cruzi infection.

Academics 69

Academics Outcomes Hospitals Wellness 69

EMergucate

SEPTEMBER 13, 2024

The chest x-ray shows medial displacement of the gastric bubble by an enlarged spleen.

EMS 52

EMS 52

ALiEM

SEPTEMBER 9, 2024

A 61-year-old female with a past medical history of hypertension, hyperlipidemia, type 2 diabetes, and normal pressure hydrocephalus s/p VP shunt (last revision nine months ago) presented to the Emergency Department (ED) for evaluation after noticing a “string” coming out of her anus today. Associated symptoms included nausea and a mild headache for one day, and one episode of vomiting prior to arrival.

Sepsis 60

Sepsis Academics Operations Emergency Department 60

Emergency Live

SEPTEMBER 13, 2024

Substances that promote tissue growth and repair are produced during sleep In recent years, scientific research has increasingly highlighted the importance of night rest for our health, especially heart. Why is sleep so important for the heart? During sleep, our body is engaged in a number of fundamental repair processes. The heart slows down, blood […] The post Why is sleeping more on the weekend good for the heart?

Research 52

Research 52

RCEM Learning

SEPTEMBER 12, 2024

The NIHR supported Emergency Care Incubator invites healthcare professionals working in urgent and emergency care to join us for our 3rd interactive symposium

Research 52

Research 52

EMergucate

SEPTEMBER 13, 2024

The pelvic x-ray shows a fracture of the right ilium.

Fractures 52

Fractures EKG/ECG EMS 52

PulmCCM

SEPTEMBER 8, 2024

From the 2018 SCCM clinical practice guidelines for prevention and management of pain, agitation/sedation, and delirium: Question: Does the level of arousal influence delirium assessments with a validated screening tool? Ungraded Statement : Level of arousal may influence delirium assessments with a validated screening tool.

52

52

Emergency Live

SEPTEMBER 13, 2024

Recent research suggests that intermittent fasting may hide unexpected risks Intermittent fasting, a diet that involves periods of abstinence from food alternating with food windows, has become increasingly popular in recent years, promising a range of health benefits, from weight loss to improved metabolic health. However, recent research from the Massachusetts Institute of Technology (MIT) […] The post Intermittent fasting: new research raises concern appeared first on Emergency Live.

Research 52

Research 52

Greater Sydney Area HEMS

SEPTEMBER 8, 2024

Visit the post for more.

52

52

EMergucate

SEPTEMBER 13, 2024

The hand x-ray shows punched out lesions with overhanging margins in the distal IP joints of index & middle fingers.

EMS 52

EMS 52

JournalFeed

SEPTEMBER 7, 2024

The JournalFeed podcast for the week of Sept 2-6, 2024. JournalFeed wants your feedback!! Tap here for a brief survey!! (<2 minutes) 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. Tuesday Spoon Feed : In a retrospective study of 142 patients with an initial shockable rhythm and 4 to 5 episodes of recurrent/refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia

Administration 52

Administration EMS Outcomes Hospitals 52

Emergency Live

SEPTEMBER 12, 2024

Australian researchers have used 3D printing to combine multiple drugs into a “poly-pill” 3D printing technology, traditionally used for rapid prototyping and complex object production, is also revolutionizing the pharmaceutical industry. Some Australian researchers have used this technology to combine multiple drugs into one “poly-pill”, and thus relieve the burden of those who must take […] The post Pharmaceutical revolution: personalised printed pills for each pa

Research 52

Research 52

Pediatric Education

SEPTEMBER 8, 2024

Patient Presentation A 4-year-old female came to clinic with a left red eye for 2 days. The mother said that it seemed to be getting redder but denied her having any pain, rubbing of the eye, photophobia or obvious visual changes. The mother denied any trauma to the head and neck and specifically the eye that she was aware of. The patient gave the same history.

Pediatrics 40

Pediatrics Wellness 40

EMergucate

SEPTEMBER 10, 2024

The abdominal x-ray is from a patient with vomiting, abdominal pain & distension. What can be seen?

EMS 52

EMS 52

The Trauma Pro

SEPTEMBER 10, 2024

Field amputation is not thought of very often, and for good reason. It is unpleasant, uncommon, and not very safe for trauma professionals due to the austere environment. I will dedicate the next several posts to the topic, starting with some of the facts. First, let’s start with definitions. Two distinct procedures are discussed here. The first and most commonly described is field amputation.

EMS 201

EMS Documentation/Coding 201

Emergency Live

SEPTEMBER 12, 2024

Italy invests 115 million euros in a project to unravel the mysteries of our most complex organ Italy is investing €115 million in an ambitious brain research project called Mnesys. This “Italian Neuroscience Cern” brings together over 500 scientists from all over Italy with the aim of uncovering the mysteries of our most complex organ […] The post Mnesys project: a journey into the human brain in search of new cures appeared first on Emergency Live.

Research 52

Research 52