Ken Grauer, MD

APRIL 9, 2023

The 12-lead ECG and long lead II rhythm strip in Figure-1 was obtained from an 86-year old man — who presented to the ED ( E mergency D epartment ) with presyncope. No chest pain. Th e patient was hemodynamically stable in association with this rhythm. How would YOU interpret the ECG in Figure-1 ? What is the rhythm ? Figure-1: The initial ECG in today's case — obtained from an 86-year old man with presyncope, but no chest pain. ( T o improve visualization — I've digitized the original ECG using

EKG/ECG 195

EKG/ECG 195

NIOSH Science Blog

APRIL 12, 2023

In November 2022, the American Journal of Industrial Medicine (AJIM) published a special issue focusing on work-related fatigue. The issue explores factors that may increase work-related fatigue and actions to reduce work-related injuries and illnesses. [1] This issue is a result of discussions and collaborations from the 2019 NIOSH Working Hours, Sleep and Fatigue Forum and also pulls from reports by the National Institute for Occupational Safety and Health (NIOSH) on long work hours and shift

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ALiEM

APRIL 12, 2023

Ever finally step away from a busy resuscitation and someone stops you for peripheral IV access? You set up everything, have the patient positioned, and then notice there is no sterile ultrasound gel. No gel? No problem. The trick is to eliminate anything of poor acoustic impedance between the ultrasound probe and the patient’s skin. Trick of the Trade 1.

Ultrasounds 103

Ultrasounds Emergency Department Resuscitation Wellness 103

Total Medical ComplianceHIPAA

APRIL 14, 2023

OSHA: If our office has the current Safety Data Sheets (SDS) for a product, do we have to keep the old one? No, the old SDS can be discarded if the original formulation is the same. When the formulation is different, the employer must keep both the old and current SDS for 30 years. HIPAA : Can you release healthcare records to the coroner for establishing cause of death or identifying a body?

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Emergency Medicine Cases

APRIL 11, 2023

How can we use the awareness of complications to identify false positive STEMI and Occlusion MI that doesn’t meet classic STEMI criteria, and consider specific treatment? Dr. Jesse McLaren reviews the complications of MI through 10 ECG cases and how they alter management. The post ECG Cases 41 – STEMI, Occlusion MI Complications appeared first on Emergency Medicine Cases.

EKG/ECG 80

EKG/ECG EMS 80

EMCrit

APRIL 9, 2023

How to teach and learn intubation and laryngoscopy EMCrit Project by Scott Weingart, MD FCCM.

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ALiEM

APRIL 14, 2023

Welcome to the AIR Procedures Module! After carefully reviewing all relevant posts in the past 12 months from the top 50 sites of the Social Media Index, the ALiEM AIR Team is proud to present the highest quality online content related to related to procedures in the Emergency Department. 6 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board.

EMS 98

EMS Ultrasounds Academics Fractures 98

The Skeptics' Guide to EM

APRIL 8, 2023

Date: April 4th, 2023 Reference: Vaughan and Browne. Reconfiguring emergency and acute services: time to pause and reflect. BMJ Qual Saf. 2023 Apr Guest Skeptics: Dr. Louella Vaugh is an internist practising as a hospitalist physician at an academic centre in London, UK with a special interest in smaller, rural and remote healthcare. Her main job […] The post SGEM Xtra: This is My Life – Centralization of Rural Emergency Healthcare first appeared on The Skeptics Guide to Emergency Medicine.

Stroke 54

Stroke Emergency Department Academics COPD 54

Dr. Smith's ECG Blog

APRIL 14, 2023

Sent by Anonymous, written by Pendell Meyers A man in his 60s with history of CAD and 2 prior stents presented to the ED complaining of acute heavy substernal chest pain that began while eating breakfast about an hour ago, and had been persistent since then, despite EMS administering aspirin and nitroglycerin. There was associated diaphoresis, but no dyspnea, nausea, or vomiting.

EKG/ECG 52

EKG/ECG Documentation/Coding Wellness EMS 52

ALiEM

APRIL 10, 2023

The patient is a 3-month-old, full-term male who presents with a rash on his head. The rash started one day prior to presentation on his forehead and spread to the rest of his head. Today, it developed a central clearing with surrounding redness. He has a history of sensitive skin since birth with patches of eczema and cradle cap. He treats these with Aquaphor and Honest Co.

Pediatrics 98

Pediatrics EKG/ECG Academics Wellness 98

Taming the SRU

APRIL 13, 2023

Morbidity & mortality - hyperthermia - airway grand rounds - dei guest lecture: racism in medicine M&M with Dr. Mullen Diagnostic Errors Diagnostic errors are often influenced by cognitive biases Anchoring bias Diagnostic momentum Confirmation bias Search satisfaction Cognitive biases are not a reflection of knowledge Obstructive Nephrolithiasis Obstructive nephrolithiasis with UTI is a urologic emergency Management of obstructive nephrolithiasis with UTI includes antibiotics (ceftriaxon

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

NRC Health

APRIL 13, 2023

NRC Health, a proud sponsor of the ICAN Women's Leadership Conference. The post NRC Health’s sponsorship of 2023 ICAN Women’s Leadership Conference inspires bold conversations appeared first on NRC Health.

Leadership 52

Leadership 52

Dr. Smith's ECG Blog

APRIL 12, 2023

A 49 year old woman with h/o COPD only presented with sudden dyspnea. She had acute pulmonary edema on exam. Prehospital Conventional algorithm interpretation: ANTERIOR INFARCT, STEMI Transformed ECG by PM Cardio: PM Cardio AI Bot interpretation: OMI with High Confidence What do you think? There is STE and hyperacute T-waves in V2 and V3, with significant STE in I and aVL, and inferior reciprocal STD.

EKG/ECG 52

EKG/ECG COPD Ultrasounds Outcomes 52

American Medical Compliance

APRIL 11, 2023

Workplace violence is any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the worksite. Moreover, it ranges from threats and verbal abuse to physical assaults and even homicide. It can affect and involve employees, clients, customers, and visitors. Physical assaults and threatening or violent behavior are growing problems in the workplace.

EMS 52

EMS 52

Emergency Medicine Cases

APRIL 11, 2023

In this episode, Dr. Roy Baskind and Dr. Ahmit Shah answer such questions as: when is an opening pressure on LP required? When should we pull the trigger on ordering a CT venogram in the patient with unexplained headache? Which older patients who present with headache require an ESR/CRP? How do the presentations of cerebral venous thrombosis (CVT) and idiopathic intracranial hypertension (IIH) compare and contrast?

EMS 52

EMS 52

Cook County EM Blog

APRIL 11, 2023

The Case : 25 year old man with no past medical history presents to the ED with acute left shoulder pain. He was playing soccer, jumped up for a header, and fell onto his left side 1 hour ago. On exam, his left upper extremity is adducted, internally rotated, and flexed at the elbow. He is neurovascularly intact, and range of motion is significantly limited secondary to pain.

Dislocations 52

Dislocations Ultrasounds Emergency Department Radiology 52

Canadian EM

APRIL 11, 2023

Police are a common presence in emergency departments. Sharing patient information between healthcare providers and the police can be essential for safety purposes. However, it can also erode the trust patients have in healthcare and pose a barrier to accessing care they need. Police presence can be distressing for many patients, especially considering that policing in Canada is intimately connected to a long history of colonial violence and racism.

Emergency Department 52

Emergency Department 52

NRC Health

APRIL 11, 2023

NRC Health's 29th annual conference, Human Understanding Beyond | HUB23, is set to take place August 9–11, 2023, in Boston. The post Human Understanding Beyond | HUB23 preview: Fundamentals First sessions appeared first on NRC Health.

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First 10 EM

APRIL 10, 2023

Before jumping into this edition, I need to address the maternal kisses study discussed last time. Obviously the study was satire, and did an excellent job in making us laugh, but most satire studies (like those in the Christmas edition of the BMJ) are real studies. Apparently this paper was entirely fictional (or perhaps the […] The post Research Roundup (April 2023) appeared first on First10EM.

Research 52

Research Sepsis Fractures EMS 52

American Medical Compliance

APRIL 10, 2023

Sexual harassment in the medical field occurs at all levels including executives, patients, and everyone in between. The #MeToo movement continues to raise awareness of harassment, including in the healthcare field, where many are taking action against abusive organizations and individuals. Individuals are making connections and empowering change throughout the industry.

Hospitals 52

Hospitals Wellness 52

Dr. Smith's ECG Blog

APRIL 9, 2023

Submitted by Ali Khan MD and James Mantas MD, MS, written by Pendell Meyers A man in his 50s with history of diabetes, hypertension, and tobacco use presented to the ED with 24 hours of worsening left sided chest pain radiating to the back, characterized as squeezing and pinching, associated with shortness of breath. His pain was initially mild, then became severely worse several hours prior to presentation, but then eased off again and was minimal on arrival.

EKG/ECG 52

EKG/ECG Wellness EMS 52

JournalFeed

APRIL 8, 2023

The JournalFeed podcast for the week of April 3-7, 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. Thoracic Aortic Dissections Spoon Feed Early identification and treatment of thoracic aortic dissections are paramount to patient survival and good clinical outcomes.

Outcomes 52

Outcomes 52

EMergucate

APRIL 11, 2023

Answers: Ph = 7.56, that is alkalaemia Both HCO3 and pCO2 are low. So, most likely we have combined metabolic and respiratory alkalosis.

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Kings County Downstate EM

APRIL 14, 2023

Author: Esteban Davila Editor: Alec Feuerbach The Case An 18-year-old male without past medical history presented to the ED with one day of fever, headache, and left sided chest pain starting 4 hours prior to arrival. The patient described the chest pain as achy, non-radiating, and worse with deep inspiration […] The post Biphasic T-Wave Inversion: Is it Wellens?

EMS 40

EMS EKG/ECG 40

PulmCCM

APRIL 14, 2023

Do you miss PulmCCM’s regular updates? Help bring them back. Subscribe for $4.16/month ($50/year annually) to reboot PulmCCM here on Substack, better than before. Bring Back PulmCCM If you have a CME allowance, and your employer’s CME policy includes online subscriptions (example below copied from a university’s policy), you should get PulmCCM at no cost to you: OK I'm In.

Research 40

Research Wellness 40

CasesBlog

APRIL 14, 2023

The apolipoprotein E (ApoE) gene makes a protein which, when combined with fat, becomes a lipoprotein. The lipoprotein ApoE is a very low-density lipoprotein, responsible in part for removing cholesterol from the bloodstream. Variations in ApoE affect cholesterol metabolism, which in turn alter your chances of having heart disease and in particular a heart attack or a stroke.

Stroke 40

Stroke 40

Emergency Medicine Education

APRIL 12, 2023

There is always a debate in the ED that should we send a patient status post ROSC to cath lab or not. JAMA in July 2022 published a French national multicenter study regarding OHCA patient who had a ROSC to assess cerebral performance category. They enrolled 279 patients and they measured 180 days survival rates. As a conclusion they did not find emergent cath lab activation to be better than delayed cath lab intervention.

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EMergucate

APRIL 11, 2023

The following knee x-ray is from a patient with knee swelling post trauma. What can be seen?

EMS 52

EMS 52

University of Maryland Department of Emergency Med

APRIL 10, 2023

Glucagon therapy in beta blocker and calcium channel blocker overdose is controversial and no high level evidence is available to support or.

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Ken Grauer, MD

APRIL 14, 2023

The ECG in Figure-1 was obtained from a 90-year old woman — who presented with a 2-to-3 day history of chest pain, that became worse on the day of admission. How would YOU interpret the ECG in Figure-1 ? Is there acute coronary occlusion? If so — What is the " culprit " artery? Figure-1: The ECG in today’s case. ( To improve visualization — I've digitized the original ECG using PMcardio ).

EKG/ECG 195

EKG/ECG Wellness Hospitals 195

Taming the SRU

APRIL 10, 2023

Case 2 HISTORY OF PRESENT ILLNESS The patient is a male in his 20s presenting after an unintentional opioid overdose. He was found down by his family. Per paramedics, the patient was responsive to 4 mg Narcan. He was found to have oxygen saturation in the low 80s by squad, with improvement to the 90s on nonrebreather mask. Patient is refusing to talk to staff and appears to have altered mental status, repeatedly stating “I can’t hear.

EKG/ECG 52

EKG/ECG Fluid Resuscitation Administration Emergency Department 52

Stop and Think

APRIL 9, 2023

Professor Andrew Gelman is a statistics and political science professor. He writes a popular blog where he is outspoken—especially about bogus studies. Few public intellectuals have more credentials than Gelman. That’s why I was drawn to his short post regarding the difficulty in digesting research claims. The two claims in question were a) Vitamin D and COVID-19 and b) fish oil and prostate cancer.

Shock 52

Shock Research 52

American Medical Compliance

APRIL 11, 2023

Sexual harassment in the workplace occurs when a person is subject to unwelcome sexual advances, requests for sexual favors, or other verbal or physical conduct of a sexual nature to such an extent that it alters the conditions of the person’s employment and creates an abusive working environment. This is a serious issue in the workplace. It is important to note that harassment situations can happen to both men and women.

EMS 52

EMS 52

Pediatric Education

APRIL 9, 2023

Patient Presentation A 10-year-old male came to clinic with a 1 day history of left cheek swelling and pain. He denied any trauma and it was described as having an insidious onset with a temperature of 99.8F and some general malaise. He said his “cheek just hurt” in general and a little more with chewing but denied any actual tooth pain, ear pain, or any new sounds with chewing.

Infectious Diseases 40

Infectious Diseases Pediatrics 40