Ken Grauer, MD

AUGUST 11, 2023

I was sent the ECG in Figure-1 , with a request for my opinion — without the benefit of any history. How would YOU interpret the ECG in Figure-1 ? What might you suspect clinically? Figure-1: The initial ECG in today’s case. ( To improve visualization — I've digitized the original ECG using PMcardio ). MY Thoughts on the ECG in Figure-1: In these days of widespread smart phone availability — transmission of ECGs to request expert opinion is an increasingly used practice, that on many occasions o

EKG/ECG 195

EKG/ECG 195

Pediatric EM Morsels

AUGUST 11, 2023

This is the 601st Ped EM Morsel ! Having authored 575 ( well, now 576 ) of them, I am often quite convinced that there are no new topics to discuss. Then July happens and we get 14 more amazing interns who help educate me and remind me that there is always more to learn. Recently, Dr. Teresa Crow encountered an important topic in children that deserves its own Morsel.

Burns 130

Burns Pediatrics EMS Outcomes 130

The Trauma Pro

AUGUST 8, 2023

In my last post, I detailed the following case: This male patient was brought to the trauma center after a high-speed car crash. He was unresponsive with GCS 3. A bleeding facial laceration was present, as was vomitus in the airway. Prehospital providers rapidly intubated the patient and inserted an orogastric tube. They rapidly packaged and transported him to the nearest trauma center.

Wellness 130

Wellness Hospitals 130

Mount Sinai EM

AUGUST 6, 2023

Materials Materials to build a DIY homemade low-cost ultrasound model for intravenous access Shallow plastic container x 2 Pipes, different sizes (Suction tubing, oxygen tubing, plastic cover for needles) Metal screw or nail Some waterproof glue or glue gun Beef gelatin 150g + warm tap water 800ml + Rubbing alcohol 50ml Hand mixer Spoon or strainer Cooking oil Making the mold Make holes to both sides of the container to pass the tubings through and through (I used a hot screw for this) Pass the

Ultrasounds 130

Ultrasounds 130

Life in the Fast Lane

AUGUST 10, 2023

James Miers, John Mackenzie and Amanda Beech Precipitous Birth in the ED Emergency Procedure: Precipitous Birth in the ED. Let’s face it, the three births you attended as a medical student don't really prepare you for this.

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Don't Forget the Bubbles

AUGUST 9, 2023

You’ve sent some bloods on a child with lethargy. Their free T4 is normal but their TSH is raised. What does this mean? Do they have subclinical hypothyroidism? Subclinical hypothyroidism is a hormonal condition. Thyroid-stimulating hormone (TSH) serum levels are raised, while free T4 (FT4) values are normal. We’ll use some cases to think about the different causes of subacute hypothyroidism, but first, let’s explore what it is.

Ultrasounds 98

Ultrasounds Pediatrics Wellness 98

ALiEM

AUGUST 9, 2023

Read this tutorial on the use of point of care ultrasonography (POCUS) for pediatric lung ultrasound. Then test your skills on the ALiEMU course page to receive your PEM POCUS badge worth 2 hours of ALiEMU course credit. Take the ALiEMU PEM POCUS: Pediatric Lung Ultrasound Quiz Module Goals List indications for performing a pediatric lung point-of-care ultrasound (POCUS).

Ultrasounds 98

Ultrasounds Pediatrics Emergency Department Operations 98

Science Based Medicine

AUGUST 7, 2023

Last week, I wrote about how COVID-19 has exposed the toothlessness of state medical boards. Last week, the American Board of Internal Medicine announced that it was going to permanently revoke the board certifications of two COVID-19 contrarian doctors, Drs. Paul Marik and Pierre Kory. Can medical specialty boards make up for the failure of state medical boards, at least partially?

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Don't Forget the Bubbles

AUGUST 7, 2023

Heart rate (HR) and respiratory rate (RR) are THE major vital signs used in Advanced Paediatric Life Support ( APLS) guidance , sepsis guidelines , and Paediatric Early Warning Scores (e.g., PEWS). Vital signs outside the normal range are used as a proxy for the severity of illness and are also used in evaluating the risk for serious bacterial infection or risk for sepsis in children and young people (CYP).

Sepsis 98

Sepsis Pediatrics Urgent Care Emergency Department 98

ALiEM

AUGUST 7, 2023

A 10-year-old male with no past medical history presents to the Emergency Department (ED) by EMS for evaluation of an injury sustained while playing tackle football. The patient was forcibly hit by another child against a tree. He complains of sharp right shoulder and chest pain that worsens with movement of his right upper extremity and he arrives wearing a sling to immobilize the arm.

Dislocations 98

Dislocations Academics Fractures Emergency Department 98

ACEP Now

AUGUST 8, 2023

Sure, he made the national news for saving a life at an Eagles game while wearing an elaborate Mummer’s Day costume, but did you know he’s also his residency’s social chair and has all the best local recommendations for ACEP23 attendees? Read on! Vincent Basile, DO, an emergency medicine resident at Einstein Medical Center in north Philadelphia, was focused on cheering for his hometown Eagles on January 1, 2023, when he realized a fellow fan was experiencing a medical crisis.

CPR 94

CPR EMS 94

Medagadget

AUGUST 9, 2023

Researchers at the University of Würzburg in Germany have developed a portable scanner that is the first to be able to image humans using Magnetic Particle Imaging (MPI). The technology could provide a radiation-free alternative to techniques such as X-ray fluoroscopy and digital subtraction angiography for minimally invasive endovascular procedures, and is well suited for viewing processes such as blood flow.

Research 91

Research Administration Wellness Radiology 91

Dr. Smith's ECG Blog

AUGUST 6, 2023

This may be my best lecture yet. I gave it virtually to the Kaiser group. You can access it also on the "Lectures and Podcasts" link on the Banner above. [link] == MY Comment, by K EN G RAUER, MD ( 8/6 /2023 ): == Brilliant talk by Dr. Smith on the state of the art addressing the “need for OMI — and the fallacy of STEMI”. For skeptics ( including cardiologists ) — Any questions about “Who is Dr.

EKG/ECG 91

EKG/ECG Research 91

St. Emlyn

AUGUST 10, 2023

St.Emlyn's - Emergency Medicine #FOAMed Can clinicians identify life threatening injury in trauma patients? Probably not as reliably as we would wish according to this paper from London. Even in an experienced high performing EHPC team it's tricky to discern which patients have life threatening, limb threatening or significant bleeding injuries.

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Science Based Medicine

AUGUST 9, 2023

The evidence for nasal sprays to prevent COVID is too preliminary to recommend their use. The post Nasal Sprays To Prevent COVID first appeared on Science-Based Medicine.

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Core Medical Group

AUGUST 11, 2023

In the bustling world of healthcare recruitment, there exists a group of individuals who work behind the scenes, bringing healthcare professionals and their dream roles together. Through the sun-soaked days on the golf course, deep-sea fishing, and the serenity of coastal waters, Ryan's story unfolds, revealing his inspiration, his victories, and his unique strategies that have earned him a spot in the spotlight.

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Medagadget

AUGUST 9, 2023

Researchers at the University of Ottawa have developed a light-activated hydrogel treatment for corneal disease. Many of the people who suffer from corneal disease, which can include corneal thinning, are not suitable for a corneal transplant, and obtaining transplants is a challenge for those who are. This technology is intended to assist with thickening and reshaping the cornea, and it may pave the way for an alternative to transplants in the future.

Research 88

Research 88

Life in the Fast Lane

AUGUST 6, 2023

Mike Cadogan Fractures App The Fractures App is yet another fantastic, simple and effective bedside app created by Tom Fadial and Spencer Tomberg

Fractures 98

Fractures 98

Emergency Live

AUGUST 5, 2023

Coarctation of the aorta is a congenital heart disease characterized by narrowing or constriction of the aorta The post Congenital heart disease: coarctation of the aorta appeared first on Emergency Live.

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RebelEM

AUGUST 7, 2023

Background: Getting a definitive airway in a critically ill trauma patient can be a stressful situation. The potential for soiled airways, cervical spine injuries, maxillofacial injuries and head injuries combined with agitation/delirium, altered mental status and hypoxemia can make securing a definitive airway both an anatomic and physiologic challenge.

Head Injuries 85

Head Injuries Outcomes Airway Management Burns 85

Medagadget

AUGUST 8, 2023

EarliTec Dx , a medtech company based in Georgia, has developed the EarliPoint Evaluation System for Autism Spectrum Disorder (ASD). This common neurodevelopmental condition is often overlooked in affected children, leading to a lack of early intervention and care. Part of the issue is a lack of access to specialists who can diagnose the condition. Another issue is the lack of quantitative tools that can assist clinicians in diagnosing ASD, and instead they rely on subjective measurements and ob

Outcomes 88

Outcomes Research Pediatrics 88

Taming the SRU

AUGUST 7, 2023

Sick vs Not Sick - Ruptured Ovarian Cyst - Stroke Updates - AV BlockS - Over-Testing in the ED - Research Sick vs. Not Sick WITH Dr. knight “The eye cannot see what the mind does not know” There is a middle ground between minimalist and risk-averse evaluation of patient EM physicians can use system 1 thinking pretty accurately to describe disposition for patients based off of initial gestalt “What do I see when I walk in the room?

Stroke 84

Stroke Outcomes EKG/ECG Research 84

Emergency Live

AUGUST 7, 2023

Lessons from the earthquake in Turkey and Syria and the importance of earthquake-resistant structures Six months have passed since the earthquake that struck Turkey and Syria on 6 February 2023, claiming tens of thousands of victims. There has been a lot of help from around the world to find and rescue many people trapped under […] The post Earthquake in Turkey and Syria - What could have been done to avoid disaster appeared first on Emergency Live.

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Dr. Smith's ECG Blog

AUGUST 10, 2023

Case submitted and written by Dr. Mazen El-Baba and Dr. Emily Austin, with edits from Jesse McLaren A 50 year-old patient presented to the Emergency Department with sudden onset chest pain that began 14-hours ago. The nurse alerted the MD because the patient was still symptomatic, diaphoretic and “looking unwell”. What do you think? ECG interpretation: sinus rhythm, normal conduction (PR, QRS, and QTc), normal axis, delayed R-wave progression, and normal voltages.

EKG/ECG 83

EKG/ECG Emergency Department Wellness 83

Sensible Medicine

AUGUST 7, 2023

In Chapter 1 of this mini-series, I explained the disruption wrought by the COURAGE trial. Seriously? Stenting severe coronary lesions did not improve survival over simple tablets? Chapter 2 added to the oodles of studies showing how much doctors can be fooled by the placebo effect. The ORBITA trial demonstrated that the caring signal of placing a stent is massive.

Shock 82

Shock Outcomes Hospitals Wellness 82

Medagadget

AUGUST 8, 2023

Researchers at ETH Zurich have developed a bacteriophage system to identify and treat bacterial bladder infections. Bacteriophages are viruses that infect bacteria, but these microorganisms have fallen out of favor as a treatment method for infection since antibiotics came along. Well, antibiotics are looking increasingly shaky as bacteria evolve to resist them, so researchers are returning to bacteriophages as a way to treat antibiotic-resistant infections.

Research 82

Research Wellness 82

Emergency Live

AUGUST 8, 2023

Water and destruction: some of the most devastating floods in history How threatening can an expanse of water be? It depends, of course, on the context, but certainly when we are talking about rivers coming out of their banks and numerous landslides and mudslides are caused by these disasters, there is little to feel safe […] The post The floods that have most affected the world - three examples appeared first on Emergency Live.

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Science Based Medicine

AUGUST 11, 2023

We all have biases, including in-group loyalty. It's often easy to see such bias in others, though nearly impossible to see in oneself. As such, it's both normal and dangerous to imagine that only those who disagree with you are vulnerable to groupthink, while you are perfect beacon of independent, rational thought- along with everyone who agrees with you.

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Emergency Medicine Cases

AUGUST 8, 2023

In this ECG Cases blog with Dr. Jesse McLaren we interpret 10 ECG cases and explore cardiac, metabolic and GI causes: We consider anginal equivalents, and look for ECG signs of Occlusion MI, including subacute occlusion from delayed presentations. We consider electrolyte disturbances and look for ECG signs of hyperkalemia or hypokalemia/hypomagnesemia, and we consider the differential of diffuse ST depression with reciprocal ST elevation in aVR, and false positive STEMI.

EKG/ECG 80

EKG/ECG EMS 80

Sensible Medicine

AUGUST 11, 2023

BW was a 66-year-old woman who presented for an urgent visit to the general medicine clinic. She reported that she had been having dizziness for the last four days. When pressed, she said it occurred intermittently, being present more than absent. She could not identify any palliative or provocative features, and when asked about associated symptoms she said that she felt “bad and scared” when it was present.

Psychiatric 78

Psychiatric Documentation/Coding Wellness 78

Emergency Live

AUGUST 8, 2023

Murphy's maneuver is a maneuver used by the doctor in semiotics to investigate the presence of pain that originates in the gallbladder (also called gall bladder) The post Maneuver and positive or negative Murphy's sign: what are they and what do they indicate? appeared first on Emergency Live.

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Science Based Medicine

AUGUST 10, 2023

The debunking resumes with the fourth installment in debunking the antivaxxer book “Turtles All the Way Down”: Chapter 4, “Epidemiology 101," in which the antivax authors put a biased spin on basic concepts in epidemiology as a lead-in to their obviously intended purpose of claiming that all the studies finding vaccines to be safe and effective should be discounted.

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Medagadget

AUGUST 7, 2023

Researchers at the Harvard Wyss Institute have developed an anti-cancer biomaterial treatment that combines adoptive T cell therapy and cancer vaccine technology to treat solid tumors. The researchers have called their technique SIVET, which is short for “synergistic in situ vaccination enhanced T cell”. The approach combines local delivery of cytotoxic T cells with longer lasting cancer vaccine technology that engages with the immune system more broadly for long lasting anticancer action.

Research 76

Research 76

Taming the SRU

AUGUST 6, 2023

Morbidity and Mortality - Left Ventricular Thrombus - Aneurysmal SAH - Opioid Use Disorder Morbidity and Mortality WITH Dr. Kletsel Pustular psoriasis Psoriasis is characterized by discrete plaques of erythema, scales, and fissures of the extremities It is associated with significant morbidity & treatment consists of topical steroids, along with referral to establish with dermatology Use caution with systemic steroids as they can potentially worsen flares While rare, pustular psoriasis is th

Infectious Diseases 74

Infectious Diseases Pediatrics Fractures Wellness 74

Emergency Live

AUGUST 7, 2023

In medicine, Blumberg's sign is a clinical sign indicating inflammation of the peritoneal wall The post Positive or negative Blumberg's sign: what it is and when it indicates peritonitis appeared first on Emergency Live.

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EMDocs

AUGUST 7, 2023

Authors: Lauren Willoughby, MD (Education Fellow, University of Wisconsin); Benjamin H. Schnapp, MD, MEd (Associate Program Director, University of Wisconsin) // Reviewed by: Joshua Lowe, MD (EM Attending Physician, USAF), Marina Boushra (EM-CCM, Cleveland Clinic Foundation); Brit Long, MD (@long_brit) Case A 36-year-old pregnant woman at 21 weeks gestation presents to the ED with chest pain.

EMS 67

EMS Wellness Emergency Department 67

Medagadget

AUGUST 8, 2023

Engineers at the Technical University of Munich in Germany have developed a system that allows them to semi automate the production of tactile sensors. Such sensors can provide robotic systems, such as robotic prostheses, with a sense of compression and tension with regard to the objects and surfaces they come in contact with. Most robotic systems have integrated sensors, but this design allows researchers to create sensors for a variety of arbitrary surfaces, and then just wrap them around the

Research 74

Research 74