Ken Grauer, MD

DECEMBER 15, 2023

The importance of the new OMI ( vs the old STEMI ) Paradigm — See My Comment in the July 31, 2020 post in Dr. Smith's ECG Blog. The January 9, 2019 post in Dr. Smith's ECG Blog ( Please scroll down to the bottom of the page to see My Comment ).

EKG/ECG 331

EKG/ECG EMS Hospitals 331

ALiEM

MAY 6, 2024

This was made possible thanks to our new co-editor, Dr. Andres Lopez , who revamped and updated the entire curriculum with Dr. Christina Shenvi to include more current articles, updated links, and new quiz questions. Check out the Bridge to EM home page and then head over to take the 9 free ALiEMU weekly quizzes.

EMS 75

EMS Wellness 75

Ken Grauer, MD

JUNE 6, 2023

== P lease N OTE : After today — No new ECG Blog posts for 2- to -3 weeks. — The INDEX tab ( in the upper right of each page ) — has linked Contents, listed by subject. The ECG in Figure-1 — was obtained from a previously healthy 70-year old man who presented to the ED ( E mergency D epartment ) with new CP ( C hest P ain ).

EKG/ECG 195

EKG/ECG Hospitals Wellness Resuscitation 195

Ken Grauer, MD

APRIL 5, 2024

For additional examples of this phenomenon whereby automatic truncation of an EMS ECG may mistakenly result in LVH serving to mimi c ischemia — Check out My Comment at the bottom of the page of the following posts in Dr. Smith's ECG Blog — the November 29, 2023 post — June 20, 2020 — March 31, 2019 — March 29, 2019 — and t he December 27, 2018 post.

EKG/ECG 231

EKG/ECG EMS Hospitals 231

Dr. Mike Sevilla

APRIL 15, 2024

I’m excited to share that I will be joining a new Primary Care office in Salem, Ohio called Salem Family Care. My current patients will have nothing to worry about, since I will not be leaving Salem, and my patients will not need to find a new doctor. Salem Family Care is located at 718 East Third Street in Salem, Ohio.

Hospitals 98

Hospitals Wellness 98

Ken Grauer, MD

OCTOBER 21, 2023

The ECG in Figure-1 is from an older man with known coronary disease — who presents to the ED ( E mergency D epartment ) with new CP ( C hest P ain ) over the past several days. Assessment of S T- T Waves in Figure-1 : In a patient with new CP — this is an extremely worrisome ECG! Troponin is pending. Should the cath lab be activated?

EKG/ECG 239

EKG/ECG Shock Wellness 239

Ken Grauer, MD

MAY 28, 2024

Easy LINKS — tinyurl.com/KG-ECG-Podcasts — [link] — Other ECG Audio PEARLS I previously made for my ECG Blog can be found in the right column of each page on this blog just below this icon — under, "ECG Audio PEARLS". Please also Check Out my new ECG Videos #406 , 407 and 408 on this topic ( CLICK HERE ). Anthony Kashou.

EKG/ECG 277

EKG/ECG Wellness 277

Ken Grauer, MD

JANUARY 20, 2024

— See My Comment at the bottom of the page in the October 14, 2020 post on Dr. Smith's ECG Blog. Acute OMI that wasn’t accepted by the Attending — See My Comment at the bottom of the page in the November 21, 2020 post on Dr. Smith’s ECG Blog.

EKG/ECG 231

EKG/ECG 231

Ken Grauer, MD

FEBRUARY 3, 2024

When true T-QRS-D is present in a patient with new symptoms — it is virtually diagnostic of acute OMI ( = of an acute coronary O cclusion M yocardial I nfarction ). The November 15, 2023 post in Dr. Smith’s ECG Blog ( See My Comment at the bottom of the page regarding MINOCA ). A picture is worth 1,000 words.

EKG/ECG 393

EKG/ECG Resuscitation Hospitals Wellness 393

Intensive Blog

JUNE 26, 2023

Author: Dr Ken Hoffman Peer reviewer: A/Prof Chris Nickson These videos are aimed at ICU staff and trainees who are new to ECMO. To learn more about ECMO check out the ECMO page on INTENSIVE and the Alfred ICU’s guidelines at ecmo.icu. The post Intro to ECMO for New ICU Staff appeared first on INTENSIVE.

CPR 98

CPR 98

Ken Grauer, MD

FEBRUARY 23, 2024

The ECG in Figure-1 was obtained from a previously healthy man in his 40s — who presented to the ED ( E mergency D epartment ) with new-onset CP ( C hest P ain ) that awakened him from sleep. I've highlighted within the RED rectangle in Figure-2 the single lead ( = lead V3 ) that in a patient with new severe CP is clearly abnormal.

EKG/ECG 412

EKG/ECG Wellness 412

Ken Grauer, MD

FEBRUARY 9, 2024

Imagine the only information provided for the ECG in Figure-1 — is that it was obtained from a 60-year old man with new CP ( C hest P ain ). This means that you can now turn your attention to the 12-lead ECG to determine IF prompt cath is ( or is not ) immediately needed in this patient with new CP. What intervention is needed?

EKG/ECG 255

EKG/ECG Operations Wellness 255

Ken Grauer, MD

MAY 20, 2023

In a patient with new and persistent CP — it is never normal to see the amount of flat ST depression that is present in lead V6. B OTTOM L ine : The patient in today's case is an older woman who presents with a 1-day history of new and persistent CP. PEARL # 1: The above noted findings in leads V1,V2,V3 are subtle!

EKG/ECG 342

EKG/ECG Wellness 342

Ken Grauer, MD

APRIL 18, 2023

The ECG in Figure-1 was obtained from a 50-year old man — who presented to the ED ( E mergency D epartment ) with new-onset CP ( C hest P ain ). Figure-1: The initial ECG in today's case — obtained from a 50-year old man with new chest pain. ( I have used the superb web page they post in their web site on this subject for years.

EKG/ECG 195

EKG/ECG Wellness 195

Ken Grauer, MD

MARCH 7, 2023

But, in a patient who presents to the ED for new chest pain — seeing these subtle findings that are localized to leads V2- thru -V4 should at the least make you consider acute posterior OMI ( O cclusion-based MI ) — until you prove otherwise. To EMPHASIZE: These are subtle findings.

EKG/ECG 195

EKG/ECG Wellness 195

SheMD

JUNE 8, 2023

July 1st is almost here and hospitals around the country will welcome in their new interns. Beginning a residency is similar to learning a new language; some words are vaguely familiar and context clues can be helpful, but ultimately you are starting from scratch. It's that time of the year.

Radiology 52

Radiology Radiology Outcomes Hospitals 52

Pediatric EM Morsels

JUNE 2, 2023

Rare diseases are not confined to the pages of a textbook or computer screen. Our patients have varied past medical histories that require us to be well-versed in even the most uncommon disorders (or know where to look things up in a pinch)!

Dehydration 189

Dehydration Shock Pediatrics Emergency Department 189

SCGH ED

MARCH 14, 2022

Emergency Medicine (mainly FOAMed) Resources I’ve been asked by several new RMO’s & Regs for good ED Resources for clinical / learning/ exams. Chantelle Badawy 2022 EM Podcasts Websites that provide good reviews of current literature: Apps / Web Pages Most web pages can be saved onto your phone home page like an “App”.

EMS 52

EMS 52

Pediatric Education

DECEMBER 24, 2023

We appreciate your continued patronage and wish everyone a happy and safe holiday season and all the best in the New Year. In the meantime, please take a look at the different Archives and Curriculum Maps listed at the top of the page. PediatricEducation.org is taking a holiday break and will return on January 8, 2024.

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Sensible Medicine

JUNE 2, 2023

Within the binder is a single page for every one of my patients who has died. The collection is not a place of bitterness and regret, nor is each entry associated with the joy of a new life. At some point, when I emptied my office for a move, I was surprised by the height of the stack of pages. Sometimes I jot down a reflection.

Hospice 72

Hospice Hospitals 72

Stop and Think

NOVEMBER 23, 2023

I looked at my statistics page this morning. To receive new posts and support my work, consider becoming a free or paid subscriber. It was nice. On this Thanksgiving morning, I write to say thank you. I am grateful for your support. Thank you for reading this newsletter. Thank you for commenting. I wish you all a peaceful day.

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ALiEM

NOVEMBER 22, 2023

Recently, identical toxins have been identified in several species of birds in New Guinea [10]. Pages 8-35. Pages 454-462. Batrachotoxin alkaloids from passerine birds: a second toxic bird genus (Ifrita kowaldi) from New Guinea. 91 (14): 3931–3938. PMID 5689118 William C. Excitable membranes. Butterworth-Heinemann.

Poisoning 113

Poisoning 113

Intensive Blog

JANUARY 29, 2023

Author: Dr Ken Hoffman Peer Reviewer: A/Prof Chris Nickson These videos are aimed at ICU staff and trainees who are new to ECMO. To learn more about ECMO check out the ECMO page on INTENSIVE and the Alfred ICU’s guidelines at ecmo.icu. Part 1 focusses on nomenclature and components of ECMO (extracorporeal membrane oxygenation).

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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. The magnitude of ST-T wave change is maximal in lead V2 — with the insert in this lead showing a positive "Mirror" Test — that in this patient who presents with new chest pain, is diagnostic of acute posterior OMI — until proven otherwise.

EKG/ECG 195

EKG/ECG Wellness 195

SCGH ED

JULY 5, 2023

This page contains information relevant to the WA Health Department transition from IMPAX to IntelePACS for the archiving and retrieval of medical imaging. This is currently happening, ie. you can use InteleConnect and InteleViewer now, but the official transition will occur at SCGH on the 22nd of July 2023.

Documentation/Coding 40

Documentation/Coding 40

Mind The Bleep

SEPTEMBER 16, 2023

Mind The Bleep: The Podcast Here at Mind The Bleep, we really want to help support the students and doctors who use our resources, so we will be releasing some new well-being content over the coming months! Below you can find some links to relevant pages or groups, and also a link to the brand-new Mind The Bleep Podcast!

Wellness 75

Wellness 75

Sensible Medicine

MARCH 21, 2024

While much innovation has occurred to ensure key information and competencies are not missed, the reality is new drugs, medical discoveries, and standards of care will henceforth be subject to “lumping and splitting” within an already oversaturated curriculum. Looking back, what mattered in this moment was that my mentor paged me.

Hospitals 107

Hospitals Patient Safety Academics Wellness 107

Stop and Think

DECEMBER 10, 2023

The second reason to write is to alert you to the new American atrial fibrillation guidelines released on November 30. This massive 156-page document updates the 2019 guidelines. (It’s To receive new posts and support my work, consider becoming a free or paid subscriber. And new evidence is hardly reassuring.

Documentation/Coding 40

Documentation/Coding 40

Sensible Medicine

DECEMBER 8, 2023

A discomfiting fact about obituaries (as well as the Wikipedia pages of the deceased) is that they usually include a cause of death. I read obituaries in the New York Times and assisted suicide remains illegal in New York. Now, at about the age he was when we had that conversation, I am an obituary devotee. Attached photo by K.

Wellness 112

Wellness 112

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

This new ECG was still interpreted as STEMI and the patient was taken to the cath lab where the angiogram showed completely normal coronary arteries throughout. 25 minutes later, EMS called back with this new ECG: Super obvious STEMI(+) OMI. To Emphasize: Both of these patients presented with new-onset CP ( C hest P ain ).

EKG/ECG 101

EKG/ECG EMS Outcomes Wellness 101

Dr. Smith's ECG Blog

MARCH 27, 2023

My Comment by K EN G RAUER, MD ( 2/22 /2023 ): = Today’s case is an important one, because as per Dr. Smith ( in this patient with new chest pain ) — “The initial ECG is diagnostic of infero-postero OMI.” The presence or absence of ST Elevation is a poor marker with which to describe a myocardial infarction. =

EKG/ECG 52

EKG/ECG 52

Medagadget

JUNE 8, 2023

The FDA is committed to advancing new device innovation that can improve the health and quality of life for people living with chronic diseases that require day-to-day maintenance, like diabetes, through precision medicine approaches.”

Research 102

Research Radiology Radiology 102

ETM Course

APRIL 29, 2020

2023 will be a huge year for ETM, with 23 courses now confirmed across Australia and New Zealand. To find out more about ETM Course, please visit the course information page here. Course dates and registration details are available here. Book your course place soon to avoid disappointment as places are already selling fast.

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ACEP Now

JANUARY 13, 2024

The 2,414-page final rule is the document that informs what Medicare payments will be for the following year. The estimated impact on emergency medicine will be minus two percent to offset increases in new payments to maintain statute-driven budget neutrality across the entire fee schedule.

Documentation/Coding 52

Documentation/Coding Hospitals 52

Sensible Medicine

DECEMBER 21, 2023

Over the last week, a debate has simmered between the pages of my Substack , Sensible Medicine, and the Sensible Medicine podcast, which you can watch here. To receive new posts and support our work, consider becoming a free or paid subscriber. Sensible Medicine is a reader-supported publication.

Wellness 111

Wellness Pediatrics 111

Maria Yang, MD

OCTOBER 6, 2023

Cycles of romanticizing and vilifying homeless people are not new. When I first received the book, I confess that I was dismayed to see in the index that “mental illness” is mentioned on only four pages of this ~250 page text. The disproportionate number of homeless people who are Black is not new.

Psychiatric 59

Psychiatric 59

Don't Forget the Bubbles

NOVEMBER 6, 2023

Captivating… I flick through the unturned pages, a satisfying crispness. A few hours later, I’m snuggled up in my daughter’s bed, and we read well past her bedtime because a new book is a fantastic thing. I gently run my fingers over the front cover of a book that I know my daughter will like. Turning it over, I scan the back.

Wellness 86

Wellness 86