Ken Grauer, MD

JULY 4, 2024

I was sent the ECG in Figure-1 — but without the benefit of any history. QUESTIONS: How would YOU interpret this tracing? WHY do I say there is, "A 2-Part Answer?" Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). MY Thoughts on Today's CASE: As important as providing a brief, relevant history is for optimal clinical ECG interpretation — Cases like the one today often prove even more educational, because we are not given any

EKG/ECG 349

EKG/ECG Wellness 349

The Trauma Pro

JULY 23, 2024

Although very few things in medicine are new, I love it when I learn about something I’ve never heard of before. Recently, while reading an autopsy report, I ran across the term “hinge fracture of the skull.” What? Maybe if I were a neurosurgeon, I would have recognized the term. This was the perfect excuse to hit the books (or, more accurately, the internet).

Fractures 263

Fractures 263

Pediatric EM Morsels

JULY 19, 2024

Previously, we covered Post-Tonsillectomy Hemorrhage and how we hope that “all bleeding eventually stops: ideally, by means that we have imposed rather than by exhaustion of the patient’s RBC resources.” Since the original morsel ( way back in 2012 ), the literature has shown that there are a few extra ingredients that we can add to our morsel recipe when we care for children with post-tonsillectomy hemorrhage.

Pediatrics 247

Pediatrics Airway Management Wellness Operations 247

Science Based Medicine

JULY 21, 2024

Actual death is worse than theoretical death. This didn't used to be controversial in medicine. The post Dr. John Ioannidis: Yet Another Doctor Who Treats Theoretical Death From The Vaccine With More Gravity Than Actual Death From COVID first appeared on Science-Based Medicine.

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St. Emlyn

JULY 9, 2024

St.Emlyn's - Emergency Medicine #FOAMed A podcast with Steve Smith ECG educator extraordinaire where we discuss occlusive myocardial infarction and the future of AI and ECG interpretation. The post Podcast – Occlusive Myocardial Infarction, ECGs and Artificial Intelligence with Steve Smith appeared first on St.Emlyn's.

EKG/ECG 134

EKG/ECG 134

Dr. Smith's ECG Blog

JULY 21, 2024

Written By Magnus Nossen — with edits by Ken Grauer and Smith. The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chest pain. The pain was 10/10 in intensity radiating bilaterally to the shoulders and also to the left arm and neck. The below ECG was recorded. The ECG shows obvious STEMI(+) OMI due to probable proximal LAD occlusion.

EKG/ECG 121

EKG/ECG Shock Hospitals Sepsis 121

The Bottom Line

JULY 19, 2024

In critically ill patients undergoing tracheal intubation does pre-oxygenation with non-invasive ventilation compared with pre-oxygenation with an oxygen mask reduce the incidence of hypoxemia during intubation?

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Pediatric EM Morsels

JULY 26, 2024

We have discussed many causes of encephalitis and encephalopathy previously (ex, Eastern Equine Encephalitis , Posterior Reversible Encephalopathy , FIRES , Reye’s Syndrome ) and have highlighted the fact that they can be challenging to diagnose early. An irritated brain can lead to such a wide array of symptoms. It is even more challenging when the initial symptoms seem to align with what we perceive as psychiatric concerns.

Seizures 141

Seizures Psychiatric Outcomes Pediatrics 141

Science Based Medicine

JULY 1, 2024

Everything old is new once again, as COVID-19 quacks rehash old cancer quack claims that chemotherapy doesn't work in order to sell their preferred cancer quackery. The post Paul Marik: Disparaging chemotherapy in order to sell cancer quackery first appeared on Science-Based Medicine.

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St. Emlyn

JULY 14, 2024

St.Emlyn's - Emergency Medicine #FOAMed Background – What do we already know about REBOA? In 2023, Dr Zaf Qasim reviewed the UK REBOA trial for us on St Emlyn’s (The UK-REBOA trial – Has the […] The post JC: Prehospital Partial Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for Exsanguinating Subdiaphragmatic Hemorrhage appeared first on St.Emlyn's.

Resuscitation 127

Resuscitation Research 127

Dr. Smith's ECG Blog

JULY 23, 2024

I was working at triage when the medics brought this patient who is 65 yo and has had chest pain for 12 hours. They recorded a prehospital ECG at 2112 and said that it was “normal”. It had already been crumpled up and put in the waste basket. So I uncrumpled it: What do you think? You need to click on it to enlarge it to view it well I was suspicious for inferior and posterior OMI (Large T-wave in aVF, slight STE in lead III with inverted T-wave in aVL, and a slightly downsloping ST with negativ

EKG/ECG 112

EKG/ECG Wellness EMS Hospitals 112

Sensible Medicine

JULY 12, 2024

Autonomy is important to me. Maybe it’s because I am a Gen X-er. Some say we were raised by wolves. I do know that we were raised knowing we had the freedom to explore but also the freedom to fail. Our autonomy taught us resilience. With autonomy comes responsibility. I need to do the adulting task of scheduling my annual doctor’s visit.

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The Trauma Pro

JULY 16, 2024

Every trauma center is required to have two specific committees: a multidisciplinary trauma performance improvement committee (PI) and a trauma operations committee (ops). However, a common question is, “How often do my committees need to meet?” Let’s start with your PI committee. The answer, of course, is “it depends.” There is no cookie-cutter, one-size-fits-all answer.

Operations 147

Operations Documentation/Coding Pediatrics 147

Pediatric EM Morsels

JULY 5, 2024

It seems like just yesterday ( or maybe ~ a month ago ) when we served up a tasty morsel on the PECARN decision rule for intra-abdominal traumatic injuries in children. Our friends at the PECARN injury group have remained busy this spring with generating more externally validated clinical decision rules. In addition to the recently published low risk intra-abdominal injury validation, we have another new tool to use this summer as school breaks, underdeveloped frontal lobes, and high speeds leav

Pediatrics 161

Pediatrics Head Injuries Dislocations Research 161

Science Based Medicine

JULY 6, 2024

"There is an ongoing, competitive process of writing the history of the pandemic." The post Pandemic Revisionism: Doctors Who Defend Dr. Scott Atlas Are Afraid to Accurately Quote Dr. Scott Atlas. I’m Not. first appeared on Science-Based Medicine.

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St. Emlyn

JULY 11, 2024

St.Emlyn's - Emergency Medicine #FOAMed The Faculty of Forensic & Legal Medicine's guidelines for managing non-fatal strangulation (NFS). These guidelines advocate a trauma-informed, multidisciplinary approach to improve outcomes for patients who have experienced NFS. @stemlyns #FOAMed The post Non-fatal strangulation appeared first on St.Emlyn's.

Forensics 126

Forensics Outcomes 126

The Bottom Line

JULY 11, 2024

Stress Ulcer Prophylaxis during Invasive Mechanical Ventilation (REVISE) D. Cook. NEJM 2024. DOI: 10.1056/NEJMoa2404245 Clinical Question In mechanically ventilated adults, does stress ulcer prophylaxis with intravenous pantoprazole (40 mg daily), compared with placebo (0.9% saline), reduce the occurrence of clinically important upper gastrointestinal bleeding at 90 days?

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Sensible Medicine

JULY 15, 2024

The GLP1 agonists (glucagon-like-peptide-1-receptor agonist) may be the biggest medical development of this century. The success of Western society has resulted in widespread obesity—and obesity-related diseases, such as diabetes, high blood pressure, heart failure and vascular disease. Obesity is clearly not a good thing for human health. The statistics on obesity—especially in children—are staggering.

Stroke 113

Stroke Research Outcomes 113

The Trauma Pro

JULY 19, 2024

In my last post, I discussed how often your multidisciplinary trauma performance improvement committee (PI) should meet. As you know, one other mandatory committee is required of all trauma centers, the Trauma Operations Committee (Ops). In this post, I will: describe how often your operations committee should meet help you determine whether your two committees should meet on the same day or separately How Often?

Operations 147

Operations Documentation/Coding Administration 147

Dr. Smith's ECG Blog

JULY 9, 2024

Written by Pendell Meyers A man in his 50s was found by his family in cardiac arrest of unknown duration. His family started CPR and called EMS, who arrived to find him in ventricular fibrillation. 15 minutes after EMS arrival, after at least 6 defibrillations, the patient achieved sustained ROSC. He arrived to the ED with severe hypotension, heart rate in the 70s, unable to follow commands but moving all extremities requiring restraint and sedation, respiratory rate around 24/min being supporte

EKG/ECG 110

EKG/ECG Resuscitation Shock CPR 110

Science Based Medicine

JULY 11, 2024

Discussions about the GBD tend to take place in the conditional tense- what would, could, and should have happened. But the GBD actually existed and we can examine what actually happened. The post Part 1: We Don’t Have to Wonder if the Great Barrington Declaration Could Have “Worked”. In the Real World, It Failed. first appeared on Science-Based Medicine.

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Emergency Live

JULY 18, 2024

In Nova Siri, Matera province, where two firefighters lost their lives while fighting a vegetation fire Yesterday afternoon in Nova Siri, Matera province, two firefighters lost their lives while engaged in extinguishing a vegetation fire. The victims, Nicola Lasalata and Giuseppe Martino, both 45 and originally from Matera, were part of the Policoro detachment.

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Emergency Medicine Journal

JULY 22, 2024

Background The outcomes of patients who call an ambulance but are discharged at scene reflect the safety and quality of emergency medical service (EMS) care. While previous studies have examined the outcomes of patients discharged at scene, none have specifically focused on paramedic-initiated discharge. This study aims to describe the outcomes of adult patients discharged at scene by paramedics and identify factors associated with 72-hour outcomes.

Outcomes 93

Outcomes EMS Hospitals Research 93

Sensible Medicine

JULY 22, 2024

I call it therapeutic fashion. Practice patterns. Beliefs. Ways of doing things. Examples: patients with new heart failure get coronary angiography; patients with chest pain without evidence of heart attack get stress tests; certain drugs and devices become favored over generics. The curious thing about many therapeutic fashions is their lack of evidentiary support.

Research 98

Research 98

The Trauma Pro

JULY 5, 2024

#7. Inappropriate prescribing Most trauma professionals worry about over-prescribing pain medication. But under-prescribing can create problems as well. Uncontrolled pain is a huge patient dissatisfier, and can lead to unwelcome complications as well (think pneumonia after rib fractures). Always do the math and make sure you are sending the right drug in the right amount home with your patient.

Documentation/Coding 113

Documentation/Coding Fractures Emergency Department Wellness 113

ECG Guru

JULY 26, 2024

In order to differentiate supraventricular extrasystoles/tachycardias with aberrant conduction from ventricular extrasystoles/tachycardias, the search for P waves is often very important. Here are some examples of how the P waves can be positioned around the ventricular extrasystoles.

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Science Based Medicine

JULY 26, 2024

Doctors who claimed that only enormous RCTs for every variant could demonstrate the COVID vaccine's benefits, were fine just casually inventing reasons not to use it. The post Making Up Reasons to Let Unvaccinated Kids Get COVID: Pediatricians Will Run Out of Time and Measles Will Return first appeared on Science-Based Medicine.

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Critical Care Now

JULY 14, 2024

Reading Time: 3 minutes Extracorporeal cardiopulmonary resuscitation (eCPR) has been somewhat of a controversial topic in the intensive care community over the years, with observational and randomized controlled trials (RCTs) swinging the pendulum of scientific consensus back and forth from “hugely beneficial” to “expensive, without significant benefit”.

Resuscitation 98

Resuscitation Outcomes CPR Sepsis 98

Emergency Live

JULY 15, 2024

In order to have the best vacation and a well-deserved rest, you need to be prepared for anything. A well-stocked first aid kit can make the difference After a long period of work, a nice trip and a well-deserved vacation are ideal for relaxing and recharging. But in order to fully enjoy your vacation, it […] The post Vacation first aid kit: your personal pharmacy on the road appeared first on Emergency Live.

Wellness 98

Wellness 98

Don't Forget the Bubbles

JULY 3, 2024

Can’t get enough of Bubble Wrap? The Bubble Wrap Plus is a monthly paediatric Journal Club reading list from Professor Jaan Toelen (University Hospitals Leuven) and Dr Anke Raaijmakers (Sydney Children’s Hospital). This comprehensive list is developed from 34 journals, including major and subspecialty paediatric journals. We suggest this list can help you discover relevant or interesting articles for your local journal club or allow you to keep a finger on the pulse of paediatric research.

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Pediatrics Fluid Resuscitation Research Hospitals 103

The Trauma Pro

JULY 2, 2024

#3. You are responsible for the conduct of your staff If the people who work for you treat patients poorly, you may be responsible. It is important that your staff have bedside manner at least as good as yours. #4. Avoiding your patients Some of your patients may need to contact you, either while in the hospital or while at home. Don’t appear to be inaccessible.

Emergency Department 113

Emergency Department Hospitals 113

Northwestern EM Blog

JULY 15, 2024

Written by: Hart Edmonson, MD (NUEM ‘27) Edited by: David Adler, MD (NUEM ‘25) Expert Commentary by : Anthony J. Esposito, MD Expert Commentary Thank you to Drs. Edmonson and Adler for this infographic that concisely emphasizes key concepts for the recognition and initial management of acute respiratory distress syndrome (ARDS) in the Emergency Department.

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Resuscitation Emergency Department Burns Sepsis 98

Science Based Medicine

JULY 10, 2024

The Human Immunodeficiency Virus (HIV) is a global pandemic, with 39 million cases worldwide, and over 1 million new infections each year. While it rose to epidemic and then pandemic levels in the 1980s, the first case goes back to 1959. HIV is a retrovirus that inserts its genetic material into the DNA of host cells, and targets the immune system as […] The post Science vs HIV first appeared on Science-Based Medicine.

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The Skeptics' Guide to EM

JULY 20, 2024

Reference: Gibbs et al. Noninvasive Ventilation for Preoxygenation during Emergency Intubation (The PREOXI trial). NEJM June 2024. Date: July 17, 2024 Guest Skeptic: Dr. Aine Yore is an Emergency Physician, practicing in the Seattle, Washington area for over twenty years. She is the former president of the Washington chapter of ACEP and her career focus outside of clinical practice has been largely devoted to health care policy.

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COPD Patient Safety Administration Emergency Department 93

Emergency Live

JULY 16, 2024

Nearly 1,000 pilgrims have died in Saudi Arabia due to extreme temperatures. Once again, high temperatures are having a dramatic impact on human health Mecca: The carnage of high temperatures During the annual Hajj pilgrimage to Mecca, a tragic heat wave hit Saudi Arabia killing nearly 1,000 people. The extreme temperatures, which exceeded 50 degrees, […] The post Killer heat hits Mecca: how to cope with high temperatures appeared first on Emergency Live.

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Taming the SRU

JULY 25, 2024

Femoral nerve block case review - morbidity & mortality - community practice - r2 Clinical pathologic case - visual diagnosis - when time matters - operational aspects of stroke care Femoral nerve Block Case Review WITH dr. stolz Why do we care about regional anesthesia, specifically femoral nerve blocks? More efficacious than parenteral opioids alone Safer than opioids Decreased delirium Patients have been shown to have improved functional outcomes at 30 days Early pain control matters!

Stroke 86

Stroke Fractures Outcomes Operations 86

Dr. Smith's ECG Blog

JULY 11, 2024

This is another case sent by the undergraduate (who is applying to med school) who works as an EKG tech. How is it possible that a kid who has not even started medical school can know so much about EKGs and cardiology? Because: 1) He has been reading this blog for a long time. 2) He is curious This is how Pendell got started. Case A 43 year old male with a history of DM II, hyperlipidemia, and a family history of myocardial infarction presented to a family clinic with two days of epigastric pain

EKG/ECG 96

EKG/ECG Outcomes Hospitals Wellness 96