Ken Grauer, MD
MARCH 1, 2024
I was sent the 2 ECGs shown in Figure-1 — which were recorded from an elderly man whose heart beat "has been irregular for years". No clear history for recent chest pain — but the patient "has not been well" for the previous week. Regarding the 2 ECGs in Figure-1 : ECG #1 is the initial tracing obtained at the scene by the EMS ( E mergency M edical S ystems ) team — in association with an alert but markedly hypotensive patient.
The Trauma Pro
MARCH 1, 2024
Seriously injured patients frequently develop coagulopathy, which makes resuscitation (and survival) more challenging. A few years ago, the CRASH-2 study lent support for using tranexamic acid (TXA) in select trauma patients to improve survival. This drug is cheap and has antifibrinolytic properties that may be beneficial if given for life-threatening bleeding within 3 hours of initial injury.
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Sensible Medicine
APRIL 14, 2024
Last week, the US FDA held a meeting to decide if a new surrogate endpoint (Minimal Residual Disease or MRD negativity) could be used to give more & faster drug approvals for patients with newly diagnosed multiple myeloma. Multiple myeloma drugs can cost $600,000 per year of treatment, but if MRD is permitted for drug approval, I suspect we will see a deluge of uncertain drugs added to the roster, and the costs per year per patient will swell to a million dollars or more.
Science Based Medicine
MARCH 29, 2024
A new analysis of 2023 MIS-C cases reveals that the COVID-19 vaccine significantly reduces the risk of this dreaded complication. The post COVID-19 Vaccination Significantly Reduces Risk of Severe Inflammatory Syndrome in Kids first appeared on Science-Based Medicine.
EM Ottawa
MARCH 14, 2024
Posterior circulation ischemia accounts for approximately 20-25% of all ischemic strokes and is a significant cause of patient disability. The diagnosis can be extremely challenging as findings are often not typically focal. Posterior strokes are misdiagnosed more than 3x more often than anterior circulation strokes.1 Similar to anterior circulation strokes, posterior strokes are most commonly […] The post Posterior Circulation Strokes appeared first on EMOttawa Blog.
EB Medicine
MAY 1, 2024
In this episode, Sam Ashoo, MD and T.R. Eckler, MD interview Reuben J. Strayer, MD, author of the May 2024 Emergency Medicine Practice article, Current Concepts in Ketamine Therapy in the Emergency Department Diving Into Ketamine Use in Emergency Medicine Understanding Ketamine: From Origins to Emergency Use Exploring the Ketamine Brain Continuum Ketamine Dosing and Administration Techniques Combining Ketamine with Neuroleptic Medications Practical Approaches to Ketamine for Pain Management In
Emergency Medicine Cases
APRIL 2, 2024
In this part 2 of our 2-part podcast on asthma with Dr. Sameer Mal and Dr. Leeor Sommer, we dig into the recognition and management of life-threatening asthma. We answer such questions as: what are the key elements in recognition of threatening asthma? What are the most time-sensitive interventions required to break the vicious cycle of asthma? What are the best options for dosing and administering magnesium sulphate, epinephrine, fentanyl and ketamine in the management of the crashing asthmatic
Emergency Care Today brings together the best content for emergency care practitioners from the widest variety of industry thought leaders.
First 10 EM
APRIL 2, 2024
Give your patients a break. Nobody is a perfect diagnostician. Not even the best trained physician can determine, with 100% accuracy, which patients have serious pathology. Even with advanced testing, we aren’t close to perfect. However, if you listen to the subtext of breakroom complaints, it seems like we expect patients to be better diagnosticians […] The post Are you a perfect diagnostician?
Stop and Think
MARCH 31, 2024
My career in cardiology can be separated into two decade-long blocks. The first decade I practiced like most other cardiologists. I went with the flow, followed the guidelines. I went to few meetings, read few studies and as a result had little (mental) tension. Then I started writing about medical evidence. This required studying the evidence. Over time, I learned the skill of critical appraisal.
The Skeptics' Guide to EM
APRIL 13, 2024
Reference: Albers GW et al. TIMELESS Investigators. Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection. NEJM Feb 2024 Date: April 12, 2024 Guest Skeptic: Dr. Vasisht Srinivasan is an Emergency Medicine physician and neurointensivist at the University of Washington and Harborview Medical Center in Seattle, WA. He is an assistant professor in Emergency […] The post SGEM#436: For the Longest Time – To Give TNK for an Acute Ischemic Stroke first appeared on The Skeptics Guid
Dr. Smith's ECG Blog
FEBRUARY 22, 2024
Written by Pendell Meyers A woman in her 30s called EMS for acute symptoms including near-syncope, nausea, diaphoresis, and abdominal pain. EMS arrived and found her to appear altered, critically ill, and hypotensive. An ECG was performed: What do you think? Extremely wide complex monomorphic rhythm just over 100 bpm. The QRS is so wide and sinusoidal that the only real possibilities left are hyperkalemia or Na channel blockade.
The Trauma Pro
MARCH 25, 2024
Generative artificial intelligence (AI) is the newest shiny toy. The best-known example, ChatGPT, burst onto the scene in November 2022 and caught most of us off guard. The earliest versions were interesting and showed great promise for a variety of applications. The easiest way to think about this technology is to compare it to the auto-complete feature in your search engine.
Sensible Medicine
MARCH 18, 2024
Dear Readers, I publish the following opinion piece regarding the use of statin drugs in low-risk individuals without heart disease even though I disagree with most of the authors’ arguments. Since this is a rebuttal to an editorial I wrote, it would be helpful to first read the linked article in the lead sentence. I do like the authors’ conclusions.
Science Based Medicine
FEBRUARY 26, 2024
Antivaxxers have weaponized a huge multinational vaccine safety study of 99 million patient records that found rare adverse events and concluded that the benefits of COVID-19 vaccines outweigh the risks. How? A combination of the Nirvana fallacy and spin. The post How antivaxxers weaponize vaccine safety studies to falsely portray vaccines as dangerous first appeared on Science-Based Medicine.
EM Ottawa
JANUARY 25, 2024
Mechanical ventilation has a lot of nuance associated with it, but a lot of reference guides focus on care in the ICU. There is certainly a need for more practical application for the ED doc or initial setup of patients on the vent. With both ER and ICU experience, this post acts as a quick […] The post Mechanical Ventilation Basics appeared first on EMOttawa Blog.
EB Medicine
APRIL 17, 2024
In this episode, Sam Ashoo, MD interviews Ashley A. Foster, MD, Bijan Ketabchi, MD, MPH and Jennifer A. Hoffmann, MD, MS on the March 2024 Pediatric Emergency Medicine Practice article, Evaluation and Management of Suicidal Ideation and Self-Harm in Children in the Emergency Department Introduction Understanding Suicidal Ideation and Self Harm in Youths Screening Tools and Approaches Ask Suicide-Screening Questions (ASQ) Toolkit Columbia Suicide Severity Rating Scale (C-SSRS) Prehospital Care
Life in the Fast Lane
JANUARY 15, 2024
Sheralyn Guilleminot and Mike Cadogan Real-World Applications of Artificial Intelligence in Medicine Interview with critical care clinician, and AI enthusiast, Dr Sameer Shaikh on the many ways to use AI to save time and increase efficiency in healthcare
ALiEM
MARCH 18, 2024
A 30-year-old female with a past medical history of Crohn’s Disease presented to the ED for evaluation of an acutely bruised right 4th finger. She stated she was typing on a computer keyboard approximately 10 minutes prior to presentation and she noticed a sudden popping sensation at the base of her right ring finger. After the popping sensation, she noticed a cool sensation of the finger and numbness to the entire finger.
First 10 EM
APRIL 22, 2024
As mentioned in my most recent review, publication bias has been a major concern when trying to decide whether to prescribe paxlovid. Pfizer rushed to publish their positive study (EPIC-HR), but refused to release the results of a second simultaneous study (EPIC-SR) that was stopped (due to futility) at the exact same time. With the […] The post EPIC-SR: The negative paxlovid data Pfizer has been sitting on appeared first on First10EM.
Emergency Medicine Cases
APRIL 2, 2024
In this ECG Cases blog, Jesse McLaren and Rajiv Thavanathan explore how ECG and POCUS complement each other for patients presenting to the emergency department with shortness of breath or chest pain. They explain complementary diagnostic insights into pericardial effusion and cardiac tamponade, occlusion MI and RV strain. The post ECG Cases 49 – ECG and POCUS for Dyspnea and Chest Pain appeared first on Emergency Medicine Cases.
The Skeptics' Guide to EM
MARCH 2, 2024
Reference: Gibbons et al. The sonographic protocol for the emergent evaluation of aortic dissections (SPEED protocol): A multicenter, prospective, observational study. AEM February 2024. Date: February 28, 2024 Guest Skeptic: Dr. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. He is the Vice Chair of the Emergency Department at Nassau University […] The post SGEM#432: SPEED, Give Me What I Need – To Diagnose Acute Aortic Dissections first appeared on Th
Dr. Smith's ECG Blog
APRIL 2, 2024
An elderly man collapsed. There was no bystander CPR. Medics found him in ventricular fibrillation. He was defibrillated, but they also noticed that he was being internally defibrillated and then found that he had an implantable ICD. He was unidentified and there were no records available After 7 shocks, he was successfully defibrillated and brought to the ED.
The Trauma Pro
FEBRUARY 27, 2024
Intraosseous (IO) lines are a godsend when we are faced with a patient who desperately needs access but has no veins. The tibia is generally easy to locate and the landmarks for insertion are straightforward. They are so easy to insert and use, we sometimes “set it and forget it”, in the words of infomercial guru Ron Popeil. But complications are possible.
Sensible Medicine
MARCH 13, 2024
Martin Kulldorff was a professor at Harvard Medical School who argued during the pandemic that school closure was misguided policy, lockdowns were inappropriate and draconian, vaccine mandates were unjust, natural immunity conferred protection against subsequent severe disease, kids did not need to be vaccinated, and that two year old children should not wear cloth masks in daycare.
Science Based Medicine
APRIL 22, 2024
No matter how implausible it is or how weak the evidence for it is, the myth that COVID vaccines cause "turbo cancer" just won't die. Quite the contrary, alas. Antivaxxers are—dare I say?—turbocharging it with bad science. The post COVID-19 vaccine-caused “turbo cancer” nonsense just keeps getting more turbocharged and nonsensical first appeared on Science-Based Medicine.
EM Ottawa
APRIL 11, 2024
Patients living with functional neurologic disorders (FND) have been deeply stigmatized by the medical system. In a patient survey by FND Hope (an international organization for the research and advocacy around FND) 82% of patient respondents felt they had been treated poorly due to stigma relating to their FND diagnosis, primarily by emergency physicians [1] […] The post Functional Neurologic Disorders appeared first on EMOttawa Blog.
EMCrit
MARCH 20, 2024
Eyelid opening apraxia refers to a specific inability to open the eyelids. This may result from non-dominant hemispheric strokes. On superficial examination it will mimic unconsciousness, but upon further examination the patient is awake and able to respond to stimuli with their extremities. I've seen a similar phenomena of eyelid opening apraxia a few times […] EMCrit Project by Josh Farkas.
EM Literature of Note
MARCH 12, 2024
A few words regarding an article highlighted in one of my daily e-mails – a report regarding the Elders Risk Assessment tool (ERA) from the Mayo Clinic. The key to the highlight is the assertion this score can be easily calculated and presented in-context to clinicians during primary care visits, allowing patients with higher scores to be easily identified for preventive interventions.
NIOSH Science Blog
FEBRUARY 15, 2024
The American Journal of Public Health recently published a special supplement with 15 articles focusing on health worker mental health. This special issue of the journal was sponsored and edited by the National Institute for Occupational Safety and Health (NIOSH) and stems from the health worker mental health initiative from the Centers for Disease Control and Prevention and NIOSH.
First 10 EM
JANUARY 15, 2024
We are once again buried in a wave of viral respiratory illnesses, and much of the burden of illness is still COVID. I did a pretty thorough review of all COVID antiviral therapies in 2022, both on First10EM and on the EMCases Journal Jam, but that was 2 years ago. I think most of us […] The post Paxlovid evidence: still very little reason to prescribe appeared first on First10EM.
St. Emlyn
FEBRUARY 6, 2024
St.Emlyn's - Emergency Medicine #FOAMed This week I am in Zermatt, Switzerland for ‘The Big Sick’ conference. This is something I have been looking forward to years, but major heart surgery (valves not pipes) and […] The post Top resus papers for TBS. St Emlyn’s appeared first on St.Emlyn's.
The Skeptics' Guide to EM
FEBRUARY 11, 2024
Reference: McLatchie et al and DAShED investigators. Diagnosis of Acute Aortic Syndrome in the Emergency Department (DAShED) study: an observational cohort study of people attending the emergency department with symptoms consistent with acute aortic syndrome. EMJ Nov 2023. Date: February 11, 2024 Guest Skeptic: Nirdosh Ashok Kumar, Emergency Medicine Specialist – Aga Khan University Hospital, Karachi, Pakistan. […] The post SGEM#430: De Do Do Do, De Dash, Dash DAShED – Diagnosing Acute Aortic Sy
Dr. Smith's ECG Blog
FEBRUARY 2, 2024
Written by Pendell Meyers First try to interpret this ECG with no clinical context: The ECG shows an irregularly irregular rhythm, therefore almost certainly atrial fibrillation. After an initially narrow QRS, there is a very large abnormal extra wave at the end of the QRS complex. These are Osborn waves usually associated with hypothermia. There is also large T wave inversion and long QT.
The Trauma Pro
JANUARY 11, 2024
The pendulum has swung from the use of whole blood in the early 20th century, to component therapy in the 1960s, and now a gradual move toward incorporating whole blood again. More and more papers are being published, and many trauma centers are looking for ways to integrate whole blood into their massive transfusion protocols. Much of the literature has been dedicated to safety and effectiveness, but little has examined thrombotic complications from its use.
Sensible Medicine
APRIL 25, 2024
The US FDA is under tremendous political pressure to approve drugs, and indeed they tout the number of approved drugs as a measure of the quality of their work. Unfortunately, you can approve bad drugs. Selenexor is a toxic poison that does not increase survival. Belantumab causes eye damage and had to be pulled from the US market Idelalisib, copanlisib, duvelisib— the entire P13k inhibitor class —may have resulted in increased deaths.
Science Based Medicine
APRIL 14, 2024
Trying to limit pediatric COVID was literally the pandemic's worst sin for pro-infection doctors, warranting severe punishment. This is how desperately they wanted them infected. The post Dr. Vinay Prasad: It’s “Good” That Parents Who Want To Vaccinate Their Kids Against COVID Get Reported To Child Protective Services first appeared on Science-Based Medicine.
EM Ottawa
FEBRUARY 15, 2024
We’re increasingly cognizant of the physiological importance of maintaining specific hemodynamics during resuscitation. Practice patterns vary broadly, so we’ve done a deep dive into the various evidence around the use of ketamine and etomidate in specific clinical scenarios. Physiology of the rapid sequence intubation Rapid sequence intubation (RSI) is the nearly simultaneous administration […] The post Ketamine and Etimodate: Into the Void appeared first on EMOttawa Blog.
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