Ken Grauer, MD
JUNE 22, 2024
The ECG in Figure-1 — was obtained from a middle-aged woman with positional tachycardia and diaphoresis with change of position from suprine to sitting. Although CP ( C hest P ain ) was not a prominent symptom — ACS ( A cute C oronary S yndrome ) was suspected from the chest lead T wave inversion seen on this ECG. QUESTIONS: How would YOU interpret the ECG in Figure-1 ?
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).
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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.
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.
Sensible Medicine
JUNE 6, 2024
The first two weeks of March 2020 were jolting. Governments read the Imperial College London report (modeling a million deaths in the US), watched horrifying scenes in Bergamo (a city with median age in the 80s fyi), and collectively embraced policies that had no precedent in human history: The global closing of borders, schools, business, and the use of the police state to enforce this lockdown.
Dr. Smith's ECG Blog
JUNE 17, 2024
Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. What do you think? If this EKG were handed to you to screen from triage without any clinical information, what would you think?
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.
Emergency Care Today brings together the best content for emergency care practitioners from the widest variety of industry thought leaders.
EM Ottawa
MAY 23, 2024
The North American opioid crisis is rapidly expanding, resulting in unprecedented levels of harm and strain on the healthcare system. The opioid epidemic is not new to ED providers across the country, but the true extent of harm is quite shocking. In Canada, there has been 40,642 apparent opioid toxicity deaths and 39,435 opioid-related hospitalizations […] The post “Tranq Dope”: A New Menace appeared first on EMOttawa Blog.
First 10 EM
JUNE 24, 2024
A can’t intubate can’t oxygenate scenario will always be scary, but after years of mental rehearsal and some real world experience, the idea of surgical front of neck access in an adult doesn’t bother me much. (I think that is an important mental space for emergency physicians to find if you want to be able […] The post The pediatric can’t intubate can’t oxygenate scenario (Use a knife) appeared first on First10EM.
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.
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
JUNE 21, 2024
The VIP syndrome occurs in healthcare when a celebrity or other well-connected “important” person receives a level of care that the average person does not. This situation was first documented in a paper published in the 1960s, which noted that VIP patients have worse outcomes. Who is a VIP? It may be a celebrity. A family member. Or even a colleague.
Critical Care North Hampton
JANUARY 25, 2024
Many thanks to Dr Manoj Wickramsinghe for his review of this fabulous POCUS textbook. He is a trainee in Anaesthesia and ICM, based in Leeds, and one of the CCN editorial team. About the book authors Editors; Hatem Soliman-Aboumarie, Marcelo Haertel Miglioranza, Luna Gargani, Giovanni Volpicelli. The authors and editors of this book include some.
Science Based Medicine
JUNE 16, 2024
When conference organizers told me not to make my talk "political", they were really saying there were certain people and ideas I wasn't allowed to criticize. I didn't get it at the time. I get it now. The post I’ve Been Silenced, Censored, and Cancelled. The Reason Why Matters. first appeared on Science-Based Medicine.
Sensible Medicine
MAY 25, 2024
Imagine if your car mechanic took $10,000 a year from Michelin tires for “consulting” and then tended to recommend their tires over Pirelli — even if the latter are on sale or better quality or both. Imagine if your Governor took campaign contributions from Panera bread and then strangely exempted Panera bread from the new minimum wage law.
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.
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.
EMCrit
JUNE 17, 2024
introduction Bilevel Sequence Intubation (BSI) refers to initiation of noninvasive bilevel positive pressure ventilation with a backup rate prior to intubation (either using a BiPAP machine or a full-featured mechanical ventilator). BSI is distinct from traditional rapid sequence intubation (RSI), since BSI involves the delivery of machine-initiated, pressure-controlled breaths following administration of sedation and paralytics. […] EMCrit Project by Josh Farkas.
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.
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?
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
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?
The Trauma Pro
JULY 9, 2024
Cervical spine injury presents a host of problems, but one of the least appreciated ones is dysphagia. Many clinicians don’t even think of it, but it is a relatively common problem, especially in the elderly. Swallowing difficulties may arise for several reasons: Prevertebral soft tissue swelling may occur with high cervical spine injuries, leading to changes in the architecture of the posterior pharynx Rigid cervical collars , such as the Miami J and Aspen, and halo vests all force the neck int
ALiEM
JUNE 10, 2024
For years, adult literature has provided clear guidelines for cervical spine imaging through the NEXUS and Canadian C-spine Rule (CCR) tools. These have been invaluable in helping clinicians decide when to image the neck in trauma patients. Similarly, the Pediatric Emergency Care Applied Research Network (PECARN) has developed robust tools for assessing blunt head trauma in children.
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.
Sensible Medicine
JUNE 15, 2024
In prior posts, I was critical of the culture among trainees. One essay described the phenomenon of calling in fake sick. Another asked what the balance is between accommodation and the rigors of the job. These essays were about the effort, dedication and professionalism of trainees. Sensible Medicine is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.
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.
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.
EMCrit
JUNE 13, 2024
the PREOXI trial validates what I have been saying for 15 years about preoxygenation for the critically ill patient EMCrit Project by Scott Weingart, MD FCCM.
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.
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.
EM Literature of Note
JUNE 5, 2024
Every so often a masterclass performance arises in the medical literature. A performance transcending the boundaries of what was once thought possible. A shining exemplar of human achievement. This is a trial, published in the New England Journal of Medicine , with the following features: Conducted by an institute sponsored by pharma. Designed by the first author, a consultant for pharma, and two employees of pharma.
Life in the Fast Lane
MAY 18, 2024
Kane Guthrie Cardiac Arrest – the 5 C’s Cardiac Arrest - the 5 C's with Cliff Reid. Causes Of Cardiac Arrest You NEVER Thought Of?! Meet The Hs & Ts & Cs!
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
Intensive Blog
MARCH 13, 2024
Everything ECMO 048: History of ECPR evidence and considerations for future research Author: Dr George Walker Peer reviewer: A/Prof Aidan Burrell Introduction The first recorded attempts to resuscitate patients were as early as 1530 where Swiss physician Paracelsus used fireplace bellows to reinflate the lungs of those who had stopped breathing. Several more centuries passed before techniques more akin to modern day cardio-pulmonary resuscitation were reported.
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.
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.
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