Ken Grauer, MD

JUNE 22, 2024

See ECG Blog #313 — as well as My Comment at the bottom of the page in the June 17, 2024 post in Dr. Smith's ECG Blog ). PEARL # 2: Acute PE remains one of the most commonly overlooked diagnoses. As per links that I provide below — IF the diagnosis of acute PE is not thought of, this entity will be missed! (

EKG/ECG 433

EKG/ECG Stroke Documentation/Coding Wellness 433

EMDocs

APRIL 3, 2025

Well see you in less than 5; be ready for us, hes a sick one. Well, if we move that patient over to a hallway bed and shuffle these 8 other people, maybe we can make it work. Well, the AV node would be next up for pacing. Its why we work so well together. Well, you have two to reach for here, Epinephrine or Dopamine.

EKG/ECG 94

EKG/ECG Documentation/Coding Wellness EMS 94

Pediatric EM Morsels

DECEMBER 20, 2024

Keep in mind, there can be extrapulmonary manifestations as well! These include: Mucocutaneous disease including rashes like erythema multiforme, mycoplasma induced rash and mucositis (AKA reactive infectious mucocutaneous eruption RIME), and SJS.

CDC 167

CDC Seizures Pediatrics EMS 167

Pediatric EM Morsels

JULY 19, 2024

DON’T forget to put on your Personal Protective Equipment as well! Have traditional, direct laryngoscopes available as well. This is worth a shot in a well appearing child that is old enough to gargle and spit. Well… sometimes it starts again. Get good light and exposure! Headlamps can also be helpful!

Airway Management 293

Airway Management Pediatrics Wellness Operations 293

American Medical Compliance

OCTOBER 14, 2024

Moreover, they pose risks to the safety and well-being of residents and staff. Empathy allows caregivers to demonstrate that they are not just there to perform tasks but are genuinely concerned about the resident’s well-being. It also contributes to the overall well-being of residents.

Wellness 105

Wellness Operations Outcomes 105

The Trauma Pro

DECEMBER 6, 2024

In the old days, we would frequently do an incidental appendectomy because… well, just because we were there. But every once in a while, I am asked about incidental appendectomy during trauma laparotomy. Is it a good idea? What reasons could there possibly be for doing it? ” Legitimate reason?

Operations 147

Operations Administration Wellness 147

The Trauma Pro

SEPTEMBER 6, 2024

I’ve included a printable pdf file, as well as the original Microsoft Publisher file in case you want to make a few modifications to suit your own hospital. There is also an indication of what you need to do, and exactly when to call your consultant. Here’s a reference sheet formatted at a 3×5 index card that you can keep in your pocket.

Operations 264

Operations Hospitals Wellness 264

Ken Grauer, MD

SEPTEMBER 22, 2023

Note also that the P wave is negative in standard lead II in Figure-1 ( as well as in leads III and aVF, which are the other 2 inferior leads ). It is well to remember that IF the P wave in lead II is negative — then by definition — You do not have sinus rhythm ( unless there is lead misplacement or dextrocardia ).

EKG/ECG 446

EKG/ECG Wellness 446

The Skeptics' Guide to EM

APRIL 26, 2025

You need to act quickly for scene safety and the patient's well-being. The patient is tachycardic (HR 122 bpm), hypertensive (BP 156/96 mmHg), and has a Glasgow Coma Scale (GCS) score of 12. Background: Acutely agitated patients in the pre-hospital setting present a unique challenge for emergency medical services (EMS).

Hospitals 128

Hospitals Evidence-Based Practice Airway Management EMS 128

Pediatric EM Morsels

OCTOBER 27, 2023

Taking care of a critically ill child can be nerve-racking to say the least, and downright petrifying for those who don’t do it frequently, even if they are well-trained and brilliant clinicians. Sinha 2012] It is useful in the prehospital setting , correlating well with actual weight and ED Broselow weight. Broselow does not.

Pediatrics 274

Pediatrics Resuscitation Documentation/Coding Wellness 274

Ken Grauer, MD

AUGUST 16, 2024

See ECG Blog #435 — ECG Blog #313 — as well as My Comment at the bottom of the page in the June 17, 2024 post in Dr. Smith's ECG Blog ). Acute PE remains one of the most commonly overlooked diagnoses. As per links that I provide below — IF the diagnosis of acute PE is not thought of, this entity will be missed! (

EKG/ECG 394

EKG/ECG Wellness Shock 394

Sensible Medicine

JANUARY 23, 2025

As a physician, scientist, wellness/longevity podcaster, and Ironman Triathlete, I strongly support healthy life choices. He is also an Ironman Triathlete, and wellness/longevity/health podcaster and writer. To hear more health thoughts, listen to his podcast: Live Long and Well With Dr. Bobby.

Wellness 116

Wellness Stroke Research 116

Ken Grauer, MD

JUNE 7, 2024

Improvement of symptoms that correlates with improvement in ECG findings does not mean "all is well". ECG Blog #193 — Reviews the basics for predicting the " culprit " artery ( as well as reviewing why the term "STEMI" — should be replaced by "OMI" = O cclusion-based MI ). Figure-2: I've labeled the initial ECG in today's case.

EKG/ECG 342

EKG/ECG Wellness 342

American Medical Compliance

OCTOBER 31, 2024

For disabled patients, training should cover a range of disabilities, including physical , intellectual, and sensory disabilities, as well as chronic illnesses. For seniors and disabled individuals, being heard and understood is essential for their emotional well-being. Communication training should also emphasize listening skills.

Best Practices 105

Best Practices Outcomes Patient Safety Wellness 105

The Trauma Pro

JULY 9, 2024

Patients with cervical fractures more commonly need a tracheostomy for ventilatory support and/or have a head injury , and these are well known culprits in dysphagia Normal soft tissue (<6mm at C2, <22mm at C6) A study in the Jan 2011 Journal of Trauma outlined the dysphagia problem seen with placement of a halo vest.

Head Injuries 264

Head Injuries Fractures Hospitals Wellness 264

Ken Grauer, MD

DECEMBER 29, 2023

The "good news" — is that after an extended hospitalization, the patient was finally discharged home, and doing well. = The ECG in Figure-1 — was obtained following successful resuscitation. A C loser L ook at Today's ECG: The rhythm in Figure-1 is sinus — with regular upright P waves with a constant and normal PR interval in lead II.

EKG/ECG 438

EKG/ECG Resuscitation Hospitals Wellness 438

Dr. Smith's ECG Blog

JANUARY 2, 2025

Clinically, it is well to remember that this variation in QTc estimation is greater at faster heart rates ( with faster heart rates being common in "sicker" patients, for whom we are most likely to need to assess the QTc ). This tells us that universal agreement for QTc estimation is not perfect.

EKG/ECG 117

EKG/ECG Sepsis Wellness Documentation/Coding 117

The Trauma Pro

SEPTEMBER 17, 2024

Much depends on local policies and procedures, training, as well as availability. And they are better versed in performing amputations that involve the upper extremity, as well as more proximal amputations (shoulder, upper thigh). In the US, it is usually a physician and typically a surgeon.

Airway Management 199

Airway Management Operations Hospitals Wellness 199

ACEP Now

MARCH 10, 2025

A sense of purpose is an integral part of well-being. A systematic review and meta-analysis on basic psychological need satisfaction, motivation, and well-being in later life: contributions of self-determination theory. 9 Furthermore, meaningful work is a cornerstone in the longevity of career academic physicians. Psychosom Med.

Academics 85

Academics Wellness CPR Hospitals 85

Ken Grauer, MD

AUGUST 8, 2024

But, given my heightened clinical suspicion — there is no denying ST segment straightening in leads I and aVL , as well as in the inferior leads. ECG Blog #193 — Reviews the basics for predicting the " culprit " artery ( as well as reviewing why the term "STEMI" — should be replaced by "OMI" = O cclusion-based MI ).

EKG/ECG 318

EKG/ECG Resuscitation Wellness 318

Don't Forget the Bubbles

MARCH 10, 2025

As well as being a practice and policy priority, there have been repeated calls for research to better understand the problem. This is something we see elsewhere in medicine as well. Challenging working conditions in health services, especially in emergency departments (ED), lead to high levels of stress and burnout.

Emergency Department 104

Emergency Department Research EMS Academics 104

The Skeptics' Guide to EM

MARCH 1, 2025

The Wells Score and Revised Geneva Score (RGS) and YEARS are widely used clinical prediction rules to stratify risk and guide appropriate use of D-dimer testing. AEM Feb 2025 Population: Patients with a high clinical probability of PE (Wells >6 or Revised Geneva Score >10) and underwent D-dimer testing in the ED.

Allergic Reactions 72

Allergic Reactions Research Emergency Department Ultrasounds 72

American Medical Compliance

NOVEMBER 29, 2024

Continuous Glucose Monitoring (CGM) technology is transforming the approach to diabetes care for healthcare providers, including endocrinologists, diabetes educators, and nurses, as well as for the patients they support. However, to maximize its benefits, healthcare providers must be well-versed in the technology.

Outcomes 105

Outcomes Wellness Operations Pediatrics 105

PEMBlog

MAY 1, 2025

Well break down the virology, epidemiology, clinical presentation, and complications of Parvovirus B19. Well, let’s get nerdy. This is the most well-known manifestation, seen primarily in school-aged children, especially in the spring and early summer. So as you can see, this virus does a lot of stuff. But what is it?

Pediatrics 93

Pediatrics Urgent Care Wellness Hospitals 93

The Trauma Pro

MAY 24, 2024

Although gastric repair is usually simple and heals well, his group did note a few severe complications. It’s probably a good idea for concomitant colon injury as well, but there’s less literature support. Of 243 patients with this injury, 15 developed ones that were considered severe, and 10 of those were empyema!

Operations 203

Operations Wellness 203

Emergency Medicine Cases

FEBRUARY 18, 2025

In this episode, with the expertise of Dr. Samantha Martin and Dr. Jennifer Tomlin, well break down the essential clinical clues, screening questions, red flags, and subtle exam findings that can help Emergency Physicians diagnose eating disorders early and initiate treatment to decrease mortality and long term morbidity in these young patients.

Psychiatric 97

Psychiatric Emergency Department EMS Outcomes 97

The Trauma Pro

NOVEMBER 17, 2023

Well, it’s not supposed to be that way. The whole point of adhering to the usual ATLS protocol is to ensure that the patient stays alive through and well after your exam. Ever been in a trauma activation where it seems like the first thing that happens is that someone steps up to the patient with the ultrasound probe in hand?

Resuscitation 214

Resuscitation Ultrasounds Hospitals Wellness 214

Ken Grauer, MD

DECEMBER 1, 2023

This blog post reviews the basics for predicting the " C ulprit" A rtery ( as well as reviewing why the term "STEMI" — should replaced by " OMI" = O cclusion-based MI ). ECG Blog #193 — illustrates use of the M irror T est to facilitate recognition of acute Posterior MI.

EKG/ECG 418

EKG/ECG EMS Wellness 418

EMDocs

APRIL 18, 2025

He hands you this ECG to take a look: Well, Intern, dont keep us waiting. Well Sir, the blue arrows show the P waves. Well, sir, traditional teaching is that first degree AV block doesnt cause much of a problem and these patients are usually totally fine. Well, Intern, that was at least ok. Uh, Rate, rhythm, uhhh STEMI?

EKG/ECG 67

EKG/ECG Wellness Shock EMS 67

Ken Grauer, MD

MARCH 1, 2024

No clear history for recent chest pain — but the patient "has not been well" for the previous week. 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".

EKG/ECG 497

EKG/ECG EMS Wellness 497

Pediatric EM Morsels

JUNE 7, 2024

For children at least 4 years of age who are not well controlled on ICS alone. Lucky for us, in 2020 there were some updates made to the NIH Asthma Management Guidelines and we’re going to discuss which ones can help us in the Emergency Department!

Pediatrics 210

Pediatrics Emergency Department Wellness EMS 210

The Trauma Pro

MAY 21, 2024

And if there is a large difference in mass between the vehicles, there are some other calculation nuances as well. If the impact is angled there is a little trigonometry involved, which I will avoid in this example. In this example, since the masses are the same, each vehicle would come to a stop on impact because the masses are equal.

Wellness 245

Wellness 245

Ken Grauer, MD

NOVEMBER 4, 2023

Instead — rate control of this patient's AFib, as well as confirmation of this rhythm diagnosis was obtained by treatment with a ß-blocker. Figure-4: Repeat ECG after IV and PO Metoprolol. Would A denosine have Worked for Today's Rhythm? Adenosine was not used in today's case.

EKG/ECG 422

EKG/ECG Wellness 422

Ken Grauer, MD

JUNE 26, 2023

That said — since today’s patient is a “young man” — and the rate of today’s rhythm is extremely fast ( ie, 250-260/minute — which is faster than is usually seen in a VT rhythm that maintains a well-defined QRS morphology ) — we clearly can not discount the possibility of an SVT rhythm.

EKG/ECG 366

EKG/ECG Wellness 366

Mind The Bleep

FEBRUARY 2, 2025

However, as an F1, you may well know the patient best and therefore you may be best placed to refer the patient. She is otherwise in good health and is responding well to chemotherapy. Often one of the scariest things you can do as you will most likely be speaking to a more senior colleague in an unfamiliar speciality.

Radiology 96

Radiology Radiology Sepsis Documentation/Coding 96

EMDocs

JANUARY 25, 2025

Well keep it short, while you keep that EM brain sharp. A previously healthy 23-year-old male with no medical or surgical history presents to the ED with generalized malaise and no energy, progressively getting worse over the last six weeks. 10^9/L) Moderate (0.50.9 10^9/L) Severe (< 0.5 10^9/L) Generalized leukopenia (i.e.

EMS 90

EMS Infectious Diseases Allergic Reactions Fluid Resuscitation 90

ACEP Now

NOVEMBER 7, 2024

Conclusion Poorly healing wounds pose a significant burden on health care systems and personal well-being, and their presence as a harbinger of severe morbidity and mortality must be appreciated.

Burns 97

Burns Documentation/Coding Outcomes Emergency Department 97