Ken Grauer, MD
NOVEMBER 1, 2024
I was sent this ECG recording — and asked for my interpretation of the rhythm in Figure-1. I had little clinical information. QUESTIONS: How was I able to guess the probable correct answer in less than 5 seconds? How was I then able to prove that my guess was correct? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ).
Sensible Medicine
NOVEMBER 5, 2024
A few month ago, we were pleased to publish a critical appraisal written by a group of students at the Wayne State University School of Medicine. The group is back with another piece about a recent article. I am enjoying this way of encouraging critical appraisal in undergraduate medical education and generating good content for Sensible Medicine. As below, please take this opportunity to appraise the appraisers.
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The Trauma Pro
NOVEMBER 1, 2024
Every trauma center has a massive transfusion protocol (MTP). But every trauma center also does it entirely differently. Ideally, an MTP is designed with the resources available at the hospital in mind. These may include whole blood, the use of O- vs. O+ blood, the number of units of each product per cooler, the different products in different coolers, and personnel available to move those coolers to the correct locations.
Science Based Medicine
NOVEMBER 1, 2024
Any doctor who is unabashedly pro-vaccine has already spoken up about the normalization of anti-vaxx quackery within our ranks. The post If RFK Jr. Turns the CDC Into An Anti-Vaxx Propaganda Outfit, I Don’t Want To Hear a Peep From Some “Respectable” Doctors first appeared on Science-Based Medicine.
Sensible Medicine
NOVEMBER 4, 2024
Nearly a thousand news outlets covered the recent publication of the positive results of the STEP-9 trial of semaglutide vs placebo for the treatment of knee pain due to osteoarthritis in patients with obesity. Twitter overflowed with positive messages after the New England Journal of Medicine publication. I am not sold on the trial. STEP-9 had many flaws but one fatal flaw.
EM Ottawa
OCTOBER 31, 2024
Delirium is a medical emergency. It is characterized by acute disturbance of consciousness, with changes in perceptual disturbances and fluctuation of symptoms. Delirium is often the initial manifestation of an underlying acute illness and can be present before fever, tachypnea, tachycardia, or hypoxia. There is an ED prevalence ranging from 7-24%, with increased mortality rates […] The post Delirium revisited appeared first on EMOttawa Blog.
Life in the Fast Lane
NOVEMBER 2, 2024
Mike Cadogan Waiting Room Medicine With exponential Emergency Department over-crowding and spiraling waiting times, the Utopian College has produced a series of guidelines to assist fondling members.
Emergency Care Today brings together the best content for emergency care practitioners from the widest variety of industry thought leaders.
Science Based Medicine
OCTOBER 31, 2024
The organization scapegoated by the lab leak-promoting GOP-led House Covid subcommittee publishes its defense The post EcoHealth Alliance Fights Back first appeared on Science-Based Medicine.
EM Literature of Note
NOVEMBER 4, 2024
It is clear LLMs have an uncanny ability to find associations between salient features, and to subsequently use those associations to generate accurate probabilistic lists of medical diagnoses. On top of that, it can take those diagnoses and use its same probabilistic functions to mimic the explanations it has seen in its training set. A powerful tool – clearly an asset to patient care?
Life in the Fast Lane
OCTOBER 30, 2024
Casey Parker and James Rippey Ultrasound Case 112 A 30 year old woman who is currently 30 weeks gestation presents to the ED with abrupt, severe right loin pain.
American Medical Compliance
OCTOBER 31, 2024
A survey reveals that falls are the most frequent health issue affecting seniors in long-term care facilities. Interestingly, while 90% of caregivers feel confident in implementing fall prevention measures, only 60% have adequate knowledge to do so effectively. As the aging population grows, so does the demand for specialized healthcare tailored to the unique needs of seniors and individuals with disabilities, posing new challenges and responsibilities for healthcare providers.
Critical Care North Hampton
NOVEMBER 2, 2024
“Quick Draw Anatomy for Medical Students” by Joanna Oram Fox is a unique educational book designed to help medical students learn anatomy through drawing. It provides step-by-step instructions on drawing, understanding, and interpreting key anatomical structures. Her fantastic methodology for learning by illustration really impressed us with her first book!
Dr. Smith's ECG Blog
OCTOBER 30, 2024
Smith Introduction: Saddleback ST Elevation is often an OMI mimic, so one needs to scrutinize these ECGs!! Written by Magnus Nossen Below are ECGs from six different patients. All of the patients contacted EMS due to acute onset chest pain. Imagine you get these ECGs in real time and you are asked whether or not the cath lab should be activated? All ECGs in this case have saddleback ST elevation.
PEMBlog
OCTOBER 31, 2024
Introduction Acute gastroenteritis affects millions of children in the U.S. every year, leading to emergency department visits and hospitalizations. Probiotics, particularly Lactobacillus rhamnosus GG (LGG), have been commonly used as a treatment, but evidence supporting their effectiveness has been limited. A new study conducted by the Pediatric Emergency Care Applied Research Network (PECARN) aimed to determine whether LGG could reduce the severity of gastroenteritis in children.
Sensible Medicine
NOVEMBER 1, 2024
Nick Arroyo is a 65-year-old man without medical problems. He feels well and sees a primary care doctor every three years or so. He had a chest CT for lung cancer screening because he smoked a pack-a-day for 50 years and heard a radio advertisement that said that lung cancer screening would be helpful. The scan detected a 1 cm nodule. A PET scan was positive, and a biopsy diagnosed it as small cell lung cancer.
Taming the SRU
OCTOBER 31, 2024
Georgette N, Michelson K, Monuteaux M, Eisenberg MA. Development of a New Screening Tool for Pediatric Septic Shock. Ann Emerg Med 2024; Big Picture Current screening tools for pediatric septic shock and sepsis are highly specific but lack sensitivity. This study substituted age adjusted vital sign measures and a pediatric shock index into currently existing pediatric sepsis scoring systems to create the qPS4.When utilizing a cut off of ≧ 2 points, the qPS4 was highly sensitive and specific, and
First 10 EM
NOVEMBER 4, 2024
It is pretty rare for the phrase “we need more research” to be immediately followed by more research, but that seems to have happened here.v On October 7 I published my post about the HEMOTION trial, looking at transfusion thresholds in traumatic brain injury, and concluding that despite being a statistically negative trial, the results […] The post Liberal or restrictive transfusion in brain injury part 2 (The TRAIN trial) appeared first on First10EM.
Dr. Smith's ECG Blog
OCTOBER 31, 2024
This case was sent by an old residency friend, Kirk Lufkin. He works in a small hospital in Northern Michigan. Case A 61 year old female. hypertension no other past history presented with 30 minutes of fluctuating non-radiating heaviness in chest, with diaphoresis and nausea. VS normal. No cardiac past history. Here is her ECG: What do you think? There are inferior hyperacute T-waves (diagnostic of inferior OMI), with 1) reciprocal ST depression in aVL, 2) a reciprocally inverted hyperacute T-wa
PulmCCM
NOVEMBER 4, 2024
“I can’t prove it was the reason, but we kept everyone’s K over 4 and Mag over 2 and we didn’t have a single code this month.” – my senior resident on an internal medicine rotation, circa 2005 As many as one-fifth of hospitalized patients develop hypokalemia, commonly defined as serum potassium less than 3.5 mEq/L.
St. Emlyn
OCTOBER 30, 2024
St.Emlyn's - Emergency Medicine #FOAMed All the best from the blog from August 2024, in our easy to digest podcast. The post August 2024 Round-Up – Goldilocks Moments, Nasal Analgesia, and Public Health in the ED appeared first on St.Emlyn's.
ALiEM
NOVEMBER 1, 2024
A 67-year-old male with a past medical history of CHF, MI, hypertension, and diabetes presented to the ED with complaints of headache, chest pain, and dyspnea for the past four days. He stated that he has been without his medications for the past few months due to cost. He denied any past surgical history. He stated that he primarily presented because he felt like “my blood pressure is high” Additional Images Physical Exam Cardiovascular : Tachycardic, 2+ pedal edema bilaterally Re
Emergency Live
NOVEMBER 5, 2024
If not recognized and treated promptly, it can lead to irreversible organ damage and death Sepsis, an extreme inflammatory response of the body to an infection, is a serious threat to the health of infants, especially those born prematurely. This condition, if not recognized and treated promptly, can lead to irreversible organ damage and, in […] The post Sepsis: a silent enemy of newborns appeared first on Emergency Live.
Dr. Smith's ECG Blog
NOVEMBER 3, 2024
Written by Magnus Nossen ( with comments and laddergram by Ken Grauer ) The patient in today’s case is a man in his 60s — who presented with palpitations and lightheadedness. He had no history of syncope. The patient had hypertension, but was otherwise healthy. Due to the reported symptoms, he was admitted for observation and put on telemetry monitoring.
PEMBlog
NOVEMBER 4, 2024
Did you know that post tonsillectomy bleeding occurs approximately 3 to 5% of the time, most often at days 5 to 7 after the surgery? Of course you did. Unstable children with active bleeding may need a trip to the OR. Otherwise ENT can help determine management. Lyrics Nasty strep or OSA Take those tonsils out today Remove adenoids just in case Now there’s blood all over the place Post T&A bleeds frequently now you call ENT If active bleed resuscitate maybe operate on this date If not
St. Emlyn
NOVEMBER 5, 2024
St.Emlyn's - Emergency Medicine #FOAMed At the Tactical Trauma 24 conference in Sundsvall, Sweden, St Emlyn’s hosts Iain Beardsell and Liz Crowe had the opportunity to speak with Alice Hutin, an emergency physician with Service […] The post Podcast – Prehospital eCPR with Alice Hutin at Tactical Trauma 2024 appeared first on St.Emlyn's.
ALiEM
OCTOBER 30, 2024
‘Dope’ is no longer heroin in an increasing number of our communities. The biggest change has been the gradual replacement of diacetylmorphine (heroin) by fentanyl and other synthetic opioids. Due in large part to the proliferation of anonymous chemical factories able to produce industrial volumes of inexpensive synthetic opioids without opium or other controlled precursors, fentanyl spilled into the United States, Canada, and Europe, heroin soon fell to market forces [1, 2].
Emergency Live
NOVEMBER 4, 2024
Health experts raise the alarm: combination of influenza and COVID-19 could have serious consequences The cold season is approaching and with it the spectrum of influenza and COVID-19 returns. This year, however, the situation could prove particularly complex. Health experts from around the world are warning that the combination of influenza and COVID-19 could trigger […] The post Flu and COVID-19 are worrying again as vaccines lose popularity appeared first on Emergency Live.
RebelEM
NOVEMBER 6, 2024
Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (80%) Demographics Most commonly affects patients between ages 10-20 years old As age increases, elbow dislocation rates tend to d
JournalFeed
NOVEMBER 2, 2024
The JournalFeed podcast for the week of Oct 28 – Nov 1, 2024. These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member. Tuesday Spoon Feed : In this NEAR database study, there was an independent association between increasing number of intubation attempts and risk of complications.
Clinical Correlations
NOVEMBER 1, 2024
By Chloe Fong Peer Reviewed The correlation between vitamin deficiency and alcohol use disorder (AUD) has been well documented in the literature, with a study from 1963 finding that 70% of patients admitted to the hospital.
EMDocs
NOVEMBER 6, 2024
Authors: Robert Nicholson, MD (EM Resident Physician, Carolinas Medical Center, Charlotte, NC) and Ann-Jeannette Geib, MD (EM Attending Physician, Medical Toxicologist, Carolinas Medical Center, Charlotte, NC) // Reviewed by: James Dazhe Cao, MD (@JamesCaoMD, Associate Professor of EM, Medical Toxicology, UT Southwestern Medical Center, Dallas, TX); Anthony Spadaro, MD (@TSpadaro91, Medical Toxicology Fellow, Rutgers New Jersey Medical School, Newark, NJ); Alex Koyfman, MD (@EMHighAK); Brit Long
Emergency Live
NOVEMBER 4, 2024
Swimming pools, gyms and changing rooms are the main risk environments for HPV contraction Warts are small skin bumps caused by human papillomavirus (HPV) infection. Although they are generally harmless, they can be a source of annoyance and embarrassment. Understanding warts, their causes and available treatments is the first step to getting rid of them […] The post What are warts, how to prevent and treat them appeared first on Emergency Live.
RebelEM
OCTOBER 30, 2024
Take Home Points Early diagnosis: erythema and warmth of the skin surrounding the umbilicus isn’t normal. Get labs, start abx and get the patient admitted Consult peds surgery on all of these patients as progression to nec fast, while uncommon, is devastating If the patient appears toxic or has systemic symptoms, the simply omphalitis has progressed and aggressive treatment including surgery is likely indicated REBEL Core Cast 130.0 – Omphalitis Click here for Direct Download of the Podcas
Don't Forget the Bubbles
NOVEMBER 6, 2024
Consider Maddie, a 12-year-old girl in your ED with a virally induced moderate asthma exacerbation, currently having her third set of 12 puffs in her burst therapy; thankfully, she’s responding pretty well, and you’re hoping to avoid an admission at this stage. This is her third presentation with a viral exacerbation of asthma. You take a history and discover that she takes her salbutamol every week before and during her soccer matches.
PulmCCM
OCTOBER 30, 2024
A majority of patients with significant strokes experience fever within the first week after their vascular injury. The presence, intensity, and persistence of fevers are associated with worse outcomes after strokes of any type. For example: Patients with ischemic strokes who develop fever within the first 24 hours have more than double the risk of death, compared to patients without fevers.
Kings County Downstate EM
NOVEMBER 5, 2024
Case Author: Ryan Pang, MD Editor: Philippe Ayres, MD A 72-year-old male with a past medical history of hypertension, diabetes, and hyperlipidemia presents to the ED with 3 months of chronic, progressively worsening swelling of his left arm. He also reports an inability to move his left arm and […] The post “Talk Dirty to Me”: Bedside Testing for Necrotizing Fasciitis appeared first on County EM.
Emergency Live
NOVEMBER 3, 2024
Vigorous exercise reduces risk of cognitive impairment, study shows A recent study by Wake Forest University has revealed a promising finding: intense physical exercise could be a valuable ally in the fight against dementia, especially in hypertensive people. SPRINT: a groundbreaking study The study is based on data collected in the context of the famous […] The post Intense exercise: an elixir against hypertension and dementia appeared first on Emergency Live.
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