Ken Grauer, MD

OCTOBER 10, 2024

I was sent the ECG shown in Figure-1 — told only that the patient was a middle-aged man with septicemia. QUESTIONS: Is this rhythm too fast to be sinus tachycardia? Are flutter waves hidden within the QRS and T waves? Are we seeing the retrograde P waves of AVNRT? Is this ATach ( A trial T achycardia )? Figure-1: The initial ECG in today's case. MY Thoughts on Today’s CASE: In my opinion — none of the above answers are optimal to describe the rhythm in Figure-1.

EKG/ECG 367

EKG/ECG Sepsis Wellness 367

The Trauma Pro

OCTOBER 11, 2024

I’ve written many posts in the past about the arguments surrounding chest tube size: large bore vs. small bore (pigtail). For the longest time, only a few decent papers were looking into this debate, and subject numbers were small. The best the papers could say was that “small-bore chest tubes are not inferior to large-bore tubes.” Not that this is not the same as saying, “small-bore tubes are better than large-bore tubes.” But finally, after more than ten years, th

Hospitals 147

Hospitals 147

Mount Sinai EM

OCTOBER 10, 2024

Many of us–myself included–often find ourselves spending more time on our smartphones than we intend to. One recent survey showed that 57% of Americans feel addicted to their smartphones. Another survey finds that millennials and gen z feel the most addicted. Earlier this year, Dr. Vivek Murthy, the U.S. Surgeon General, called for a warning label on social media platforms in a New York Times guest essay.

Wellness 100

Wellness Research Outcomes 100

Sensible Medicine

OCTOBER 10, 2024

I appreciate this essay for its reframing of our debates about cancer screening; viewing them through an ethical lens. The speculation that we might eventually be able to identify individuals harmed by radiographic screening and how this would alter our approach is both intriguing and alarming. Adam Cifu Sensible Medicine is a reader-supported publication.

Hospitals 122

Hospitals Wellness 122

Science Based Medicine

OCTOBER 11, 2024

It doesn't bode well for the future that "leaders" of major American institutions look at naked emperors and compliment them on their beautiful clothes. The post The President of Stanford Wants Us To Debate Which Number is Larger, 9 or 133 first appeared on Science-Based Medicine.

Wellness 112

Wellness 112

Dr. Smith's ECG Blog

OCTOBER 8, 2024

This was sent to me by a reader who wishes to remain anonymous. A lady in her 60s came to the ER with chest discomfort and shortness of breath. She had a history of previous anterior MI treated by primary PCI to the proximal LAD. The first EKG is from 2:30 PM on the day of presentation to the ER. Smith : To me this is a blatantly obvious acute anterior OMI.

EKG/ECG 103

EKG/ECG Documentation/Coding Resuscitation Shock 103

PulmCCM

OCTOBER 8, 2024

Particle Health, a health tech startup, sued Epic Systems in federal court for the Southern District of New York, accusing the giant EHR vendor of monopolistic behavior outlawed by the Sherman Act. The allegations arose from a business dispute between the two firms dating back months. Besides providing insight into Epic’s business practices, the lawsuit will shine a spotlight on the intense but largely secret battle for control of patient data in healthcare.

Wellness 98

Wellness 98

EMDocs

OCTOBER 12, 2024

We always work hard, but we may not have time to read through a bunch of journals. It’s time to learn smarter. Originally published at JournalFeed , a site that provides daily or weekly literature updates. Follow Dr. Clay Smith at @spoonfedEM , and sign up for email updates here. #1: LR or NS for Sickle Cell Pain Crisis? Spoon Feed For sickle cell patients (particularly Hgb SS) with a vaso-occlusive episode (VOE), large volume resuscitation (>2L) with lactated ringers (LR) has been shown to

Resuscitation 81

Resuscitation Outcomes Hospitals 81

Science Based Medicine

OCTOBER 10, 2024

Accumulated evidence does not demonstrate that elderberry has meaningful beneficial effects. The post Elderberry (What is it good for) first appeared on Science-Based Medicine.

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Dr. Smith's ECG Blog

OCTOBER 10, 2024

Written by Pendell Meyers A man in his early sixties with no significant medical history (including a "negative cardiac workup a few years ago" for unclear indication) called 911 for acute chest pain constantly for the past 5 hours. EMS arrived and recorded vital signs within normal limits and the following ECG during active pain: EMS1 @ 0157: What do you think?

EKG/ECG 91

EKG/ECG EMS 91

EM Literature of Note

OCTOBER 9, 2024

This exploration of LLMs in the emergency department is a bit unique in its conceptualization. While most demonstrations of generative AI applied to the ED involve summarization of records, digital scribing, or composing discharge letters, this attempts clinical decision-support. That is to say, rather than attempting to streamline or deburden clinicians from some otherwise time-intensive task, the LLM here taps into its ability to act as a generalized prediction engine – and tries its hand at p

Radiology 86

Radiology Radiology Emergency Department Documentation/Coding 86

St. Emlyn

OCTOBER 10, 2024

St.Emlyn's - Emergency Medicine #FOAMed I’m back at the Sage in Gateshead for day 2 of the conference. David Williams and William Rutherford lectures. These are two prestigious named lectures at ASC. Dr John Ryan […] The post RCEM ASC conference 2024. Day 2. appeared first on St.Emlyn's.

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EMDocs

OCTOBER 8, 2024

Today on the emDOCs cast Brit Long interviews Zachary Aust on the use of a mental model for patients with unexplained sinus tachycardia. Episode 108: Unexplained Sinus Tachycardia Mental Model Background: When a patient in the ED has sinus tachycardia our job as emergency physicians is to identify and treat of the underlying pathology. This is done with a HPI, review of systems, physical exam, and as indicated further diagnostic studies.

Shock 88

Shock Emergency Department Pediatrics EKG/ECG 88

The Bottom Line

OCTOBER 13, 2024

Potassium Supplementation and Prevention of Atrial Fibrillation After Cardiac Surgery: The TIGHT K Randomized Clinical Trial O’Brien. JAMA 2024; 332:979 – 988. doi:10.1001/jama.2024.17888 Clinical Question In adult patients undergoing coronary artery bypass surgery (CABG) is supplementing potassium when serum concentration is ≤ 3.5 mEq/L non-inferior to supplementation when serum concentration is ≤ 4.

Operations 68

Operations 68

Dr. Smith's ECG Blog

OCTOBER 12, 2024

Written by Bobby Nicholson What do you think of this “STEMI”? A man in his 90s with a history of HTN, CKD, COPD, and OSA presented to the emergency department after being found unresponsive at home. With EMS, patient had a GCS of 3 and was saturating 60% on room air. He improved to 100% with the addition of non-rebreather, however remained altered and was intubated by EMS with ketamine and succinylcholine.

EKG/ECG 81

EKG/ECG Documentation/Coding Emergency Department COPD 81

Sensible Medicine

OCTOBER 14, 2024

Last Monday I wrote about one of the most positive drug trials in all of cardiology. In the RALES trial, the mineralocorticoid receptor antagonist (MRA) spironolactone substantially reduced death rates in patients with heart failure due to a weak heart. There were two big limitations to the RALES story. One was that the most common kind of heart failure now is heart failure with preserved heart function.

Outcomes 68

Outcomes Hospitals Wellness 68

St. Emlyn

OCTOBER 12, 2024

St.Emlyn's - Emergency Medicine #FOAMed The final day of the RCEM Annual Scientific Conference with papers on chest pain, trauma, psychosocial, diagnostics and more. #rcemasc #FOAMed @stemlyns The post RCEM Annual Scientific Conference. Day 3. appeared first on St.Emlyn's.

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Science Based Medicine

OCTOBER 9, 2024

The 2024 Nobel prize in physiology or medicine goes to two researchers, Victor Ambros and Gary Ruvkun, for their work on microRNA. They began their research in the same lab in the late 1980s as postdoctoral fellow, and then continued to collaborate after they each started their own labs. Their research involves a key question about multicellular life.

Research 84

Research 84

First 10 EM

OCTOBER 14, 2024

Another month, another set of articles. Some clinically relevant. Some just thought provoking. One is more than 100 years old. Yes, I look everywhere for these papers. The BroomeDocs podcast version can be found here: [link] Clinically but not statistically significant: what do you do? Turgeon AF, Fergusson DA, Clayton L,et al. Liberal or Restrictive […] The post The October 2024 Research Roundup appeared first on First10EM.

Research 64

Research EMS 64

Dr. Smith's ECG Blog

OCTOBER 15, 2024

This was sent to me by an undergraduate name Hans Helseth, who is an EKG tech, but who is an expert OMI ECG reader. He wrote most of it and I (Smith) edited. A prehospital “STEMI” activation was called on a 75 year old male ( Patient 1 ) with a history of hyperlipidemia and LAD and Cx OMI with stent placement. He arrived to the ED by helicopter at 1507, about three hours after the start of his chest pain while chopping wood around noon.

EKG/ECG 90

EKG/ECG Hospitals Wellness 90

EMDocs

OCTOBER 14, 2024

Authors: Lloyd Tannenbaum, MD (EM Attending Physician, Geisinger Wyoming Valley, PA); Mai Saber, DO (EM Attending Physician, Hackensack University Medical Center, NJ); Rachel Bridwell, MD (EM Attending Physician, Charlotte, NC) // Reviewer: Brit Long, MD (@long_brit) Hello and welcome back to ECG Pointers, a series designed to make you more confident in your ECG interpretations.

EKG/ECG 62

EKG/ECG EMS Resuscitation Emergency Department 62

Don't Forget the Bubbles

OCTOBER 10, 2024

With millions of journal articles published yearly, it is impossible to keep up. This time the team from Bristol Royal Children’s Hospital ED tell us what is new in the world of paediatric literature… Led by Dr John Coveney a Paediatric Emergency Medicine Trainee in Bristol who has revived The Journal Club at Bristol Royal Children’s Hospital ED on a monthly basis.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

American Medical Compliance

OCTOBER 14, 2024

Assisted living facilities are a lifeline for elderly and vulnerable individuals who need care and support in a safe, nurturing environment. Yet, even in these compassionate settings, caregivers often face the challenge of managing aggressive behaviors among residents. Imagine the case of Mrs. Stevens, a once gentle and kind woman who, after the onset of dementia, began exhibiting sudden outbursts of anger.

Wellness 60

Wellness Operations Outcomes 60

The Skeptics' Guide to EM

OCTOBER 12, 2024

Reference: Ma K et al. A national survey of children’s experiences and needs when attending Canadian pediatric emergency departments. PLoS One. June 2024 Date: Oct 1, 2024 Guest Skeptic: Dr. Andrew (Andy) Tagg is an Emergency Physician with a special interest in education and lifelong learning. He is the co-founder of website lead of Don’t Forget the Bubbles (DFTB).

Emergency Department 73

Emergency Department Pediatrics Outcomes EMS 73

Stop and Think

OCTOBER 8, 2024

I wrote yesterday over at Sensible Medicine about the RALES (circa 1999) trial of spironolactone vs placebo in patients with heart failure. Patients treated in the spironolactone arm had an 11% lower rate of death. The number needed to save a life with this daily inexpensive pill was a mere 9—a massive effect size. The thing about the 1990s era of cardiology is that there were lots of hugely positive trials similar to RALES.

Hospitals 73

Hospitals Academics Outcomes 73

EMDocs

OCTOBER 10, 2024

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. The goal of MMI-LFL is to improve patient safety, educate physicians and reduce the cost and stress of medical malpractice lawsuits. To opt in to the free subscriber list, click here. Stories of med mal lawsuits can save lives.

Documentation/Coding 71

Documentation/Coding Hospitals Sepsis Infectious Diseases 71

Sensible Medicine

OCTOBER 15, 2024

It is my pleasure to introduce this article by Joseph Marine, MD in response to mandatory masking policies in a number of California hospitals. There is simply no randomized evidence to support these policies, and they make little sense in 2024. I worry about the mental abilities of the public health officers who instituted these policies, and that their actions will further erode trust in public health.

Hospitals 69

Hospitals Wellness 69

EM Ottawa

OCTOBER 10, 2024

We often talk about PoCUS for first-trimester bleeding. Is there an IUP? NDIUP? IDK? Yet one of the most common questions patients ask is; “Can you see the heartbeat?” While measuring fetal heart rate is not always our top priority, I’m here to convince you of the following: Measuring it still has clinical value. […] The post PoCUS Pearl – Measuring Fetal Heart Rate appeared first on EMOttawa Blog.

Ultrasounds 65

Ultrasounds Radiology Radiology 65

Board Bombs

OCTOBER 14, 2024

These 5 high yield pearls all share a common thread: helping you ACE the upcoming boards! If you are premium member you get access to the next 5. Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind at [link] Cite this podcast as: Briggs, Blake; Husain, Iltifat. 236. Potpourri Board Blitz October 14th, 2024.

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Life in the Fast Lane

OCTOBER 14, 2024

Pramod Chandru Network Five: Practice Changes In Paediatric Wheeze Management Network Five Emergency Medicine Journal Club Episode 30 reviewing updates on paediatric wheeze management with paediatric respiratory and sleep specialist Dr Chetan Pandit!

Pediatrics 52

Pediatrics 52

Emergency Medicine Ireland

OCTOBER 14, 2024

Welcome back to the tasty morsels of critical care podcast. Following on from our initial post in this entirely accidental series on “things you don’t want to find in the chest drain” we turn our eyes (if not our noses) to empyema. Many penumonias will develope a parapneumonic effusion. This is largely reactive and inflammatory but by no means does it mean there is infection.

Wellness 52

Wellness Ultrasounds 52

Don't Forget the Bubbles

OCTOBER 14, 2024

Some definitions Asylum seeker: A person who has fled their country and applied to another country to be recognised as a refugee but has not yet been granted this status. Refugee: Someone whose asylum application has been successful. The government recognizes they cannot return to their country of origin owing to a well-founded fear of being persecuted for the reasons provided for in the United Nations Refugee Convention or European Convention on Human Rights (such as persecution due to race, se

Documentation/Coding 52

Documentation/Coding Hospitals Wellness Operations 52

EM Ottawa

OCTOBER 10, 2024

Ever tried injecting local anesthetic into the bottom of someone’s foot? If you have, you’ll understand the incredible pain and difficulty in trying to anesthetize this region. Fortunately, there’s a better way to anesthetize the plantar foot, and avoid getting kicked in the face or causing a needle-stick injury: performing an ultrasound-guided tibial nerve block.1 […] The post PoCUS Pearl – Tibial Nerve Block appeared first on EMOttawa Blog.

Ultrasounds 65

Ultrasounds Radiology Radiology 65

Taming the SRU

OCTOBER 14, 2024

THE CASE A female in her 60’s with a remote history of bilateral cataract surgery presented to the emergency department (ED) with a two-week history of right eye swelling. Six days prior, the patient was evaluated at an urgent care and prescribed doxycycline and prednisone. She was re-evaluated over the following days and was transitioned from doxycycline to cephalexin.

Ultrasounds 52

Ultrasounds Urgent Care Emergency Department Documentation/Coding 52

PulmCCM

OCTOBER 14, 2024

Albumin is a protein produced by the liver whose molecular weight and negative charge attract sodium cations, and with them water molecules. In this way albumin produces most of the vascular system’s oncotic pressure—the force tending to retain fluid in blood vessels without its leaking into the extravascular space. This increases mean arterial pressure.

Resuscitation 52

Resuscitation Shock Wellness 52

PEMBlog

OCTOBER 14, 2024

Did you know that pancreatitis is mostly caused by viruses in kids? They don’t drink alcohol or get gallstones like grown ups. Also, scorpion bites apparently cause it. But that’s silly and only something you see in board review books. Anyway, this would be a better Broadway musical than most retreads of 1980s & 90s movies. Lyrics [Verse] Pancreatitis calls out my name The pain the intensity, I cannot explain My mom said I ate too many wings My dad told me to focus on more pleasa

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ALiEM

OCTOBER 11, 2024

A 76-year-old female presented with a lingering cough and an oral lesion to the left lower cheek. She reported ten days of improving flu-like symptoms but had a persistent cough and nasal congestion. On the day of presentation, she developed a painful, intermittently bleeding “blood blister” to the left lower cheek that had increased in size, as well as new red spots on her arms and legs.

Academics 60

Academics Wellness 60