Ken Grauer, MD

APRIL 23, 2023

IF dual AV nodal pathways were operative in today's case — then the BLUE arrow P waves in Figure-10 may be conducting with a very long PR interval — and — it may be that the WHITE arrow P waves are the ones that are not conducted because of this unusual pattern of Mobitz I.

EKG/ECG 195

EKG/ECG Wellness Operations Hospitals 195

Ken Grauer, MD

FEBRUARY 9, 2024

Awareness of this common association made me instantly suspect that some type of Wenckebach conduction is probably operative in today's rhythm — even though I admittedly do not see any pattern of consistent group beating, or any repetitive PR intervals that typically clue me in to Mobitz I conduction defects.

EKG/ECG 266

EKG/ECG Operations Wellness 266

Don't Forget the Bubbles

NOVEMBER 29, 2023

Awake fiberoptic intubation where the patient consents, co-operative AND the airway is prepared with local anaesthesia. 2013 Jan;31(1):222-6. When there is an immediate threat to life (e.g., in cardiac arrest where the time taken to site a line may lead to preventable neurological damage). What are the potential physiological sequelae?

Airway Management 135

Airway Management Emergency Department Resuscitation Psychiatric 135

Taming the SRU

JULY 25, 2024

Femoral nerve block case review - morbidity & mortality - community practice - r2 Clinical pathologic case - visual diagnosis - when time matters - operational aspects of stroke care Femoral nerve Block Case Review WITH dr. stolz Why do we care about regional anesthesia, specifically femoral nerve blocks? for obstructive CAD, OR 1.8

Stroke 98

Stroke Fractures Operations Outcomes 98

Don't Forget the Bubbles

OCTOBER 11, 2023

She spent around five days as an inpatient post-operatively. 2013 Dec 1;62(6):604-8. One magnet was found in the jejunum, and the other was in the ileum. They were stuck to each other with bowel wall in between. There was one perforation, which was repaired. She tolerated eating and drinking normally. 2012 Sep 1;55(3):239-42.

Pediatrics 116

Pediatrics Operations Radiology Radiology 116

RebelEM

JANUARY 25, 2023

Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43 Absent bowel sounds Peritoneal signs (i.e. rebound and guarding) Diagnostics Laboratory Tests Commonly ordered lab tests (i.e. Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

PHEM Cast

APRIL 27, 2023

Further reading Matt has kindly provided a list of references from his Trauma Care talk which this podcast is based on: Peri-operative and critical care management of the brain – current evidence. Anaesthesia: Vol 77, No S1. – Wiles – 2017 – Anaesthesia Blood pressure management in trauma: from feast to famine?

Resuscitation 52

Resuscitation Shock Operations Hospitals 52

EMDocs

AUGUST 12, 2023

Management consists of intravenous antibiotics , and hand surgery should be consulted to consider operative debridement. April 9, 2013. Inoculation usually occurs by penetrating injury , which seeds the tendon sheath. Unrecognized or persistent infection can lead to necrosis of the tendon. Medicine (Baltimore). 2019;98(44):e17823.

EMS 96

EMS Fractures Operations Ultrasounds 96

Cook County EM Blog

APRIL 7, 2022

Treatment can be achieved non-operatively if only the posterior ligaments of the tibiofibular syndesmosis are partially damaged. Otherwise, most cases require operative repair. 2013 Feb;44(2):e251-5. Additionally, repair of the deltoid ligament and distal tibiofibular syndesmosis aims to restore ankle mortise stability.

Fractures 52

Fractures Operations Hospitals 52

EMDocs

SEPTEMBER 25, 2023

Improved Visualization: Video laryngoscopes allow for the use of standard or hyperangulated geometry, essentially allowing the operator to “look around the corner” on an anterior airway. Operators can manipulate the blade with less force to optimize the view, making it easier to identify and navigate the endotracheal tube into the trachea.

Emergency Department 93

Emergency Department Soft Tissue Injuries Airway Management Operations 93

Don't Forget the Bubbles

APRIL 22, 2024

Occasionally, lacrimal probing does not work, and an operation is needed. 2013 Jun 1:E158-62. After applying a topical anaesthetic, a small probe is inserted into the lower punctum of the lacrimal canal to relieve the obstruction. This might be balloon dacryoplasty, stenting, or dacryocystorhinostomy (DCR). 2021 Jan 2;40(1):18-23.

Infectious Diseases 85

Infectious Diseases Sepsis Pediatrics Operations 85

EMDocs

FEBRUARY 7, 2024

3 Increasing Strikes and Unions Labor actions in healthcare can disrupt normal hospital operations, potentially impacting costs and threatening patient quality of care. 2013 Dec;14:1-0. Despite a plateau in overall union membership of around 10% in 2023 1 , major labor actions shook the U.S. March 23, 2023. BMC Medical Ethics.

Hospitals 98

Hospitals Research Patient Safety Wellness 98

RebelEM

AUGUST 12, 2024

Contemp Clin Trials. Epub 2022 Aug 28. PMID: 36038001 Levi TM, et al. Comparison of the RIFLE, AKIN and KDIGO criteria to predict mortality in critically ill patients. Rev Bras Ter Intensiva. PMID: 24553510 Iacone R, et al. Macronutrients in Parenteral Nutrition: Amino Acids.

Outcomes 81

Outcomes Hospitals Operations Shock 81

RebelEM

JANUARY 25, 2024

Point-of-care ultrasound (PoCUS) is inherently operator-dependent, which may have led to inconsistencies in the quality and findings of the ultrasound exams across different operators. R I Med J (2013). This may not be feasible in busier EDs in the US, making this portion of the protocol not generalizable to all environments.

Ultrasounds 129

Ultrasounds Outcomes COPD Hospitals 129

ACEP Now

DECEMBER 11, 2023

Patients who require inpatient boarding remain a significant challenge to ed operations. The time interval referred to as ED boarding time has been part of the hospital’s required data submission to CMS since 2013. These numbers have been trending higher and 2022 was no exception. The pandemic saw the time interval increase.

Emergency Department 52

Emergency Department Hospitals EMS Operations 52

PHEM Cast

DECEMBER 1, 2017

Journal of Special Operations Medicine : a Peer Reviewed Journal for SOF Medical Professionals , 13 (4), 53–58. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine , 11 (2), 211–213. link] Harcke, H. L., & Mazuchowski, E. Branco, B. Eckstein, M., link] MD, E. M., & RDMS, J. link] Netto, F.

Academics 52

Academics Radiology Radiology Resuscitation 52

PHEM Cast

JULY 6, 2017

Cricothyrotomy performed with the Melker set or the QuickTrach kit: procedure times, learning curves and operators’ preference. Sottile, D., Del Vecchio, L., Merola, R., Il Giornale Di Chirurgia , 35 (7-8), 165–170. Woodall, N., & Frerk, C. Appendix 4 NAP4 Summary: major complications of airway management in the United Kingdom.

Airway Management 52

Airway Management Academics Operations Resuscitation 52

PulmCCM

OCTOBER 16, 2024

Animal studies have suggested that the body could be prepped or trained to better withstand ischemic-reperfusion injury, by inducing mild ischemia in another tissue bed before the operation. The mechanism is unclear. Patients received RIPC after induction of anesthesia and before the initial incision.

Outcomes 52

Outcomes Operations Research Hospitals 52

Pediatric Emergency Playbook

MARCH 1, 2016

Often children even with high-grade splenic and liver lacerations can be managed non-operatively. Unfortunately, a negative FAST cannot help with detecting or grading the laceration for non-operative management. CT Abdomen and Pelvis, IV contrast: helpful in grading splenic and liver lacerations with goal to manage non-operatively.

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

Dr. Smith's ECG Blog

DECEMBER 19, 2023

Unfortunately, we do not have those images for review, but the operators described a ruptured LAD plaque and they stented this area, which ensures the stability of the plaque. Fortunately, that is exactly what happened. The patient did well afterward without any recurrence of symptoms. There are no further EKGs or troponin measurements.

EKG/ECG 127

EKG/ECG EMS Wellness Operations 127

Taming the SRU

AUGUST 30, 2023

Similarly, a 2013 meta-analysis of 6 studies with 1,006 patients published in the American Journal of Emergency Medicine showed neither CRP nor PCT are sufficient to rule-in or rule-out infective endocarditis, with PCT having a pooled sensitivity of 64% and specificity of 73% and CRP having a pooled sensitivity of 75% and specificity of 73% [40].

Infectious Diseases 89

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89

Advanced Emergency Nursing from AENJ

MAY 3, 2014

Review of the Wellcome Library movies on YouTube (1945) [ links below in references ] is instructive as to resuscitative methods of the 1930s and 1940s: Manual methods; gas bag or bellows operated by hand or machine; an anesthesia gas machine; or iron lung. Evaluation: Manually Operated Resuscitators (1971) Emergency Care Research Institute.

Resuscitation 40

Resuscitation Military Operations Emergency Nursing 40

Northwestern EM Blog

APRIL 25, 2022

Although limited, a 2013 study by Konda et al, where direct arthroscopic visualization or septic arthritis at follow-up were used as the gold standard for diagnosis, found imaging by CT scan to be 100% sensitive and specific for diagnosing traumatic knee arthrotomy. Definitive treatment is joint wash out in the Operating Room.

Soft Tissue Injuries 52

Soft Tissue Injuries Fractures Sepsis Documentation/Coding 52

Northwestern EM Blog

SEPTEMBER 12, 2022

This post will discuss a brief overview of hospital planning and operational setup with key elements of a disaster response from events that cause high numbers of blunt trauma, penetrating trauma, burns or crush injuries that may be seen following explosive events, mass shootings, or large scale motor vehicle collisions, to name a few.

Mass Casualty Incidents 52

Mass Casualty Incidents EMS Hospitals Hazardous Materials 52

Advanced Emergency Nursing from AENJ

NOVEMBER 20, 2014

Rohit Shahani , MD , MS, MCh & Jan David Galla, MD, PhD Penetrating Chest Trauma Treatment & Management Medscape Updated: Dec 13, 2013 Dicpinigaitis, P. Khoshdel, A. Modaghegh, M. H., & Kazemzadeh, G. Prehospital Management of Gunshot Patients at Major Trauma Care Centers: Exploring the Gaps in Patient Care. 8, 2012 12:12 a.m.

Military 40

Military Forensics Documentation/Coding Emergency Nursing 40

Don't Forget the Bubbles

MARCH 11, 2024

Craniosynostosis needs urgent referral and is usually corrected operatively before a child’s first birthday. Craniosynostosis can lead to raised intracranial pressure and failure to thrive. and can worsen and become harder to correct over time. This can lead to intracranial hypertension and neurodevelopmental delay. Vollman, A. Hatfield, J.,

Radiology 59

Radiology Radiology Pediatrics Documentation/Coding 59

ACEP Now

MARCH 14, 2024

18 The finger is inserted through the stoma alongside the endotracheal tube and, while 90 percent success rate has been reported with this method in controlling bleeding, the pressure must be maintained until the patient is transferred to the operating room. 2013:1960-62. Ann Thorac Cardiovasc Surg. Scalise P, Prunk SR, Healy D, et al.

Operations 52

Operations Pediatrics Radiology Radiology 52

Northwestern EM Blog

MAY 16, 2022

Follow up CT should depend on the patient and ultrasound operator. Lastly the POCUS operators were ED physicians with training “recommended by ACEP.” In this study, 40.7% of those in the POCUS group and 27% in the formal ultrasound group underwent subsequent CT. References Fwu, C. Eggers, P. Kimmel, P. W., & Kirkali, Z.

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Pediatric Emergency Playbook

FEBRUARY 1, 2016

REBOA If you have access to resuscitative endovascular balloon occlusion of the aorta or REBOA, this may be an option to temporize the child to get him to the relative control of the operating room. 2013 Sep;184(1):352-7. 2013 Jun;48(6):1377-83. J Surg Res. Moore HB, Moore EE, Bensard DD. J Pediatr Surg. 2015 Oct 19.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

Pediatric Emergency Playbook

JUNE 1, 2017

Fontan Operation and the Single Ventricle. 2013; 34(3):489-491. 2013; 34(4). 2013; 8(2):61-63. 2013; 6(5):752-761. 2013; 57:812-819. References Congenital AboulHosn JA et al. Congenit Heart Dis. 2007; 2:2-11. Aliku TO et al. World Journal for Pediatric Congenital Heart Surgery. 2014; 5(4)L631-634.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Advanced Emergency Nursing from AENJ

JULY 9, 2015

They may be entrapped; have limited access; may be midway in an operating position that can’t be changed; may need to be sitting due to pulmonary edema, morbid obesity, aspiration prevention or for awake intubation. Video] Sep 15, 2013. Video] Nov 19, 2013. Most training is likewise done with the patient on a table.

Airway Management 40

Airway Management Pediatrics Resuscitation Emergency Nursing 40

PHEM Cast

SEPTEMBER 6, 2017

Qvigstad et al showed in again in Resuscitation in 2013, confirming inter-individual variation in effectiveness of CPR using ETCO2 as a surrogate for CO Trauma Deakin et al. (J. trauma 2004) showed that end-tidal CO2 may be of value in predicting outcome from major trauma (19). 2013;118(1):192-201. doi:10.1097/ALN.0b013e318278c8b6

CPR 52

CPR Resuscitation Operations Shock 52

ACEP Now

JULY 7, 2024

2 A study of routine EEG in the ED in 2013 found that five percent of ED patients with altered mental status had nonconvulsive seizures (of whom 75 percent were in nonconvulsive status epilepticus). Some institutions have the capability to perform real-time EEG monitoring and interpretation by a neurologist in the ED.

Seizures 52

Seizures Emergency Department Outcomes EMS 52

EB Medicine

JULY 8, 2019

Jeff: Do note, however that 2013 guidelines do not recommend one procedure over another and leave that decision up to local surgical expertise, patient specific risk factors, and treatment goals. Jeff: Even more shockingly, some series showed a 52% repeat operation rate. These patients often require emergent operative intervention.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EMDocs

OCTOBER 30, 2023

3 A study of CT use trends in the ED has shown increasing use of CTs by almost 60% from 2005 to 2013. Under standard operating protocols, residual contrast materials are usually wasted, according to current CDC and JC standards.

Radiology 101

Radiology Radiology Emergency Department Hospitals 101

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

Farrington] Rebuilding of outdated hospitals put emergency rooms on ground level with nearby X-ray service, and, ideally, sometimes closer to the Blood Bank and the Operating Rooms. 10/20/2013. We applied to "The Golden Hour" the attitudes and abilities that led to a man on the moon. There is also FOANed for Nursing.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Taming the SRU

FEBRUARY 19, 2024

12) Axillary While axillary arterial line placement has been uncommon, in the age of facile ultrasound operators it may become a more advantageous and accessible site particularly in patients with high BMIs. Shock 40(6):p 527-531, December 2013. | Placement is theoretically faster and easier than a radial arterial line.

Shock 59

Shock Resuscitation Ultrasounds Research 59