Ken Grauer, MD

JANUARY 5, 2024

Section 2F ( 6 pages = the " short " Answer ) from my ECG-2014 Pocket Brain book provides quick written review of the AV Blocks. Section 20 ( 54 pages = the " long " Answer ) from my ACLS-2013-Arrhythmias Expanded Version provides detailed discussion of WHAT th e AV Blocks are — and what they are not !

EKG/ECG 441

EKG/ECG Wellness 441

Pediatric EM Morsels

AUGUST 18, 2023

Rose 2014) They are the most frequently prescribed class of medications in adults; however, in children they are the least frequently prescribed class , <2% of antibiotics. Hersh 2014) Fluoroquinolone Use in Children: Indications for use Let’s keep this simple, Pseudomonas ! The low dose range (30 mg/kg) did show sporadic lesions.

Pediatrics 130

Pediatrics Infectious Diseases Seizures Hospitals 130

Ken Grauer, MD

MARCH 18, 2023

PEARL # 5: We could probably get a better idea of the sequence of events in today's case with some additional history that correlates the timing of ECG #1 — with the timing of symptom onset — and — with the presence ( as well as relative severity ) of chest pain at the time the initial tracing in Figure-1 was done.

EKG/ECG 195

EKG/ECG Wellness 195

Ken Grauer, MD

JULY 29, 2023

This young woman did well for a year — but unfortunately suffered another cardiac arrest, from which she could not be resuscitated. Epsilon waves are best seen in leads V1 , V2 — and a bit less well seen in V3,V4. MRI confirmed ARVC. About A RVC/ A RVD. ARVD is a genetic disorder of the myocardium.

EKG/ECG 370

EKG/ECG Resuscitation Documentation/Coding Hospitals 370

PulmCCM

OCTOBER 28, 2024

However, in those trials, glucocorticoids were given well after the onset of STEMI. 2014 Apr 29;63(16):1593-603. Epub 2014 Feb 13. It was hypothesized that much earlier treatment with steroids, i.e., by paramedics en route to the hospital, might improve outcomes. Seropian IM, Toldo S, Van Tassell BW, Abbate A. J Am Coll Cardiol.

Outcomes 98

Outcomes Hospitals Wellness 98

The Skeptics' Guide to EM

JULY 8, 2023

She looks well enough to go home but asks if she should be prescribed oseltamivir (Tamiflu) because some of her friends have been given it recently by their doctors. Safety issues popped up soon after widespread use of the drug including neuropsychiatric effects as well as the more common adverse effects of nausea and vomiting.

CDC 94

CDC Hospitals EMS Emergency Department 94

Ken Grauer, MD

MARCH 7, 2023

C ONCLUSION of T oday's C ase : The subtle-but-real ST-T wave changes in today's initial tracing — as well as the equally subtle-but-real " dynamic " ST-T wave changes seen in the repeat tracing — went unrecognized for 9 hours. Fortunately — this patient did well, and was discharged with surprisingly good LV function.

EKG/ECG 195

EKG/ECG Wellness 195

Ken Grauer, MD

APRIL 13, 2024

The PR interval for the PACs ( YELLOW arrow P waves ) in ECG #2 appear to have a slightly longer PR interval — but PR interval duration of PACs may vary depending on from where in the atria the PACs arise, as well as conduction velocity through the atria, which may be altered by early occurrence of these supraventricular impulses.

EKG/ECG 292

EKG/ECG Wellness 292

The Skeptics' Guide to EM

APRIL 20, 2024

A clinical decision tool called the STUMBL score was derived and validated by Battle et al in 2014 [3]. It did not perform as well which is not unusual for a clinical decision instrument [5]. It risks stratified older patients with blunt trauma.

Fractures 82

Fractures Ultrasounds Emergency Department CDC 82

Sensible Medicine

APRIL 14, 2024

For instance, CAR-T was given to myeloma patients in 2014, but we only learned it can cause Parkinsonism in 2021. A few companies will get rich doing this, and many well-intentioned people will be cheering us over the cliff. My biggest concern with the change wasn’t the cost however, but the safety risk.

Patient Safety 135

Patient Safety Academics Outcomes Wellness 135

EMDocs

JUNE 22, 2024

The newborn is doing well, but the mother is complaining of shortness of breath and chest pain. Epub 2014 Jun 30. A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. She had a precipitous delivery while the ambulance was pulling in. Triage vital signs (VS) include BP 88/45, HR 121, T 97.1,

EMS 96

EMS Resuscitation Blood Transfusions Seizures 96

Don't Forget the Bubbles

JANUARY 24, 2024

The first human trials for children with SRSE were conducted in 2014 where 2 patients responded well to the treatment and there have been encouraging results in open label adult trials more recently. 2014 Dec;76(6):911-5. Epub 2014 Nov 11. There are small scale case series of its use in FIRES with some success.

Seizures 111

Seizures Pediatrics Outcomes Hyperthermia / Hypothermia 111

Ken Grauer, MD

FEBRUARY 9, 2024

P wave "i" seems perfectly positioned to conduct beat #5 to the ventricles ( in a similar way that P waves "k" and "m" seemed well positioned to be conducting beat #6 and beat #7 , respectively ). Section 2F ( 6 pages = the " short " Answer ) from my ECG-2014 Pocket Brain book provides quick written review of the AV Blocks.

EKG/ECG 262

EKG/ECG Operations Wellness 262

ACEP Now

AUGUST 14, 2024

This recommendation is a departure from the 2014 guideline iteration that only recommended against CCBs in patients with decompensated heart failure. as well as conversion to sinus rhythm (OR 1.75; 95 percent CI 1.08-2.84).7 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation. J Emerg Med.

Emergency Department 105

Emergency Department Outcomes Research Wellness 105

ALiEM

APRIL 12, 2023

The thin alcohol layer serves to eliminate any air bubbles under the adhesive cover as well as minimizes residual adhesive material sticking to the probe when removing the cover. Hynynen, 10.08 – Ultrasound Therapy, Editor(s): Anders Brahme, Comprehensive Biomedical Physics, Elsevier, 2014, Pages 153-168, ISBN 9780444536334.

Ultrasounds 103

Ultrasounds Emergency Department Resuscitation Wellness 103

EMDocs

DECEMBER 20, 2023

In 2014 I was asked by 4 different plaintiff attorneys to review 4 separate cases of a missed SEA, all in Washington State. That you considered an SEA, tested for it, and the result was negative is proof that you made a judgment call well within the standard of care. Missed SEA’s were the genesis of Med Mal Insights.

Patient Safety 77

Patient Safety Wellness 77

Taming the SRU

APRIL 14, 2024

You may place cold packs or ice packs to the hernia site to help reduce inflammation and swelling, as well as to assist in local analgesia. Symptoms include persistent tenderness in the area, as well as symptoms of obstruction including nausea, vomiting, and pain, despite reduction. (2) 6, June 2014, pp. 6, June 2005, pp.

Ultrasounds 92

Ultrasounds Emergency Department Pediatrics Radiology 92

RebelEM

FEBRUARY 29, 2024

Patient data anonymized when presented to adjudication committee to avoid detection bias Well-balanced patient characteristics between groups. Critical Care 2014 , 18 (2), 208. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014 , 35 (8), 915-936.

CDC 114

CDC Radiology Radiology Outcomes 114

Ken Grauer, MD

OCTOBER 27, 2023

A cknowledgment : My appreciation to Hans Helseth ( from Minnesota, USA ) for the case and this tracing ( and CREDIT to Hans for his well-drawn laddergram that I have slightly modified ). = Section 2F ( 6 pages = the " short " Answer ) from my ECG-2014 Pocket Brain book provides quick written review of the AV Blocks.

EKG/ECG 254

EKG/ECG Resuscitation Hospitals Wellness 254

Ken Grauer, MD

APRIL 23, 2023

S T- T Wave Changes — There is coved ST elevation in high-lateral leads I and aVL — as well as in lead V2 ( and to a much lesser extent in lead V1 ). The patient did well with conservative management — and both ECG and the rhythm abnormality resolved as his clinical condition improved.

EKG/ECG 195

EKG/ECG Wellness Operations Hospitals 195

Dr. Smith's ECG Blog

AUGUST 4, 2024

The patient did well. == MY Comment , by K EN G RAUER, MD ( 8/4 /2024 ): == I thought today's case by Dr. Meyers is an important one for emergency providers for a number of reasons. A DDENDUM ( 8/3/2024 ) : In the following 5 Figures — I post written summary from my ECG-2014-ePub on the ECG diagnosis of A cute P ericarditis.

EKG/ECG 93

EKG/ECG Wellness Operations Emergency Department 93

Don't Forget the Bubbles

AUGUST 23, 2023

Definitive emotional support is critical to our emotional and psychological well-being. 2014) “Death of a child in the emergency department” American Academy of Pediatrics. This gives rise to feelings of failure alongside the feelings of grief. Psychological harm occurs. & MacNeil, G. Best Practices in Mental Health. 2 (57-68).

Emergency Department 98

Emergency Department Resuscitation Documentation/Coding Best Practices 98

EMergucate

DECEMBER 7, 2014

I presented this talk at the ACEM Annual Scientific Meeting 2014 – Monday 8/12/14 References Mortality of Untreated … Continue reading →

Wellness 52

Wellness 52

RebelEM

JANUARY 25, 2024

CHF, in particular, lends itself well to diagnosis and treatment with PoCUS, as it readily reveals the presence of B lines. 2014 Aug;2(8):638-46. Epub 2014 Jul 3. Furthermore, the serial US group included more patients with conditions detectable with US. vs. 18.3%). vs. 74%), consolidation (37.3% Lancet Respir Med.

Ultrasounds 126

Ultrasounds Outcomes COPD Hospitals 126

Emergency Medicine Journal

SEPTEMBER 25, 2024

Background The number of asylum seekers awaiting decisions on their claims in the UK has more than tripled since 2014. Study findings can potentially contribute to the development of ED-specific guidelines as well as inform wider health policy and provide a focus and direction for further research.

Research 52

Research Hospitals Wellness 52

Don't Forget the Bubbles

AUGUST 9, 2023

There is no pain or discharge, no lymphadenopathy, and she is otherwise well. 2014) Cardiovascular risk factors in children with long-standing untreated idiopathic subclinical hypothyroidism. Her parents first noticed it when she was two years old, and since then, it has gradually been increasing in size. J Clin Endocrinol Metab.

Ultrasounds 98

Ultrasounds Pediatrics Wellness 98

Emergency Medicine Ireland

OCTOBER 14, 2024

Similarly loculations can be very easily seen with ultrasound, better than CT it seems but again don’t necessarily correlate that well with empyema. Well, adding extra or bigger drains is all very reasonable and it would seem wise to involve a thoracic surgeon at some point. 11, 1419–1425 (2014). LDH>1000 Sugar <2.2

Wellness 52

Wellness Ultrasounds 52

ALiEM

SEPTEMBER 27, 2023

What well-known adverse reaction results from ingestion of the pictured mushroom? Disulfiram-like reaction with ethanol consumption Coprinus atramentarius or Ink Cap mushroom is well known to cause a disulfiram-like reaction when it is consumed prior to ethanol. The post was peer reviewed on behalf of ACMT by Drs. Mushrooms, Coprine.

Seizures 67

Seizures Academics Wellness 67

Taming the SRU

JUNE 12, 2023

However, there have been no studies statistically powered well enough regarding dog bite lacerations to confirm or dispute this claim. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Considerations for antibiotics. 2014;59(2):147-159.

Infectious Diseases 102

Infectious Diseases Emergency Department Administration Academics 102

Pediatric EM Morsels

MARCH 17, 2023

In the US, the venomous snakes include rattlesnakes , copperheads, cottonmouths/water moccasins , and coral snakes [ CDC, 2021 ] Rattlesnakes live all across the United State s Copperheads inhabit the eastern U.S. as far west as Texas Cottonmouths/Water Moccasins live in the southeastern U.S.

CDC 130

CDC Poisoning Pediatrics Shock 130

PHEM Cast

JULY 14, 2016

Crane T, Cooke MW, Wellings R, Wayte S, Higgins J. 2014 Feb 11;7(4):251–5. 2014 Mar 15;31(6):531–40. 2014 Jul 3;14(1):1–5. 2014 Mar 15;31(6):531–40. Elsevier Ltd; 2015 Apr 1;46(4):528–35. Smyth M, Cooke MW. Value of a rigid collar: in need of more research and better devices. Emergency Medicine Journal.

Fractures 52

Fractures Hospitals Shock Research 52

EMDocs

FEBRUARY 7, 2024

Multiple well-designed, multicenter, multinational studies suggest GLP-1 agonists are associated with improved glucose control in diabetes type 2 and approximately a 15% reduction in weight over 1-2 years (around 2/3s of patients regain weight if treatment is stopped). 2014 Fall-Winter;11(3-4):202-30. Obesity affects over 40% of U.S.

Allergic Reactions 75

Allergic Reactions Anaphylaxis Dehydration Wellness 75

EMDocs

JANUARY 11, 2025

Well keep it short, while you keep that EM brain sharp. Admission allows for close monitoring, given the risks of perforation, ischemic bowel, and ulceration, as well as appropriate management of the condition and patient symptoms. link] com staff (2014). Gill, M., & Ganti, L. Cureus, 15(12), e50511. ISSN 2002-4436.

EMS 72

EMS Sepsis Shock Fluid Resuscitation 72

Ken Grauer, MD

FEBRUARY 24, 2023

As a result he was treated with potent medications ( that each have potential for side effects ) — and told not to work for 4 weeks — as well as being given a medical diagnosis that will stay on his chart. In the following 5 Figures — I post written summary from my ECG-2014-ePub on the ECG diagnosis of A cute P ericarditis.

EKG/ECG 195

EKG/ECG Hospitals Wellness 195

Don't Forget the Bubbles

FEBRUARY 19, 2024

Studies like those conducted by Granic, Lobel, and Engels (2014) highlight how problem-solving skills honed in gaming environments can translate to everyday life. The Role of Gaming in Emotional Well-being Stress Relief: Gaming can be a form of relaxation and stress relief, providing an escape from the pressures of daily life.

Academics 59

Academics Leadership Research Teamwork 59

The Skeptics' Guide to EM

MAY 14, 2022

He denies numbness or paresthesia in both lower extremities, as well as bowel or bladder dysfunctions. These include: acetaminophen ( Williams et al Lancet 2014), steroids ( Balakrishnamoorthy et al Emerg Med J 2014) and benzodiazepines ( Friedman et al Ann Emerg Med 2017).

Emergency Department 52

Emergency Department Research Wellness 52

The Skeptics' Guide to EM

SEPTEMBER 12, 2020

I have discussed burnout and wellness a number […] The post SGEM Xtra: The Water is Wide first appeared on The Skeptics Guide to Emergency Medicine. Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Shanafelt et al.

Emergency Department 52

Emergency Department Wellness 52