Ken Grauer, MD

APRIL 5, 2024

For additional examples of this phenomenon whereby automatic truncation of an EMS ECG may mistakenly result in LVH serving to mimi c ischemia — Check out My Comment at the bottom of the page of the following posts in Dr. Smith's ECG Blog — the November 29, 2023 post — June 20, 2020 — March 31, 2019 — March 29, 2019 — and t he December 27, 2018 post.

EKG/ECG 236

EKG/ECG EMS Hospitals 236

EMDocs

NOVEMBER 13, 2024

Paracentesis performed within 12 hours was associated with lower in-hospital mortality and shorter length of stay when compared to paracentesis performed within 12-72 hours (13% compared to 27%). 2018 Apr;36(4):689-698. The benefit of paracentesis on hospitalized adults with cirrhosis and ascites. 2018 Dec;15:41-47.

Hyperthermia / Hypothermia 103

Hyperthermia / Hypothermia Ultrasounds Shock Hospitals 103

Mind The Bleep

FEBRUARY 2, 2025

In some hospitals, there is an infection ward round and MDTs for selected patients, however elsewhere your phone call may be all the information micro receive about the patient whose samples they are processing. Also, in larger hospitals, virology may be a separate department with its own advice system. Around 20 on Amazon.

Radiology 98

Radiology Radiology Documentation/Coding Hospitals 98

EMDocs

DECEMBER 1, 2024

Treatment significantly shortens the duration of illness, and early initiation of therapy can prevent severe complications and reduce the length of hospitalization. 2018 Oct-Dec;55(4):258-264. Answer : Murine Typhus Epidemiology: Murine typhus is endemic in several parts of the U.S.: pregnant patients). J Vector Borne Dis.

EMS 101

EMS Infectious Diseases Shock Airway Management 101

Pediatric EM Morsels

JULY 21, 2023

cats and dogs have their own GCS scores [Lapsley 2019, Ash 2018] Moral of the Morsel Modified can make it Merrier! 2018 Jun;128(6):1612-1620. 2018): 192–200. Fun fact for animal lovers!- Brennan PM, Murray GD, Teasdale GM. Simplifying the use of prognostic information in traumatic brain injury. J Neurosurg.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

Emergency Medicine Journal

OCTOBER 26, 2023

Objective Over 300 000 cases of out-of-hospital cardiac arrests (OHCAs) occur each year in the USA and Europe. Methods We investigated four 18-month periods between 2005 and 2018. Primary outcome was survival at hospital discharge with a good neurological outcome.

Resuscitation 75

Resuscitation Basic Life Support Hospitals CPR 75

ACEP Now

DECEMBER 8, 2024

ED visit estimates and utilization rates for 2018 to 2022 are shown in Figure 1. Because older patients are admitted to the hospital more often, they disproportionately affect ED staff time and work. The ED is clearly perceived as serving the needs of patients and as the front door to the hospital. Click to enlarge.

CDC 52

CDC Emergency Department Hospitals 52

Taming the SRU

JUNE 11, 2023

End-tidal carbon dioxide measured at emergency department triage outperforms standard triage vital signs in predicting in-hospital mortality and intensive care unit admission. Enrollment period was from February 2016 to August 2018. The primary outcome was in-hospital mortality. Ladde JG, Miller S, Chin K, et al.

Hospitals 88

Hospitals Emergency Department EMS Outcomes 88

Dr. Smith's ECG Blog

OCTOBER 6, 2024

An ECG was recorded immediately at triage and, at this hospital, the Queen of Hearts is routinely used to determine cath lab activation. This patient had the onset of chest pain 24 hours before arrival to the ED. Here is that ECG: Original ECG What do you think? There is ST depression maximal in V1-V4, which is diagnostic of posterior OMI.

Hospitals 79

Hospitals EKG/ECG 79

Emergency Medicine Journal

DECEMBER 30, 2024

Methods Non-random purposive sampling was used to recruit doctors and nurses from EDs in five hospitals in Cape Town. Data collection took place over 8 weeks between June and August 2018. By capturing stories in the ED, valuable insights can be gained into organisational culture and identity.

Emergency Department 52

Emergency Department Hospitals 52

American Medical Compliance

APRIL 10, 2023

MeToo’s Impact on Sexual Harassment in Hospitals Victims have recently gone to Twitter and used the hashtag #MeTooMedicine, connecting these individuals with others that share their experiences. Reference Christina Jewett (22 March 2018). Women in healthcare are saying #MeToo about sexual harassment in hospitals.

Hospitals 52

Hospitals Wellness 52

ACEP Now

JANUARY 5, 2025

Dr. Helman is an emergency physician at North York General Hospital in Toronto. Published August 6, 2018. Special thanks to Dr. Kevin Wasko, guest expert on the EM Cases podcast on this topic, who inspired this column. Anesthetic management of the pediatric bleeding tonsil. Paediatr Anaesth. 2010;20(11):982-986. Morgenstern J.

Airway Management 98

Airway Management Operations Resuscitation Pediatrics 98

The Trauma Pro

OCTOBER 18, 2024

Bottom line: I have visited a number of hospitals that successfully use the Nelson score to assist with admission service decision-making while the patient is still in the emergency department. Journal of Trauma Nursing, 25 (3), 192-195, 2018. The only gray zone is the score of 4 or 5. Am Surg, 88(7), 1537-1540, 2022.

Documentation/Coding 147

Documentation/Coding Emergency Department Hospitals 147

Don't Forget the Bubbles

JUNE 14, 2023

In this talk, Ben dissects the healthcare system and finds that hospitals have immune systems to protect them from unnecessary referrals, and one of the primary neutrophils they have is shame; creating a sense of shame to be calling and a sense of shame for not knowing what to do. So why isn’t it?

Pediatrics 135

Pediatrics Hospitals 135

Pediatric EM Morsels

AUGUST 18, 2023

Wirth 2018) One study including 4.4 Etminan 2019) In Belgium between 2010 – 2013, of the 262 children treated with fluroquinolones while hospitalized, only 17% were used for labelled indications. Meesters 2018) Resistance is growing (likely from inappropriate / overuse)! 451 pediatric patients were included. 37(8):e207-e213.

Pediatrics 130

Pediatrics Infectious Diseases Seizures Hospitals 130

Ken Grauer, MD

JUNE 6, 2023

Apparently while waiting on the hospital floor for the decision regarding optimal aortic replacement — the patient took one of his sublingual NTG ( nitroglycerin ) tablets. The November 4, 2018 post in Dr. Smith's ECG Blog — My Comment ( at the bottom of the page ) reviews 3 ECG Clues for rapid recognition of erroneous lead V1,V2 placement.

EKG/ECG 195

EKG/ECG Hospitals Wellness Resuscitation 195

EMDocs

JANUARY 11, 2025

Pediatric Emergency Care 34(9):p e159-e160, September 2018. | Fecal Impaction and Nonperforated Stercoral Colitis: Red Flags for Poor Outcomes. Cureus, 15(7), e41705. link] Proulx, Erik MD * ; Glass, Casey MD . Constipation-Associated Stercoral Colitis. DOI: 10.1097/PEC.0000000000001600 Abdom Radiol (NY). 2023 Oct;48(10):3050-3062.

EMS 94

EMS Sepsis Shock Fluid Resuscitation 94

Don't Forget the Bubbles

MARCH 19, 2024

This has coincided with a widespread shortage of specialist placements for children facing behavioural, psychiatric, and child protection challenges, leading to an over-reliance on the placement of these children in hospitals. A paediatric social admission is one where a child is admitted to the hospital but not for a medical reason.

Hospitals 52

Hospitals Psychiatric Documentation/Coding Pediatrics 52

Emergency Medicine Journal

OCTOBER 26, 2023

Background Blood transfusion for bleeding trauma patients is a promising pre-hospital intervention with potential to improve outcomes. However, it is not yet clear which patients may benefit from pre-hospital transfusions. Decisions are influenced by experience and are subject to bias.

Blood Transfusions 52

Blood Transfusions Hospitals Outcomes 52

The Trauma Pro

OCTOBER 25, 2024

To sum up, both are equally effective in controlling hemorrhage, but the hospital costs for patients undergoing angioembolization are significantly less. The primary outcome was the development of VTE during the hospitalization. DVT was detected using duplex ultrasound, and PE was detected by CT angiography.

Fractures 113

Fractures Head Injuries Operations Ultrasounds 113

ACEP Now

JULY 7, 2023

Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. Heart disease and stroke statistics—2018 update: A report from the American Heart Association. Benjamin EJ, et al. Circulation. 2018;137(12).

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

The Skeptics' Guide to EM

FEBRUARY 11, 2024

Date: February 11, 2024 Guest Skeptic: Nirdosh Ashok Kumar, Emergency Medicine Specialist – Aga Khan University Hospital, Karachi, Pakistan. […] The post SGEM#430: De Do Do Do, De Dash, Dash DAShED – Diagnosing Acute Aortic Syndrome in the ED. EMJ Nov 2023. first appeared on The Skeptics Guide to Emergency Medicine. EMJ Nov 2023.

Emergency Department 130

Emergency Department Resuscitation Hospitals EKG/ECG 130

The Trauma Pro

SEPTEMBER 14, 2023

” This guideline was implemented in 2018-2019, and patients presenting before implementation were compared to those arriving after. It is a relatively minor one and will allow us to avoid placement of a few more chest tubes and to shave off a few days of hospital stay.

Resuscitation 124

Resuscitation Hospitals Wellness 124

EMDocs

SEPTEMBER 26, 2024

An attorney is consulted and a lawsuit filed against the hospital, the first ED physician, the EM group, and the PCP. Even if we don’t know who the second EP was, he was an agent of the hospital, so the hospital is also liable. J Am Coll Rad 15:4;639-647, April 1, 2018. You didn’t see your PCP as instructed.

Radiology 93

Radiology Radiology EKG/ECG Documentation/Coding 93

EMDocs

NOVEMBER 7, 2023

The recurrence rate and length of hospital stay were the same. Hospital stay was significantly shorter in the observation group (2 versus 3 days; P = 0·006). 2018 Jul;113(7):1045-1052.  Antibiotics Do Not Reduce Length of Hospital Stay for Uncomplicated Diverticulitis in a Pragmatic Double-Blind Randomized Trial. Clin

Sepsis 108

Sepsis Best Practices Hospitals Outcomes 108

Dr. Smith's ECG Blog

SEPTEMBER 26, 2023

See these 2 articles Association between pre-hospital chest pain severity and myocardial injury in ST elevation myocardial infarction: A post-hoc analysis of the AVOID study Author links open overlay panel [link] 1 Background We sought to determine if an association exists between prehospital chest pain severity and markers of myocardial injury.

EKG/ECG 121

EKG/ECG Hospitals Outcomes Wellness 121

EMDocs

JUNE 1, 2023

Take Aways: The data do not suggest that targeted hypothermia improves neurological function, reduces death, or reduces hospital length of stay as compared to normothermia. 2018; 320(21):2211-2220. Bradycardia: 18.8% Average ventilator days (8.3 Bradycardia: 18.8% Average ventilator days (8.3 Bradycardia: 18.8% Bradycardia: 18.8%

Hyperthermia / Hypothermia 76

Hyperthermia / Hypothermia Outcomes Hospitals Emergency Department 76

Greater Sydney Area HEMS

FEBRUARY 20, 2024

The cohort of patients that require this intervention in the pre-hospital setting are likely to be the most critically unwell patients we encounter. Anesthesiology 2018; 128 : 38–43. [v] Medicine 2018; 97 : e13661. Those who are shocked, shut down with limited or no other options for peripheral access require central access.

Ultrasounds 98

Ultrasounds Shock Research Operations 98

EMDocs

FEBRUARY 12, 2025

The patient also reported significant pain and had a Hospital Anxiety and Depression Scale (HADS) score indicating severe anxiety and depression. She had previously undergone carbon ion radiotherapy, receiving a cumulative dose of 75 GyE in 20 fractions over two courses from December 2020 to January 2021. a: Fluoroscopy dose management.

Best Practices 54

Best Practices Documentation/Coding Radiology Radiology 54

The Skeptics' Guide to EM

FEBRUARY 17, 2018

[display_podcast] Date: February 14th, 2018 Reference: Alam N et al. Case: EMS is dispatched to a retirement […] The post SGEM#207: Ahh (Don’t) Push It – Pre-Hospital IV Antibiotics for Sepsis. display_podcast] Date: February 14th, 2018 Reference: Alam N et al. The Lancet Nov 2017. per hour (Kumar et al).

Sepsis 40

Sepsis Hospitals Fluid Resuscitation Administration 40

Emergency Medicine Journal

FEBRUARY 20, 2024

Background Andexanet alfa was approved in 2018 for reversal of direct oral anticoagulants but due to issues of cost and access, four-factor prothrombin complex concentrate (4F-PCC) continues to be used for this indication. Primary outcome includes rate of mortality/hospice at hospital discharge.

Hospice 74

Hospice Outcomes Hospitals 74

Dr. Smith's ECG Blog

MAY 3, 2024

In fact, most do not make it to the hospital alive, which explains why only a tiny percent of OMI are due to full LM occlusion. Today's patient did make it to the hospital — but was in cardiogenic shock, and despite valiant attempt at treatment, succumbed soon after. Moreover, left main occlusion often presents near death.

Shock 128

Shock EKG/ECG Hospitals EMS 128

RebelEM

JANUARY 29, 2024

JACC Cardiovasc Interv 2018. in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below). A Randomized Trial of the Optimum Duration of Acoustic Pulse Thrombolysis Procedure in Acute Intermediate-Reisk Pulmonary Embolism: The OPTALYSE PE Trial. PMID: 30025734 Sharifi M et al.

Stroke 133

Stroke Outcomes Hospitals Administration 133

Sensible Medicine

NOVEMBER 14, 2023

In one scene Shakur asks his friend, played by Roth, to stab him because a knife wound seems to be the only way to get past the emergency room's crowded waiting area and into the hospital. A systematic review of studies from 2013-2018 examined 23 papers that studied residential treatment programs lasting from four weeks to 12 months.

Research 131

Research Psychiatric CDC Best Practices 131

The Skeptics' Guide to EM

SEPTEMBER 29, 2018

[display_podcast] Date: September 21st, 2018 Reference: Kawano et al. Intraosseous Vascular Access Is Associated With Lower Survival and Neurologic Recovery Among Patients With Out-of-Hospital Cardiac Arrest. display_podcast] Date: September 21st, 2018 Reference: Kawano et al. BLS for out-of-hospital cardiac arrest (OHCA).

Basic Life Support 52

Basic Life Support Airway Management CPR Resuscitation 52

The Skeptics' Guide to EM

FEBRUARY 23, 2019

Association Between Early Intravenous Fluids Provided by Paramedics and Subsequent In-Hospital Mortality Among Patients With Sepsis. JAMA 2018 Guest Skeptics: Jay Loosley is the Superintendent of Education at Middlesex-London Paramedic Service. This led to a petition requesting the SSC retract their 2018 guidelines ( SGEM Xtra ).

Sepsis 52

Sepsis Administration Documentation/Coding Hospitals 52

The Skeptics' Guide to EM

DECEMBER 7, 2018

Date: December 6th , 2018 Reference: Perkins et al. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. Date: December 6th , 2018 Reference: Perkins et al. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest.

Advances Cardiac Life Support (ACLS) 52

Advances Cardiac Life Support (ACLS) CPR Resuscitation Hospitals 52