2019 - Emergency Care Today

ECG Blog #432 — "Should I Shock this Patient?"

Ken Grauer, MD

MAY 31, 2024

The September 27, 2019 post — for the Rowlands & Moore article with the above-noted formulas for recognizing the “culprit” extremity. The September 22, 2019 post — intermittent ST-T wave artifact. The August 26, 2019 post — baseline artifact. The October 17, 2020 post — for a 70-year old woman with " Artifactual VT ".

Shock

Shock EKG/ECG Seizures

Fires in 2019 and the Prolonged Consequences

Emergency Live

JULY 26, 2023

Global fire crisis, a problem since 2019 Before the Pandemic, there were other crises that unfortunately went to be rather forgotten. In this case we have to describe the issue of fires, which in 2019 presented itself as a virtually global threat.

ECG Blog #415 — The Cath showed NO Occlusion!

Ken Grauer, MD

FEBRUARY 3, 2024

I i llustrate the ECG finding of T-QRS-D below in Figure-3 , which I've excerpted from My Comment i n the November 14, 2019 post in Dr. Smith's ECG Blog. The November 14, 2019 post in Dr. Smith’s ECG Blog ( Please scroll down to the BOTTOM of the page for My Comment and illustration of the phenomenon of T-QRS-D = T erminal QRS D istortion ).

EKG/ECG

EKG/ECG Resuscitation Hospitals Wellness

ECG Blog #406 — To Do Additional Leads?

Ken Grauer, MD

DECEMBER 1, 2023

For my clarifying Figure illustrating T-QRS-D ( 2nd bullet ) — See My Comment at the bottom of the page in Dr. Smith’s November 14, 2019 post. = The February 16, 2019 post in Dr. Smith's ECG Blog — My Comment ( at the bottom of the page ) emphasizes utility of the M irror T est for diagnosis of acute Posterior MI.

EKG/ECG

EKG/ECG EMS Wellness

Congenital Pulmonary Airway Malformation (CPAM)

Pediatric EM Morsels

JUNE 30, 2023

Fetal Congenital Cystic Adenomatoid Malformation (CCAM): Pathogenesis, Diagnosis, and Clinical Management: A Case Report. Clinical and Experimental Obstetrics & Gynecology. Dec 46 (6) 999–1002, [link]. Leblanc C, Baron M, Desselas, E, Phan, MH, Rybak A, Thouvenin G, Lauby C, Irtan S.

Ultrasounds

Ultrasounds Pediatrics Operations EMS

ECG Video Blog #407 (292): Why the Patient Died?

Ken Grauer, MD

DECEMBER 8, 2023

The January 9, 2019 post in Dr. Smith's ECG Blog ( Please scroll down to the bottom of the page to see My Comment ). ECG Blog #194 — Reviews how to tell IF the “culprit” ( ie, acutely occluded ) artery has reperfused using clinical and ECG data. ECG Blog #115 — Shows an example of how drastically the ECG may change in as little as 8 minutes.

EKG/ECG

EKG/ECG Hospitals

Superior Mesenteric Artery Syndrome (SMA Syndrome) in Children

Pediatric EM Morsels

AUGUST 4, 2023

Okamoto, 2019) Superior Mesenteric Artery Syndrome: Presentation Presenting complaints are often vague but include epigastric abdominal pain, gastric distension, early satiety, and vomiting. Okamoto, 2019) In unable to tolerate PO intake next steps include nasojejunal tube feed or TPN if necessary. Ann Vasc Surg. 76: 514-535.

Pediatrics

Pediatrics Burns Operations Ultrasounds

Imported Malaria

Pediatric EM Morsels

NOVEMBER 3, 2023

2019; 17: 98. 2019; 47(2): 183–193. PMID: 27186577 Conroy AL, Opoka RO, Bangirana P, Idro R, Ssenkusu JM, Datta D, Hodges JS, Morgan C, John CC. Acute kidney injury is associated with impaired cognition and chronic kidney disease in a prospective cohort of children with severe malaria. Pediatr Clin N Am 69 (2022) 47–64. 8 Dec 2022.

Seizures

Seizures Pediatrics CDC Infectious Diseases

Glasgow Coma Scale in Children

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! 2019 Jul;20(7):660-666. 2019 Sep;241:112-118. Epub 2019 Apr 22. 2019 Jul;20(7):682-683. 2019): 478–483. Fun fact for animal lovers!- Pediatr Crit Care Med. doi: 10.1097/PCC.0000000000001938.

Head Injuries

Head Injuries Pediatrics Outcomes Shock

ECG Blog #434 — WHY Did this Patient Arrest?

Ken Grauer, MD

JUNE 14, 2024

I i llustrate the ECG finding of T-QRS-D below in Figure-3 , which I've excerpted from My Comment in the November 14, 2019 post in Dr. Smith's ECG Blog. Figure-3: Comparison between ST elevation in lead V3 due to a repolarization variant ( TOP — from 4/27/2019 ) — vs acute OMI ( BOTTOM — from 9/20/2015 ), which manifests T-QRS-D ( See text ).

EKG/ECG

EKG/ECG Wellness Hospitals

ECG Blog #451 — Premature Closure.

Ken Grauer, MD

OCTOBER 10, 2024

The October 16, 2019 post in Dr. Smith's ECG Blog. Please check out the November 12, 2019 post in Dr. Smith's ECG Blog — in which I reviewed the case of a different kind of regular SVT Rhythm ( AFlutter ). ECG Blog #40 — Another regular SVT that turned out to be AFlutter.

EKG/ECG

EKG/ECG Sepsis Wellness

ECG Blog #424 — Proportionality and the "Cut Off"

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

EKG/ECG EMS Hospitals

Acute Transverse Myelitis in Children

Pediatric EM Morsels

JUNE 14, 2024

Tavasoli 2018, Wolf 2012) More common in adults; children comprise 20% of total cases (Pidcock 2007, Wang 2019) Bimodal age distribution (Absoud 2016) Children < 5 years Children > 10 years Symptoms evolve over 2-4 days and peak at 5-6 days (Absoud 2016) ATM may occur alone OR as part of another disorders (e.g.

Pediatrics

Pediatrics EMS Outcomes

The Broselow-Luten System

Pediatric EM Morsels

OCTOBER 27, 2023

2019 Jan;22(1):147-156. x exp[0.02 x length or height (cm)] There is a great review article that lists many other weight estimation formulae. Accuracy of the Broselow Tape in South Sudan, “The Hungriest Place on Earth” Acad Emerg Med. 2016;23(1):21-28. doi:10.1111/acem.12854 Public Health Nutr. doi: 10.1017/S1368980018002549.

Pediatrics

Pediatrics Resuscitation Documentation/Coding Wellness

ECG Blog #412 — Is Cardiac Cath Indicated?

Ken Grauer, MD

JANUARY 13, 2024

The March 31, 2019 post in Dr. Smith's ECG Blog — My Comment ( at the bottom of the page ) illustrates the potentially misleading effect the pre-hospital ECG may have in patients with LVH , by cutting off S wave voltage in the anterior leads.

EKG/ECG

EKG/ECG Hospitals

Ocular POCUS and ICP elevation

Mount Sinai EM

OCTOBER 10, 2024

2019 , included all ages and any reference standard. 2019) , of 6 studies with 352 patients, established a single ONSD cutoff of 5 mm to detect elevated ICP. ICP and ONSD had a correlation coefficient of 0.7. All studies defined elevated ICP as >20, however ONSD cutoff varied from 4.8

Urgent Care

Urgent Care Ultrasounds

Neurogenic Shock in Children

Pediatric EM Morsels

SEPTEMBER 22, 2023

McGraw Hill Education; 2019:104-109 Dave S, DAHLSTROM JJ. McGraw Hill Education; 2019:125-138 Ziu E, Mesfin FB. References Coleman-Satterfield, TT. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. In: Strange and Schafermeyer’s: Pediatric Emergency Medicine. 5 th Edition. Neurogenic Shock. Updated 2022 Feb 10]. 5 th Edition.

Shock

Shock Pediatrics Hyperthermia / Hypothermia Dislocations

ECG Video Blog #408 (392) — 20 Minutes Later.

Ken Grauer, MD

DECEMBER 15, 2023

The January 9, 2019 post in Dr. Smith's ECG Blog ( Please scroll down to the bottom of the page to see My Comment ). The importance of the new OMI ( vs the old STEMI ) Paradigm — See My Comment in the July 31, 2020 post in Dr. Smith's ECG Blog. This case is remarkable for the dynamic ST-T wave changes that are seen.

EKG/ECG

EKG/ECG EMS Hospitals

Traveling Ticks: Tickborne Illnesses and International Travel

Pediatric EM Morsels

APRIL 5, 2024

Silva-Ramos 2021) Majority of cases arise from travel to South Africa. (Frean 2019) The classic triad described is fever, eschar and rash. Ricardi 2019) Tick-Borne Encephalitis has a biphasic pattern of symptoms. Ricardi 2019) Initial symptoms are nonspecific and include fever, malaise, headache, nausea, vomting and myalgias.

CDC

CDC Infectious Diseases Pediatrics Wellness

Direct Oral Anticoagulant (DOAC) Reversal: Part 1

The Trauma Pro

DECEMBER 20, 2024

Effective October 2019, Medicare agreed to reimburse a hospital about $18,000 for Andexxa over and above the DRG for the patient’s care. NEJM 380(14):1326-1335, 2019. Neurocrit Care epub ahead of print, 22 Oct 2019. So, we don’t really know how useful it is when treating bleeding after DOAC administration.

Head Injuries

Head Injuries Administration Hospitals

Proximal Tibiofibular Joint Dislocation in Children

Pediatric EM Morsels

JULY 7, 2023

Horan, 2006 ] Anatomy of the PTF Joint [ Cunningham, 2019 ] The PTF joint is a synovial joint between the lateral condyle of the tibia and the head of the fibula. Cunningham, 2019 ] Treatment [ Horan, 2006 ] 1st option for Subluxation and Anterolateral Dislocation is Manual Reduction ( similar to reducing that Nursemaid’s Elbow ).

Dislocations

Dislocations Fractures Pediatrics EMS

Andexanet alfa: expensive and harmful?

First 10 EM

MAY 27, 2024

Connolly 2019) At that point, I concluded that andexanet alfa should clearly not be used (although our pharmacies didn’t listen and wasted a lot […] The post Andexanet alfa: expensive and harmful?

EMS

MEDALL Lecture Slides — Blog #351 — Posterior Leads.

Ken Grauer, MD

OCTOBER 29, 2023

For my clarifying Figure illustrating T-QRS-D ( 2nd bullet ) — See My Comment at the bottom of the page in Dr. Smith’s November 14, 2019 post. Smith’s ECG Blog with 20-minute video talk by Dr. Meyers on The O MI M anifesto.

EKG/ECG

Typhoid Fever in Children

Pediatric EM Morsels

OCTOBER 6, 2023

(Forster, 2021) Transmission is by Fecal-Oral route (Chiodini 2018) Incubation period 6-30 days after exposure (Chiodini 2018) Salmonella typhi produces an endotoxin although its clinical significance is not yet well understood (Gibani 2019) Two typhoid vaccines are available for those > 6 m/o and are 50-80% effective. Lancet Infect Dis.

Pediatrics

Pediatrics CDC Seizures Documentation/Coding

Acute Esophageal Variceal Bleeding in Children

Pediatric EM Morsels

JUNE 9, 2023

Specific Therapies for Variceal Hemorrhage : [ Luoto, 2020 ; Castillo, 2019; Garcia-Tsao, 2007 ] Antibiotic prophylaxis (usually for 7 days) Ceftriaxone is reasonable 1st choice. Castillo, 2019 ] Somatostatin (or its analogues, like Octreotide) Guidelines do recommend this… There is great variability in its administration, though.

Pediatrics

Pediatrics Head Injuries Airway Management Administration

Topical Therapies for Pediatric Burns

Pediatric EM Morsels

JUNE 21, 2024

Chaganti 2019] Other studies have not shown a difference in infection rates between silver-containing creams and antimicrobial ointments.

Burns

Burns Pediatrics Hospitals Wellness

Cuffed Endotracheal Tubes for Children: ReBaked Morsel

Pediatric EM Morsels

NOVEMBER 17, 2023

2019 Sep;74(9):1186-1190. Epub 2019 Jul 16. West J Emerg Med. 2023 Apr 28;24(3):579-587. doi: 10.5811/westjem.59560. PMID: 37278787; PMCID: PMC10284523. Shah A, Carlisle JB. Cuffed tracheal tubes: guilty now proven innocent. Anaesthesia. doi: 10.1111/anae.14787. PMID: 31313280. Shi F, Xiao Y, Xiong W, Zhou Q, Huang X.

Pediatrics

Pediatrics Emergency Department Outcomes Sepsis

Unpacking the PEACH Trial: What is Levetiracetam’s Role in Spontaneous Intracerebral Hemorrhage?

RebelEM

SEPTEMBER 7, 2023

BACKGROUND: intracerebral hemorrhage (ICH) makes up 10-15% of all strokes and significantly contributes to overall stroke-related morbidity and mortality ( Hostettler 2019 ). 2019 Jul;19(7):679-694. Epub 2019 Jun 12. 2019 May;68:38-45. Intracerebral hemorrhage: an update on diagnosis and treatment. Expert Rev Neurother.

Seizures

Seizures Stroke Outcomes Research

Anti-NMDA Receptor Encephalitis in Children and Adolescents

Pediatric EM Morsels

JULY 26, 2024

Epub 2019 Dec 19. Anti-N-methyl-D-aspartate receptor encephalitis with accompanying ovarian teratoma in female patients from East China: Clinical features, treatment, and prognostic outcomes. 2020 Feb;75:55-62. doi: 10.1016/j.seizure.2019.12.016. 2019.12.016. PMID: 31874360.

Psychiatric

Psychiatric Seizures Outcomes Pediatrics

The Decision To Stop In Geriatric Trauma

The Trauma Pro

AUGUST 29, 2023

The University of Arizona at Tucson group analyzed the Trauma Quality Improvement Program (TQIP) database on withdrawal of care from 2017-2019. Is it possible to identify the common factors that predict appropriate withdrawal of care? The authors included only patients aged 65 and older.

Trauma Resuscitation Updates

RebelEM

MAY 25, 2023

Lancet 2019. JAMA Surgery 2019. Lancet 2010 [10] >20,000 adult trauma patients with SBP <90mmHg Patients randomized to TXA 1g over 10 min + 1g IV over 8hrs vs Placebo given within 8hrs of injury In-hospital mortality by 28d reduced (14.5% PMID: 31461138 Brotfain E et al. PMID: 31623894 Curry N et al. J Trauma Acute Care Surg.

Resuscitation

Resuscitation Fluid Resuscitation Head Injuries Shock

How to try to prevent diabetes

Emergency Live

MARCH 26, 2024

In 2019, according to the International Diabetes Federation, approximately 59.3 Prevention: a major challenge for health Diabetes affects many people in Europe. million adults were diagnosed with diabetes. An even larger number of people are at risk of developing it.

ECG Blog #384 — Why So Fast?

Ken Grauer, MD

JUNE 26, 2023

Please check out the November 12, 2019 post in Dr. Smith's ECG Blog — in which I reviewed the case of a different kind of regular SVT Rhythm ( AFlutter ). González-Torrecilla et al: Ann Noninvasive Electrocardiol 16(1):85-95, 2011 — Reviews distinction between AVNRT vs AVRT and other regular SVT rhythms in patients without WPW.

EKG/ECG

EKG/ECG Wellness

Safety Culture in Healthcare Settings

NIOSH Science Blog

SEPTEMBER 27, 2023

As of 2019, more than 18 million people, 11.5 % of the United States workforce, were employed in healthcare settings. Everyday healthcare workers face hazardous work conditions due to exposures to infectious agents and hazardous drugs and chemicals.

Outcomes

Culture of safety in an adult and paediatric emergency department before and after the COVID-19 pandemic

Emergency Medicine Journal

NOVEMBER 21, 2024

In 2019, we conducted a survey using the Spanish-adapted Hospital Survey on Patient Safety Culture open to all staff (doctors, nurses and paediatric residents) in AED and PED. Results The 2019 questionnaire was completed by 125 AED workers and 65 PED workers. Methods A quasi-experimental study was performed.

Emergency Department

Emergency Department Teamwork Patient Safety Hospitals

Targeted Temperature Management in Paediatric Traumatic Brain Injury

Don't Forget the Bubbles

NOVEMBER 11, 2024

explored the evidence in a 2019 systematic review, which forms part of the Brain Trauma Foundation Guidelines, as did Utsumi et al. 2019 Apr;20(4):404]. The injury is not uniform across the brain. There tends to be a mixture of localised and widespread components. What is the evidence behind targeted temperature management?

Hyperthermia / Hypothermia

Hyperthermia / Hypothermia Outcomes Pediatrics Resuscitation

Snake Bites and Children

Pediatric EM Morsels

MARCH 17, 2023

Judge 2019) Best when given within 4 hours of the bite, but still effective within 24 hours Always give an entire vial of antivenom, never a partial vial. Published November 13, 2019. as far west as Texas Cottonmouths/Water Moccasins live in the southeastern U.S. It’s expensive, so if you’re giving some of a vial, give it all.

CDC

CDC Poisoning Pediatrics Shock

Sudden cardiac death and arrhythmias in athletes

Sensible Medicine

OCTOBER 18, 2023

2019 Nov 19;140(21):1706-1716. Epub 2019 Oct 21. Weissler-Snir A, Allan K, Cunningham K, Connelly KA, Lee DS, Spears DA, Rakowski H, Dorian P. Hypertrophic Cardiomyopathy-Related Sudden Cardiac Death in Young People in Ontario. Circulation. doi: 10.1161/CIRCULATIONAHA.119.040271. 119.040271. PMID: 31630535.

Uber / Lyft For Medical Transport???

The Trauma Pro

OCTOBER 1, 2024

Health Econ 28(7)L817-829, 2019. I would not encourage the general public to use these services for medical transport, and neither do the companies themselves! Reference: Did UberX Reduce Ambulance Volume?

Ambulance Services

Ambulance Services EMS Hospitals

Vegan Diets in Children

Pediatric EM Morsels

MAY 5, 2023

2019 Oct;26(7):442-450. Epub 2019 Oct 12. Vegan diet in children and adolescents. Recommendations from the French-speaking Pediatric Hepatology, Gastroenterology and Nutrition Group (GFHGNP). Arch Pediatr. doi: 10.1016/j.arcped.2019.09.001. 2019.09.001. PMID: 31615715.

Pediatrics

Pediatrics Documentation/Coding EMS

ECG Blog #409 — Every-Other-Beat.

Ken Grauer, MD

DECEMBER 23, 2023

The November 12, 2019 post in Dr. Smith's ECG Blog — in which I review my approach to a Regular SVT rhythm. See ECG Blog #250 — for a regular SVT with ST depression. ECG Blog #229 — reviews distinction between AFlutter vs ATach ( and WHY AFlutter is so commonly overlooked ).

EKG/ECG

EKG/ECG Wellness

ECG Blog #446 — What Kind of SVT?

Ken Grauer, MD

SEPTEMBER 6, 2024

The October 16, 2019 post in Dr. Smith's ECG Blog. Please check out the November 12, 2019 post in Dr. Smith's ECG Blog — in which I reviewed the case of a different kind of regular SVT Rhythm ( AFlutter ). Other sites where I've discussed similar cases: The March 6, 2020 post in Dr. Smith's ECG Blog.

EKG/ECG

EKG/ECG Administration Wellness Operations

Sudden shock with a Nasty looking ECG. What is it?

Dr. Smith's ECG Blog

MAY 3, 2024

In Figure-1 — I reproduce major points that I've summarized from Dr. Smith's August 9, 2019 post on the subject. Figure-1: Reasons for the varied ECG presentation of acute LMain occlusion — excerpted from Dr. Smith’s 8/9/2019 post ( See text ). Quite literally — You can see almost anything!

Shock

Shock EKG/ECG Hospitals EMS

ECG Blog #420 — A "Fast" Complete Heart Block?

Ken Grauer, MD

MARCH 11, 2024

The November 12, 2019 post in Dr. Smith's ECG Blog — in which I review my approach to a Regular SVT rhythm. ECG Blog #210 — for review of the Every-Other-Beat Method for rapi d estimation of heart rate ( See Video Pearl #27 in this post ). ECG Blog #229 — reviews distinction between AFlutter vs ATach.

EKG/ECG

ECG Blog #432 — "Should I Shock this Patient?"

Fires in 2019 and the Prolonged Consequences

Trending Sources

ECG Blog #415 — The Cath showed NO Occlusion!

ECG Blog #406 — To Do Additional Leads?

Congenital Pulmonary Airway Malformation (CPAM)

ECG Video Blog #407 (292): Why the Patient Died?

Superior Mesenteric Artery Syndrome (SMA Syndrome) in Children

Imported Malaria

Glasgow Coma Scale in Children

ECG Blog #434 — WHY Did this Patient Arrest?

ECG Blog #451 — Premature Closure.

ECG Blog #424 — Proportionality and the "Cut Off"

Acute Transverse Myelitis in Children

The Broselow-Luten System

ECG Blog #412 — Is Cardiac Cath Indicated?

Ocular POCUS and ICP elevation

Neurogenic Shock in Children

ECG Video Blog #408 (392) — 20 Minutes Later.

Traveling Ticks: Tickborne Illnesses and International Travel

Direct Oral Anticoagulant (DOAC) Reversal: Part 1

Proximal Tibiofibular Joint Dislocation in Children

Andexanet alfa: expensive and harmful?

MEDALL Lecture Slides — Blog #351 — Posterior Leads.

Typhoid Fever in Children

Acute Esophageal Variceal Bleeding in Children

Topical Therapies for Pediatric Burns

Cuffed Endotracheal Tubes for Children: ReBaked Morsel

Unpacking the PEACH Trial: What is Levetiracetam’s Role in Spontaneous Intracerebral Hemorrhage?

Anti-NMDA Receptor Encephalitis in Children and Adolescents

The Decision To Stop In Geriatric Trauma

Trauma Resuscitation Updates

How to try to prevent diabetes

ECG Blog #384 — Why So Fast?

Safety Culture in Healthcare Settings

Culture of safety in an adult and paediatric emergency department before and after the COVID-19 pandemic

Targeted Temperature Management in Paediatric Traumatic Brain Injury

Snake Bites and Children

Sudden cardiac death and arrhythmias in athletes

Uber / Lyft For Medical Transport???

Vegan Diets in Children

ECG Blog #409 — Every-Other-Beat.

ECG Blog #446 — What Kind of SVT?

Sudden shock with a Nasty looking ECG. What is it?

ECG Blog #420 — A "Fast" Complete Heart Block?

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