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 411

EKG/ECG Resuscitation Hospitals Wellness 411

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 246

Pediatrics Burns Operations Ultrasounds 246

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 232

Urgent Care Ultrasounds 232

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 418

EKG/ECG EMS Wellness 418

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 238

EKG/ECG EMS Hospitals 238

JournalFeed

NOVEMBER 14, 2020

We cover the importance of starting low tidal volume ventilation in the ED, fluid overload and ICU mortality, flying during COVID-19, the top critical care articles of 2019, and the accuracy (or lack thereof) of physician ECG interpretation. It’s the JournalFeed Podcast for the week of Nov 9-13, 2020.

EKG/ECG 52

EKG/ECG 52

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 281

Ultrasounds Pediatrics Operations EMS 281

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 278

Seizures Pediatrics CDC Infectious Diseases 278

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 246

Head Injuries Pediatrics Outcomes Shock 246

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 161

CDC Infectious Diseases Pediatrics Wellness 161

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 141

Dislocations Fractures Pediatrics EMS 141

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 412

EKG/ECG Hospitals 412

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 113

EMS 113

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 425

EKG/ECG Sepsis Wellness 425

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 269

Pediatrics Resuscitation Documentation/Coding Wellness 269

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 130

Ambulance Services EMS Hospitals 130

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 407

EKG/ECG Wellness Hospitals 407

ALiEM

OCTOBER 21, 2024

2019 Aug;276(8):2199-2203. Epub 2019 May 11. Klug TE, Holm N, Greve T, Ovesen T. Perichondritis of the auricle: bacterial findings and clinical evaluation of different antibiotic regimens. Eur Arch Otorhinolaryngol. doi: 10.1007/s00405-019-05463-z. PMID: 31079204.

Academics 67

Academics Wellness 67

EMergucate

DECEMBER 3, 2019

You are shown and ECG on a 54 years of age male patient you have yet to review with decreased exercise tolerance with intermittent dizziness. Describe and discuss the abnormalities.

EKG/ECG 52

EKG/ECG EMS 52

EMergucate

NOVEMBER 5, 2019

Following ECG was obtained from a 24 years of age man complaining of a week history of intermittent chest pain. He is clinically well and his haemodynamics are all within normal limits. Describe t…

EKG/ECG 52

EKG/ECG Wellness 52

EMergucate

OCTOBER 29, 2019

You are reviewing the ECG of an 82 year old man who has had an episode of syncope after a herald of spinning and dizzyness. He has had similar symptoms for the last 4 days, particularly when gettin…

EKG/ECG 52

EKG/ECG EMS 52

PulmCCM

AUGUST 12, 2024

There was a terrible case in 2019 of a police officer who cracked his neck to relieve some discomfort and dissected his vertebral artery. He immediately felt and looked bad and his coworkers had an ambulance take him to the ED. The initial CT read suggested vertebral artery stenosis but used equivocal language.

98

98

EMergucate

OCTOBER 15, 2019

The following is an ECG of an 88 years of age man complaining of a lack of energy for the past 3 days. The nurse has mentioned that his initial observation are within normal limits with a blood pre…

EKG/ECG 52

EKG/ECG 52

EMergucate

OCTOBER 8, 2019

You are seeing a 52 year old man who has had an MI 14 years ago secondary to a spontaneous RCA dissection. He presented late (with Q waves seen on ECG) and so was treated medically. 8 years later h…

EKG/ECG 52

EKG/ECG EMS 52

EMergucate

SEPTEMBER 24, 2019

The following ECG is shown to you at 0130 hours of a monday morning on a 49 years of man struggling with severe crushing central chest heaviness for 6 hours. He is unwell and clammy with stable hem…

EKG/ECG 52

EKG/ECG EMS 52

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.

95

95

ER Nurses

MAY 6, 2019

High five a nurse. Give a hug to a nurse you love. Buy some flowers, or some beer.

52

52

EMergucate

AUGUST 27, 2019

58 years of age lady presented with being generally unwell for 2 days. She has had a renal transplant and at clinical examination was noted to be tachycardic , normotensive and febrile at 38.3

EKG/ECG 52

EKG/ECG EMS 52

EMergucate

AUGUST 13, 2019

61 years of age lady presented with an acute shortness of breath whilst walking her dog. She denied any chest pain nor any pre-syncope. She looked well from the end of the bed and at clinical exami…

EKG/ECG 52

EKG/ECG Wellness EMS 52

EMergucate

JULY 23, 2019

Following is an ECG of a 52 years of age man with a 3 day hx of intermittent chest discomfort. He is currently asymptomatic with a BP 150/95 mmHg. Describe the ECG abnormalities and what would you …

EKG/ECG 52

EKG/ECG EMS 52

EMergucate

JULY 2, 2019

You are asked to review an ECG of a 24 years of age man complaining of a two day history of a mild intermittent non cardiac sounding chest pain. En route you the noted on his CXR showed cardiomegal…

EKG/ECG 52

EKG/ECG EMS 52

EMergucate

APRIL 8, 2020

Following is an ECG of a 25 years old man with a four day history of left sided chest pain and its 0400 hours in the morning. He’s in a mild discomfort but looks well from the end of the bed and hi…

EKG/ECG 52

EKG/ECG Wellness 52

EMergucate

JUNE 25, 2019

Following is an ECG of a 63 years of age man complaining of a 45 minute duration of a chest discomfort. You find him in mild discomfort and apart for being mildly hypertensive all his other observa…

EKG/ECG 52

EKG/ECG EMS 52

EMergucate

MAY 21, 2019

The ECG below is taken from an 83 year old man with a seizure history for the past 8 years. He presents after two 10 minute generalised tonic-conic seizures at home 10 days after self ceasing his C…

EKG/ECG 52

EKG/ECG Seizures 52

EMergucate

JUNE 18, 2019

An 86 year old diabetic man presents to ED with a 1 month history of diarrhoea and fatigue and intermittent upper abdominal pain over the last week. His ECG is as below.

EKG/ECG 52

EKG/ECG 52

EMergucate

MAY 6, 2019

You are shown an ECG of a 25 years of age Chinese female at 0200 hours on a saturday morning complaining of chest discomfort. Due to the department being busy a nurse has done her blood test prior…

EKG/ECG 52

EKG/ECG EMS 52

EMergucate

APRIL 30, 2019

The ECG below is taken from a man who has been referred by his GP after presenting symptom-free for a health check following an electric shock at work in a domestic current.

EKG/ECG 52

EKG/ECG Shock 52