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. In contrast, Kochanek reviewed each meta-analysis, as well as the RCT and secondary analyses, separately to assess overall results and potential moderators of effect. 2019 Apr;20(4):404].

Hyperthermia / Hypothermia 117

Hyperthermia / Hypothermia Pediatrics Outcomes Resuscitation 117

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. Positional changes after intake can also be helpful including the lateral decubitus position as well as knee to chest. Ann Vasc Surg.

Pediatrics 246

Pediatrics Burns Operations Ultrasounds 246

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

NOVEMBER 3, 2023

With concern for malaria, it is very important to identify who is non-immune and semi-immune as this can affect both the timeframe for illness after departure from the endemic country as well as severity of illness. 2019; 17: 98. 2019; 47(2): 183–193. Third times the charm! Pediatr Clin N Am 69 (2022) 47–64. 8 Dec 2022.

Seizures 281

Seizures Pediatrics CDC Infectious Diseases 281

Pediatric EM Morsels

SEPTEMBER 22, 2023

” Children compensate for blood and volume loss very well… until they don’t. McGraw Hill Education; 2019:104-109 Dave S, DAHLSTROM JJ. McGraw Hill Education; 2019:125-138 Ziu E, Mesfin FB. Physical exam findings of occult shock in children can be subtle. Fortunately, there are screening tools for occult shock.

Shock 304

Shock Pediatrics Dislocations Hyperthermia / Hypothermia 304

EMDocs

NOVEMBER 19, 2024

1,2 Neuroleptic malignant syndrome (NMS) (hyperthermia, autonomic instability, rigidity, altered mental status [AMS]) can occur as well and is most often seen with clozapine but has been observed with other atypicals. New York, NY: McGraw-Hill Education; 2019. Cambridge: Cambridge University Press; 2019. Published 2019.

Poisoning 111

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 111

Ken Grauer, MD

JUNE 26, 2023

That said — since today’s patient is a “young man” — and the rate of today’s rhythm is extremely fast ( ie, 250-260/minute — which is faster than is usually seen in a VT rhythm that maintains a well-defined QRS morphology ) — we clearly can not discount the possibility of an SVT rhythm.

EKG/ECG 365

EKG/ECG Wellness 365

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. Seen in sports that involved aggressive twisting of the knee (ex, snowboarding, soccer, horse-riding) as well as direct trauma. 2019 Apr;31(2):156-162. MANAGE PAIN!

Dislocations 143

Dislocations Fractures Pediatrics EMS 143

Pediatric EM Morsels

JULY 26, 2024

These females should have imaging with either MRI or CT as well as abdominal or transvaginal ultrasound to assess for ovarian teratoma. Epub 2019 Dec 19. The prevalence ranges from 12.5%-61% 61% in females of reproductive age, with approximately 45% of females older than 18 years old with teratoma. 2020 Feb;75:55-62. 2019.12.016.

Psychiatric 271

Psychiatric Seizures Outcomes Pediatrics 271

NIOSH Science Blog

AUGUST 29, 2022

Most research on the mental health and well-being of healthcare workers has focused on physicians and nurses, with less attention paid to other healthcare occupations. 1] Assessing Mental Health and Wellbeing Researchers evaluated data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2017 to 2019.

Wellness 49

Wellness Research 49

Northwestern EM Blog

FEBRUARY 4, 2025

Treating Kratom toxicity varies based upon the clinical presentation as well as severity of symptoms. The patient was ultimately discharged from the Emergency Department with primary care and neurology referrals along with seizure precautions and advised to abstain from Kratom use. Just over half of these cases required medical intervention.

Seizures 72

Seizures Poisoning Forensics Emergency Department 72

PEMBlog

MARCH 4, 2025

Well cover its clinical presentation, epidemiology, diagnostic approach, and management, including why standard beta-lactam antibiotics wont work. Plus, well discuss whether M. Clin Infect Dis 2019; 68:13. pneumoniae even needs to be treated in the first place! 2024 Dec;56(1):2386636. doi: 10.1080/07853890.2024.2386636.

Pediatrics 94

Pediatrics Military CDC Hospitals 94

Ken Grauer, MD

SEPTEMBER 6, 2024

Alternatively — when a portion of the reentry circuit is made up of an AP ( A ccessory P athway ) — the retrograde P wave will typically manifest a moderately long RP' interval ( that occurs well after the QRS — usually within the latter part of the ST segment ). The October 16, 2019 post in Dr. Smith's ECG Blog.

EKG/ECG 248

EKG/ECG Administration Operations Wellness 248

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. The most specific diagnostic ECG sign of ARVD is the E psilon w ave ( Pérez-Riera et al — Ind Pacing Electrophys J 19:63-67, 2019 ). MRI confirmed ARVC. About A RVC/ A RVD. in these right-sided leads.

EKG/ECG 370

EKG/ECG Resuscitation Documentation/Coding Hospitals 370

EM Literature of Note

SEPTEMBER 11, 2023

Well, PRISMS demonstrated unfavorable results. The population included for analysis is the Austrian Stroke Unit Registry from 2018 until 2019, an original cohort of 53,899 patients. The remaining ~4,000 were analyzed both in their unadjusted cohorts, as well as propensity scored cohorts comprised of roughly 20% of the original.

Stroke 114

Stroke Outcomes Wellness 114

Ken Grauer, MD

DECEMBER 23, 2023

This is perhaps best seen in lead V1 ( but also well seen in leads V3,V4,V6 ). The November 12, 2019 post in Dr. Smith's ECG Blog — in which I review my approach to a Regular SVT rhythm. Since the R-R interval is just under 2 large boxes in duration — I estimate the ventricular R ate to be just over 150/minute.

EKG/ECG 441

EKG/ECG Wellness 441

NIOSH Science Blog

MAY 14, 2020

This year has seen nurses all over the world step up and battle coronavirus disease 2019 (COVID-19) fearlessly, often while navigating evolving guidance and operating under difficult conditions with strained resources. The World Health Organization proclaimed 2020 the Year of the Nurse and Midwife.

Wellness 52

Wellness Operations 52

Mind The Bleep

OCTOBER 29, 2024

Alkali burns result in liquefaction necrosis, allowing for deeper tissue injury as well as vascular injury that can lead to both local and systemic toxicity [1]. These systemic effects can include central nervous system (agitation, seizures , and coma), as well as cardiac ( hypotension and dysrhythmias) [10, 11]. Epub 2019 Nov 29.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

EMergucate

APRIL 8, 2020

He’s in a mild discomfort but looks well from the end of the bed and hi… 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.

EKG/ECG 52

EKG/ECG Wellness 52

Ken Grauer, MD

FEBRUARY 15, 2024

The above said — On occasion, there may be focal triggered activity that results in the marked irregularity of the monomorphic VT seen in ECG #1 ( Zhang et al — Circulation 139:1750-1752, 2019 ).

EKG/ECG 323

EKG/ECG Wellness 323

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 130

CDC Poisoning Pediatrics Shock 130

Ken Grauer, MD

APRIL 14, 2023

NOTE: Although the end of the QRS is not well seen in many of the leads in today's tracing — it is clearly delineated in leads II and aVR in the limb leads — and especially in lead V1 in the chest leads. PCI was successful — and this 90-year old patient did surprisingly well! There was no significant disease in the LCx or RCA.

EKG/ECG 195

EKG/ECG Wellness Hospitals 195

RebelEM

MAY 25, 2023

CRYSTALLOIDS Too much crystalloid resuscitation in traumatic hemorrhagic shock can increase dilutional coagulopathy, as well as increase morbidity and mortality Bickell WH et al. Lancet 2019. vs SBP target <90mmHg which resulted in a mortality of 33.4% NEJM 1994. [2] PMID: 31461138 Brotfain E et al. PMID: 31623894 Curry N et al.

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

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

The Skeptics' Guide to EM

FEBRUARY 22, 2020

Bringing value, balance and humanity to the emergency department: The Right Care Top 10 for emergency […] The post SGEM Xtra: Right, You’re Bloody Well Right, You’ve got the Bloody Right to Care first appeared on The Skeptics Guide to Emergency Medicine. Reference: Dorsett et al. Reference: Dorsett et al.

Wellness 52

Wellness Emergency Department EMS 52

Ken Grauer, MD

JUNE 6, 2023

That said — lack of a well defined P wave in lead II makes assessment of the PR interval difficult — and — the QRS looks a little wide in lead V3, albeit QRS duration does not appear to exceed 0.10 This explains the marked increased in QRS amplitude in the lateral chest leads — as well as some of the ST-T wave depression in these leads.

EKG/ECG 195

EKG/ECG Hospitals Wellness Resuscitation 195

Pediatric EM Morsels

APRIL 7, 2023

Observation, interaction with patient, as well as parent information is key to bring the whole picture together!

Stroke 130

Stroke Pediatrics Seizures Sepsis 130

The Trauma Pro

OCTOBER 4, 2024

And unfortunately, I’m not able to guess the numbers well enough to do the power calculation for this study. Be sure to follow with your performance improvement program to make sure that they actually do work as well as you think! J Ped Surg 54:335-339, 2019. Did they have the statistical power to show such a difference?

Pediatrics 113

Pediatrics Outcomes Operations Emergency Department 113

Ken Grauer, MD

OCTOBER 21, 2023

P EARL # 2: As noted above — ECG #1 is remarkable for the presence of diffuse ST depression ( in more than 7 leads! ) — with ST elevation in lead aVR ( as well as in lead V1 ). The January 9, 2019 post in Dr. Smith's ECG Blog ( Please scroll down to the bottom of the page to see My Comment ).

EKG/ECG 248

EKG/ECG Shock Wellness 248

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

Dr. Smith's ECG Blog

DECEMBER 19, 2023

The patient did well afterward without any recurrence of symptoms. From My Comment in the November 14, 2019 post in Dr. Smith's ECG Blog: A subject well worth periodic review — is the concept of Terminal QRS Distortion ( T-QRS-D ). Figure-4: I've labeled the first 2 ECGs shown in the November 14, 2019 post ( See text ).

EKG/ECG 127

EKG/ECG EMS Wellness Operations 127

The Trauma Pro

JUNE 18, 2024

Objective MTP activation criteria have been developed and are well-supported by the literature. Epub 2019 Nov 1. All of the trauma professionals are busy with the patient and are rudely surprised when they ask for the first unit of blood. The ABC score and the shock index are two of the more common methods. J Pediatr Surg. 2019.10.008.

Pediatrics 113

Pediatrics Blood Transfusions Resuscitation Shock 113

33 Charts

NOVEMBER 5, 2021

Our patients are seen as collections of proteins, genes and markers (I was privileged to talk about this at DotMD 2019). It owns the space where technology, art, digital culture, creativity, wellness and human narrative collide for a broader view of the care experience. All of this neutralizes the texture of the human journey.

Wellness 91

Wellness 91

Dr. Smith's ECG Blog

JUNE 14, 2024

But artifact is "alive and well" — and learning to recognize it will amaze many of your colleagues ( and may serve to avoid an unnecessary defibrillation or two ). KEY Point: As per Dr. Frick: i ) Artifact is "alive and well" in 2024. The September 22, 2019 post — intermittent ST-T wave artifact.

EKG/ECG 81

EKG/ECG Wellness Hospitals 81

EMDocs

DECEMBER 6, 2024

5 Severe metabolic acidosis persists Multi-system organ failure The endpoints of deferoxamine are less well defined but it can be weaned off as the patient is clinically improving, the anion gap resolves, and down-trending serum iron concentration. McGraw Hill; 2019. 10 Maximum daily dose of 6-8g total of defuroxamine. Tenenbein M.

Poisoning 98

Poisoning Fluid Resuscitation Seizures Resuscitation 98

Ken Grauer, MD

MAY 12, 2023

ECG Blog #240 — Reviews the definition of what an "SVT" is — as well as illustrating the different types of reentry SVT rhythms ( with assessment of the RP' interval ). 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 ).

EKG/ECG 195

EKG/ECG Wellness 195

EMDocs

AUGUST 22, 2024

Well-meaning providers who are not highly fluent may contribute to miscommunication and diagnostic errors. Providers should respect and utilize this mode of communication, as well as document the patient’s request for a non-certified interpreter. April 2019. January 2019. January 2019. 45:446-458. Taira B, et al.

Documentation/Coding 105

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 105