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

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.

Seizures 269

Seizures Psychiatric Outcomes Pediatrics 269

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

Dr. Smith's ECG Blog

JANUARY 2, 2025

Clinically, it is well to remember that this variation in QTc estimation is greater at faster heart rates ( with faster heart rates being common in "sicker" patients, for whom we are most likely to need to assess the QTc ). J Am Coll Cardiol. This tells us that universal agreement for QTc estimation is not perfect. 1 for a rate ~75/min 1.

EKG/ECG 119

EKG/ECG Sepsis Wellness Documentation/Coding 119

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

EMergucate

NOVEMBER 5, 2019

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

EKG/ECG 52

EKG/ECG Wellness 52

EMergucate

AUGUST 13, 2019

She looked well from the end of the bed and at clinical exami… 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.

EKG/ECG 52

EKG/ECG Wellness EMS 52

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

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

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

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

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 245

EKG/ECG Shock Wellness 245

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

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 82

EKG/ECG Wellness Hospitals 82

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

SheMD

JULY 30, 2023

According to ,, AAMC , there were 53,371 medical school applicants in the 2019-2020 application cycle, and only 21,869 matriculated. Remember, letter writers can talk about your intellectual strengths as well as your personal attributes and character. Ask your potential letter of recommendation writers well in advance.

Academics 104

Academics Leadership Research Wellness 104

The Trauma Pro

SEPTEMBER 14, 2023

” This guideline was implemented in 2018-2019, and patients presenting before implementation were compared to those arriving after. The Medical College of Wisconsin trauma group performed a retrospective review of 391 patient charts to test a new 300cc rule defining when a hemothorax is “too big.”

Resuscitation 124

Resuscitation Hospitals Wellness 124

Dr. Smith's ECG Blog

OCTOBER 20, 2024

This series of ECGs ( ECG #1 , #2 and #4 ) illustrate well that subtotal occlusion of the left main is usually associated with severe subendocardial ischemia (profound and diffuse ST depression), whereas an ECG recorded during total occlusion of the LMCA (ECG #2) will show widespread ST elevations. There is now some flow in the LMCA!

EKG/ECG 131

EKG/ECG Shock Emergency Department Ambulance Services 131

Ken Grauer, MD

FEBRUARY 28, 2023

As a result — IF the 1 lead you are monitoring happens to be one in which P waves are not well seen — then you might assume the irregular rhythm in front of you was AFib. The September 30, 2019 post in Dr. Smith’s ECG Blog — for an example of “MAT”, but without the tachycardia. Remember — 12 leads are better than one!

EKG/ECG 195

EKG/ECG Documentation/Coding Sepsis COPD 195

ALiEM

OCTOBER 21, 2024

F; RR 22; O2 Sat 100% RA General : Alert, interactive, well-appearing HEENT : Left ear with moderate redness, swelling, warmth, and tenderness of the auricle sparing the lobule. 2019 Aug;276(8):2199-2203. Epub 2019 May 11. Physical Exam Vitals : BP 130/68; HR 105; Temp 98.9°F; Superficial lineal abrasion over concha, hemostatic.

Academics 67

Academics Wellness 67

Dr. Smith's ECG Blog

AUGUST 2, 2024

The LCx and OM branches are not as well seen. We've highlighted a considerable number of acute RV MI cases in Dr. Smith's ECG Blog ( See the October 7, 2019 and May 10, 2024 posts , to name just two ). This is the right anterior oblique cranial view Here is a representative still. There is non-obstructive disease here.

EKG/ECG 122

EKG/ECG Fluid Resuscitation Academics Resuscitation 122

Dr. Smith's ECG Blog

JULY 21, 2024

In this study — Procainamide was superior to Amiodarone for terminating monomorphic VT, as well as having fewer adverse effects than Amiodarone ( Ortiz et al — Eur Heart J 1;38 (17): 1329-1335, 2017 ). The decision was made to try Quinidine ( as this case was felt to represent conditions consistent with Quinidine-responsive PMVT ).

EKG/ECG 134

EKG/ECG Shock Hospitals Sepsis 134

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 94

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 94

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. Egan, Pharmacology and Physiology for Anesthesia (Second Edition), Elsevier, 2019, Pages 390-411, ISBN 9780323481106. Hemmings, Talmage D.

Ultrasounds 103

Ultrasounds Emergency Department Resuscitation Wellness 103

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. Also, likely different lead placement of the precordial leads. In this case, QOH V1 said Not OMI with low confidence, while V2 said Not OMI with high confidence.

EKG/ECG 120

EKG/ECG Wellness Operations Emergency Department 120

SheMD

AUGUST 3, 2023

AMCAS- $170 for processing fee + one med school designation, $40 for additional designations (AAMC, 2019) AACOMAS- $195 initial application fee + one med school designation, $45 for additional designations (AACOMAS, 2019) TMDSAS- $185 flat rate (TMDSAS, 2019) Secondaries- varies by school. Best of luck applying to med school!

Wellness 98

Wellness 98

Dr. Smith's ECG Blog

OCTOBER 3, 2024

Smith : "Gestalt, but if I must explain: well formed J-waves and high voltage R waves." It has some inferior ST elevation with some reciprocal ST depression and inverted T in aVL. This usually indicates inferior OMI. My answer: "Fake: pretty certain, but not 100% certain." Sam : "why do you say fake?"

EKG/ECG 127

EKG/ECG Wellness 127

Dr. Smith's ECG Blog

APRIL 9, 2024

The patient sought medical attention when the pain recurred for a second straight night accompanied by arm numbness as well as radiating pain. The pain was worse in the night and better when moving. The above ECG was recorded. It is easy to say pericarditis in such a case.

EKG/ECG 110

EKG/ECG Wellness 110

Ken Grauer, MD

MARCH 12, 2023

PEARL # 1: An additional ( less well known ) feature of QRS morphology in today’s initial tracing that favors aberrant conduction — is the finding of the mirror -image opposite morphology for the QRS in lead I and/or lead V6 — compared to the rSR’ complex just described for lead V1. ECG Blog #287 — More on AFlutter.

EKG/ECG 195

EKG/ECG Administration Wellness 195

Sensible Medicine

MARCH 27, 2024

Peter Attia - From Surgeon to Longevity Guru I first encountered Peter Attia online while researching ketosis , the Atkins diet and low carb diets in 2012 and found his writing to be incredibly well-researched and helpful. FACP, FNLA, a world-renowned expert in lipidology. To support his Medicine 3.0 To support his Medicine 3.0 Medicine 3.0,

Research 107

Research Documentation/Coding Wellness 107

Dr. Smith's ECG Blog

AUGUST 6, 2024

There may be hyperacute T waves from V2-V5, as well as in leads I and II. I would have favored emergent coronary CT angiogram had I cared for this patient. == Learning points: Diagnosis of occlusion myocardial infarction (OMI) can be extremely difficult and takes time and effort to learn well. The ECG shows ST depression in lead V3.

EKG/ECG 106

EKG/ECG Wellness Hospitals EMS 106

RebelEM

JUNE 26, 2023

4F-PCC contains factors II, VII, IX, X as well as Proteins S and C. J Trauma Acute Care Surg 2019. Some clinicians have advocated for early administration of 4-factor prothrombin complex concentrate (4F-PCC) based on limited observational data. High-quality studies are needed to determine the utility of this intervention.

Administration 135

Administration Outcomes Resuscitation Radiology 135