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

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 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

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 141

Dislocations Fractures Pediatrics EMS 141

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

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 278

Seizures Pediatrics CDC Infectious Diseases 278

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

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. Antibacterial ointments , like bacitracin, tend to be well tolerated and promote faster wound healing than silver sulfadiazine and other creams in partial thickness wounds. Get the Goop!

Burns 169

Burns Pediatrics Hospitals Wellness 169

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

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 112

Stroke Outcomes Wellness 112

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

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

ALiEM

OCTOBER 11, 2024

On the day of presentation, she developed a painful, intermittently bleeding “blood blister” to the left lower cheek that had increased in size, as well as new red spots on her arms and legs. Initial diagnostics include a CBC which will show isolated thrombocytopenia, as well as hemolysis labs to exclude alternative etiologies.

Academics 60

Academics Wellness 60

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.

Pediatrics 161

Pediatrics CDC Seizures Documentation/Coding 161

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 147

Pediatrics Outcomes Operations Emergency Department 147

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 300

Shock Pediatrics Hyperthermia / Hypothermia Dislocations 300

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

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 77

EKG/ECG Wellness Hospitals 77

Sensible Medicine

NOVEMBER 19, 2024

It is a critical appraisal deep dive by “friend of the stack” David Rind that combines the “letter to the editor” feel that we like so much as well some nice EBM history. Because I deal so well with my judgment being doubted, I feel compelled to justify the report’s conclusions here on Sensible Medicine.

Burns 67

Burns Wellness Academics 67

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 Wellness Operations 248

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 147

Pediatrics Blood Transfusions Resuscitation Shock 147

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 269

Psychiatric Seizures Outcomes Pediatrics 269

Emergency Medicine Ireland

OCTOBER 14, 2024

Similarly loculations can be very easily seen with ultrasound, better than CT it seems but again don’t necessarily correlate that well with empyema. Well, adding extra or bigger drains is all very reasonable and it would seem wise to involve a thoracic surgeon at some point. 2019, (2019). LDH>1000 Sugar <2.2

Wellness 52

Wellness Ultrasounds 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

American Medical Compliance

JANUARY 16, 2024

Rates and Statistics of Workplace Violence According to the Bureau of Labor Statistics, 20,870 workers in the private industry experienced trauma from nonfatal workplace violence in 2019. 68% of these individuals identified as female as well. Also, these incidents required days away from work.

Wellness 52

Wellness 52

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 366

EKG/ECG Wellness 366

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 81

Documentation/Coding Emergency Department Best Practices Federal Emergency Management Agency 81

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 72

Hyperthermia / Hypothermia Outcomes Pediatrics Resuscitation 72

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 125

EKG/ECG Shock Emergency Department Ambulance Services 125

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

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 74

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 74

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

Pediatric EM Morsels

AUGUST 18, 2023

Etminan 2019) In Belgium between 2010 – 2013, of the 262 children treated with fluroquinolones while hospitalized, only 17% were used for labelled indications. (Jackson 2016) It can also be used in UTIs , but is typically reserved for special cases where the infectious bacteria is found to be multidrug resistant or in complicated UTIs.

Pediatrics 130

Pediatrics Infectious Diseases Seizures Hospitals 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. 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 162

Resuscitation Hospitals Wellness 162

Taming the SRU

MAY 13, 2024

The patient is a well-appearing male who is awake, alert, and oriented. There is also a well-appearing, healed surgical scar. There is also a well-appearing, healed surgical scar. The skin is warm and well perfused with brisk capillary refill. Respiratory and cardiovascular exams are normal. BMP : Na 136, K 4.3,

Ultrasounds 97

Ultrasounds Emergency Department Wellness Operations 97

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 118

EKG/ECG EMS Wellness Operations 118

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