Ken Grauer, MD

FEBRUARY 23, 2024

ECG Blog #193 — Reviews the basics for predicting the " culprit " artery ( as well as reviewing why the term "STEMI" — should be replaced by "OMI" = O cclusion-based MI ). ECG Blog #294 — Reviews how to tell IF the " culprit " artery has reperfused.

EKG/ECG 420

EKG/ECG Wellness 420

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. 2020 Feb;75:55-62. 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. doi: 10.1016/j.seizure.2019.12.016.

Seizures 269

Seizures Psychiatric Outcomes Pediatrics 269

Pediatric EM Morsels

APRIL 7, 2023

Observation, interaction with patient, as well as parent information is key to bring the whole picture together! American Society of Hematology 2020 guidelines for sickle cell disease: prevention, diagnosis, and treatment of cerebrovascular disease in children and adults. 2020 Apr 28;4(8):1554-1588. doi: 10.1182/bloodadvances.2019001142.

Stroke 130

Stroke Pediatrics Seizures Sepsis 130

Ken Grauer, MD

APRIL 18, 2023

This blog post reviews the basics for predicting the " C ulprit" A rtery ( as well as reviewing why the term "STEMI" — should replaced by " OMI" = O cclusion-based MI ). The February 11, 2020 post ( LA-RA reversal ). The March 18, 2020 post ( LA-RA reversal ). The August 28, 2020 post ( LA-LL reversal ).

EKG/ECG 195

EKG/ECG Wellness 195

Pediatric EM Morsels

AUGUST 11, 2023

Having authored 575 ( well, now 576 ) of them, I am often quite convinced that there are no new topics to discuss. 2020 Oct 24;12(10):e11141. This is the 601st Ped EM Morsel ! Then July happens and we get 14 more amazing interns who help educate me and remind me that there is always more to learn. Can Fam Physician. doi: 10.46747/cfp.6809661.

Burns 130

Burns Pediatrics EMS Outcomes 130

RebelEM

APRIL 17, 2023

However, It is unclear how well POCUS performs in ruling in or ruling out the diagnosis of PTA. Question: How well does the US perform in diagnosing PTA compared to CT, needle aspiration, or Incision and Drainage? 2020 Nov;163(5):915-922. Epub 2020 Jun 2. 2020, August 18). Article: Kim DJ et al. Acad Emerg Med.

Ultrasounds 129

Ultrasounds Radiology Radiology Operations 129

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

Sensible Medicine

OCTOBER 15, 2024

Forced masking sends a false signal to the public that health care facilities are “dangerous” This idea did tremendous harm in the first covid wave in 2020 when many patients with serious symptoms avoided hospitals. Being forced to comply with irrational requirements is a well-understood cause of moral injury and burnout.

Hospitals 135

Hospitals Wellness 135

EMergucate

AUGUST 18, 2020

This 36 year old normally well woman presented with an episode of chest pain radiating to her arm. Her ECG … Continue reading →

EKG/ECG 52

EKG/ECG Wellness 52

The Trauma Pro

OCTOBER 25, 2024

Authors from several well-known trauma centers collaborated to re-analyze data from the CLOTT study. Here are the factoids: The original data were derived from a 17-center study conducted from 2018-2020; this study only included 1,387 patients who had pelvic fractures (as well as other injuries).

Fractures 113

Fractures Head Injuries Operations Ultrasounds 113

ALiEM

FEBRUARY 9, 2024

Let’s apply the ESC 2020 0/1 hour pathway [2], with some modifications based on the 2022 ACC guidelines [1]: Figure 1. Pulses are well felt in all four limbs. She would be low risk by gestalt or structured scoring systems (Wells or revised Geneva), and a negative D-dimer would essentially rule out pulmonary embolism here.

EKG/ECG 110

EKG/ECG Emergency Department Burns Wellness 110

SheMD

JULY 30, 2023

Some of the interview information may not be relevant during the 2020-2021 & 2021-2022 academic years. According to ,, AAMC , there were 53,371 medical school applicants in the 2019-2020 application cycle, and only 21,869 matriculated. Ask your potential letter of recommendation writers well in advance.

Academics 104

Academics Leadership Research Wellness 104

EMergucate

AUGUST 18, 2020

This 36 year old normally well woman presented with an episode of chest pain radiating to her arm. Her ECG … Continue reading →

EKG/ECG 52

EKG/ECG Wellness 52

Stop and Think

NOVEMBER 19, 2023

Also well known—from old data—was that myocarditis is a cause of cardiac arrest during sport. Notably, the authors reported only one case of myocarditis-related death during the 2020-2022 period. In my opinion, the downplay of the myocarditis signal from the vaccine as well as the mandates shredded public trust.

Documentation/Coding 130

Documentation/Coding Wellness Resuscitation 130

Sensible Medicine

AUGUST 4, 2024

A neuroradiologist and public policy expert at Stanford’s Hoover Institution, Atlas was brought into the White House in August 2020 to provide badly needed counterpoint to the groupthink-dominated authoritarian lockdown approach championed by Birx and Fauci. It is only two pages and well worth a read.

Academics 133

Academics Administration Hospitals Wellness 133

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

Sensible Medicine

JANUARY 11, 2024

She and the audience reflected on the dark days of 2020. I remember a hike in the mountains of northern New Mexico, summer 2020, on which everyone pulled on a mask when passing each other on the trail. If I reside too far to one side of my well-adjusted, poetry reading acquaintances, I imagine the masked live too far on the other side.

Wellness 107

Wellness 107

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

Sensible Medicine

FEBRUARY 17, 2025

But you cannot use placebo if there are proven or well accepted alternatives. In 2020, the authors allowed crossover to Cabo. This trial strikes me as a classic example where investigators are more interested in their own careers rather than the well-being of their cancer patients. How can we defend the status quo in oncology?

Hospice 96

Hospice Wellness Research 96

Sensible Medicine

JULY 28, 2023

MJ is a 24-year-old man who presents to his primary care physician on March 16, 2020 with fever, myalgia, and sore throat. March 2020: COVID strips a veteran physician of his invincibility. Early 2020 was scary. July 2020: A reprieve. June and July of 2020 felt like February 2020. Case rates were low.

Hospitals 97

Hospitals PPE Urgent Care Academics 97

Sensible Medicine

OCTOBER 2, 2024

More recently, in 2020, the Federation of State Medical Boards announced that the first “step” of the United States Medical Licensing Exam would no longer generate a report of a numeric score for residency programs. Over time, unsurprisingly, this evolution moved from the admission process to the medical curriculum itself.

Academics 122

Academics Wellness 122

RebelEM

JUNE 7, 2023

Moderate Patients The vast majority of patients will present with a concerning history but clinically may look relatively well. 2020 Apr 30;382(18):1739-1748. In that population, it is essential to recognize that the absence of oropharyngeal lesions/burns cannot exclude the presence of gastrointestinal injury internally. N Engl J Med.

Poisoning 92

Poisoning Burns Resuscitation Pediatrics 92

PulmCCM

NOVEMBER 6, 2023

The therapy was approved for emergency use in 2020 by FDA after an observational study of 10 patients showed likely benefit (yes, 10, which should remind us of our collective desperation). patients infected with the Wuhan/Delta variants in 2020-2021). Only it turns out, it did help. Or could, anyway.

Blood Transfusions 98

Blood Transfusions Operations Resuscitation Infectious Diseases 98

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

But he did well. PEARL #2: The automatic EMS truncation effect is most likely to cause confusion in chest pain patients who manifest marked LVH with deep anterior S waves ( just as we saw for Patient #1 in today's case — and as I describe in the December 27, 2018 post , as well as in the above posts that I cited in Pearl #1 ).

EKG/ECG 128

EKG/ECG EMS Outcomes Wellness 128

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 August 22, 2020 post in Dr. Smith's ECG Blog — which illustrates another case of dynamic ST-T wave changes that resulted from a repolarization variant.

EKG/ECG 245

EKG/ECG Shock Wellness 245

RebelEM

JANUARY 18, 2024

It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Background: Sepsis remains one of the leading causes of morbidity and mortality. to 0.97; p = 0.02 Length of ICU Stay 906 patients Prehospital Abx: 300 pts No Prehospital Abx: 606 pts Pooled Mean Difference 0.11; 95% CI -1.85

Sepsis 129

Sepsis Hospitals Administration Outcomes 129

ACEP Now

JULY 11, 2024

Deaths from drinking increased 25 percent from 2019 to 2020 and another 10 percent in 2021. The percentage of suicides while intoxicated with alcohol has increased, particularly among women, and traffic fatalities in 2020 were at their highest point in over a decade. 2020:8;279. problem drinking has reached a steady state.

Emergency Department 98

Emergency Department Psychiatric Outcomes Wellness 98

The Trauma Pro

JUNE 18, 2024

Objective MTP activation criteria have been developed and are well-supported by the literature. 2020 Feb;55(2):331-334. 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.

Pediatrics 113

Pediatrics Blood Transfusions Resuscitation Shock 113

Sensible Medicine

APRIL 18, 2024

David Rind sent me this article, a thoughtful, well-argued, reply. As such, I’ll start with a single absolute statement: with the strain of Covid that circulated in the spring of 2020, having the provider wear a surgical mask and eye protection and the patient wear a surgical mask was highly effective in an outpatient setting.

Academics 82

Academics Wellness Hospitals 82

Ken Grauer, MD

MAY 26, 2023

The QRS complex is tiny ( as well as fragmented ) in lead V3 — with disproportionate J-point ST depression, followed by a coved, downsloping ST segment with an abnormally biphasic terminal T wave. 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.

EKG/ECG 195

EKG/ECG Resuscitation Wellness 195

EMDocs

NOVEMBER 7, 2023

Antibiotics are recommended for those with complicated diverticulitis, as well as surgical specialist consult if necessary (e.g., 2020 Mar 30:S1542-3565(20)30426-2. 2020 Mar 30:S1542-3565(20)30426-2. 2020 update of the WSES guidelines for the management of acute colonic diverticulitis in the emergency setting.

Sepsis 100

Sepsis Best Practices Hospitals Outcomes 100

PulmCCM

SEPTEMBER 28, 2023

Predominant SARS-CoV-2 strains during that trial’s enrollment (July-December 2020) were Wuhan, Alpha and Delta. Enrollment was April-November 2020, during the Wuhan strain era. Those receiving budesonide reported feeling better three days sooner than patients in the usual-care arm.

COPD 95

COPD Stroke Academics Urgent Care 95

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. These cases provide insight to assessment for MAT: The January 5, 2020 post in Dr. Smith’s ECG Blog — for an example of MAT. Remember — 12 leads are better than one!

EKG/ECG 195

EKG/ECG Documentation/Coding Sepsis COPD 195

EM Literature of Note

SEPTEMBER 13, 2024

Most regions used a strategy in which nirsevimab was provided to new births during RSV season, as well as other young infants born prior to the onset of the season. The two “COVID seasons” of 2020-21 and 2021-22 were excluded from their comparisons.

Emergency Department 87

Emergency Department Pediatrics Administration Wellness 87

EMDocs

DECEMBER 20, 2023

That you considered an SEA, tested for it, and the result was negative is proof that you made a judgment call well within the standard of care. Missed SEA’s were the genesis of Med Mal Insights. But your suspicion alone warrants closer followup than the usual back pain patient.

Patient Safety 89

Patient Safety Wellness 89

The Skeptics' Guide to EM

JULY 8, 2023

She looks well enough to go home but asks if she should be prescribed oseltamivir (Tamiflu) because some of her friends have been given it recently by their doctors. Safety issues popped up soon after widespread use of the drug including neuropsychiatric effects as well as the more common adverse effects of nausea and vomiting.

CDC 96

CDC Hospitals EMS Emergency Department 96

Don't Forget the Bubbles

JULY 19, 2023

Olivia, a previously well 13-year-old girl, is referred to the paediatric ED from the Ophthalmology ED. This data was collected over a five-year period (2016-2020) had true papilloedema. 2020 and Hyde et al. 2020 Oct [cited 2023 May 14];10:966–7. She went to the optician today to get a new pair of glasses.

Pediatrics 98

Pediatrics Emergency Department Outcomes Wellness 98