Ken Grauer, MD

JUNE 14, 2024

Today's case is also noteworthy in that T-QRS-D is seen in association with RBBB — which has only been described on rare occasions ( See the March 28, 2021 post i n Dr. Smith's ECG Blog ). Prompt cath is therefore advised if the post-ROSC shows an acute STEMI.

EKG/ECG 407

EKG/ECG Wellness Hospitals 407

Pediatric EM Morsels

FEBRUARY 2, 2024

Abdel-Haq 2021). Travel dates can help to exclude certain infections by their incubation periods (Abdel-Haq 2021) Physical examination can sometimes reveal concerning features including hepatomegaly , jaundice or a rash that may guide differential. A study of swiss tourists found they compromised 53.4%

Infectious Diseases 161

Infectious Diseases Pediatrics Sepsis Documentation/Coding 161

Pediatric EM Morsels

OCTOBER 6, 2023

The most common countries of acquisition were Bangladesh, India, Nepal, and Pakistan (Forster 2021) For travelers, the peak incidence occurs at age 10 and those who are visiting to their country of birth. Rauniyar 2021) Up to 10% of patients may present with constipation as opposed to diarrhea. Shah 2021).

Pediatrics 161

Pediatrics CDC Seizures Documentation/Coding 161

Pediatric EM Morsels

APRIL 5, 2024

Silva-Ramos 2021) Majority of cases arise from travel to South Africa. (Silva-Ramos 2021) Majority of cases arise from travel to South Africa. (Frean 2019) The classic triad described is fever, eschar and rash. Silva-Ramos 2021) Fever and a characteristic eschar (tache noir) are seen 90% of the time.

CDC 161

CDC Infectious Diseases Pediatrics Wellness 161

Pediatric EM Morsels

MAY 5, 2023

Vegan Diets in Children: Basics Vegan Diets avoid/prohibit consumption of any animal products Exclusion of meat, eggs, honey, dairy products, etc This is often adopted due to heightened concern of animal maltreatment, but also for religious reasons or health benefits Roughly 2-5% of Western nation populations follow a vegan based diet (Sutter, 2021) (..)

Pediatrics 130

Pediatrics Documentation/Coding EMS 130

Pediatric EM Morsels

JUNE 2, 2023

2021 Nov 29;92(S7):e2021518. Today we are talking about a rare disease called FPIES (food protein induced enterocolitis syndrome) and how you might encounter these patients in the Pediatric Emergency Department. Update on Food protein-induced enterocolitis syndrome (FPIES). Acta Biomed. doi: 10.23750/abm.v92iS7.12394.

Dehydration 189

Dehydration Shock Pediatrics Emergency Department 189

Ken Grauer, MD

SEPTEMBER 22, 2023

The November 27, 2021 post ( LA-RA reversal ). The March 18, 2020 post ( LA-RA reversal ). The July 28, 2020 post ( RA-LL reversal ). The August 28, 2020 post ( LA-LL reversal ). The November 19, 2020 post ( LA-LL reversal ). The April 17, 2022 post ( Leads V1,V2 misplacement ). The May 5, 2022 post ( LA-RA reversal ).

EKG/ECG 446

EKG/ECG Wellness 446

Science Based Medicine

SEPTEMBER 12, 2023

Doctors who repeatedly predicted herd immunity in 2020 and 2021, mocking and berating those who disagreed, now treat herd immunity as a taboo phrase. The post When Did “Herd Immunity” Become a Taboo Phrase? first appeared on Science-Based Medicine.

142

142

Pediatric EM Morsels

JULY 21, 2023

Gag reflex is much better predictor (45% vs 6%) [Conzelmann 2021] Positive predictive value of GCS indicating aspiration in intoxication was only 3%. BMJ Open 2021; 11: e053619. doi: 10.1136/bmjopen-2021-053619 Orso D, Vetrugno L, Federici N, D’Andrea N, Bove T. 2021 Jan 1;90(1):21-26. J Trauma Acute Care Surg.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

Science Based Medicine

AUGUST 25, 2024

Vinay Prasad started treating vaccine side effects as a fate worse than death in February 2021, before these was a COVID vaccine for children. The post Dr. Vinay Prasad Opposed The Pediatric COVID Vaccine Before There Was A Pediatric COVID Vaccine first appeared on Science-Based Medicine.

Pediatrics 121

Pediatrics 121

Pediatric EM Morsels

MARCH 17, 2023

In the US, the venomous snakes include rattlesnakes , copperheads, cottonmouths/water moccasins , and coral snakes [ CDC, 2021 ] Rattlesnakes live all across the United State s Copperheads inhabit the eastern U.S. If you are managing a snake bite from a snake that does not typically reside in the U.S.,

CDC 130

CDC Poisoning Pediatrics Shock 130

Science Based Medicine

OCTOBER 1, 2023

Overselling the vaccine in 2021 was not being pro-vaccine. It was pro-stop-worrying-about-the pandemic, from the doctors who assured us herd immunity was imminent. The post Overhyping Vaccines Wasn’t Pro-Vaccine. It Was Pro-Stop-Worrying-About-COVID. first appeared on Science-Based Medicine.

127

127

Emergency Medicine Journal

NOVEMBER 21, 2024

million ED visits from 2016 to 2021. of self-injury-related ED visits in 2020 and 2021, respectively (pandemic years), compared with an average of 8.4% Results Our analysis covered 419.4 Individuals experiencing homelessness constituted 1.8% (7.4 million) of ED visits. Overall, 1.8% of ED visits (7.7 in the previous years.

Emergency Department 52

Emergency Department Outcomes Hospitals 52

Pediatric EM Morsels

AUGUST 9, 2024

2019, there were 1,875 and this trend has continued to increase (2,157 case in 2020; 2,855 cases in 2021). Early Congenital Syphilis Present before 2 years of age [ Hussain, 2023 ; Foles, 2024; Fang, 2022; Morrisroe, 2021 ] Only ~33% of newborns present with symptoms at birth and can be subtle. 2021 Feb 5;14(2):e240532.

Hyperthermia / Hypothermia 152

Hyperthermia / Hypothermia Emergency Department Seizures Pediatrics 152

Ken Grauer, MD

SEPTEMBER 8, 2023

ECG Criteria for the diagnosis of MBBB are described by Dhanse et al ( J Clin Diag Research: 10(9), 2016 ) — and Buttner and Cadogan ( LITFL, 2021 ) — and include the following: An ECG pattern consistent with RBBB in the chest leads ( ie, with a widened, predominantly positive QRS in lead V1 ).

EKG/ECG 296

EKG/ECG Research 296

Pediatric EM Morsels

MAY 10, 2024

Published 2021 Feb 4. [link] Hanson MG, Chan B. The role of point-of-care ultrasound in the diagnosis of pericardial effusion: a single academic center retrospective study. Ultrasound J. 2021;13(1):2. doi:10.1186/s13089-021-00205-x The post Chest Pain in Children: ReBaked Morsel appeared first on Pediatric EM Morsels.

EKG/ECG 268

EKG/ECG Pediatrics Ultrasounds Seizures 268

RebelEM

FEBRUARY 19, 2024

The 2021 Surviving Sepsis Campaign Guidelines suggest starting vasopressors peripherally rather than delaying infusion until a CVC is placed [2]. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med 2021. CHEST 2024. PMID: 37611862 Evans L et al.

Administration 137

Administration Sepsis EMS Shock 137

Science Based Medicine

OCTOBER 23, 2023

Tech bro turned antivax influencer Steve Kirsch is claiming that Michigan State University economist Mark Skidmore has been "exonerated" after having had a paper retracted claiming 278K deaths from COVID-19 vaccines in 2021 alone.

124

124

Pediatric EM Morsels

JUNE 16, 2023

2021) Morel-Lavallee lesion , Orthobullets. Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment. Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment. Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment.

Soft Tissue Injuries 152

Soft Tissue Injuries Dehydration Fractures Operations 152

Mount Sinai EM

OCTOBER 10, 2024

2021) of 16 prospective studies with 619 total patients found a sensitivity of 90% and specificity of 85% for elevated ICP, as compared to invasive ICP monitoring. Image Credit: POCUS Toronto Contraindications to Evaluation : Globe rupture The Evidence: A meta-analysis (Ohle et al., A meta-analysis (Aletreby et al.,

Urgent Care 232

Urgent Care Ultrasounds 232

RebelEM

JULY 1, 2024

Balkan Med J 2021. Balkan Med J 2021. Cureus 2021. Comparison of BPAP S/T and Average Volume-Assured Pressure Support Modes for Hypercapnic Respiratory Failure in the Emergency Department: A Randomized Controlled Trial. AVAPS: 0.07 P = 0.015 PaCO2 Excretion in 1 st Hour BPAP S/T: 4.75 AVAPS: 10.20

COPD 133

COPD Emergency Department Outcomes EMS 133

The Trauma Pro

JANUARY 8, 2024

However, it is at odds with a paper published in 2021 from George Washington University. 2021 Nov;49:393-398. They advise that the chest ultrasound should be used alone with caution. Bottom line: This is an interesting and relatively large study. false negative rate. T hese are very disparate numbers. EAST 2024, Podium paper 21.

Ultrasounds 113

Ultrasounds Fractures 113

Pediatric EM Morsels

NOVEMBER 3, 2023

Travel Medicine and Infectious Disease 44 (2021) 102196. falciparum parasitemia , and no other defined cause of AMS (WHO 2023). PMID: 36209409 Comelli A, Guarner ME, Tomasoni LR, Zamboni AF, Pavo BM, Zanotti P, Caligaris S, Matteeli A, Soriano-Arandes A, Castelli F.

Seizures 278

Seizures Pediatrics CDC Infectious Diseases 278

Pediatric EM Morsels

NOVEMBER 17, 2023

2021 Jun;31(6):713-719. Epub 2021 Apr 11. References : To YH, Ong YG, Chong SL, Ang PH, Bte Zakaria ND, Lee KP, Pek JH. Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments. Paediatr Anaesth. doi: 10.1111/pan.14185. PMID: 33774880.

Pediatrics 183

Pediatrics Emergency Department Outcomes Sepsis 183

Dr. Smith's ECG Blog

DECEMBER 5, 2023

2021 Aug 10;144(6):e123-e135. Epub 2021 Jul 7. 2021 Aug 10;144(6):e149. 2021 Apr 18;13(4):700. 2021 Aug;17(4):335-340. 2021 Aug;17(4):335-340. Epub 2021 May 20. Diagnosis and Management of Myocarditis in Children: A Scientific Statement From the American Heart Association. Circulation. PMID: 34229446.

Pediatrics 120

Pediatrics EKG/ECG Hospitals Burns 120

Emergency Medicine Cases

SEPTEMBER 26, 2023

The tragic death of his son Ben McKenzie at the age 15 from hypoxic respiratory arrest as a result of anaphylaxis and asthma in 2021 has led Dr. McKenzie on a mission to prevent deaths from anaphylaxis and asthma by educating emergency providers around the world using his AMAX4 algorithm as a framework.

Anaphylaxis 114

Anaphylaxis Resuscitation EMS 114

Pediatric EM Morsels

JULY 26, 2024

2021 Oct 9;22(20):10911. search=anti+nmda+receptor+encephalitis&source=search_result&selectedTitle=1~29&usage_type=default&display_rank=1#H2973236366. Wu CY, Wu JD, Chen CC. The Association of Ovarian Teratoma and Anti-N-Methyl-D-Aspartate Receptor Encephalitis: An Updated Integrative Review. Int J Mol Sci.

Psychiatric 269

Psychiatric Seizures Outcomes Pediatrics 269

Emergency Live

JANUARY 31, 2024

Female Health Awareness at the Center of European Strategies The New Era of Women’s Healthcare Prevention in Europe Female healthcare prevention has taken on new importance in Europe, particularly through the EU4Health 2021-2027 program.

98

98

Emergency Live

OCTOBER 19, 2023

In the case of Corey O’Connell, a young Australian who went missing in 2021, it was drone technology that provided the decisive breakthrough in […] The post Drones and Photogrammetry: help in the Search for Missing Persons appeared first on Emergency Live.

105

105

Science Based Medicine

NOVEMBER 3, 2023

Part 1 is available here. “There is No COVID Heart” On May 14, 2021, three “medical conservatives,” Drs. ” Though the virus had existed for barely over year, they were very […] The post Part 2: Is an Abnormal Lab Value After Vaccination More Concerning Than Death From COVID?

108

108

RebelEM

SEPTEMBER 27, 2023

Mohan 2021 ) Recall that the subsequently alkalemia will shift potassium intracellular. 2021 Sep;61(3):259-264. Epub 2021 Jun 17. As a result, it is essential to replete potassium simultaneously. References Boehnert MT, Lovejoy FH Jr. PMID: 4022081. Mohan S, Backus T, Furlano E, Howland MA, Smith SW, Su MK. J Emerg Med.

Poisoning 105

Poisoning Seizures Administration EKG/ECG 105

ALiEM

FEBRUARY 9, 2024

This is endorsed in the 2022 ACC pathway [1] and the 2021 AHA chest pain guidelines [7]. 2021 May 14;42(19):1908] [published correction appears in Eur Heart J. 2021 May 14;42(19):1925] [published correction appears in Eur Heart J. 2021 May 13;:]. 2021 Jun 22;143(25):e1118]. 2021 Nov 30;144(22):e455].

EKG/ECG 110

EKG/ECG Emergency Department Burns Wellness 110

Science Based Medicine

JULY 4, 2023

817,000 thousand Americans had already died of COVID by December 23, 2021, and 244,000 more would die the next year. Millions more survived, but were injured. The post When Doctors Have Different Standards of Evidence for the Virus and the Vaccine first appeared on Science-Based Medicine.

103

103

Pediatric EM Morsels

MAY 12, 2023

2021 Sep;78(3):321-330.e1. Epub 2021 Jun 17. PECARN is highly sensitive for identifying those with clinically important TBI. of these had a CT performed 1 (0.2%) had a clinically important TBI (ciTBI) 10 (5.1%) had any TBI on CT 9 (4.6%) had skull fractures Remember to always watch out for NAT ! Ann Emerg Med. 2021.04.015.

Head Injuries 130

Head Injuries Fractures Pediatrics EMS 130

Emergency Medicine Journal

NOVEMBER 21, 2024

The survey was repeated in 2021 after the first wave of the COVID-19 pandemic. The 2021 questionnaire was completed by 79 AED workers and 50 PED workers. Results The 2019 questionnaire was completed by 125 AED workers and 65 PED workers.

Emergency Department 93

Emergency Department Teamwork Patient Safety Hospitals 93

Sensible Medicine

OCTOBER 18, 2023

2021 May 1;320(5):H2101-H2111. Epub 2021 Mar 26. Weissler Snir A, Connelly KA, Goodman JM, Dorian D, Dorian P. Exercise in hypertrophic cardiomyopathy: restrict or rethink. Am J Physiol Heart Circ Physiol. doi: 10.1152/ajpheart.00850.2020. 00850.2020. PMID: 33769918.

98

98

RebelEM

APRIL 17, 2023

A repeat search was completed in May 2021 & November 2022. 2021 May 12:34894211015590. Published on October 25, 2021. Accessed on December 3, 2021. Two investigators independently assessed and screened all studies for eligibility. AJR Am J Roentgenol. 2015 May;204(5):1064-8. PMID: 25905942. Ann Otol Rhinol Laryngol.

Ultrasounds 129

Ultrasounds Radiology Radiology Operations 129