Ken Grauer, MD

FEBRUARY 3, 2024

I’ve taken th e l ead V 3 examples in Figure-3 from previous cases posted on Dr. Smith’s ECG Blog : T OP in Figure-3 — Despite the marked ST elevation in this lead V3 — this is not T-QRS-D, because there is well-defined J-point notching ( BLUE arrow ). This patient had a repolarization variant as the reason for ST elevation.

EKG/ECG 411

EKG/ECG Resuscitation Hospitals Wellness 411

Emergency Medicine Journal

AUGUST 21, 2024

It was performed in our non-academic ED in the Netherlands from July 2021 to April 2022. Moreover, the correlation of noise sensitivity with staff well-being and its effect on interventions were evaluated. Moreover, the correlation of noise sensitivity with staff well-being and its effect on interventions were evaluated.

Wellness 98

Wellness Emergency Department Academics 98

Ken Grauer, MD

SEPTEMBER 22, 2023

Note also that the P wave is negative in standard lead II in Figure-1 ( as well as in leads III and aVF, which are the other 2 inferior leads ). It is well to remember that IF the P wave in lead II is negative — then by definition — You do not have sinus rhythm ( unless there is lead misplacement or dextrocardia ).

EKG/ECG 445

EKG/ECG Wellness 445

ACEP Now

DECEMBER 17, 2024

But we should not have to sacrifice our own well-being in the process. 8 Striking is a last resort, but we were ready to follow in these footsteps, knowing that securing a fair contract is essential for our health and well-being and the quality of care we provide to our patients. In Washington, D.C., The ER docs strike back.

Burns 105

Burns Hospitals Documentation/Coding Emergency Department 105

Pediatric EM Morsels

JUNE 2, 2023

Our patients have varied past medical histories that require us to be well-versed in even the most uncommon disorders (or know where to look things up in a pinch)! 2021 Nov 29;92(S7):e2021518. Rare diseases are not confined to the pages of a textbook or computer screen. Update on Food protein-induced enterocolitis syndrome (FPIES).

Dehydration 193

Dehydration Shock Pediatrics Emergency Department 193

ACEP Now

NOVEMBER 7, 2024

Conclusion Poorly healing wounds pose a significant burden on health care systems and personal well-being, and their presence as a harbinger of severe morbidity and mortality must be appreciated. 2020;95(9):2021-2034. Emergency Medicine News 2004;26(13):19. Hoversten K, Kiemele L, Stolp A, et.al. Mayo Clin Proc.

Burns 97

Burns Documentation/Coding Outcomes Emergency Department 97

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

EMDocs

NOVEMBER 19, 2024

of exposures reported to poison control centers in 2021 were related to antipsychotics or sedative-hypnotics with the majority of those exposures occurring in patients 20 years of age or older. 2021 Annual Report of the National Poison Data System © (NPDS) from America’s Poison Centers: 39th Annual Report. Front Psychiatry.

Poisoning 111

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 111

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. 2021 Oct 9;22(20):10911. 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. Wu CY, Wu JD, Chen CC.

Psychiatric 271

Psychiatric Seizures Outcomes Pediatrics 271

EMDocs

JANUARY 11, 2025

Well keep it short, while you keep that EM brain sharp. Admission allows for close monitoring, given the risks of perforation, ischemic bowel, and ulceration, as well as appropriate management of the condition and patient symptoms. A 73-year-old female is brought in by EMS for abdominal pain, vomiting, and weakness for two days.

EMS 98

EMS Sepsis Shock Fluid Resuscitation 98

Northwestern EM Blog

DECEMBER 27, 2021

Congratulations to all of the authors with the most popular posts of 2021! Despite previous black box warnings on droperidol causing it to fall out of favor, it is safe and well-tolerated at the doses typically used in an emergency department setting.

Dislocations 52

Dislocations Emergency Department Burns Shock 52

EMDocs

JANUARY 25, 2025

Well keep it short, while you keep that EM brain sharp. A previously healthy 23-year-old male with no medical or surgical history presents to the ED with generalized malaise and no energy, progressively getting worse over the last six weeks. 10^9/L) Moderate (0.50.9 10^9/L) Severe (< 0.5 10^9/L) Generalized leukopenia (i.e. link] Lu, W.,

EMS 96

EMS Infectious Diseases Allergic Reactions Fluid Resuscitation 96

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

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. Travel Medicine and Infectious Disease 44 (2021) 102196. Third times the charm!

Seizures 281

Seizures Pediatrics CDC Infectious Diseases 281

RebelEM

JULY 1, 2024

Balkan Med J 2021. AVAPS may be useful, but we still need a well conducted RCT to find out if it is (i.e 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

COPD 132

COPD Emergency Department Outcomes EMS 132

EM Literature of Note

AUGUST 25, 2024

Well, yes to all of the above, in the appropriate clinical context – But, most prominently, as featured in this brief report, for asthma – particularly childhood asthma. It’s NHAMCS – so it is representative data being transformed into rough weighted estimates – between 2010-2021, but we see its use increasing from 3.5%

Emergency Department 94

Emergency Department Administration Wellness Pediatrics 94

Ken Grauer, MD

DECEMBER 23, 2023

This is perhaps best seen in lead V1 ( but also well seen in leads V3,V4,V6 ). in the field, regarding distinction between AFlutter vs Atrial Tachycardia ( 5/29/2021 ). — — E CG M edia P EARL # 57 ( 8:00 minutes Audio ) — What is r ate- r elated B undle B ranch B lock ? QRS morphology varies every- other -beat!

EKG/ECG 441

EKG/ECG Wellness 441

ALiEM

APRIL 10, 2023

Additional Images Physical Exam General: Well appearing, no distress. Skin: Large, serpiginous rash on the left forehead and scalp with central clearing and peripheral erythema as well as areas of erythematous plaques. Updated 2021 Jun 30]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. In: StatPearls [Internet].

Pediatrics 98

Pediatrics EKG/ECG Academics Wellness 98

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? A repeat search was completed in May 2021 & November 2022. 2021 May 12:34894211015590. Acad Emerg Med.

Ultrasounds 130

Ultrasounds Radiology Radiology Operations 130

The Skeptics' Guide to EM

AUGUST 21, 2021

Date: August 19th, 2021 Reference: Pantell et al. Evaluation and management of well-appearing febrile infants 8 to 60 days old. Pediatrics 2021 Guest Skeptic: Dr. Dennis Ren is a pediatric emergency medicine fellow at Children’s National Hospital in Washington, DC. Date: August 19th, 2021 Reference: Pantell et al.

Wellness 52

Wellness Pediatrics Emergency Department Hospitals 52

SheMD

JULY 30, 2023

Some of the interview information may not be relevant during the 2020-2021 & 2021-2022 academic years. 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

ALiEM

FEBRUARY 9, 2024

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. This is endorsed in the 2022 ACC pathway [1] and the 2021 AHA chest pain guidelines [7]. 2021 May 13;:]. Eur Heart J.

EKG/ECG 110

EKG/ECG Emergency Department Burns Wellness 110

EMergucate

JANUARY 12, 2021

His symptoms had spontaneously resolved and he currently feels well. The following ECG is taken from a 28 year old man who presented with palpitations and presyncope. Describe and interpret his ECG…

EKG/ECG 52

EKG/ECG Wellness 52

Sensible Medicine

AUGUST 12, 2024

Surely you do as well. You can improve your chances by eating well, exercising, avoiding smoking and too much alcohol. And that was the result of screening for just 5 cancers (breast, cervical, colorectal, lung and prostate) in the year 2021. My thinking aligns well with his. I would like to live a long life.

Outcomes 133

Outcomes Research Wellness Hospitals 133

EMDocs

FEBRUARY 7, 2024

there were 31 recorded healthcare strikes in 2021, 39 recorded healthcare strikes in 2022, and 37 healthcare strikes in 2023 as of November 3rd. months between 1993 and 2021 to one strike every 1.4 months between 1993 and 2021 to one strike every 1.4 Trends in labor unionization among US health care workers, 2009-2021.

Hospitals 98

Hospitals Research Patient Safety Wellness 98

ACEP Now

SEPTEMBER 5, 2024

A 2021 systematic review and meta-analysis also explored the diagnosis of malrotation and midgut volvulus via ultrasound. It is important to evaluate for both the position of the SMA in relationship to the SMV as well as for the “whirlpool” sign. The post How Well Does Ultrasound Detect Volvulus in Infants? ANZ J Surg.

Ultrasounds 40

Ultrasounds Wellness Pediatrics Poisoning 40

Don't Forget the Bubbles

MAY 31, 2023

The DIMPLES study by PERUKI sought to investigate the incidence of new-onset diabetes in the paediatric population across the UK and Ireland, as well as the characteristics of these ED presentations, and to determine if SARS-CoV2 infection was involved. Crit Care 25, 399 (2021). Which patients were involved? How good was this paper?

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

The Trauma Pro

MARCH 8, 2024

The literature on this topic was searched from 1960 to 2021, and only observational and randomized studies were included. They decrease handoff errors and reduce preventable adverse events as well. The EMS to trauma team handoff is well-received and is subjectively valuable.

EMS 113

EMS Wellness 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 ). Figure-2: I've labeled some findings from Figure-1. T oday's C ASE C ontinues: The worrisome findings in ECG #1 were recognized.

EKG/ECG 248

EKG/ECG Shock Wellness 248

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 132

Sepsis Hospitals Administration Outcomes 132

ALiEM

NOVEMBER 17, 2023

kg General : Well-appearing 4-year-old female acting appropriately with grandmother and mother at the bedside. link] Published 2021. link] Published 2021. Of note, the patient’s father took her to a trampoline park with her younger sister two days ago. C; Wt 18.2 Abdomen : Soft, nontender, nondistended. Laufer M, Emans S.

Pediatrics 100

Pediatrics Emergency Department Academics OB/GYN 100

Pediatric EM Morsels

APRIL 28, 2023

Has undergone many modifications as well to include up to 5 types. The Athlete is at risk of both Osgood Schlatter’s disease as well as Tibial Tubercle Avulsion Fracture. October 26, 2021. Most commonly used is the Ogdon Classification system (a modification of the Watson-Jones criteria). References: Cole, rd et al.

Fractures 130

Fractures Pediatrics Operations Wellness 130

EMDocs

FEBRUARY 7, 2024

Multiple well-designed, multicenter, multinational studies suggest GLP-1 agonists are associated with improved glucose control in diabetes type 2 and approximately a 15% reduction in weight over 1-2 years (around 2/3s of patients regain weight if treatment is stopped). Published June 04, 2021. 2021 Mar 18;384(11):989-1002.

Allergic Reactions 98

Allergic Reactions Anaphylaxis Dehydration Wellness 98

Sensible Medicine

APRIL 14, 2024

For instance, CAR-T was given to myeloma patients in 2014, but we only learned it can cause Parkinsonism in 2021. A few companies will get rich doing this, and many well-intentioned people will be cheering us over the cliff. It can take several years for the full safety profile of drugs to be known.

Patient Safety 145

Patient Safety Academics Outcomes Wellness 145

Northwestern EM Blog

MARCH 1, 2025

In this study, they found that prone positioning resulted in significant improvement in oxygenation, as well as a 50% decrease in mortality at 28 days (Guerin et. Position arms in a comfortable position, avoiding any position that could cause a brachial plexus injury, and ensure they are well-supported to avoid pressure ulcers.

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 52

RebelEM

SEPTEMBER 21, 2023

Troponins are highly specific to cardiac myocytes but do exist in other muscle types as well. A troponin is a protein (not an enzyme) that is detected when there is breakdown of muscle in the body. Who should have troponins sent? After conversion to sinus rhythm, do a good history, physical and analysis of the ECG.

EKG/ECG 143

EKG/ECG Sepsis EMS Outcomes 143

Pediatric EM Morsels

JULY 7, 2023

Seen in sports that involved aggressive twisting of the knee (ex, snowboarding, soccer, horse-riding) as well as direct trauma. Epub 2021 Nov 2. Mechanism of dislocation : [ Horan, 2006 ] Typically, the injury occurs when: The Knee is in Flexion and The Foot is rotated and plantar flexed. Am J Emerg Med. 2022 Apr;54:328.e3-328.e4.

Dislocations 143

Dislocations Fractures Pediatrics EMS 143