Ken Grauer, MD

SEPTEMBER 6, 2024

Depending on which of above considerations is operative — the differential diagnosis of the rhythm in ECG #1 will be between: i ) A reentry SVT rhythm with retrograde atrial conduction; ii ) ATach ( A trial T achycardia ) ; — or — iii ) Junctional Tachycardia. What is happening in today's case is different.

EKG/ECG 248

EKG/ECG Administration Operations Wellness 248

Taming the SRU

MARCH 12, 2024

The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. as well as patients less than 18 years old were excluded from analysis. The study’s primary outcomes were the operational impacts of the SQuID protocol on EDLOS and ICU admission rates. Acad Emerg Med 2023;30(8):800–8.

Operations 97

Operations Hospitals Best Practices Wellness 97

EMDocs

FEBRUARY 7, 2024

3 Increasing Strikes and Unions Labor actions in healthcare can disrupt normal hospital operations, potentially impacting costs and threatening patient quality of care. 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 since 2022.

Hospitals 98

Hospitals Research Patient Safety Wellness 98

RebelEM

FEBRUARY 1, 2024

What they Did : Investigator-initiated, Multicenter, Parallel-ground, Open-label, Registry-linked, Randomized, Controlled, Non-Inferiority trial 22 Canadian Primary and Comprehensive Stroke Centers from December 2019 to January 2022 Eligible ischemic stroke patients randomized 1:1 to receive intravenous tenecteplase (0.25 vs Alteplase 34.8%

Stroke 135

Stroke Blood Transfusions Outcomes EMS 135

Total Medical ComplianceHIPAA

JANUARY 12, 2023

Department of Health and Human Services (HHS) Office for Civil Rights (OCR) had its busiest year with the announcement of its 22 nd enforcement settlement on December 15, 2022. Many comments to the NPRM noted that this would be an operational and compliance risk issue for providers. Last year, the U.S.

Operations 104

Operations Best Practices Documentation/Coding Administration 104

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. Article: Kim DJ et al. Acad Emerg Med. 2023 Jan 10.

Ultrasounds 129

Ultrasounds Radiology Radiology Operations 129

PulmCCM

NOVEMBER 6, 2023

Intuitively, plasma seemed even less likely to help the very sickest of the sick— those mechanically ventilated with ARDS from Covid-19, whose mortality rate was well over 50% at many centers. Only it turns out, it did help. Or could, anyway. patients infected with the Wuhan/Delta variants in 2020-2021).

Blood Transfusions 98

Blood Transfusions Operations Resuscitation Infectious Diseases 98

EMDocs

DECEMBER 11, 2023

In October 2022, the American College of Cardiology released an updated expert consensus decision regarding the evaluation of chest pain in the emergency department. There are multiple criteria systems for diagnostic an acute myocardial infarction in this population, as well as patients with ventricular-paced rhythms. PMID: 36241466.

EKG/ECG 119

EKG/ECG Emergency Department Academics Operations 119

ACEP Now

JULY 7, 2023

1 Ventricular tachycardia (VT) and ventricular fibrillation (VF) represent the most common initial rhythms for patients presenting to the ED in out-of-hospital cardiac arrest, as well as for patients who develop cardiac arrest while in the ED. Heart disease and stroke statistics-2022 update: A report from the American Heart Association.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

EMDocs

MAY 25, 2024

Treasure Island (FL): StatPearls Publishing; September 26, 2022. Updated 2022 Aug 8]. In: StatPearls. Insalaco LF. Ferri’s clinical advisor 2023. Sialadenitis. 01/01/2023:1391-1392.e1. doi: 10.1016/B978-0-323-75573-3.00837-4. Adhikari R, Soni A. Submandibular Sialadenitis and Sialadenosis. In: StatPearls [Internet].

EMS 98

EMS Dehydration Operations Hospitals 98

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 117

EKG/ECG Wellness Operations Emergency Department 117

EMDocs

AUGUST 12, 2023

He presented to the emergency department because he is having numbness distal to the site of injury, as well as constant bleeding and some difficulty with flexing his finger. Management consists of intravenous antibiotics , and hand surgery should be consulted to consider operative debridement.

EMS 95

EMS Fractures Operations Ultrasounds 95

PulmCCM

APRIL 18, 2024

The real world success rates by operators experienced with intubation remained unknown. In the relatively few studies comparing video to direct laryngoscopy, intubations were usually performed by inexperienced trainees, and sample sizes were small.

Airway Management 98

Airway Management Operations EMS Research 98

Don't Forget the Bubbles

JUNE 30, 2023

You will be running the show today, and you want to use your preparation time well. These procedures require an experienced operator. These procedures require an experienced operator. These procedures require an experienced operator. 2022 Dec;57(12):986-993. The trauma call goes out. Really, in a 14-year-old?

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

RebelEM

APRIL 29, 2024

CVC vs PIV The critically ill patient is often associated with pathology that makes IV access difficult such as shock state, hypovolemia, obesity, IV drug abuse, end-stage renal disease, cardiac arrest, as well as other conditions. 2022 PMID: 35206981 2. Labs can be drawn from an IO to help with rapid diagnosis in emergencies.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

RebelEM

JANUARY 25, 2024

Point-of-care ultrasound (PoCUS) is inherently operator-dependent, which may have led to inconsistencies in the quality and findings of the ultrasound exams across different operators. CHF, in particular, lends itself well to diagnosis and treatment with PoCUS, as it readily reveals the presence of B lines. 2022 Dec;106:9-38.

Ultrasounds 129

Ultrasounds Outcomes COPD Hospitals 129

Dr. Smith's ECG Blog

SEPTEMBER 9, 2024

The cut points for what constitute OMI and not OMI as well as confidence levels are calibrated to maximize sensitivity and specificity according to the receiver operating characteristic. The diagonal branches are overlapping one another and not well visualized in this view. Next is RAO cranial shot.

EKG/ECG 66

EKG/ECG Operations Wellness Ultrasounds 66

Don't Forget the Bubbles

MAY 22, 2023

These can be operated and maintained by patients and their families at home. Gemma tells you that as well as the physio, Robin’s LTV Consultant has also prescribed some oral antibiotics. Since then, he has been well in himself. Advances in technology have also led to more portable ventilators. You go to see Robin.

Radiology 98

Radiology Radiology Hospitals Wellness 98

RebelEM

JUNE 8, 2023

2022 Sep 5. 2022 2022 Sep 5. Prior literature primarily focused on safety and medication errors, and while this study did the same, they also assessed variables associated with PDP response. Paper: Singer S, et al. The safety and efficacy of push dose vasopressors in critically ill adults. Am J Emerg Med. Am J Emerg Med.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

Taming the SRU

NOVEMBER 3, 2023

41, 2695–2701 (2022). Broad strokes In this prospective, non-randomized study published by Kring et al in January 2022 out of Maine Medical Center, researchers compared mean pain scores at rest and during incentive spirometry before, at 15 minutes after, and then 60 minutes after treatment with a serratus anterior plane block.

Fractures 98

Fractures Ultrasounds Research Outcomes 98

RebelEM

AUGUST 12, 2024

Epub 2022 Aug 28. Thus further adding to the well known safety of amino acid infusions The lack of a diversified patient population in combination with having used only one type of amino acid formulary greatly limits this study’s generalizability. Epub 2022 Aug 28. The PROTECTION trial. Contemp Clin Trials. The PROTECTION trial.

Outcomes 81

Outcomes Hospitals Operations Shock 81

ACEP Now

MAY 4, 2023

The chest X-ray showed multiple displaced right rib fractures and chest wall subcutaneous emphysema without definitive evidence of a pneumothorax, as well as right lower lobe atelectasis versus contusion (Figure 1). On hospital day 2, he was taken to the operating room for surgical rib fixation. 2022; 22(11):432-439. J Surg Res.

EMS 52

EMS Fractures Operations Radiology 52

Medical Law

SEPTEMBER 15, 2024

California drivers should still maintain their vehicles to ensure they’re well-prepared for wet and cool conditions. Oil Changes Cooler temperatures can cause oil to thicken, which can hinder efficient engine operation. Contact our Santa Barbara car accident lawyers at (805) 962-2022 for a consultation.

Operations 52

Operations Wellness 52

SheMD

MAY 4, 2023

Women were more likely to be first appointed to educational rather than operational roles (52.6% vs 61.2%, p=0.02) as well as to be in those roles immediately prior to first chair appointment (p=0.01). Dig Dis Sci 67, 364–366 (2022). There were no gender differences in residency type, board certification, or fellowship position.

Leadership 52

Leadership Academics Operations Emergency Department 52

Intensive Blog

AUGUST 17, 2023

Approximately half of these cases meet the criteria for major bleeding as established by the International Society on Thrombosis and Haemostasis (Kalbhenn and Zieger, 2022). Retrospective data showed comparable major bleeding rates between V-A and V-V ECMO patients (Nguyen et al, 2022). Major bleeding (Arachchilage et al, 2021) 1.

Blood Transfusions 52

Blood Transfusions Operations Wellness 52

Taming the SRU

APRIL 5, 2023

The kidney will have a different axis as well as level of lie, so care should be taken to scan broadly if the renal cortex is not immediately apparent. Operators should take care to obtain clear images of the upper renal poles with the understanding that inferior pole evaluation will be limited from the isthmus. 2022 Nov 28.

Ultrasounds 52

Ultrasounds Pediatrics Radiology Radiology 52

Don't Forget the Bubbles

SEPTEMBER 23, 2023

This talk, from Clare Skinner, on music, medicine and leadership , comes from our 2022 DFTB conference in Brisbane. There is leadership operating at many levels. Just like a hospital, or a health system, an orchestra needs every player doing their thing and doing it well. In practice, though, things are more complicated.

Leadership 136

Leadership Teamwork Hospitals Emergency Department 136

Don't Forget the Bubbles

JUNE 17, 2024

Loss of psychological safety and mental well-being persist long after the episode and can impact future episodes of care. 2022 May 12;46(3):319-24. Exposure to incivility hinders clinical performance in a simulated operative crisis. The lasting effects of incivility cannot be understated. Australian Health Review.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

Medical Law

FEBRUARY 12, 2021

Well, yes and no. While you typically won’t see an aircraft recording the speeds of passing cars, it is a possibility — and some roadways are even patrolled by drones, which can operate without a a pilot. To speak with one of our excellent legal team members, call NordstrandBlack PC, at (805) 962-2022.

Operations 59

Operations Wellness 59

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

Regarding my Systematic assessment of ECG #1: There is significant baseline artifact , as well as baseline wander. since what appears to be a major causative factor ( simultaneous ingestion of 9 herbal preparations ) is no longer operative. For clarity in Figure-1 — I've reproduced the initial ECG in today's case.

Seizures 113

Seizures EKG/ECG EMS Stroke 113

ALiEM

OCTOBER 30, 2023

The same goes for clinical operations and research – interesting, but there hasn’t been any “a ha” moment to illuminate her calling. Well, instead of passively waiting for Godot, you can seize the initiative and bend the arc of your career into alignment with your values, strengths, and passions, and, by extension, toward fulfillment.

Academics 64

Academics Leadership Wellness Research 64

ALiEM

MAY 13, 2024

They may be well-circumscribed or may have irregular borders. Well-circumscribed abscess with heterogeneous debris C. Larger abscess with well-circumscribed borders D. Superficial abscess with well-circumscribed borders Table 1. 2022 Feb 1;38(2):e674-e677. The ultrasound can only see what is scanned.

Ultrasounds 64

Ultrasounds Pediatrics Emergency Department Wellness 64

RebelEM

DECEMBER 19, 2022

2022 Nov 6 PMID: 36342151 Clinical Question: How does double defibrillation and vector change defibrillation compare to standard therapy in OHCA patients with refractory ventricular fibrillation? While many healthcare systems across the world operate in a similar fashion, the United States does not. N Engl J Med.

EMS 52

EMS CPR Shock Resuscitation 52

Don't Forget the Bubbles

MAY 10, 2023

In May 2022, Holly and Joe, two students on the joint QMUL and DFTB PEM MSc , created video presentations on human factors. Then the patient is rapidly moved to the operating theatre. The effects of aviation-style non-technical skills training on technical performance and outcome in the operating theatre. Take a break.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

Taming the SRU

JUNE 11, 2023

Utilized in the pre-hospital setting, ICU and the Operating Room, it is a non-invasive measurement that reflects a patient’s current state of metabolism, circulation and ventilation. It’s reflection of underlying metabolism, circulation and ventilation may serve well to identify patients with early dysfunction of physiologic functions.

Hospitals 88

Hospitals Emergency Department EMS Outcomes 88

ACEP Now

DECEMBER 10, 2023

ACEP said as much to the White House by writing a powerful letter in November 2022 supported by 34 organizations to show how serious the issue has become. Multiple stakeholders emphasized the importance of sharpening the focus, as well as refining the federal and state review of training programs for nurses and long-term care workers.

Emergency Department 52

Emergency Department Leadership Hospitals Operations 52

Don't Forget the Bubbles

JANUARY 17, 2024

Point-of-care ultrasound may show well-demarcated, round, and hypoechoic material in the stomach and first part of the duodenum, though it can underestimate the number of beads present. They passed away a few days after a second operation. From Mullens et al., Unfortunately, the anastomosis broke down. It’s beads, too!

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111