Ken Grauer, MD

NOVEMBER 9, 2024

I was asked to interpret the ECG in Figure-1 — told only that this 30-ish year old man had a history of having undergone a number of operations for CHD ( C ongenital H eart D isease ) as a child. PEARL # 1: The KEY feature in today's history is that this patient was diagnosed with CHD as a child, and underwent a number of operations for this.

EKG/ECG 257

EKG/ECG Operations 257

Emergency Live

MAY 30, 2024

How Case Studies Can Improve Rescue Operations Some successfully handled incident case studies can serve as excellent foundations for better preparing future rescues and organizing updates and new guidelines for rescuers. Let’s analyze some.

Operations 97

Operations 97

Pediatric EM Morsels

NOVEMBER 3, 2023

This allowed US hospitals to stock the drug to ensure quick treatment of suspected severe cases, rather than having to ship it from the CDC under the prior expanded-access protocol (Thomas 2023). Both have a range of detection limits, which can be greatly dependent on operator.

Seizures 278

Seizures Pediatrics CDC Infectious Diseases 278

ACEP Now

MARCH 6, 2024

The Sisyphean task remains to try to keep up—and, in that vein—here is a light round of the emergency medicine literature from 2023. 7 The operators involved in the trial were mostly emergency medicine residents or critical care fellows, but this fact does not diminish the generalizability of these observations. All bleeding stops.

Research 52

Research Airway Management Stroke Outcomes 52

Emergency Live

SEPTEMBER 28, 2023

Sinora Srl takes the field at the 2023 edition of REAS with the latest mission- and business-critical technology at the service of industry operators The 22nd International Emergency Exhibition is just around the corner.

Operations 105

Operations 105

Emergency Live

AUGUST 19, 2024

27% in più rispetto al 2023 The summer of 2024 proved to be particularly demanding for the Italian fire brigade. Oltre 531.000 interventi dall’inizio dell’anno, in particolare dovuti agli incendi.

Operations 52

Operations 52

PulmCCM

NOVEMBER 17, 2023

Kenny MD [ @heart_lung ] In part 1 , right atrial pressure [P ra ] and cardiac output/venous return [CO/VR] were considered as two hemodynamic measures bound at the operating point [OP] of the circulatory system. OP is operating point. Shows what happens when Ppc, Pmsf, Rcardiac and Rvr all vary [grey operating points].

Operations 129

Operations Ultrasounds Resuscitation Blood Transfusions 129

Pediatric EM Morsels

JULY 19, 2024

4-17% will rebleed No difference in rebleed rate between those that are treated operatively and those that are observed On average, the second bleed occurs 3-4 days after the first bleed Some bleeds are considered “ delayed post-tonsillectomy hemorrhage ” and can occur over 14 days after tonsillectomy. 2023 Aug;171:111644. 2023.111644.

Pediatrics 286

Pediatrics Airway Management Wellness Administration 286

The Trauma Pro

DECEMBER 22, 2023

Rapid placement of some kind of marker on all wounds followed by a quick image allows them to roughly predict what was hit, and assess the possibility that there might be bleeding that would drive the team straight to the operating room. 1485, Dec 2023. So yes, this is dogma.

Operations 250

Operations Outcomes 250

Emergency Live

JANUARY 8, 2024

Structure and Sizes of Civil Protection Units in Key European Countries Introduction In 2023, the importance of civil protection forces, including firefighters, healthcare personnel, and ambulance operators, became increasingly evident in Europe.

Operations 52

Operations 52

ALiEM

SEPTEMBER 13, 2024

An emergent ophthalmology consult is needed to plan for operative repair. 2023, March 23). Copyright Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2023 SAEM Annual Meeting | Copyrighted by SAEM 2023 – all rights reserved. Consult ophthalmology emergently.

Emergency Department 64

Emergency Department Academics Hospitals Fractures 64

Mind The Bleep

SEPTEMBER 14, 2024

Operative management: Surgical washout of the flexor sheath within 24 hours of the decision to operate. Non-operative management: An experienced hand surgeon should make the decision for non-operative management. Non-operative management: An experienced hand surgeon should make the decision for non-operative management.

Operations 52

Operations Sepsis Documentation/Coding 52

The Skeptics' Guide to EM

SEPTEMBER 2, 2023

Date: August 30, 2023 Reference: Griffey et al. The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. AEM August 2023 Guest Skeptic: Dr. Suchismita Datta. Date: August 30, 2023 Reference: Griffey et al. AEM August 2023 Guest Skeptic: Dr. Suchismita Datta.

Operations 80

Operations Diabetic Emergencies Hospitals Research 80

RebelEM

NOVEMBER 6, 2024

Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (..)

Dislocations 59

Dislocations Fractures Soft Tissue Injuries Outcomes 59

Don't Forget the Bubbles

JANUARY 1, 2024

Data from the Nurse-Family Partnership program involving 60,171 families were analysed across four cohorts, including pre-pandemic and three pandemic cohorts (from July 2022 to October 2023). However, children who had an operation experienced improvements in behaviour, symptoms, and quality of life and had lower blood pressure.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

PulmCCM

SEPTEMBER 4, 2024

OP is operating point, the operating point defines the cardiac output on the y-axis and Pra on the x-axis; Rcardiac is cardiac resistance (i.e., OP1 is operating point 1 at baseline. With tamponade, operating point 2 (OP2) is formed. Pmsa and Pra do not correlate (inset, upper right). cardiac function).

Ultrasounds 84

Ultrasounds Operations Research Outcomes 84

Taming the SRU

SEPTEMBER 22, 2023

389, 418–429 (2023). million adults undergo tracheal intubation outside of the operating room each year in the United States. The operator reported a subjective assessment of the anticipated difficulty. of operators being either emergency medicine residents or critical care fellows. Background More than 1.5

Operations 104

Operations Outcomes Emergency Department Academics 104

RebelEM

OCTOBER 2, 2023

The SQuID Protocol (Subcutaneous Insulin in /diabetic Ketoacidosis): Impacts on ED Operational Metrics. Acad Emerg Med 2023. No statistical differences in safety between groups Operational Impact Median ED LOS (PRIMARY OUTCOME): SQuID: 8.9hrs (6.5 Acad Emerg Med 2023. Paper: Griffey RT et al. tests/hr (0.8 Traditional: 1.0

Operations 105

Operations Academics Outcomes Fluid Resuscitation 105

Taming the SRU

MAY 22, 2023

weight-bearing status, operative vs. non-operative) If necessary/helpful to ensure adequate follow-up At time of discharge: Counsel on expected course of injury, supportive care (e.g., Accessed March 5, 2023. Updated 2023 Apr 22]. A comparison between pre-operative ultrasonography and surgical findings. 9(1):31-36.

Fractures 77

Fractures Dislocations Operations Radiology 77

Pediatric EM Morsels

NOVEMBER 17, 2023

2023 Apr 28;24(3):579-587. 0.41), p < 0.001. Paediatr Anaesth. 2018 Mar;28(3):210-217. doi: 10.1111/pan.13340. PMID: 29436138. Kim JH, Ahn JH, Chae YJ. Pediatric Application of Cuffed Endotracheal Tube. West J Emerg Med. doi: 10.5811/westjem.59560. PMID: 37278787; PMCID: PMC10284523. Shah A, Carlisle JB. Anaesthesia. doi: 10.1111/anae.14787.

Pediatrics 183

Pediatrics Emergency Department Outcomes Sepsis 183

Pediatric EM Morsels

MARCH 1, 2024

Chest CT Demonstrates parenchymal disease better Allows for operative planning (if needed) Lung Abscess in Children: Management Rarity of the condition affects what is known (no randomized control trials on therapeutic options). Patients with immunocompromised conditions are at risk of Fungal infections.

Pediatrics 169

Pediatrics Ultrasounds Operations Hospitals 169

ACEP Now

JULY 7, 2024

2,3 In this case, aortic dissection was visualized neither on initial bedside nor on repeat inpatient TTE, despite operator knowledge of a known lesion and extensive operator training. Her orthopedic injury was managed non-operatively until her aortic repair could be performed. Published 2023 Apr 17. Click to enlarge.)

Operations 59

Operations Hospitals Administration Outcomes 59

ACEP Now

JUNE 21, 2023

For example, applicant interest in EM significantly declined after the EM workforce report was published resulting in a final count of 132 unfilled programs in 2023. Therefore, applicant, funding, and operational factors may influence programs to offer a particular curriculum length. Advanced Data Tables 2023 Main Residency Match.

EMS 114

EMS Academics Telemedicine Operations 114

Broome Docs

APRIL 30, 2024

2023 Feb 8:S0735-6757(23)00066-9. 2023 Mar 6;5(3):e0855. Video Laryngoscopy vs Direct Laryngoscopy for Endotracheal Intubation in the Operating Room: A Cluster Randomized Clinical Trial. 2023 Aug 17;389(7):e12. Epub 2023 Aug 12. J Trauma Acute Care Surg. 2022 Aug 1;93(2):157-165. doi: 10.1097/TA.0000000000003554.

Poisoning 70

Poisoning Dislocations Operations Ultrasounds 70

EMDocs

MAY 27, 2023

81,4 (2023): 453-465. 2023 Feb 8;S0140-6736(22)02600-9. Source The SQuID Protocol (Subcutaneous Insulin in Diabetic Ketoacidosis): Impacts on ED Operational Metrics. 2023 Feb 12. FARES also had the most favorable score for pain during reduction. Annals of emergency medicine vol. doi:10.1016/j.annemergmed.2022.10.020

Dislocations 57

Dislocations Stroke Operations 57

EMDocs

NOVEMBER 1, 2023

Accessed September 30, 2023. Accessed September 30, 2023. Accessed October 1, 2023. Answer : Esophageal Perforation 1-6 Epidemiology : Most frequent etiology is iatrogenic injury from instrumentation accounting for 60% of cases (e.g. upper endoscopy, transesophageal echo, etc.). McGraw-Hill Education; 2014. Am J Emerg Med.

Operations 67

Operations Radiology Radiology Fluid Resuscitation 67

JournalFeed

APRIL 15, 2023

The JournalFeed podcast for the week of April 10-14, 2023. These are summaries from just 2 of the 5 article we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.

Academics 52

Academics Pediatrics Administration Operations 52

Pediatric EM Morsels

JUNE 16, 2023

Available at: [link] (Accessed: 12 June 2023). Available at: [link] (Accessed: 12 June 2023). Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment. Arch Gen Med. 1863;1:20-38, 172-200, 300-332 Sharareh, B. and Taylor, B. 2021) Morel-Lavallee lesion , Orthobullets.

Soft Tissue Injuries 152

Soft Tissue Injuries Dehydration Fractures Operations 152

ALiEM

SEPTEMBER 9, 2024

General surgery and neurosurgery should be consulted emergently for further operative interventions. Copyright Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2023 SAEM Annual Meeting | Copyrighted by SAEM 2023 – all rights reserved. Surg Neurol Int.

Sepsis 60

Sepsis Academics Operations Wellness 60

EMDocs

MAY 25, 2024

Ferri’s clinical advisor 2023. 01/01/2023:1391-1392.e1. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Accessed June 22, 2023. Treasure Island (FL): StatPearls Publishing; September 26, 2022. Insalaco LF. Sialadenitis. doi: 10.1016/B978-0-323-75573-3.00837-4. Adhikari R, Soni A. Updated 2022 Aug 8].

EMS 80

EMS Dehydration Operations Hospitals 80

RebelEM

APRIL 17, 2023

2023 Jan 10. Furthermore, another small retrospective study found that approximately 30% of patients with CT-diagnosed PTA lacked purulence on drainage attempts (Eliason 2023). While operator dependent, the dynamic ability of POCUS augments bedside diagnosis and can assist with drainage. 2023 Feb 9;15(2):e34820.

Ultrasounds 130

Ultrasounds Radiology Radiology Operations 130

EMDocs

FEBRUARY 7, 2024

Despite a plateau in overall union membership of around 10% in 2023 1 , major labor actions shook the U.S. 3 Increasing Strikes and Unions Labor actions in healthcare can disrupt normal hospital operations, potentially impacting costs and threatening patient quality of care. October 16, 2023. 2023 October 9.

Hospitals 77

Hospitals Research Patient Safety Wellness 77

Don't Forget the Bubbles

OCTOBER 10, 2024

2023 Mar 30;110(4):432-438. Ten thousand children in the UK are operated on a year for fingertip injuries, and 96% of surgeons currently report replacing the nail plate intra-operatively. 2024 Jul 10:archdischild-2023-326727. doi: 10.1136/archdischild-2023-326727. doi: 10.1136/archdischild-2023-326247.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

The Trauma Pro

JUNE 13, 2023

And even if you firmly believe you can’t be swayed, you can’t change the basic operating system in your brain. 0000000000004024, 2023. Believe it or not, these little things can change your attitude regarding their product. Your behavior will change. What if the gift is not so small? What about a research grant?

Research 245

Research Academics Operations Hospitals 245

Taming the SRU

MAY 23, 2023

weight-bearing status, operative vs. non-operative) If necessary/helpful to ensure adequate follow-up At time of discharge Counsel on expected course of injury, supportive care (e.g., Updated 2023 Apr 22]. Updated 2023 Mar 30]. Updated 2023, Apr 14]. Updated 2023 Feb 3]. PMID: 24971221; PMCID: PMC4071746.

Fractures 57

Fractures Dislocations Operations EMS 57

EMDocs

AUGUST 12, 2023

Management consists of intravenous antibiotics , and hand surgery should be consulted to consider operative debridement. Accessed June 24, 2023. Treasure Island (FL): StatPearls Publishing; February 5, 2023. Accessed June 10, 2023. Accessed June 4, 2023. There are no extensor tendon sheaths (A) in the hand.

EMS 69

EMS Fractures Operations Ultrasounds 69

JournalFeed

MAY 13, 2023

The JournalFeed podcast for the week of May 8-12, 2023. CT Ped C-Spine Spoon Feed In this large, single-institution retrospective review of pediatric blunt trauma patients, no clinically significant injuries (requiring operative intervention) were missed when using multi-detector CT scan as the imaging modality of choice.

Operations 40

Operations Pediatrics Outcomes 40