Ken Grauer, MD

MAY 28, 2024

I recently recorded a series of 4 podcasts regarding KEY concepts in ECG interpretation. Easy LINKS — tinyurl.com/KG-ECG-Podcasts — [link] — Other ECG Audio PEARLS I previously made for my ECG Blog can be found in the right column of each page on this blog just below this icon — under, "ECG Audio PEARLS". My New E CG P odcasts ( 5/28/2024 ): These podcasts are part of the Mayo Clinic Cardiovascular CME Podcasts Series ( "Making Waves" ) — hosted by Dr.

EKG/ECG 367

EKG/ECG Wellness 367

The Trauma Pro

MAY 28, 2024

I’ve covered the problem of performing MRI on patients with external fixators. This is typically a problem that arises in head-injured patients with extremity or pelvic fixators for concomitant fractures. MRI is an indispensable tool for the evaluation of head, spine, and soft tissue trauma. However, a great deal of effort is required to ensure that any patient scheduled for this test is “MRI compatible.

Fractures 230

Fractures Hospitals 230

Sensible Medicine

MAY 28, 2024

Regardless of the reason for a primary care visit in the United States, patients are routinely asked how often they feel “hopeless” or "like a failure” These questions come from the PHQ-9. The PHQ-9 has since been validated and is now widely used to screen for depression. Since the United States Preventive Services Task Force (USPSTF) first recommended depression screening 22 years ago, the practice has become standard in primary care despite an absence of evidence.

Outcomes 137

Outcomes Military Psychiatric Wellness 137

Emergency Medicine Cases

MAY 28, 2024

Once the diagnosis of nontraumatic subarachnoid hemorrhage (SAH) has been made, our job is not done. Mortality in SAH patients can be up to 30% even without neurological deficit. Paying attention to the time-sensitive details of ED management of SAH patients can have a significant impact on their outcome. In this second part of our 2-part podcast series on subarachnoid hemorrhage with Dr.

Outcomes 122

Outcomes EMS 122

Emergency Medicine Journal

MAY 28, 2024

Clinical introduction An octogenarian presented to the hospital post-fall from a bed, sustaining left facial and chest bruises without consciousness loss. He had diabetes, hypertension, stroke and atrial fibrillation, and was on aspirin 100 mg and edoxaban 30 mg daily. Vital signs were stable. Examination showed left periorbital swelling and anterior thoracic bruising.

Stroke 98

Stroke Fractures Hospitals 98

EMDocs

MAY 28, 2024

Today on the emDOCs cast with Brit Long, MD ( @long_brit) , we cover part 2 of acute chest syndrome. Episode 101: Acute Chest Syndrome Part 2 Background SCD is an autosomal recessive condition that results in the formation of hemoglobin S (HbS). HbS has reduced solubility in the setting of hypoxia, leading to sickling of the RBCs. Other causes of sickling: acidosis, dehydration, inflammation, infection, fever, and blood stasis.

Blood Transfusions 75

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 75

Emergency Medicine Cases

MAY 28, 2024

Dr. Howard Ovens reflects on the role of leader in the EM in this 2nd part of a 2-part Waiting to Be Seen blog series on EM leadership. He touches on mentoring, being committed, aligning with patients' interests, being a role model and a few quick takes on some controversial issues in EM. The post WTBS 30 Lessons on Emergency Medicine Leadership: The Role of The Leader appeared first on Emergency Medicine Cases.

Leadership 71

Leadership EMS 71

EMCrit

MAY 28, 2024

Do we need ETCO2 for PSA in the ED? EMCrit Project by Scott Weingart, MD FCCM.

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Canadian EM

MAY 28, 2024

Is your team about to embark on a new Quality Improvement (QI) project that involves patients but you’re not sure how to structure it? Are you looking for a meaningful and empathetic approach that champions the user perspective from start to finish and complements traditional QI methods? Design thinking has been gaining attention across a wide range of industries over the past several years, building a strong reputation for its emphasis on forging.

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AED Leader

MAY 28, 2024

AED (Automated External Defibrillator) batteries play a crucial role in ensuring the proper functioning of these life-saving devices. However, like any other battery, AED batteries have a limited lifespan and must be replaced periodically. But what should you do with the old batteries? This comprehensive guide will walk you through the step-by-step process of properly disposing of AED batteries.

Hazardous Materials 52

Hazardous Materials Documentation/Coding 52

American Medical Compliance

MAY 28, 2024

The Opioid Addiction Training for Dental Healthcare Professionals educates dental healthcare professionals (DHCP) on the issue of opioid addiction. Opioid addiction is a pressing public health crisis, and dental healthcare professionals are at the forefront of this battle. Dentists and oral surgeons frequently prescribe opioids for pain management, particularly after surgical procedures.

Best Practices 52

Best Practices 52

AED Leader

MAY 28, 2024

In emergencies, every second counts. When someone experiences sudden cardiac arrest, immediate intervention is crucial to increase their chances of survival. This is where AED (Automated External Defibrillator) defibrillator portable machines play a vital role. These life-saving devices are designed to deliver an electric shock to the heart, restoring its normal rhythm and potentially saving a person’s life.

Shock 52

Shock Operations Wellness 52

Emergency Medicine Cases

MAY 28, 2024

Once the diagnosis of nontraumatic subarachnoid hemorrhage (SAH) has been made, our job is not done. Mortality in SAH patients can be up to 30% even without neurological deficit. Paying attention to the time-sensitive details of ED management of SAH patients can have a significant impact on their outcome. In this second part of our 2-part podcast series on subarachnoid hemorrhage with Dr.

Outcomes 52

Outcomes EMS Seizures Resuscitation 52

Emergency Medicine Journal

MAY 28, 2024

Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication.

Research 52

Research 52

Don't Forget the Bubbles

MAY 28, 2024

Having been the neonatal SHO for a few weeks now, you feel in your element, grunting baby reviews? Done! Screened baby for infections? Also done, deliveries? You have lost track of how many you have attended. So, when you get the call to attend a forceps delivery due to prolonged labour and meconium-stained liquor, you walk into the labour ward with a smile, ready to go.

Sepsis 52

Sepsis Ultrasounds Pediatrics Research 52

Emergency Medicine Journal

MAY 28, 2024

This month’s update is by the Royal Bolton Hospital. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper. The papers are ranked as: Worth a peek—interesting, but not yet ready for prime time.

Ultrasounds 52

Ultrasounds Hospitals Outcomes 52

EMergucate

MAY 28, 2024

The lateral neck x-ray is from a patient with dysphagia. What can be seen? Answer will be posted later.

EMS 52

EMS 52

Emergency Medicine Journal

MAY 28, 2024

Case presentation A woman in her 60s with a medical history of chronic obstructive pulmonary disease, obstructive sleep apnoea and diabetes mellitus presents for 1 week of worsening shortness of breath and fever despite increasing usage of her home nebulisers. The patient describes daily fever, increased cough and mild achy chest pain. She denies abdominal pain, nausea, vomiting, orthopnoea, leg swelling or other symptoms on review of systems.

Ultrasounds 52

Ultrasounds 52

EMergucate

MAY 28, 2024

The following ECG is from a 64-year-old man who presents with severe abdominal pain.

EKG/ECG 52

EKG/ECG 52

Emergency Medicine Journal

MAY 28, 2024

Clinical introduction An 18-day-old male patient presented to the ED with a 2-day history of abdominal distension and blood in the faeces. The patient was born at 34 weeks. Meconium was passed within the first 24 hours. On physical examination, vital signs were normal. There was marked abdominal distention with dilated veins on the abdominal wall and bowel sounds quieter than usual.

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Emergency Medicine Journal

MAY 28, 2024

Objectives Only a small proportion of patients presenting to an ED with headache have a serious cause. The SNNOOP10 criteria, which incorporates red and orange flags for serious causes, has been proposed but not well studied. This project aims to compare the proportion of patients with 10 commonly accepted red flag criteria (singly and in combination) between patients with and without a diagnosis of serious secondary headache in a large, multinational cohort of ED patients presenting with headac

Emergency Department 52

Emergency Department Outcomes Wellness 52

Emergency Medicine Journal

MAY 28, 2024

Introduction The Modified Early Warning Score (MEWS) is an effective tool to identify patients in the acute care chain who are likely to deteriorate. Although it is increasingly being implemented in the ED, the optimal moment to use the MEWS is unknown. This study aimed to determine at what moment in the acute care chain MEWS has the highest accuracy in predicting critical illness.

Operations 52

Operations 52

Emergency Medicine Journal

MAY 28, 2024

Hip fractures require prompt, effective analgesia. However, there is evidence from national audits in the UK that pain is often managed ineffectively in this population. 1 The fascia iliaca compartment block (FIB) provides targeted analgesia without the systemic risks of opioids and non-steroidal anti-inflammatories. 2 In this technique, a large volume of long-acting local anaesthetic (such as 40 mL 0.25% bupivacaine) is deposited beneath the fascia iliaca where it spreads along the fascial plan

Fractures 52

Fractures Ultrasounds 52

Emergency Medicine Journal

MAY 28, 2024

Background Fascia iliaca block (FIB) is an effective technique for analgesia. While FIB using ultrasound is preferred, there is no current standardised training technique or assessment scale. We aimed to create a valid and reliable tool to assess ultrasound-guided FIB. Method This prospective observational study was conducted in the ABS-Lab simulation centre, University of Poitiers, France between 26–29 October and 14–17 December 2021.

Ultrasounds 52

Ultrasounds 52

Emergency Medicine Journal

MAY 28, 2024

Introduction Most patients presenting to the ED are in pain but previous work from the UK has shown that this is often not asked about, recorded or treated effectively. 1 The Royal College of Emergency Medicine (RCEM) Best Practice Guidelines (BPGs) on Management of Pain in Adults 2 and Children 3 advocate recording a pain score, delivering timely and adequate analgesia, then assessing the response.

Wellness 52

Wellness Best Practices 52

Emergency Medicine Journal

MAY 28, 2024

Clinical introduction A woman aged 61 years with a history of diabetes mellitus presented to the ED with acute dyspnoea and altered consciousness for 1 day. Her RR was 36 breaths/min and BP was 81/60 mm Hg. Examination revealed decreased breath sounds in the left lung. A CXR was performed ( figure 1 ). Question Based on the imaging, which of the following is the most likely diagnosis?

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Emergency Medicine Journal

MAY 28, 2024

Three-quarters of older adults visit an ED in the last 6 months of life. 1 For older patients with serious, life-limiting illnesses, those who have good awareness of their illness severity have better outcomes. Prognostic awareness is associated with better-informed decisions about patient care, 2 improved ability to cope with illnesses 3 and increased acceptance of illnesses, 4 yielding more patient-centred care at the end of life.

Emergency Department 52

Emergency Department Outcomes 52

Emergency Medicine Journal

MAY 28, 2024

Welcome to the June 2024 issue of the Emergency Medicine Journal. As we head into another heady summer in the northern hemisphere (though that’s wishful thinking for those of us in the UK), we once again have a superb array of papers on topics as diverse as acute headache, fascia iliaca block and patient predictions of their own mortality. We hope that you may enjoy digesting this wonderful offering on a light and sunny evening.

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Emergency Medicine Journal

MAY 28, 2024

Patients commonly present to the ED with cardiac sounding chest pain 1 and a non-diagnostic ECG, yet an important proportion will be suffering from a myocardial infarction (MI) eligible for percutaneous coronary intervention. 2 Age, male sex, hypertension, diabetes mellitus, hyperlipidaemia, ischaemic heart disease and smoking are all associated with an increased likelihood of an MI, 2 but another potential predictor may be mode of ED arrival.

Emergency Department 52

Emergency Department Research EKG/ECG Hospitals 52