Ken Grauer, MD
MARCH 29, 2023
The ECG in Figure-1 is from a man in his 30s — who overall has been healthy, except for a history of "intermittent palpitations" that he has had since childhood. Episodes typically last less than 2 minutes — but this time, he presented to the ED ( E mergency D epartment ) because of ongoing symptoms lasting a number of hours. The patient consumed alcohol at a party the night before.
Pediatric EM Morsels
MARCH 31, 2023
Children love to trick us! Sometimes it is all in good fun and other times it is quite serious! They like to pretend to be well when they are truly sick ( remember to check that Cap Refill and to never trust a Neonate! ) and they often show us “odd” findings that are really normal (ex, Growth Plates, Primitive Reflexes ). They like to keep us on our toes so much, that even their cervical bones can deceive us.
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Mount Sinai EM
MARCH 20, 2023
Sickle cell disease affects ~ 100,000 people in the US. Though pain is the most common ED presentation for patients with SCD, we should always consider life-threatening emergencies in this devastating and complicated disease. Acute Chest Syndrome ACS is the leading cause of morbidity and mortality in patients with SCD. It’s caused by sickling in the pulmonary vasculature, leading to a cycle of hypoxia, vaso-occlusion, and consequently more hypoxia.
EMCrit
MARCH 21, 2023
Steroid is worthless for pneumonia! Wait, a new study shows it's beneficial! Hang on, a fresh meta-analysis shows that steroid it's useless! And wait, here's a fresh NEJM study showing mortality benefit!! This feels like a roller coaster. What's going on here? Several factors may explain this: Steroid is beneficial, but only in a subset […] EMCrit Project by Josh Farkas.
NIOSH Science Blog
MARCH 15, 2023
Employers can play a vital role in suicide prevention. Historically, suicide, mental health, and well-being have been underrepresented in workplace health and safety efforts, but this is changing. In some European countries, there are workplace standards for workplace psychosocial hazards that put workers at risk for suicide. Additionally, in France, employers have been made accountable for toxic workplaces and management practices that contributed to worker suicides.[1] Some of the latest workp
NRC Health
MARCH 22, 2023
NRC Health is named to Becker’s 'top places to work in healthcare' list for 2023. The post NRC Health named to Becker’s ‘top places to work in healthcare’ list appeared first on NRC Health.
Ken Grauer, MD
MARCH 23, 2023
The 12-lead ECG and long lead II rhythm strip shown in Figure-1 — was obtained from a previously healthy, elderly woman who collapsed in the hospital parking lot. She underwent cardiopulmonary resuscitation for VT/VFib — with ROSC ( R eturn O f S pontaneous C irculation ) following defibrillation and treatment with Epinephrine and Amiodarone. A series of cardiac arrhythmias were seen during the course of her resuscitation — including the interesting arrhythmia shown in the long lead II of Figure
Emergency Care Today brings together the best content for emergency care practitioners from the widest variety of industry thought leaders.
Mount Sinai EM
MARCH 20, 2023
Trauma is the leading cause of non-obstetric death in pregnant women. MVAs and intimate partner violence account for most cases. Let’s first discuss the physiological changes to consider when managing a pregnant patient in a trauma. AIRWAY : Progesterone: floppier airway with more edema Predict a more difficult tube Decreased esophageal tone and -> higher risk for aspiration Decompress early with NG or OG tube BREATHING : Increase in respiratory drive -> hyperventilation -> chronic r
RebelEM
MARCH 30, 2023
Background: Previous observational studies published in 2015 (Geri 2015)(Vyas 2015) indicated that early cardiac catheterization in patients with out-of-hospital cardiac arrest (OHCA) might improve mortality and result in more favorable neurological outcomes. The TOMAHAWK (Desch 2021), COACT (Abella 2019), and PEARL (Lemkes 2019) trials examined patients with OHCA without ST elevation with a shockable rhythm, and investigators found no difference in delayed versus emergency angiogram.
EMCrit
MARCH 17, 2023
A new format of ED Critical Care perfectly suited to rural environments EMCrit Project by Scott Weingart, MD FCCM.
NRC Health
MARCH 29, 2023
In this episode we are joined by Toya Gorley, Improvement Advisor at NRC Health and Dr. Elizabeth Paskas, Senior Vice President, Chief Patient Experience Officer at Hackensack Meridian Health as they discuss the Fundamentals First mentality and how it has impacted health systems. The post Hackensack Meridian Health & NRC Health: Fundamentals First appeared first on NRC Health.
Ken Grauer, MD
MARCH 18, 2023
The ECG in Figure-1 was obtained from a man in his mid-60s — who presented with new chest pain. Should the cath lab be activated? Figure-1: T he initial ECG in today’s case. Should the cath lab be activated? MY Thoughts on the Initial ECG: The rhythm in ECG #1 — is sinus at ~70/minute. All intervals ( PR, QRS, QTc ) are normal. There is no chamber enlargement.
Mind The Bleep
MARCH 22, 2023
Introduction Clinical Definition An open fracture is when the broken bone breaks through the skin or any other body cavity that is open to the outside, including those through the rectum or vagina. Classification Gustilo and Anderson Classification 1,2 Type Wound Size Contamination Fracture Arterial injury requiring repair Soft Tissue Coverage 1 < 1cm Minimal Minimal None Adequate – local 2 1-10cm Moderate Moderate None Adequate – local 3A >10cm Extensive Severe None Adequate
Total Medical ComplianceHIPAA
MARCH 15, 2023
With the pandemic drawing to a close in May , many employers are requiring their workers to return to the physical workplace. Patients that are afraid that their medical situation makes that return too risky at this time are requesting a letter from the doctor preventing that return. If the doctor believes this to be valid, they generate the letter.
The Skeptics' Guide to EM
MARCH 31, 2023
Date: March 28, 2023 Reference: Fowler et al. Objective assessment of sleep and fatigue risk in emergency medicine physicians. AEM March 2023 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called www.First10EM.com Case: You arrive at 7am to relieve your colleague after a night shift. You find her at […] The post SGEM#399: I’m So Tired – Emergency Medicine and Fatigue first appeared on The Skeptics Guide to Emergency Medicine.
EMCrit
MARCH 25, 2023
Hayden Richards is a communications maven. EMCrit Project by Scott Weingart, MD FCCM.
Dr. Smith's ECG Blog
MARCH 31, 2023
This was sent to me by a friend. It is from a 50-something with chest pain: What do you think? This was marked as "Not a STEMI" by the physicians. It is not a STEMI, but it is diagnostic of an LAD OMI (Occlusion MI). There is subtle ST Elevation in V1-V4 and hyperacute T-waves in V2-V6. There is also subtle but diagnostic INFERIOR ST Elevation, with reciprocal ST Depression in aVL.
Ken Grauer, MD
MARCH 12, 2023
I start today’s case with the ECG shown in Figure-1 — obtained from a 30-something year old man, who presented with palpitations. How would YOU interpret the ECG in Figure-1 ? Treatment? What is unusual about this arrhythmia? = NOTE: The ECG in Figure-1 has been recorded at the usual 25mm/second speed — but with the Cabrera format ( Please see my Editorial Note near the top of the page in ECG Blog #365 for review of the basics of this recording system ). = Figure-1: The initial ECG in today’s ca
Taming the SRU
MARCH 30, 2023
Ospina-Tascón GA, Teboul J-L, Hernandez G, et al. Diastolic shock index and clinical outcomes in patients with septic shock. Ann Intensive Care 2020;10(1):41. 10.1186/s13613-020-00658-8 P: A total of 761 patients from two separate cohorts found to have septic shock I: Diastolic shock index C: Comparison to a variety of well adopted markers of morbidity and mortality, including systolic shock index, SOFA score, APACHE II score, lactate, etc.
Dr. Mike Sevilla
MARCH 30, 2023
A cheeseburger really is not healthy, right? Well, in a recent news report , a survey claimed that the food chain Whataburger (we have no restaurants around here) has the “healthiest” cheeseburger in America. The wildly popular food website called Mashed (they have 25 monthly readers worldwide) reached out for my comment on this. You can probably guess what I said about it.
American Medical Compliance
MARCH 30, 2023
After the COVID-19 pandemic, there has been a greater importance in implementing proper infection control protocols, such as identifying cases of infections and supplying proper personal protective equipment (PPE) to emergency medical workers. All medical facilities must establish and follow proper infection control guidelines due to the high potential of exposure to infectious materials and patients that healthcare personnel face.
NRC Health
MARCH 30, 2023
Compliment Sharing is a new digital solution to address burnout and boost morale among frontline care teams. The post NRC Health energizes healthcare organizations with digital solution to ease burnout for care teams appeared first on NRC Health.
Dr. Smith's ECG Blog
MARCH 30, 2023
= My Comment by K EN G RAUER, MD ( 3/30 /2023 ): = The ECG in Figure-1 was sent to me without the benefit of any history. I thought the rhythm illustrated a number of essential concepts for clinicians dedicated to Emergency Care. Do YOU know what the rhythm is? IF this arrhythmia is puzzling to you — READ ON! I illustrate how to make the diagnosis within less than 15 seconds.
Ken Grauer, MD
MARCH 7, 2023
You are given this ECG to review. No history is provided — except knowing that this patient was seen in the ED ( E mergency D epartment ). QUESTION: Is there a potential problem with this ECG? Figure-1: The initial ECG in today's case. == N OTE : Many of us are charged with reviewing ECGs that have been interpreted by other clinicians — often without the benefit of much ( or any ) history.
Stop and Think
MARCH 28, 2023
There is this idea that one of the main problems with US healthcare is that our system is set up to profit from sick care. This comment from my friend Dr. David Albert captures the idea: Martha, as you well know, we have a sick care system not a well care system that doesn't make $ from wellness but from caring for the sick. Not sure it will change (Trillions of dollars at stake).
Dr. Mike Sevilla
MARCH 30, 2023
Over the past three years, we have learned a lot about getting COVID infections, and being re-infected with the COVID virus. Looking back, there is a lot that we know now that we did not know previously. Thanks to CNET for reaching out to me to comment on this for their story “ What to know about getting COVID again (and again) in 2023.” I encourage you to click on the article and to check out my comments.
American Medical Compliance
MARCH 30, 2023
OSHA (Occupation Safety and Health Administration) views workplace violence as a major occupational risk. In response to this risk, OSHA may install additional safety standards to combat workplace violence. Over the last decade, the number of workplace violence instances has grown significantly. These instances have continued to increase as a result of the COVID-19 pandemic.
Emergency Medicine Cases
MARCH 28, 2023
Dr. Nav Sahsi gives us a quick primer on Doctors Without Borders, explains the difference between humanitarian work and development work and describes the motivation, personal skills, education, time commitment and flexibility required for humanitarian work for all those with an interest in Global EM. The post Global EM 3 So you want to be a humanitarian doctor?
Cook County EM Blog
MARCH 28, 2023
The Case: The patient is a 61-year-old male with non-insulin dependent diabetes, hypertension, coronary artery disease status post CABG in 2019 who presented with blurry vision of the left eye after being hit on the face with a blunt object by his roommate approximately ten days prior to presentation. The patient reports that over the past year his roommate had been abusing him physically.
NRC Health
MARCH 28, 2023
Check out the latest spring highlights on how we put Human Understanding® into practice The post Partnering for progress: Our spring highlights in healthcare innovation appeared first on NRC Health.
Ultrasound Gel
MARCH 27, 2023
Virtual reality ultrasound?! It is here, and it might be a valuable educational tool. Special host Shawn Sethi, usual but still somewhat special host Mike, and definitely special guest ultrasound educator Suean Pascoe discuss the available evidence and their own perspectives on this innovative technology. [link] Virtual reality ultrasound?! It is here, and it might be a valuable educational tool.
Emergency Medicine Ireland
MARCH 27, 2023
Welcome back to the tasty morsels of critical care podcast. Oh Chapter 37 is dedicated to NIV in the ICU and is probably worth some time given that this is a common respiratory support both in the ICU and throughout the hospital. Many of the benefits of NIV are similar to those seen with ventilation with the blue plastic tube through the vocal cords.For example you still get: positive airway pressure which recruits alveoli and improves oxygenation improved alveolar ventilation which improves min
Dr. Smith's ECG Blog
MARCH 27, 2023
I was reading ECGs on the system, and saw this one: What do you think? I knew that, if the patient had presented with chest discomfort, that this ECG is diagnostic of inferior posterior OMI, even though it is not a STEMI. However, it is difficult to recognize for an interpreter who is does not have special expertise in OMI ECG diagnosis. We taught an AI system from PM Cardio to recognize patterns of subtle OMI (beware: this version of the app is not available to the public yet).
Emergency Medicine Cases
MARCH 28, 2023
In this month's EM Quick Hits podcast: Anand Swaminathan on 3-pronged approach to aortic dissection management, Jonathan Wallace on rural practice tips for glue removal and ESP block for renal colic, Sara Gray on everything you need to know about High Flow Nasal Cannula but were afraid to ask, Maria Ivankovic on reducing the duration of antibiotic therapy for uncomplicated common bacterial infections, Tahara Bhate on handover and learner oversight on QI corner and Kerstin De Wit on the ADJUST-UN
AED Leader
MARCH 27, 2023
Heart palpitations may come on after eating certain foods or you may have heart palpitations for another reason, such as dehydration, low electrolyte levels, pregnancy, anxiety, anemia, thyroid issues, or an underlying heart disease or arrhythmia like atrial fibrillation. While experiencing heart palpitations after eating is fairly common and is usually not dangerous, an irregular Read More "10 Foods You Should Avoid if You Have Heart Palpitations" The post 10 Foods You Should Avoid if You Have
RebelEM
MARCH 27, 2023
Background Information: Obtaining definitive control of the airway, when indicated, is the responsibility of the emergency medicine physician. Traditionally patients were managed on the ventilator with lung volumes of 10 – 15 ml/kg. However, that practice is long-outdated and patients managed on lower tidal volumes (6 ml/kg) were found to have decreased mortality. 1 This practice of lower tidal volumes has been termed “lung protective ventilation” (LPV) and is now the standard of care for
NRC Health
MARCH 27, 2023
NRC Health is proud to host and participate in several special events you won’t want to miss this spring! The post Spring’s healthcare events you don’t want to miss—come see us! appeared first on NRC Health.
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