Ken Grauer, MD
JUNE 26, 2023
The ECG in Figure-1 was obtained from a young man with a history of rheumatic heart disease — who presented with “palpitations”. He was hemodynamically stable at the time this tracing was recorded. How would YOU interpret the ECG in Figure-1 ? How would you treat the patient? Figure-1: The initial ECG in today’s case. What is the rhythm? How would you treat the patient?
Pediatric EM Morsels
JUNE 30, 2023
I’m sure you can recall at least several parents who bring their children into the ED for concern of recurrent pneumonias. Often the parents focus on a possible underlying immunodeficiency. Fortunately, most commonly these pneumonias are due to viral infections, and we can often offer reassurances to the parent. The differential could also include aspiration , asthma , and bronchiectasis depending on the patient’s history.
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The Trauma Pro
JUNE 6, 2023
In today’s post, I will review the diaphragmatic injury practice guidelines published by the Eastern Association for the Surgery of Trauma (EAST). I will follow this up on Friday with an interesting delayed diaphragm injury case. Diaphragm injury is a troublesome one to diagnose. It is essentially an elliptical sheet of muscle that is doubly curved, so it does not lend itself well to diagnosis by axial imaging.
Don't Forget the Bubbles
JUNE 30, 2023
A PEM adventure It’s time for another PEM adventure. Join us on another journey (with an inbuilt time travel machine) in managing Elsa, a 2-year-old girl who is a HUGE fan of the Disney movie, Frozen. Elsa was found face down in the family pool 20 minutes after last visual contact and was picked up without resuscitation. Emergency Medical Services found her apneic and pulseless.
RebelEM
JUNE 29, 2023
Back on June 1 st , 2023, Swami wrote a blog post on REBEL EM titled, The CT FIRST Trial, Should We Pan-CT After ROSC? This stemmed a lot of discussion in the background between Swami, myself, and Scott. We felt it was worthwhile to record this as a podcast to better flush out some nuanced points. Below you will find some of the points we discussed.
The Bottom Line
JUNE 19, 2023
In adult patients with major trauma, who are at risk for trauma-induced coagulopathy does early administration of 1g of tranexamic acid (TXA) followed by an infusion of 1g over 8 hours, compared with placebo, increase survival with a favourable functional outcome at 6 months?
Ken Grauer, MD
JUNE 6, 2023
== P lease N OTE : After today — No new ECG Blog posts for 2- to -3 weeks. — I will also not be prompt in replying to emails. == All material on this ECG Blog site remains open! The INDEX tab ( in the upper right of each page ) — has linked Contents, listed by subject. So IF you are looking for ECG material — There is plenty on this web site! IF you scroll down a little on the right-hand column of this blog — You'll see a lot of icons.
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The Trauma Pro
JUNE 23, 2023
What are common sources of malpractice complaints against nurses? The most common event is medication error. Most people worry about common errors like wrong dose, wrong drug, and wrong route of administration. But one less commonly considered drug-related responsibility is assessment for side effects and toxicity of medications administered. Other common reasons include failure to adequately monitor and assess the patient, and failure to supervise a patient that results in harm.
Don't Forget the Bubbles
JUNE 30, 2023
A PEM adventure Meet Polly, a 6-year-old girl with a penchant for shopping. Besides a few febrile convulsions when she was two, she’s a healthy 6-year-old. Having just bought the most gorgeous pair of red ballet pumps that would go delightfully with the red bow she bought in Harrods last week, she was skipping down Regent’s Street with her nanny. As they crossed the front of Liberty, a huge letter L came plummeting down, crashing in front of her.
RebelEM
JUNE 26, 2023
Background: Hemorrhage is the leading cause of mortality in trauma patients. Interventions such as early application of hemorrhage control, tranexamic acid, reduction of crystalloid fluid administration and balanced ratio blood product transfusion have improved many patients’ outcomes. However, mortality still remains high due to trauma-induced coagulopathy.
Life in the Fast Lane
JUNE 11, 2023
Neil Long and Chris Nickson AMAX4 Algorithm AMAX4 is a best-practice algorithm for critical care clinicians in anaphylaxis and asthma resuscitation.
Ken Grauer, MD
JUNE 2, 2023
I was sent the Holter monitor tracing in Figure-1 — but without the benefit of any clinical information. QUESTIONS: A total of 9 QRS complexes are seen in the 2 simultaneously-recorded monitoring leads. How would YOU interpret the rhythm in Figure-1 ? How many P waves do you see? Why do the QRS complexes of beats #4 and 5 in the bottom lead look different than the other 7 beats?
Pediatric EM Morsels
JUNE 16, 2023
The subcutaneous space is a vast region of potential space where things can collect. Sometimes this can be used to our advantage, like when we need to give subcutaneous fluids to a dehydrated patient without an IV, or when we need to give SQ medications for things like Sulfonylurea overdose , Hereditary Angioedema , or DVTs. Sometimes, however, these deeper layers of the subcutaneous space can collect dangerous infections , like Necrotizing Fasciitis.
The Trauma Pro
JUNE 9, 2023
Diaphragm injury from blunt trauma is uncommon, occurring in only a few percent of patients after high-energy mechanisms. They usually occur on the left side and are more frequently seen after t-bone type car crashes and in pedestrians struck by a car. Blunt diaphragm injury on the right side is very unusual. Even so, it is more easily detected due to obvious displacement of the liver that can be seen on chest x-ray.
Don't Forget the Bubbles
JUNE 12, 2023
I remember how I felt when. I first watched “ Just a Routine Operation “, – the story of the events that led to the tragic death of Elaine Bromiley. Elaine Bromiley went into hospital for a routine operation. Despite an appropriate pre-operative assessment, the anaesthetists tasked with intubating Elaine found themselves in a Can’t Intubate, Can’t Oxygenate scenario, though they failed to recognise it at the time.
RebelEM
JUNE 22, 2023
Background: The COVID-19 pandemic has been the focus of massive research efforts over the last three years. Our understanding of the disease and effective treatments to reduce mortality have progressed rapidly during this time. However, the medical community is only just starting to understand long-COVID (WHO Definition: the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation).
Science Based Medicine
JUNE 12, 2023
Last week, an antivaxxer on Substack—where else?—tried to argue that Robert F. Kennedy, Jr. is not antivaccine by encouraging you to judge him by his own words. I agree. You should judge RFK Jr. by his own words, as they show definitively that he has been antivaccine since at least 2005. The post Is Robert F. Kennedy, Jr. antivaccine? Judge him by his own words!
St. Emlyn
JUNE 2, 2023
St.Emlyn's - Emergency Medicine #FOAMed New guidelines from @RCollEM and @RCRadiologists finally agree that contrast CT should not be delayed in the critically ill/injured #FOAMed The post Contrast Induced Nephropathy – sense at last. St Emlyn’s appeared first on St.Emlyn's.
Pediatric EM Morsels
JUNE 9, 2023
When we think of severe hemorrhage in children, we typically think about trauma. Maybe injuries to the spleen or kidney come to mind. Perhaps thoughts of pelvic injuries or severe head injury dominate our considerations. Of course, we all have a healthy respect for post-tonsillectomy hemorrhage and we like to talk about Damage Control Resuscitation.
The Trauma Pro
JUNE 13, 2023
For the longest time, one of my pet peeves has been potential conflicts of interest (COI) involving authors on research papers. There is no simple definition of the term “conflict of interest.” However, a simple way to think of it is a situation where one’s personal interests may influence their professional responsibilities. Upton Sinclair said it more simply in a book he was writing in the 1930s: “It is difficult to get a man to understand something when his salary depends up
Don't Forget the Bubbles
JUNE 19, 2023
You are asked to see a baby boy in the labour ward. He was born at 38 weeks and 5 days gestational age and weighs 2600 grams. His mother is healthy, but she does mention that her first-born daughter was also small. She weighed 2570 grams at 39 weeks and is now perfectly healthy. The parents are of South-Asian descent. There were no issues during the pregnancy, and estimated fetal growth by ultrasound was constant.
RebelEM
JUNE 14, 2023
Anaphylactic Shock is an acute, life-threatening hypersensitivity disorder, with a generalized, rapidly evolving, multi-systemic allergic reaction (IgE-mediated disorder). If not treated rapidly can become fatal. Scott Weingart, MD put together a manual titled the Resuscitation Crisis Manual , which in short, is composed of two-page protocols for various situations that involve crashing patients.
Science Based Medicine
JUNE 11, 2023
Three new studies tell us what we already knew- vaccine isn't perfect, but it's far safer than the virus for children. The post Three New Studies Show the COVID Vaccines Are Very Safe for Children first appeared on Science-Based Medicine.
First 10 EM
JUNE 19, 2023
The internet is alive with rumors of a simple, cheap, low-risk cure for long COVID. Sound too good to be true? That’s because it almost certainly is. Let’s talk about this COVIT-OUT trial and what it says about metformin. The paper Bramante CT, Buse JB, Liebovitz DM, et al. Outpatient treatment of COVID-19 and incidence […] The post No, metformin is probably not the cure for long COVID appeared first on First10EM.
Broome Docs
JUNE 20, 2023
Hi All, we are back with another instalment of the Journal Club with Justin Morgenstern. Big news this month is that Justin has just been invited to visit my home shop as the honorary WG Smith Fellow and deliver a series of EBM lectures to the local teams in Western Australia. So we are planning to take this show on th eraod and do some live sessions later in 2023.
The Trauma Pro
JUNE 27, 2023
It’s been five years since I published my series on the use of the electronic trauma flow sheet (eTFS). Anyone who knows me is familiar with my skepticism about this tool. I’ve been writing about the significant problems it can create since 2008! With the progress in computing power and interfaces we have enjoyed, we would have this problem solved by now.
Don't Forget the Bubbles
JUNE 30, 2023
A PEM Adventure Ranulf is a 14-year-old explorer. He has already climbed Ben Nevis in Scotland, visited the Gobi desert (possibly from the comfort of his parents 4 x 4, but who’s judging) and has his bronze D of E nailed. Whilst you were busy managing head injuries and drownings, Ranulf had been out with a group of boys from school this evening. They had been enjoying a celebratory dinner following their safe return from a trip to the Amazon rainforest.
RebelEM
JUNE 1, 2023
Background: Achieving ROSC in out of hospital cardiac arrest (OHCA) is no easy feat but, care doesn’t end with ROSC. Post-ROSC management is nuanced and challenging but helps to ensure good outcomes. Identification of the underlying cause of the cardiac arrest is a critical area of focus in post-arrest care. Although myocardial infarction, dysrhythmias and pulmonary emboli are common pathologies to consider, there are a host of other causes including subarachnoid hemorrhage, trauma and electroly
Science Based Medicine
JUNE 4, 2023
My critics lack the courage to accurately quote me. That tells you everything about them and nothing about me. The post Dr. Jay Bhattacharya Responds to Words I Never Said first appeared on Science-Based Medicine.
First 10 EM
JUNE 12, 2023
Can herbs cure sepsis? The EXIT-SEP trial was just published, and demonstrated a decrease in all cause mortality from xuebijing – a product manufactured by a pharmaceutical company from a combination of Carthamus tinctorius flowers (Honghua in Chinese), Paeonia lactiflora roots (Chishao), Ligusticum chuanxiong rhizomes (Chuanxiong), Angelica sinensis roots (Danggui), and Salvia miltiorrhiza roots (Danshen). […] The post Finally, a cure fore sepsis: Herbs appeared first on First10EM.
Emergency Live
JUNE 28, 2023
An early prototype defibrillator was built by the American surgeon Claude S. Beck at the University of Cleveland in 1974; it saved the life of a 14-year-old boy who suffered ventricular fibrillation during surgery The post Defibrillator, a bit of history appeared first on Emergency Live.
The Trauma Pro
JUNE 20, 2023
Back in the old, old days, there was really no such thing as nursing malpractice. Nurses had little true responsibility, and liability largely fell to the treating physicians. But as nursing responsibilities have grown, they have become an integral part of the assessment, planning, and management of their patients. As all trauma professionals know, our work is very complex.
Don't Forget the Bubbles
JUNE 14, 2023
This post, from Ben Symon on XXX, is the first of our 2022 DFTB conference. Some tickets are still left for DFTB23 in Adelaide, so sign up while you can. Ben Symon is a pediatric emergency medicine physician. He’s fascinated by the interactions and boundaries between how we interact together as clinicians and with our patients. Kindness is central to our speciality – but it should be central to all of our specialities.
St. Emlyn
JUNE 7, 2023
St.Emlyn's - Emergency Medicine #FOAMed If you’re working in the UK then you will know that there is currently a shortage of ketamine (I know!). Specifically we are struggling to get hold of the 10mg/ml … Etomidate for RSI induction? St Emlyn’s Read More » The post Etomidate for RSI induction? St Emlyn’s appeared first on St.Emlyn's.
Science Based Medicine
JUNE 24, 2023
The amount of energy needed to refute b t is an order of magnitude bigger than that needed to produce it. The post Steve Kirsch and Brandolini’s law first appeared on Science-Based Medicine.
Medagadget
JUNE 6, 2023
Researchers at the University of California San Diego have created a wearable ultrasound system that can monitor deep tissues, as far as 16.5 cm (6.5 inches) below the surface of the body. Moreover, the team employed a machine learning algorithm to reduce the noise associated with movement, helping to obtain reliable readings while the wearer goes about their day.
Emergency Live
JUNE 19, 2023
Myocarditis is an inflammation of the heart muscle that affects the middle layer of the heart wall, the muscular tonaca called the myocardium The post Inflammations of the heart: myocarditis appeared first on Emergency Live.
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