Ken Grauer, MD
NOVEMBER 23, 2024
I was sent the ECG shown in Figure-1 — told only that that it was from an acutely ill patient on a ventilator, who was being evaluated for bradycardia. His providers thought this rhythm was complete AV block. QUESTIONS: How would you interpret the ECG in Figure-1 ? Is the rhythm complete AV block? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ).
The Trauma Pro
NOVEMBER 8, 2024
Patients with severe TBI frequently undergo surgical procedures to remove clot or decompress the brain. Most of the time, they undergo a craniotomy, in which a bone flap is raised temporarily and then replaced at the end of the procedure. But in decompressive surgery, the bone flap cannot be replaced because doing so may increase intracranial pressure.
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Pediatric EM Morsels
NOVEMBER 15, 2024
Seizures are super scary for a parent to witness, but not all seizures mean danger. There is actually a diagnosis of seizures that has “ BENIGN” in the name! Have you ever had that feeling of falling that rapidly wakes you from sleep? While it’s unlikely that you were having Benign Epilepsy with CentroTemporal Spikes (BECTS) seizures or a benign Rolandic seizure, that tenuous state between sleeping and waking is a time when some odd neurologic things can happen, including BECTS.
Sensible Medicine
NOVEMBER 23, 2024
It is my pleasure to introduce this article by Joseph Marine, MD. Mr. Marine has 10 sensible suggestions for reform at the NIH. I love them all, but particularly #3, 6, and 8, which I have railed about for years. Vinay Prasad, MD MPH The NIH needs reform The recent news that Dr. Jayanta Bhattacharya is being considered for the post of Director of the National Institutes of Health (NIH) was received with enthusiasm by many of us who opposed the US pandemic response.
First 10 EM
NOVEMBER 11, 2024
In the most recent BroomeDocs podcast, we talk about an attempt to use the IM route to give cardiac arrest victims epinephrine faster. (The podcast and Research Roundups blog post might actually come out next week.) I was skeptical about the outcomes, partly because the evidence that epinephrine helps at all in cardiac arrest is […] The post IV versus IO for cardiac arrest (PARAMEDIC3 and IVIO) appeared first on First10EM.
ECG Guru
NOVEMBER 16, 2024
The Patient: Sixty-year-old man with a complaint of severe substernal chest pain. Denies hx of M.I., but reports feeling short of breath on exertion for about a year. Hx of hypertension, but admits he is non-compliant with his medication. Appears pale and diaphoretic, BP 110/68. The ECG: The rhythm is sinus at 62 bpm. The QRS is slightly wide at 110 ms (.11 seconds), but still within normal limits.
Ken Grauer, MD
NOVEMBER 15, 2024
Today's case was contributed by Dr. Magnus Nossen ( from Fredrikstad, Norway ). Dr. Nossen was at his computer — reviewing ECGs from patients recently admitted to his group's hospital service. He came across the ECG shown in Figure-1 — obtained from a woman in her 70s who was admitted to the hospital for new CP ( C hest P ain ). QUESTION: How would YOU interpret the ECG in Figure-1 ?
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Stop and Think
NOVEMBER 19, 2024
The OPTION trial compared two strategies to reduce stroke and bleeding after catheter ablation of atrial fibrillation. The current strategy is to continue an anticoagulant medication. The alternative tested in OPTION is to implant a left atrial appendage device—abbreviated as LAAC (left atrial appendage closure). AF ablation is one of the most common procedures in my field.
Science Based Medicine
NOVEMBER 8, 2024
Doctors who are concerned about members of our profession enabling powerful anti-vaxx disinformation agents should speak up before it's too late. But its probably too late already. The post Robert Kennedy Jr. & His Doctor Friends May Just Be Getting Started first appeared on Science-Based Medicine.
Sensible Medicine
NOVEMBER 22, 2024
OK, the title is click bait. Sensible Medicine is a reader-supported publication. I you appreciate our work, consider becoming a free or paid subscriber. I am a great believer in the healthy lifestyle. If Americans lived healthier lives, we would all be in a better place. There would be less obesity, diabetes, and heart disease. We would probably be treating fewer patients for depression, cancer, and addictions.
EM Ottawa
NOVEMBER 28, 2024
What do you do when expert nurses tell you they can’t obtain IV access? Do you spend 20 minutes performing an invasive central line? Does your resident finally get two IO EPAs? Or do you save the day with a slick, ultrasound guided IV? Obtaining peripheral ultrasound guided IV access is not only a core […] The post Ultrasound Guided Peripheral IVs appeared first on EMOttawa Blog.
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. QUESTIONS: In Figure-1 — Is the rhythm VT — or — SVT with aberrant conduction — or — potentially neither of these possibilities? IF told that this patient was hypotensive in association with the rhythm in Figure-1 — Does It Matter what the specific etiology of this rhythm is?
St. Emlyn
NOVEMBER 6, 2024
St.Emlyn's - Emergency Medicine #FOAMed Creating a learning culture in the emergency department (ED) fosters psychological safety, open communication, and continuous improvement. This approach supports team resilience, enhances patient care, and reduces burnout. Learn practical steps to build a strong learning culture in your ED, promoting growth and collaborative excellence in emergency medicine.
Dr. Smith's ECG Blog
NOVEMBER 14, 2024
This was texted to me by a paramedic while I was out running one day: "54 yo male chest pain started at 1pm. History of diabetes type II and stent placement in 2018. I’m seeing hyperacute T waves III, aVF, down sloping depression I and aVL. Thoughts?" What do you think? I responded: "Definite inferior OMI. And Right Ventricular. Activated the Cath Lab.
Science Based Medicine
NOVEMBER 15, 2024
When RFK Jr. does to the U.S. what he did to Samoa, doctors will say they are horrified, that they love vaccines, blah blah blah. But it will be too late. The post If You Sanewashed RFK Jr., Or If You Sanewashed Doctors Who Did, You Own the Next 4 Years first appeared on Science-Based Medicine.
Sensible Medicine
NOVEMBER 4, 2024
Nearly a thousand news outlets covered the recent publication of the positive results of the STEP-9 trial of semaglutide vs placebo for the treatment of knee pain due to osteoarthritis in patients with obesity. Twitter overflowed with positive messages after the New England Journal of Medicine publication. I am not sold on the trial. STEP-9 had many flaws but one fatal flaw.
Don't Forget the Bubbles
NOVEMBER 11, 2024
One-liner… Traumatic brain injury (TBI) is a leading cause of mortality and morbidity in paediatric populations, and fever is associated with worse outcomes. Should we aim to prevent fever, or should we cool patients? A 12-year-old boy presents with a significant head injury following a road traffic accident. At the scene, his lowest GCS was 5 (E1V2M2).
Ken Grauer, MD
NOVEMBER 30, 2024
I was sent this tracing — and told that providers thought that the rhythm was 3rd-degree ( ie, complete ) AV block. Do YOU agree? Figure-1: The initial ECG in today’s case. NOTE: The tracing in Figure-1 is an 8-lead rhythm strip ( and not a complete 12-lead ECG ). This offers the advantage of providing 8 leads with simultaneously-recorded viewpoints of the same 7 beats that we see in this tracing.
St. Emlyn
NOVEMBER 22, 2024
St.Emlyn's - Emergency Medicine #FOAMed This retrospective study explores the link between intra-arrest arterial blood pressure (IBP) and return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA). Analysing data from 80 patients attended by the East Anglian Air Ambulance, it found that higher diastolic blood pressure (DBP) during CPR significantly increased the likelihood of ROSC.
Dr. Smith's ECG Blog
NOVEMBER 25, 2024
Introductory Angiography Guide To find the guide later, go to the banner at the top of the blog: This blog is dedicated to improving understanding of ECGs in the context of emergency medicine. A substantial proportion of cases discussed include diagnostic angiography. Attaining expertise in angiography requires dedication and practice. What follows is an introduction to angiography -- a guide meant for people with no prior experience interpreting angiograms.
Science Based Medicine
NOVEMBER 1, 2024
Any doctor who is unabashedly pro-vaccine has already spoken up about the normalization of anti-vaxx quackery within our ranks. The post If RFK Jr. Turns the CDC Into An Anti-Vaxx Propaganda Outfit, I Don’t Want To Hear a Peep From Some “Respectable” Doctors first appeared on Science-Based Medicine.
Sensible Medicine
NOVEMBER 24, 2024
Marty Makary, an editorial board member of Sensible Medicine, is up for FDA commissioner. In honor of that, we reprint one of his essays. Elsewhere I have a short piece on how the media coverage of him has been biased, and why I support his nomination. In the piece below Marty was correct that there is no data to support year over year COVID boosters, and I, like most Americans, don’t get them.
EMCrit
NOVEMBER 28, 2024
I discussed the reasons for migrating to BlueSky here. I've received positive feedback from several FOAMed expats who migrated to Bluesky and enjoy it there. I've also received some questions about getting started on BlueSky, so here is a brief guide to moving into MedSky. [1] Set up your account & profile This is essentially […] EMCrit Project by Josh Farkas.
Ken Grauer, MD
NOVEMBER 1, 2024
I was sent this ECG recording — and asked for my interpretation of the rhythm in Figure-1. I had little clinical information. QUESTIONS: How was I able to guess the probable correct answer in less than 5 seconds? How was I then able to prove that my guess was correct? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ).
St. Emlyn
NOVEMBER 26, 2024
St.Emlyn's - Emergency Medicine #FOAMed In this podcast, Liz Crowe discusses the effect bad behaviour has on teams and ultimately patient safety. The post Podcast – Bad Behaviour in Teams with Liz Crowe at Tactical Trauma 2024 appeared first on St.Emlyn's.
Dr. Smith's ECG Blog
NOVEMBER 19, 2024
These ECGs were texted to me by one of our previous ultrasound fellows, Will Smoot An elderly male arrived via EMS for acute substernal chest pain with radiation to left shoulder and arm that awakened him from sleep at 0030. He took two full strength aspirin prior to EMS arrival. The pain was relieved by one prehospital NTG spray. He arrived at the ED just shy of two hours after onset, pain free.
Science Based Medicine
NOVEMBER 16, 2024
It means pertussis and measles outbreaks will be happening under your watch and you'll be held responsible while your boss is an anti-vaxx crank. Enjoy! The post What Does it Mean to Own the Next 4 Years? first appeared on Science-Based Medicine.
RebelEM
NOVEMBER 13, 2024
Take Home points : Always suspect an open joint if there is a laceration, regardless of size, the lies over joint CT scan of the affected joint is widely considered to be the standard approach to evaluation but the saline load test may be useful in certain circumstances. Obtain emergency orthopedics consultation for all open joints and administer antibiotics and update tetanus in all patients REBEL Core Cast 131.0 – Traumatic Arthrotomy Click here for Direct Download of the Podcast.
Sensible Medicine
NOVEMBER 25, 2024
When a clinical trial is published, people are relieved. The researchers did the work, analyzed the data, published the report and surely feel a sense of completion. Clinicians are relieved because we have more evidence to use in patient care. The question is how certain we should be about the trial’s result. In April, I covered the work of Dena Zeraatker , from McMaster University, who elegantly showed that there were thousands of ways to analyze data from observational studies.
Emergency Medicine Cases
NOVEMBER 12, 2024
In this EM Cases main episode podcast, we tackle the complexities of trauma airway management, including direct trauma to the airway. We discuss indications and timing of intubation, penetrating neck trauma, the head injured patient, the agitated patients and the soiled airway. The critical question is: when should we deviate from, delay or modify RSI, and how do we navigate the unique challenges presented by trauma airways and airway trauma?
St. Emlyn
NOVEMBER 24, 2024
St.Emlyn's - Emergency Medicine #FOAMed GLP-1A toxicity: What do emergency clinicians need to know about drugs like Ozempic® and Wegovy®? #FOAMed @stemlyns Greg Yates takes through a paper reporting overdoses in US practice. The post GLP-1A toxicity: What do emergency clinicians need to know about drugs like Ozempic® and Wegovy®? appeared first on St.Emlyn's.
PulmCCM
NOVEMBER 22, 2024
ChatGPT crushed 50 academic attendings and residents in a diagnostic reasoning contest. At the end of 2023, 26 attendings and 24 residents (mostly in internal medicine at Stanford, Beth Israel/Harvard, and the University of Virginia) read clinical case vignettes and were randomized to answer them either with conventional resources like decision support tools (e.g., Google search, UpToDate™), or to use ChatGPT-4.
Science Based Medicine
NOVEMBER 10, 2024
Mass purges and prosecutions of scientists have happened before. We shouldn't pretend they can't happen here. The post Dr. Vinay Prasad: “I Don’t Believe in Forgiveness Because in My Opinion These Pieces of S**t Are Still Lying.” first appeared on Science-Based Medicine.
EMCrit
NOVEMBER 15, 2024
Medtwitter was great. We met amazing people and exchanged ideas. There were endless arguments about electrolytes and intubation. But the strength of Medtwitter was never the platform – it was the people. Twitter has been deteriorating for years. For example, the algorithm is horrific, the blocking feature has been largely removed, posts from paid users […] EMCrit Project by Josh Farkas.
Sensible Medicine
NOVEMBER 5, 2024
A few month ago, we were pleased to publish a critical appraisal written by a group of students at the Wayne State University School of Medicine. The group is back with another piece about a recent article. I am enjoying this way of encouraging critical appraisal in undergraduate medical education and generating good content for Sensible Medicine. As below, please take this opportunity to appraise the appraisers.
Emergency Medicine Journal
NOVEMBER 21, 2024
Background The WHO recognises patient safety as a serious public health problem. The COVID-19 pandemic affected adult EDs (AEDs) and paediatric EDs (PEDs) differently. We compared the culture of safety in the adult AED and PED before and after the COVID-19 pandemic. Methods A quasi-experimental study was performed. In 2019, we conducted a survey using the Spanish-adapted Hospital Survey on Patient Safety Culture open to all staff (doctors, nurses and paediatric residents) in AED and PED.
St. Emlyn
NOVEMBER 19, 2024
St.Emlyn's - Emergency Medicine #FOAMed Traditionally, large-bore chest tubes have been standard for managing hemothorax, but smaller tubes are now proving just as effective in stable patients, with added benefits like reduced pain and fewer tube days. This review explores outcomes in drainage efficacy, complication rates, and patient comfort, showing that small-bore thoracostomy may be a reliable alternative for non-emergent cases.
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