Ken Grauer, MD
FEBRUARY 23, 2024
The ECG in Figure-1 was obtained from a previously healthy man in his 40s — who presented to the ED ( E mergency D epartment ) with new-onset CP ( C hest P ain ) that awakened him from sleep. ECG #1 was recorded ~90 minutes after the patient was awakened from sleep. He was still having CP. QUESTIONS: In view of this history — How would YOU interpret the ECG in Figure-1 ?
The Trauma Pro
FEBRUARY 27, 2024
Intraosseous (IO) lines are a godsend when we are faced with a patient who desperately needs access but has no veins. The tibia is generally easy to locate and the landmarks for insertion are straightforward. They are so easy to insert and use, we sometimes “set it and forget it”, in the words of infomercial guru Ron Popeil. But complications are possible.
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Sensible Medicine
FEBRUARY 15, 2024
It’s been a few years since I first heard about the Galleri test produced by the Menlo Park startup Grail. Galleri is a blood-based screening test for cancer. I think I first heard about it from doctors in concierge practices; next I heard whispers from my own better-off patients who brought me results or asked what I thought of the test. Sensible Medicine is a reader-supported publication.
St. Emlyn
FEBRUARY 6, 2024
St.Emlyn's - Emergency Medicine #FOAMed This week I am in Zermatt, Switzerland for ‘The Big Sick’ conference. This is something I have been looking forward to years, but major heart surgery (valves not pipes) and […] The post Top resus papers for TBS. St Emlyn’s appeared first on St.Emlyn's.
Speaker: Simran Kaur, Co-founder & CEO at Tattva.Health
AI is transforming clinical trials—accelerating drug discovery, optimizing patient recruitment, and improving data analysis. But its impact goes far beyond research. As AI-driven innovation reshapes the clinical trial process, it’s also influencing broader healthcare trends, from personalized medicine to patient outcomes. Join this new webinar featuring Simran Kaur for an insightful discussion on what all of this means for the future of healthcare!
Dr. Smith's ECG Blog
FEBRUARY 22, 2024
Written by Pendell Meyers A woman in her 30s called EMS for acute symptoms including near-syncope, nausea, diaphoresis, and abdominal pain. EMS arrived and found her to appear altered, critically ill, and hypotensive. An ECG was performed: What do you think? Extremely wide complex monomorphic rhythm just over 100 bpm. The QRS is so wide and sinusoidal that the only real possibilities left are hyperkalemia or Na channel blockade.
RebelEM
FEBRUARY 15, 2024
Background: Patients with decreased level of consciousness due to alcohol, drugs, or medications commonly present to the ED. These patients can be at risk of vomiting and aspiration and often prompts clinicians to pursue definitive airway management to avoid pneumonia and other complications. It is unclear, though, if the risks of intubation (including ventilator associated pneumonia) outweighs the benefits.
Emergency Care Today brings together the best content for emergency care practitioners from the widest variety of industry thought leaders.
The Trauma Pro
FEBRUARY 20, 2024
Let’s look at an uncommon scenario that crops up from time to time. Most seasoned trauma professionals have seen this one a time or two: An elderly male is driving on a sunny afternoon, and crashes his car into a highway divider at 25 miles per hour. EMS responds and notes that he has a few facial lacerations, is awake but confused. They note some possible facial asymmetry and perhaps a bit of upper extremity weakness.
Sensible Medicine
FEBRUARY 9, 2024
You can only listen to, or read, what doctors have to say for so long. Today, in our Friday, “reflective writing” slot, an essay from someone in the bed rather than beside it. Adam Cifu Sensible Medicine is a reader-supported publication. If you appreciate our work, consider becoming a free or paid subscriber. After ten days tethered to an IV of cyclosporine, the surgeon explained that he would remove my colon, create a stoma, and hitch a colostomy bag to my abdomen.
St. Emlyn
FEBRUARY 27, 2024
St.Emlyn's - Emergency Medicine #FOAMed A review of Acute on Chronic Liver Disease (ACLD / decompensated liver disease) in the ED. How we can improve patient outcomes. #FOAMed @stemlyns The post Decompensated. Liver disease in the ED. St Emlyn’s appeared first on St.Emlyn's.
Dr. Smith's ECG Blog
FEBRUARY 2, 2024
Written by Pendell Meyers First try to interpret this ECG with no clinical context: The ECG shows an irregularly irregular rhythm, therefore almost certainly atrial fibrillation. After an initially narrow QRS, there is a very large abnormal extra wave at the end of the QRS complex. These are Osborn waves usually associated with hypothermia. There is also large T wave inversion and long QT.
RebelEM
FEBRUARY 19, 2024
Background: Use of vasopressors is a common practice to support hemodynamics and optimization of tissue perfusion in patients presenting with shock. Historically the administration of vasopressors was restricted to central venous catheters (CVC) due to concerns for local tissue injury resulting from vasoconstriction if extravasation occurred from a peripheral IV.
Ken Grauer, MD
FEBRUARY 15, 2024
The ECG in Figure-1 was obtained from a previously healthy middle-aged man — who presented to the ED ( E mergency D epartment ) for shortness of breath. QUESTIONS: How would YOU interpret the ECG shown in Figure-1 ? Given the irregular irregularity of beats #4-through 17 — Is this a run of AFib ( A trial Fib rillation ) with aberrant conduction? Figure-1: The initial ECG in today's case.
The Trauma Pro
FEBRUARY 23, 2024
Kids are frequent flyers when it comes to abdominal injury, with about 15% of their injuries involving this anatomic area. Solid organ injuries, mainly the liver and spleen, are the most prevalent ones. The American Pediatric Surgical Association (APSA) published a practice guideline way back in 2000 that outlined a consistent way to care for children with solid organ injuries.
Sensible Medicine
FEBRUARY 16, 2024
It is July 1 st , 1988, Cara’s first day as a medicine intern on my ward team. She meets her existing patients and picks up a new one, Bill. Bill is 35 and has a severe cardiomyopathy. He is waiting a heart transplant but has been having worsening episodes of ventricular tachycardia (VT). He was a direct admission after an electrophysiologic (EP) study.
The Skeptics' Guide to EM
FEBRUARY 11, 2024
Reference: McLatchie et al and DAShED investigators. Diagnosis of Acute Aortic Syndrome in the Emergency Department (DAShED) study: an observational cohort study of people attending the emergency department with symptoms consistent with acute aortic syndrome. EMJ Nov 2023. Date: February 11, 2024 Guest Skeptic: Nirdosh Ashok Kumar, Emergency Medicine Specialist – Aga Khan University Hospital, Karachi, Pakistan. […] The post SGEM#430: De Do Do Do, De Dash, Dash DAShED – Diagnosing Acute Aortic Sy
Dr. Smith's ECG Blog
FEBRUARY 16, 2024
Written by Pendell Meyers A teenager was playing basketball when he suddenly developed palpitations and lightheadedness. He presented soon afterward at the Emergency Department with ongoing symptoms. Mentation and blood pressure were normal. He had no chest pain or shortness of breath. Heart rates on the monitor fluctuated from 180-250 bpm. Here is his triage ECG: What do you think?
EM Ottawa
FEBRUARY 15, 2024
We’re increasingly cognizant of the physiological importance of maintaining specific hemodynamics during resuscitation. Practice patterns vary broadly, so we’ve done a deep dive into the various evidence around the use of ketamine and etomidate in specific clinical scenarios. Physiology of the rapid sequence intubation Rapid sequence intubation (RSI) is the nearly simultaneous administration […] The post Ketamine and Etimodate: Into the Void appeared first on EMOttawa Blog.
Ken Grauer, MD
FEBRUARY 9, 2024
Imagine the only information provided for the ECG in Figure-1 — is that it was obtained from a 60-year old man with new CP ( C hest P ain ). QUESTIONS: In view of this brief history — How would YOU interpret this ECG in Figure-1 ? Is the cardiac rhythm related to the 12-lead ECG? Figure-1: The initial ECG in today’s case. MY Thoughts on the ECG in Figure-1: The goal of practicing clinicians is to interpret both parts of the tracing in Figure-1 ( = the cardiac rhythm and the 12-lead ECG ) — in an
The Trauma Pro
FEBRUARY 16, 2024
Here’s a post from my archive describing a different way to remove the foreign body. This is the technique I used, instead of the standard neck incision. The final incision was just a slight extension of the puncture wound, measuring only 1cm. I was able to grasp the head and pull it out without difficulty. The surprising thing to me was the amount of force I needed to apply to actually pull it out!
Sensible Medicine
FEBRUARY 27, 2024
In the ideal, clinical guidelines incorporate evidence and expert opinion and enable clinicians to make evidence-based decisions without having to read the primary literature. These guidelines serve as an authority, defining high-quality care and how medical care should be delivered. Clinical guidelines have potential benefits: improved health outcomes, consistency of care, and reduced uncertainty (for the clinician).
First 10 EM
FEBRUARY 8, 2024
Long time readers will know that I generally dislike guidelines. Although there are exceptions, I think that guidelines are often more problematic than helpful. However, I know that many people work in places that have medicolegal structures that leave them feeling completely paralyzed, and unable to practice in the absence of a relevant guideline. The […] The post ACEP says its OK to use topical anesthetics for simple corneal abrasions appeared first on First10EM.
Dr. Smith's ECG Blog
FEBRUARY 20, 2024
A 20-something type, 1 diabetic presented by EMS with altered mental status. Blood pressure was 117/80, pulse 161, Resp 45, SpO2 100 on oxygen. Here is the 12-lead ECG: Wide complex tachycardia What do you think? The providers thought that this wide QRS was purely due to (severe) hyperkalemia. They treated with 4 ampules (200 mL) of bicarb and 1 gram of calcium gluconate.
RebelEM
FEBRUARY 8, 2024
Background: Patients with shock frequently present with hypotension. Many of these patients are started on vasopressor and inopressor medications to assist in efforts to normalize blood pressure to help improve organ perfusion. In shocky patients, arterial lines are often used to monitor hemodynamic parameters and inform treatment decisions. However, there is limited data on the benefit of invasive blood pressure monitoring over non-invasive blood pressure monitoring.
Emergency Medicine Cases
FEBRUARY 13, 2024
In this month's ECG Cases blog Dr. Jesse McLaren reviews interpretation of the pre-arrest ECG: identifying high risk ECGs requiring empiric treatment like calcium for hyperkalemia, magnesium for long QT, or reperfusion for Occlusion MI; the intra-arrest ECG: identifying pseudo-PEA; and post-arrest ECG: the importance of serial ECGs to reduce false positive STEMI, role of POCUS to help with the differential of diffuse ST depression with reciprocal ST elevation in aVR, and identifying signs of Occ
The Trauma Pro
FEBRUARY 9, 2024
This case involves an accidental nail gun injury to the neck. The patient is hemodynamically stable, neurologically intact, the airway is patent and not threatened, and there is no apparent hematoma. There is a small puncture near the sternocleidomastoid muscle on the right, fairly high on the neck. The nail is not palpable on either side. And the patient only complains of a little discomfort when he swallows.
Sensible Medicine
FEBRUARY 12, 2024
Academic medicine sometimes gets it right. This is a positive story about a negative trial. Neurologist Hooman Kamel from the Weil Cornell Medical Center in NY had an idea about atrial fibrillation and stroke. Old thinking held that clots formed in the left atrium during periods of irregular rapid fibrillatory activity. Stroke came when these clots moved northward to the brain.
First 10 EM
FEBRUARY 5, 2024
In the Rapid Review series, I briefly review the key points of a clinical review paper (which often extends to multiple papers because I can’t help myself). The topic this time: Propofol Related Infusion Syndrome (PRIS). Like many rapid review topics, this was chosen for my own education because I have next to no experience […] The post Propofol Related Infusion Syndrome (PRIS) appeared first on First10EM.
EMCrit
FEBRUARY 9, 2024
The acute crit care med rec EMCrit Project by Scott Weingart, MD FCCM.
RebelEM
FEBRUARY 29, 2024
Background: Ventilator-associated pneumonia (VAP), or what the CDC recently renamed infection-related ventilator-associated complication (IVAC), is defined as a nosocomial pneumonia occurring on day 3 of mechanical ventilation that was preceded by 2 days of stable or decreasing ventilator requirements. 1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. 3, 4 It is the most common nosocomial infection in patients on m
The Bottom Line
FEBRUARY 7, 2024
What’s new in the Critical Care literature – monthly updates
The Trauma Pro
FEBRUARY 6, 2024
Here’s a very interesting case for you. A construction worker was carrying an object inside a building WHILE HOLDING HIS NAIL GUN! As he passed through the door, his elbow hit the frame and he brushed his neck with the business end of the gun. Guess what happened? He experienced sharp pain, then noted pain every time he swallowed. He checked himself out in the mirror, and there was a small puncture wound in the right side of his neck.
Sensible Medicine
FEBRUARY 6, 2024
Two things are clear about the internal medicine residents I get to work with. First, their qualifications are spectacular: academic accolades, research, publications, clinical medicine experiences prior to residency, even real-life professional experiences. When they enter internship, their CVs dwarf those of my residency colleagues (’93 - ’96).
First 10 EM
FEBRUARY 19, 2024
Nail bed injuries aren’t quite common enough to cause the same debates as TXA, or IV antibiotics, or tPa, but talk to 10 different emergency doctors and you are likely to get 10 different opinions about the management of these injuries. Therefore, even though the NINJA study doesn’t answer the most important question (in my […] The post The NINJA trial: Do you replace the fingernail after nail bed repair?
Life in the Fast Lane
FEBRUARY 8, 2024
Sheralyn Guilleminot and Mike Cadogan AI-Assisted Learning and Teaching AI-assisted learning and teaching is an often-overlooked use of artificial intelligence in medicine! Here are 4 ways to do it.
Dr. Smith's ECG Blog
FEBRUARY 6, 2024
Written by Pendell Meyers A teenager was involved in a motor vehicle collision and presented to the Emergency Department via EMS altered and potentially critically ill. He was intubated for altered mental status. Chest trauma was suspected on initial exam. Here is his initial ECG around 1330: What do you think? The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia.
Emergency Medicine Cases
FEBRUARY 27, 2024
Anand Swaminathan on an update on the appropriate selection of induction agents. Hans Rosenberg on when to use gabapentinoids for pain control in the ED. Katie Lin on pearls for neuroprotective intubation. Nour Khatib and Hamza Jalal on an approach to paresthesias in the ED. Eric Wortmann on preventing burnout in emergency medicine. Please support EM Cases with a donation [link] The post EM Quick Hits 55 – Induction Agents, Gabapentinoids, Neuroprotective Intubation, Approach to Paresthesi
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