Ken Grauer, MD

APRIL 29, 2023

The patient whose initial ECG is shown in Figure-1 — is a middle-aged man who presented to the ED ( E mergency D epartment ) for new-onset CP ( C hest P ain ). He was hemodynamically stable at the time this tracing was done. The patient was still having CP at the time ECG #1 was obtained — although the severity of his CP was unclear ( ie, It is not known IF this patient’s CP was increasing — the same — or decreasing — at the time the ECG in Figure-1 was recorded ).

EKG/ECG 195

EKG/ECG Wellness 195

EMCrit

APRIL 27, 2023

The precise utilization of ABG, VBG, and pulse oximetry remains controversial. Unfortunately, there is little high-level evidence investigating whether these interventions affect patient outcomes (for example, there is precious little evidence to support most of the target values that we're chasing after). This chapter attempts to explore the strengths, weaknesses, and indications for various techniques. […] EMCrit Project by Josh Farkas.

Outcomes 133

Outcomes 133

RebelEM

APRIL 26, 2023

Take Home Points Alcoholic Ketoacidosis (AKA) can present with significant acidemia (pH < 7.00). Despite the significant acidemia, patients with AKA can remain alert and lucid despite their severe metabolic derangement. Relying on urine ketones for diagnosis can be misleading, as acetoacetate is the primary ketone detected in the urine but not the most common ketone generated in AKA.

Sepsis 131

Sepsis Administration EMS 131

Pediatric EM Morsels

APRIL 28, 2023

Pediatric x-rays are challenging. Of course, we want children to grow, but those darn growth plates really make interpretation of their films difficult !! We have previously discussed how the surrounding ligaments and tendon are often stronger than the weakest part of the child’s bone necessitating our vigilance when addressing the pediatric extremity complaint (ex, Ankle Pain , Elbow Injury , Supracondylar Fractures ).

Fractures 130

Fractures Pediatrics Operations Wellness 130

Mount Sinai EM

APRIL 7, 2023

Tuberculosis in the ED Patient presents to Elmhurst ED with cough, hemoptysis, night sweats and fatigue – quick, what’s the first diagnosis that comes to mind? This is the classic presentation for tuberculosis. But several times now I have been surprised by less typical symptoms of TB. So I thought it might be helpful to review how TB might present in the ED, especially since some estimates say that ⅓ of the world’s population is infected.

Shock 130

Shock Hospitals 130

ALiEM

APRIL 12, 2023

Ever finally step away from a busy resuscitation and someone stops you for peripheral IV access? You set up everything, have the patient positioned, and then notice there is no sterile ultrasound gel. No gel? No problem. The trick is to eliminate anything of poor acoustic impedance between the ultrasound probe and the patient’s skin. Trick of the Trade 1.

Ultrasounds 103

Ultrasounds Emergency Department Resuscitation Wellness 103

Ken Grauer, MD

APRIL 23, 2023

The 12-lead ECG and long lead rhythm strip in Figure-1 — was obtained from a previously healthy 15-year old male , who presented with fever and diarrhea. He was hemodynamically stable. No chest pain. How would YOU interpret the ECG in Figure-1 ? What is the cardiac rhythm? What do you suspect as the clinical diagnosis? Figure-1: The initial ECG in today’s case — obtained from a 15-year old male with fever and diarrhea.

EKG/ECG 195

EKG/ECG Wellness Operations Hospitals 195

RebelEM

APRIL 17, 2023

Background: The increased utility and accessibility of point-of-care ultrasound (POCUS) has allowed clinicians the freedom to rethink their diagnostic approach for many common diseases, including peritonsillar abscess (PTA). Clinical evaluation may prove difficult since many PTA and peritonsillar cellulitis symptoms overlap. Physical examination is approximately 75% sensitive and 50% specific for identifying PTA.

Ultrasounds 129

Ultrasounds Radiology Radiology Operations 129

Pediatric EM Morsels

APRIL 7, 2023

There are many conditions that we would like to think belong only to the “ adult patient problem DDx; ” however, as we have discussed several times previously, pediatric patients can experience many “adult conditions” (see, Aortic Dissection , Kidney Stones , and Cholecystitis ). Those conditions usually have a substantial risk factor and one of the most risky of risk factors is Sickle Cell Disease !

Stroke 130

Stroke Pediatrics Seizures Sepsis 130

Mount Sinai EM

APRIL 7, 2023

“Take a deep breath and hold it. Now without exhaling, try to breathe in again.” We were in the cardiac room, discussing a young man that had died a few hours before we came onto our shift. He had been brought in after he was found in the subway with albuterol inhalers all around him. And Dr. Cherkas, in his infinite wisdom, was helping me understand what it’d be like to have an asthma exacerbation.

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ALiEM

APRIL 14, 2023

Welcome to the AIR Procedures Module! After carefully reviewing all relevant posts in the past 12 months from the top 50 sites of the Social Media Index, the ALiEM AIR Team is proud to present the highest quality online content related to related to procedures in the Emergency Department. 6 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board.

EMS 98

EMS Ultrasounds Academics Fractures 98

Ken Grauer, MD

APRIL 18, 2023

The ECG in Figure-1 was obtained from a 50-year old man — who presented to the ED ( E mergency D epartment ) with new-onset CP ( C hest P ain ). QUESTIONS: There are at least 3 principal findings on this ECG — some of which deal with a possible “culprit” artery and / or the location of whatever is going on. How many of these findings can YOU identify?

EKG/ECG 195

EKG/ECG Wellness 195

EMCrit

APRIL 3, 2023

(Blogitorials are short, informal blogs that are written in the spirit of a tweetorial). Stress hyperglycemia is an everyday occurence in the ICU, but we hardly know how to treat it. I've been waiting years for this topic to be clarified… but I've realized that such clarity will probably never be reached. Why? The traditional […] EMCrit Project by Josh Farkas.

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RebelEM

APRIL 5, 2023

REBEL Core Cast 99.0 – Bundle Branch Blocks Click here for Direct Download of the Podcast Cardiac Conduction System (LITFL) Definition: Interruption of the normal conduction system leading to aberrant conduction and an abnormal QRS morphology Anatomy: At the AV node, conduction splits into the right and left bundle branches. The left bundle branch is composed of anterior and posterior branches.

EKG/ECG 98

EKG/ECG EMS 98

Total Medical ComplianceHIPAA

APRIL 14, 2023

OSHA: If our office has the current Safety Data Sheets (SDS) for a product, do we have to keep the old one? No, the old SDS can be discarded if the original formulation is the same. When the formulation is different, the employer must keep both the old and current SDS for 30 years. HIPAA : Can you release healthcare records to the coroner for establishing cause of death or identifying a body?

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PDC Healthcare

APRIL 4, 2023

PDC Thermal Wristbands are Lab Tested to Perform in Demanding Healthcare Environment Healthcare providers are constantly evaluating patient safety standards to improve methods to reduce medical errors. Identification plays an important role here, specifically with the use of barcode technology to ensure a patient is receiving the correct care at the correct time.

Patient Safety 95

Patient Safety Research 95

ALiEM

APRIL 10, 2023

The patient is a 3-month-old, full-term male who presents with a rash on his head. The rash started one day prior to presentation on his forehead and spread to the rest of his head. Today, it developed a central clearing with surrounding redness. He has a history of sensitive skin since birth with patches of eczema and cradle cap. He treats these with Aquaphor and Honest Co.

Pediatrics 98

Pediatrics EKG/ECG Academics Wellness 98

Ken Grauer, MD

APRIL 14, 2023

The ECG in Figure-1 was obtained from a 90-year old woman — who presented with a 2-to-3 day history of chest pain, that became worse on the day of admission. How would YOU interpret the ECG in Figure-1 ? Is there acute coronary occlusion? If so — What is the " culprit " artery? Figure-1: The ECG in today’s case. ( To improve visualization — I've digitized the original ECG using PMcardio ).

EKG/ECG 195

EKG/ECG Wellness Hospitals 195

EMCrit

APRIL 1, 2023

RACC Lit Review for March 2023 EMCrit Project by Scott Weingart, MD FCCM.

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Science Based Medicine

APRIL 25, 2023

In 2019, Drs. John Mandrola, Adam Cifu, Vinay Prasad, and Andrew Foy wrote an article titled The Case for Being a Medical Conservative. They wrote that the “choice of the term ‘medical conservative’ does not imply a political philosophy.” Instead, they recognized “that many developments promoted as medical advances offer, at best, marginal benefits”.

Outcomes 92

Outcomes 92

NIOSH Science Blog

APRIL 12, 2023

In November 2022, the American Journal of Industrial Medicine (AJIM) published a special issue focusing on work-related fatigue. The issue explores factors that may increase work-related fatigue and actions to reduce work-related injuries and illnesses. [1] This issue is a result of discussions and collaborations from the 2019 NIOSH Working Hours, Sleep and Fatigue Forum and also pulls from reports by the National Institute for Occupational Safety and Health (NIOSH) on long work hours and shift

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Greater Sydney Area HEMS

APRIL 15, 2023

It is a rare but confronting situation where a pre-hospital and retrieval medicine team are presented with a sick newborn. At one of our recent education days we heard Dr Mark Russell and Dr Mark Newcombe deliver excellent presentations of cases which they had been involved in, involving resuscitative hysterotomy and neonatal resuscitation respectively.

Hospitals 85

Hospitals Resuscitation Hyperthermia / Hypothermia Teamwork 85

SheMD

APRIL 24, 2023

As Editor of SheMD, I'm sharing my story of #PhysicianInfertility, because we have to start the conversation. We have to talk about the fact that we, female physicians, have INCREASED rates of infertility. Physician infertility isn't something we learn about in medical school. We learn about physician infertility when we become the patient, when it may be too late.

Ultrasounds 83

Ultrasounds Radiology Radiology Emergency Department 83

Ken Grauer, MD

APRIL 9, 2023

The 12-lead ECG and long lead II rhythm strip in Figure-1 was obtained from an 86-year old man — who presented to the ED ( E mergency D epartment ) with presyncope. No chest pain. Th e patient was hemodynamically stable in association with this rhythm. How would YOU interpret the ECG in Figure-1 ? What is the rhythm ? Figure-1: The initial ECG in today's case — obtained from an 86-year old man with presyncope, but no chest pain. ( T o improve visualization — I've digitized the original ECG using

EKG/ECG 195

EKG/ECG 195

EMCrit

APRIL 9, 2023

How to teach and learn intubation and laryngoscopy EMCrit Project by Scott Weingart, MD FCCM.

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Total Medical ComplianceHIPAA

APRIL 14, 2023

When can you share protected health information (PHI) with law enforcement? There are certain circumstances when the law allows you to share PHI. You should always keep the “minimum necessary” rule in mind whenever you are giving out information. New HIPAA rules proposed by Health and Human Services (HHS). On April 11, 2023, the HHS published a notice on upcoming new rules to add greater protection to reproductive health care because of new state laws passed due to the outcome of the Supreme Cou

Documentation/Coding 83

Documentation/Coding Outcomes Wellness 83

Emergency Medicine Cases

APRIL 11, 2023

How can we use the awareness of complications to identify false positive STEMI and Occlusion MI that doesn’t meet classic STEMI criteria, and consider specific treatment? Dr. Jesse McLaren reviews the complications of MI through 10 ECG cases and how they alter management. The post ECG Cases 41 – STEMI, Occlusion MI Complications appeared first on Emergency Medicine Cases.

EKG/ECG 82

EKG/ECG EMS 82

NRC Health

APRIL 26, 2023

In this episode we are joined by "Dana Caviness, Assistant Vice President, System Patient Experience, Wellstar and Greg Makoul, Chief Transformation Officer, NRC Health to discuss the rise in consumerism and patient expectations in healthcare. Learn how PeopleCare and other initiatives are rising to the challenge by increasing personalization. The post A Look into PeopleCare and the Patient Experience appeared first on NRC Health.

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Mind The Bleep

APRIL 2, 2023

Junior Doctors in the UK are increasingly moving to Australia after FY1, for FY3 or other years in between training. You can even join an exchange programme as part of your training to spend a year abroad. The helpful thing is that with a similar healthcare system and with so many doctors from the UK, it tends to be a really easy transition. Let’s face it – rotational training has made us specialists in moving far away to a new place and making new friends (although this distance is

Hospitals 59

Hospitals Wellness 59

Ken Grauer, MD

APRIL 3, 2023

I was asked for my interpretation of this tracing. No history was provided. How would YOU interpret this long lead II rhythm strip? Are the different-looking beats PVCs or supraventricular impulses conducted with aberration? — or — Something else? Figure-1: The long lead II rhythm strip for today’s case. No history was available. ( To improve visualization — I've digitized the original ECG using PMcardio ).

EKG/ECG 195

EKG/ECG 195

EMCrit

APRIL 26, 2023

Is there an easier way to mix up push-dose epinephrine that is still as safe? EMCrit Project by Scott Weingart, MD FCCM.

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The Skeptics' Guide to EM

APRIL 8, 2023

Date: April 4th, 2023 Reference: Vaughan and Browne. Reconfiguring emergency and acute services: time to pause and reflect. BMJ Qual Saf. 2023 Apr Guest Skeptics: Dr. Louella Vaugh is an internist practising as a hospitalist physician at an academic centre in London, UK with a special interest in smaller, rural and remote healthcare. Her main job […] The post SGEM Xtra: This is My Life – Centralization of Rural Emergency Healthcare first appeared on The Skeptics Guide to Emergency Medicine.

Stroke 55

Stroke Emergency Department Academics COPD 55

SheMD

APRIL 30, 2023

Here at sheMD, we believe in the importance of practicing Evidence-Based Medicine. We believe the same principles apply to discussing Gender and Medical Education. Therefore, we are bringing you an entire Journal Club series! Our series will focus on foundational and new literature within the gender and medicine space. Today, we will be discussing the article entitled, IMPACT survey: IMpaired fecundity in Physicians and Association with Clinical Time.

CDC 52

CDC EMS Outcomes 52

Pediatric Education

APRIL 30, 2023

Patient Presentation A 3-year-old female came to clinic for her initial health maintenance visit after moving to the area. She had a history of neonatal stroke for which she had received physical and occupational therapy. She still had some minor difficulty with her left hand and needed a referral to a new occupational therapist for continued therapy.

Stroke 52

Stroke Seizures Pediatrics Hyperthermia / Hypothermia 52

Life in the Fast Lane

APRIL 30, 2023

Mike Cadogan, James Miers and John Mackenzie Emergency Procedures Introducing the SECOND iteration of the FOAMed online, peer reviewed, evidence based, Emergency Procedures app for iOS and android

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Board Bombs

APRIL 30, 2023

Hypotensive patient? Just reflexively give 30 cmL/kg, trend lactates, and broad spec antibiotics right? NOPE. Turns out, the heart could really care less. In fact, it might just decide to kill the patient if you do that. Let’s talk about a lesser common cause of shock. Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here: emrapidbombs.supercast.com.

Shock 52

Shock Sepsis 52

EMCrit

APRIL 25, 2023

CAR-T cell therapy is rapidly expanding as a miraculous therapy for numerous malignancies. However, it also causes a variety of unique and severe side-effects, which frequently cause ICU admission. This chapter explores current approaches to complications including CRS (cytokine release syndrome), HLH (hemophagocytic lymphohistiocytosis), and ICANS (immune effector cell-associated neurotoxicity syndrome).

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