Ken Grauer, MD

AUGUST 29, 2024

The ECG in Figure-1 was obtained from an 80-year old woman — who presented to the ED ( E mergency D epartment ) — with a several hour history of "palpitations" and CP ( C hest P ain ). She was hemodynamically stable at the time ECG #1 was recorded. QUESTIONS: The ECG in Figure-1 was seen by a number of physicians — the majority of whom thought the rhythm was some form of SVT ( S upra V entricular T achycardia ) with LBBB ( L eft B undle B ranch B lock ) aberration.

EKG/ECG 389

EKG/ECG Hospitals Wellness 389

Pediatric EM Morsels

AUGUST 23, 2024

Concussions are commonly encountered in the Emergency Department. We have previously discussed an approach to the question of when a patient “ can return to sport.” That recommendation has been revised ( calling for us to Rebake this Morsel ) and now also pays specific attention to the important aspect of scholastic activities. Let’s take a quick minute to digest a morsel on the current concussion in sport recommendations with respect to Return to Learn and Return to Sport : Re

Seizures 281

Seizures Pediatrics Academics Emergency Department 281

Mount Sinai EM

AUGUST 7, 2024

Ultrasound during cardiac arrest has quickly become standard. Initially, data suggested that the use of ultrasound during arrest increased pauses between compressions which worsens outcomes. To decrease time between compressions, many protocols were proposed (see here ). One such protocol that successfully decreased time between compressions is the CASA (Cardiac Arrest Sonographic Assessment) protocol.

Ultrasounds 235

Ultrasounds CPR Documentation/Coding COPD 235

The Trauma Pro

AUGUST 16, 2024

And another law to end the first week! Any time I give a pediatric talk, I mention it. This one applies to anyone who takes care of children, and is particularly important to EMS / prehospital providers and emergency physicians. On occasion, medics are called to a home to treat a child in extremis, or occasionally in arrest. Similarly, extremely sick children are often brought to the ED by parents or other caregivers.

Pediatrics 203

Pediatrics Sepsis EMS 203

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!

Outcomes

Sensible Medicine

AUGUST 3, 2024

Last week Adam Cifu and Vinay Prasad offered dueling interpretations of a randomized trial of masking. These posts were read by nearly a hundred thousand readers, and you can read them below. One reader, Ben Recht, a Berkeley Professor, thinks both of them are wrong. This is his column. Sensible Medicine Adam Cifu is Wrong About Masking In a recent post on Sensible Medicine, written on my phone while traveling, I criticized a randomized trial of masking in the BMJ that found Norweigans told to w

Documentation/Coding 144

Documentation/Coding Outcomes Research 144

EMCrit

AUGUST 26, 2024

We often joke that the right ventricle is the “forgotten ventricle,” but there is a sad truth behind this joke. Recently, there has been increased recognition of the importance of right ventricle failure and systemic congestion within some circles (e.g., nephrologists and resuscitationists). However, overall the right ventricular failure continues to be commonly overlooked.

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Pediatric EM Morsels

AUGUST 9, 2024

Neonates presenting to the Emergency Department often cause a lot of uncertainty. Is this scalp swelling normal? Is this bloody stool concerning? Are this odd movements part of normal development? Is that umbilical area ok or concerning? Fortunately, we have addressed many neonatal issues in the PedEMMorsels. Obviously, one of the most concerning considerations in neonates is the potential for infection.

Hyperthermia / Hypothermia 154

Hyperthermia / Hypothermia Emergency Department Seizures Pediatrics 154

St. Emlyn

AUGUST 1, 2024

St.Emlyn's - Emergency Medicine #FOAMed "Time Critical: Information Light" decision-making is vital in emergency medicine, requiring swift actions with minimal data. However, uncertainty decreases over time as more information becomes available. This model highlights the importance of making high-stakes decisions promptly, avoiding premature or delayed interventions.

Resuscitation 136

Resuscitation 136

The Trauma Pro

AUGUST 15, 2024

You’ve just received a young male who had been stabbed under his right arm in your emergency department. He’s awake, talking, and very friendly. He met your trauma activation criteria, so you are cruising through the full evaluation. Lines in, blood drawn, clothes off. He wonders aloud if all this is really necessary. Then, on FAST exam, you see it.

Emergency Department 203

Emergency Department 203

Sensible Medicine

AUGUST 4, 2024

Editors note: a shortened version of this post was originally submitted to the New England Journal, but it was rejected. Refusing to host debates is why journals will die. By Joseph Marine, MD In a recent NEJM Perspective piece , Drs. Mullen, Topol, and Verghese argue “in support of institutional voices” to take public positions on matters of public controversy “when it concludes that a faculty member’s opinion could cause public harm.” Their essay (ironically publi

Academics 140

Academics Administration Hospitals Wellness 140

Emergency Medicine Cases

AUGUST 19, 2024

We over-admit low risk acute heart failure patients and under-admit high risk heart failure patients. In this podcast we discuss the diagnostic accuracy of various clinical features, lab tests and imaging modalities for acute heart failure, the 3 validated risk stratification tools and a simple approach to PoCUS for the diagnosis and prognostication of acute heart failure in the ED to improve our diagnostic accuracy and disposition decisions for patients with acute heart failure.

EMS 125

EMS 125

Ken Grauer, MD

AUGUST 8, 2024

I was sent the ECG shown in Figure-1 — told only that that this middle-aged woman noted chest tightness and nausea an hour earlier. QUESTIONS: How would YOU interpret the ECG in Figure-1 ? — IF told that this patient arrested shortly after ECG #1 — Does this change your interpretation? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original EC G using PMcardio ).

EKG/ECG 318

EKG/ECG Resuscitation Wellness 318

Pediatric EM Morsels

AUGUST 2, 2024

It’s never comfortable and is often very distressing to have skin problems and infections, such as intertrigo , folliculitis , panniculitis , omphalitis , or even preseptal or periorbital cellulitis. It’s even more distressing when the skin problem affects the penis. While summer is starting to wind down, and Summer Penile Syndrome is less likely to occur, we must still be vigilant for penile problems that can occur all year long.

Pediatrics 154

Pediatrics Allergic Reactions EMS Infectious Diseases 154

Dr. Smith's ECG Blog

AUGUST 26, 2024

A 60-something woman with no cardiac history presented with epigastric and right upper quadrant pain after eating spicy food. She had an ECG recorded at triage: What do you think? This was sent to me without any info while I was out and about, and I looked at it on my phone. I responded: "That is a tough one. V2 is very worrisome. But no other leads are.

EKG/ECG 122

EKG/ECG Outcomes 122

The Trauma Pro

AUGUST 27, 2024

Here’s the last one… for now. If you have followed this blog for any period of time, you are aware of the skepticism I bring to bear when I am reading new material or learning of new ideas. Why is this? Because it is very difficult in this day and age to ascertain the veracity of anything we see, hear, or read. This is not new compared to, say, a hundred years ago.

Head Injuries 202

Head Injuries Operations Research 202

Sensible Medicine

AUGUST 12, 2024

I would like to live a long life. Surely you do as well. You can improve your chances by eating well, exercising, avoiding smoking and too much alcohol. There is also the matter of luck. The question today is whether modern medical screening can improve on those basic lifestyle choices. People believe it can, obviously. The screening industry is a money-making machine.

Outcomes 133

Outcomes Research Wellness Hospitals 133

Stop and Think

AUGUST 28, 2024

One area continues to dominate my field of cardiology. It is the search for and treatment of ischemic heart disease. Coronary heart disease dominates the minds of patients and doctors alike. Find blockages so they can be fixed before a heart attack or death occurs—goes the thinking. Coronary artery scans are the newest tool. But stress labs run days and weekends.

Outcomes 120

Outcomes Shock Hospitals Wellness 120

Ken Grauer, MD

AUGUST 22, 2024

The ECG shown in Figure-1 — was obtained from an older man with “CP” ( C hest P ain ) for the past 2 days. BP = 80/50 mm/Hg. Adenosine 6 mg IV was tried without response. QUESTIONS: How would YOU interpret this ECG? Your thoughts regarding optimal management? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ).

EKG/ECG 257

EKG/ECG Wellness 257

ACEP Now

AUGUST 12, 2024

Every once in a while, I get a text from a friend of a meme decrying the inevitability of becoming interested in birds as you age. In a way, it’s true; it came out of nowhere for me. And granted it can seem peculiar to the uninitiated. But now that I have been indoctrinated for a couple of years, it has become much more than a hobby to me. I see it as a healthful exercise, a practice in mindfulness.

Ultrasounds 116

Ultrasounds Emergency Department Wellness 116

Dr. Smith's ECG Blog

AUGUST 2, 2024

Written by Willy Frick A 50 year old man with no medical history presented with acute onset substernal chest pain. His ECG is shown below. Pretty obvious anterior current of injury. This was a machine read STEMI positive OMI. Readers of this blog can easily appreciate the hyperacute T waves in the precordium, clearest in V1-V4. What would you guess is the culprit artery?

EKG/ECG 119

EKG/ECG Fluid Resuscitation Academics Resuscitation 119

The Trauma Pro

AUGUST 12, 2024

Let’s get started with the Laws of Trauma! After pursuing any discipline for an extended period, one begins to see the common threads and underlying principles of their area of expertise. I’ve been trying to crystallize these for years, and today I’m going to share one of the most basic laws of trauma care. The First Law of Trauma Any anomaly in your trauma patient is due to trauma, no matter how unlikely it may seem.

Stroke 203

Stroke 203

Sensible Medicine

AUGUST 17, 2024

A few years ago, a colleague of mine was applying for, and eventually received, a grant to study lung cancer screening in a vulnerable population. One day, we were having coffee, and she mused. “Look at these 20 year old tech start up people. 8 of them living in a house. Spending day and night coding. All dreaming that they will make it big. It’s sad to watch, knowing how few will succeed.

Documentation/Coding 121

Documentation/Coding Research Burns 121

Life in the Fast Lane

AUGUST 11, 2024

Jeremy Rogers and Chris Moseley High Flow Nasal Cannula

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115

St. Emlyn

AUGUST 21, 2024

St.Emlyn's - Emergency Medicine #FOAMed Listen to the podcast recorded live at the Premier Conference 2024 about neuroprotection in the prehospital phase of care. The post Podcast – Prehospital Neuroprotection appeared first on St.Emlyn's.

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ACEP Now

AUGUST 13, 2024

The inclusion of diversity, equity, and inclusion (DEI) principles in undergraduate medical education is considered crucial for creating a just and fair health care system. Though DEI education, including critical race theory and its derivatives, is still a topic of public debate, many industry specialists and educators believe that it forms the foundation of high quality health care practices and the achievement of health equity.

Leadership 111

Leadership Outcomes Academics Emergency Department 111

Dr. Smith's ECG Blog

AUGUST 4, 2024

Written by Pendell Meyers Try first to interpret the ECG without any clinical context: What do you think? Sinus rhythm with abnormal STE in V2-V6, and I, II, aVF. Reciprocal STD in aVR and V1. Most leads with STE have remarkably non-hyperacute, flat T waves. Most would say that there is Spodick's sign. The PR depression in II (and its reciprocal PR elevation in aVR) is probably beyond normal baseline values.

EKG/ECG 117

EKG/ECG Wellness Operations Emergency Department 117

The Trauma Pro

AUGUST 21, 2024

All trauma professionals need to keep up with the current thinking in their field. There are a variety of ways to do this, including lectures, courses, online curricula, meetings, and reading journal articles. The last method requires a bit of skill and patience. Many research papers are dry, long, and hard to read. Quite a few people do not have the patience to wade through them, and get lost in all the details.

Research 201

Research 201

Sensible Medicine

AUGUST 16, 2024

I’d been certain that all would be well in medicine in the age of AI. I had been telling myself that the addition of AI to medical practice would be a net positive. AI would assist with some of the drudgery that is part of every doctor’s job. We would also incorporate AI into our decision making. AI would help us read X-rays or pathology specimens.

Documentation/Coding 120

Documentation/Coding Wellness 120

First 10 EM

AUGUST 12, 2024

The concept of a “deepity” was, I believe, coined by Daniel Dennet in his great book “Intuition pumps and other tools for thinking”. He says, “a deepity is a proposition that seems both important and true – and profound – but achieves this effect by being ambiguous. On one reading it is manifestly false, but […] The post Is “First do no harm” a “deepity”?

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St. Emlyn

AUGUST 8, 2024

St.Emlyn's - Emergency Medicine #FOAMed Is intranasal ketorolac an option for analgesia in renal colic. A review of a paper from the Annals of Emergency Medicine. The post Intranasal ketorolac in renal colic appeared first on St.Emlyn's.

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Emergency Medicine Cases

AUGUST 19, 2024

ECG artifact and lead reversal can mimic tachy-arrhythmia, infarct or Brugada. Learn how to identify these errors to prevent misdiagnosis on this month's ECG Cases with Dr. Jesse McLaren. The post ECG Cases 51 – Artifact and Lead Misplacement appeared first on Emergency Medicine Cases.

EKG/ECG 106

EKG/ECG EMS 106

Dr. Smith's ECG Blog

AUGUST 16, 2024

Written by Pendell Meyers A man in his 60s presented with acute chest pain and normal vital signs. Here is his triage ECG: What do you think? The ECG shows massively hyperacute T waves of LAD OMI, plus WPW. V3-V5 also have the depressed HATW takeoff which qualifies them as the rare de Winter subtype of HATWs. Its hard to measure the STE in I exactly with the moving baseline, but there is almost certainly not enough STE to meet STEMI criteria.

EKG/ECG 112

EKG/ECG Wellness 112

The Trauma Pro

AUGUST 14, 2024

Trauma patients don’t always behave the way we would like. They continually surprise us, sometimes for the better when they recover more quickly and completely than we thought. But sometimes it’s for the worse. They occasionally crash when we think everything is going so well. The crashing patient is in obvious need of help and most trauma professionals know what to do.

Radiology 202

Radiology Radiology Operations Resuscitation 202

Sensible Medicine

AUGUST 11, 2024

When I was a resident, I worked 7 nights of 12 hour shifts alternating with 7 days of 14 hour shifts. The jet lag was like flying to Moscow. I also worked 28 hour shifts Q4 (on paper), which actually ran as high as 32-36 hours (in reality). Often, I was tired. Whether or not residents need to work long hours, and what they do during that time is an open debate.

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American Medical Compliance

AUGUST 27, 2024

According to Rock Health , digital health funding still totaled $15.3 billion in 2022, despite economic challenges. This figure underscores the critical role technology continues to play in healthcare, particularly in advancing access and equity. As healthcare providers, organizations, and policymakers increasingly recognize the persistent disparities in health outcomes across different populations, technology is emerging as a powerful tool to bridge these gaps.

Outcomes 105

Outcomes 105

St. Emlyn

AUGUST 27, 2024

St.Emlyn's - Emergency Medicine #FOAMed Is it time to rethink peer review? Delve into the pros and cons of this crucial process in scientific research. Is open peer review a better option for the future? @richardbody has tried it and we think he likes it. @stemlyns #FOAMed The post Open and Ongoing Peer Review: A New Model for Scientific Research appeared first on St.Emlyn's.

Research 106

Research 106