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 346

EKG/ECG Hospitals Wellness 346

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 259

Ultrasounds CPR Documentation/Coding COPD 259

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 243

Seizures Pediatrics Academics Emergency Department 243

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 193

Pediatrics Sepsis EMS 193

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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Science Based Medicine

AUGUST 31, 2024

I trust you'll have the intellectual integrity to play videos of these speakers. Anything less, would be misinformation and censorship. The post An Open Letter to the President of Stanford, Jonathan Levin: Don’t Censor Drs. Scott Atlas, John Ioannidis, Sunetra Gupta, Marty Marky, Monica Gandhi, Jay Bhattacharya, and Vinay Prasad. Amplify Their Voices. first appeared on Science-Based Medicine.

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Ken Grauer, MD

AUGUST 16, 2024

The ECG in Figure-1 was obtained from a man in his 40s — who presented to the ED ( E mergency D epartment ) because of CP ( C hest P ain ) and shortness of breath. QUESTIONS: In view of the above history — How would YOU interpret the ECG in Figure-1 ? Based on the history and the patient's initial ECG — the cath lab was activated. Do you agree? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ).

EKG/ECG 328

EKG/ECG Wellness Shock 328

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.

Emergency Department 152

Emergency Department Hyperthermia / Hypothermia Seizures Pediatrics 152

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 241

Emergency Department 241

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

Science Based Medicine

AUGUST 21, 2024

It’s interesting to follow the scientific exploration of a new clinical entity in real time. It reveals a lot about how medical science works, and how scientists nibble away at complex problems. This is partly why I have been closely following the story of long COVID as it has unfolded over the last few years. I also see patients with long COVID […] The post More on Long COVID first appeared on Science-Based Medicine.

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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 394

EKG/ECG Resuscitation Wellness 394

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 115

Ultrasounds Emergency Department Wellness 115

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 152

Pediatrics Allergic Reactions Infectious Diseases EMS 152

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 230

Stroke 230

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 113

EMS 113

Science Based Medicine

AUGUST 26, 2024

This week, Stanford University announced a conference on pandemic policy that features several of the usual suspects who spread misinformation during the COVID-19 pandemic. Truly, Stanford has become the "respectable" academic face of efforts to undermine public health. The post Stanford University will host a conference on pandemic planning featuring the usual (COVID-19) suspects first appeared on Science-Based Medicine.

Academics 132

Academics 132

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 261

EKG/ECG Wellness 261

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 116

Resuscitation 116

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 111

Documentation/Coding Research Burns 111

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 217

Head Injuries Operations Research 217

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

Science Based Medicine

AUGUST 25, 2024

Dr. Vinay Prasad started treating vaccine side effects as a fate worse than death in February 2021, before these was a COVID vaccine for children. The post Dr. Vinay Prasad Opposed The Pediatric COVID Vaccine Before There Was A Pediatric COVID Vaccine first appeared on Science-Based Medicine.

Pediatrics 125

Pediatrics 125

The Skeptics' Guide to EM

AUGUST 31, 2024

Date: August 30, 2024 Guest Skeptic: Dr. Mel Herbert is a famous Emergency Medicine Physician, award-winning educator, entrepreneur and philanthropist. Mel founded both EM:RAP which creates and distributes Emergency Medicine education in over 160 countries. He also started a non-profit company called EM:RAP GO. This is an SGEM Xtra to end Season#12.

Wellness 106

Wellness 106

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 108

EKG/ECG Outcomes 108

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 110

Documentation/Coding Wellness 110

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 212

Research 212

NRC Health

AUGUST 22, 2024

NRC Health announces the acquisition of leading healthcare rounding technology company Nobl and a new strategic partnership with customer and employee experience management leader Medallia. The post NRC Health announces Nobl acquisition & Medallia partnership to advance healthcare experience innovation appeared first on NRC Health.

Leadership 105

Leadership 105

Science Based Medicine

AUGUST 24, 2024

Dr. Jay Bhattacharya and the merging of political pandemic narratives The post Great Barrington Declaration Author Joins COVID-19 Lab Leak-Pushing Group first appeared on Science-Based Medicine.

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123

Life in the Fast Lane

AUGUST 26, 2024

Caleb Lin Hyperbaric Oxygen for the ICU Patient OVERVIEW INTENSIVE CARE INDICATIONS PRACTICAL ISSUES IN CRITICAL CARE Consideration & Prior to Treatment In the Chamber A: ETT cuff to be filled with sterile water or connected to dynamic cuff inflator B: Titrate ventilation to PaCO2, note that EtCO2 is not linearly proportionate at higher pressures C: Haemodynamic shifts related to hyperoxic vasoconstriction D: Increased […]

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101

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 112

EKG/ECG Fluid Resuscitation Academics Resuscitation 112

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.

110

110

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 214

Radiology Radiology Operations Resuscitation 214

EM Literature of Note

AUGUST 25, 2024

Move over ketamine and TXA, there’s another medication gradually approaching do-it-all darling status in Emergency Medicine: dexamethasone. Sore throats? Croup? Headaches? Non-specific aches? Well, yes to all of the above, in the appropriate clinical context – But, most prominently, as featured in this brief report, for asthma – particularly childhood asthma.

Administration 100

Administration Emergency Department Wellness Pediatrics 100

Science Based Medicine

AUGUST 30, 2024

Vaccines save lives and money according to a recently published CDC report. This shouldn't come as a surprise, but it's still nice to see. The post Vaccines: Saving Lives and Money for Over 200 Years first appeared on Science-Based Medicine.

CDC 118

CDC 118

PEMBlog

AUGUST 9, 2024

Recently, I had the opportunity to present a morning report to the residents and medical students at Cincinnati Children’s, focusing on the topic of febrile seizures. The session was highly engaging, with a lot of interest from the audience, as febrile seizures are a common but often frightening experience for families. During the presentation, we covered a range of topics, including the definition and incidence of febrile seizures, their causes, and how to manage and counsel families when their

Seizures 105

Seizures Emergency Department 105

Don't Forget the Bubbles

AUGUST 19, 2024

Sione, a young Pacific Islander boy, is brought to the emergency department with a 3-day history of acute onset, progressively worsening central chest pain. He points to his sternum when you ask him where the pain is. and tells you that it is made worse by deep breathing and movement. His sternum is warm to touch and exquisitely tender, inferior to the manubrium.

Infectious Diseases 101

Infectious Diseases Pediatrics Emergency Department Hospitals 101