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 392

EKG/ECG Hospitals Wellness 392

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 270

Seizures Pediatrics Academics Emergency Department 270

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 201

Pediatrics Sepsis EMS 201

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 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 131

Academics 131

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 394

EKG/ECG Wellness Shock 394

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 134

Documentation/Coding Outcomes Research 134

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 256

Emergency Department 256

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 117

Outcomes Shock Hospitals Wellness 117

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 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 412

EKG/ECG Resuscitation Wellness 412

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 EMS Infectious Diseases 152

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 128

Academics Administration Hospitals Wellness 128

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 249

Stroke 249

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 116

EMS 116

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 117

Pediatrics 117

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 115

Ultrasounds Emergency Department Wellness 115

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 123

Outcomes Research Wellness Hospitals 123

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 239

Head Injuries Operations Research 239

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 118

Resuscitation 118

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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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 109

EKG/ECG Fluid Resuscitation Academics Resuscitation 109

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

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

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 236

Radiology Radiology Operations Resuscitation 236

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

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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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 105

EKG/ECG Outcomes 105

ACEP Now

AUGUST 14, 2024

The American Heart Association and American College of Cardiology released a comprehensive guideline on the management of atrial fibrillation (AF). 1 Most of the AHA/ACC recommendations are either irrelevant to the general emergency physician or common sense. For example, if a patient has hemodynamic instability attributable to AF, perform immediate electrical cardioversion.

Emergency Department 105

Emergency Department Outcomes Research Wellness 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 104

Infectious Diseases Pediatrics Emergency Department Hospitals 104

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 233

Research 233

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

Science Based Medicine

AUGUST 23, 2024

We do not have herd immunity to COVID and we should reject doctors who seek to redefine basic terms because they are incapable of uttering the words "I was wrong." The post Part 2: We Don’t Have to Wonder if the Great Barrington Declaration Could Have “Worked”. In the Real World It Failed & Redefining Basic Medical Terms Won’t Change That. first appeared on Science-Based Medicine.

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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 102

EKG/ECG Wellness 102

Sensible Medicine

AUGUST 7, 2024

In Post #1 last Wednesday, Elizabeth Fama introduced her critical appraisal series on the Back to Sleep recommendation. This week, she explores the downsides of sleeping babies on their backs. JMM Sensible Medicine is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Possible Downsides of Back Sleeping Sleep Quality For adults, it’s fairly interchangeable to sleep on the stomach, side, or back.

CDC 106

CDC Documentation/Coding Research Pediatrics 106