Ken Grauer, MD
SEPTEMBER 21, 2024
The ECG in Figure-1 was obtained from a previously healthy man in his early 20s — who initially presented with GI symptoms, that then evolved into CP ( C hest P ain ). The patient was thought to have anxiety. QUESTIONS: Given the above history — How would YOU interpret the initial ECG that is shown in Figure-1 ? Does the patient's age infuence your interpretation?
The Trauma Pro
SEPTEMBER 6, 2024
Trauma professionals don’t always know everything. Sometimes we have to engage a specialist in the care of our patient. And unfortunately, we don’t always know which conditions demand immediate attention and which can wait. This can lead to overuse of our consultant colleagues and calls at inappropriate times. So what if we diagnose an injury in their area of expertise at 2 am?
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Sensible Medicine
SEPTEMBER 19, 2024
Dr. Marty Makary has a powerful new book, BLIND SPOTS: When medicine gets it wrong and what it means for our health , that came out on Tuesday and instantly hit #2 bestselling book on Amazon. I loved the book and highly recommend it. In this piece, he discusses one of those blind spots of the modern medical establishment—America is getting sicker right before our eyes.
St. Emlyn
SEPTEMBER 26, 2024
St.Emlyn's - Emergency Medicine #FOAMed The diagnosis of subarachnoid haemorrhage in the emergency department is a constant source of anxiety. How do we make sure we pick up everyone with a bleed, but not overinvestigate […] The post The Subarachnoid Haemorrhage in the Emergency Department (SHED) Study appeared first on St.Emlyn's.
Science Based Medicine
SEPTEMBER 20, 2024
If Drs. Vinay Prasad and Tracy Hoeg want to prove they actually care about routine vaccines, they can do what the should have done a long time ago and openly and unequivocally denounce Mr. Kennedy and his fire hose of anti-vaxx disinformation. The post A Simple Challenge For Drs. Vinay Prasad and Tracy Hoeg: Denounce Robert Kennedy Jr. For Promoting The Movie Vaxxed 3: Authorized to Kill first appeared on Science-Based Medicine.
Dr. Smith's ECG Blog
SEPTEMBER 18, 2024
By Smith, peer-reviewed by Interventional Cardiologist Emre Aslanger Submitted by anonymous A 53 y.o. male presents to the ED at 6:45 AM with left sided chest dull pressure that woke him up from sleep at 3am. The pain radiated to both shoulders. He arrived to the ED at around 6:45am, and stated the pain has persisted. He has had similar pain in recent weeks that has occurred at rest, but it typically goes away after about an hour.
Ken Grauer, MD
SEPTEMBER 28, 2024
The ECG in Figure-1 — was obtained from a 45-year old man with diabetes, who was being treated for septic shock. QUESTIONS: How would YOU interpret the ECG in Figure-1 ? What is the rhythm? Why does QRS morphology in the long lead II rhythm strip change every-other-beat? Figure-1: The initial ECG in today's case. MY Thoughts on the ECG in Figure-1: This is a challenging ECG to interpret because of: i ) the changing QRS morphology; and , ii ) the difficulty in seeing all of the P waves.
Emergency Care Today brings together the best content for emergency care practitioners from the widest variety of industry thought leaders.
Sensible Medicine
SEPTEMBER 5, 2024
The lay media is abuzz with stories about Elle Macpherson, who admits in a new memoir to declining chemotherapy seven years ago. Although precise details are not provided, it sounds like Ms. Macpherson had localized or regional breast cancer and underwent surgery. We learned something about the risks of commenting on the health of celebrities over a decade ago when an OpEd we published in Washington Post about former president George W.
St. Emlyn
SEPTEMBER 18, 2024
St.Emlyn's - Emergency Medicine #FOAMed Case series of dirty epi drips in Australia. A potentially useful tool in austere/remote settings, but lots of caveats and cautions before we all start doing this! Be careful, but do learn about this potential therapy. #FOAMed @stemlyns The post The Dirty Adrenaline (Epi) drip. appeared first on St.Emlyn's.
RebelEM
SEPTEMBER 2, 2024
Background: Emergency intubations present a unique set of challenges, particularly when dealing with heavily contaminated airways. Anesthesiologist, Dr. James DuCanto, developed the DuCanto catheter to enhance airway management in these high-stakes situations. The commonly used 14 Fr Yankauer catheter, with its smaller bore, may struggle to clear heavily contaminated airways effectively.
Dr. Smith's ECG Blog
SEPTEMBER 12, 2024
Written by Pendell Meyers A man in his 40s called EMS for acute chest pain that awoke him from sleep, along with nausea and shortness of breath. His history included known heart failure with prior EF 18%, insulin dependent diabetes, and polysubstance abuse. Vitals were within normal limits except for tachypnea. Here are his EMS ECGs along with the Queen of Hearts interpretations below each one: EMS1 0650 EMS2 0707 Click here to sign up for Queen of Hearts Access The ECGs show RBBB and LAFB, with
Ken Grauer, MD
SEPTEMBER 13, 2024
I was sent the ECG shown in Figure-1 — being told only that providers on the case suspected AFib ( A trial Fib rillation ) with RBBB ( R ight B undle B ranch B lock ) aberrancy. QUESTIONS: Is the wide tachycardia that is seen best in the chest leads, too irregular to be VT ( V entricular T achycardia )? — How certain are YOU of your answer? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). == PEARL # 1: Before reviewing my a
The Trauma Pro
SEPTEMBER 13, 2024
There are basically four indications, two absolute and two relative : Absolute #1 : entrapped extremity with a lengthy extrication and a physiologically impaired patient who does not respond to fluids. In this case, there is occult blood loss in other areas that is killing your patient, and they need to get out quickly for definitive management. Absolute #2 : entrapped extremity with a lengthy extrication and an unstable physical environment.
Sensible Medicine
SEPTEMBER 15, 2024
Recently John Mandrola, once again, stepped out of his lane. About a recent, cancer trial, which was celebrated by oncologists, he said this: In fact, John’s observation is broadly true for this revolutionary class of medications. Although these drugs— checkpoint inhibitors— are great for melanoma and cutaneous squamous cell cancer, they aren’t wonder drugs and many uses are marginal.
St. Emlyn
SEPTEMBER 29, 2024
St.Emlyn's - Emergency Medicine #FOAMed This blog post reviews a study comparing non-invasive blood pressure (NIBP) and invasive blood pressure (IBP) monitoring in pre-hospital critical care. Using a retrospective cohort design, the study found that NIBP measurements are often inaccurate in patients with haemodynamic instability, particularly in hypotensive and hypertensive states.
Science Based Medicine
SEPTEMBER 21, 2024
I think some respected newspapers could do a better job of being honest with their readers about some pretty basic and pretty important things. The post Open Letter to Pamela Paul of the New York Times: Watch Some Interviews With Dr. Marty Makary. They Are More Important Than Peanut Allergies. first appeared on Science-Based Medicine.
Dr. Smith's ECG Blog
SEPTEMBER 7, 2024
A 70-something y.o. male presents to triage with shortness of breath. He reports significant chest pain at the base of his scapula on the right side along with new shortness of breath. ECG 1 at time zero EARLY REPOLARIZATION ABNORMAL ECG ED final official overread: "early repol vs hyperacute T, minimal changes from previous (previous shown below)" What do YOU think?
Ken Grauer, MD
SEPTEMBER 6, 2024
You are shown the ECG in Figure-1 — told only that the patient had a “continuous" tachycardia. QUESTIONS: How would YOU interpret the ECG in Figure-1 ? What is the differential diagnosis? — Treatment? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). MY Thoughts on the ECG in Figure-1: The rhythm in Figure-1 — is a regular SVT ( S upra V entricular T achycardia ) at a rate just under 150/minute , without clear sign of sinus
The Trauma Pro
SEPTEMBER 24, 2024
We’ve covered all the preparation for field amputation. Now, it’s time to do it! But wait, exactly what equipment is needed? There are two principles that you must adhere to: figure it all out in advance, and keep it simple. It is crucial that the trauma program design and assemble equipment and drug packs in advance, otherwise critical equipment may not make it to the field.
Sensible Medicine
SEPTEMBER 16, 2024
Few things interest my writing brain more than when a common practice gets overturned. That’s why I was drawn to Paula Span’s column in the New York Times titled, Three Medical Practices That Older Patients Should Question. One of these practices is the prescription of thickened liquids to older patients with swallowing problems. The idea goes like this: aspiration pneumonia is a common cause of death in the frail and elderly.
PulmCCM
SEPTEMBER 20, 2024
China has supplanted the U.S. as the largest producer of scientific articles. More and more Chinese clinical trials are being published in Western medical journals, including elite publications like the New England Journal of Medicine , JAMA , and The Lancet. The trend can only be expected to grow. Many of these trials report new findings that could significantly impact the practice of medicine in the U.S. and worldwide.
Science Based Medicine
SEPTEMBER 14, 2024
Maybe this isn't a drill. The post We Want Them Infected Doctors Sanewashed Robert F. Kennedy Jr. Will He Reward Them With Appointments at the CDC, FDA, and NIH? first appeared on Science-Based Medicine.
Dr. Smith's ECG Blog
SEPTEMBER 23, 2024
Written by Willy Frick with edits by Ken Grauer A woman in her 70s with a history of hypertension presented with acute onset shortness of breath. She was out walking her dog when she developed sudden dizziness and light-headedness. When EMS found her, she was dyspneic and diaphoretic. Her ECG is shown below: What do you think? The conventional machine algorithm interpreted this ECG as STEMI.
Ken Grauer, MD
SEPTEMBER 15, 2024
== Review of ECG Rhythms — MIS-C Case Report ( 9/5 /2024 ): == What follows below are my first impressions of the ECG rhythms sent to me from the Case Report by Dimah Jarmakani et al — of a 12-year old boy with MIS-C ( M ultisystem I nflammatory S yndrome in C hildren ). For full discussion of the case — CLICK HERE — ECG Rhythm Overview: A 12-year-old boy was admitted to our hospital with severe myocardial dysfunction and chaotic rhythm with tachy- and bradycardic arrhythmias.
The Trauma Pro
SEPTEMBER 10, 2024
Field amputation is not thought of very often, and for good reason. It is unpleasant, uncommon, and not very safe for trauma professionals due to the austere environment. I will dedicate the next several posts to the topic, starting with some of the facts. First, let’s start with definitions. Two distinct procedures are discussed here. The first and most commonly described is field amputation.
Sensible Medicine
SEPTEMBER 2, 2024
First a review of the main trial then to the new paper in the Journal of the American College of Cardiology. SELECT Trial The SELECT trial was the first to show that the glucagon-like-peptide-1 receptor agonist (GLP1) semaglutide could actually modify cardiovascular disease. The discovery of another disease-modifying agent for heart disease is a breakthrough.
First 10 EM
SEPTEMBER 30, 2024
Some topics come up over and over again, and it may seem somewhat repetitive or wasteful to spend so much time on them, but seeing as so many people are still using outpatient IV antibiotics despite overwhelming evidence that oral antibiotics are just as good, if not better, I will continue to cover papers as […] The post Oral antibiotics are noninferior to IV in pediatric bone and joint infections (obviously) appeared first on First10EM.
Science Based Medicine
SEPTEMBER 8, 2024
Bhattacharya, Atlas, and Makary are also set to speak at Stanford next month The post Hopkins Business School to Platform COVID-19 Contrarians at Health Policy Symposium first appeared on Science-Based Medicine.
Dr. Smith's ECG Blog
SEPTEMBER 25, 2024
This is another case sent by the undergraduate (who is applying to med school) who works as an EKG tech. The undergraduate is now willing to identify himself: Hans Helseth. A 56 year old male with a history of diabetes, dyslipidemia, hypertension, and coronary artery disease presented to the emergency department with sudden onset weakness, fatigue, lethargy, and confusion.
Life in the Fast Lane
SEPTEMBER 11, 2024
James Miers and John Mackenzie Procedure: Pericardiocentesis Emergency Procedure: Pericardiocentesis. one of the most difficult and risky emergency procedures, but one you already have the ultrasound and line skills to perform well.
The Trauma Pro
SEPTEMBER 17, 2024
Various trauma professionals (prehospital, emergency physician, surgeon) may provide this “service” at various places around the world. In the US, it is usually a physician and typically a surgeon. In my opinion, anyone can be trained to do a basic field amputation. Much depends on local policies and procedures, training, as well as availability. In most cases, prehospital providers are on the scene, so it makes sense that they could do a field amputation with appropriate training.
Sensible Medicine
SEPTEMBER 1, 2024
As seems to be the norm on Sensible Medicine these days, whenever John, Vinay, or I publicly disagree with one another, one of our readers chimes in to explain how all of us are off the mark. Today I am happy to post the latest comeuppance, this one by Dr. Thomas Huddle. Adam Cifu Sensible Medicine is a reader-supported publication. If you appreciate our work, consider becoming a free or paid subscriber.
Emergency Medicine Ireland
SEPTEMBER 30, 2024
Welcome back to the tasty morsels of critical care podcast. Today we look at quite a niche topic, that of chylothorax. We are used to many things in the pleural space, like simple fluid or blood or air but the presence of the myseterious substance chyle is a much more unusual and note worthy event. As a reminder of the basics which I of course knew implicitly and definitely did not have to resort to wikipedia to check… Chyle is largely formed in the small intestine as the gut transports fr
Science Based Medicine
SEPTEMBER 6, 2024
I suppose it's my turn to be called a fraudster, liar, perjurer, felon, grifter, stooge, imbecile, and maybe even murderer. What I won't get is a reasonable explanation as to why supposedly releasing a deadly virus was mass murder, but intentionally spreading it was a forgivable "policy position". The post Biosafety Now: Releasing The Virus Was Mass Murder.
Dr. Smith's ECG Blog
SEPTEMBER 11, 2024
A former resident texted me this case: "Hey Dr. Smith. Hope you’re doing well! How excited would you have been about this case?" Here is the case: Report from EMS was witnessed syncope, his son did CPR, but the patient had pulses when EMS arrived. When the patient arrived in the ED, he was still hypotensive in 70s, slowly improving with EMS fluids. No Chest Pain, but somnolent.
American Medical Compliance
SEPTEMBER 9, 2024
In assisted living, one of the most critical aspects of resident care is the prevention and management of skin issues. For instance, one of the most common risk factors associated with the development of pressure ulcers is being 70 years of age or older. Skin health is not only a matter of comfort and well-being but also a key indicator of a resident’s overall health status.
The Trauma Pro
SEPTEMBER 20, 2024
Now it’s time to look at the logistics involved in carrying out a field amputation/dismemberment. There are two main considerations here: getting the right people and equipment to the scene and keeping them safe. The following presumes that the procedure will be done by a physician who is based at a trauma center. It will be different if performed by other trauma professionals.
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