Ken Grauer, MD

OCTOBER 10, 2024

I was sent the ECG shown in Figure-1 — told only that the patient was a middle-aged man with septicemia. QUESTIONS: Is this rhythm too fast to be sinus tachycardia? Are flutter waves hidden within the QRS and T waves? Are we seeing the retrograde P waves of AVNRT? Is this ATach ( A trial T achycardia )? Figure-1: The initial ECG in today's case. MY Thoughts on Today’s CASE: In my opinion — none of the above answers are optimal to describe the rhythm in Figure-1.

EKG/ECG 429

EKG/ECG Sepsis Wellness 429

Mount Sinai EM

OCTOBER 10, 2024

The Case: A woman in her twenties with no significant medical history presents with one month of progressive frontal headaches radiating to her occiput. Her headaches have been intermittent, however over the past few days she has had a few episodes of vomiting and brief episodes of blurred vision. Her headache is 8/10 currently. Last emesis and blurred vision were both 12 hours prior.

Urgent Care 232

Urgent Care Ultrasounds 232

The Trauma Pro

OCTOBER 22, 2024

Today’s post is directed to all those prehospital trauma professionals out there. Car crashes account for a huge number of injuries worldwide. About 40% of people involved are trapped in the vehicle. And unfortunately, entrapped individuals are much more likely to die. There are four basic groups (and their category in parentheses) of trapped car occupants : those who can self-extricate or extricate with minimal assistance (self-extrication) individuals who cannot self-extricate due to pai

EMS 212

EMS 212

Science Based Medicine

OCTOBER 2, 2024

Just recently, in casual conversation, someone commented to me that “they” already have a cure for cancer but are hiding it. This is a claim I frequently encounter. One survey, from 2005, found that 27.3% of those surveyed endorsed this belief. Another survey from 2014 found that 37% of people believe the FDA is suppressing natural cancer cures on behalf of “Big […] The post Conspiracy Thinking And Alternative Medicine first appeared on Science-Based Medicine.

126

126

Sensible Medicine

OCTOBER 20, 2024

In a world where doctors are increasingly treated like cogs in a machine, the question arises: Would you recommend your son or daughter pursue the field? Recently, I saw this poll: I said ‘unsure’, but that is just a fragment of what I think. Here is my answer (leave yours in the comments). My answer is: it depends on who is asking. I would strongly encourage you to pursue medicine if… Your primary goal in a career is using your talents to improve the well being of others.

Wellness 124

Wellness Hospitals 124

EM Ottawa

OCTOBER 24, 2024

Precedex (dexmedetomidine) is an alpha-2 adrenergic agonist increasingly used in critical care environments for sedation and anxiolysis. It offers a unique profile of sedation without respiratory depression, making it an attractive option in various clinical scenarios. Historically, it has been used more frequently in the ICU than in Emergency Departments, likely due to provider comfort. […] The post Is there a Precedence for Precedex in the ED?

Emergency Department 120

Emergency Department Resuscitation 120

Ken Grauer, MD

OCTOBER 19, 2024

The patient whose ECG is shown in Figure-1 — presented with acute dyspnea and hypotension. QUESTION: In Figure-1 — Is the rhythm VT? — 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 ). == MY Thoughts on the ECG in Figure-1: Although at first glance, the ECG in Figure-1 appears to be wide — this is a false initial impression!

EKG/ECG 286

EKG/ECG Shock 286

The Trauma Pro

OCTOBER 29, 2024

CT scans are commonly used to aid the workup of patients with blunt trauma. They are occasionally useful in penetrating trauma, specifically when penetration into a body cavity is uncertain, and the patient has no hard signs that would send him or her immediately to the operating room. Is there any role for CT in operative penetrating trauma, after the patient has already been to the OR?

Operations 217

Operations Fractures Radiology Radiology 217

Science Based Medicine

OCTOBER 31, 2024

The organization scapegoated by the lab leak-promoting GOP-led House Covid subcommittee publishes its defense The post EcoHealth Alliance Fights Back first appeared on Science-Based Medicine.

105

105

Sensible Medicine

OCTOBER 10, 2024

I appreciate this essay for its reframing of our debates about cancer screening; viewing them through an ethical lens. The speculation that we might eventually be able to identify individuals harmed by radiographic screening and how this would alter our approach is both intriguing and alarming. Adam Cifu Sensible Medicine is a reader-supported publication.

Hospitals 128

Hospitals Wellness 128

EM Ottawa

OCTOBER 31, 2024

Delirium is a medical emergency. It is characterized by acute disturbance of consciousness, with changes in perceptual disturbances and fluctuation of symptoms. Delirium is often the initial manifestation of an underlying acute illness and can be present before fever, tachypnea, tachycardia, or hypoxia. There is an ED prevalence ranging from 7-24%, with increased mortality rates […] The post Delirium revisited appeared first on EMOttawa Blog.

Infectious Diseases 111

Infectious Diseases EMS 111

Ken Grauer, MD

OCTOBER 25, 2024

The ECG in Figure-1 was obtained from a middle-aged man who presented with a 2 week history of progressively increasing CP ( C hest P ain ) with exertion. He had his most severe episode of CP the day before he was seen with this ECG. His CP was much less compared to the day before — but it had not yet completely resolved. An initial Troponin drawn less than 1 hour after the ECG in Figure-1 was recorded was over 10,000.

EKG/ECG 242

EKG/ECG Shock Hospitals 242

Life in the Fast Lane

OCTOBER 30, 2024

Casey Parker and James Rippey Ultrasound Case 112 A 30 year old woman who is currently 30 weeks gestation presents to the ED with abrupt, severe right loin pain.

Ultrasounds 110

Ultrasounds 110

The Trauma Pro

OCTOBER 18, 2024

All trauma centers admit some of their patients to nonsurgical services. This usually occurs when patients have medical comorbidities that overshadow their injuries. Unfortunately, the decision-making that goes into balancing the medical versus trauma issues is not always straightforward. The fear is that if trauma patients are inappropriately placed on a nonsurgical service, mortality and morbidity may be higher because their injuries may not receive adequate attention.

Documentation/Coding 147

Documentation/Coding Emergency Department Hospitals 147

First 10 EM

OCTOBER 28, 2024

As with everything that comes out of the PECARN group, this is a huge study, and is therefore one that everyone needs to know about. That being said, despite working in two very busy community hospitals with a high percentage of pediatrics visits, c-spine injuries are just not an issue I struggle with. I have […] The post The PECARN c-spine rule could cause a lot of harm appeared first on First10EM.

Pediatrics 107

Pediatrics Hospitals EMS 107

Sensible Medicine

OCTOBER 15, 2024

It is my pleasure to introduce this article by Joseph Marine, MD in response to mandatory masking policies in a number of California hospitals. There is simply no randomized evidence to support these policies, and they make little sense in 2024. I worry about the mental abilities of the public health officers who instituted these policies, and that their actions will further erode trust in public health.

Hospitals 121

Hospitals Wellness 121

Science Based Medicine

OCTOBER 24, 2024

Millions of Americans are taking herbal remedies that may be toxic to the liver. The post Widespread Use of Dietary Supplements Linked to Liver Damage first appeared on Science-Based Medicine.

106

106

St. Emlyn

OCTOBER 22, 2024

St.Emlyn's - Emergency Medicine #FOAMed This post accompanies the podcast “Simulation for Elite Team Performance,” which was recorded live at the Tactical Trauma 2024 conference in Sundsvall, Sweden. We are grateful to the organizing team […] The post Podcast – Simulation for Elite Team Performance with Andrew Petrosoniak at Tactical Trauma 2024 appeared first on St.Emlyn's.

Emergency Department 103

Emergency Department 103

RebelEM

OCTOBER 2, 2024

Take Home Points Toxic alcohols generally refer to methanol and ethylene glycol as these substances pose significant metabolic derangement and end-organ damage. Patient who present shortly after ingestion will simply look inebriated – no different than ethanol intoxication. At this point, patients will have an elevated osmolar gap and little to no anion gap.

EMS 110

EMS 110

Dr. Smith's ECG Blog

OCTOBER 27, 2024

This was submitted by a paramedic, Hailey Kennedy A late 50s male called 911 following 2 hours of chest pain that started while working at his desk. He reported the crushing chest pain radiated down his left arm. Pt took an antacid with no relief and decided to call at the request of his wife. Here is his EMS ECG: What do you think? This was sent to me with no clinical information, and my initial impression viewing it on my phone was "It’s a tricky one.

EKG/ECG 99

EKG/ECG EMS Outcomes 99

First 10 EM

OCTOBER 21, 2024

I love toxicologists, but it’s time for someone to call them out. (I also love ranting. Let’s see if I can get myself cancelled by a group of physicians that are definitely smarter than me.) I am sick of the anti-science rhetoric. Every time a toxicologist takes the stage at a conference, or grabs the […] The post Toxicology: the excuses must stop appeared first on First10EM.

104

104

Sensible Medicine

OCTOBER 21, 2024

The story begins in Nottingham UK in 1980. It was a small study at one hospital. But its lessons are large. First the background. I believe the CAST trial (1991) was the most important trial in all of modern medicine. It showed that the common practice of using drugs to suppress rhythm disturbances (anti-arrhythmics) in patients after heart attack (myocardial infarction) led to higher death rates.

Evidence-Based Practice 110

Evidence-Based Practice Shock Outcomes Fractures 110

Science Based Medicine

OCTOBER 11, 2024

It doesn't bode well for the future that "leaders" of major American institutions look at naked emperors and compliment them on their beautiful clothes. The post The President of Stanford Wants Us To Debate Which Number is Larger, 9 or 133 first appeared on Science-Based Medicine.

Wellness 110

Wellness 110

EM Ottawa

OCTOBER 7, 2024

Methodology: 2.5/5 Usefulness: 3.5/5d Gaudreau-Simard M, et al. Ultrasound J. 2024 Feb 22;16(1):15. doi: 10.1186/s13089-023-00352-3. Question and Methods: The authors aimed to determine the test characteristics of point-of-care ultrasonography (POCUS) for detecting hydronephrosis in acute kidney injury. Findings: From 65 patients, POCUS had a sensitivity of 85% (95% CI 71-94%), specificity of 78% (95% CI […] The post Test characteristics of point-of-care ultrasonography in patients with ac

Ultrasounds 107

Ultrasounds 107

PulmCCM

OCTOBER 28, 2024

Inflammation is implicated in acute myocardial infarction in at least two ways: Inflamed plaques are more likely to rupture and produce coronary occlusion. A robust and potentially damaging inflammatory response occurs after reperfusion with coronary stenting. It has been estimated that inflammation resulting from the reperfusion injury could produce as much as half of the eventual myocardial damage, significantly contributing to disability and death post-MI.

Outcomes 97

Outcomes Hospitals Wellness 97

RebelEM

OCTOBER 16, 2024

Take Home Points Orogastric lavage may still play an important role in treatment of the overdose patient. Do not perform lavage if the ingestion has limited toxicity at any dose or the ingested dose is unlikely to cause significant toxicity. Strongly consider orogastric lavage in a patient who has taken an overdose of drugs that are particularly toxic, suspected extreme doses associated with high morbidity/mortality and do not have easily available and effective antidotes.

EMS 103

EMS 103

ACEP Now

OCTOBER 10, 2024

Every two years, Americans go to the polls to choose our representatives in Congress and at the state level. Few of the candidates vying to represent us have truly walked in our shoes as emergency physicians. However, seven emergency physicians—some incumbents and a few newcomers—are hoping to represent their communities in Washington, D.C. ACEP Now reached out to Drs.

Critical Access 105

Critical Access Telemedicine Hospitals Administration 105

Sensible Medicine

OCTOBER 25, 2024

The woman with palpitations. The man with whom you used to joke and trade barbs who now sits silently, absent, while you talk to his wife. The woman whose depression dominates every visit; her depression being the one problem she refuses to address. The man whose joy and charisma makes every visit an absolute pleasure, despite his painful disability about which you can really do nothing.

Urgent Care 103

Urgent Care Wellness 103

Science Based Medicine

OCTOBER 23, 2024

A recent meta-analysis of eye movement desensitization and reprocessing (EMDR) therapy concludes that the evidence “confirms” EMDR is effective in treating depression. It is a great example of the limitations of meta-analysis, and how easy it is to create essentially a false narrative using poor quality research. EMDR was “developed” by Dr.

Research 103

Research 103

Broome Docs

OCTOBER 6, 2024

Welcome to a special edition of the Journal Club with Justin. This month we recorded live with a bunch of fantastic Broome junior doctors. Justin gate-crashed our local journal club to share his approach to “reading a paper” ( Video version here) and then we dived into a bunch of new papers… and one really old one. Thanks to Drs Emily Wishart, Josh Briotti and Will Arnott who were brave enough to join the chaos and unscripted nerd fest that we put on every month or two.

Emergency Department 106

Emergency Department EMS Research Outcomes 106

Dr. Smith's ECG Blog

OCTOBER 15, 2024

This was sent to me by an undergraduate name Hans Helseth, who is an EKG tech, but who is an expert OMI ECG reader. He wrote most of it and I (Smith) edited. A prehospital “STEMI” activation was called on a 75 year old male ( Patient 1 ) with a history of hyperlipidemia and LAD and Cx OMI with stent placement. He arrived to the ED by helicopter at 1507, about three hours after the start of his chest pain while chopping wood around noon.

EKG/ECG 102

EKG/ECG Hospitals Wellness 102

Emergency Medicine Journal

OCTOBER 23, 2024

Patients who present to the ED usually have their BP measured as part of their routine triage assessment. BP measurements suggesting hypertension (≥140 systolic or ≥90 diastolic 1 ) are a frequent incidental finding, unrelated to the patient’s presenting complaint, but require follow-up. 2 Hypertension is associated with an increased risk of cardiovascular events, so its detection in ED may be an opportunity to initiate further investigations and management. 3 Guidance produced

Emergency Department 98

Emergency Department 98

The Skeptics' Guide to EM

OCTOBER 5, 2024

Date: October 2, 2024 Reference: Paxton et al. Headpulse measurement can reliably identify large-vessel occlusion stroke in prehospital suspected stroke patients: Results from the EPISODE-PS-COVID study. AEM Sept 2024 Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the UMass Chan Medical School – Baystate.

Stroke 103

Stroke EMS Outcomes Research 103

Sensible Medicine

OCTOBER 2, 2024

This post continues yesterday’s. If you have not read Part I, I suggest you read it first. Adam Cifu Sensible Medicine is a reader-supported publication. Please consider becoming a free or paid subscriber. There was a time when, right or wrong, there was a consensus within medicine regarding what kind of person would make a good doctor. It was believed that being a doctor meant you had to remember a great number of obscure things, and so we designed tests that heavily weighted memorization

Academics 106

Academics Wellness 106

Science Based Medicine

OCTOBER 4, 2024

Dying of COVID is worse. The post If Dr. Jay Bhattacharya Saw What I Saw, He’d Realize That Being Called “Fringe” Isn’t So Bad After All first appeared on Science-Based Medicine.

95

95

American Medical Compliance

OCTOBER 31, 2024

A survey reveals that falls are the most frequent health issue affecting seniors in long-term care facilities. Interestingly, while 90% of caregivers feel confident in implementing fall prevention measures, only 60% have adequate knowledge to do so effectively. As the aging population grows, so does the demand for specialized healthcare tailored to the unique needs of seniors and individuals with disabilities, posing new challenges and responsibilities for healthcare providers.

Outcomes 91

Outcomes Best Practices Patient Safety Wellness 91

Dr. Smith's ECG Blog

OCTOBER 8, 2024

This was sent to me by a reader who wishes to remain anonymous. A lady in her 60s came to the ER with chest discomfort and shortness of breath. She had a history of previous anterior MI treated by primary PCI to the proximal LAD. The first EKG is from 2:30 PM on the day of presentation to the ER. Smith : To me this is a blatantly obvious acute anterior OMI.

EKG/ECG 104

EKG/ECG Documentation/Coding Resuscitation Shock 104