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 425

EKG/ECG Sepsis Wellness 425

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 264

EMS 264

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

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 134

Hospitals Wellness 134

Dr. Smith's ECG Blog

OCTOBER 20, 2024

Written by Magnus Nossen The patient in today's case is a male in his 70s with hypertension and type II diabetes mellitus. His wife contacted the ambulance service after the patient experienced an episode of loss of consciousness. The syncope lasted about 2-3 minutes according to his wife. He woke up alert and with chest pain which he also had experienced intermittently over the previous few days.

EKG/ECG 130

EKG/ECG Shock Emergency Department Ambulance Services 130

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 121

Emergency Department Resuscitation 121

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 282

EKG/ECG Shock 282

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.

120

120

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 132

Wellness Hospitals 132

Dr. Smith's ECG Blog

OCTOBER 3, 2024

This was sent to me from Sam Ghali ( @EM_Resus ) with no other information. I assumed it was a patient with acute chest pain. "What do you think, Steve? Real or just fake?" What do YOU think? It has some inferior ST elevation with some reciprocal ST depression and inverted T in aVL. This usually indicates inferior OMI. My answer: "Fake: pretty certain, but not 100% certain.

EKG/ECG 116

EKG/ECG Wellness 116

PEMBlog

OCTOBER 31, 2024

Introduction Acute gastroenteritis affects millions of children in the U.S. every year, leading to emergency department visits and hospitalizations. Probiotics, particularly Lactobacillus rhamnosus GG (LGG), have been commonly used as a treatment, but evidence supporting their effectiveness has been limited. A new study conducted by the Pediatric Emergency Care Applied Research Network (PECARN) aimed to determine whether LGG could reduce the severity of gastroenteritis in children.

Outcomes 105

Outcomes Pediatrics Emergency Department Research 105

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 238

EKG/ECG Shock Hospitals 238

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

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 118

Infectious Diseases EMS 118

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 133

Hospitals Wellness 133

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 111

Ultrasounds 111

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 114

EKG/ECG Documentation/Coding Resuscitation Shock 114

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 112

Emergency Department EMS Research Outcomes 112

The Trauma Pro

OCTOBER 1, 2024

In this day and age of ride-sharing apps like Uber and Lyft, it is possible to get a cheap ride virtually anywhere there is car service and a smartphone. And, of course, some people have used these services for transportation to the hospital instead of an ambulance ride. What might the impact of ride services on patient transport be for both patient and EMS?

Ambulance Services 130

Ambulance Services EMS Hospitals 130

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

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 116

Evidence-Based Practice Shock Fractures Outcomes 116

St. Emlyn

OCTOBER 9, 2024

St.Emlyn's - Emergency Medicine #FOAMed Day one report of the Annual Scientific Conference of the Royal College of Emergency Medicine #RCEMASC #FOAMed @stemlyns The post RCEM ASC 2024. appeared first on St.Emlyn's.

109

109

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 112

EKG/ECG Hospitals Wellness 112

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

The Trauma Pro

OCTOBER 25, 2024

Earlier this year, I wrote a series of posts on the two commonly used pelvic fracture interventions: preperitoneal packing (PPP) and angioembolization (AE). To sum up, both are equally effective in controlling hemorrhage, but the hospital costs for patients undergoing angioembolization are significantly less. This is probably because there is no need to perform repeated operations to insert and remove the preperitoneal packs when angiography is used.

Fractures 113

Fractures Head Injuries Operations Ultrasounds 113

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.

105

105

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 117

Academics Wellness 117

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 107

Emergency Department 107

Dr. Smith's ECG Blog

OCTOBER 10, 2024

Written by Pendell Meyers A man in his early sixties with no significant medical history (including a "negative cardiac workup a few years ago" for unclear indication) called 911 for acute chest pain constantly for the past 5 hours. EMS arrived and recorded vital signs within normal limits and the following ECG during active pain: EMS1 @ 0157: What do you think?

EKG/ECG 108

EKG/ECG EMS 108

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 105

EMS 105

The Trauma Pro

OCTOBER 11, 2024

I’ve written many posts in the past about the arguments surrounding chest tube size: large bore vs. small bore (pigtail). For the longest time, only a few decent papers were looking into this debate, and subject numbers were small. The best the papers could say was that “small-bore chest tubes are not inferior to large-bore tubes.” Not that this is not the same as saying, “small-bore tubes are better than large-bore tubes.” But finally, after more than ten years, th

Hospitals 113

Hospitals 113

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.

Telemedicine 105

Telemedicine Critical Access Hospitals Administration 105

Sensible Medicine

OCTOBER 16, 2024

Dr. Satel is a bit of a regular here on Sensible Medicine. Today she returns to a topic that she wrote about in January 2023 , changing our organ donation laws to increase organ availability. Adam Cifu Sensible Medicine is a reader-supported publication. If you support our work, consider becoming a free or paid subscriber. What if we could solve the organ donor shortage with a simple tax credit?

Operations 115

Operations Research 115

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.

102

102

Emergency Medicine Cases

OCTOBER 1, 2024

In this ECG Cases blog we look at 5 cases of ECGs falsely labeled 'normal'. Can you spot the critical abnormality? Written by Jesse McLaren; Peer Reviewed and edited by Anton Helman. October 2024 Five patients presented with ECGs labeled ‘normal’. Can you use systematic ECG interpretation to identify the [.] The post ECG Cases 51 – ECGs falsely labeled “normal” appeared first on Emergency Medicine Cases.

EKG/ECG 104

EKG/ECG EMS 104

Dr. Smith's ECG Blog

OCTOBER 12, 2024

Written by Bobby Nicholson What do you think of this “STEMI”? A man in his 90s with a history of HTN, CKD, COPD, and OSA presented to the emergency department after being found unresponsive at home. With EMS, patient had a GCS of 3 and was saturating 60% on room air. He improved to 100% with the addition of non-rebreather, however remained altered and was intubated by EMS with ketamine and succinylcholine.

EKG/ECG 103

EKG/ECG Documentation/Coding Emergency Department COPD 103

The Trauma Pro

OCTOBER 4, 2024

Just about every practice guideline out there regarding liver and spleen injury has some physical activity restrictions associated with it. The accepted dogma is that moving around too much, climbing stairs, lifting objects, or getting tackled while playing rugby could exacerbate the injury and lead to complications or surgery. But is it true? Activity restrictions after solid organ injury have been around longer than I have been a trauma surgeon.

Pediatrics 113

Pediatrics Outcomes Operations Emergency Department 113