Ken Grauer, MD

MAY 31, 2024

I was sent the ECG in Figure-1 — without the benefit of any history. Is this VT? What is the 1st thing — that YOU would do? Figure-1: I was sent this ECG without any history. Is this VT? MY Thoughts on Today’s CASE: As tempting as it might be to reach for the defibrillator on seeing the ECG shown in Figure-1 — My initial reaction was different. At 1st glance , my impression from seeing ECG #1 — was that the rhythm is very fast and irregular — with a highly variable QRS morphology — and, without

Shock 414

Shock EKG/ECG Seizures 414

Pediatric EM Morsels

MAY 10, 2024

Children like to pretend to be grown-ups. Unfortunately, sometimes they develop grown-up problems ( Cholelithiasis , Kidney Stones , and Hypertension ). Additionally, often kids will complain of symptoms that warrant great concern in adults, but often engender apathy when considered in children. Chest Pain in Children is a great example of one of these complaints.

EKG/ECG 268

EKG/ECG Pediatrics Ultrasounds Seizures 268

The Trauma Pro

MAY 17, 2024

Uncontrolled bleeding is the bane of trauma professionals everywhere. Early in a resuscitation, we focus on identifying potential sources. We’ve developed numerous techniques for plugging them up. And we have processes in place to replace the blood that’s been lost. Unfortunately, blood products are a perishable item. Packed red blood cells have a typical shelf-life of 42 days.

Resuscitation 263

Resuscitation Research Hospitals 263

Sensible Medicine

MAY 25, 2024

Imagine if your car mechanic took $10,000 a year from Michelin tires for “consulting” and then tended to recommend their tires over Pirelli — even if the latter are on sale or better quality or both. Imagine if your Governor took campaign contributions from Panera bread and then strangely exempted Panera bread from the new minimum wage law.

Academics 145

Academics Poisoning Research Wellness 145

RebelEM

MAY 27, 2024

Background: The REVERT Randomized Controlled Trial demonstrated the superiority of the modified valsalva maneuver (MVM) over the standard valsalva maneuver (VM) in re-establishing normal sinus rhythm (NSR) in patients with PSVT (Appelboam 2015). MVM exaggerates venous return to the heart and increases vagal outflow by elevating the patient’s legs.

Outcomes 137

Outcomes Research Hospitals Operations 137

St. Emlyn

MAY 18, 2024

St.Emlyn's - Emergency Medicine #FOAMed The practice of coordinating, consulting and managing an entire acute clinical service in real-time is fairly unique to emergency medicine. Central to this is the EPiC (or emergency physician in charge) role #FOAMed @stemlyns with @codingbrown The post An EPiC mental model. St Emlyn’s appeared first on St.Emlyn's.

Leadership 131

Leadership 131

Ken Grauer, MD

MAY 16, 2024

The ECG in Figure-1 — was obtained from an older man who had just completed dialysis — and , is now complaining of abdominal discomfort that radiates to his chest. The consultant interpreted this tracing as “LBBB” ( L eft B undle B ranch B lock ) — but not indicative of anything acute. QUESTIONS: Do you agree with the consultant’s interpretation? How would YOU approach this case?

EKG/ECG 405

EKG/ECG Wellness 405

The Trauma Pro

MAY 28, 2024

I’ve covered the problem of performing MRI on patients with external fixators. This is typically a problem that arises in head-injured patients with extremity or pelvic fixators for concomitant fractures. MRI is an indispensable tool for the evaluation of head, spine, and soft tissue trauma. However, a great deal of effort is required to ensure that any patient scheduled for this test is “MRI compatible.

Fractures 261

Fractures Hospitals 261

Sensible Medicine

MAY 28, 2024

Regardless of the reason for a primary care visit in the United States, patients are routinely asked how often they feel “hopeless” or "like a failure” These questions come from the PHQ-9. The PHQ-9 has since been validated and is now widely used to screen for depression. Since the United States Preventive Services Task Force (USPSTF) first recommended depression screening 22 years ago, the practice has become standard in primary care despite an absence of evidence.

Outcomes 139

Outcomes Military Psychiatric Wellness 139

Dr. Smith's ECG Blog

MAY 20, 2024

This was sent by an undergraduate (not yet in medical school, but applying now) who works as an ED technician (records all EKGs, helps with procedures, takes vital signs) and who reads this blog regularly. Edited by Smith He also sent me this great case. A 63 year old man with a history of hypertension, hyperlipidemia, prediabetes, and a family history of CAD developed chest pain, shortness of breath, and diaphoresis after consuming a large meal at noon.

EKG/ECG 129

EKG/ECG Hospitals Wellness Emergency Department 129

Life in the Fast Lane

MAY 18, 2024

Kane Guthrie Cardiac Arrest – the 5 C’s Cardiac Arrest - the 5 C's with Cliff Reid. Causes Of Cardiac Arrest You NEVER Thought Of?! Meet The Hs & Ts & Cs!

Resuscitation 126

Resuscitation 126

Ken Grauer, MD

MAY 28, 2024

I recently recorded a series of 4 podcasts regarding KEY concepts in ECG interpretation. Easy LINKS — tinyurl.com/KG-ECG-Podcasts — [link] — Other ECG Audio PEARLS I previously made for my ECG Blog can be found in the right column of each page on this blog just below this icon — under, "ECG Audio PEARLS". My New E CG P odcasts ( 5/28/2024 ): These podcasts are part of the Mayo Clinic Cardiovascular CME Podcasts Series ( "Making Waves" ) — hosted by Dr.

EKG/ECG 367

EKG/ECG Wellness 367

Emergency Medicine Cases

MAY 28, 2024

Once the diagnosis of nontraumatic subarachnoid hemorrhage (SAH) has been made, our job is not done. Mortality in SAH patients can be up to 30% even without neurological deficit. Paying attention to the time-sensitive details of ED management of SAH patients can have a significant impact on their outcome. In this second part of our 2-part podcast series on subarachnoid hemorrhage with Dr.

Outcomes 124

Outcomes EMS 124

The Trauma Pro

MAY 21, 2024

Trauma professionals, both prehospital and in trauma centers, make a big deal about “closing velocity” when describing motor vehicle crashes. How important is this? So let me give you a little quiz to illustrate the concept: Two cars, of the same make and model, are both traveling on a two lane highway at 60 mph in opposite directions.

Wellness 245

Wellness 245

Science Based Medicine

MAY 27, 2024

I've long argued that antivax beliefs, indeed all science denial, is conspiracy theory. Leave it to The Brownstone Institute's Jeffery Tucker to make my point better for me than I ever could. Of course, Brownstone was always going to "go there." The post The ultimate COVID-19 antivax conspiracy theory, courtesy of The Brownstone Institute and Jeffery Tucker first appeared on Science-Based Medicine.

123

123

Dr. Smith's ECG Blog

MAY 25, 2024

An elderly dialysis patient presented with chest pain. She has poor LV function. Previous echo 4 months ago (confirmed with ED bedside echo): The estimated left ventricular ejection fraction is 30%. Severely decreased LV function. Regional wall motion abnormality-inferior, inferolateral, septum, anterolateral, anterior and apex, lateral. Here is her ECG: Regular Wide Complex Tachycardia.

EKG/ECG 127

EKG/ECG 127

St. Emlyn

MAY 24, 2024

St.Emlyn's - Emergency Medicine #FOAMed JC: Review of an RCT of serratus anterior plane blocks in the emergency department for chest/rib injury. Is this now a standard of care? @stemlyns #FOAMed The post JC: Serratus Anterior Plane Blocks for rib fractures in the ED. St Emlyn’s appeared first on St.Emlyn's.

Fractures 122

Fractures Emergency Department 122

Ken Grauer, MD

MAY 11, 2024

The 12-lead ECG and long lead II rhythms shown in Figure-1 — was obtained from an older man with a recent history of “easy fatiguability” and a presyncopal episode. QUESTIONS: How would YOU interpret the ECG in Figure-1 ? Is the group beating due to the Mobitz I or Mobitz II type of 2nd-degree AV block? Figure-1: The initial ECG in today’s case. MY Initial Thoughts on Today’s CASE: For clarity, given the above clinical history — I present my initial thoughts regarding clinical interpretation of

EKG/ECG 274

EKG/ECG 274

Sensible Medicine

MAY 17, 2024

MM is 94 years old. Her only active medical issues are hypertension and vitamin D deficiency. She takes only 20 mg of lisinopril and 1000 units of vitamin D3 each day. She has no cognitive decline and gardens every day if the Chicago weather allows. Her Friday afternoon appointment is the doctor’s last of the week. Sensible Medicine is a reader-supported publication.

Hospitals 122

Hospitals Wellness 122

The Trauma Pro

MAY 24, 2024

Here’s an operative tip for trauma professionals who find themselves in the OR. Heard of “lunchothorax?” I’m sure most of you haven’t. The term originated in a 1993 paper on the history of thoracoscopic surgery. It really hasn’t been written about in the context of trauma surgery, though. Lunchothorax is an empyema caused by pleural contamination in patients with concomitant diaphragm and hollow viscus injury.

Operations 203

Operations Wellness 203

Science Based Medicine

MAY 8, 2024

Remember back in 1997, the Pokemon seizure episode? Hundreds of children reported symptoms, including seizures, after watching a specific episode of the Pokemon cartoon that includes a sequence of flashing alternating red and blue lights. The press reported the episode at face value, attributing the reaction to a known phenomenon of photosensitive epilepsy.

Seizures 124

Seizures 124

Dr. Smith's ECG Blog

MAY 27, 2024

Written by Jesse McLaren, with a very few edits by Smith A 60-year-old presented with chest pain. The ECG did not meet STEMI criteria, and the final cardiology interpretation was “ST and T wave abnormality, consider anterior ischemia”. But are there any other signs of Occlusion MI? There’s only minimal ST elevation in III, which does not meet STEMI criteria of 1mm in two contiguous leads.

EKG/ECG 125

EKG/ECG Documentation/Coding Emergency Department 125

First 10 EM

MAY 27, 2024

We have previously discussed the many pharmaceutical advertisements published by the New England Journal of Medicine, thinly disguised as science, such as the original open label uncontrolled look at andexanet alfa. (Connolly 2019) At that point, I concluded that andexanet alfa should clearly not be used (although our pharmacies didn’t listen and wasted a lot […] The post Andexanet alfa: expensive and harmful?

EMS 118

EMS 118

EB Medicine

MAY 1, 2024

In this episode, Sam Ashoo, MD and T.R. Eckler, MD interview Reuben J. Strayer, MD, author of the May 2024 Emergency Medicine Practice article, Current Concepts in Ketamine Therapy in the Emergency Department Diving Into Ketamine Use in Emergency Medicine Understanding Ketamine: From Origins to Emergency Use Exploring the Ketamine Brain Continuum Ketamine Dosing and Administration Techniques Combining Ketamine with Neuroleptic Medications Practical Approaches to Ketamine for Pain Management In

Administration 112

Administration Emergency Department 112

Sensible Medicine

MAY 15, 2024

Recently, I learned about a student on their clinical rotations who had to be sent home at precisely 9 hours. No matter how busy the day or service, the student would leave at the 9 hour mark. The reason? The student had a disability accommodation because he suffered from attention deficit hyperactivity disorder. Subscribe now In medicine there is a tension.

Administration 120

Administration Documentation/Coding Hospitals Wellness 120

The Trauma Pro

MAY 14, 2024

Resuscitative thoracotomy is a (sometimes) life-saving procedure reserved for trauma patients in extremis. Thankfully, most trauma centers do very few of these a year. However, that makes it one of those “high severity – low frequency” procedures that generate many, many quality improvement problems. Many of these issues are due to operator unfamiliarity or equipment availability.

Resuscitation 162

Resuscitation Operations Hospitals 162

Science Based Medicine

MAY 6, 2024

A poorly framed article on people who believe that COVID-19 vaccines injured them is being trumpeted by antivaxxerst. Where the New York Times and its reporter Apoorva Mandavilli go wrong? The post A poorly framed article on COVID-19 vaccine injury in the New York Times first appeared on Science-Based Medicine.

CDC 121

CDC 121

Dr. Smith's ECG Blog

MAY 7, 2024

A 30-something presented with chest pain, palpitations, and SOB. He has had similar symptoms for 4 years, but has never been evaluated. Here is his presenting ECG, which was sent to me real time, along with the 2nd ECG below: Regular Narrow Fast without P-waves. PSVT. It is very difficult to tell if this is: 1) AVNRT or 2) orthodromic AVRT (Orthodromic AVRT = WPW with orthograde conduction down the AV node and retrograde up an accessory pathway) See Ken Grauer's discussion below in differentiati

EKG/ECG 125

EKG/ECG 125

EM Ottawa

MAY 13, 2024

Methodology: 4/5 Usefulness: 3/5 von Hellmann R, et al. Ann Emerg Med. 2024 Feb;83(2):132-144. Question and Methods: Systematic review of 18 studies (12 RCT) of adult patients comparing bougie use vs standard of care in tracheal intubations to evaluate first-attempt success. Findings: Bougie was associated with increased first-attempt intubation success overall (RR 1.11 95%CI 1.06 […] The post Effect of Bougie Use on First-Attempt Success in Tracheal Intubations: A Systematic Review and M

110

110

Life in the Fast Lane

MAY 7, 2024

Sheralyn Guilleminot and Mike Cadogan What Are the Best AI Detectors? We investigated to see which tools are the best detectors of artificial intelligence in medical writing. One tool was the clear winner, while others clearly struggled with accuracy!

110

110

Sensible Medicine

MAY 20, 2024

The story of reversal agents for anticoagulants exposes many of the complexities of treating human beings. I like the story and I think you will too. Some background, then to the ANNEXA-I study. The new anticoagulants are called direct acting oral anticoagulants or DOACs. Rivaroxaban (Xarelto) and apixaban (Eliquis) are the two most popular. These drugs surpassed the old one, warfarin, because of convenience, efficacy and safety.

Stroke 109

Stroke Outcomes Hospitals Wellness 109

The Trauma Pro

MAY 31, 2024

Call me slow. I’ve subconsciously seen those capital letters in drug names for years. But I never really paid attention or thought much about them. For whatever reason, I just now realized that they are EVERYwhere! So I decided to investigate. Technically, they are called tall man letters. Here are some examples: Certain parts of the drug name are capitalized to highlight differences from a drug with similar spelling.

147

147

Science Based Medicine

MAY 17, 2024

The virus massively disrupted schools around the world, and those of us who did nothing more than acknowledge this obvious reality were absurdly blamed for it. The post Pro-Infection Doctors Didn’t Just Want Kids in School. They Wanted Them There Unvaccinated, Untested, and Unmasked. They Wanted Them Infected. first appeared on Science-Based Medicine.

121

121

Dr. Smith's ECG Blog

MAY 5, 2024

An undergraduate (not yet in medical school) who works as an ED technician (records all EKGs, helps with procedures, takes vital signs) and who reads this blog regularly arrived at work and happened to glance down and see this previously recorded ECG on a table in the ED. It was recorded at 0530: What do you think? The young ED tech immediately suspected LAD OMI.

EKG/ECG 122

EKG/ECG Wellness 122

EM Ottawa

MAY 30, 2024

In this month’s PTM Journal Club, we explored the most recent literature on trauma care in the pre-hospital setting. If you missed last months PTM Journal Club, make sure to check-it out by clicking HERE. Ketamine vs Morphine for Out-Of-Hospital Traumatic Pain Background and Objectives Inadequate analgesia is a common challenge in the out-of-hospital treatment […] The post PTM Journal Club: Trauma Care appeared first on EMOttawa Blog.

Hospitals 108

Hospitals Ultrasounds 108

EMCrit

MAY 16, 2024

Piperacillin-tazobactam is an antibiotic that a lot of people love to hate. Combine this with the conservatism that often (rightfully) surrounds drug safety, and it creates a lot of volatility. Before going further, we should review some recent history regarding piptazo. In the early 2010's, a series of retrospective correlational studies found that patients treated […] EMCrit Project by Josh Farkas.

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St. Emlyn

MAY 27, 2024

St.Emlyn's - Emergency Medicine #FOAMed This JC from St Emlyn's looks at a paper from SJTRM and explores the association between first-pass success (FPS) during pre-hospital intubation and 30-day mortality in patients treated by Finnish helicopter emergency medical services (HEMS). The post JC: Is First Pass Success an important outcome in PHEA research?

Research 107

Research Outcomes Hospitals 107