Ken Grauer, MD

MAY 20, 2023

The ECG in Figure-1 — was obtained from an older woman with persistent CP ( C hest P ain ) over the previous day. Her symptoms lessened after Nitroglycerin — so the decision was made not to activate the cath lab. Do YOU agree with this decision? Figure-1: The initial ECG in today's case. MY Thoughts on the ECG in Figure-1: In a patient with CP that had been persistent over the previous day ( until Nitroglycerin was given ) — the initial ECG shown in Figure-1 is extremely worrisome.

EKG/ECG 361

EKG/ECG Wellness 361

RebelEM

MAY 29, 2023

Background: Sepsis can induce numerous physiologic derangements. At the most severe end, this includes endothelial dysfunction leading to increased vascular permeability, abnormal nitric oxide metabolism, and vasodilation (i.e. septic shock). Judicious fluid resuscitation is indicated in patients with signs of hypo perfusion but is often inadequate necessitating the administration of vasoactive medications.

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

Greater Sydney Area HEMS

MAY 30, 2023

In the first in this series, HEMS physician and podcast host Dr Samuel Bulford interviews senior staff specialist Dr Cliff Reid who describes a case that changed his life and set his approach to mission preparation and training on a new trajectory.

Leadership 137

Leadership 137

EMCrit

MAY 4, 2023

My attempt to model my empirical experience with Burnout EMCrit Project by Scott Weingart, MD FCCM.

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Speaker: Simran Kaur, Co-founder & CEO at Tattva.Health

AI is transforming clinical trials—accelerating drug discovery, optimizing patient recruitment, and improving data analysis. But its impact goes far beyond research. As AI-driven innovation reshapes the clinical trial process, it’s also influencing broader healthcare trends, from personalized medicine to patient outcomes. Join this new webinar featuring Simran Kaur for an insightful discussion on what all of this means for the future of healthcare!

Outcomes

Don't Forget the Bubbles

MAY 31, 2023

What’s the relationship between COVID-19 and diabetes? May saw the e-publication of the DIMPLES study. Let’s take a deep dive into this paper and its implications for PEM internationally. Ponmani C, Nijman RG, Roland D, Barrett M, Hulse T, Whittle V, Lyttle MD on behalf of PERUKI. Children presenting with diabetes and diabetic ketoacidosis to Emergency Departments during the COVID-19 pandemic in the UK and Ireland: an international retrospective observational study.

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

Emergency Medicine News

MAY 31, 2023

An abstract is unavailable.

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RebelEM

MAY 25, 2023

I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. In the initial management of trauma resuscitation there are 4 key principles that should be followed: Control bleeding Restore tissue perfusion Minimize iatrogenic injury from resuscitation itself Promote hemostasis In this blog post I will summarize the lecture and the evidence for each of these principles… MINIMIZE IATROGENIC INJURY PERMISSIVE HYPOTENSION Maintaining a lower blood pressure than physiol

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Resuscitation Fluid Resuscitation Head Injuries Shock 145

The Trauma Pro

MAY 19, 2023

The serial hemoglobin (Hgb) determination. We’ve all done them. Not only trauma professionals, but other in-hospital clinical services as well. But my considered opinion is that they are not of much use. They inflict pain. They wake patients up at inconvenient hours. And they are difficult to interpret. So why do them? I’m reposting this mini-series on serial hemoglobin draws in light of a new paper that was published in the Journal of Trauma Nursing.

Fractures 130

Fractures Hospitals Wellness 130

Pediatric EM Morsels

MAY 12, 2023

We all know that Gravity Works ! While this fact can adversely affect anyone, it offers the greatest challenge for those who cannot protect themselves , like children less than 3 months of age ! We last pondered this in 2011 Morsel , just a couple years after PECARN head injury data was published. Since that time there have been several studies externally validating the PECARN rule in all age groups and in multiple different countries.

Head Injuries 130

Head Injuries Fractures Pediatrics EMS 130

St. Emlyn

MAY 31, 2023

St.Emlyn's - Emergency Medicine #FOAMed Although these terms may be heard more often in a Build-a-Bear factory or a kitchen at Christmas than a Emergency Department, it doesn’t mean they’re any less relevant. What on earth … Packers, Pushers and Stuffers – Drug Concealment in the ED Read More » The post Packers, Pushers and Stuffers – Drug Concealment in the ED appeared first on St.Emlyn's.

Emergency Department 99

Emergency Department 99

SheMD

MAY 23, 2023

To all the 4th year medical students out there CONGRATULATIONS! We know Match Day was not exactly how you pictured in this post-COVID19 world, but it is still a huge accomplishment and you should be so proud! While the world is a little different right now than we thought it would be, we know that you all are both excited and anxious to begin your residency.

OB/GYN 98

OB/GYN Hospitals Administration Wellness 98

Ken Grauer, MD

MAY 12, 2023

I was sent the rhythm strip shown in Figure-1 — obtained from telemetry monitoring. I did not know the history. Can YOU explain what happens after beat #4? Figure-1: Multi-lead rhythm strip obtained from telemetry monitoring. MY Thoughts on the Rhythm Strip in Figure-1: The first 4 beats in this 11-beat rhythm strip are sinus — as determined by the presence of regular upright P waves , with a constant PR interval in lead II ( RED arrows in Figure-2 ).

EKG/ECG 195

EKG/ECG Wellness 195

RebelEM

MAY 18, 2023

Background: IV fluids are part of the standard resuscitation bundle in septic shock, however it is unclear if they provide a significant benefit. These patients can have a vasodilated vascular bed and the initial use of fluids is hypothesized to serve two purposes: Augmenting the macrovascular system (stroke volume and cardiac output) and augmenting the microvascular perfusion (capillary blood flow).

Sepsis 104

Sepsis Shock Resuscitation Outcomes 104

The Trauma Pro

MAY 12, 2023

Any trauma professional who has dealt with spleen injuries knows that the white blood cell (WBC) count rises afterwards. And unfortunately, this elevation can be confusing if the patient is at risk for developing inflammatory or infectious processes that might be monitored using the WBC count. Is there any rhyme or reason to how high WBCs will rise after injury?

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Pediatric EM Morsels

MAY 5, 2023

Our world has become inundated with the newest food and diet crazes. It seems like every social media persona provides “expert” opinions on the best way to nourish our bodies. Adults are one thing, but how does that translate to our growing, developing pediatric patients? Today we are focusing on vegan diets in children , and which nutritional deficiencies we need to remain vigilant to spot!

Pediatrics 130

Pediatrics Documentation/Coding EMS 130

St. Emlyn

MAY 22, 2023

St.Emlyn's - Emergency Medicine #FOAMed On Thursday 18th May the National Institute for Health and Care Excellence (NICE) released the updated head injury guidelines: assessment and early management [NG232] There have been three head injury … NICE Head Injury Guidelines 2023: Now who do we scan? Read More » The post NICE Head Injury Guidelines 2023: Now who do we scan?

Head Injuries 98

Head Injuries 98

EMDocs

MAY 31, 2023

Author: Walid Malki, MD ( @Wandering_ER ) // Reviewed by: Brit Long, MD (@long_brit); Alex Koyfman, MD (@EMHighAK) Welcome the Visual Wednesdays, a series that provides focused EM updates with infographics. Please follow us on Instagram to see past, current and future infographics! The post Visual Wednesdays: Septic Shock Management appeared first on emDOCs.net - Emergency Medicine Education.

Shock 98

Shock EMS Sepsis 98

Ken Grauer, MD

MAY 6, 2023

The ECG in Figure-1 — was obtained from an older woman with chest pain. How would YOU interpret this tracing? What kind of AV block is present? — OR — Is there no clear evidence of any AV block? 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: This tracing is challenging to interpret because of the changing QRS morphology — and because of the uncertainty regarding atrial activity.

EKG/ECG 195

EKG/ECG 195

ALiEM

MAY 29, 2023

Massive epistaxis is considered a medical emergency that requires immediate attention. Symptoms of massive epistaxis include sudden and heavy bleeding from the nose, difficulty breathing, dizziness, and a rapid heartbeat. If left untreated, it can lead to significant blood loss, shock, airway obstruction, and even death. We report a case of a 50-year-old man with end stage renal disease with massive nasal bleeding from the left nostril, shortness of breath, and confusion.

Blood Transfusions 98

Blood Transfusions Emergency Department Shock Hospitals 98

The Trauma Pro

MAY 9, 2023

For years, I’ve taught my residents participating in trauma activations, “Your patient is bleeding to death until proven otherwise.” This concept served as the basis of the [poorly documented] “Golden Hour” and for decades has directed our efforts at getting patients to a center with an immediately available OR as quickly as possible.

Head Injuries 130

Head Injuries Operations Documentation/Coding Outcomes 130

Don't Forget the Bubbles

MAY 22, 2023

You’ve just started working in the Children’s Emergency Department (CED). The triage nurse comes to let you know about Robin. He is eight years old, with a background of cerebral palsy and severe scoliosis. He has come in today because he has noisy breathing with rattly secretions that seem to be getting worse. The community physiotherapist (who has been visiting daily for the last 4 days) told Mum that Robin’s oxygen saturations were low.

Radiology 98

Radiology Radiology Hospitals Wellness 98

PDC Healthcare

MAY 1, 2023

Patient tracking during large-scale events is a challenge. Patients may be passed between first responders, ground transport, air transport, and then transferred from one facility to another. For routine calls with individual patients, it’s feasible to track who transported the patient and where they ended up. But in mass-casualty incidents and large-scale hazards, chaotic scenes […] The post PDC Partners with Pulsara to Streamline Communication Between EMS, Hospital Personnel, and Emergen

Mass Casualty Incidents 98

Mass Casualty Incidents EMS Hospitals Documentation/Coding 98

Dr. Smith's ECG Blog

MAY 23, 2023

Written by Pendell Meyers A man in his early 40s experienced acute onset chest pain. The chest pain started about 24 hours ago, but there was no detailed information available about whether his pain had come and gone, or what prompted him to be evaluated 24 hours after onset. EMS arrived and recorded this ECG: What do you think? See same ECG below with computer automated interpretation, using the Glasgow ECG algorithm which apparently is used by many different providers and devices Amazing that

EKG/ECG 98

EKG/ECG Wellness Emergency Department EMS 98

RebelEM

MAY 15, 2023

You are working in a rural ED, and an older woman from a local assisted care facility arrives via ambulance in obvious respiratory distress. EMS is able to tell you that she is currently being treated for pneumonia. The patient is on a nonrebreather mask, and vital signs on arrival are BP 110/50 mm Hg, HR 120 bpm, RR 40/min, T 98.6°F (37°C), and SpO2 86%.

EMS 98

EMS Documentation/Coding Resuscitation 98

ALiEM

MAY 19, 2023

A heavy alcohol drinker, who is well known to your Emergency Department, presents with altered mental status, except that he looks different this time. He looks really bad, stating that he has been vomiting blood. He is hypotensive. He then vomits a copious amount of blood right in front of you. You intubate the patient and initiate the massive transfusion protocol, but everything you pour into him seemingly comes right back out.

Emergency Department 98

Emergency Department Ultrasounds Wellness EMS 98

The Trauma Pro

MAY 26, 2023

Here’s the final post on my series covering serial hemoglobin testing in the management of solid organ injury. We developed our first iteration of a solid organ injury practice guideline at Regions Hospital way back in 2002. It was borne out of the enormous degree of clinical variability I saw among my partners. We based it on what little was publicly available, including an EAST practice guideline.

Blood Transfusions 100

Blood Transfusions Operations Pediatrics Hospitals 100

Don't Forget the Bubbles

MAY 29, 2023

You are working with your colleagues to assist an 8-year-old with multiple injuries following a high-impact traffic collision. You’re thinking about the next steps and voicing the options; you hear an impatient voice saying, “Are up for this? Should I do it?” from one of the team. What does incivility look like? Whilst not a new concept, incivility is still a widely reported concern within healthcare.

Leadership 98

Leadership Patient Safety Academics Research 98

EMDocs

MAY 26, 2023

Original podcast posted on PEM Currents – Hosted by Brad Sobolewski ( @PEMTweets ) and co-authored by Dennis Ren ( @DennisRenMD ) This podcast series by PEM Currents is a co-production with the Emergency Medical Services for Children Innovation and Improvement Center (EMSC IIC), whose mission is to minimize morbidity and mortality of acutely ill and injured children across the emergency continuum.

Pediatrics 97

Pediatrics Emergency Department Psychiatric Documentation/Coding 97

Dr. Smith's ECG Blog

MAY 26, 2023

A 20-something presented after a huge verapamil overdose in cardiogenic shock. He had been seen at an outside institution and been given 6 g calcium gluconate, KCl, and a norepinephrine drip. The initial K was 3.0 mEq/L and ionized calcium was 5.5 mg/dL (sorry, Europeans, for the weird units) Here was the initial ED ECG: There is a junctional rhythm with retrograde P-waves (see the dip in the T-wave in lead II across the bottom; you can follow that up to all the other leads and see the retrograd

Shock 98

Shock EKG/ECG Documentation/Coding Resuscitation 98

PEMBlog

MAY 15, 2023

Syncope is described as a brief loss of consciousness and postural tone caused by transient global cerebral hypoperfusion. It is followed by a complete recovery. An estimated 80% of pediatric syncope is due to autonomic (vasovagal or neurocardiogenic) syncope. Our role as providers is to identify the patients who have a life-threatening etiology to their syncope.

Pediatrics 97

Pediatrics EKG/ECG Emergency Department Burns 97

Sensible Medicine

MAY 21, 2023

It’s my pleasure to introduce today’s guest post by Dave Allely. Although Mr. Allely is a medical student— his analysis of the RSV vaccine for pregnant women is superior to the FDAs. He notes a bizarre moment in the recent VRBPAC meeting where Peter Marks asked Pfizer to make a closing statement— seemingly in an effort to get the vote he wanted.

Outcomes 97

Outcomes Hospitals Research 97

The Trauma Pro

MAY 17, 2023

The Rural Trauma Team Development Course (RTTDC) was introduced by the American College of Surgeons (ACS) to improve the care of trauma patients in rural communities. It is a staple of education for Level III and IV trauma centers in rural areas. Like everything else, most courses were shut down by the COVID-19 pandemic. Conemaugh Memorial Medical Center in Johnstown, Pennsylvania, polled its local referral hospitals and discovered that the majority felt a significant need for continuing, in-per

Administration 100

Administration Hospitals 100

EM Ottawa

MAY 18, 2023

Welcome Back to BHP Corner For those who are new to this segment of the EMOttawa Blog, here’s a little refresher. In the Base Hospital Program (BHP) Corner, we aim to review interesting and evolving topics, as they pertain to the prehospital/paramedicine world. Advances, reviews, and changes to Ontario and local practices, you name […] The post BHP Corner – Out of Hospital Discharge: Pearls and Pitfalls appeared first on EMOttawa Blog.

Hospitals 97

Hospitals EMS 97

RebelEM

MAY 24, 2023

Take Home Points The Parkland formula can be used to be a guide for initial fluid resuscitation. This is based on second- and third-degree burns (not first-degree). Utilize response to treatment as a guide to continue fluid resuscitation. Patients in fires in closed spaces for a prolonged time are at risk for airway edema and need for intubation. History of fire is very important and please monitor patient condition, patients’ voice, and repeat physical exam.

Burns 96

Burns Fluid Resuscitation Resuscitation EMS 96

Dr. Smith's ECG Blog

MAY 30, 2023

A 50-something man presented in shock with severe chest pain. His prehospital ECG was diagnostic of inferior posterior OMI. The patient was in clinical shock with a lactate of 8. BP was 108 systolic (if a cuff pressure can be trusted) but appeared to be maintaining BP only by very high systemic vascular resistance. He appeared gray in color, with cool skin.

Shock 97

Shock EKG/ECG Academics Stroke 97

EMCrit

MAY 27, 2023

My dear pulmonologists, I have some bad news. Santa Claus isn't real. Neither is “ARDS.” “ARDS” has traditionally been conflated with a specific histopathological form of lung injury: diffuse alveolar damage (DAD). Lectures, chapters, and articles typically juxtapose these two entities, promoting the concept that they're one and the same.

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