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 362

EKG/ECG Wellness 362

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

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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Emergency Medicine News

MAY 31, 2023

An abstract is unavailable.

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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

Ken Grauer, MD

MAY 26, 2023

The ECG in Figure-1 was obtained from a 60-ish year old man with a history of coronary disease ( including prior CABG ) — who presented to the ED ( E mergency D epartment ) with new CP ( C hest P ain ) of 3 hours duration , diaphoresis and nausea/vomiting. The patient was hypotensive at the time his initial ECG in Figure-1 was obtained. The decision was made not to immediately perform cardiac cath — because there is no ST elevation in Figure-1 — and because the initial troponin was negative.

EKG/ECG 195

EKG/ECG Resuscitation Wellness 195

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

Science Based Medicine

MAY 21, 2023

British consulting cardiologist Dr. Aseem Malhotra has become the latest darling of the COVID-19 minimization and antivaccine movement in the UK. Previously known for anti-statin views and advocacy of the Pioppi diet who pivoted to more dangerous misinformation during the pandemic. The post Unsafe and Ineffective: Aseem Malhotra first appeared on Science-Based Medicine.

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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

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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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

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

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 98

Outcomes Hospitals Research 98

Science Based Medicine

MAY 18, 2023

A condensed timeline of the events, people, and far-right global politics that repurposed science and medicine to promote fake miracle cures for COVID-19 and spread deadly disinformation with a focus on the United States, France, and Brazil. The post Repurposed to Radical: How drug repurposing created a global right-wing market for COVID early treatment fraud first appeared on Science-Based Medicine.

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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 Patient Safety 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

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

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

Sensible Medicine

MAY 30, 2023

Thank goodness John Ioannidis exists. Inter alia, if it wasn’t for his research, plenty of the work of academic journal editors and science publishers would go unnoticed, through thick and thin. Instead, his meta-research prompts us to question about these professions and about the future of science communication. Two of his very recent papers pushed me to reflect - from my possibly biased point of view (I am a scientific publisher) – on what is an important issue also to those who w

Research 97

Research Academics Wellness 97

Science Based Medicine

MAY 31, 2023

Why plausibility must play a central role in scientific medicine. The post Why Scientific Plausibility Matters first appeared on Science-Based Medicine.

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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

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

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

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

Sensible Medicine

MAY 31, 2023

The names and various details of the patients presented below have been altered to preserve confidentiality. Permission was obtained for all images used. Some images have been altered to remove any identifying marks and preserve anonymity. Sensible Medicine is a reader-supported publication. If you appreciate our work, consider becoming a free or paid subscriber.

Psychiatric 97

Psychiatric Hospitals Wellness Military 97

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 97

Head Injuries 97

Emergency Medicine News

MAY 31, 2023

An abstract is unavailable.

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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

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

Science Based Medicine

MAY 5, 2023

None of us have to fantasize what we would have done during a pandemic. What you actually did the past three years is exactly what you would have done. The post Letter to a Medical Student: There Is No Elite RCT Strike Force first appeared on Science-Based Medicine.

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Thinking Critical Care

MAY 20, 2023

Super excited for this. No issues with travel this year, the H&R family all keen on getting together again, the lineup is awesome, most of the OGs able to make it, lots of new additions, and the programme is looking really sweet. Am totally amped to have Katie Wiskar as the Chair of The Hospitalist as she’s putting together a great group with sharp lectures and super interesting workshops.

Airway Management 95

Airway Management Resuscitation EKG/ECG CPR 95

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 95

Sepsis Shock Resuscitation Outcomes 95

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 93

Shock EMS Sepsis 93

The Trauma Pro

MAY 5, 2023

Some trauma centers receive a significant number of transfers from referring hospitals. Much of the time, a portion of the workup has already been done by the outside hospital. If the patient meets one or more of your trauma activation criteria, do you still need to activate your team when they arrive? And the answer is: sometimes. But probably not that often.

Fractures 100

Fractures Hospitals 100

Dr. Smith's ECG Blog

MAY 31, 2023

I received the following text message with these 3 EKGs (providers text me ECGs all day every day; most are false positives; many are subtle true positives): "Hi Steve, here are 3 EKGs for you (my colleague's case). A 67 yo f developed chest pain this morning." EKG #1 Followed 15 minutes by this #2 EKG: Then the patient received aspirin and Dilaudid (hydromorphone, same effect as morphine) and the pain went away and there was this 3rd ECG: Smith comment: hydromorphone will make any pain go away

EKG/ECG 96

EKG/ECG Outcomes Academics Wellness 96

Science Based Medicine

MAY 22, 2023

Last week Dr. Vinay Prasad wrote a Substack arguing that medical students should learn the principles of evidence-based medicine before basic science.This is a recipe for amplifying the main flaw in EBM that science-based medicine was meant to correct, and Dr. Prasad's arguments would have been right at home on an integrative medicine blog. [Note ADDENDUM.

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