Emergency Live
DECEMBER 5, 2023
The benefits and challenges in the digital age: the telemedicine revolution in emergency care Telemedicine is playing an increasingly significant role in emergency care, revolutionizing the way care is delivered. The ability to conduct remote medical consultations has opened up new opportunities for faster and more efficient response to medical emergencies.
The Trauma Pro
DECEMBER 5, 2023
Blunt cardiac injury can be an enigma. Significant injuries are uncommon, and the literature on it consists of case reports and small series. The group at Scripps La Jolla has an excellent review article on the topic that is currently in press. This post will relate some of the key points in this nicely prepared article. Use the correct nomenclature.
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Ken Grauer, MD
DECEMBER 23, 2023
The ECG in Figure-1 — was obtained from a patient with palpitations. The patient was hemodynamically stable in association with this rhythm. QUESTIONS: What is the rhythm in Figure-1 ? — How certain are you of your answer? — Why is QRS morphology changing ? Figure-1: The initial ECG in today's case. My Interpretation of the ECG in Figure-1: Since the patient is hemodynamically stable — there is time for systematic assessment of the rhythm.
Sensible Medicine
DECEMBER 18, 2023
Good morning all. This Monday, I take a day off. For the study of the week, Vinay Prasad contrasts the different recommendations on the treatment of childhood obesity. The USPSTF or United States Preventive Services Task Force is an independent volunteer panel of experts in disease prevention and evidence-based medicine. They are as close to neutral judges of medical evidence as it gets.
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!
EMCrit
DECEMBER 10, 2023
Within the past year, two major societies have released guidelines on ARDS: the ATS (American Thoracic Society) and the ESICM (European Society of Intensive Care Medicine). Don’t be fooled by their names – both of these organizations are fundamentally international in scope. Some authors on the ATS document were from Europe, and similarly some authors […] EMCrit Project by Josh Farkas.
Dr. Smith's ECG Blog
DECEMBER 5, 2023
Beyond STEMI: Diagnosing Acute Coronary Occlusion on the ECG. The Queen of Hearts AI app can do it for you. With explainability too.
Emergency Care Today brings together the best content for emergency care practitioners from the widest variety of industry thought leaders.
The Trauma Pro
DECEMBER 22, 2023
As I was browsing through my journal list this week, I ran into an interesting title for an article that is currently in press. “The use of radio-opaque markers is medical dogma” Catchy, especially since I love writing about dogma vs what is really supported by the literature. The author questions the justification of this practice and posits that there are risks to extrapolating information based on radiographs with markers placed by the trauma team.
Ken Grauer, MD
DECEMBER 29, 2023
QUESTION: HOW would YOU interpret the ECG in Figure-1 — if no clinical information was provided? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). = The H ISTORY in T oday's C ASE: The patient in today's case is a teenager who presented to the ED ( E mergency D epartment ) in cardiac arrest after electrocution.
Sensible Medicine
DECEMBER 28, 2023
Vinay started with this: Professor Frank Harrell responded As has often been the case, hyperbole limits the value of some of your opinions Vinay. To say that the FDA is a rubber stamp is ludicrous. Sure there are shortcomings as with any organization but sponsors know they can't get approval without a heck of a lot of work. I don’t know. The laxity of the FDA has lately surprised me—especially for devices.
Don't Forget the Bubbles
DECEMBER 18, 2023
“Okay team, we’ve been following the APLS algorithm for 30 minutes and have considered all reversible causes. This child has been in cardiac arrest for at least an hour and none of the interventions we have carried out have made a difference. The blood gas is incompatible with life. I think we should stop resuscitation. Does anyone have any objections?
Dr. Smith's ECG Blog
DECEMBER 27, 2023
Written by Willy Frick A man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. He described it as severe, sharp, and substernal with associated nausea, vomiting, chills, and diaphoresis.
Emergency Live
DECEMBER 12, 2023
The crucial role of women in emergency response and post-crisis reconstruction The Rise of Women in Civil Protection Roles In recent years, there has been a significant increase in female presence in civil protection roles globally. This shift reflects a growing recognition of the value that women bring to these crucial roles, not just as […] The post Women in Civil Protection: Agents of Change and Resilience appeared first on Emergency Live.
The Trauma Pro
DECEMBER 29, 2023
The 37th Annual Assembly of the Eastern Association for the Surgery of Trauma is just around the corner! And, as in previous years, I will be publishing regular posts on some of the abstracts I find the most interesting. Here are some of the topics I’ve selected: MAP and spinal cord injury VTE in pediatric patients Chest irrigation and retained hemothorax Accuracy of eFAST More on the 35mm rule for pneumothorax Pan-scanning and missed injuries King Airway vs i-Gel Airway Whole blood transf
Ken Grauer, MD
DECEMBER 1, 2023
== CLICK HERE — for a V ideo presentation of this case! ( 19:40 min. ) Below are slides used in my video presentation. For full discussion of this case — See ECG Blog #351 — == The ECG in Figure-1 — was obtained from a previously healthy older man who contacted EMS ( E mergency M edical S ervices ) because of "chest tightness" that began ~1 hour earlier.
Sensible Medicine
DECEMBER 30, 2023
I started it all by claiming on Twitter that the FDA was a rubber stamp. From boosters for 6 month old babies (no data), to postpartum depression drugs that are basically Xanax , to bad cancer drug approvals, in my mind, the FDA is failing the American people. In a recent post, John Mandrola reviewed 5 cardiology devices approved by the FDA with questionable data.
The Skeptics' Guide to EM
DECEMBER 16, 2023
Reference: Punches et al. Patient Perceptions of Microaggressions and Discrimination Towards Patients During Emergency Department Care. AEM Dec 2023 Date: December 14, 2023 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and assistant Professor at the University of Calgary. He is also an avid FOAM supporter/producer through various online outlets including TheSGEM.
Dr. Smith's ECG Blog
DECEMBER 19, 2023
This is written by Willy Frick, an amazing cardiology fellow in St. Louis. [link] A 62 year old man with a history of hypertension, type 2 diabetes mellitus, and carotid artery stenosis called 911 at 9:30 in the morning with complaint of chest pain. He described it as "10/10" intensity, radiating across his chest from right to left. EMS obtained the following vital signs: pulse 50, respiratory rate 16, blood pressure 96/49.
EMCrit
DECEMBER 28, 2023
Setting PEEP and Righting the RV in ARDS with Matt Siuba EMCrit Project by Scott Weingart, MD FCCM.
The Trauma Pro
DECEMBER 19, 2023
In my last post, I discussed the growing number of choices for plasma replacement. Today I’ll look at some work that was done that tried to determine if any one of them is better than the others when used for the massive transfusion protocol (MTP). As noted last time, fresh frozen plasma (frozen within 8 hours, FFP) and frozen plasma (frozen within 24 hours, FP) have a shelf life of 5 days once thawed.
Ken Grauer, MD
DECEMBER 8, 2023
== CLICK HERE — for a V ideo presentation of this case! (22:3 0 min. ) Below are slides used in my video presentation. For full discussion of this case — See ECG Blog #292 — == The 2 ECGs shown in Figure-1 were obtained from a man in his 30s — who presented to the ED ( E mergency D epartment ) with chest pain that began several hours earlier. ECG #2 was recorded 1 hour after ECG #1.
St. Emlyn
DECEMBER 30, 2023
St.Emlyn's - Emergency Medicine #FOAMed We generally try and review studies that are close to use in practice. but occasionally we spot something that is just interesting and which might give us a clue as … JC: Selective aortic arch perfusion. St Emlyn’s Read More » The post JC: Selective aortic arch perfusion. St Emlyn’s appeared first on St.Emlyn's.
PEMBlog
DECEMBER 7, 2023
The Case A middle-school aged boy presents with a slightly pruritic rash that started along the side of his chest, but then soon spread to encompass several dozen similar lesions across his torso, especially his back. he has had no other symptoms, including fever or upper respiratory complaints. There are no new food, personal care product, or animal exposures.
Dr. Smith's ECG Blog
DECEMBER 24, 2023
Written by Pendell Meyers A woman in her 20s with connective tissue disorder and history of aortic root and valve repair presented with palpitations. Here is her triage ECG: What do you think? Atrial flutter with 2:1 conduction. The atrial flutter rate is approximately 200 bpm, with 2:1 AV conduction resulting in ventricular rate almost exactly 100 bpm.
Life in the Fast Lane
DECEMBER 18, 2023
Neil Long Button Battery Update 3.0 Want to know the latest on button battery management, prevention and immediate care? Look no further than our latest tox offering.
The Trauma Pro
DECEMBER 15, 2023
I’ll spend the next two posts discussing plasma. This is an important component of any trauma center’s massive transfusion protocol (MTP). Coagulopathy is the enemy of any seriously injured patient, and this product is used to attempt to fix that problem. And now there are two flavors available: liquid plasma and fresh frozen plasma. But there is often confusion when discussing these products, especially when there are really three flavors!
Ken Grauer, MD
DECEMBER 15, 2023
== CLICK HERE — for a V ideo presentation of this case! ( 18:00 min. ) Below are slides used in my video presentation. For full discussion of this case — See ECG Blog #392 — == The ECG in Figure-1 was obtained from a man in his 60s — who described the sudden onset of "chest tightness" that began 20 minutes earlier, but who now ( at the time this ECG was recorded ) — was no longer having symptoms.
St. Emlyn
DECEMBER 7, 2023
St.Emlyn's - Emergency Medicine #FOAMed Here at St Emlyn’s we have often talked about decisions and decision complexity. Our belief is that one of the key attributes of the clinician who works in emergency care … JC: Prehospital transfusion decision making. St Emlyn’s Read More » The post JC: Prehospital transfusion decision making.
ECG Guru
DECEMBER 18, 2023
If a wide complex tachycardia occurs, the probability is very high that it is a ventricular tachycardia (approx. 80%, in patients with a previous myocardial infarction (.) approx. 90%). Here we see a broad complex tachycardia that looks like an RBBB + LAFB, which is regular. In this constellation, 3 causes must be considered: 1. fascicular tachycardia from the left posterior fascicle of the left tawara fascicle (QRS width usually only around 130 ms, but sometimes significantly longer). 2.
Dr. Smith's ECG Blog
DECEMBER 7, 2023
Written by Willy Frick The OMI paradigm has taught me that any diagnosis of NSTEMI is cause for immediate evaluation. "A patient just arrived as a transfer for NSTEMI." I quickly reviewed the patient’s records and saw that she was a 53 year old woman with a history of BMI 40, but no other identifiable risk factors for coronary artery disease. Her first hsTnI at the referring facility was undetectable.
Sensible Medicine
DECEMBER 8, 2023
My father was an avid reader of obituaries. Once, when I was a teenager, I told him that his habit of reading them every morning with his cappuccino was weird. At the time, I considered anything I didn’t understand weird, and the word “morbid” wasn’t part of my lexicon. My father, never one to take the bait from his occasionally irksome son, explained that reading obituaries was an excellent way to learn recent history.
The Trauma Pro
DECEMBER 26, 2023
Everyone knows that venous thromboembolism (VTE) is a potential problem in hospitalized patients, and especially so in trauma patients. Several groups of them are at higher risk by virtue of the particular injuries they have sustained and the activity restriction caused. Nearly every trauma program uses some form of screening and prophylaxis in an attempt to reduce the occurrence of this problem, which can result in deep venous thrombosis (DVT) and/or pulmonary embolism (PE).
Emergency Medicine News
DECEMBER 31, 2023
An abstract is unavailable.
Life in the Fast Lane
DECEMBER 14, 2023
Sheralyn Guilleminot and Mike Cadogan AI Prompting Techniques 4 AI Prompting Techniques to Help You Stay Ahead in Medicine. AI prompting techniques are the key to using artificial intelligence efficiently and getting usable output.
EMDocs
DECEMBER 11, 2023
Authors: Genevieve Pentecost, MD (@genpentecost, Emergency Medicine Resident, Washington University School of Medicine in St Louis) and Aaron Lacy, MD (@AaronLacyMD, Assistant Professor of Emergency Medicine, Washington University School of Medicine in St Louis) // Reviewed by: Jamie Santistevan, MD (EM Physician, Presbyterian Hospital, Albuquerque, NM); Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Introduction Welcome back to ECG Pointers from emDOCS.
Dr. Smith's ECG Blog
DECEMBER 13, 2023
This middle aged patient presented with chest pain: What do you think? There is VERY low voltage. There is some ST Elevation, but it is MINIMAL. But look how small the QRS is!! Let's stretch out the QRS vertically so it is not so tiny: On upper left is the original. On the right are the precordial leads stretched vertically, so that the QRS is not tiny.
Sensible Medicine
DECEMBER 21, 2023
Over the last week, a debate has simmered between the pages of my Substack , Sensible Medicine, and the Sensible Medicine podcast, which you can watch here. Sensible Medicine Mandrola and Prasad are back Listen now 4 days ago · 60 likes · 18 comments · Vinay Prasad and John Mandrola Briefly put the argument is: Yes, of course, medicine would benefit from more large, well done randomized studies, and better epidemiologic evidence, but this is expensive, costly, requires coordinatio
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