Ken Grauer, MD
JUNE 22, 2024
The ECG in Figure-1 — was obtained from a middle-aged woman with positional tachycardia and diaphoresis with change of position from suprine to sitting. Although CP ( C hest P ain ) was not a prominent symptom — ACS ( A cute C oronary S yndrome ) was suspected from the chest lead T wave inversion seen on this ECG. QUESTIONS: How would YOU interpret the ECG in Figure-1 ?
The Trauma Pro
JUNE 21, 2024
The VIP syndrome occurs in healthcare when a celebrity or other well-connected “important” person receives a level of care that the average person does not. This situation was first documented in a paper published in the 1960s, which noted that VIP patients have worse outcomes. Who is a VIP? It may be a celebrity. A family member. Or even a colleague.
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Pediatric EM Morsels
JUNE 7, 2024
Knowing how to manage a severe asthma exacerbation in the ER is a vital ingredient to being a successful ER doctor, but what about the more mild cases? The kids with a history of wheezing that are at the start of a viral URI but not yet in the midst of an exacerbation? What recommendations should we be giving these families? Lucky for us, in 2020 there were some updates made to the NIH Asthma Management Guidelines and we’re going to discuss which ones can help us in the Emergency Department!
Sensible Medicine
JUNE 6, 2024
The first two weeks of March 2020 were jolting. Governments read the Imperial College London report (modeling a million deaths in the US), watched horrifying scenes in Bergamo (a city with median age in the 80s fyi), and collectively embraced policies that had no precedent in human history: The global closing of borders, schools, business, and the use of the police state to enforce this lockdown.
Dr. Smith's ECG Blog
JUNE 17, 2024
Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. What do you think? If this EKG were handed to you to screen from triage without any clinical information, what would you think?
First 10 EM
JUNE 24, 2024
A can’t intubate can’t oxygenate scenario will always be scary, but after years of mental rehearsal and some real world experience, the idea of surgical front of neck access in an adult doesn’t bother me much. (I think that is an important mental space for emergency physicians to find if you want to be able […] The post The pediatric can’t intubate can’t oxygenate scenario (Use a knife) appeared first on First10EM.
Ken Grauer, MD
JUNE 14, 2024
The ECG in Figure-1 — was obtained from a middle-aged man who presented to the ED ( E mergency D epartment ) in cardiac arrest. ROSC ( R eturn O f S pontaneous C irculation ) was obtained — and ECG #1 was recorded. In view of this history — How would YOU interpret the ECG in Figure-1 ? Should you activate the cath lab? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ).
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Pediatric EM Morsels
JUNE 21, 2024
The management of pediatric thermal burns always seems to be a hot topic , whether we are caring for a little future chef who splashed a scalding microwaved noodle cup on himself, or a toddling youngster who pulled a pot of boiling water on herself. Or maybe you have the adventurous adolescent who was a little too aggressive with the lighter fluid before igniting the campfire.
Sensible Medicine
JUNE 15, 2024
In prior posts, I was critical of the culture among trainees. One essay described the phenomenon of calling in fake sick. Another asked what the balance is between accommodation and the rigors of the job. These essays were about the effort, dedication and professionalism of trainees. Sensible Medicine is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.
Science Based Medicine
JUNE 16, 2024
When conference organizers told me not to make my talk "political", they were really saying there were certain people and ideas I wasn't allowed to criticize. I didn't get it at the time. I get it now. The post I’ve Been Silenced, Censored, and Cancelled. The Reason Why Matters. first appeared on Science-Based Medicine.
EMCrit
JUNE 13, 2024
the PREOXI trial validates what I have been saying for 15 years about preoxygenation for the critically ill patient EMCrit Project by Scott Weingart, MD FCCM.
Ken Grauer, MD
JUNE 27, 2024
The ECG in Figure-1 — was obtained from an older man with known coronary disease. He was on a number of medications — including antiplatelet agents, a statin drug and Digoxin. The patient presented to the ED ( E mergency D epartment ) for an episode of syncope. He developed cardiac arrest shortly after the ECG in Figure-1 was recorded. QUESTIONS: How would YOU interpret the ECG in Figure-1 ?
The Trauma Pro
JUNE 28, 2024
Many trauma professionals believe that they can only be sued if they make a medical error and some harm occurs. Unfortunately, this is not entirely true. Yes, this is one obvious way to spark a suit or claim. Unfortunately, it goes beyond that. Your patient may sue you if they even believe that they were harmed in some way, or think that something untoward happened while you were providing care.
Pediatric EM Morsels
JUNE 14, 2024
Ooooo the infamous chief complaint of “ weakness ” ……. We just love those don’t we? Although neurological complaints may not be a crowd’s favorite, it is one we must become comfortable with. Timely recognition and treatment can be life-improving and life-saving! So, with that goal in mind, let us digest another delicious morsel on weakness – Acute Transverse Myelitis in Children : Acute Transverse Myelitis in Children: Basics Rare, non-compressive, inflammatory condition of the spinal cord
Sensible Medicine
JUNE 17, 2024
The richer a society gets the higher the rates of atrial fibrillation. Obesity, lack of exercise, alcohol use and advancing age are the main drivers of AF. The AF-treatment market size in the US is measured in the billions of dollars. It’s expected to grow at high rates, powered largely by expansion of catheter ablation. The new technology in ablation of AF is something called pulsed field ablation or PFA.
First 10 EM
JUNE 13, 2024
Preparation for intubation, appropriate preoxygenation, and preventing peri-intubation arrests has been one of my core topics for conference talks. My initial airway series emphasized “optimizing the basics” and carefully considering “is this patient ready for intubation?”. My “RSI and then they die” lecture is by far my most watched video on YouTube.
ALiEM
JUNE 10, 2024
For years, adult literature has provided clear guidelines for cervical spine imaging through the NEXUS and Canadian C-spine Rule (CCR) tools. These have been invaluable in helping clinicians decide when to image the neck in trauma patients. Similarly, the Pediatric Emergency Care Applied Research Network (PECARN) has developed robust tools for assessing blunt head trauma in children.
Ken Grauer, MD
JUNE 7, 2024
The ECG in Figure-1 was obtained from a previously healthy older man — who presented to the ED ( E mergency D epartment ) with new but atypical CP ( C hest P ain ) for several hours. QUESTIONS: Given this history — How would YOU interpret this ECG? Which lead is the most concerning? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ).
The Trauma Pro
JUNE 25, 2024
Readmission of any patient to the hospital is considered a quality indicator. Was the patient discharged too soon for some reason? Were there any missed or undertreated injuries? Information from the Medicare system in the US (remember, this represents an older age group than the usual trauma patient) indicates that 18% of patients are readmitted and 13% of these are potentially preventable.
EMCrit
JUNE 1, 2024
intro: the challenge of procedural sedation in critical illness Procedural sedation for critically ill patients is a minefield for several reasons: Patients are already physiologically unstable. Procedures are emergent (a factor widely associated with greater complications). Time constraints often prevent a complete pre-anesthetic evaluation (e.g., medical history and laboratory studies may be unknown).
Don't Forget the Bubbles
JUNE 19, 2024
Why is this study needed? Cervical spine injuries are a rare but serious finding following blunt trauma, affecting around 1-2% of presentations. In adult trauma cases, there has been significant research to help decide which patients require X-ray or CT imaging for possible cervical spine injuries, leading to the development of the National Emergency X-Ray (NEXUS) prediction rule and the Canadian C-Spine Rule (CCR).
St. Emlyn
JUNE 9, 2024
St.Emlyn's - Emergency Medicine #FOAMed Presentation skills - what are they and why do we need to have them? This post covers the things to consider before you even open any presentation software. The post Ten Tips for Better Presentations – Part 1 appeared first on St.Emlyn's.
Dr. Smith's ECG Blog
JUNE 27, 2024
By Sofiya Diurba MD, reviewed by Meyers, Grauer A woman in her 50s with PMH known RBBB and prior syncopal events presents to the ED for five syncopal events over the last 24 hours. Each event is associated with a prodrome of mild substernal CP, SOB, and “brain fog.” EMS reports intermittent sinus tachycardia and bradycardia secondary to some type of heart block during transport.
Sensible Medicine
JUNE 9, 2024
Recently I heard the story about a residency program where it is a cultural norm to call out “fake sick.” In other words, if a resident has a particularly long or rough day, if they feel they need some rest— even in the absence of fever, chills, drenching night-sweats and propulsive vomiting— they will call out “sick” Covering residents remark how interesting it is that fake sick days are usually on weekends or adjacent to weekends (Mon-Fri), and that this is
The Trauma Pro
JUNE 14, 2024
A bucket-handle injury is a relatively uncommon complication of blunt trauma to the abdomen. It only occurs in a few percent of patients, but is much more likely if they have a seat belt sign. The basic pathology is that the bowel mesentery (small bowel of sigmoid colon) gets pulled away from the intestinal wall. This injury is problematic because it may take a few days for the bowel itself to die and perforate.
EMCrit
JUNE 17, 2024
introduction Bilevel Sequence Intubation (BSI) refers to initiation of noninvasive bilevel positive pressure ventilation with a backup rate prior to intubation (either using a BiPAP machine or a full-featured mechanical ventilator). BSI is distinct from traditional rapid sequence intubation (RSI), since BSI involves the delivery of machine-initiated, pressure-controlled breaths following administration of sedation and paralytics. […] EMCrit Project by Josh Farkas.
Science Based Medicine
JUNE 9, 2024
If were are supposed to be indifferent to the deaths of young people because "hardly any" died, and we are supposed to be indifferent to the deaths of older people because "their time to death in general is not that long," which of the 1.1 million COVID deaths should we care about? The post “This Thing Has Killed Less Than Or About As Many As Flu Would Kill In A Normal Year In Kids, I Say Hardly Any” & “80-Year-Olds, Their Time To Death In General Is Not That Long.” first appeared on Science
ETM Course
JUNE 27, 2024
We are excited to announce that after a hibernation period, the ETM Course podcast is back! In our first episode of the new podcast we talk to Dr Christine Bowles, Emergency Physician and Trauma Physician at St George Hospital, one of Sydney’s Major Trauma Centres. Also available on Apple Spotify YouTube iHeart Podchaser PlayerFM In this episode we talk in detail about the evolution of the “Trauma Physician” role and Emergency Physicians working on inpatient trauma services, th
Emergency Medicine Cases
JUNE 18, 2024
Dr. Jesse McLaren illustrates the paradigm shift from STEMI to Occlusion MI (OMI) through 9 cases, and drives home the points that if there is STEMI criteria, consider false positives (eg. secondary and proportional to LVH or BER); if there is no STEMI criteria, consider false negatives and look for other signs of occlusion (eg. acute Q waves or loss of R waves, hyperacute T waves, or reciprocal STD/TWI) and if the ECG is nondiagnostic, consider other OMI signs including clinical (refractory isc
EM Literature of Note
JUNE 5, 2024
Every so often a masterclass performance arises in the medical literature. A performance transcending the boundaries of what was once thought possible. A shining exemplar of human achievement. This is a trial, published in the New England Journal of Medicine , with the following features: Conducted by an institute sponsored by pharma. Designed by the first author, a consultant for pharma, and two employees of pharma.
Sensible Medicine
JUNE 26, 2024
When I type the words coronary artery disease I bet that you picture angiograms with stenotic lesions— blockages in colloquial language. Indeed a high grade plaque from atherosclerosis in the inside of a coronary artery can limit flow to the heart muscle. But. But. Not as much as you think. You know why? Because there is something called the coronary microcirculation.
Dr. Smith's ECG Blog
JUNE 11, 2024
Written by Pendell Meyers with edits by Smith. Sent by anonymous A man in his 40s with no previous heart disease presented within 30 minutes of onset of acute chest pain that started while exercising. There was associated shortness of breath and left arm radiation. This Triage ECG (ECG #1) was recorded on a chest pain patient at triage at 1906 (top highest quality image, bottom photo including computer algorithm interpretation): "Sinus rhythm, normal ECG" (This was performed on a Mortara machine
Science Based Medicine
JUNE 22, 2024
This essay stems from concerns about two editorials published in The New York Times recently. We felt that they were problematic in that the past is viewed through a blurred prism to produce revisionist history. The post Why is The New York Times now promoting an anti-science agenda? first appeared on Science-Based Medicine.
ALiEM
JUNE 24, 2024
With some things in life, speed is everything. Adenosine is one of those things. With an ultrafast half-life estimated to be between 0.6 to 10 seconds [1], parenterally administered adenosine needs to reach the cells of the AV-node and cardiac pacemaker cells in an expedited fashion to facilitate the termination of supraventricular tachycardias (SVTs).
The Trauma Pro
JUNE 18, 2024
Early resuscitation, particularly with blood products in patients with hemorrhage, is literally a lifesaver. As each minute ticks by, survival slowly diminishes. To facilitate this, massive transfusion protocols (MTP) have been designed to rapidly deliver sizable quantities of blood products to the trauma resuscitation bay. One of the recurring issues I see at trauma centers is the lack of a reliable way of activating the MTP.
The Bottom Line
JUNE 24, 2024
Liberal or Restrictive Transfusion Strategy in Patients with Traumatic Brain Injury Turgeson AF. NEJM June 13 2024; doi:10.
Sensible Medicine
JUNE 10, 2024
This is a story about placebo effects. I raise the issue because the prominent journal JAMA-Psychiatry published a paper purporting to show that placebos have great effects in many psychiatric conditions. The erroneous conclusion provides excellent teaching points. First a Thought Experiment Say I gave 100 cyclists a red supplement designed to increase muscle contraction and increase pedal power.
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