Ken Grauer, MD
MARCH 1, 2024
I was sent the 2 ECGs shown in Figure-1 — which were recorded from an elderly man whose heart beat "has been irregular for years". No clear history for recent chest pain — but the patient "has not been well" for the previous week. Regarding the 2 ECGs in Figure-1 : ECG #1 is the initial tracing obtained at the scene by the EMS ( E mergency M edical S ystems ) team — in association with an alert but markedly hypotensive patient.
Pediatric EM Morsels
MARCH 29, 2024
Often our job requires us to consider the presence of needles of significant illness in the haystack of nonspecific symptoms. With the help of our favorite geneticist , Dr. Liz Baker, we will dive into the haystack headfirst and find those needles. Hopefully, without getting poked. Let’s consider Inborn Errors of Metabolism Presenting in the ED : Inborn Errors of Metabolism: Basics Common Presentations, Uncommon Kiddos For the child with lethargy, vomiting, acidosis, hypoglycemia , organom
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The Trauma Pro
MARCH 1, 2024
Seriously injured patients frequently develop coagulopathy, which makes resuscitation (and survival) more challenging. A few years ago, the CRASH-2 study lent support for using tranexamic acid (TXA) in select trauma patients to improve survival. This drug is cheap and has antifibrinolytic properties that may be beneficial if given for life-threatening bleeding within 3 hours of initial injury.
Sensible Medicine
MARCH 18, 2024
Dear Readers, I publish the following opinion piece regarding the use of statin drugs in low-risk individuals without heart disease even though I disagree with most of the authors’ arguments. Since this is a rebuttal to an editorial I wrote, it would be helpful to first read the linked article in the lead sentence. I do like the authors’ conclusions.
Stop and Think
MARCH 31, 2024
My career in cardiology can be separated into two decade-long blocks. The first decade I practiced like most other cardiologists. I went with the flow, followed the guidelines. I went to few meetings, read few studies and as a result had little (mental) tension. Then I started writing about medical evidence. This required studying the evidence. Over time, I learned the skill of critical appraisal.
EM Ottawa
MARCH 14, 2024
Posterior circulation ischemia accounts for approximately 20-25% of all ischemic strokes and is a significant cause of patient disability. The diagnosis can be extremely challenging as findings are often not typically focal. Posterior strokes are misdiagnosed more than 3x more often than anterior circulation strokes.1 Similar to anterior circulation strokes, posterior strokes are most commonly […] The post Posterior Circulation Strokes appeared first on EMOttawa Blog.
Ken Grauer, MD
MARCH 27, 2024
I was sent the ECG in Figure-1 — with the following history: The patient is a young man in his early 20s — who presents to the ED ( E mergency D epartment ) because of SOB ( S hortness O f B reath ) that had been ongoing for several hours. No chest pain. He reports a number of similar previous episodes over the past few years ( although apparently has not been formerly evaluated for this ).
Emergency Care Today brings together the best content for emergency care practitioners from the widest variety of industry thought leaders.
The Trauma Pro
MARCH 25, 2024
Generative artificial intelligence (AI) is the newest shiny toy. The best-known example, ChatGPT, burst onto the scene in November 2022 and caught most of us off guard. The earliest versions were interesting and showed great promise for a variety of applications. The easiest way to think about this technology is to compare it to the auto-complete feature in your search engine.
Sensible Medicine
MARCH 13, 2024
Martin Kulldorff was a professor at Harvard Medical School who argued during the pandemic that school closure was misguided policy, lockdowns were inappropriate and draconian, vaccine mandates were unjust, natural immunity conferred protection against subsequent severe disease, kids did not need to be vaccinated, and that two year old children should not wear cloth masks in daycare.
First 10 EM
MARCH 25, 2024
There is little doubt that the use of testing has increased dramatically in emergency medicine during my career. Between 2001 and 2010 the use of CT in emergency departments increased 3-fold (and the use of MRI increased 9-fold, but for some reason it is still almost impossible for me to get one done.) (Carpenter 2015) […] The post Overdiagnosis: Would we better better off not looking?
Intensive Blog
MARCH 13, 2024
Everything ECMO 048: History of ECPR evidence and considerations for future research Author: Dr George Walker Peer reviewer: A/Prof Aidan Burrell Introduction The first recorded attempts to resuscitate patients were as early as 1530 where Swiss physician Paracelsus used fireplace bellows to reinflate the lungs of those who had stopped breathing. Several more centuries passed before techniques more akin to modern day cardio-pulmonary resuscitation were reported.
Ken Grauer, MD
MARCH 15, 2024
What if you were asked to interpret the ECG in Figure-1 ? How would YOU interpret the rhythm? Even without the benefit of any history — Has there been a recent MI? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). MY Approach to Today’s Tracing: As always — I favor beginning assessment with a quick look at the long lead rhythm strips at the bottom of the tracing.
Pediatric EM Morsels
MARCH 1, 2024
We have digested many Morsels regarding various pulmonary complaints. While some are very rare (ex, Pulmonary Embolism , Pulmonary Hypertensive Crisis , Negative Pressure Pulmonary Edema , CPAM ) others are commonly encountered (ex, Croup , Bronchiolitis , Sinusitis ). It is pneumonia , however, that often generates the most conversations. When should I consider a CXR ?
The Trauma Pro
MARCH 14, 2024
Trauma professionals are never satisfied with the size of their trauma bay. Today, I’ll write about optimal trauma bay size. Next week, I’ll describe my system for quantifying the space in your trauma bay and address the equipment layout in your resuscitation room. Trauma resuscitation rooms vary tremendously. They can range from very spacious… to very tight… Most trauma bays that I have visited were somewhere between 225 and 300 square feet (21-28 sq meters), although some were quit
Sensible Medicine
MARCH 25, 2024
You may have heard the ruckus about the study showing that intermittent fasting was associated with a 91% higher rate of dying of heart disease. I call it a ruckus because after the AHA sent out a press release about the study, two things happened: The mainstream health press covered it as they do (breathlessly) for any clickable story. The Top People of cardiology and health went ballistic in their criticism of the paper.
Science Based Medicine
MARCH 29, 2024
A new analysis of 2023 MIS-C cases reveals that the COVID-19 vaccine significantly reduces the risk of this dreaded complication. The post COVID-19 Vaccination Significantly Reduces Risk of Severe Inflammatory Syndrome in Kids first appeared on Science-Based Medicine.
First 10 EM
MARCH 18, 2024
Looking back, I am somewhat surprised I never published a First10 approach to sympathetic crashing pulmonary edema. I guess it never felt necessary, as it was the first ever EMCrit post, and therefore felt well covered in the FOAMed community. However, a full 15 years after that first EMCrit podcast (congrats on the decade and […] The post High dose nitroglycerin is correct dose nitroglycerin appeared first on First10EM.
Ken Grauer, MD
MARCH 11, 2024
I was asked to interpret the 2-lead rhythm strip shown in Figure-1 — without the benefit of any history. What are YOUR thoughts? Is there AV block? If so — Is it complete AV block? Figure-1: You are asked to interpret this 2-lead rhythm strip without the benefit of any history. = NOTE: Today's rhythm is challenging — especially if you have not seen this type of rhythm before.
Dr. Smith's ECG Blog
MARCH 28, 2024
A 69 y.o. male with pertinent past medical history including Atrial fibrillation, atrial flutter, cardiomyopathy, Pulmonary Embolism, and hypertension presented to the Emergency Department via ambulance for respiratory distress and tachycardia. Per EMS report, patient believes he has been in atrial fibrillation for 5 days, since coming down with flu-like illness with rhinorrhea, productive cough, SOB.
The Trauma Pro
MARCH 21, 2024
In the last two posts, I discussed the size of your trauma bay and how to measure it. This can obviously be helpful if you are updating or building new resuscitation rooms. But what about all the stuff that goes into it? Where is the best place to put it? If you are in the enviable position of being able to stock a brand-new room, here are some tips.
Sensible Medicine
MARCH 19, 2024
One of the aspects of editing Sensible Medicine that I have truly enjoyed is receiving excellent, unsolicited manuscripts. 1 We published one of these a couple of weeks ago by Aleksi Raudasoja titled From Guideline Recommendations to Articulated Harms and Benefits. Even better is when one unsolicited manuscript leads to another. What follows is one of those written by Mariana Barosa.
ALiEM
MARCH 18, 2024
A 30-year-old female with a past medical history of Crohn’s Disease presented to the ED for evaluation of an acutely bruised right 4th finger. She stated she was typing on a computer keyboard approximately 10 minutes prior to presentation and she noticed a sudden popping sensation at the base of her right ring finger. After the popping sensation, she noticed a cool sensation of the finger and numbness to the entire finger.
First 10 EM
MARCH 4, 2024
This is an invited guest post by Dr. Cory Rohlfsen (@CoryRohlfsen) based on an interesting twitter thread of his from a few month back. Dr. Rohlfsen is a hybrid internal medicine clinician at the University of Nebraska Medical Center. He splits his time between hospitalist duties and primary care clinic. He is passionate about fostering […] The post Diagnostic reasoning as artificial intelligence emerges: a distributed cognition framework appeared first on First10EM.
EMCrit
MARCH 20, 2024
Eyelid opening apraxia refers to a specific inability to open the eyelids. This may result from non-dominant hemispheric strokes. On superficial examination it will mimic unconsciousness, but upon further examination the patient is awake and able to respond to stimuli with their extremities. I've seen a similar phenomena of eyelid opening apraxia a few times […] EMCrit Project by Josh Farkas.
The Skeptics' Guide to EM
MARCH 2, 2024
Reference: Gibbons et al. The sonographic protocol for the emergent evaluation of aortic dissections (SPEED protocol): A multicenter, prospective, observational study. AEM February 2024. Date: February 28, 2024 Guest Skeptic: Dr. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. He is the Vice Chair of the Emergency Department at Nassau University […] The post SGEM#432: SPEED, Give Me What I Need – To Diagnose Acute Aortic Dissections first appeared on Th
Science Based Medicine
MARCH 12, 2024
"Science cannot survive in a society that does not value truth and strive to discover it." The post Dr. Martin Kulldorff, Who Posted Pictures of Guillotines and Promised Herd Immunity Would Arrive 3-6 Months After Lockdowns Ended, Fired for “Clinging to the Truth”. first appeared on Science-Based Medicine.
Sensible Medicine
MARCH 4, 2024
Studies that tempt me to change my mind are worth telling you about. The story this week centers on the use of aspirin for prevention of cardiac events in people without heart disease. I used italics because this story ONLY applies to people without heart disease—so called primary prevention. In 2018, the NEJM and the Lancet published three trials that randomized tens of thousands of patients without heart disease to either low-dose aspirin or a placebo.
Life in the Fast Lane
MARCH 25, 2024
Sheralyn Guilleminot and Mike Cadogan AI Tools for Learning AI Tools for Learning - a review of a selection of tools - which ones work and which ones don’t, plus, the future of AI-assisted learning
Dr. Smith's ECG Blog
MARCH 7, 2024
A young man presented with a gunshot wound to the right chest, with hemo-pneumothorax and hemorrhagic shock. He got a chest tube and intubation and massive transfusion and stabilized. CT of chest showed the bullet path through his right lung but nowhere near his heart. But he did get an EKG: What is this? There were times when it would be usurped by sinus tachycardia, then return to this rhythm.
ACEP Now
MARCH 11, 2024
ACEP Now wishes to congratulate the medical students who matched into emergency medicine today! This year, it is estimated that only about 137 of more than 3,000 spots remained unfilled as of Monday, March 11, 2024. This is in comparison to more than 550 unmatched positions last year. While the full explanation for the rebound in emergency medicine remains unknown, one potential reason is a large increase in international medical graduate applicants this year.
ALiEM
MARCH 5, 2024
Which medication can be derived from the bark of the pictured tree? Aspirin Atropine Colchicine Quinine Reveal the Answer 1. Aspirin Background The photo shows a weeping willow, a member of the Salix genus of trees. Willow tree bark contains salicin from which aspirin (acetylsalicylic acid) can be derived. For over 3500 years, willow bark has been used as a traditional medicine to treat fevers and pain [1].
Science Based Medicine
MARCH 17, 2024
Doctors portrayed those who tried to avoid the virus as pathetic, disordered weaklings, afflicted by irrational panic, fear, and anxiety. It only makes sense if you remember one thing, they wanted you infected. The post Dr. Jay Bhattacharya, April 2021: “The Central Problem Right Now I Think Is The Fear That People Still Feel About COVID.” first appeared on Science-Based Medicine.
Sensible Medicine
MARCH 2, 2024
Since the start of the pandemic, I have written 200 op-eds on COVID-19 policy and published 20+ peer reviewed articles. I was opposed to school closure, masking kids, vaccine mandates, especially for young men in college who already had COVID-19, and took on many other controversial topics. Yet, from 2020-2022, I was not asked to debate these topics at any university.
EMDocs
MARCH 2, 2024
Authors: Mounir Contreras Cejin, MD (EM Resident Physician, UT Southwestern – Dallas, TX); Felipe Gonzalez Gutierrez (Medical Student, UT Southwestern – Dallas, TX); Emmanuel Ohuabunwa, MD, MBA (Attending Physician, UT Southwestern – Dallas, TX) // Reviewed by: Sophia Görgens, MD (EM Physician, Northwell, NY); Cassandra Mackey, MD (Assistant Professor of Emergency Medicine, UMass Chan Medical School); Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Welcome to EM@3AM, an emDOCs series
Dr. Smith's ECG Blog
MARCH 22, 2024
Written by Willy Frick A man in his 50s with history of hypertension, hyperlipidemia, and a 30 pack-year smoking history presented to the ER with 1 hour of acute onset, severe chest pain and diaphoresis. His ECG is shown: What do you think? The history thus far is highly suggestive of OMI, so we must study the ECG very closely to see if we can confirm this.
EM Literature of Note
MARCH 12, 2024
A few words regarding an article highlighted in one of my daily e-mails – a report regarding the Elders Risk Assessment tool (ERA) from the Mayo Clinic. The key to the highlight is the assertion this score can be easily calculated and presented in-context to clinicians during primary care visits, allowing patients with higher scores to be easily identified for preventive interventions.
Emergency Medicine Cases
MARCH 19, 2024
In this part 1 of our 2-part podcast series on Asthma Management we explore a systematic approach to managing patients presenting to the ED with asthma exacerbations. Our discussion will emphasize the critical role of a thorough history and physical examination in effectively stratifying patient risk and guiding treatment/disposition decisions. Additionally, we'll examine the importance of providing comprehensive discharge medications and instructions to mitigate both mortality and morbidity ass
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