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.
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.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Pediatric EM Morsels
MARCH 15, 2024
We encounter seizures commonly in the Emergency Department. While they can be dramatic and devastating, we have learned to become comfortable with the wide variety that may present in children. From the simple febrile seizure to the complex seizure, we know how to stabilize and how to evaluate. While fortunately most seizure activity is short lived, we also know that status epilepticus can be difficult to manage, and persistent seizures should make us consider specific etiologies (ex.
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.
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.
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.
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.
Emergency Care Today brings together the best content for emergency care practitioners from the widest variety of industry thought leaders.
.jpg) |
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 ?
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.
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.
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.
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?
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.
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.
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.
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.
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.
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.
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
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
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 3, 2024
Actually running an RCT is a lot harder than merely calling for one. Those who recognized this obvious fact are not against RCTs. The post Doctors Who Performatively Fetishized RCTs Aren’t Out to Advance Medical Research, But Rather to Sow Doubt & Mistrust first appeared on Science-Based Medicine.
Dr. Smith's ECG Blog
MARCH 14, 2024
Written by Jesse McLaren Three patients presented with acute chest pain and ECGs that were labeled by the computer as completely normal, and which was confirmed by the final cardiology interpretation (which is blinded to patient outcome) also as completely normal. What do you think? Case 1: Case 2: Case 3: Triage ECGs labeled ‘normal’ There have been a number of small studies suggesting that triage ECGs labeled ‘normal’ are unlikely to have clinical significance, and therefore that emergency phy
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.
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
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.
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.
Science Based Medicine
MARCH 31, 2024
Part 1: Doctors who said the pandemic ended 3-years ago now have the audacity to lament the "damaged public trust in the medical profession." The post Dr. Marty Makary: “We’ll Have Herd Immunity by April” & “It’s Okay To Have an Incorrect Scientific Hypothesis. But When New Data Proves It Wrong, You Have To Adapt.” first appeared on Science-Based Medicine.
Dr. Smith's ECG Blog
MARCH 9, 2024
Written by Willy Frick A 67 year old man with a history of hypertension presented with three days of chest pain radiating to his back. He had associated nausea, vomiting, and dyspnea. What do you think? This ECG together with these symptoms is certainly concerning for OMI, but the ECG is not fully diagnostic, and another consideration could be acute pericarditis.
The Bottom Line
MARCH 22, 2024
What’s new in the Critical Care literature – monthly updates
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
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.
Sensible Medicine
MARCH 12, 2024
On February 8th, Lisa Rosenbaum published an excellent and thought-provoking piece in the New England Journal titled: On Being Well While Doing Well — Distinguishing Necessary from Unnecessary Discomfort in Training. This article, and the accompanying podcast , has stimulated more conversation than a “non-research” article has in years.
Science Based Medicine
MARCH 22, 2024
The campaign against boosters was just a small part of a pathetic, pandemic-long pattern where doctors expressed grave concern about the mildest harms of measures to limit COVID, even purely theoretical ones, while being totally indifferent to literally anything the virus could do, including the deaths of children and young adults. The post Some Doctors Cared Much More About Sore Arms Than Cold Bodies first appeared on Science-Based Medicine.
Dr. Smith's ECG Blog
MARCH 19, 2024
This case was sent by Amandeep (Deep) Singh at Highland Hospital, part of Alameda Health System. The patient presented to an outside hospital An 80yo female per triage “patient presents with chest pain, also hurts to breathe” PMH: CAD, s/p stent placement, CHF, atrial fibrillation, pacemaker (placed 1 month earlier), LBBB. HPI: Abrupt onset of substernal chest pain associated with nausea/vomiting 30 min PTA.
The Bottom Line
MARCH 22, 2024
What’s new in the Critical Care literature – monthly updates
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].
Expert insights. Personalized for you.
387 
.jpg)
Let's personalize your content