Ken Grauer, MD

JULY 29, 2023

The ECG in Figure-1 was obtained from an 18-year old woman — who moments before been resuscitated from out-of-hospital cardiac arrest. QUESTIONS: In light of the above clinical history. How would YOU interpret her post-resuscitation ECG? Does this ECG in Figure-1 provide clue(s) to the etiology of this patient's cardiac arrest? Figure-1: The initial ECG in today's case — obtained following resuscitation from cardiac arrest of an 18-year old woman.

EKG/ECG 370

EKG/ECG Resuscitation Documentation/Coding Hospitals 370

Pediatric EM Morsels

JULY 28, 2023

Authors: Drs. Kendra Jackson and Rebecca Raffler While we’ve gotten to snack on a Morsel on this subject before , new guidelines and research surrounding DKA and cerebral edema have come to light since the first go ‘round! Thankfully, Dr. Fox wasn’t too “ salty” when we asked to rehydrate this topic. Rates of type 1 diabetes have increased since the COVID-19 pandemic.

Fluid Resuscitation 246

Fluid Resuscitation Pediatrics Resuscitation Research 246

Mount Sinai EM

JULY 27, 2023

Fever in the Asplenic Patient Why we care Fever in a patient with impaired splenic function = early sign of sepsis Infections in this population can develop precipitously with very minimal antecedent symptoms, and can become fulminant and fatal within hours of symptom onset DIC can occur early in the course Patient population Anatomic Asplenia (post-splenectomy, congenital asplenia) Functional Asplenia (e.g. sickle cell anemia) Hyposplenia (from atrophy, infarction, engorgement, or infiltration

Sepsis 182

Sepsis Wellness Infectious Diseases 182

RebelEM

JULY 5, 2023

Take Home Points Provider assessment of how the patient looks is extremely important. If it looks and feels like a STEMI clinically, get serial ECGs and consult Cardiology immediately. POCUS has been a phenomenal tool in the management and early diagnosis of a lot of abnormal ECG and chest pain presentations. Isolated elevation in aVR with diffuse ST depressions can be a sign of Left Main occlusion.

EKG/ECG 144

EKG/ECG Sepsis EMS 144

MEDEST118

JULY 2, 2023

By Mario Rugna

Airway Management 143

Airway Management 143

Science Based Medicine

JULY 2, 2023

Robert F. Kennedy, Jr. has resurrected the antivax claim that the childhood vaccine schedule has never been tested in randomized controlled trials (RCTs) with a saline placebo controls (and therefore the vaccine schedule is unsafe). This is an old and deceptive antivax half-truth that ignores both what constitutes a scientifically valid placebo and the ethical requirements for RCTs.

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Ken Grauer, MD

JULY 22, 2023

The ECG in Figure-1 was obtained from an elderly man with a history of coronary disease — who contacted EMS for "burning" chest discomfort that woke him at 3am. Unlike his "usual" anginal episodes — this chest discomfort was not relieved by NTG. Some amount of time passed at home — during which his chest discomfort persisted The patient was hemodynamically stable at the time he was seen by EMS, when ECG #1 was recorded.

EKG/ECG 195

EKG/ECG Burns EMS Wellness 195

Mount Sinai EM

JULY 21, 2023

Why is this a pearl? We get G-tube dislodgments quite often at Sinai, and they can be an easy patient encounter with a quick note and quick dispo. But they made me so nervous as an intern and early 2! Now I love ‘em and you can love ‘em too! ** GJ-tubes or J-tubes do not get replaced in the ED. Tell me about the PEG tube. Gastrostomy tube (G-tube) or Percutaneous Endoscopic Gastrostomy tube (PEG tube) is a tube placed in the stomach for long-term enteral nutritional support.

EMS 181

EMS Radiology Radiology 181

The Trauma Pro

JULY 28, 2023

As a followup to my hip dislocation post on Tuesday, here is a short 5 minute video that goes through the entire process of reducing hip dislocations. There are lots of little tips and tricks. Enjoy! In the next post, a novel variant of the hip reduction technique, the Captain Morgan. Originally shown at Trauma Education: The Next Generation 2013 in St.

Dislocations 130

Dislocations 130

Don't Forget the Bubbles

JULY 5, 2023

Topic Sickle Cell Disease Author Beatrice Zanetti Duration Up to 2 Hours Facilitator Level ST4+ Learner Level Most useful for those in experience seeing paediatric patients regularly. From FY1 + and 5+ nurses on Equipment Required None Outline Pre-reading Basics Case 1: Salmonella osteomyelitis Case 1: Discussion Case 2: Acute painful crisis and Priapism Case 2: Discussion Advanced Case 1: Acute chest syndrome Advanced Case 1: Discussion Advanced Case 2: Stroke in sickle cell disease patient Adv

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Emergency Live

JULY 4, 2023

Telangiectasias are caused by enlarged blood vessels. This condition is much more common than you think and you will probably have come across this problem at least once in your life The post Teleangiectasias: what are they? appeared first on Emergency Live.

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Ken Grauer, MD

JULY 15, 2023

The ECG in Figure-1 was obtained from a previously healthy middle-aged man — who while performing his regular exercise routine, developed "slight" chest discomfort and "palpitations". These symptoms persisted for over an hour, which led the patient to contact EMS. Surprisingly — he was hemodynamically stable with minimal discomfort at the time his initial ECG in Figure-1 was recorded.

EKG/ECG 195

EKG/ECG Shock EMS 195

Pediatric EM Morsels

JULY 7, 2023

In the past, we have discussed several causes of Knee Pain in children. Some of those causes are benign (ex, Osgood Schlatter’s Disease ) while others are scary (ex, osteosarcoma ). Evaluating the limping child , though, requires us to ponder not only the common (ex, Toddler’s Fracture ), but also to be vigilant for the severe (ex, Septic Arthritis ).

Dislocations 141

Dislocations Fractures Pediatrics EMS 141

Mount Sinai EM

JULY 30, 2023

TR Pearl: Thyroid Storm Management Endocrine emergency: severe clinical manifestations of thyrotoxicosis Mortality rate of thyroid storm is 10-30% Often precipitated in patients with hx of hyperthyroidism by an acute event such as surgery (thyroid or non-thyroidal surgery), trauma, infection, acute iodine load (including amiodarone), or parturition Risk factor includes irregular use or discontinuation of antithyroid drugs Diagnosing Thyroid Storm : The distinction between severe thyrotoxicosis a

Administration 179

Administration COPD Wellness 179

The Trauma Pro

JULY 25, 2023

Although posterior hip dislocation is an uncommon injury, the consequences of delayed recognition or treatment can be dire. The majority are caused by head-on car crashes, and 90% of these are posterior dislocations. The femoral head is forced across the back wall of the acetabulum, either by the knee striking the dash, or by forces moving up the leg when the knee is locked.

Dislocations 130

Dislocations Wellness 130

The Skeptics' Guide to EM

JULY 2, 2023

Date: July 1, 2023 Reference: PATCH-Trauma Investigators and ANZICS Clinical Trial Group. Prehospital Tranexamic Acid for Severe Trauma. NEJM 2023. Guest Skeptic: Dr. Salim Rezaie is a community emergency physician in San Antonio, TX. He is the Creator and founder of REBEL EM, a free, critical appraisal blog that tries to cut down knowledge translation gaps of […] The post SGEM#408: Hey, I, Oh I’m Still Alive – Is it due to TXA?

EMS 119

EMS Outcomes Hospitals Research 119

Emergency Live

JULY 1, 2023

Water retention is a problem that affects most women. However, most people confuse water retention and cellulite The post Water retention, how to deal with it appeared first on Emergency Live.

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Ken Grauer, MD

JULY 9, 2023

The ECG in Figure-1 was obtained from a 60-year old woman — who presented to the ED ( E mergency D epartment ) for “palpitations”. Her vital signs were normal at the time this triage ECG was recorded. Blood was drawn , and the patient was promptly placed in a room to be seen — but on entering, the ED physician found her unresponsive in cardiac arrest.

EKG/ECG 195

EKG/ECG 195

St. Emlyn

JULY 2, 2023

St.Emlyn's - Emergency Medicine #FOAMed Zaf Qasim @resusone reviews the UKREBOA trial. No benefit shown, but is this really the end of REBOA in trauma? #FOAMed @stemlyns The post JC: The UK-REBOA trial. Has the balloon popped? St Emlyn’s appeared first on St.Emlyn's.

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Science Based Medicine

JULY 5, 2023

Despite the leaked new classification as a "possible" carcinogen, the evidence still shows aspartame is safe. The post Aspartame and Cancer first appeared on Science-Based Medicine.

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The Bottom Line

JULY 1, 2023

What’s new in the Critical Care literature – monthly updates

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Sensible Medicine

JULY 9, 2023

I always tell junior faculty that your contract means little, and, indeed, I found that to be the case, when a mid-career faculty departed and I inherited a third of his lung cancer patients. Yet, like most unexpected clinical changes in my career, I ended up learning unexpected truths. One man taught me about lung cancer screening. He was the most improbable 74 year old.

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Emergency Live

JULY 3, 2023

Schizophrenia comes from the Greek and literally means “separate mind”: those affected struggle to distinguish reality from imagination It is a psychiatric disorder that seriously compromises self-perception. In addition to negatively affecting social relationships and the performance of normal daily activities. This disease also affects perception, memory, attention, learning and emotions.

Psychiatric 119

Psychiatric 119

PulmCCM

JULY 3, 2023

Video laryngoscopy was superior to direct laryngoscopy in first-pass success among ED residents and CCM fellows intubating critically ill patients (DEVICE trial). Surprisingly to me, video laryngoscopy (VL) has not consistently been shown to increase first-pass intubation success over direct laryngoscopy (DL) in critically ill patients. Most studies have been small, single center, and only some have favored video.

Airway Management 105

Airway Management Outcomes Hospitals Emergency Department 105

SheMD

JULY 30, 2023

Disclaimer: This post was written before the COVID-19 pandemic. Some of the interview information may not be relevant during the 2020-2021 & 2021-2022 academic years. Hello premeds! ,, AMCAS , ,, AACOMAS , and ,, TMDSAS all opened in the beginning of May. We are kicking it into high-gear with premeds so they can turn in their medical school applications as soon as they are able.

Academics 104

Academics Leadership Research Wellness 104

Science Based Medicine

JULY 4, 2023

817,000 thousand Americans had already died of COVID by December 23, 2021, and 244,000 more would die the next year. Millions more survived, but were injured. These numbers could have been lower if doctors not become defense attorneys for SARS‑CoV‑2 and prosecutors against the vaccine, and instead applied similar standards of evidence to both. The post When Doctors Have Different Standards of Evidence for the Virus and the Vaccine first appeared on Science-Based Medicine.

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First 10 EM

JULY 3, 2023

The pace of these literature summaries has decreased over the years, but perhaps that means that quality has increased? I think there is an interesting variety of papers this time around, from sepsis, to b t, to patient access to their own results online. A few huge papers dropped in the past few weeks, including RCTs […] The post Research Roundup (July 2023) appeared first on First10EM.

Research 103

Research Sepsis EMS 103

Mount Sinai EM

JULY 24, 2023

This week, I wanted to touch a bit on Meconium Aspirators as apart of our GI Bleed intubation tool kit. At some point during second year, many of my fellow classmates and I started throwing these into airway boxes at Elmhurst. Especially in cardiac/resus, I think knowing to reach for one when you need one is critical, though I don’t think they need to be in every airway box.

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Emergency Live

JULY 3, 2023

Bladder cancer is a malignant transformation of the cells - mainly those called transitional cells - which cover the inner walls of the bladder, the organ responsible for collecting and expelling urine once it has been filtered by the kidneys The post Bladder cancer: what is it? appeared first on Emergency Live.

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The Trauma Pro

JULY 21, 2023

In the last post, I discussed what to do if your hospital is thinking about switching to an electronic trauma flow sheet (eTFS). Today I’ll give you some tips on what to do if the cat’s already out of the bag and it’s already been implemented. The number one priority is to show the impact of the eTFS on the trauma program. This involves the same two components I’ve already written about: Accuracy.

Administration 100

Administration Hospitals 100

Emergency Medicine News

JULY 31, 2023

An abstract is unavailable.

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Don't Forget the Bubbles

JULY 31, 2023

With millions of journal articles published yearly, it is impossible to keep up. Our team have scoured what’s new (well, mostly new!) in the paediatric literature. One reviewer has returned to an oldie but a goodie to answer a clinical question! Article 1: Does rapid diagnostic testing for Malaria work? Bird C, Hayward GN, Turner PJ, Merrick V, Lyttle MD, Mullen N, Fanshawe TR.

Rapid Diagnostic Testing 98

Rapid Diagnostic Testing Resuscitation Emergency Department Pediatrics 98

PulmCCM

JULY 31, 2023

New Practice Guidelines for Diagnosis and Management of Acute Respiratory Distress Syndrome As mentioned here previously , a group of U.S. and European experts arrived at a consensus of new recommendations for the management of acute respiratory distress syndrome (ARDS), now publishing their guidance in JAMA. The highlights include: A trial of high-flow nasal cannula oxygen was advised before intubating patients.

Shock 98

Shock Documentation/Coding Outcomes Wellness 98

RebelEM

JULY 27, 2023

Background: Current stroke guidelines recommend IV alteplase for patients with acute ischemic stroke presenting within 4.5hrs of symptom onset based on the NINDS and ECASS III publications. Both NINDS and ECASS III excluded patients with mild stroke symptoms but failed to clearly define a threshold for mild stroke. Many patients, however, will have minor strokes (defined as an NIHSS score ≤5).

Stroke 98

Stroke Outcomes EMS Hospitals 98

Emergency Live

JULY 4, 2023

The aircraft was carrying five people, prompt rescue, all survived A helicopter, involved in the route between the high altitude refuges Capanna Gnifetti and Regina Margherita on Monte Rosa, crashed in the area of the municipality of Alagna Valsesia. The helicopter was performing its usual service connecting the two refuges, offering tourists and climbers, all […] The post Helicopter crashes on Monte Rosa, no fatalities appeared first on Emergency Live.

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The Trauma Pro

JULY 18, 2023

I’ve spent several posts showing you the major problems inherent in using an electronic trauma flow sheet (eTFS). It boils down to Garbage In / Garbage Out and time. It costs a lot of money and weakens an otherwise robust trauma performance improvement process. Here’s the real bottom line: ” A hospital using an electronic trauma flow sheet is paying a lot of money for a product that forces them to pay even more money for people to essentially transcribe inaccurate data back on

Administration 100

Administration Hospitals 100

EM Ottawa

JULY 27, 2023

Acute scrotal pain is a common in emergency departments, comprising ~ 0.5% of all presentations. However, torsion is another very time sensitive diagnosis that is ubiquitous across all ages as seen by this Rosen’s table. Incidence / Epidemiology Unfortunately, epidemiological data is poor. Acute scrotal complaints make up approximately 0.5% of all ED visits […] The post Testicular Torsion appeared first on EMOttawa Blog.

Emergency Department 98

Emergency Department Resuscitation 98