Ken Grauer, MD

JULY 4, 2024

I was sent the ECG in Figure-1 — but without the benefit of any history. QUESTIONS: How would YOU interpret this tracing? WHY do I say there is, "A 2-Part Answer?" Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). MY Thoughts on Today's CASE: As important as providing a brief, relevant history is for optimal clinical ECG interpretation — Cases like the one today often prove even more educational, because we are not given any

EKG/ECG 357

EKG/ECG Wellness 357

Pediatric EM Morsels

JULY 19, 2024

Previously, we covered Post-Tonsillectomy Hemorrhage and how we hope that “all bleeding eventually stops: ideally, by means that we have imposed rather than by exhaustion of the patient’s RBC resources.” Since the original morsel ( way back in 2012 ), the literature has shown that there are a few extra ingredients that we can add to our morsel recipe when we care for children with post-tonsillectomy hemorrhage.

Pediatrics 285

Pediatrics Airway Management Wellness Administration 285

The Trauma Pro

JULY 23, 2024

Although very few things in medicine are new, I love it when I learn about something I’ve never heard of before. Recently, while reading an autopsy report, I ran across the term “hinge fracture of the skull.” What? Maybe if I were a neurosurgeon, I would have recognized the term. This was the perfect excuse to hit the books (or, more accurately, the internet).

Fractures 259

Fractures 259

Science Based Medicine

JULY 21, 2024

Actual death is worse than theoretical death. This didn't used to be controversial in medicine. The post Dr. John Ioannidis: Yet Another Doctor Who Treats Theoretical Death From The Vaccine With More Gravity Than Actual Death From COVID first appeared on Science-Based Medicine.

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Sensible Medicine

JULY 22, 2024

I call it therapeutic fashion. Practice patterns. Beliefs. Ways of doing things. Examples: patients with new heart failure get coronary angiography; patients with chest pain without evidence of heart attack get stress tests; certain drugs and devices become favored over generics. The curious thing about many therapeutic fashions is their lack of evidentiary support.

Research 141

Research 141

St. Emlyn

JULY 9, 2024

St.Emlyn's - Emergency Medicine #FOAMed A podcast with Steve Smith ECG educator extraordinaire where we discuss occlusive myocardial infarction and the future of AI and ECG interpretation. The post Podcast – Occlusive Myocardial Infarction, ECGs and Artificial Intelligence with Steve Smith appeared first on St.Emlyn's.

EKG/ECG 136

EKG/ECG 136

ETM Course

JULY 31, 2024

In this episode of the ETM Course Podcast we talk to Dr Chris Partyka, Emergency Physician and Prehospital and Retrieval Specialist from Sydney and lead author for the recently published SABRE trial which compared Serratus Anterior Plane Blocks to a standard analgesia package for patients with rib fractures. Also available on Apple Spotify YouTube iHeart Podchaser PlayerFM This was a really well designed and executed study, and the results will be practice changing for anyone who treats trauma p

Fractures 119

Fractures Wellness 119

The Trauma Pro

JULY 30, 2024

There’s a lot of dogma in trauma care, as well as in the field of medicine generally. The knee dislocation dogma is that the incidence of vascular injury is high (around 50%) with posterior dislocation and somewhat lower with non-posterior dislocation. At least, that’s what I learned way back when. After recently finding myself spouting off those numbers, I wondered if it was really true.

Dislocations 244

Dislocations Wellness 244

Science Based Medicine

JULY 29, 2024

On Friday, JAMA Health Forum published a study that is just more evidence that public health interventions against COVID-19 saved lives. The post As imperfect as they are, public health interventions save lives first appeared on Science-Based Medicine.

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Sensible Medicine

JULY 28, 2024

In a recent post on Sensible Medicine, written on my phone while traveling, I criticized a randomized trial of masking in the BMJ that found Norweigans told to wear masks for 2 weeks had a lower self-reported rate of cold symptoms from 12% to 9%. A reduction of 3%. In a follow up post , Adam Cifu, my friend and colleague, took me to task. Let me highlight his criticism, and why he is wrong both about the trial, and my Kurt Cobain shirt.

Research 127

Research Wellness 127

St. Emlyn

JULY 14, 2024

St.Emlyn's - Emergency Medicine #FOAMed Background – What do we already know about REBOA? In 2023, Dr Zaf Qasim reviewed the UK REBOA trial for us on St Emlyn’s (The UK-REBOA trial – Has the […] The post JC: Prehospital Partial Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for Exsanguinating Subdiaphragmatic Hemorrhage appeared first on St.Emlyn's.

Resuscitation 126

Resuscitation Research 126

The Bottom Line

JULY 19, 2024

In critically ill patients undergoing tracheal intubation does pre-oxygenation with non-invasive ventilation compared with pre-oxygenation with an oxygen mask reduce the incidence of hypoxemia during intubation?

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Dr. Smith's ECG Blog

JULY 21, 2024

Written By Magnus Nossen — with edits by Ken Grauer and Smith. The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chest pain. The pain was 10/10 in intensity radiating bilaterally to the shoulders and also to the left arm and neck. The below ECG was recorded. The ECG shows obvious STEMI(+) OMI due to probable proximal LAD occlusion.

EKG/ECG 112

EKG/ECG Shock Hospitals Sepsis 112

The Trauma Pro

JULY 9, 2024

Cervical spine injury presents a host of problems, but one of the least appreciated ones is dysphagia. Many clinicians don’t even think of it, but it is a relatively common problem, especially in the elderly. Swallowing difficulties may arise for several reasons: Prevertebral soft tissue swelling may occur with high cervical spine injuries, leading to changes in the architecture of the posterior pharynx Rigid cervical collars , such as the Miami J and Aspen, and halo vests all force the neck int

Head Injuries 237

Head Injuries Fractures Hospitals Wellness 237

Science Based Medicine

JULY 1, 2024

Everything old is new once again, as COVID-19 quacks rehash old cancer quack claims that chemotherapy doesn't work in order to sell their preferred cancer quackery. The post Paul Marik: Disparaging chemotherapy in order to sell cancer quackery first appeared on Science-Based Medicine.

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Sensible Medicine

JULY 12, 2024

Autonomy is important to me. Maybe it’s because I am a Gen X-er. Some say we were raised by wolves. I do know that we were raised knowing we had the freedom to explore but also the freedom to fail. Our autonomy taught us resilience. With autonomy comes responsibility. I need to do the adulting task of scheduling my annual doctor’s visit.

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St. Emlyn

JULY 11, 2024

St.Emlyn's - Emergency Medicine #FOAMed The Faculty of Forensic & Legal Medicine's guidelines for managing non-fatal strangulation (NFS). These guidelines advocate a trauma-informed, multidisciplinary approach to improve outcomes for patients who have experienced NFS. @stemlyns #FOAMed The post Non-fatal strangulation appeared first on St.Emlyn's.

Forensics 125

Forensics Outcomes 125

The Bottom Line

JULY 11, 2024

Stress Ulcer Prophylaxis during Invasive Mechanical Ventilation (REVISE) D. Cook. NEJM 2024. DOI: 10.1056/NEJMoa2404245 Clinical Question In mechanically ventilated adults, does stress ulcer prophylaxis with intravenous pantoprazole (40 mg daily), compared with placebo (0.9% saline), reduce the occurrence of clinically important upper gastrointestinal bleeding at 90 days?

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Dr. Smith's ECG Blog

JULY 25, 2024

This patient was witnessed by bystanders to collapse. They started CPR. EMS arrived and found him in Ventricular Fibrillation (VF). He was defibrillated into VT. He then underwent dual sequential defibrillation into asystole. After 1 mg of epinephrine they achieved ROSC. Total prehospital meds were epinephrine 1 mg x 3, amiodarone 300 mg and 100 mL of 8.4% sodium bicarbonate.

Resuscitation 110

Resuscitation EKG/ECG CPR Shock 110

The Trauma Pro

JULY 16, 2024

Every trauma center is required to have two specific committees: a multidisciplinary trauma performance improvement committee (PI) and a trauma operations committee (ops). However, a common question is, “How often do my committees need to meet?” Let’s start with your PI committee. The answer, of course, is “it depends.” There is no cookie-cutter, one-size-fits-all answer.

Operations 147

Operations Documentation/Coding Pediatrics 147

Science Based Medicine

JULY 11, 2024

Discussions about the GBD tend to take place in the conditional tense- what would, could, and should have happened. But the GBD actually existed and we can examine what actually happened. The post Part 1: We Don’t Have to Wonder if the Great Barrington Declaration Could Have “Worked”. In the Real World, It Failed. first appeared on Science-Based Medicine.

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Sensible Medicine

JULY 27, 2024

When a friend makes a mistake, it is your responsibility to let him know. In the words of the Ad Council and the US Department of Transportation, “friends don’t let friends drive drunk.” They also “don’t let friends misinterpret the medical literature because they have been blinded by their priors.” Friends do this even if the results of the paper in question should change nobody’s behavior and if calling them out will invite the wrath of Sensible Medici

Wellness 123

Wellness Hospitals 123

First 10 EM

JULY 29, 2024

Gestalt for sepsis? This paper hits two of my biggest pet peeves in medicine. 1) The endless emphasis on rushing to hit treatment targets in sepsis or otherwise and 2) the assumption that decision instruments must be better than basic clinical judgment. I am aware, therefore, that my interpretation is more likely to be biased, […] The post Gestalt is better than decision tools for identifying sepsis appeared first on First10EM.

Sepsis 106

Sepsis 106

St. Emlyn

JULY 22, 2024

St.Emlyn's - Emergency Medicine #FOAMed Background As I think I have mentioned before, I spend some of my time as a major trauma consultant on the major trauma ward (MTW). You may be shocked to […] The post JC: Evaluation of Lidocaine Patches for Elderly Patients with Rib Fractures: A Feasibility Study appeared first on St.Emlyn's.

Fractures 106

Fractures Shock 106

Dr. Smith's ECG Blog

JULY 23, 2024

I was working at triage when the medics brought this patient who is 65 yo and has had chest pain for 12 hours. They recorded a prehospital ECG at 2112 and said that it was “normal”. It had already been crumpled up and put in the waste basket. So I uncrumpled it: What do you think? You need to click on it to enlarge it to view it well I was suspicious for inferior and posterior OMI (Large T-wave in aVF, slight STE in lead III with inverted T-wave in aVL, and a slightly downsloping ST with negativ

EKG/ECG 106

EKG/ECG Wellness EMS Hospitals 106

NRC Health

JULY 23, 2024

Patients, families, and even healthcare team members often walk into medical settings filled with fear—and when they’re scared, they can’t fully grasp the critical information providers are trying to convey. Mindy G. Spigel, RN, MSN, CPXP, will delve into her research on patient and family fear, offering key strategies to alleviate this anxiety at Human Understanding Beyond | HUB 24 in San Diego, August 21–23.

Research 102

Research 102

Science Based Medicine

JULY 6, 2024

"There is an ongoing, competitive process of writing the history of the pandemic." The post Pandemic Revisionism: Doctors Who Defend Dr. Scott Atlas Are Afraid to Accurately Quote Dr. Scott Atlas. I’m Not. first appeared on Science-Based Medicine.

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Sensible Medicine

JULY 15, 2024

The GLP1 agonists (glucagon-like-peptide-1-receptor agonist) may be the biggest medical development of this century. The success of Western society has resulted in widespread obesity—and obesity-related diseases, such as diabetes, high blood pressure, heart failure and vascular disease. Obesity is clearly not a good thing for human health. The statistics on obesity—especially in children—are staggering.

Stroke 122

Stroke Research Outcomes 122

Don't Forget the Bubbles

JULY 3, 2024

Can’t get enough of Bubble Wrap? The Bubble Wrap Plus is a monthly paediatric Journal Club reading list from Professor Jaan Toelen (University Hospitals Leuven) and Dr Anke Raaijmakers (Sydney Children’s Hospital). This comprehensive list is developed from 34 journals, including major and subspecialty paediatric journals. We suggest this list can help you discover relevant or interesting articles for your local journal club or allow you to keep a finger on the pulse of paediatric research.

Pediatrics 105

Pediatrics Fluid Resuscitation Hospitals Research 105

St. Emlyn

JULY 30, 2024

St.Emlyn's - Emergency Medicine #FOAMed Listen to the podcast recorded live at the Premier Conference 2024. The post Podcast – Button Battery Ingestion appeared first on St.Emlyn's.

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Dr. Smith's ECG Blog

JULY 9, 2024

Written by Pendell Meyers A man in his 50s was found by his family in cardiac arrest of unknown duration. His family started CPR and called EMS, who arrived to find him in ventricular fibrillation. 15 minutes after EMS arrival, after at least 6 defibrillations, the patient achieved sustained ROSC. He arrived to the ED with severe hypotension, heart rate in the 70s, unable to follow commands but moving all extremities requiring restraint and sedation, respiratory rate around 24/min being supporte

EKG/ECG 101

EKG/ECG Resuscitation Shock CPR 101

Emergency Medicine Journal

JULY 22, 2024

Naloxone is a potent opioid receptor antagonist that reliably reverses life-threatening respiratory depression in opioid overdose but can precipitate severe withdrawal in opioid-dependent individuals. 1 Guidelines recommend naloxone specifically for respiratory depression and not for reduced level of consciousness alone, with lower doses recommended in patients who may be opioid-dependent. 2 3 The extent to which such guidelines are applied in practice has received little attention.

Emergency Department 98

Emergency Department Hospitals 98

Science Based Medicine

JULY 31, 2024

Over the last few decades there has been a steady infiltration of acupuncture into Western mainstream medicine. It is not unreasonable to conclude that acupuncture’s journey from an exotic Eastern practice to a fringe treatment to mainstream acceptance has been complete. Knowledgeable proponents of science based medicine (SBM) who remain skeptical of acupuncture now find themselves on the fringe.

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Sensible Medicine

JULY 31, 2024

Hi everyone. It is John. I am pleased to once again feature writer and economist Elizabeth Fama, PhD , who delved into the evidence underpinning the recommendation to place babies on their back to sleep. Her critical appraisal is a tour de force in everything we love here at Sensible Medicine. I had no idea how weak the evidence was for this recommendation.

Research 103

Research Pediatrics Outcomes Wellness 103

Emergency Live

JULY 18, 2024

In Nova Siri, Matera province, where two firefighters lost their lives while fighting a vegetation fire Yesterday afternoon in Nova Siri, Matera province, two firefighters lost their lives while engaged in extinguishing a vegetation fire. The victims, Nicola Lasalata and Giuseppe Martino, both 45 and originally from Matera, were part of the Policoro detachment.

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Critical Care Now

JULY 14, 2024

Reading Time: 3 minutes Extracorporeal cardiopulmonary resuscitation (eCPR) has been somewhat of a controversial topic in the intensive care community over the years, with observational and randomized controlled trials (RCTs) swinging the pendulum of scientific consensus back and forth from “hugely beneficial” to “expensive, without significant benefit”.

Resuscitation 98

Resuscitation Outcomes CPR Sepsis 98

Northwestern EM Blog

JULY 22, 2024

Written by : Jilan Shimberg, MD (NUEM ‘26) Edited by : Michael Tandlich, MD (NUEM ‘24) Expert Commentary by : Matthew B Maas, MD MS Expert Commentary Posterior Reversible Encephalopathy Syndrome (PRES) is a potentially catastrophic but frequently overlooked diagnosis. It often coexists in a pathophysiological spectrum with Reversible Cerebral Vasoconstriction Syndrome (RCVS).

Seizures 97

Seizures Documentation/Coding Hospitals 97