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 389

EKG/ECG Wellness 389

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.

Airway Management 286

Airway Management Pediatrics Wellness Administration 286

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 264

Dislocations Wellness 264

Sensible Medicine

JULY 25, 2024

Atle Freithem and colleagues report in the British Medical journal the results of a pragmatic randomized control trial. The take-home message is that wearing a surgical mask for 2 weeks during the winter season of 2023 reduced the spread of self-reported viral illness. According to some, the study proves masks work. First, I commend the authors for running a randomized control trial.

Academics 145

Academics Documentation/Coding Research 145

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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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 138

EKG/ECG 138

Ken Grauer, MD

JULY 18, 2024

How would YOU interpret the rhythm in Figure-1 — if you were sent this tracing without the benefit of any history? Figure-1: How would YOU interpret this rhythm? The "Quick" Answer: My initial thoughts on the rhythm in Figure-1 : The rhythm in Figure-1 is not completely regular. That said — the R-R interval for the first 5 beats looks regular. The R-R interval for the last few beats is shorter than this — but also regular.

EKG/ECG 218

EKG/ECG Wellness 218

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 264

Fractures 264

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 138

Research 138

RebelEM

JULY 1, 2024

Background: Non-invasive positive pressure ventilation (NIPPV) is an effective treatment modality for patients with both hypoxemic or hypercapnic respiratory failure and has been shown to decrease the need for intubation [2]. Continuous positive airway pressure (CPAP) provides a constant positive pressure support throughout the breathing cycle, while bilevel positive airway pressure (BPAP) provides different levels of positive airway pressure during inspiration and expiration.

COPD 133

COPD Emergency Department Outcomes EMS 133

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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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 129

Resuscitation Research 129

Pediatric EM Morsels

JULY 5, 2024

It seems like just yesterday ( or maybe ~ a month ago ) when we served up a tasty morsel on the PECARN decision rule for intra-abdominal traumatic injuries in children. Our friends at the PECARN injury group have remained busy this spring with generating more externally validated clinical decision rules. In addition to the recently published low risk intra-abdominal injury validation, we have another new tool to use this summer as school breaks, underdeveloped frontal lobes, and high speeds leav

Pediatrics 161

Pediatrics Head Injuries Dislocations Research 161

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 264

Head Injuries Fractures Hospitals Wellness 264

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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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 122

EKG/ECG Shock Hospitals Sepsis 122

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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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 128

Forensics Outcomes 128

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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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

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 123

Research Wellness 123

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

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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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 119

Resuscitation EKG/ECG CPR Shock 119

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 112

Fractures Shock 112

The Trauma Pro

JULY 19, 2024

In my last post, I discussed how often your multidisciplinary trauma performance improvement committee (PI) should meet. As you know, one other mandatory committee is required of all trauma centers, the Trauma Operations Committee (Ops). In this post, I will: describe how often your operations committee should meet help you determine whether your two committees should meet on the same day or separately How Often?

Operations 113

Operations Documentation/Coding Administration 113

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 122

Wellness Hospitals 122

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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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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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 115

EKG/ECG Wellness EMS Hospitals 115

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 111

Sepsis 111

The Trauma Pro

JULY 5, 2024

#7. Inappropriate prescribing Most trauma professionals worry about over-prescribing pain medication. But under-prescribing can create problems as well. Uncontrolled pain is a huge patient dissatisfier, and can lead to unwelcome complications as well (think pneumonia after rib fractures). Always do the math and make sure you are sending the right drug in the right amount home with your patient.

Documentation/Coding 113

Documentation/Coding Fractures Emergency Department Wellness 113

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

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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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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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 110

EKG/ECG Resuscitation Shock CPR 110

Don't Forget the Bubbles

JULY 22, 2024

Pre-school wheezers remain a poorly understood cohort of children despite seeing them every day in paediatric EDs. Unfortunately, the number of acute wheeze exacerbations coming through the doors is still rising , but are we equipped to manage these children? In the UK, national guidance advises giving oral prednisolone early when treating paediatric asthma attacks.

Outcomes 105

Outcomes Research Pediatrics Hospitals 105