Ken Grauer, MD
AUGUST 22, 2024
The ECG shown in Figure-1 — was obtained from an older man with “CP” ( C hest P ain ) for the past 2 days. BP = 80/50 mm/Hg. Adenosine 6 mg IV was tried without response. QUESTIONS: How would YOU interpret this ECG? Your thoughts regarding optimal management? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ).
Pediatric EM Morsels
AUGUST 23, 2024
Concussions are commonly encountered in the Emergency Department. We have previously discussed an approach to the question of when a patient “ can return to sport.” That recommendation has been revised ( calling for us to Rebake this Morsel ) and now also pays specific attention to the important aspect of scholastic activities. Let’s take a quick minute to digest a morsel on the current concussion in sport recommendations with respect to Return to Learn and Return to Sport : Re
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The Trauma Pro
AUGUST 21, 2024
All trauma professionals need to keep up with the current thinking in their field. There are a variety of ways to do this, including lectures, courses, online curricula, meetings, and reading journal articles. The last method requires a bit of skill and patience. Many research papers are dry, long, and hard to read. Quite a few people do not have the patience to wade through them, and get lost in all the details.
Emergency Medicine Cases
AUGUST 19, 2024
We over-admit low risk acute heart failure patients and under-admit high risk heart failure patients. In this podcast we discuss the diagnostic accuracy of various clinical features, lab tests and imaging modalities for acute heart failure, the 3 validated risk stratification tools and a simple approach to PoCUS for the diagnosis and prognostication of acute heart failure in the ED to improve our diagnostic accuracy and disposition decisions for patients with acute heart failure.
Science Based Medicine
AUGUST 21, 2024
It’s interesting to follow the scientific exploration of a new clinical entity in real time. It reveals a lot about how medical science works, and how scientists nibble away at complex problems. This is partly why I have been closely following the story of long COVID as it has unfolded over the last few years. I also see patients with long COVID […] The post More on Long COVID first appeared on Science-Based Medicine.
Sensible Medicine
AUGUST 17, 2024
A few years ago, a colleague of mine was applying for, and eventually received, a grant to study lung cancer screening in a vulnerable population. One day, we were having coffee, and she mused. “Look at these 20 year old tech start up people. 8 of them living in a house. Spending day and night coding. All dreaming that they will make it big. It’s sad to watch, knowing how few will succeed.
The Trauma Pro
AUGUST 19, 2024
Here’s another one. I’ve seen the clinical problems and poor outcomes that can arise from ignoring it many times over the years. You’ve ordered a CT or a conventional x-ray image. The result comes back in your EMR. You take a quick glance at the summary at the bottom of the report. No abnormal findings are listed. So now, in your own mind and in any sign-outs that you provide, the image is normal.
Emergency Care Today brings together the best content for emergency care practitioners from the widest variety of industry thought leaders.
Science Based Medicine
AUGUST 23, 2024
We do not have herd immunity to COVID and we should reject doctors who seek to redefine basic terms because they are incapable of uttering the words "I was wrong." The post Part 2: We Don’t Have to Wonder if the Great Barrington Declaration Could Have “Worked”. In the Real World It Failed & Redefining Basic Medical Terms Won’t Change That. first appeared on Science-Based Medicine.
St. Emlyn
AUGUST 21, 2024
St.Emlyn's - Emergency Medicine #FOAMed Listen to the podcast recorded live at the Premier Conference 2024 about neuroprotection in the prehospital phase of care. The post Podcast – Prehospital Neuroprotection appeared first on St.Emlyn's.
The Trauma Pro
AUGUST 23, 2024
Several years ago, I ran a series of posts on my Laws of Trauma. I assembled them into newsletter that contained all nine that existed at the time. If you’d like to download it, just click this link. I’ve been struck by another pattern, and I think it’s about time to add the tenth law. Weirdly enough, it was inspired by Dancing With The Stars.
Don't Forget the Bubbles
AUGUST 19, 2024
Sione, a young Pacific Islander boy, is brought to the emergency department with a 3-day history of acute onset, progressively worsening central chest pain. He points to his sternum when you ask him where the pain is. and tells you that it is made worse by deep breathing and movement. His sternum is warm to touch and exquisitely tender, inferior to the manubrium.
Emergency Medicine Journal
AUGUST 21, 2024
Background and introduction The ED is often perceived as noisy. Excessive noise has deleterious effects on health and productivity. This study evaluated if a package of noise-reducing interventions altered workload, physical complaints, productivity and room acoustics. Methods This was an observational pre-post implementation study. It was performed in our non-academic ED in the Netherlands from July 2021 to April 2022.
Emergency Medicine Cases
AUGUST 19, 2024
ECG artifact and lead reversal can mimic tachy-arrhythmia, infarct or Brugada. Learn how to identify these errors to prevent misdiagnosis on this month's ECG Cases with Dr. Jesse McLaren. The post ECG Cases 51 – Artifact and Lead Misplacement appeared first on Emergency Medicine Cases.
The Trauma Pro
AUGUST 22, 2024
Okay, here’s another one! But it’s a doozy. It’s the most important one I live by. It ensures that you don’t get bogged down by habit, custom, dogma, ignorance, or just plain laziness. Question everything! If someone ever says, “but that’s the way I/we always do it,” or “that’s what the policy says,” or even “I read a good paper/chapter on this,” take it with a really big grain of salt.
Sensible Medicine
AUGUST 19, 2024
This winter I showed the seminal trials comparing coronary artery bypass surgery (CABG) vs medical therapy. These were done in the 1970s and 80s. Two of the big three trials found no mortality benefit from CABG. Most of these patients had normal ventricular function. Along with my colleagues Andrew Foy and Mohammed Ruzieh, we have recently reviewed these trials over at the Cardiology Trials Substack.
Emergency Medicine Journal
AUGUST 21, 2024
Aim Junior doctors joining EDs are required to rapidly acquire new knowledge and skills, but there is little research describing how this process can be facilitated. We aimed to understand what would make ED formal induction and early socialisation more effective. Methods Qualitative study; informal interviews of junior doctors, consultants and nursing staff and direct observation of clinical interactions, induction and training in a single ED in an English Emergency Department between August an
Dr. Smith's ECG Blog
AUGUST 18, 2024
Written by Pendell Meyers A man in his 70s presented with history of pacemaker presented with shortness of breath with exertion and presyncope. Here is his triage ECG with minimal symptoms: What do you think? The ECG shows pacemaker failure with inability to capture or sense, with either underlying atrial fibrillation or junctional escape rhythm. The QRS shows LVH and there are diffuse ST-T abnormalities likely in part appropriate for the LVH, though memory T waves are also a consideration.
The Trauma Pro
AUGUST 20, 2024
Healthcare is a complex affair, and sometimes things don’t go entirely as planned. Occasionally, an elective OR may not be available the next day. This is especially true now in the COVID age with hospitals decreasing their OR capabilities. Or it may take longer than usual to medically clear a frail patient for surgery. But here is something to keep at top of mind: Your patient is at their healthiest as they roll in through the emergency department door Yes, major trauma patients are sick
Core Medical Group
AUGUST 23, 2024
Jason is a dedicated Permanent Placement Recruiter at CoreMedical Group. With years of experience, he excels at identifying top talent and building strong connections with his candidates. Outside of work, Jason enjoys watching and attending sports games, as well as exploring various forms of art, including music, films, and gastronomy.
Emergency Medicine Journal
AUGUST 21, 2024
Background Lidocaine patches, applied over rib fractures, may reduce pulmonary complications in older patients. Known barriers to recruiting older patients in emergency settings necessitate a feasibility trial. We aimed to establish whether a definitive randomised controlled trial (RCT) evaluating lidocaine patches in older patients with rib fracture(s) was feasible.
RebelEM
AUGUST 22, 2024
Background: Retinal artery occlusion (RAO) is a time-sensitive ophthalmic emergency that demands rapid diagnosis and intervention. Administration of intravenous tissue plasminogen activator (IV tPA) within 4.5 hours of symptom onset appears to be the most promising approach for improving visual outcomes, supported by multiple studies and meta-analyses. 1,2 Intra-arterial (IA) tPA has also shown benefit but is less well studied. 3,4 It’s important to note that the available studies have severa
EMDocs
AUGUST 22, 2024
Authors: Natalie Hernandez, MD, MPH, (Harbor-UCLA Medical Center Department of Emergency Medicine); IV Mirus, MD (Assistant Professor of Emergency Medicine, UT Southwestern Medical Center); Manpreet Singh, MD, MBE (Director, Undergraduate Medical Education, Harbor-UCLA Medical Center Department of Emergency Medicine) // Reviewed by: Brit Long, MD (@long_brit You walk into a patient room to find the patient has brought a family member to interpret for them.
The Skeptics' Guide to EM
AUGUST 17, 2024
Date: August 13, 2024 Guest Skeptics: We have two guest skeptics for this SGEM Xtra episode. Dr. Palma Dr. Francisco Campillo Palma is an Emergency Medicine doctor. He works in prehospital (EMS and HEMS), and at Morales Meseguer Hospital in public medical service in Murcia, Spain. Franciso has postgraduate Master's degrees in emergencies and urgent care, clinical ultrasound, and emergency and disaster management, from the University of Elche, the University of Madrid, and the University of Ovied
Emergency Medicine Journal
AUGUST 21, 2024
There is evidence that the actual shelf lives of some drug products are greater than their labelled expiration dates. When transported and stored correctly, many products have been found to remain stable for several months or in specific cases even years after reaching their labelled expiration date. In the USA, a shelf-life extension programme has been developed to generate stability data beyond labelled expiration dates. 1 In their EMJ paper, Soopairin et al systematically review existing prec
Intensive Blog
AUGUST 19, 2024
Author: Dr Ken Hoffman Peer Reviewer: A/Prof Chris Nickson In this 5 minute video we examine the use of inhaled nitric oxide in ICU, reviewing the administration, mechanism of action, indications and side effects. If you find these videos useful, please hit the like button on Youtube and subscribe to see more! Finally, this video was made possible by an education project grant awarded by The Australian and New Zealand Intensive Care Foundation , a charity dedicated to improving the care of crit
University of Maryland CC Project
AUGUST 18, 2024
Dr. Colin Grissom is professor of medicine at Intermountain Healthcare as well as University of Utah. He discusses his experience with implementing best practices, specifically low tidal volume ventilation, across […] Dr. Colin Grissom is professor of medicine at Intermountain Healthcare as well as University of Utah. He discusses his experience with implementing best practices, specifically low tidal volume ventilation, across multiple hospitals and states.
EMDocs
AUGUST 17, 2024
We always work hard, but we may not have time to read through a bunch of journals. It’s time to learn smarter. Originally published at JournalFeed , a site that provides daily or weekly literature updates. Follow Dr. Clay Smith at @spoonfedEM , and sign up for email updates here. #1: TNK Up to 24 Hours for Stroke? Spoon Feed In patients with large vessel occlusions(LVO) presenting 4.5-24 hours after onset, without access to endovascular thrombectomy (ET), tenecteplase(TNK) administration bested
ECG Guru
AUGUST 18, 2024
We see an ECG with the limb leads and V1/V2. It shows a normal sinus rhythm with 1. degreeAV block and 1 conducted and 1 nonconducted PAC before the pause. There is a short pause in the middle of the ECG, how can this be explained? On closer inspection, a PAC can be seen in the ST segment/at the beginning of the T wave. This cannot be conducted due to the short coupling interval.
Science Based Medicine
AUGUST 19, 2024
Nature Reviews Cancer published a propaganda piece disguised as commentary promoting "integrative oncology," or what I like to call "integrating" quackery with oncology. The post Revisiting “integrative oncology”: The battle to integrate quackery with oncology continues first appeared on Science-Based Medicine.
University of Maryland CC Project
AUGUST 18, 2024
Dr. Lane Smith is a critical care medicine specialist at Atrium Health Carolinas Medical Center located in Charlotte, North Carolina and serving as the Charlotte academic branch of Wake Forest […] Dr. Lane Smith is a critical care medicine specialist at Atrium Health Carolinas Medical Center located in Charlotte, North Carolina and serving as the Charlotte academic branch of Wake Forest School of Medicine.
NRC Health
AUGUST 22, 2024
NRC Health debuted healthcare’s most comprehensive experience management platform and announced strategic acquisitions and partnerships to enable greater human connection across the healthcare journey. The post AI meets empathy: NRC Health launches first AI-enabled solutions to elevate healthcare experience appeared first on NRC Health.
ALiEM
AUGUST 19, 2024
Dr. Sara Krzyzaniak, EM Match Advice Podcast Host and Stanford University PD, discusses key changes in the 2024 MyERAS (Electronic Residency Application Service) application that all EM applicants should know about. Take a listen to this short 14-minute, high-yield episode before submitting your application. Podcast 45: Key 2024 MyERAS updates Highlights Hometown preferences are now limited to 3 (no longer 5).
EM Ottawa
AUGUST 22, 2024
Assessing patients with pleural effusions in the emergency department (ED) can be challenging and nuanced. This is largely due to the lack of guidelines around pleural effusions in the ED. In part one we focused on imaging, diagnosis, and management of parapneumonic effusions. In this second part, we will look at malignant and CHF-related effusions, […] The post By the Hammer of Thora: Pleural Effusions in the ED (Part 2) appeared first on EMOttawa Blog.
PulmCCM
AUGUST 18, 2024
Patients who become persistently encephalopathic after the resolution of severe illness (e.g., brain injury due to trauma, ischemic or hemorrhagic stroke) enter a liminal state of existence while those around them decide their fate.
NRC Health
AUGUST 19, 2024
NRC Health is pleased to announce the recipients of the 2024 Consumer Loyalty Awards and the Excellence in Patient Experience Awards. The post NRC Health announces winners of 2024 patient experience and loyalty awards appeared first on NRC Health.
Science Based Medicine
AUGUST 18, 2024
Dr. Scott Atlas said the Great Barrington Declaration was aligned with the advice he gave to the President of the United States. He also said he never read it. The post Dr. Scott Atlas: “I Never Read the Full Great Barrington Declaration Website and Everything”. first appeared on Science-Based Medicine.
EMCrit
AUGUST 23, 2024
A deep dive into vasopressin EMCrit Project by Scott Weingart, MD FCCM.
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