Ken Grauer, MD

AUGUST 16, 2024

The ECG in Figure-1 was obtained from a man in his 40s — who presented to the ED ( E mergency D epartment ) because of CP ( C hest P ain ) and shortness of breath. QUESTIONS: In view of the above history — How would YOU interpret the ECG in Figure-1 ? Based on the history and the patient's initial ECG — the cath lab was activated. Do you agree? Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ).

EKG/ECG 394

EKG/ECG Wellness Shock 394

The Trauma Pro

AUGUST 16, 2024

And another law to end the first week! Any time I give a pediatric talk, I mention it. This one applies to anyone who takes care of children, and is particularly important to EMS / prehospital providers and emergency physicians. On occasion, medics are called to a home to treat a child in extremis, or occasionally in arrest. Similarly, extremely sick children are often brought to the ED by parents or other caregivers.

Pediatrics 201

Pediatrics Sepsis EMS 201

Sensible Medicine

AUGUST 12, 2024

I would like to live a long life. Surely you do as well. You can improve your chances by eating well, exercising, avoiding smoking and too much alcohol. There is also the matter of luck. The question today is whether modern medical screening can improve on those basic lifestyle choices. People believe it can, obviously. The screening industry is a money-making machine.

Outcomes 123

Outcomes Research Wellness Hospitals 123

ACEP Now

AUGUST 12, 2024

Every once in a while, I get a text from a friend of a meme decrying the inevitability of becoming interested in birds as you age. In a way, it’s true; it came out of nowhere for me. And granted it can seem peculiar to the uninitiated. But now that I have been indoctrinated for a couple of years, it has become much more than a hobby to me. I see it as a healthful exercise, a practice in mindfulness.

Ultrasounds 115

Ultrasounds Emergency Department Wellness 115

Dr. Smith's ECG Blog

AUGUST 16, 2024

Written by Pendell Meyers A man in his 60s presented with acute chest pain and normal vital signs. Here is his triage ECG: What do you think? The ECG shows massively hyperacute T waves of LAD OMI, plus WPW. V3-V5 also have the depressed HATW takeoff which qualifies them as the rare de Winter subtype of HATWs. Its hard to measure the STE in I exactly with the moving baseline, but there is almost certainly not enough STE to meet STEMI criteria.

EKG/ECG 102

EKG/ECG Wellness 102

The Trauma Pro

AUGUST 15, 2024

You’ve just received a young male who had been stabbed under his right arm in your emergency department. He’s awake, talking, and very friendly. He met your trauma activation criteria, so you are cruising through the full evaluation. Lines in, blood drawn, clothes off. He wonders aloud if all this is really necessary. Then, on FAST exam, you see it.

Emergency Department 256

Emergency Department 256

Sensible Medicine

AUGUST 16, 2024

I’d been certain that all would be well in medicine in the age of AI. I had been telling myself that the addition of AI to medical practice would be a net positive. AI would assist with some of the drudgery that is part of every doctor’s job. We would also incorporate AI into our decision making. AI would help us read X-rays or pathology specimens.

Documentation/Coding 104

Documentation/Coding Wellness 104

Science Based Medicine

AUGUST 12, 2024

I've long been writing about "alternative cancer clinics" (i.e., quack clinics) that sell false hope in the form of very expensive but ineffective treatments to desperate cancer patients. A recent study demonstrates how they use Google to do this. The post How Google listings are used by alternative cancer clinics to lure in desperate patients first appeared on Science-Based Medicine.

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The Trauma Pro

AUGUST 12, 2024

Let’s get started with the Laws of Trauma! After pursuing any discipline for an extended period, one begins to see the common threads and underlying principles of their area of expertise. I’ve been trying to crystallize these for years, and today I’m going to share one of the most basic laws of trauma care. The First Law of Trauma Any anomaly in your trauma patient is due to trauma, no matter how unlikely it may seem.

Stroke 249

Stroke 249

Sensible Medicine

AUGUST 11, 2024

When I was a resident, I worked 7 nights of 12 hour shifts alternating with 7 days of 14 hour shifts. The jet lag was like flying to Moscow. I also worked 28 hour shifts Q4 (on paper), which actually ran as high as 32-36 hours (in reality). Often, I was tired. Whether or not residents need to work long hours, and what they do during that time is an open debate.

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ACEP Now

AUGUST 14, 2024

The American Heart Association and American College of Cardiology released a comprehensive guideline on the management of atrial fibrillation (AF). 1 Most of the AHA/ACC recommendations are either irrelevant to the general emergency physician or common sense. For example, if a patient has hemodynamic instability attributable to AF, perform immediate electrical cardioversion.

Emergency Department 105

Emergency Department Outcomes Research Wellness 105

American Medical Compliance

AUGUST 14, 2024

As healthcare professionals, especially within the dental field, you play a crucial role in the early detection and prevention of abuse and neglect. This P.A.N.D.A. (Preventing Abuse and Neglect Through Dental Awareness) Training program is designed to equip dental professionals with the knowledge and tools necessary to recognize the signs of abuse and neglect in patients, particularly those who may be vulnerable or unable to speak up for themselves.

Burns 96

Burns Documentation/Coding Wellness 96

The Trauma Pro

AUGUST 14, 2024

Trauma patients don’t always behave the way we would like. They continually surprise us, sometimes for the better when they recover more quickly and completely than we thought. But sometimes it’s for the worse. They occasionally crash when we think everything is going so well. The crashing patient is in obvious need of help and most trauma professionals know what to do.

Radiology 236

Radiology Radiology Operations Resuscitation 236

First 10 EM

AUGUST 12, 2024

The concept of a “deepity” was, I believe, coined by Daniel Dennet in his great book “Intuition pumps and other tools for thinking”. He says, “a deepity is a proposition that seems both important and true – and profound – but achieves this effect by being ambiguous. On one reading it is manifestly false, but […] The post Is “First do no harm” a “deepity”?

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ACEP Now

AUGUST 13, 2024

Question My new employer wants to make me a “1099.” What do I need to know as I transition away from being a true employee? Answer First, let’s make sure we understand the terminology. Emergency physicians are typically “paid on” one of three types of tax forms: W-2, K-1, or 1099. Those who receive a W-2 at the end of the year are employees, those paid on a K-1 are partners, and those paid on a 1099 are independent contractors.

Best Practices 98

Best Practices Hospitals 98

Dr. Smith's ECG Blog

AUGUST 14, 2024

Written by Willy Frick I was reading through ECGs in the queue when I saw the following. What do you think of the rhythm? At first glance there seems to be a lot of variation happening, but by focusing on one part of the ECG at a time we can make sense of it. Ignore the first QRS complex and look at beats 2 through 5. I have labeled them below for ease of reference: We see P waves which are upright in leads I, II, and aVF, and upside down in aVR.

EKG/ECG 93

EKG/ECG Outcomes Wellness 93

The Trauma Pro

AUGUST 13, 2024

There are two broad categories of things that kill trauma patients. No, I’m not talking about violent penetrating injury, falls, car crashes, or any other specific mechanisms. I am referring to the end events (on a macro scale) that take their lives. These two basic killers are: hemorrhage and brain injury. The vast majority of the time, a dying trauma patient has either suffered a catastrophic brain injury, or has ongoing and uncontrolled bleeding.

Operations 219

Operations Shock 219

American Medical Compliance

AUGUST 15, 2024

In the healthcare industry, where sensitive financial and personal information is regularly processed, maintaining secure Payment Card Industry (PCI) compliance is critical. PCI compliance not only protects patient payment data but also ensures that healthcare organizations meet stringent regulatory requirements. Failure to comply with PCI standards can lead to severe financial penalties, legal repercussions, and damage to the organization’s reputation.

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Taming the SRU

AUGUST 11, 2024

ABEM updates - R4 Capstone - Sepsis Operations update - R3 taming the sru - traveler’s diarrhea abem updates WITH dr. melissa platt, abem board of directors Beginning 2026, ABEM will be requiring a new certifying exam to replace the previous oral boards. This was felt to be a necessary change in response to decreasing ITE scores and first-time board pass rates The written exam will still be required and is not changing The new certifying exam will be offered in-person in Raleigh, North Carolina

Sepsis 89

Sepsis Burns Shock Operations 89

EB Medicine

AUGUST 14, 2024

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the August 2024 Emergency Medicine Practice article, Emergency Department Management of Patients With Sickle Cell Disease Epidemiology Common Presentation of Sickle Cell Disease in the ED Screening and Diagnosis Differences Epidemiology: 200,000 ED Visits Annually, 85% for Pain Pathophysiology Life Expectancy and Complications Vado-Occlusive Crises and Pathophysiology Sequestration Crisis in Sickle Cell Patients Acute Chest Syndrome a

Critical Access 86

Critical Access Emergency Department Hospitals 86

EMDocs

AUGUST 13, 2024

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association released an updated scientific statement on management of elevated blood pressure. This post will provide the key points for emergency clinicians. Background Hypertension (HTN) is significant issue globally and a leading risk factor for cardiovascular disease.

Stroke 85

Stroke Administration Outcomes Hospitals 85

American Medical Compliance

AUGUST 15, 2024

In the healthcare industry, ethical behavior is the cornerstone of trust between providers and patients. This training serves as a guiding framework that ensures healthcare professionals uphold the highest standards of integrity, respect, and compassion in their interactions with patients, colleagues, and the broader community. Adhering to the code of conduct is not only a legal and professional obligation but also a mortal duty that fosters a culture of accountability and excellence in patient

Documentation/Coding 87

Documentation/Coding Outcomes Wellness 87

RebelEM

AUGUST 12, 2024

Background Information: Acute kidney injury (AKI) is one of the most frequent complications of cardiac surgery and the cause is complex. Renal hypoperfusion from decreased glomerular filtration rate after cardiopulmonary bypass is a major contributor. 1 This in combination with exogenous toxins, endogenous metabolites, oxidative stress, bleeding and reperfusion injury can all lead to the patient ending up on renal replacement therapy postoperatively.

Outcomes 81

Outcomes Hospitals Operations Shock 81

Science Based Medicine

AUGUST 14, 2024

We have often stated here on SBM that vaccine programs are the most effective, and most cost effective, public health measures in human history. They save lives, prevent disease, and save money. These benefits are all well researched and copiously documented. A recent CDC study adds to the literature on the benefits of vaccines and vaccine programs, focusing on the effects of […] The post Vaccine for Children Program Works first appeared on Science-Based Medicine.

CDC 76

CDC Documentation/Coding Research Wellness 76

St. Emlyn

AUGUST 13, 2024

St.Emlyn's - Emergency Medicine #FOAMed Some expert guidance and top tips about how to care for a child with lifelimiting illness who presents to the Emergency Department The post Podcast – Paediatric Palliative Care in the ED appeared first on St.Emlyn's.

Emergency Department 82

Emergency Department 82

American Medical Compliance

AUGUST 14, 2024

In the demanding environment of healthcare, maintaining a safe and professional workplace is paramount. The presence of drugs and alcohol in the workplace not only jeopardizes the well-being of healthcare personnel but also poses significant risks to patient safety and care quality. This Drugs and Alcohol in the Workplace Training for Healthcare Personnel is designed to equip healthcare professionals with the knowledge and tools necessary to recognize, address, and prevent substance abuse in the

Patient Safety 84

Patient Safety Wellness 84

EMCrit

AUGUST 15, 2024

Getting sued in the maelstrom that is the US malpractice system is horrible!! Let's talk about how to make it better. EMCrit Project by Scott Weingart, MD FCCM.

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Don't Forget the Bubbles

AUGUST 12, 2024

One-liner… Understanding the underpinning principles and management of raised intracranial pressure is essential for reducing the morbidity and mortality of traumatic brain injuries. Seven-year-old Dan was involved in a motor vehicle collision. At the scene, he was vomiting and drowsy with a low Glasgow Coma Score (GCS). The air ambulance service intubated him at the scene and pre-alerted the department before arrival.

Seizures 75

Seizures Pediatrics Emergency Department Ambulance Services 75

Dr. Smith's ECG Blog

AUGUST 11, 2024

Written by Jesse McLaren A healthy 75 year old developed 7/10 chest pain associated with diaphoresis and nausea, which began on exertion but persisted. Below is the first ECG recorded by paramedics after 2 hours of chest pain, interpreted by the machine as “possible inferior ischemia”. What do you think? There’s competing sinus bradycardia and junctional rhythm, with otherwise normal conduction, borderline right axis, normal R wave progression and voltages.

EKG/ECG 74

EKG/ECG EMS Hospitals 74

American Medical Compliance

AUGUST 15, 2024

In today’s complex and rapidly evolving healthcare environment, the safety and security of both patients and staff are of the utmost importance. Healthcare professionals must be equipped not only with the latest medical knowledge but also with the skills to handle a wide range of challenges, from IT security threats to emergency situations like active shooter incidents.

Leadership 82

Leadership Best Practices Operations Outcomes 82

Science Based Medicine

AUGUST 16, 2024

Have researchers proven the existence of acupoints by shoving needles into subjects brains? Will you soon be able to buy an OTC acupuncture kit at CVS? No! This is satire. The post Science-Based Satire: Acupuncture Researchers Find Powerful Proof of Ancient Mechanism of Action first appeared on Science-Based Medicine.

Research 73

Research 73

EM Ottawa

AUGUST 15, 2024

Assessing patients with pleural effusions in the emergency department (ED) can be challenging and unclear. This is largely due to the lack of guidelines around pleural effusions in the ED. In this post, I’ve tried to highlight some key information about an approach to patients presenting with a new pleural effusion. This is not all-encompassing, […] The post By the Hammer of Thora: Pleural Effusions in the ED (part 1) appeared first on EMOttawa Blog.

Emergency Department 71

Emergency Department Infectious Diseases Resuscitation 71

Sensible Medicine

AUGUST 14, 2024

In her first post , Ms. Fama introduced the concept of the “Back to Sleep” campaign, including the changing recommendations for sleep position and the correlation (emphasis on correlation) between the declining rate of sudden infant deaths and back sleeping. In her second post she explored the possible downsides of supine sleep for infants.

CDC 74

CDC Sepsis Research Pediatrics 74

American Medical Compliance

AUGUST 14, 2024

The HIPAA Refresher training reinforces your understanding of key HIPAA provisions, highlights recent updates, and provides practical tips for maintaining compliance in your daily operations. Whether you’re new to HIPAA or need a quick review, this HIPAA Refresher training will ensure you have the knowledge to protect patient privacy effectively.

Operations 81

Operations Outcomes 81

Science Based Medicine

AUGUST 15, 2024

Should we be concerned about new research linking sugar alcohols like xylitol and erythritol? The post Are dietary sugar alcohol sweeteners safe? first appeared on Science-Based Medicine.

Research 72

Research 72

PulmCCM

AUGUST 12, 2024

There was a terrible case in 2019 of a police officer who cracked his neck to relieve some discomfort and dissected his vertebral artery. He immediately felt and looked bad and his coworkers had an ambulance take him to the ED. The initial CT read suggested vertebral artery stenosis but used equivocal language.

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The Skeptics' Guide to EM

AUGUST 10, 2024

Date: July 29, 2024 Reference: Connolly SJ et al (ANNEXA-I investigators) Andexanet for Factor Xa Inhibitor–Associated Acute Intracerebral Hemorrhage. NEJM May 2024 Guest Skeptic: Dr. Vasisht Srinivasan is an Emergency Medicine physician and neurointensivist at the University of Washington and Harborview Medical Center in Seattle, WA. He is an assistant professor in Emergency Medicine, Neurology, and Neurosurgery at the School of Medicine at the University of Washington.

Stroke 70

Stroke Airway Management Documentation/Coding Outcomes 70